Most Cited International Journal of Surgery Articles
The most cited articles published since 2011, extracted from Scopus.
CONSORT 2010 explanation and elaboration: Updated guidelines for reporting parallel group randomised trialsDavid Moher | Sally Hopewell | Kenneth F. Schulz | Victor Montori | Peter C. Gøtzsche | P. J. Devereaux | Diana Elbourne | Matthias Egger | Douglas G. Altman
Volume 10, Issue 1, January 2012, Pages 28-55
Overwhelming evidence shows the quality of reporting of randomised controlled trials (RCTs) is not optimal. Without transparent reporting, readers cannot judge the reliability and validity of trial findings nor extract information for systematic reviews. Recent methodological analyses indicate that inadequate reporting and design are associated with biased estimates of treatment effects. Such systematic error is seriously damaging to RCTs, which are considered the gold standard for evaluating interventions because of their ability to minimise or avoid bias.A group of scientists and editors developed the CONSORT (Consolidated Standards of Reporting Trials) statement to improve the quality of reporting of RCTs. It was first published in 1996 and updated in 2001. The statement consists of a checklist and flow diagram that authors can use for reporting an RCT. Many leading medical journals and major international editorial groups have endorsed the CONSORT statement. The statement facilitates critical appraisal and interpretation of RCTs.During the 2001 CONSORT revision, it became clear that explanation and elaboration of the principles underlying the CONSORT statement would help investigators and others to write or appraise trial reports. A CONSORT explanation and elaboration article was published in 2001 alongside the 2001 version of the CONSORT statement.After an expert meeting in January 2007, the CONSORT statement has been further revised and is published as the CONSORT 2010 Statement. This update improves the wording and clarity of the previous checklist and incorporates recommendations related to topics that have only recently received recognition, such as selective outcome reporting bias.This explanatory and elaboration document-intended to enhance the use, understanding, and dissemination of the CONSORT statement-has also been extensively revised. It presents the meaning and rationale for each new and updated checklist item providing examples of good reporting and, where possible, references to relevant empirical studies. Several examples of flow diagrams are included.The CONSORT 2010 Statement, this revised explanatory and elaboration document, and the associated website (www.consort-statement.org) should be helpful resources to improve reporting of randomised trials. © 2010 Moher et al/Ottawa Hospital Research Institute.
CONSORT 2010 statement: Updated guidelines for reporting parallel group randomised trialsKenneth F. Schulz | Douglas G. Altman | David Moher
Volume 9, Issue 8, December 2011, Pages 672-677
The strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studiesErik von Elm | Douglas G. Altman | Matthias Egger | Stuart J. Pocock | Peter C. Gøtzsche | Jan P. Vandenbroucke
Volume 12, Issue 12, January 2014, Pages 1495-1499
© 2014 The Authors. Much biomedical research is observational. The reporting of such research is often inadequate, which hampers the assessment of its strengths and weaknesses and of a study's generalisability. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Initiative developed recommendations on what should be included in an accurate and complete report of an observational study. We defined the scope of the recommendations to cover three main study designs: cohort, case-control, and cross-sectional studies. We convened a 2-day workshop in September 2004, with methodologists, researchers, and journal editors to draft a checklist of items. This list was subsequently revised during several meetings of the coordinating group and in e-mail discussions with the larger group of STROBE contributors, taking into account empirical evidence and methodological considerations. The workshop and the subsequent iterative process of consultation and revision resulted in a checklist of 22 items (the STROBE Statement) that relate to the title, abstract, introduction, methods, results, and discussion sections of articles. 18 items are common to all three study designs and four are specific for cohort, case-control, or cross-sectional studies. A detailed Explanation and Elaboration document is published separately and is freely available on the Web sites of PLoS Medicine, Annals of Internal Medicine, and Epidemiology. We hope that the STROBE Statement will contribute to improving the quality of reporting of observational studies.
Effect of green tea (Camellia sinensis) extract on healing process of surgical wounds in ratSayyed Yazdan Asadi | Pouya Parsaei | Mehrdad Karimi | Sareh Ezzati | Alaleh Zamiri | Fereshteh Mohammadizadeh | Mahmoud Rafieian-kopaei
Volume 11, Issue 4, March 2013, Pages 332-337
Green tea (Camellia sinensis) has anti-oxidant and anti-inflammatory properties and may enhance wound healing process. The present study, therefore, was aimed to examine the effect of green tea ethanolic extract on wound healing process. For this experimental study, 36 healthy male Wistar rats were randomly designated to three groups of A, B, and C which, respectively treated with, Vaseline + 0.6% green tea extract, Vaseline and normal saline for 21 days. Wounds' length and area were measured by caliper every other day and specimens were taken at 3rd, 12th, and 21st day for microscopical examinations. Data were analyzed by SPSS 16 using survival analysis (Breslow test), repeated measured ANOVA, one-way ANOVA and Mann-Whitney. P < 0.05 was considered as statistically significant. The mean healing duration of surgical wounds in groups A and B was 14.66 and 20.66 (P = 0.018), respectively. Decrease in healing duration in the group A was significantly higher within the first two weeks compared with control groups (P = 0.05). Microscopic examinations also indicated a significant difference in wound healing process between groups A and C throughout the whole study duration as well as groups A and B during the 3rd week of the study (P < 0.05).Green tea extract could help wound healing process, probably effective on surgical wounds healing. © 2013 Surgical Associates Ltd.
