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Vallance AE. A systematic methodology review of fluorescence-guided cancer surgery to inform the development of a core master protocol and outcome set. BMC Cancer 2024; 24:697. [PMID: 38844894 PMCID: PMC11157717 DOI: 10.1186/s12885-024-12386-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 05/14/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Fluorescence-guided precision cancer surgery may improve survival and minimize patient morbidity. Efficient development of promising interventions is however hindered by a lack of common methodology. This methodology review aimed to synthesize descriptions of technique, governance processes, surgical learning and outcome reporting in studies of fluorescence-guided cancer surgery to provide guidance for the harmonized design of future studies. METHODS A systematic search of MEDLINE, EMBASE and CENTRAL databases from 2016-2020 identified studies of all designs describing the use of fluorescence in cancer surgery. Dual screening and data extraction was conducted by two independent teams. RESULTS Of 13,108 screened articles, 426 full text articles were included. The number of publications per year increased from 66 in 2016 to 115 in 2020. Indocyanine green was the most commonly used fluorescence agent (391, 91.8%). The most common reported purpose of fluorescence guided surgery was for lymph node mapping (195, 5%) and non-specific tumour visualization (94, 2%). Reporting about surgical learning and governance processes incomplete. A total of 2,577 verbatim outcomes were identified, with the commonly reported outcome lymph node detection (796, 30%). Measures of recurrence (32, 1.2%), change in operative plan (23, 0.9%), health economics (2, 0.1%), learning curve (2, 0.1%) and quality of life (2, 0.1%) were rarely reported. CONCLUSION There was evidence of methodological heterogeneity that may hinder efficient evaluation of fluorescence surgery. Harmonization of the design of future studies may streamline innovation.
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Affiliation(s)
- Abigail E Vallance
- Centre for Surgical Research, Population Health Sciences, University of Bristol, 39 Whatley Road, Clifton, Bristol, BS8 2PS, UK.
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Richards HS, Cousins S, Scroggie DL, Elliott D, Macefield R, Hudson E, Mutanga IR, Shah M, Alford N, Blencowe NS, Blazeby J. Examining the application of the IDEAL framework in the reporting and evaluation of innovative invasive procedures: secondary qualitative analysis of a systematic review. BMJ Open 2024; 14:e079654. [PMID: 38803251 PMCID: PMC11129025 DOI: 10.1136/bmjopen-2023-079654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 05/01/2024] [Indexed: 05/29/2024] Open
Abstract
OBJECTIVES The development of new surgical procedures is fundamental to advancing patient care. The Idea, Developments, Exploration, Assessment and Long-term (IDEAL) framework describes study designs for stages of innovation. It can be difficult to apply due to challenges in defining and identifying innovative procedures. This study examined how the IDEAL framework is operationalised in real-world settings; specifically, the types of innovations evaluated using the framework and how authors justify their choice of IDEAL study design. DESIGN Secondary qualitative analysis of a systematic review. DATA SOURCES Citation searches (Web of Science and Scopus) identified studies following the IDEAL framework and citing any of the ten key IDEAL/IDEAL_D papers. ELIGIBILITY CRITERIA Studies of invasive procedures/devices of any design citing any of the ten key IDEAL/IDEAL_D papers. DATA EXTRACTION AND SYNTHESIS All relevant text was extracted. Three frameworks were developed, namely: (1) type of innovation under evaluation; (2) terminology used to describe stage of innovation and (3) reported rationale for IDEAL stage. RESULTS 48 articles were included. 19/48 described entirely new procedures, including those used for the first time in a different clinical context (n=15/48), reported as IDEAL stage 2a (n=8, 53%). Terminology describing stage of innovation was varied, inconsistent and ambiguous and was not defined. Authors justified their choice of IDEAL study design based on limitations in published evidence (n=36) and unknown feasibility and safety (n=32) outcomes. CONCLUSION Identifying stage of innovation is crucial to inform appropriate study design and governance decisions. Authors' rationale for choice of IDEAL stage related to the existing evidence base or lack of sufficient outcome data for procedures. Stage of innovation was poorly defined with inconsistent descriptions. Further work is needed to develop methods to identify innovation to inform practical application of the IDEAL framework. Defining the concept of innovation in terms of uncertainty, risk and degree of evidence may help to inform decision-making.
