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Khan DZ, Newall N, Koh CH, Das A, Aapan S, Layard Horsfall H, Baldeweg SE, Bano S, Borg A, Chari A, Dorward NL, Elserius A, Giannis T, Jain A, Stoyanov D, Marcus HJ. Video-Based Performance Analysis in Pituitary Surgery - Part 2: Artificial Intelligence Assisted Surgical Coaching. World Neurosurg 2024:S1878-8750(24)01370-6. [PMID: 39127380 DOI: 10.1016/j.wneu.2024.07.219] [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: 07/14/2024] [Accepted: 07/31/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND Superior surgical skill improves surgical outcomes in endoscopic pituitary adenoma surgery. Video-based coaching programs, pioneered in professional sports, have shown promise in surgical training. In this study, we developed and assessed a video-based coaching program using artificial intelligence (AI) assistance. METHODS An AI-assisted video-based surgical coaching was implemented over 6 months with the pituitary surgery team. The program consisted of 1) monthly random video analysis and review; and 2) quarterly 2-hour educational meetings discussing these videos and learning points. Each video was annotated for surgical phases and steps using AI, which improved video interactivity and allowed the calculation of quantitative metrics. Primary outcomes were program feasibility, acceptability, and appropriateness. Surgical performance (via modified Objective Structured Assessment of Technical Skills) and early surgical outcomes were recorded for every case during the 6-month coaching period, and a preceding 6-month control period. Beta and logistic regression were used to assess the change in modified Objective Structured Assessment of Technical Skills scores and surgical outcomes after the coaching program implementation. RESULTS All participants highly rated the program's feasibility, acceptability, and appropriateness. During the coaching program, 63 endoscopic pituitary adenoma cases were included, with 41 in the control group. Surgical performance across all operative phases improved during the coaching period (P < 0.001), with a reduction in new postoperative anterior pituitary hormone deficit (P = 0.01). CONCLUSIONS We have developed a novel AI-assisted video surgical coaching program for endoscopic pituitary adenoma surgery - demonstrating its viability and impact on surgical performance. Early results also suggest improvement in patient outcomes. Future studies should be multicenter and longer term.
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Affiliation(s)
- Danyal Z Khan
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK; Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK.
| | - Nicola Newall
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK; Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Chan Hee Koh
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK; Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Adrito Das
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Sanchit Aapan
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK; Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Hugo Layard Horsfall
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK; Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Stephanie E Baldeweg
- Department of Diabetes & Endocrinology, University College London Hospitals NHS Foundation Trust, London, UK; Division of Medicine, Department of Experimental and Translational Medicine, Centre for Obesity and Metabolism, University College London, London, UK
| | - Sophia Bano
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Anouk Borg
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Aswin Chari
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Neil L Dorward
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Anne Elserius
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Theofanis Giannis
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Abhiney Jain
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Danail Stoyanov
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK; Digital Surgery Ltd, Medtronic, London, UK
| | - Hani J Marcus
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK; Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
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Khan DZ, Koh CH, Das A, Valetopolou A, Hanrahan JG, Horsfall HL, Baldeweg SE, Bano S, Borg A, Dorward NL, Olukoya O, Stoyanov D, Marcus HJ. Video-Based Performance Analysis in Pituitary Surgery-Part 1: Surgical Outcomes. World Neurosurg 2024:S1878-8750(24)01363-9. [PMID: 39122112 DOI: 10.1016/j.wneu.2024.07.218] [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: 07/14/2024] [Accepted: 07/31/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND Endoscopic pituitary adenoma surgery has a steep learning curve, with varying surgical techniques and outcomes across centers. In other surgeries, superior performance is linked with superior surgical outcomes. This study aimed to explore the prediction of patient-specific outcomes using surgical video analysis in pituitary surgery. METHODS Endoscopic pituitary adenoma surgery videos from a single center were annotated by experts for operative workflow (3 surgical phases and 15 surgical steps) and operative skill (using modified Objective Structured Assessment of Technical Skills [mOSATS]). Quantitative workflow metrics were calculated, including phase duration and step transitions. Poisson or logistic regression was used to assess the association of workflow metrics and mOSATS with common inpatient surgical outcomes. RESULTS 100 videos from 100 patients were included. Nasal phase mean duration was 24 minutes and mean mOSATS was 21.2/30. Mean duration was 34 minutes and mean mOSATS was 20.9/30 for the sellar phase, and 11 minutes and 21.7/30, respectively, for the closure phase. The most common adverse outcomes were new anterior pituitary hormone deficiency (n = 26), dysnatremia (n = 24), and cerebrospinal fluid leak (n = 5). Higher mOSATS for all 3 phases and shorter operation duration were associated with decreased length of stay (P = 0.003 &P < 0.001). Superior closure phase mOSATS were associated with reduced postoperative cerebrospinal fluid leak (P < 0.001), and superior sellar phase mOSATS were associated with reduced postoperative visual deterioration (P = 0.041). CONCLUSIONS Superior surgical skill and shorter surgical time were associated with superior surgical outcomes, at a generic and phase-specific level. Such video-based analysis has promise for integration into data-driven training and service improvement initiatives.