Towards evidence-based medicine in surgical practice: Best BETsOmar A. Khan | Joel Dunning | Amjad C. Parvaiz | Riaz Agha | David Rosin | Kevin Mackway-Jones
Volume 9, Issue 8, August 2011, Pages 585-588
Surgeons are faced with the dilemma that many clinical questions in their daily practice to do not have universally agreed answers, but patients increasingly demand the 'best practice' from their doctors. In addition time pressures mean that clinicians are unable to keep up with the full spectrum of published research. We have adopted an approach first pioneered in emergency medicine, namely the Best Evidence Topic or Best BET. Clinicians select a clinical scenario from their daily practice that highlights an area of controversy. From this, a three-part question is generated and this is used to search Medline and other appropriate databases for relevant papers. Once the relevant papers are found, these papers are critically appraised, the relevant data to answer the question is extracted, tabulated and summarised. A clinical bottom line is reached after this process. The resulting BETs, written by practising surgeons can then provide robust evidence-based answers to important clinical questions asked during our daily practice. © 2011 Surgical Associates Ltd.
Google Glass in pediatric surgery: An exploratory studyOliver J. Muensterer | Martin Lacher | Christoph Zoeller | Matthew Bronstein | Joachim Kübler
Volume 12, Issue 4, January 2014, Pages 281-289
Introduction: Personal portable information technology is advancing at a breathtaking speed. Google has recently introduced Glass, a device that is worn like conventional glasses, but that combines a computerized central processing unit, touchpad, display screen, high-definition camera, microphone, bone-conduction transducer, and wireless connectivity. We have obtained a Glass device through Google's Explorer program and have tested its applicability in our daily pediatric surgical practice and in relevant experimental settings. Methods: Glass was worn daily for 4 consecutive weeks in a University Children's Hospital. A daily log was kept, and activities with a potential applicability were identified. Performance of Glass was evaluated for such activities. In-vitro experiments were conducted where further testing was indicated. Results: Wearing Glass throughout the day for the study interval was well tolerated. Colleagues, staff, families and patients overwhelmingly had a positive response to Glass. Useful applications for Glass were hands-free photo/videodocumentation, making hands-free telephone calls, looking up billing codes, and internet searches for unfamiliar medical terms or syndromes. Drawbacks encountered with the current equipment were low battery endurance, data protection issues, poor overall audio quality, as well as long transmission latency combined with interruptions and cut-offs during internet videoconferencing. Conclusion: Glass has the some clear utility in the clinical setting. However, before it can be recommended universally for physicians and surgeons, substantial improvements to the hardware are required, issues of data protection must be solved, and specialized medical applications (apps) need to be developed. © 2014 Surgical Associates Ltd.
Robot-assisted laparoscopic pancreaticoduodenectomy versus open pancreaticoduodenectomy - A comparative studyEric C H Lai | George P C Yang | Chung Ngai Tang
Volume 10, Issue 9, July 2012, Pages 475-479
Background: Traditionally, pancreatic surgery is considered as one of the most complex surgeries. The recently developed robotic technology allows surgeons to perform pancreaticoduodenectomy. A comparative study was undertaken to study outcomes between robotic approach and open approach. Methods: A consecutive patients underwent pancreaticoduodenectomy (robotic approach, n = 20; open approach = 67) between January 2000 and February 2012 at a single institution were analyzed. Results: The robotic group had a significantly longer operative time (mean, 491.5 vs. 264.9 min), reduced blood loss (mean, 247 vs. 774.8 ml), and shorter hospital stay (mean, 13.7 vs. 25.8 days) compared to the open group. Open conversion rate was 5%. There was no significant difference between the two groups in terms of overall complication rates, mortality rates, R0 resection rate and harvested lymph node numbers. Conclusions: This study showed that robot-assisted laparoscopic pancreaticoduodenectomy was safe and feasible in appropriately selected patients. However, it is too early to draw definitive conclusions about the value of robot-assisted laparoscopic pancreaticoduodenectomy. In light of remaining uncertainties regarding short-term and long-term outcome, caution should be exercised in the assessment of the appropriateness of this operation for individual patient. © 2012 Surgical Associates Ltd.
