Background
In the past decade, deep learning has revolutionized medical image processing. This technique may advance laparoscopic surgery. Study objective was to evaluate whether deep learning ...networks accurately analyze videos of laparoscopic procedures.
Methods
Medline, Embase, IEEE Xplore, and the Web of science databases were searched from January 2012 to May 5, 2020. Selected studies tested a deep learning model, specifically convolutional neural networks, for video analysis of laparoscopic surgery. Study characteristics including the dataset source, type of operation, number of videos, and prediction application were compared. A random effects model was used for estimating pooled sensitivity and specificity of the computer algorithms. Summary receiver operating characteristic curves were calculated by the bivariate model of Reitsma.
Results
Thirty-two out of 508 studies identified met inclusion criteria. Applications included instrument recognition and detection (45%), phase recognition (20%), anatomy recognition and detection (15%), action recognition (13%), surgery time prediction (5%), and gauze recognition (3%). The most common tested procedures were cholecystectomy (51%) and gynecological—mainly hysterectomy and myomectomy (26%). A total of 3004 videos were analyzed. Publications in clinical journals increased in 2020 compared to bio-computational ones. Four studies provided enough data to construct 8 contingency tables, enabling calculation of test accuracy with a pooled sensitivity of 0.93 (95% CI 0.85–0.97) and specificity of 0.96 (95% CI 0.84–0.99). Yet, the majority of papers had a high risk of bias.
Conclusions
Deep learning research holds potential in laparoscopic surgery, but is limited in methodologies. Clinicians may advance AI in surgery, specifically by offering standardized visual databases and reporting.
Irreversible electroporation (IRE) is a non-thermal cell ablation approach that induces selective damage to cell membranes only. The purpose of the current study was to evaluate and optimize its use ...for in-vivo myocardial decellularization.
Forty-two Sprague-Dawley rats were used to compare myocardial damage of seven different IRE protocols with anterior myocardial infarction damage. An in-vivo open thoracotomy model was used, with two-needle electrodes in the anterior ventricular wall. IRE protocols included different combinations of pulse lengths (70 vs. 100 μseconds), frequency (1, 2, 4 Hz), and number (10 vs. 20 pulses), as well as voltage intensity (50, 250 and 500 Volts). All animals underwent baseline echocardiographic evaluation. Degree of myocardial ablation was determined using repeated echocardiography measurements (days 7 and 28) as well as histologic and morphometric analysis at 28 days.
All animals survived 28 days of follow-up. Compared with 50V and 250V, electroporation with 500V was associated with significantly increased myocardial scar and reduction in ejection fraction (67.4%±4% at baseline vs. 34.6%±20% at 28 days; p <0.01). Also, compared with pulse duration of 70 μsec, pulses of 100 μsec were associated with markedly reduced left ventricular function and markedly increased relative scar area ratio (28%±9% vs. 16%±3%, p = 0.02). Decreasing electroporation pulse frequency (1Hz vs. 2Hz, 2Hz vs. 4Hz) was associated with a significant increase in myocardial damage. Electroporation protocols with a greater number of pulses (20 vs. 10) correlated with more profound tissue damage (p<0.05). When compared with myocardial infarction damage, electroporation demonstrated a considerable likeness regarding the extent of the inflammatory process, but with relatively higher levels of extra-cellular preservation.
IRE has a graded effect on the myocardium. The extent of ablation can be controlled by changing pulse length, frequency and number, as well as by changing electric field intensity.
Background and aims
Crohn’s disease (CD) is associated with increased postoperative morbidity. Sarcopenia correlates with increased morbidity and mortality in various medical conditions. We assessed ...correlations of the lean body mass marker and psoas muscle area (PMA), with postoperative outcomes in CD patients undergoing gastrointestinal surgery.
Methods
We included patients with CD who underwent gastrointestinal surgery between June 2009 and October 2018 and had CT/MRI scans within 8 weeks preoperatively. PMA was measured bilaterally on perioperative imaging.