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Affiliation(s)
- Danyal Z Khan
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK; Wellcome / EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK.
| | - Chan Hee Koh
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK; Wellcome / EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Adrito Das
- Wellcome / EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Alexandra Valetopolou
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK; Wellcome / EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - John G Hanrahan
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK; Wellcome / EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Hugo Layard Horsfall
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK; Wellcome / EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Stephanie E Baldeweg
- Department of Diabetes & Endocrinology, University College London Hospitals NHS Foundation Trust, London, UK; Division of Medicine, Department of Experimental and Translational Medicine, Centre for Obesity and Metabolism, University College London, London, UK
| | - Sophia Bano
- Wellcome / EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Anouk Borg
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Neil L Dorward
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Olatomiwa Olukoya
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Danail Stoyanov
- Wellcome / EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK; Digital Surgery Ltd, Medtronic, London, UK
| | - Hani J Marcus
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK; Wellcome / EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
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Higa J, Nkatha S, Ramirez Herrera R, Marcus H, Yoo S, Blandford A, Opie J. Augmented reality for endoscopic transsphenoidal surgery: evaluating design factors with neurosurgeons. Int J Comput Assist Radiol Surg 2024:10.1007/s11548-024-03225-9. [PMID: 39060888 DOI: 10.1007/s11548-024-03225-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 06/24/2024] [Indexed: 07/28/2024]
Abstract
PURPOSE This study investigates the potential utility of augmented reality (AR) in the endoscopic transsphenoidal approach (TSA). While previous research has addressed technical challenges in AR for TSA, this paper explores how design factors can improve AR for neurosurgeons from a human-centred design perspective. METHODS Preliminary qualitative research involved observations of TSA procedures ( n = 2 ) and semi-structured interviews with neurosurgeons ( n = 4 ). These informed the design of an AR mockup, which was evaluated with neurosurgeons ( n = 3 ). An interactive low-fidelity prototype-the "AR-assisted Navigation for the TransSphenoidal Approach (ANTSA)"-was then developed in Unity 3D. A user study ( n = 4 ) evaluated the low-fidelity prototype of ANTSA through contextual interviews, providing feedback on design factors. RESULTS AR visualisations may be beneficial in streamlining the sellar phase and reducing intraoperative errors such as excessive or inadequate exposure. Key design recommendations include a lean mesh rendering, an intuitive colour palette, and optional structure highlighting. CONCLUSION This research presents user-centred design guidelines to improve sensemaking and surgical workflow in the sellar phase of TSA, with the goal of improving clinical outcomes. The specific improvements that AR could bring to the workflow are discussed along with surgeons' reservations and its possible application towards training less experienced physicians.
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Affiliation(s)
- Jennifer Higa
- UCLIC, University College London, London, WC1E 6BT, UK
| | - Sonia Nkatha
- UCLIC, University College London, London, WC1E 6BT, UK
| | - Roxana Ramirez Herrera
- UCLIC, University College London, London, WC1E 6BT, UK.
- WEISS, University College London, London, W1W 7TY, UK.
| | - Hani Marcus
- WEISS, University College London, London, W1W 7TY, UK
| | - Soojeong Yoo
- UCLIC, University College London, London, WC1E 6BT, UK
- WEISS, University College London, London, W1W 7TY, UK
| | - Ann Blandford
- UCLIC, University College London, London, WC1E 6BT, UK
- WEISS, University College London, London, W1W 7TY, UK
| | - Jeremy Opie
- UCLIC, University College London, London, WC1E 6BT, UK
- WEISS, University College London, London, W1W 7TY, UK
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Baussart B, Hudelist B, Reina V, Villa C, Bertherat J, Assié G, Gaillard S. Diaphragm reconstruction using a TachoSil patch as alternative to intrasellar packing for small focal diaphragm defects in pituitary surgery: a cohort study. Acta Neurochir (Wien) 2024; 166:258. [PMID: 38853198 DOI: 10.1007/s00701-024-06152-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/31/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND During pituitary surgery, CSF leaks are often treated by intrasellar packing, using muscle or fat grafts. However, this strategy may interfere with the interpretation of postoperative MRI and may impact the quality of resection in cases of second surgery, due to the existence of additional fibrous tissue. We present an alternative technique, using a diaphragm reconstruction with a heterologous sponge combining fibrinogen and thrombin (TachoSil), applied in selected patients with low-flow CSF leaks. This study investigates the surgical outcome of patients treated with this strategy. METHODS From a cohort of 2231 patients treated from June 2011 to June 2023 by endoscopic endonasal approach for pituitary surgery, the surgical technique of diaphragm repair with TachoSil patch performed in 55 patients (2.6%) was detailed, and the rate of closure failure was analyzed at 6 months postoperatively. No intrasellar packing was used and sellar floor reconstruction was performed whenever possible. The rate of postoperative CSF leak was compared with that reported in three previous publications that also used the TachoSil patch technique. RESULTS Patients were mostly women (F/M ratio: 1.2) with a median age of 53.6 years. Surgery was indicated for non-functioning adenomas, Cushing's disease, acromegaly, and Rathke's cleft cysts in 38/55 (69.1%), 6/55 (10.9%), 5/55 (9.1%) and 6/55 (10.9%) patients respectively. The rate of postoperative CSF leak was 1.8% (n = 1/55), which was not significantly different from that reported in the three cohorts from the literature (2.8%, p > 0.05). No postoperative meningitis was recorded. CONCLUSIONS In highly selected patients with low-flow CSF leaks related to small focal diaphragm defects, diaphragm reconstruction using a TachoSil patch can be a safe and valuable alternative to intrasellar packing.
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Affiliation(s)
- Bertrand Baussart
- Department of Neurosurgery, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière University Hospital, Assistance Publique Hôpitaux de Paris, 47-83 Boulevard de L'Hôpital, 75013, Paris, France.