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Affiliation(s)
- Hollie Sarah Richards
- National Institute for Health Research Bristol Biomedical Research Centre Surgical and Orthopaedic Innovation Theme, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol Medical School, Bristol, UK
| | - Sian Cousins
- National Institute for Health Research Bristol Biomedical Research Centre Surgical and Orthopaedic Innovation Theme, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol Medical School, Bristol, UK
| | - Darren L Scroggie
- National Institute for Health Research Bristol Biomedical Research Centre Surgical and Orthopaedic Innovation Theme, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol Medical School, Bristol, UK
| | - Daisy Elliott
- National Institute for Health Research Bristol Biomedical Research Centre Surgical and Orthopaedic Innovation Theme, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol Medical School, Bristol, UK
| | - Rhiannon Macefield
- National Institute for Health Research Bristol Biomedical Research Centre Surgical and Orthopaedic Innovation Theme, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol Medical School, Bristol, UK
| | - Elizabeth Hudson
- National Institute for Health Research Bristol Biomedical Research Centre Surgical and Orthopaedic Innovation Theme, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol Medical School, Bristol, UK
| | - Ian Rodney Mutanga
- National Institute for Health Research Bristol Biomedical Research Centre Surgical and Orthopaedic Innovation Theme, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol Medical School, Bristol, UK
| | - Maximilian Shah
- National Institute for Health Research Bristol Biomedical Research Centre Surgical and Orthopaedic Innovation Theme, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol Medical School, Bristol, UK
| | - Natasha Alford
- National Institute for Health Research Bristol Biomedical Research Centre Surgical and Orthopaedic Innovation Theme, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol Medical School, Bristol, UK
| | - Natalie S Blencowe
- National Institute for Health Research Bristol Biomedical Research Centre Surgical and Orthopaedic Innovation Theme, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol Medical School, Bristol, UK
| | - Jane Blazeby
- National Institute for Health Research Bristol Biomedical Research Centre Surgical and Orthopaedic Innovation Theme, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol Medical School, Bristol, UK
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Walker R, Currie A, Wiggins T, Markar SR, Blencowe NS, Underwood T, Hollyman M. Results of the ARROW survey of anti-reflux practice in the United Kingdom. Dis Esophagus 2023; 36:doad021. [PMID: 37019630 PMCID: PMC10543366 DOI: 10.1093/dote/doad021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 02/14/2023] [Indexed: 04/07/2023]
Abstract
Gastro-esophageal reflux disease (GERD) is a common, significant health burden. United Kingdom guidance states that surgery should be considered for patients with a diagnosis of GERD not suitable for long-term acid suppression. There is no consensus on many aspects of patient pathways and optimal surgical technique, and an absence of information on how patients are currently selected for surgery. Further detail on the delivery of anti-reflux surgery (ARS) is required. A United Kingdom-wide survey was designed to gather surgeon opinion regarding pre-, peri- and post-operative practice of ARS. Responses were received from 155 surgeons at 57 institutions. Most agreed that endoscopy (99%), 24-hour pH monitoring (83%) and esophageal manometry (83%) were essential investigations prior to surgery. Of 57 units, 30 (53%) had access to a multidisciplinary team to discuss cases; case-loads were higher in those units (median 50 vs. 30, P < 0.024). The most popular form of fundoplication was a Nissen posterior 360° (75% of surgeons), followed by a posterior 270° Toupet (48%). Only seven surgeons stated they had no upper limit of body mass index prior to surgery. A total of 46% of respondents maintain a database of their practice and less than a fifth routinely record quality of life scores before (19%) or after (14%) surgery. While there are areas of consensus, a lack of evidence to support workup, intervention and outcome evaluation is reflected in the variability of practice. ARS patients are not receiving the same level of evidence-based care as other patient groups.
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Affiliation(s)
| | - Robert Walker
- Guys and St Thomas’ Oesophago-Gastric Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK
- Faculty of Medicine, School of Cancer Sciences, University of Southampton, Southampton, UK
| | - Andrew Currie
- Service de Chirurgie Digestive A Pôle Digestif, CHU de Montpellier, Montpellier, France
| | - Tom Wiggins
- Department of Bariatric Surgery, University Hospitals Birmingham, Birmingham, UK
| | - Sheraz R Markar
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- Nuffield Department of Surgery, University of Oxford, Oxford, UK
| | - Natalie S Blencowe
- Population Health Sciences, University of Bristol, Bristol, UK
- Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Tim Underwood
- Faculty of Medicine, School of Cancer Sciences, University of Southampton, Southampton, UK
| | - Marianne Hollyman
- Upper Gastrointestinal Surgery Department, Musgrove Park Hospital, Taunton, UK
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4
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McLean KA, Knight SR, Diehl TM, Varghese C, Ng N, Potter MA, Zafar SN, Bouamrane MM, Harrison EM. Readiness for implementation of novel digital health interventions for postoperative monitoring: a systematic review and clinical innovation network analysis. Lancet Digit Health 2023; 5:e295-e315. [PMID: 37100544 DOI: 10.1016/s2589-7500(23)00026-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 04/28/2023]
Abstract
An increasing number of digital health interventions (DHIs) for remote postoperative monitoring have been developed and evaluated. This systematic review identifies DHIs for postoperative monitoring and evaluates their readiness for implementation into routine health care. Studies were defined according to idea, development, exploration, assessment, and long-term follow-up (IDEAL) stages of innovation. A novel clinical innovation network analysis used coauthorship and citations to examine collaboration and progression within the field. 126 DHIs were identified, with 101 (80%) being early stage innovations (IDEAL stage 1 and 2a). None of the DHIs identified had large-scale routine implementation. There is little evidence of collaboration, and there are clear omissions in the evaluation of feasibility, accessibility, and the health-care impact. Use of DHIs for postoperative monitoring remains at an early stage of innovation, with promising but generally low-quality supporting evidence. Comprehensive evaluation within high-quality, large-scale trials and real-world data are required to definitively establish readiness for routine implementation.