Results
Of 121 patients, the mean age was 35.98 ± 15.07 years; 51.2% were male. The mean BMI was 21.56 ± 4 kg/m2. The mean PMA was 95.12 ± 263.2cm
2
. Patients with postoperative complications (
N
= 31, 26%) had significantly lower PMA compared with patients with a normal postoperative recovery (8.5 ± 2.26 cm2 vs. 9.85 ± 2.68 cm2,
P
= 0.02). A similar finding was noted comparing patients with anastomotic leaks to those without anastomotic leaks (7.48 ± 0.1 cm2 vs. 9.6 ± 2.51 cm2,
P
= 0.04). PMA correlated with the maximum degree of complications per patient, according to the Clavien-Dindo classification (Spearman’s coefficient = −0.26,
P
= 0.004). Patients with major postoperative complications (Clavien-Dindo ≥ 3) had lower mean PMA (8.12 ± 2.75 cm2 vs. 9.71 ± 2.57 cm2,
P
= 0.03). Associations were similar when stratifying by gender and operation urgency. On multivariate analysis, PMA (HR = 0.72/cm2,
P
= 0.02), operation urgency (HR = 3.84, P < 0.01), and higher white blood cell count (HR = 1.14, P = 0.02) were independent predictive factors for postoperative complications.
Conclusion
PMA is an easily measured radiographic parameter associated with postoperative complications in patients with CD undergoing bowel resection.
Abstract
Introduction: Anal fissure (AF) is a common anorectal disease. Although several pharmacological treatments are available, many patients still require surgical interventions. In this study, ...we aimed to evaluate the efficacy of an ointment based on a multifunctional blend of herbal ingredients including hemp (ProctoFiz) for chronic AF. Methods: A single-arm, questionnaire-based prospective study was conducted in a large tertiary center to evaluate the outcomes of patients suffering from chronic AF treated with topical ProctoFiz. Results: Ninety-two patients were included in the study, 54 (58.7%) were females with a median age of 39 (range 17–78). 32 patients (34.7%) suffered from recurrent AF before enrolling in the study, and 5 patients (5.4%) underwent previous surgical interventions for AF. Three patients (3.2%) were lost to follow-up, leaving 89 patients for analysis. Eighty patients (89.9%) reported significant improvement of symptoms after 1 week using ProctoFiz, and 79 patients reported continued improvement after 1 month of treatment. The mean pain Visual Analog Score (VAS) declined by 6.6 points (8.9 vs. 2.3; 95% CI: 7.20 to −5.99, p < 0.0001) following 1 week of treatment, with continuous improvement to a mean of 0.64 after 1 month. Negative impact on quality of life significantly decreased from a mean of 8.8 to 0.38 following a month of treatment (p < 0.0001), with significant reduction in the number of patients suffering from bleeding following bowel movements (64.1–2.5%; p = 0.0001). Conclusion: Hemp-based topical treatment of AF is feasible and significantly improves AF-correlated symptoms.
Smoldering diverticulitis is a form of chronic uncomplicated diverticulitis with continuous non-resolving abdominal pain that commonly requires surgical intervention. In this study, we aimed to ...evaluate post-operative outcomes in patients undergoing colon resection for smoldering diverticular disease. We performed a single tertiary historical records review including all patients operated for diverticular disease of the sigmoid between January 2009 and January 2020. Only patients with smoldering diverticulitis were included in the final analysis. Demographic, peri-operative, and post-operative outcomes were collected from patient medical charts and analyzed. We reviewed the data of 3124 patients that were hospitalized due to diverticulitis during 2009–2020. Overall, 184 patients were operated due to diverticular disease. Of those, 18 patients (9.78%) were operated for smoldering diverticulitis. Eight (42%) patients were men; mean patient age was 62 SD 11 years. Median Charlson’s comorbidity score was 1 (0–3). Ten patients were operated laparoscopically (55.56%), with a conversion rate of 40% (
n
=
4
). Three patients (16.67%) underwent primary stoma formation. Post-operative complications were seen in 6 (33%) patients with a median Clavien-Dindo score of 3 (1–4) and 2 patients underwent re-operation (11.11%). Median length of stay was 8 days (range 4–26). Five (27.78%) patients required an unplanned re-admission following their surgical procedure. Median follow-up time was 5.3 months (1–127). Thirteen (72.22%) patients were free of symptoms at the last follow-up. Quality of life questionnaire demonstrated significant improvement after surgery (
P
<
0.01
) that lasts during follow-up time (
P
=
0.52
). Length of stay was correlated with age (
P
<
0.01
, Pearson’s coefficient = 1) and serum white blood counts (< 0.01, 0.79). Smoldering diverticulitis is a fairly rare surgical condition with unneglectable risk for post-operative complications. However, most patients report improvement of symptoms after surgery and both short-term and long-term surveillance.
Surgical treatment of complex perianal fistula is technically challenging, associated with risk of failure, and may require multiple procedures. In recent years, several biologic agents have been ...developed for permanently eradicating anal fistulous disease with variable success. In this study, the treatment is an autologous whole-blood product created from the patients' blood. It forms a provisional matrix that was found to be safe and effective in healing acute and chronic cutaneous wounds.