- Université Paris Cité, CNRS, INSERM, Institut Cochin, 75014, Paris, France.
| | - Benoit Hudelist
- Department of Neurosurgery, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière University Hospital, Assistance Publique Hôpitaux de Paris, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
| | - Vincent Reina
- Department of Neurosurgery, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière University Hospital, Assistance Publique Hôpitaux de Paris, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
| | - Chiara Villa
- Department of Neuropathology, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière University Hospital, Paris, France
| | - Jérôme Bertherat
- Université Paris Cité, CNRS, INSERM, Institut Cochin, 75014, Paris, France
- Department of Endocrinology, Center for Rare Adrenal Diseases, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Paris, France
| | - Guillaume Assié
- Université Paris Cité, CNRS, INSERM, Institut Cochin, 75014, Paris, France
- Department of Endocrinology, Center for Rare Adrenal Diseases, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Paris, France
| | - Stephan Gaillard
- Department of Neurosurgery, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière University Hospital, Assistance Publique Hôpitaux de Paris, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
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Mao Z, Das A, Islam M, Khan DZ, Williams SC, Hanrahan JG, Borg A, Dorward NL, Clarkson MJ, Stoyanov D, Marcus HJ, Bano S. PitSurgRT: real-time localization of critical anatomical structures in endoscopic pituitary surgery. Int J Comput Assist Radiol Surg 2024; 19:1053-1060. [PMID: 38528306 PMCID: PMC11178578 DOI: 10.1007/s11548-024-03094-2] [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: 01/19/2024] [Accepted: 02/28/2024] [Indexed: 03/27/2024]
Abstract
PURPOSE Endoscopic pituitary surgery entails navigating through the nasal cavity and sphenoid sinus to access the sella using an endoscope. This procedure is intricate due to the proximity of crucial anatomical structures (e.g. carotid arteries and optic nerves) to pituitary tumours, and any unintended damage can lead to severe complications including blindness and death. Intraoperative guidance during this surgery could support improved localization of the critical structures leading to reducing the risk of complications. METHODS A deep learning network PitSurgRT is proposed for real-time localization of critical structures in endoscopic pituitary surgery. The network uses high-resolution net (HRNet) as a backbone with a multi-head for jointly localizing critical anatomical structures while segmenting larger structures simultaneously. Moreover, the trained model is optimized and accelerated by using TensorRT. Finally, the model predictions are shown to neurosurgeons, to test their guidance capabilities. RESULTS Compared with the state-of-the-art method, our model significantly reduces the mean error in landmark detection of the critical structures from 138.76 to 54.40 pixels in a 1280 × 720-pixel image. Furthermore, the semantic segmentation of the most critical structure, sella, is improved by 4.39% IoU. The inference speed of the accelerated model achieves 298 frames per second with floating-point-16 precision. In the study of 15 neurosurgeons, 88.67% of predictions are considered accurate enough for real-time guidance. CONCLUSION The results from the quantitative evaluation, real-time acceleration, and neurosurgeon study demonstrate the proposed method is highly promising in providing real-time intraoperative guidance of the critical anatomical structures in endoscopic pituitary surgery.
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Affiliation(s)
- Zhehua Mao
- Department of Computer Science, University College London, London, UK.
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK.
| | - Adrito Das
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Mobarakol Islam
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Danyal Z Khan
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Simon C Williams
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - John G Hanrahan
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Anouk Borg
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Neil L Dorward
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Matthew J Clarkson
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Danail Stoyanov
- Department of Computer Science, University College London, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Hani J Marcus
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Sophia Bano
- Department of Computer Science, University College London, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
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Garvayo M, Villa C, Jouinot A, Messerer M, Reina V, Hage M, Raffin-Sanson ML, Courtillot C, Bachelot A, Kamenicky P, Chanson P, Vatier C, Christin-Maitre S, Bertherat J, Assié G, Gaillard S, Baussart B. Pituitary surgery outcome in patients 75 years and older: a retrospective study. Acta Neurochir (Wien) 2023; 165:3409-3420. [PMID: 37736839 DOI: 10.1007/s00701-023-05809-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 09/09/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND As the population ages, the number of elderly patients with an indication for pituitary surgery is rising. Information on the outcome of patients aged over 75 is limited. This study reports a large series assessing the feasibility of surgical resection in this specific age range, focusing on surgical complications and postoperative results. METHODS A retrospective cohort study of patients with pituitary adenomas and Rathke's cleft cysts was conducted. All patients were aged 75 years or over and treated by a single expert neurosurgical team. A control population included 2379 younger adult patients operated by the same surgeons during the same period. RESULTS Between 2008 and 2022, 155 patients underwent surgery. Indication was based on vision impairment in most patients (79%). Median follow-up was 13 months (range: 3-96). The first surgery was performed with an endoscopic transsellar approach, an extended endonasal transtuberculum approach and a microscopic transcranial approach in 96%, 3%, and 1% of patients, respectively. Single surgery was sufficient to obtain volume control in 97% of patients. From Kaplan-Meier estimates, 2-year and 5-year disease control with a single surgery were 97.3% and 86.2%, respectively. Resection higher than 80% was achieved in 77% of patients. No vision worsening occurred. In acromegaly and Cushing's disease, endocrine remission was obtained in 90% of non-invasive adenomas. Surgical complications were noted in 5% of patients, with 30-day mortality, hematoma, cerebrospinal fluid leak, meningitis, and epistaxis occurring in 0.6%, 0.6%, 1.9%, 0.6%, and 1.3% respectively. New endocrine anterior deficits occurred in only 5%, while no persistent diabetes insipidus was noted. Compared with younger patients, the complication rate was not statistically different. CONCLUSIONS Surgery beyond the age of 75, mainly relying on an endoscopic endonasal transsellar approach, is effective and safe, provided that patients are managed in tertiary centers.