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Affiliation(s)
- Kenneth A McLean
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Stephen R Knight
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Thomas M Diehl
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Chris Varghese
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Nathan Ng
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Mark A Potter
- Colorectal Unit, Western General Hospital, Edinburgh, UK
| | - Syed Nabeel Zafar
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Matt-Mouley Bouamrane
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Ewen M Harrison
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.
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Avery KNL, Wilson N, Macefield R, McNair A, Hoffmann C, Blazeby JM, Potter S. A Core Outcome Set for Seamless, Standardized Evaluation of Innovative Surgical Procedures and Devices (COHESIVE): A Patient and Professional Stakeholder Consensus Study. Ann Surg 2023; 277:238-245. [PMID: 34102667 PMCID: PMC9831031 DOI: 10.1097/sla.0000000000004975] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To develop a COS, an agreed minimum set of outcomes to measure and report in all studies evaluating the introduction and evaluation of novel surgical techniques. SUMMARY OF BACKGROUND DATA Agreement on the key outcomes to measure and report for safe and efficient surgical innovation is lacking, hindering transparency and risking patient harm. METHODS (I) Generation of a list of outcome domains from published innovation-specific literature, policy/regulatory body documents, and surgeon interviews; (II) Prioritization of identified outcome domains using an international, multi-stakeholder Delphi survey; (III) Consensus meeting to agree the final COS. Participants were international stakeholders, including patients/public, surgeons, device manufacturers, regulators, trialists, methodologists, and journal editors. RESULTS A total of 7972 verbatim outcomes were identified, categorized into 32 domains, and formatted into survey items/questions. Four hundred ten international participants (220 professionals, 190 patients/public) completed at least one round 1 survey item, of which 153 (69.5%) professionals and 116 (61.1%) patients completed at least one round 2 item. Twelve outcomes were scored "consensus in" ("very important" by ≥70% of patients and professionals) and 20 "no consensus." A consensus meeting, involvingcontext: modifications, unexpected disadvantages, device problems, technical procedure completion success, patients' experience relating to the procedure being innovative, surgeons'/operators' experience. Other domains relate to intended benefits, whether the overall desired effect was achieved and expected disadvantages. CONCLUSIONS The COS is recommended for use in all studies before definitive randomized controlled trial evaluation to promote safe, transparent, and efficient surgical innovation.
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Affiliation(s)
- Kerry N L Avery
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Clifton, Bristol, UK
| | - Nicholas Wilson
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Clifton, Bristol, UK
| | - Rhiannon Macefield
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Clifton, Bristol, UK
| | - Angus McNair
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Clifton, Bristol, UK
- Gastrointestinal Surgery, North Bristol NHS Trust, Bristol, UK
| | - Christin Hoffmann
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Clifton, Bristol, UK
| | - Jane M Blazeby
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Clifton, Bristol, UK
- Division of Surgery, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Shelley Potter
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Clifton, Bristol, UK
- Bristol Breast Care Centre, North Bristol NHS Trust, Southmead Road, Bristol, UK
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Removal of the magnetic sphincter augmentation device: an assessment of etiology, clinical presentation, and management. Surg Endosc 2023; 37:3769-3779. [PMID: 36689039 PMCID: PMC10156860 DOI: 10.1007/s00464-023-09878-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/08/2023] [Indexed: 01/24/2023]
Abstract
BACKGROUND Magnetic sphincter augmentation (MSA) erosion, disruption or displacement clearly requires device removal. However, up to 5.5% of patients without anatomical failure require removal for dysphagia or recurrent GERD symptoms. Studies characterizing these patients or their management are limited. We aimed to characterize these patients, compare their outcomes, and determine the necessity for further reflux surgery. METHODS This is a retrospective review of 777 patients who underwent MSA at our institution between 2013 and 2021. Patients who underwent device removal for persistent dysphagia or recurrent GERD symptoms were included. Demographic, clinical, objective testing, and quality of life data obtained preoperatively, after implantation and following removal were compared between removal for dysphagia and GERD groups. Sub-analyses were performed comparing outcomes with and without an anti-reflux surgery (ARS) at the time of removal. RESULTS A total of 40 (5.1%) patients underwent device removal, 31 (77.5%) for dysphagia and 9 (22.5%) for GERD. After implantation, dysphagia patients had less heartburn (12.9-vs-77.7%, p = 0.0005) less regurgitation (16.1-vs-55.5%, p = 0.0286), and more pH-normalization (91.7-vs-33.3%, p = 0.0158). Removal without ARS was performed in 5 (55.6%) GERD and 22 (71.0%) dysphagia patients. Removal for dysphagia patients had more complete symptom resolution (63.6-vs-0.0%, p = 0.0159), freedom from PPIs (81.8-vs-0.0%, p = 0.0016) and pH-normalization (77.8-vs-0.0%, p = 0.0455). Patients who underwent removal for dysphagia had comparable symptom resolution (p = 0.6770, freedom from PPI (p = 0.3841) and pH-normalization (p = 0.2534) with or without ARS. Those who refused ARS with removal for GERD had more heartburn (100.0%-vs-25.0%, p = 0.0476), regurgitation (80.0%-vs-0.0%, p = 0.0476) and PPI use (75.0%-vs-0.0%, p = 0.0476). CONCLUSIONS MSA removal outcomes are dependent on the indication for removal. Removal for dysphagia yields excellent outcomes regardless of anti-reflux surgery. Patients with persistent GERD had worse outcomes on all measures without ARS. We propose a tailored approach to MSA removal-based indication for removal.