Bioactive components and preventive effect of green tea (Camellia sinensis) extract on post-laparotomy intra-abdominal adhesion in ratsPouya Parsaei | Mehrdad Karimi | Sayyed Yazdan Asadi | Mahmoud Rafieian-kopaei
Volume 11, Issue 9, September 2013, Pages 811-815
Background: Adhesion formation is an important complication of abdomino-pelvic surgery. Green tea (Camellia sinensis) has anti-oxidant and anti-inflammatory effects which prevent production and accumulation of collagen and, thus, may reduce adhesion formation. The present study examined the effect of green tea alcoholic extract on intra-abdominal adhesion formation. Total phenolic, flavonoid and flavonol contents as well as anti-oxidant activity were also evaluated. Methods: Thirty healthy male Wistar rats were randomly assigned to two equal groups of green tea (A) and distilled water (B). After anesthesia, the abdominal wall was opened and three shallow longitudinal and transverse incisions of 2cm in length were made on the right side of the peritoneum by scalpel blade. A 2×2cm square of the left abdominal wall peritoneum was removed by surgical scissors. Green tea extract or distilled water was introduced into the abdominal cavity of each rat. The rats were sacrificed two weeks post-laparotomy and adhesion bands were scored according to severity, extent and appearance. Fibrosis and inflammation were also scored via histopathological examination. Results: There was a significant difference in mean adhesion scores between the green tea and distilled water groups (3.2±3.503 and 7.33±0.51, respectively) (p=0.001). In terms of fibrosis (p=0.002) and inflammation (p=0.003) a statistically significant difference was also seen between the two groups following histopathological examination. Conclusion: Green tea extract reduces intra-peritoneal adhesions in an animal model. © 2013.
Robot-assisted laparoscopic hemi-hepatectomy: Technique and surgical outcomesEric C H Lai | Chung Ngai Tang | Michael K W Li
Volume 10, Issue 1, January 2012, Pages 11-15
Background: Laparoscopic major hepatectomies remain a challenge for liver surgeons. The recent introduction of robotic surgical systems has revolutionized the field of minimally invasive surgery. It was developed to overcome the disadvantages of conventional laparoscopic surgery. The use of robotic system in laparoscopic major hepatectomy was not known yet. Methods: Between December 2010 and July 2011, 6 right hemi-hepatectomies and 4 left hemi-hepatectomies were performed by robot-assisted laparoscopic approach. Prospectively collected data was analyzed retrospectively. Results: Overall mean duration of the operation was 347.4±85.9 (SD) minutes. Mean duration of the operation for right hemi-hepatectomy was 364.8±98.1ml, while mean duration of the operation for left hemi-hepatectomy was 321.3±67.8ml. Overall mean operative blood loss was 407±286.8ml. Mean operative blood loss for right hemi-hepatectomy was 500±303.3ml, while mean operative blood loss for left hemi-hepatectomy was 156.9±40.7ml. No open conversion was needed. Three patients (30%) had postoperative complications. There was no mortality. Mean hospital stay was 6.7±3.5 days. Conclusions: Our series indicate that in experienced hands, robot-assisted laparoscopic approach for hemi-hepatectomy is feasible and safe. As experience grows, this procedure will be more common. © 2011 Surgical Associates Ltd.
The value of abnormal muscle response monitoring during microvascular decompression surgery for hemifacial spasmTing Ting Ying | Shi Ting Li | Jun Zhong | Xin Yuan Li | Xu Hui Wang | Jin Zhu
Volume 9, Issue 4, March 2011, Pages 347-351
Background and objectives: Abnormal muscle response (AMR) to the electrical stimulation of a branch of facial nerve is a specific electrophysiological feature of primary hemifacial spasm (HFS). The aim of this study was to evaluate the value of AMR monitoring during microvascular decompression surgery (MVD), and the correlation between the AMR changes and the clinical outcomes. Methods: This study included 241 cases of MVDs. Intraoperative AMR monitoring was performed for each subject. The patients were divided into two groups based on whether the AMR-disappeared or not following decompression of the facial nerve. Results: Postoperatively, 229 (95.0%) patients were relieved from the spasm, 215 (93.9%) occurred in the AMR-disappeared group, 14 (6.1%) in the non-AMR-disappeared group. The correlation between intraoperative AMR abolition and HFS relief was statistically significant. Conclusions: Intraoperative AMR monitoring was an effective assistant for a successful MVD for the patient with HFS. It is worth being routinely employed during the operation. © 2011 Surgical Associates Ltd.
Laparoscopic adrenalectomy, a safe procedure for pheochromocytoma. A retrospective review of clinical seriesGiovanni Conzo | Mario Musella | Francesco Corcione | Maurizio De Palma | Fausto Ferraro | Antonietta Palazzo | Salvatore Napolitano | Marco Milone | Daniela Pasquali | Antonio Agostino Sinisi | Vittorio Colantuoni | Luigi Santini
Volume 11, Issue 2, January 2013, Pages 152-156
Background: Minimally invasive adrenalectomy for pheochromocytoma (PCC) is a complex surgical procedure especially because of the haemodynamic instability due to the excessive secretion of cathecolamines, which may result in a considerable risk of conversion and complications. Aim: By a multicentric retrospective study, the authors reported the results of laparoscopic adrenalectomies in patients operated for adrenal pheochromocytomas with the aim of investigating the role of the laparoscopic approach in managing adrenal disease. Methods: Sixty patients, preoperatively treated with a selective alpha1-blocker, underwent 61 laparoscopic adrenalectomies for PCC smaller or larger than 6 cm - group A (≤6 cm), group B (>6 cm). We compared the two groups of patients analyzing haemodynamic instability, operative time, conversion rate, incidence of complications, length of hospital stay and medium and long-term outcomes. Results: In 23 cases tumor was >6 cm in diameter. Average operative time was 165 min, with a 5% conversion rate. There was no mortality and morbidity rate was 8.3%. Intraoperative hypertensive crises were registered in 15% of patients, whereas 5/60 patients had hypotensive crises. After comparing the two groups of patients, no statistically significant differences in terms of haemodynamic instability, operative time, conversion rate, morbidity and length of hospital stay were observed. Conclusions: As a surgical treatment of pheochromocytomas, laparoscopic adrenalectomy is an effective and safe approach, in selected cases even for PCCs >6 cm in diameter, although patients with such large tumors may have a higher conversion rate and more intraoperative hypertensive crises. Preoperative selective adrenergic blockade does not prevent intraoperative hypertensive crises, but by facilitating the pharmacological management of the perioperative haemodynamic instability, may avoid the onset of major adverse cardiovascular complications. © 2012 Surgical Associates Ltd.
Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): Explanation and elaborationJan P. Vandenbroucke | Erik von Elm | Douglas G. Altman | Peter C. Gøtzsche | Cynthia D. Mulrow | Stuart J. Pocock | Charles Poole | James J. Schlesselman | Matthias Egger | Maria Blettner | Paolo Boffetta | Hermann Brenner | Genevie've Chêne | Cyrus Cooper | George Davey-Smith | France Gagnon | Philip Greenland | Sander Greenland | Claire Infante-Rivard | John Ioannidis | Astrid James | Giselle Jones | Bruno Ledergerber | Julian Little | Margaret May | David Moher | Hooman Momen | Alfredo Morabia | Hal Morgenstern | Fred Paccaud | Martin Röösli | Dietrich Rothenbacher | Kenneth Rothman | Caroline Sabin | Willi Sauerbrei | Lale Say | Jonathan Sterne | Holly Syddall | Ian White | Susan Wieland | Hywel Williams | Guang Yong Zou
Volume 12, Issue 12, January 2014, Pages 1500-1524
© 2014 The Authors. Much medical research is observational. The reporting of observational studies is often of insufficient quality. Poor reporting hampers the assessment of the strengths and weaknesses of a study and the generalisability of its results. Taking into account empirical evidence and theoretical considerations, a group of methodologists, researchers, and editors developed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) recommendations to improve the quality of reporting of observational studies. The STROBE Statement consists of a checklist of 22 items, which relate to the title, abstract, introduction, methods, results and discussion sections of articles. Eighteen items are common to cohort studies, case-control studies and cross-sectional studies and four are specific to each of the three study designs. The STROBE Statement provides guidance to authors about how to improve the reporting of observational studies and facilitates critical appraisal and interpretation of studies by reviewers, journal editors and readers. This explanatory and elaboration document is intended to enhance the use, understanding, and dissemination of the STROBE Statement. The meaning and rationale for each checklist item are presented. For each item, one or several published examples and, where possible, references to relevant empirical studies and methodological literature are provided. Examples of useful flow diagrams are also included. The STROBE Statement, this document, and the associated Web site (http://www.strobe-statement.org/) should be helpful resources to improve reporting of observational research.
Heme oxygenase-1 mediates the anti-inflammatory effect of molecular hydrogen in LPS-stimulated RAW 264.7 macrophagesHong Guang Chen | Ke Liang Xie | Huan Zhi Han | Wei Na Wang | Da Quan Liu | Guo Lin Wang | Yong Hao Yu
Volume 11, Issue 10, October 2013, Pages 1060-1066
Background: Molecular hydrogen (H2) as a new medical gas has an anti-inflammatory effect. In the present study, we investigated whether heme oxygenase-1 (HO-1) contributes to the anti-inflammatory effect of H2 in lipopolysaccharide (LPS)-stimulated RAW 264.7 macrophages. Methods: RAW 264.7 macrophages were stimulated by LPS (1μg/mL) with presence or absence of different concentrations of H2. Cell viability and injury were tested by 3-(4,5)-dimethylthiahiazo (-z-y1)-3,5-di-phenytetrazoliumromide (MTT) assay and lactate dehydrogenase (LDH) release, respectively. The cell culture supernatants were collected to measure inflammatory cytokines [TNF-α, IL-1β, HMGB1 (high mobility group box-1) and IL-10] at different time points. Moreover, HO-1 protein expression and activity were tested at different time points. In addition, to further identify the role of HO-1 in this process, zinc protoporphyrin (ZnPP)-IX, an HO-1 inhibitor, was used. Results: H2 treatment had no significant influence on cell viability and injury in normally cultured RAW 264.7 macrophages. Moreover, H2 treatment dose-dependently attenuated the increased levels of pro-inflammatory cytokines (TNF-α, IL-1β, HMGB1), but further increased the level of anti-inflammatory cytokine IL-10 at 3h, 6h, 12h and 24h after LPS stimulation. Furthermore, H2 treatment could also dose-dependently increase the HO-1 protein expression and activity at 3h, 6h, 12h and 24h in LPS-activated macrophages. In addition, blockade of HO-1 activity with ZnPP-IX partly reversed the anti-inflammatory effect of H2 in LPS-stimulated macrophages. Conclusions: Molecular hydrogen exerts a regulating role in the release of pro- and anti-inflammatory cytokines in LPS-stimulated macrophages, and this effect is at least partly mediated by HO-1 expression and activation. © 2013 Surgical Associates Ltd.