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Affiliation(s)
- Marta Garvayo
- Department of Neurosurgery, La Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
- Department of Neurosurgery, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Chiara Villa
- Université Paris Cité, CNRS, INSERM, Institut Cochin, 75014, Paris, France
- Department of Neuropathology, La Pitié-Salpêtière University Hospital, AP-HP, Sorbonne University, Paris, France
| | - Anne Jouinot
- Université Paris Cité, CNRS, INSERM, Institut Cochin, 75014, Paris, France
| | - Mahmoud Messerer
- Department of Neurosurgery, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Vincent Reina
- Department of Neurosurgery, La Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
| | - Mirella Hage
- Department of Endocrinology, Assistance Publique-Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne Billancourt, France
- Université de Versailles Saint-Quentin-en-Yvelines UFR Des Sciences de La Santé Simone Veil, Montigny-Le-Bretonneux, France
| | - Marie-Laure Raffin-Sanson
- Department of Endocrinology, Assistance Publique-Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne Billancourt, France
- Université de Versailles Saint-Quentin-en-Yvelines UFR Des Sciences de La Santé Simone Veil, Montigny-Le-Bretonneux, France
| | - Carine Courtillot
- Department of Endocrinology and Reproductive Medicine, Centre de Référence Des Maladies Endocriniennes Rares de La Croissance Et du Développement, CRMERC, Endo-ERN, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France
| | - Anne Bachelot
- Department of Endocrinology and Reproductive Medicine, Centre de Référence Des Maladies Endocriniennes Rares de La Croissance Et du Développement, CRMERC, Endo-ERN, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France
| | - Peter Kamenicky
- Université Paris-Saclay, Inserm, Physiologie Et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d'Endocrinologie Et Des Maladies de La Reproduction, Centre de Référence des Maladies Rares de L'Hypophyse, Le Kremlin-Bicêtre, France
| | - Philippe Chanson
- Université Paris-Saclay, Inserm, Physiologie Et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d'Endocrinologie Et Des Maladies de La Reproduction, Centre de Référence des Maladies Rares de L'Hypophyse, Le Kremlin-Bicêtre, France
| | - Camille Vatier
- Sorbonne University, Endocrine Unit, Reproductive Medicine, Centre de Référence Des Maladies Endocriniennes Rares de La Croissance Et du Développement (CRMERC), Endo-ERN (Id 739527), Saint-Antoine Hospital, AP-HP, Paris, France
- Inserm UMRS938, Saint-Antoine Research Center, Sorbonne University, 75012, Paris, France
| | - Sophie Christin-Maitre
- Sorbonne University, Endocrine Unit, Reproductive Medicine, Centre de Référence Des Maladies Endocriniennes Rares de La Croissance Et du Développement (CRMERC), Endo-ERN (Id 739527), Saint-Antoine Hospital, AP-HP, Paris, France
- INSERM UMR-833, Trousseau Hospital, Paris, France
| | - Jérôme Bertherat
- Université Paris Cité, CNRS, INSERM, Institut Cochin, 75014, Paris, France
- Department of Endocrinology, Center of Rare Adrenal Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Guillaume Assié
- Université Paris Cité, CNRS, INSERM, Institut Cochin, 75014, Paris, France
- Department of Endocrinology, Center of Rare Adrenal Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Stephan Gaillard
- Department of Neurosurgery, La Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
| | - Bertrand Baussart
- Department of Neurosurgery, La Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, 47-83 Boulevard de L'Hôpital, 75013, Paris, France.
- Université Paris Cité, CNRS, INSERM, Institut Cochin, 75014, Paris, France.
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Gillani M, Rupji M, Devin C, Purvis L, Olson TP, Jarc A, Shields M, Liu Y, Rosen S. Quantification of Surgical Workflow during Robotic Proctectomy. RESEARCH SQUARE 2023:rs.3.rs-3462719. [PMID: 37886442 PMCID: PMC10602135 DOI: 10.21203/rs.3.rs-3462719/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Aim Assessments of surgical workflow offer insight regarding procedure variability, case complexity and surgeon proficiency. We utilize an objective method to evaluate step-by-step workflow and step transitions during robotic proctectomy (RP). Methods We annotated 31 RPs using a procedure-specific annotation card. Using Spearman's correlation, we measured strength of association of step time and step visit frequency with console time (CT) and total operative time (TOT). Results Across 31 RPs, a mean (± standard deviation) of 49.0 (± 20.3) steps occurred per procedure. Mean CT and TOT were 213 (± 90) and 283 (± 108) minutes. Posterior mesorectal dissection required most visits (8.7 ± 5.0), while anastomosis required most time (18.0 [± 8.5] minutes). Inferior mesenteric vein (IMV) ligation required least visits (1.0 ± 0.0) and lowest duration (0.9 [± 0.5] minutes). Strong correlations were seen with CT and step times for IMV dissection and ligation (ρ = 0.60 for both), lateral-to-medial splenic flexure mobilization (SFM) (ρ = 0.63), left rectal dissection (ρ = 0.64) and mesorectal division (ρ = 0.71). CT correlated strongly with medial-to-lateral and supracolic SFM visit frequency (ρ = 0.75 and ρ = 0.65). There were strong correlations with TOT and initial exposure time (ρ = 0.60), as well as visit frequency for medial-to-lateral (ρ = 0.67) and supracolic SFM (ρ = 0.65). Descending colon mobilization was nodal, rectal mobilization convergent and rectal transection divergent. Conclusion This study correlates individual surgical steps with CT and TOT through standardized annotation. It provides an objective approach to quantify workflow.