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7
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Cousins S, Richards HS, Zahra J, Robertson H, Mathews JA, Avery KNL, Elliott D, Blencowe NS, Main B, Hinchliffe R, Clarke A, Blazeby J. Healthcare organization policy recommendations for the governance of surgical innovation: review of NHS policies. Br J Surg 2022; 109:1004-1012. [PMID: 36084337 PMCID: PMC10364689 DOI: 10.1093/bjs/znac223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/15/2022] [Accepted: 05/30/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND The governance for introducing innovative surgical procedures/devices differs from the research requirements needed for new drugs. New invasive procedures/devices may be offered to patients outside of research protocols with local organization oversight alone. Such institutional arrangements exist in many countries and written policies provide guidance for their use, but little is known about their scope or standards. METHODS One hundred and fifty acute NHS trusts in England and seven health boards in Wales were systematically approached for information about their policies. A modified framework approach was used to analyse when policies considered new procedures/devices to be within local organization remit and/or requiring research ethics committee (REC) approval. RESULTS Of 113 policies obtained, 109 and 34 described when local organization and REC approval was required, respectively. Procedures/devices being used for the first time in the organization (n = 69) or by a clinician (n = 67) were commonly within local remit, and only 36 stated that evidence was required. Others stated limited evidence as a rationale for needing REC approval (n = 13). External guidance categorizing procedures as 'research only' was the most common reason for gaining REC approval (n = 15). Procedures/devices with uncertain outcomes (n = 28), requiring additional training (n = 26), and not previously used (n = 6) were within the remit of policies, while others recommended REC application in these situations (n = 5, 2 and 7, respectively). CONCLUSION This study on NHS policies for surgical innovation shows variability in the introduction of procedures/devices in terms of local oversight and/or need for REC approval. Current NHS standards allow untested innovations to occur without the safety of research oversight and thus a standard approach is urgently needed.
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Affiliation(s)
- Sian Cousins
- National Institute for Health Research Bristol Biomedical Research Centre Surgical Innovation Theme, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol, Bristol, UK
| | - Hollie S Richards
- National Institute for Health Research Bristol Biomedical Research Centre Surgical Innovation Theme, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jez Zahra
- National Institute for Health Research Bristol Biomedical Research Centre Surgical Innovation Theme, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol, Bristol, UK
| | - Harry Robertson
- National Institute for Health Research Bristol Biomedical Research Centre Surgical Innovation Theme, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol, Bristol, UK
| | - Johnny A Mathews
- National Institute for Health Research Bristol Biomedical Research Centre Surgical Innovation Theme, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol, Bristol, UK
| | - Kerry N L Avery
- National Institute for Health Research Bristol Biomedical Research Centre Surgical Innovation Theme, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol, Bristol, UK
| | - Daisy Elliott
- National Institute for Health Research Bristol Biomedical Research Centre Surgical Innovation Theme, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol, Bristol, UK
| | - Natalie S Blencowe
- National Institute for Health Research Bristol Biomedical Research Centre Surgical Innovation Theme, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol, Bristol, UK
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Barry Main
- National Institute for Health Research Bristol Biomedical Research Centre Surgical Innovation Theme, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol, Bristol, UK
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Robert Hinchliffe
- National Institute for Health Research Bristol Biomedical Research Centre Surgical Innovation Theme, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol, Bristol, UK
- North Bristol NHS Trust, Bristol, UK
| | - Adrian Clarke
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Jane Blazeby
- National Institute for Health Research Bristol Biomedical Research Centre Surgical Innovation Theme, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol, Bristol, UK
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Huttman MM, Robertson HF, Smith AN, Biggs SE, Dewi F, Dixon LK, Kirkham EN, Jones CS, Ramirez J, Scroggie DL, Zucker BE, Pathak S, Blencowe NS. A systematic review of robot-assisted anti-reflux surgery to examine reporting standards. J Robot Surg 2022; 17:313-324. [PMID: 36074220 PMCID: PMC10076351 DOI: 10.1007/s11701-022-01453-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 08/11/2022] [Indexed: 12/01/2022]
Abstract
Robot-assisted anti-reflux surgery (RA-ARS) is increasingly being used to treat refractory gastro-oesophageal reflux disease. The IDEAL (Idea, Development, Exploration, Assessment, Long-term follow up) Collaboration's framework aims to improve the evaluation of surgical innovation, but the extent to which the evolution of RA-ARS has followed this model is unclear. This study aims to evaluate the standard to which RA-ARS has been reported during its evolution, in relation to the IDEAL framework. A systematic review from inception to June 2020 was undertaken to identify all primary English language studies pertaining to RA-ARS. Studies of paraoesophageal or giant hernias were excluded. Data extraction was informed by IDEAL guidelines and summarised by narrative synthesis. Twenty-three studies were included: two case reports, five case series, ten cohort studies and six randomised controlled trials. The majority were single-centre studies comparing RA-ARS and laparoscopic Nissen fundoplication. Eleven (48%) studies reported patient selection criteria, with high variability between studies. Few studies reported conflicts of interest (30%), funding arrangements (26%), or surgeons' prior robotic experience (13%). Outcome reporting was heterogeneous; 157 distinct outcomes were identified. No single outcome was reported in all studies.The under-reporting of important aspects of study design and high degree of outcome heterogeneity impedes the ability to draw meaningful conclusions from the body of evidence. There is a need for further well-designed prospective studies and randomised trials, alongside agreement about outcome selection, measurement and reporting for future RA-ARS studies.