The study aimed to assess the efficacy and safety of an autologous blood clot product as a treatment for transsphincteric perianal fistulas.
A prospective single-arm study.
A single tertiary medical center.
Patients with simple or complex transsphincteric fistulas confirmed by MRI were included in the study. Cause was either cryptoglandular or Crohn's disease related (in the absence of active luminal bowel disease).
The outpatient procedure was performed under general anesthesia and consisted of: 1) physical debridement and cleansing of the fistula tract; 2) suture closure of the internal opening; and 3) instillation of the autologous blood clot product into the entire tract.
Safety and efficacy at 6- and 12-months after surgery.
Fifty-three patients (77% men) with a median age of 42 (20-72) years were included in the study. Three patients withdrew consent, and 1 patient was lost to follow-up. At the time of this interim analysis, 49 and 33 patients completed the 6- and 12-month follow-up period. Thirty-four of the 49 patients achieved complete healing (69%) at 6 months, but 20 of the 33 patients (60%) achieved healing after 1 year. All patients who achieved healing at 6 months remained healed at the 1-year mark. In a subgroup analysis of patients with Crohn's disease, 7 of 9 patients completed 1-year follow-up, with 5 patients (71%) achieving clinical remission. No major side effects or postoperative complications were noted, but 2 adverse events occurred (admission for pain control and coronavirus 2019 infection).
Noncomparative single-arm pilot study.
Treatment with an autologous blood clot product in perianal fistular disease was found to be feasible and safe, with an acceptable healing rate in both cryptoglandular and Crohn's disease fistula-in-ano. Further comparative assessment is required to determine its potential role in the treatment paradigm of fistula-in-ano. See Video Abstract .
ANTECEDENTES:El tratamiento quirúrgico de la fístula perianal compleja es técnicamente desafiante, se asocia con riesgo de fracaso y puede requerir múltiples procedimientos. En los últimos años, se han desarrollado varios agentes biológicos con el fin de erradicar permanentemente la enfermedad fistulosa anal con éxito variable. El tratamiento RD2-Ver.02 es un producto de sangre total autólogo creado a partir de la sangre de los pacientes, que forma una matriz provisional que resultó segura y eficaz para curar heridas cutáneas agudas y crónicas.OBJETIVO:Evaluar la eficacia y seguridad de RD2-Ver.02 como tratamiento para las fístulas perianales transesfinterianas.DISEÑO:Un estudio prospectivo de un solo brazo.LUGARES:Un único centro médico terciario.PACIENTES:Se incluyeron en el estudio pacientes con fístulas transesfinterianas simples o complejas confirmadas mediante resonancia magnética. La etiología fue criptoglandular o relacionada con la enfermedad de Crohn (en ausencia de enfermedad intestinal luminal activa).INTERVENCIÓN:El procedimiento ambulatorio se realizó bajo anestesia general y consistió en: 1) desbridamiento físico y limpieza del trayecto fistuloso; 2) cierre con sutura de la abertura interna; y 3) instilación de RD2-Ver.02 en todo el tracto.PRINCIPALES MEDIDAS DE VALORACIÓN:Seguridad y eficacia a los 6 y 12 meses después de la cirugía.RESULTADOS:Se incluyeron en el estudio 53 pacientes (77% varones) con una mediana de edad de 42 (20-72) años. Tres pacientes retiraron su consentimiento y un paciente se perdió durante el seguimiento. En el momento de este análisis intermedio, 49 y 33 pacientes completaron el período de seguimiento de 6 y 12 meses, respectivamente. Treinta y cuatro (34) pacientes lograron una curación completa (69%) a los 6 meses, mientras que 20 de 33 pacientes (60%) lograron una curación después de un año. Todos los pacientes que lograron la curación a los 6 meses permanecieron curados al año. En un análisis de subgrupos de pacientes con enfermedad de Crohn, 7/9 pacientes completaron un seguimiento de un año y 5 pacientes (71%) alcanzaron la remisión clínica. No se observaron efectos secundarios importantes ni complicaciones postoperatorias, mientras que ocurrieron 2 eventos adversos (ingreso para control del dolor e infección por COVID-19).LIMITACIONES:Estudio piloto no comparativo de un solo brazo.CONCLUSIONES:Se encontró que el tratamiento con RD2-Ver.02 en la enfermedad fístula perianal es factible y seguro, con una tasa de curación aceptable tanto en la fístula criptoglandular como en la de Crohn en el ano. Se requiere una evaluación comparativa adicional para determinar su papel potencial en el paradigma de tratamiento de la fístula anal. (Pre-proofed version ).