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Horsfall HL, Khan DZ, Collins J, Cooke S, Freeman SR, Gurusinghe N, Hampton S, Hardwidge C, Irving R, Kitchen N, King A, Khalil S, Koh CH, Leonard C, Marcus HJ, Muirhead W, Obholzer R, Pathmanaban O, Robertson IJA, Shapey J, Stoyanov D, Teo M, Tysome JR, Grover P, Saeed SR. Generating Operative Workflows for Vestibular Schwannoma Resection: A Two-Stage Delphi's Consensus in Collaboration with the British Skull Base Society. Part 2: The Translabyrinthine Approach. J Neurol Surg B Skull Base 2023; 84:433-443. [PMID: 37671296 PMCID: PMC10477015 DOI: 10.1055/s-0042-1755578] [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: 03/03/2022] [Accepted: 06/20/2022] [Indexed: 10/17/2022] Open
Abstract
Objective An operative workflow systematically compartmentalizes operations into hierarchal components of phases, steps, instrument, technique errors, and event errors. Operative workflow provides a foundation for education, training, and understanding of surgical variation. In this Part 2, we present a codified operative workflow for the translabyrinthine approach to vestibular schwannoma resection. Methods A mixed-method consensus process of literature review, small-group Delphi's consensus, followed by a national Delphi's consensus was performed in collaboration with British Skull Base Society (BSBS). Each Delphi's round was repeated until data saturation and over 90% consensus was reached. Results Seventeen consultant skull base surgeons (nine neurosurgeons and eight ENT [ear, nose, and throat]) with median of 13.9 years of experience (interquartile range: 18.1 years) of independent practice participated. There was a 100% response rate across both the Delphi rounds. The translabyrinthine approach had the following five phases and 57 unique steps: Phase 1, approach and exposure; Phase 2, mastoidectomy; Phase 3, internal auditory canal and dural opening; Phase 4, tumor debulking and excision; and Phase 5, closure. Conclusion We present Part 2 of a national, multicenter, consensus-derived, codified operative workflow for the translabyrinthine approach to vestibular schwannomas. The five phases contain the operative, steps, instruments, technique errors, and event errors. The codified translabyrinthine approach presented in this manuscript can serve as foundational research for future work, such as the application of artificial intelligence to vestibular schwannoma resection and comparative surgical research.
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Affiliation(s)
- Hugo Layard Horsfall
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
| | - Danyal Z. Khan
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
| | - Justin Collins
- Department of Urooncology, University College London Hospitals National Health Service Foundation Trust, London, United Kingdom
| | - Stephen Cooke
- Department of Neurosurgery, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Simon R. Freeman
- Department of Otolaryngology, Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Salford, United Kingdom
| | - Nihal Gurusinghe
- Department of Neurosurgery, Lancashire Teaching Hospital, Preston, United Kingdom
| | - Susie Hampton
- Department of Ear, Nose and Throat, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Carl Hardwidge
- Department of Neurosurgery, University Hospital Sussex, Brighton, United Kingdom
| | - Richard Irving
- Ear, Nose and Throat, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Neil Kitchen
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Andrew King
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Northern Care Alliance National Health Service Group, University of Manchester, Manchester, United Kingdom
| | - Sherif Khalil
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
- The Royal National Throat, Nose and Ear Hospital, London, United Kingdom
| | - Chan H. Koh
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
| | - Colin Leonard
- Department of Ear, Nose and Throat, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Hani J. Marcus
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
| | - William Muirhead
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
| | - Rupert Obholzer
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
- The Royal National Throat, Nose and Ear Hospital, London, United Kingdom
| | - Omar Pathmanaban
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Salford, United Kingdom
| | - Iain J. A. Robertson
- Department of Neurosurgery, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Jonathan Shapey
- Department of Neurosurgery, Kings College Hospital, London, United Kingdom
| | - Danail Stoyanov
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
| | - Mario Teo
- Bristol Institute of Clinical Neuroscience, Southmead Hospital, Bristol, United Kingdom
| | - James R. Tysome
- Department of Ear, Nose and Throat, Cambridge University Hospitals, Cambridge, United Kingdom
| | - Patrick Grover
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Shakeel R. Saeed
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
- The Royal National Throat, Nose and Ear Hospital, London, United Kingdom
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Wahba AJ, Cromwell DA, Hutchinson PJ, Mathew RK, Phillips N. Assessing national patterns and outcomes of pituitary surgery: is hospital administrative data good enough? Br J Neurosurg 2023; 37:1135-1142. [PMID: 36727284 DOI: 10.1080/02688697.2023.2170982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 01/03/2023] [Indexed: 02/03/2023]
Abstract
PURPOSE Patterns of surgical care, outcomes, and quality of care can be assessed using hospital administrative databases but this requires accurate and complete data. The aim of this study was to explore whether the quality of hospital administrative data was sufficient to assess pituitary surgery practice in England. METHODS The study analysed Hospital Episode Statistics (HES) data from April 2013 to March 2018 on all adult patients undergoing pituitary surgery in England. A series of data quality indicators examined the attribution of cases to consultants, the coding of sellar and parasellar lesions, associated endocrine and visual disorders, and surgical procedures. Differences in data quality over time and between neurosurgical units were examined. RESULTS A total of 5613 records describing pituitary procedures were identified. Overall, 97.3% had a diagnostic code for the tumour or lesion treated, with 29.7% (n = 1669) and 17.8% (n = 1000) describing endocrine and visual disorders, respectively. There was a significant reduction from the first to the fifth year in records that only contained a pituitary tumour code (63.7%-47.0%, p < .001). The use of procedure codes that attracted the highest tariff increased over time (66.4%-82.4%, p < .001). Patterns of coding varied widely between the 24 neurosurgical units. CONCLUSION The quality of HES data on pituitary surgery has improved over time but there is wide variation in the quality of data between neurosurgical units. Research studies and quality improvement programmes using these data need to check it is of sufficient quality to not invalidate their results.