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Affiliation(s)
- Marc M Huttman
- Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.,University College Hospital, University College London Hospitals NHS Foundation Trust, London, UK
| | - Harry F Robertson
- St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | | | - Sarah E Biggs
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Ffion Dewi
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Lauren K Dixon
- Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.,University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Emily N Kirkham
- Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.,Musgrove Park Hospital, Somerset NHS Foundation Trust, Taunton, UK
| | - Conor S Jones
- Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.,Torbay Hospital, Torbay and South Devon NHS Foundation Trust, Torquay, UK
| | - Jozel Ramirez
- Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.,University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Darren L Scroggie
- Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Benjamin E Zucker
- Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.,University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Samir Pathak
- Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.,St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Natalie S Blencowe
- Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
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9
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Kirkham EN, Jones CS, Higginbotham G, Biggs S, Dewi F, Dixon L, Huttman M, Main BG, Ramirez J, Robertson H, Scroggie DL, Zucker B, Blazeby JM, Blencowe NS, Pathak S. A systematic review of robot-assisted cholecystectomy to examine the quality of reporting in relation to the IDEAL recommendations: systematic review. BJS Open 2022; 6:6770691. [PMID: 36281734 PMCID: PMC9593068 DOI: 10.1093/bjsopen/zrac116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/12/2022] [Accepted: 08/18/2022] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Robotic cholecystectomy (RC) is a recent innovation in minimally invasive gallbladder surgery. The IDEAL (idea, development, exploration, assessment, long-term study) framework aims to provide a safe method for evaluating innovative procedures. This study aimed to understand how RC was introduced, in accordance with IDEAL guidelines. METHODS Systematic searches were used to identify studies reporting RC. Eligible studies were classified according to IDEAL stage and data were collected on general study characteristics, patient selection, governance procedures, surgeon/centre expertise, and outcome reporting. RESULTS Of 1425 abstracts screened, 90 studies were included (5 case reports, 38 case series, 44 non-randomized comparative studies, and 3 randomized clinical trials). Sixty-four were single-centre and 15 were prospective. No authors described their work in the context of IDEAL. One study was classified as IDEAL stage 1, 43 as IDEAL 2a, 43 as IDEAL 2b, and three as IDEAL 3. Sixty-four and 51 provided inclusion and exclusion criteria respectively. Ethical approval was reported in 51 and conflicts of interest in 34. Only 21 reported provision of training for surgeons in RC. A total of 864 outcomes were reported; 198 were used in only one study. Only 30 reported a follow-up interval which, in 13, was 1 month or less. CONCLUSION The IDEAL framework was not followed during the adoption of RC. Few studies were conducted within a research setting, many were retrospective, and outcomes were heterogeneous. There is a need to implement appropriate tools to facilitate the incremental evaluation and reporting of surgical innovation.