Emergency surgical repair is the standard approach to the management of an incarcerated abdominal wall hernia (IAWH). In cases of very high-risk patients, manual closed reduction (MCR) of IAWH may ...prevent the need for emergency surgery.
To evaluate the safety, success rate, and complications of MCR in the management of IAWH conducted in an emergency department.
The data of all patients who underwent MCR between 2012 and 2018 were retrospectively collected. Patient demographics, presenting symptoms, clinical parameters, and management during the hospitalization were retrieved from the medical charts.
Overall, 548 patients underwent MCR during the study period. The success rate was 25.4% (139 patients). One patient had a complication that required a laparotomy 2 days after his discharge. A recurrent incarceration occurred in 23%, 60% of them underwent successful repeated MCR and the others underwent emergency surgery. Six patients (1.4%) had a bowel perforation after a failed MCR.
MCR can be performed safely in the emergency department and should be consider as an option to treat IAWH, especially in high operative risk patients.
Background
The Naples Prognostic Score (NPS) has proven efficacy as a prognostic tool for postoperative outcomes in patients undergoing surgery for neoplastic diseases. However, the role of the NPS ...score in inflammatory surgical diseases has not yet been studied. We aimed to evaluate NPS predictive value in patients undergoing colectomy due to diverticulitis.
Methods
A single-center retrospective study including all patients who underwent colectomy for diverticulitis between July 2008 and March 2020 was established. Patients' demographics, clinical and surgical data were recorded and analyzed. Patients were scored on a scale of 0-4 and received one point for preoperation albumin <4 g/dL, cholesterol ≤180 mg/dL, Neutrophil to Lymphocyte Ratio >2.96, and Lymphocyte to Monocyte ≤4.44.
Results
Out of 3292 patients admitted because of diverticulitis during the study period, 159 patients (4.83%) underwent colectomy. Of those patients, fifty patients were eligible for NPS analysis. 35 patients (70%) were females with a mean age of 62.81 ± 14.51. Thirty-two (64%) patients underwent an elective operation. The postoperative complications rate was 36% (N = 18). The mortality rate was 6% (N = 3). ROC showed a strong association between the NPS and mortality (area = .88, P = .03) and wound infection (area = .78, P = .01). In patients who underwent urgent surgery, there was an association between NPS and re-operation (P = .04). There was a correlation between NPS and Clavien-Dindo score (Spearman’s coefficient = .284, P = .045).
Conclusions/Discussion
The Naples prognostic score is an effective tool for predicting postoperative complications in patients undergoing colectomy for diverticulitis. It may assist the surgeon in deciding on extent of the operation for diverticulitis and in elective cases also on timing.
Background
Most Crohn's Disease (CD) patients will require surgical intervention over their lifetime, with considerably high rates of post‐operative complications. Risk stratification with reliable ...prognostic tools may facilitate clinical decision making in these patients. Blood cell interaction based inflammatory markers have proven useful in predicting patient outcomes in oncological and benign diseases. The aim of this study was to investigate their prognostic value in CD patients undergoing surgery.
Methods
A retrospective single institution study of CD patients who underwent surgery between the years 2008 and 2019 was conducted. Data were collected from medical records and analysed for association of Platelet‐to‐Lymphocyte Ratio (PLR), Neutrophil‐to‐Lymphocyte Ratio (NLR), Lymphocyte‐to‐Monocyte Ratio (LMR) and the modified Systemic Inflammatory Score (mSIS) with post‐operative outcomes.
Results
A total of 81 patients were included in the analysis. Half were females; mean age was 36 ± 15.54 years. Fifty seven percent (n = 46) were operated in expedited settings, with 23.5% developing post‐operative complications. In elective patients, higher pre‐operative NLR (P = 0.029) and PLR (P = 0.034) were associated with major post‐operative complications, higher NLR (P = 0.029) and PLR (P = 0.034) were associated with re‐operation and higher PLR correlated with Clavien‐Dindo score (P = 0.032). In patients operated in expedited operations, higher pre‐operative NLR (P = 0.021) and lower pre‐operative LMR (P = 0.018) were associated with thromboembolic events and higher mSIS was associated with major post‐operative complications (P = 0.032).
Conclusions
Blood cell interaction based inflammatory markers confer an association with post‐operative complications in CD patients undergoing surgery. These indices may facilitate patient selection and optimization when considering the risks and benefits of surgical interventions.
Blood cell interaction based inflammatory markers have proven useful in predicting patient outcomes in oncological and benign diseases. The aim of this study was to investigate their prognostic value in Crohn's Disease patients undergoing surgery.
PDF