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Affiliation(s)
- Adam J Wahba
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
- Leeds Institute of Medical Research, School of Medicine, University of Leeds, Leeds, UK
| | - David A Cromwell
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Peter J Hutchinson
- Division of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Department of Research, Royal College of Surgeons of England, London, UK
| | - Ryan K Mathew
- Leeds Institute of Medical Research, School of Medicine, University of Leeds, Leeds, UK
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Nick Phillips
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Layard Horsfall H, Khan DZ, Collins J, Cooke S, Freeman SR, Gurusinghe N, Hampton S, Hardwidge C, Irving R, Kitchen N, King A, Khalil S, Koh CH, Leonard C, Marcus HJ, Muirhead W, Obholzer R, Pathmanaban O, Robertson IJA, Shapey J, Stoyanov D, Teo M, Tysome JR, Saeed SR, Grover P. Generating Operative Workflows for Vestibular Schwannoma Resection: A Two-Stage Delphi's Consensus in Collaboration with the British Skull Base Society. Part 1: The Retrosigmoid Approach. J Neurol Surg B Skull Base 2023; 84:423-432. [PMID: 37671298 PMCID: PMC10477012 DOI: 10.1055/a-1886-5500] [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: 03/03/2022] [Accepted: 06/20/2022] [Indexed: 10/17/2022] Open
Abstract
Objective An operative workflow systematically compartmentalizes operations into hierarchal components of phases, steps, instrument, technique errors, and event errors. Operative workflow provides a foundation for education, training, and understanding of surgical variation. In this Part 1, we present a codified operative workflow for the retrosigmoid approach to vestibular schwannoma resection. Methods A mixed-method consensus process of literature review, small-group Delphi's consensus, followed by a national Delphi's consensus, was performed in collaboration with British Skull Base Society (BSBS). Each Delphi's round was repeated until data saturation and over 90% consensus was reached. Results Eighteen consultant skull base surgeons (10 neurosurgeons and 8 ENT [ear, nose, and throat]) with median 17.9 years of experience (interquartile range: 17.5 years) of independent practice participated. There was a 100% response rate across both Delphi's rounds. The operative workflow for the retrosigmoid approach contained three phases and 40 unique steps as follows: phase 1, approach and exposure; phase 2, tumor debulking and excision; phase 3, closure. For the retrosigmoid approach, technique, and event error for each operative step was also described. Conclusion We present Part 1 of a national, multicenter, consensus-derived, codified operative workflow for the retrosigmoid approach to vestibular schwannomas that encompasses phases, steps, instruments, technique errors, and event errors. The codified retrosigmoid approach presented in this manuscript can serve as foundational research for future work, such as operative workflow analysis or neurosurgical simulation and education.
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Affiliation(s)
- Hugo Layard Horsfall
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
| | - Danyal Z. Khan
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
| | - Justin Collins
- Department of Urooncology, University College London Hospitals National Health Service Foundation Trust, London, United Kingdom
| | - Stephen Cooke
- Department of Neurosurgery, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Simon R. Freeman
- Department of Otolaryngology, Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Salford, United Kingdom
| | - Nihal Gurusinghe
- Department of Neurosurgery, Lancashire Teaching Hospital, Preston, United Kingdom
| | - Susie Hampton
- Department of Ear, Nose and Throat, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Carl Hardwidge
- Department of Neurosurgery, University Hospital Sussex, Brighton, United Kingdom
| | - Richard Irving
- Department of Ear, Nose and Throat, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Neil Kitchen
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Andrew King
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Northern Care Alliance National Health Service Group, University of Manchester, Manchester, United Kingdom
| | - Sherif Khalil
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
- The Royal National Throat, Nose and Ear Hospital, London, United Kingdom
| | - Chan H. Koh
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
| | - Colin Leonard
- Department of Ear, Nose and Throat, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Hani J. Marcus
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
| | - William Muirhead
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
| | - Rupert Obholzer
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
- The Royal National Throat, Nose and Ear Hospital, London, United Kingdom
| | - Omar Pathmanaban
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Salford, United Kingdom
| | - Iain J. A. Robertson
- Department of Neurosurgery, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Jonathan Shapey
- Department of Neurosurgery, Kings College Hospital, London, United Kingdom
| | - Danail Stoyanov
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
| | - Mario Teo
- Bristol Institute of Clinical Neuroscience, Southmead Hospital, Bristol, United Kingdom
| | - James R. Tysome
- Department of Ear, Nose and Throat, Cambridge University Hospitals, Cambridge, United Kingdom
| | - Shakeel R. Saeed
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
- The Royal National Throat, Nose and Ear Hospital, London, United Kingdom
| | - Patrick Grover
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
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Khan DZ, Hanrahan JG, Baldeweg SE, Dorward NL, Stoyanov D, Marcus HJ. Current and Future Advances in Surgical Therapy for Pituitary Adenoma. Endocr Rev 2023; 44:947-959. [PMID: 37207359 PMCID: PMC10502574 DOI: 10.1210/endrev/bnad014] [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: 09/30/2022] [Revised: 03/14/2023] [Accepted: 05/17/2023] [Indexed: 05/21/2023]
Abstract
The vital physiological role of the pituitary gland, alongside its proximity to critical neurovascular structures, means that pituitary adenomas can cause significant morbidity or mortality. While enormous advancements have been made in the surgical care of pituitary adenomas, numerous challenges remain, such as treatment failure and recurrence. To meet these clinical challenges, there has been an enormous expansion of novel medical technologies (eg, endoscopy, advanced imaging, artificial intelligence). These innovations have the potential to benefit each step of the patient's journey, and ultimately, drive improved outcomes. Earlier and more accurate diagnosis addresses this in part. Analysis of novel patient data sets, such as automated facial analysis or natural language processing of medical records holds potential in achieving an earlier diagnosis. After diagnosis, treatment decision-making and planning will benefit from radiomics and multimodal machine learning models. Surgical safety and effectiveness will be transformed by smart simulation methods for trainees. Next-generation imaging techniques and augmented reality will enhance surgical planning and intraoperative navigation. Similarly, surgical abilities will be augmented by the future operative armamentarium, including advanced optical devices, smart instruments, and surgical robotics. Intraoperative support to surgical team members will benefit from a data science approach, utilizing machine learning analysis of operative videos to improve patient safety and orientate team members to a common workflow. Postoperatively, neural networks leveraging multimodal datasets will allow early detection of individuals at risk of complications and assist in the prediction of treatment failure, thus supporting patient-specific discharge and monitoring protocols. While these advancements in pituitary surgery hold promise to enhance the quality of care, clinicians must be the gatekeepers of the translation of such technologies, ensuring systematic assessment of risk and benefit prior to clinical implementation. In doing so, the synergy between these innovations can be leveraged to drive improved outcomes for patients of the future.