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Affiliation(s)
- Emily N Kirkham
- Bristol Centre for Surgical Research, Population Health Sciences, University of Bristol, Bristol, UK
- Musgrove Park Hospital, Taunton, UK
| | - Conor S Jones
- Bristol Centre for Surgical Research, Population Health Sciences, University of Bristol, Bristol, UK
- North Bristol NHS Foundation Trust, Bristol, UK
| | | | - Sarah Biggs
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Ffion Dewi
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Lauren Dixon
- Bristol Centre for Surgical Research, Population Health Sciences, University of Bristol, Bristol, UK
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Marc Huttman
- Bristol Centre for Surgical Research, Population Health Sciences, University of Bristol, Bristol, UK
- University College Hospital, University College London Hospitals NHS Foundation Trust, London, UK
| | - Barry G Main
- Bristol Centre for Surgical Research, Population Health Sciences, University of Bristol, Bristol, UK
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Bristol Dental School, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical research centre, Bristol, UK
| | - Jozel Ramirez
- Bristol Centre for Surgical Research, Population Health Sciences, University of Bristol, Bristol, UK
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Harry Robertson
- Bristol Centre for Surgical Research, Population Health Sciences, University of Bristol, Bristol, UK
- Imperial College Healthcare NHS Trust, London
| | - Darren L Scroggie
- Bristol Centre for Surgical Research, Population Health Sciences, University of Bristol, Bristol, UK
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Benjamin Zucker
- Bristol Centre for Surgical Research, Population Health Sciences, University of Bristol, Bristol, UK
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Jane M Blazeby
- Bristol Centre for Surgical Research, Population Health Sciences, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical research centre, Bristol, UK
| | - Natalie S Blencowe
- Bristol Centre for Surgical Research, Population Health Sciences, University of Bristol, Bristol, UK
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- NIHR Bristol Biomedical research centre, Bristol, UK
| | - Samir Pathak
- Correspondence to: Sami Pathak, St James’s University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK (e-mail: )
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10
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Wilson N, Macefield RC, Hoffmann C, Edmondson MJ, Miller RL, Kirkham EN, Blencowe NS, McNair AGK, Main BG, Blazeby JM, Avery KNL, Potter S. Identification of outcomes to inform the development of a core outcome set for surgical innovation: a targeted review of case studies of novel surgical devices. BMJ Open 2022; 12:e056003. [PMID: 35487755 PMCID: PMC9058790 DOI: 10.1136/bmjopen-2021-056003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Outcome selection and reporting in studies of novel surgical procedures and devices lacks standardisation, hindering safe and effective evaluation. A core outcome set (COS) to measure and report in all studies of surgical innovation is needed. We explored outcomes in a specific sample of innovative surgical device case studies to identify outcome domains specifically relevant to innovation to inform the development of a COS. DESIGN A targeted review of 11 purposive selected case studies of innovative surgical devices. METHODS Electronic database searches in PubMed (July 2018) identified publications reporting the introduction and evaluation of each device. Outcomes were extracted and categorised into domains until no new domains were conceptualised. Outcomes specifically relevant to evaluating innovation were further scrutinised. RESULTS 112 relevant publications were identified, and 5926 outcomes extracted. Heterogeneity in study type, outcome selection and reporting was observed across surgical devices. Categorisation of outcomes was performed for 2689 (45.4%) outcomes into five broad outcome domains. Outcomes considered key to the evaluation of innovation (n=66; 2.5%) were further categorised as surgeon/operator experience (n=40; 1.5%), unanticipated events (n=15, 0.6%) and modifications (n=11; 0.4%). CONCLUSION Outcome domains unique to evaluating innovative surgical devices have been identified. Findings have been combined with multiple other data sources relevant to the evaluation of surgical innovation to inform the development of a COS to measure and report in all studies evaluating novel surgical procedures/devices.
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Affiliation(s)
- Nicholas Wilson
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Rhiannon C Macefield
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Christin Hoffmann
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Matthew J Edmondson
- Anaesthetics Department, Musgrove Park Hospital, Somerset NHS Foundation, Taunton, UK
| | - Rachael L Miller
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
- Department of Vascular Surgery, North Bristol NHS Trust, Bristol, UK
| | - Emily N Kirkham
- Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - Natalie S Blencowe
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
- Division of Surgery, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Angus G K McNair
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
- Department of Gastrointestinal Surgery, North Bristol NHS Trust, Bristol, UK
| | - Barry G Main
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
- Division of Surgery, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Bristol Dental School, University of Bristol, Bristol, UK
| | - Jane M Blazeby
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
- Division of Surgery, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Kerry N L Avery
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Shelley Potter
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
- Bristol Breast Care Centre, North Bristol NHS Trust, Westbury on Trym, UK
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11
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Welford P, Blencowe NS, Pardington E, Jones CS, Blazeby JM, Main BG. Systematic review of the introduction, early phase study and evaluation of pyrocarbon proximal interphalangeal joint arthroplasty. PLoS One 2021; 16:e0257497. [PMID: 34665802 PMCID: PMC8525747 DOI: 10.1371/journal.pone.0257497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 09/02/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In 2002 a pyrocarbon interphalangeal joint implant was granted Food and Drug Administration approval with limited evidence of effectiveness. It is important to understand device use and outcomes since this implant entered clinical practice in order to establish incremental evidence, appropriate study design and reporting. This systematic review summarised and appraised studies reporting pyrocarbon proximal interphalangeal joint arthroplasty. METHODS Systematic review of MEDLINE, EMBASE, SCOPUS, Web of Science, BIOSIS, CINAHL and CENTRAL from inception to November 2020. All study designs reporting pyrocarbon proximal interphalangeal joint arthroplasty in humans were included. Data extracted included information about study characteristics, patient selection, regulatory (gaining research ethics approval) and governance issues (reporting of conflicting interests), operator and centre experience, technique description and outcome reporting. Descriptive and narrative summaries were reported. RESULTS From 4316 abstracts, 210 full-text articles were screened. A total of 38 studies and 1434 (1-184) patients were included. These consisted of three case reports, 24 case series, 10 retrospective cohort studies and one randomised trial. Inclusion and exclusion criteria were stated in 25 (66%) studies. Most studies (n = 27, 71%) gained research ethics approval to be conducted. Six studies reported conflicting interests. Experience of operating surgeons was reported in nine (24%) and caseload volume in five studies. There was no consensus about the optimal surgical approach. Technical aspects of implant placement were reported frequently (n = 32) but the detail provided varied widely. Studies reported multiple, heterogenous outcomes. The most commonly reported outcome was range of motion (n = 37). CONCLUSIONS This systematic review identified inconsistencies in how studies describing the early use and update of an innovative procedure were reported. Incremental evidence was lacking, risking the implant being adopted without robust evaluation. This review adds to evidence highlighting the need for more rigorous evaluation of how implantable medical devices are used in practice following licencing.