A technical review of flexible endoscopic multitasking platformsBaldwin Po Man Yeung | Terence Gourlay
Volume 10, Issue 7, June 2012, Pages 345-354
Background: Further development of advanced therapeutic endoscopic techniques and natural orifice translumenal endoscopic surgery (NOTES) requires a powerful flexible endoscopic multitasking platform. Methods: Medline search was performed to identify literature relating to flexible endoscopic multitasking platform from year 2004-2011 using keywords: Flexible endoscopic multitasking platform, NOTES, Instrumentation, Endoscopic robotic surgery, and specific names of various endoscopic multitasking platforms. Key articles from articles references were reviewed. Results: Flexible multitasking platforms can be classified as either mechanical or robotic. Purely mechanical systems include the dual channel endoscope (DCE) (Olympus), R-Scope (Olympus), the EndoSamurai (Olympus), the ANUBIScope (Karl-Storz), Incisionless Operating Platform (IOP) (USGI), and DDES system (Boston Scientific). Robotic systems include the MASTER system (Nanyang University, Singapore) and the Viacath (Hansen Medical). The DCE, the R-Scope, the EndoSamurai and the ANUBIScope have integrated visual function and instrument manipulation function. The IOP and DDES systems rely on the conventional flexible endoscope for visualization, and instrument manipulation is integrated through the use of a flexible, often lockable, multichannel access device. The advantage of the access device concept is that it allows optics and instrument dissociation. Due to the anatomical constrains of the pharynx, systems are designed to have a diameter of less than 20 mm. All systems are controlled by traction cable system actuated either by hand or by robotic machinery. In a flexible system, this method of actuation inevitably leads to significant hysteresis. This problem will be accentuated with a long endoscope such as that required in performing colonic procedures. Systems often require multiple operators. To date, the DCE, the R-Scope, the IOP, and the Viacath system have data published relating to their application in human. Conclusion: Alternative forms of instrument actuation, camera control and master console ergonomics should be explored to improve instrument precision, sphere of action, size and minimize assistance required. © 2012 Surgical Associates Ltd.
Clinical outcomes of facial transplantation: A reviewKumaran Shanmugarajah | Shehan Hettiaratchy | Alex Clarke | Peter E M Butler
Volume 9, Issue 8, November 2011, Pages 600-607
A total of 18 composite tissue allotransplants of the face have currently been reported. Prior to the start of the face transplant programme, there had been intense debate over the risks and benefits of performing this experimental surgery. This review examines the surgical, functional and aesthetic, immunological and psychological outcomes of facial transplantation thus far, based on the predicted risks outlined in early publications from teams around the world.The initial experience has demonstrated that facial transplantation is surgically feasible. Functional and aesthetic outcomes have been very encouraging with good motor and sensory recovery and improvements to important facial functions observed. Episodes of acute rejection have been common, as predicted, but easily controlled with increases in systemic immunosuppression. Psychological improvements have been remarkable and have resulted in the reintegration of patients into the outside world, social networks and even the workplace. Complications of immunosuppression and patient mortality have been observed in the initial series. These have highlighted rigorous patient selection as the key predictor of success.The overall early outcomes of the face transplant programme have been generally more positive than many predicted. This initial success is testament to the robust approach of teams. Dissemination of outcomes and ongoing refinement of the process may allow facial transplantation to eventually become a first-line reconstructive option for those with extensive facial disfigurements. © 2011 Surgical Associates Ltd.
The protective effects of dexmedetomidine on the liver and remote organs against hepatic ischemia reperfusion injury in ratsAdnan Tüfek | Orhan Tokgöz | Ibrahim Aliosmanoglu | Ulaş Alabalik | Osman Evliyaoglu | Taner Çiftçi | Abdülmenap Güzel | Zeynep Baysal Yildirim
Volume 11, Issue 1, January 2013, Pages 96-100
Aim: To investigate the protective effects of dexmedetomidine against hepatic ischemia/reperfusion (IR) injury and hepatic IR induced remote organ injury. Methods: Forty Wistar albino rats were divided into the following four groups: sham, dexmedetomidine, IR, and IR + dexmedetomidine. Hepatic ischemia was created by the Pringle maneuver for 30 min followed by a 30 min reperfusion period in the IR and IR + dexmedetomidine groups. The dexmedetomidine and IR + dexmedetomidine groups were administered dexmedetomidine (100 μg/kg, single dose) intraperitoneally after the anesthesia insult. Blood samples and hepatic, renal, and lung tissue specimens were obtained to measure serum and tissue total oxidative activity (TOA), total antioxidant capacity (TAC), paraoxonase (PON-1), and oxidative stress index (OSI) after 60 min in all groups. Results: According to the biochemical analyses of the samples taken from the serum and the liver, lung, and kidney tissues, when comparing the sham group and the IR group, TOA and OSI values were higher in the IR group, while TAC and PON-1 values were lower (p < 0.05). It was observed that TOA and OSI values were significantly lower, while TAC and PON-1 values increased with dexmedetomidine treatment (p < 0.05). In addition, dexmedetomidine ameliorated hepatic histopathological changes inducing IR, but there were no significant histopathological changes in the remote organs. Conclusion: This study demonstrated that dexmedetomidine markedly reduced the oxidative stress in serum, liver, and remote organs induced by hepatic IR injury, and ameliorated the histopathological damage in the liver. © 2012 Surgical Associates Ltd.