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Affiliation(s)
- Danyal Z Khan
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London W1W 7TY, UK
| | - John G Hanrahan
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London W1W 7TY, UK
| | - Stephanie E Baldeweg
- Department of Diabetes & Endocrinology, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK
- Centre for Obesity and Metabolism, Department of Experimental and Translational Medicine, Division of Medicine, University College London, London WC1E 6BT, UK
| | - Neil L Dorward
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
| | - Danail Stoyanov
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London W1W 7TY, UK
- Digital Surgery Ltd, Medtronic, London WD18 8WW, UK
| | - Hani J Marcus
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London W1W 7TY, UK
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Fischer E, Jawed KJ, Cleary K, Balu A, Donoho A, Thompson Gestrich W, Donoho DA. A methodology for the annotation of surgical videos for supervised machine learning applications. Int J Comput Assist Radiol Surg 2023; 18:1673-1678. [PMID: 37245179 DOI: 10.1007/s11548-023-02923-0] [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: 01/12/2023] [Accepted: 04/14/2023] [Indexed: 05/29/2023]
Abstract
PURPOSE Surgical data science is an emerging field focused on quantitative analysis of pre-, intra-, and postoperative patient data (Maier-Hein et al. in Med Image Anal 76: 102306, 2022). Data science approaches can decompose complex procedures, train surgical novices, assess outcomes of actions, and create predictive models of surgical outcomes (Marcus et al. in Pituitary 24: 839-853, 2021; Røadsch et al. in Nat Mach Intell, 2022). Surgical videos contain powerful signals of events that may impact patient outcomes. A necessary step before the deployment of supervised machine learning methods is the development of labels for objects and anatomy. We describe a complete method for annotating videos of transsphenoidal surgery. METHODS Endoscopic video recordings of transsphenoidal pituitary tumor removal surgeries were collected from a multicenter research collaborative. These videos were anonymized and stored in a cloud-based platform. Videos were uploaded to an online annotation platform. Annotation framework was developed based on a literature review and surgical observations to ensure proper understanding of the tools, anatomy, and steps present. A user guide was developed to trained annotators to ensure standardization. RESULTS A fully annotated video of a transsphenoidal pituitary tumor removal surgery was produced. This annotated video included over 129,826 frames. To prevent any missing annotations, all frames were later reviewed by highly experienced annotators and a surgeon reviewer. Iterations to annotated videos allowed for the creation of an annotated video complete with labeled surgical tools, anatomy, and phases. In addition, a user guide was developed for the training of novice annotators, which provides information about the annotation software to ensure the production of standardized annotations. CONCLUSIONS A standardized and reproducible workflow for managing surgical video data is a necessary prerequisite to surgical data science applications. We developed a standard methodology for annotating surgical videos that may facilitate the quantitative analysis of videos using machine learning applications. Future work will demonstrate the clinical relevance and impact of this workflow by developing process modeling and outcome predictors.
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Affiliation(s)
- Elizabeth Fischer
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC, USA.
| | - Kochai Jan Jawed
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC, USA
| | - Kevin Cleary
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC, USA
| | - Alan Balu
- Division of Neurosurgery, Center for Neuroscience and Behavioral Medicine, Children's National Hospital, Washington, DC, USA
- Georgetown University School of Medicine, Washington, DC, USA
| | | | | | - Daniel A Donoho
- Georgetown University School of Medicine, Washington, DC, USA
- Department of Neurosurgery and Pediatrics, School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
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Nyangoh Timoh K, Huaulme A, Cleary K, Zaheer MA, Lavoué V, Donoho D, Jannin P. A systematic review of annotation for surgical process model analysis in minimally invasive surgery based on video. Surg Endosc 2023:10.1007/s00464-023-10041-w. [PMID: 37157035 DOI: 10.1007/s00464-023-10041-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 03/25/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Annotated data are foundational to applications of supervised machine learning. However, there seems to be a lack of common language used in the field of surgical data science. The aim of this study is to review the process of annotation and semantics used in the creation of SPM for minimally invasive surgery videos. METHODS For this systematic review, we reviewed articles indexed in the MEDLINE database from January 2000 until March 2022. We selected articles using surgical video annotations to describe a surgical process model in the field of minimally invasive surgery. We excluded studies focusing on instrument detection or recognition of anatomical areas only. The risk of bias was evaluated with the Newcastle Ottawa Quality assessment tool. Data from the studies were visually presented in table using the SPIDER tool. RESULTS Of the 2806 articles identified, 34 were selected for review. Twenty-two were in the field of digestive surgery, six in ophthalmologic surgery only, one in neurosurgery, three in gynecologic surgery, and two in mixed fields. Thirty-one studies (88.2%) were dedicated to phase, step, or action recognition and mainly relied on a very simple formalization (29, 85.2%). Clinical information in the datasets was lacking for studies using available public datasets. The process of annotation for surgical process model was lacking and poorly described, and description of the surgical procedures was highly variable between studies. CONCLUSION Surgical video annotation lacks a rigorous and reproducible framework. This leads to difficulties in sharing videos between institutions and hospitals because of the different languages used. There is a need to develop and use common ontology to improve libraries of annotated surgical videos.
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Affiliation(s)
- Krystel Nyangoh Timoh
- Department of Gynecology and Obstetrics and Human Reproduction, CHU Rennes, Rennes, France.
- INSERM, LTSI - UMR 1099, University Rennes 1, Rennes, France.
- Laboratoire d'Anatomie et d'Organogenèse, Faculté de Médecine, Centre Hospitalier Universitaire de Rennes, 2 Avenue du Professeur Léon Bernard, 35043, Rennes Cedex, France.