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Affiliation(s)
- Paul Welford
- North Bristol NHS Trust, Bristol, United Kingdom
- Bristol Centre for Surgical Research, Department of Population Health Sciences, Bristol Medical School, Bristol, United Kingdom
| | - Natalie S. Blencowe
- Bristol Centre for Surgical Research, Department of Population Health Sciences, Bristol Medical School, Bristol, United Kingdom
- National Institute for Health Research Biomedical Research Centre at Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Emily Pardington
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Conor S. Jones
- North Bristol NHS Trust, Bristol, United Kingdom
- Bristol Centre for Surgical Research, Department of Population Health Sciences, Bristol Medical School, Bristol, United Kingdom
| | - Jane M. Blazeby
- Bristol Centre for Surgical Research, Department of Population Health Sciences, Bristol Medical School, Bristol, United Kingdom
- National Institute for Health Research Biomedical Research Centre at Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Barry G. Main
- Bristol Centre for Surgical Research, Department of Population Health Sciences, Bristol Medical School, Bristol, United Kingdom
- National Institute for Health Research Biomedical Research Centre at Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
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12
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Currie AC, Glaysher MA, Blencowe NS, Kelly J. Systematic Review of Innovation Reporting in Endoscopic Sleeve Gastroplasty. Obes Surg 2021; 31:2962-2978. [PMID: 33774775 DOI: 10.1007/s11695-021-05355-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/03/2021] [Accepted: 03/16/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Endoscopic sleeve gastroplasty (ESG) is a novel endoscopic procedure used to treat obesity-related comorbidities. Whilst its use is increasing in clinical practice, there is comparatively little understanding about how it has been evaluated. This study aimed to systematically summarize and appraise the reporting of ESG in the context of guidelines for evaluating innovative surgical devices and procedures. METHODS Systematic searches were used to identify all published studies reporting ESG insertion. Data collected included patient selection, governance arrangements, proceduralist expertise, technique description and outcome reporting. RESULTS Searches identified 2289 abstracts; 37 full-text papers were included (one prospective comparative cohort study, 16 retrospective cohort studies, 17 prospective cohort studies and three case reports). No randomized trials were identified. Eighteen studies were conducted prospectively. The number of patients in the included studies ranged from 1 to 1000. The lower BMI limit ranged from 27 to 35 kg/m2. Research approvals were reported in 26 studies. Two studies reported on the learning curve. All studies reported some aspect of technical implementation, but many variations were noted. Suturing device used and suture pattern were the most commonly reported aspects (32 studies). Follow-up ranged from 1 to 24 months, but was 12 months or less in 28 studies. Forty-eight different outcomes were reported across all studies. CONCLUSION The literature on ESG has demonstrated some progression in reporting and analysis and the next stage of assessment should be a randomized controlled trial to demonstrate efficacy.
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Affiliation(s)
- Andrew C Currie
- Department of Bariatric Surgery, Ashford & St Peter's Hospital NHS Trust, Guildford Street, Chertsey, UK.