Multimodality laparoscopic liver resection for hepatic malignancy - From conventional total laparoscopic approach to robot-assisted laparoscopic approachEric C H Lai | Chung Ngai Tang | George P C Yang | Michael K W Li
Volume 9, Issue 4, March 2011, Pages 324-328
Introduction: Laparoscopic liver resection can either be total laparoscopic or hand-assisted laparoscopic approach. The recent introduction of robotic surgical systems has revolutionized the field of minimally invasive surgery. It was developed to overcome the disadvantages of conventional laparoscopic surgery. The role of robotic system in laparoscopic surgery was not well evaluated yet. The aim of this cohort study was to evaluate the outcome of multimodality approach of laparoscopic liver resection for hepatic malignancy. Methods: From January 1998 to August 2010, all patients with hepatic malignancy underwent laparoscopic liver resection were included. A prospectively collected data was analyzed retrospectively. Results: During the study period, a total of 56 patients with hepatic malignancies (hepatocellular carcinoma, HCC, n = 42; colorectal liver metastases, CLM, n = 14) underwent laparoscopic liver resection in our surgical unit. The majority of cases were performed by hand-assisted laparoscopic approach, n = 31 (55.3%) and the remainder were with total laparoscopic approach, n = 10 (17.9%) and robot-assisted laparoscopic approach, n = 15 (26.8%). The median operation time was 150 min (range, 75-307 min). The median blood loss during surgery was 175 ml (range, 5-2000 ml). Two patients (3.6%) needed open conversion and one patient (1.8%) needed to be converted to hand-assisted laparoscopic approach. The morbidity rate was 14.3%. There was no procedure-related death. 89.3% of patients had R0 resection and 10.7% of patients had R1 resection. The median hospital stay was 6.5 days (range, 2-13 days).The 1-year, 3-year, and 5-year disease-free survival rates for HCC were 85%, 47%, and 38%, respectively. The 1-year, 3-year, and 5-year overall survival rates for HCC were 96%, 67%, and 52%, respectively. The 1-year, and 3-year disease-free survival rates for CLM were 92% and 72%. The 1-year, and 3-year overall survival rates for CLM were 100% and 88%, respectively. Conclusions: Multimodality approach of laparoscopic liver resection of hepatic malignancy was feasible, and safe in selected patients. It was associated with a low complications rate. The mid-term and long-term survival outcome was favorable also. © 2011 Surgical Associates Ltd.
Current management of gastrointestinal stromal tumors - A comprehensive reviewEric C H Lai | Stephanie H Y Lau | Wan Yee Lau
Volume 10, Issue 7, June 2012, Pages 334-340
Background: Gastrointestinal stromal tumors (GISTs) comprise < 1% of all gastrointestinal (GI) tumors, but GISTs are the most common mesenchymal tumors of the GI tract. Dramatic changes in clinical practice have been observed in the last decade. This review highlights the overall management of GIST and its recent developments. Method: We identified literature by searching Medline and PubMed from January 1995 to December 2011 using the keywords "gastrointestinal stromal tumors", "GIST", "imatinib" and "tyrosine kinase inhibitor". Additional papers were identified by a manual search of the references from the key articles. There were no exclusion criteria for published information to the topics. Results: For localized primary GISTs, surgical resection is the mainstay of therapy. The 5-year survival rate after complete resection of GISTs is approximately 50%-65%. Many factors including tumor size, mitotic rate, tumor location, kinase mutational status and occurrence of tumor rupture have been extensively studied and proposed to be predictors of survival outcomes. Adjuvant imatinib is proposed as an option for those patients with a substantial risk of relapse. Unresectable metastatic or recurrent GIST can be treated with a tyrosine kinase inhibitor, imatinib, with a remarkable response (50%-70%) and prolonged survival (median progression-free survival: 18-20 months; median overall survival: 51-57 months). The standard approach in the case of tumor progression on 400 mg once per day is to increase the imatinib dose to 400 mg twice per day as permitted by toxicity. Use of a second-line targeted agent, sunitinib, in patients with advanced GIST who fail (or are intolerant of) imatinib therapy is advised. Conclusion: Treatment for GISTs has become increasingly complex because of the growing understanding of its biology. A multidisciplinary team that includes radiologists, medical oncologists, pathologists, and surgeons is paramount for the effective treatment of GIST. © 2012 Surgical Associates Ltd.