| | - Michael A Glaysher
- Department of Upper Gastrointestinal Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Natalie S Blencowe
- NIHR Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Jamie Kelly
- Department of Upper Gastrointestinal Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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13
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The IDEAL Reporting Guidelines: A Delphi Consensus Statement Stage Specific Recommendations for Reporting the Evaluation of Surgical Innovation. Ann Surg 2021; 273:82-85. [PMID: 32649459 DOI: 10.1097/sla.0000000000004180] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The aim of this study was to define reporting standards for IDEAL format studies. BACKGROUND The IDEAL Framework and Recommendations establish an integrated pathway for evaluation of new surgical techniques and complex therapeutic technologies. However guidance on implementation has been incomplete, and incorrect use is commonly seen. We describe the consensus development of reporting guidelines for the IDEAL stages, and plans for their dissemination and evaluation. METHODS Using the EQUATOR Network recommendations, participants with knowledge of IDEAL were surveyed to determine which IDEAL stages needed reporting guidelines. Draft checklists for stages 1, 2a, 2b, and 4 were subsequently developed by 3 researchers (N.B., A.H., P.M.), and revised through a 2-round Delphi consensus process. A final consensus teleconference resolved outstanding disagreements and clarified wording for checklist items. RESULTS Sixty-one participants completed the initial survey, a clear majority indicating that new reporting guidelines were needed for IDEAL Stage 1 (69.5%), Stage 2a (78%), Stage 2b (74.6%), and Stage 4 (66%). A proposed set of checklists was modified by survey participants in 2 online Delphi rounds (n = 54 and n = 47, respectively), resulting in a penultimate checklist for each stage. Fourteen expert working group members finalized the checklist items and successfully resolved any outstanding areas without agreement on a consensus call. CONCLUSIONS Participants familiar with IDEAL called for reporting guidelines for studies in all IDEAL stages except stage 3. The checklists developed have the potential to improve standards of reporting and thereby advance the quality of research on surgery and complex interventions and technologies, but require further evaluation in use.
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Rausa E, Manfredi R, Kelly ME, Bianco F, Aiolfi A, Bonitta G, Lucianetti A, Zappa MA. Magnetic Sphincter Augmentation Placement for Recalcitrant Gastroesophageal Reflux Disease Following Bariatric Procedures: A Systematic Review and Bayesian Meta-Analysis. J Laparoendosc Adv Surg Tech A 2020; 31:1034-1039. [PMID: 33347784 DOI: 10.1089/lap.2020.0763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: This study aims to consolidate all available articles on this topic and evaluate MSA effectiveness in the management of gastroesophageal reflux disease (GERD). Matherials and Methods: We conducted an electronic systematic search using MEDLINE databases (PubMed), EMBASE, and Web of Science. An electronic systematic search of articles comparing preoperative and postoperative health-related quality of life (GERD-HRQL) scores in patients who underwent MSA placement for management of GERD following bariatric surgery was performed. Three retrospective studies totaling 33 patients met the inclusion criteria and were included in this meta-analysis. Results: The pooled mean difference in change from preoperative GERD-HRQL score was 17.5 (95% CrI; -22.88 to -12.20) and it was statistically significant. The between-study variability is 3.621 (95% HPD; 1.39 4.99) with low heterogeneity (I2 = 15%; 95% HPD; 2.1 26.2%). Conclusions: MSA for refractory GERD following bariatric surgery appears feasible. Prospective randomized controlled with standardized surgical technique and objective follow-up evaluation is needed to better assess short- and long-term efficacy.
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Affiliation(s)
- Emanuele Rausa
- General Surgery I, Ospedale Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Roberto Manfredi
- General Surgery I, Ospedale Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Michael Eamon Kelly
- Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Federica Bianco
- General Surgery I, Ospedale Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Alberto Aiolfi
- General Surgery, Istituto Clinico Sant'Ambrogio, Milano, Italy
| | - Gianluca Bonitta
- General Surgery I, Ospedale Papa Giovanni XXIII Hospital, Bergamo, Italy
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15
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Abstract
Advanced technology has resulted in major changes in surgery and medicine over the past three decades. There are many barriers to the adoption of advanced technologies, which can be more prevalent in rural hospitals and surgical practices. Despite barriers to implementation of new technologies in rural communities, many rural hospitals have endorsed and invested in these technologies for the benefit of the hospital and community. The rural surgeon is often the driving force in evaluating and deciding on new technologies for their surgical program. This article discusses advantages, challenges, and limitations in the use of advanced technologies in rural locations.
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Bonavina L, Boyle N, Dunn C, Horbach T, Knowles TB, Lipham JC, Louie BE, Markar S, Schppmann SF, Zehetner J. Comment on: Systematic review of the introduction and evaluation of magnetic augmentation of the lower oesophageal sphincter for gastro-oesophageal reflux disease. Br J Surg 2020; 107:e209. [PMID: 32320049 DOI: 10.1002/bjs.11567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 02/03/2020] [Indexed: 01/08/2023]
Affiliation(s)
- L Bonavina
- Deaprtment of Surgery, University of Milan Medical School, Milan, Italy
| | - N Boyle
- London Reflux Centre, Lister Hospital, London, UK
| | - C Dunn
- Division of Upper GI and General Surgery, Department of Surgery, Keck Medical Center of USC, University of Southern California, Los Angeles, California, USA
| | - T Horbach
- General and Abdominal Surgery, Schoen Clinic, Nürnberg Fürth, Germany
| | - T B Knowles
- Swedish Digestive Health Institute, Division of Thoracic Surgery, Swedish Medical Center, Seattle, Washington, USA
| | - J C Lipham
- Division of Upper GI and General Surgery, Department of Surgery, Keck Medical Center of USC, University of Southern California, Los Angeles, California, USA
| | - B E Louie
- London Reflux Centre, Lister Hospital, London, UK
| | - S Markar
- Department of Surgery and Cancer, Imperial College, London, UK
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