Introduction, availability and role of simulation in surgical education and training: review of current evidence and recommendations from the Association of Surgeons in Training.J. A. Milburn | G. Khera | S. T. Hornby | P. S. Malone | J. E. Fitzgerald
Volume 10, Issue 8, December 2012, Pages 393-398
The utility of simulation in surgical training is now well-established, with proven validity and demonstrable transfer of skills to the clinical setting. Through a reduction in the technical learning curve, simulation can prepare surgeons for actual practice and in doing so it has the potential to improve both patient safety and service efficiency. More broadly, multi-disciplinary simulation of the theatre environment can aid development of non-technical skills and assist in preparing theatre teams for infrequently encountered scenarios such as surgical emergencies. The role of simulation in the formal training curriculum is less well-established, and availability of facilities for this is currently unknown. This paper reviews the contemporary evidence supporting simulation in surgical training and reports trainee access to such capabilities. Our national surgical trainee survey with 1130 complete responses indicated only 41.2% had access to skills simulator facilities. Of those with access, 16.3% had availability out-of-hours and only 54.0% had local access (i.e. current work place). These results highlight the paucity in current provision of surgical skills simulator facilities, and availability (or awareness of availability) varies widely between region, grade and specialty. Based on these findings and current best-evidence, the Association of Surgeons in Training propose 22 action-points for the introduction, availability and role of simulation in surgical training. Adoption of these should guide trainers, trainees and training bodies alike to ensure equitable provision of appropriate equipment, time and resources to allow the full integration of simulation into the surgical curriculum. Copyright © 2012 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.
The European Working Time Directive: a practical review for surgical trainees.J. E. Fitzgerald | B. C. Caesar
Volume 10, Issue 8, December 2012, Pages 399-403
The European Working Time Directive (EWTD) 2003/88/EC is a Union Directive laying down minimum health and safety requirements for the organisation of working time. Originally primarily intended as labour law, its progressive introduction up to full implementation for doctors-in-training in August 2009 has substantially reduced duty-hours and caused widespread concern in surgery. Detrimental effects on the continuity of patient care, reduced availability of medical staff with associated rota difficulties, and the reduction in time for training junior doctors have been widely cited. Craft-specialities such as surgery and those providing an acute service have faced particular challenges. This review offers a practical guide for surgical trainees, explaining the European regulations in the context of current terms and conditions of doctor's employment in the UK. Information is provided on protecting training, opting-out, seeking remuneration for this, and ensuring doctors and patients are protected with appropriate medical indemnity cover in place. Copyright © 2012 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.
Diagnosis of acute appendicitisAndy Petroianu
Volume 10, Issue 3, February 2012, Pages 115-119
Appendicitis is the most common abdominal emergency. While the clinical diagnosis may be straightforward in patients who present with classic signs and symptoms, atypical presentations may result in diagnostic confusion and delay in treatment. Abdominal pain is the primary presenting complaint of patients with acute appendicitis. Nausea, vomiting, and anorexia occur in varying degrees. Abdominal examination reveals localised tenderness and muscular rigidity after localisation of the pain to the right iliac fossa. Laboratory data upon presentation usually reveal an elevated leukocytosis with a left shift. Measurement of C-reactive protein is most likely to be elevated. The advances in imaginology trend to diminish the false positive or negative diagnosis. Radiographic image of faecal loading image in the caecum has a sensitivity of 97% and a negative predictive value that is 98%. In experienced hands, ultrasound may have a sensitivity of 90% and specificity higher than 90%. Helical CT has reported a sensitivity that may reach 95% and specificity higher than 95%. Despite all medical advances, the diagnosis of acute appendicitis continues to be a medical challenge. © 2012 Surgical Associates Ltd.
The quality and readability of colorectal cancer information on the internetP. Grewal | S. Alagaratnam
Volume 11, Issue 5, March 2013, Pages 410-413
Introduction: Patients can rapidly access the internet and more young people are using their mobile to access health-related information. The aim of this study is to assess the readability and quality of colorectal disease websites for colorectal cancer. Methods: We searched the Google, Yahoo and Bing for colorectal cancer. Readability was assessed using Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade (FKG) and Gunning Fog Index (GFI). The LIDA tool and DISCERN instrument were used to measure the design and content of health information on the Internet. A sub-group analysis was performed on websites certified by HONcode and Information Standard against non-certified websites. Results: The mean FRES were 56.3, mean FKG of 6.9, mean GFI of 9.5, equivalent to TIME magazine. The mean LIDA Tool overall score was 85.6% and mean DISCERN instrument was 52.2 (95% CI 45-59.4). Conclusion: This study shows that colorectal cancer websites were readable but potentially unreliable. Government certified sites were superior to non-certified sites.Improvements are required to provide patients with reliable information to make informed decisions on medical treatments.We propose that national cancer services develop reliable and easily readable information regarding the diagnosis and investigation of colorectal cancer. The site should provide adequate information regarding the treatment options and importantly how each treatment option would affect the patient's quality of life. Clinicians can then provide these websites to the patients before and after their consultations to allow the patient to be fully informed. © 2013 Surgical Associates Ltd.
The effect of hydroxyapatite-hPRP, and coral-hPRP on bone healing in rabbits: Radiological, biomechanical, macroscopic and histopathologic evaluationZahra Shafiei-Sarvestani | Ahmad Oryan | Amin Sadegh Bigham | Abdolhamid Meimandi-Parizi
Volume 10, Issue 2, February 2012, Pages 96-101
There is a continuing search for bone substitutes to avoid or minimize the need for autogenous bone grafts. Human platelet-rich plasma (hPRP) is used to stimulate bone formation in vivo. Hydroxyapatite, a crystalline phase of calcium phosphate found naturally in bone minerals, has shown tremendous promise as a graft material. Coral is an osteoconductive material used as a bone graft extender. This study examined the effect of human platelet-rich plasma in combination with hydroxyapatite and coral on osteogenesis in vivo using rabbit model bone healing.A critical size defect of 10 mm elongation was created in the radial diaphysis of 36 rabbit and either supplied with human platelet-rich plasma (12 rabbits), and in combination with hydroxyapatite (12 rabbits), or coral (12 rabbits). Radiographs of each forelimb were taken postoperatively on 1st day and then at the 2nd, 4th, 6th and 8th weeks post injury to evaluate bone defect healing. The operated radiuses were removed on the 56th postoperative day and were grossly and histopathologically evaluated. In addition, biomechanical test was conducted on the operated and normal forearms of another half of the rabbits in each group. This study demonstrated that high concentrations of xenogenic platelets lead to superior and faster bone formation in comparison with hydroxyapatite-hPRP and coral-hPRP. Hydroxyapatite-hPRP and coral-hPRP resulted to almost similar results in bone healing process at this stage. © 2012 Surgical Associates Ltd.
Changing trends in well differentiated thyroid carcinoma over eight decadesIain J. Nixon | Ian Ganly | Snehal G. Patel | Frank L. Palmer | Monica M. Whitcher | Rony Ghossein | R. Michael Tuttle | Ashok R. Shaha | Jatin P. Shah
Volume 10, Issue 10, November 2012, Pages 618-623
Introduction: The incidence of well differentiated thyroid cancer (WDTC) is rising in the USA. The objective of this study is to present the changes in incidence, presentation, management and outcomes of WDTC within our institution over the past 8 decades. Methods: 2797 patients managed between 1932 and 2005 at Memorial Sloan Kettering Cancer Center were identified from our institutional database. Results: There has been an increase in the number of patients managed per decade. Although the median age was 45 years, patients managed post-1985 were more likely to be over 45 years (53% versus 44%, p < 0.001). The percentage of women increased from 68% to 72% (p = 0.026), and the percentage of papillary carcinomas also increased, from 78% to 92%, p < 0.001. An increase in early stage tumors was observed with pT1 lesions increasing from 19% to 48%. Patients in the latter cohort were less likely to have thyroid lobectomy (29% versus 72%, p < 0.001). There was a significant change in the use of RRA, with 8% of the early versus 44% of the latter group receiving post-operative RRA (p < 0.001). Since the introduction of risk group stratification disease specific survival (DSS) has not changed significantly. With a median follow up of 90 months, 10 year DSS rates were below 90% in the cohort managed prior to the 1970s, which rose to >95% thereafter (p < 0.001). Conclusions: Older patients with earlier stage disease present an increasing workload for surgical oncologists. Excellent outcomes remain unchanged despite increasingly aggressive surgical and medical management. © 2012 Surgical Associates Ltd.
A meta-analysis examining the use of tacker fixation versus no-fixation of mesh in laparoscopic inguinal hernia repairM. S. Sajid | N. Ladwa | L. Kalra | K. Hutson | P. Sains | M. K. Baig
Volume 10, Issue 5, April 2012, Pages 224-231
Objective: The objective of this article is to systematically analyse the randomised, controlled trials comparing tacker mesh fixation (TMF) versus no-mesh fixation (NMF) in laparoscopic inguinal hernia repair (LIHR). Methods: Randomised, controlled trials comparing TMF versus NMF in LIHR were analysed systematically using RevMan®, and combined outcomes were expressed as risk ratio (RR) and standardised mean difference (SMD). Results: Eight randomised, controlled trials encompassing 1386 patients were retrieved from the electronic databases. There were 691 patients in the TMF group and 695 patients in the NMF group. Statistically there was non-significant heterogeneity among trials. In random effects models, operating time (. p = 0.15), post-operative pain (. p = 0.45), post-operative complications (. p = 0.55) and length of hospital stay (. p = 0.11) were statistically comparable between two techniques of mesh fixation in LIHR. The risk of developing chronic groin pain (. p = 0.67) and risk of hernia recurrence (. p = 0.77) was also similar. Conclusion: NMF in LIHR does not increase the risk of hernia recurrence. It is comparable with TMF in terms of operation time, post-operative pain, post-operative complications, length of hospital stay and chronic groin pain. Therefore, based upon the results of this review NMF approach may be adopted routinely and safely in LIHR. © 2012 Surgical Associates Ltd.