- Department of Obstetrics and Gynecology, Rennes Hospital, Rennes, France.
| | - Arnaud Huaulme
- INSERM, LTSI - UMR 1099, University Rennes 1, Rennes, France
| | - Kevin Cleary
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC, 20010, USA
| | - Myra A Zaheer
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Vincent Lavoué
- Department of Gynecology and Obstetrics and Human Reproduction, CHU Rennes, Rennes, France
| | - Dan Donoho
- Division of Neurosurgery, Center for Neuroscience, Children's National Hospital, Washington, DC, 20010, USA
| | - Pierre Jannin
- INSERM, LTSI - UMR 1099, University Rennes 1, Rennes, France
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Balogun JA, Daniel A, Idowu OK. Navigating the learning curve with large and giant tumors: Initial experience with endoscopic endonasal transphenoidal resection of PitNETs. J Clin Neurosci 2023; 112:6-11. [PMID: 37023497 DOI: 10.1016/j.jocn.2023.04.001] [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: 03/15/2023] [Revised: 03/21/2023] [Accepted: 04/01/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND The endoscopic endonasal approach (EEA) has progressively become the preferred choice of surgical intervention for PitNETs. However, the adoption in Sub-Saharan Africa has been low. We report our initial experience with the utility of the EEA in PitNETs particularly in large and giant tumors despite limited resources. METHODS The study was over a 73-month period at the University College Hospital, Ibadan, Nigeria. Pre and post-operative clinical, imaging and neuro-ophthalmological findings were documented. Perioperative and postoperative outcomes were recorded. We compared the outcomes between the early 23 and later 22 patients. Data were analyzed using descriptive statistics, student's t test, Mann-Whitney U test and Chi square test at α = 0.05. RESULTS There were 45 patients; 25(55.6%) were males. Mean age was 49.9 ± 13.4 years. Visual symptoms predominated with 12(26%) blind in at least one eye. Median tumor volume was 20.9 cm3 and mean tumor diameter was 4.09 ± 0.89 cm. 31(68.9%) had gross or near total excision. Vision improved in 31(68.9%). There were 2 procedure related mortality from CSF leak/meningitis. The mean of the tumor diameter of the earlier patients was less than that of the latter (3.84 vs 4.40 cm, p = 0.04,). The latter group also had more gross or near total resections (26.8% versus 41.5%) but this was not statistically significant. There was no difference in postoperative complications. CONCLUSIONS EEA remains a veritable option for PitNETs, including for large and huge tumors, even within resource challenged environments, with acceptable limits of complications.
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Affiliation(s)
- James Ayokunle Balogun
- Division of Neurosurgery, Department of Surgery, College of Medicine, University of Ibadan, Nigeria; Department of Neurosurgery, University College Hospital, Ibadan, Nigeria.
| | - Adekunle Daniel
- Department of Otorhinolaryngology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Olusola Kayode Idowu
- Department of Anaesthesia, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Machine learning driven prediction of cerebrospinal fluid rhinorrhoea following endonasal skull base surgery: A multicentre prospective observational study. Front Oncol 2023; 13:1046519. [PMID: 37035179 PMCID: PMC10076706 DOI: 10.3389/fonc.2023.1046519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 01/27/2023] [Indexed: 04/11/2023] Open
Abstract
Background Cerebrospinal fluid rhinorrhoea (CSFR) is a common complication following endonasal skull base surgery, a technique that is fundamental to the treatment of pituitary adenomas and many other skull base tumours. The CRANIAL study explored CSFR incidence and related risk factors, particularly skull base repair techniques, via a multicentre prospective observational study. We sought to use machine learning to leverage this complex multicentre dataset for CSFR prediction and risk factor analysis. Methods A dataset of 865 cases - 725 transsphenoidal approach (TSA) and 140 expanded endonasal approach (EEA) - with cerebrospinal fluid rhinorrhoea as the primary outcome, was used. Relevant variables were extracted from the data, and prediction variables were divided into two categories, preoperative risk factors; and repair techniques, with 6 and 11 variables respectively. Three types of machine learning models were developed in order to predict CSFR: logistic regression (LR); decision tree (DT); and neural network (NN). Models were validated using 5-fold cross-validation, compared via their area under the curve (AUC) evaluation metric, and key prediction variables were identified using their Shapley additive explanations (SHAP) score. Results CSFR rates were 3.9% (28/725) for the transsphenoidal approach and 7.1% (10/140) for the expanded endonasal approach. NNs outperformed LR and DT for CSFR prediction, with a mean AUC of 0.80 (0.70-0.90) for TSA and 0.78 (0.60-0.96) for EEA, when all risk factor and intraoperative repair data were integrated into the model. The presence of intraoperative CSF leak was the most prominent risk factor for CSFR. Elevated BMI and revision surgery were also associated with CSFR for the transsphenoidal approach. CSF diversion and gasket sealing appear to be strong predictors of the absence of CSFR for both approaches. Conclusion Neural networks are effective at predicting CSFR and uncovering key CSFR predictors in patients following endonasal skull base surgery, outperforming traditional statistical methods. These models will be improved further with larger and more granular datasets, improved NN architecture, and external validation. In the future, such predictive models could be used to assist surgical decision-making and support more individualised patient counselling.
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Layard Horsfall H, Lawrence A, Venkatesh A, Loh RTS, Jayapalan R, Koulouri O, Sharma R, Santarius T, Gurnell M, Dorward N, Mannion R, Marcus HJ, Kolias AG. Reported outcomes in transsphenoidal surgery for pituitary adenomas: a systematic review. Pituitary 2023:10.1007/s11102-023-01303-w. [PMID: 36862265 DOI: 10.1007/s11102-023-01303-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/16/2023] [Indexed: 03/03/2023]
Abstract
PURPOSE Transsphenoidal surgery is an established treatment for pituitary adenomas. We examined outcomes and time points following transsphenoidal surgery for pituitary adenoma to identify reporting heterogeneity within the literature. METHODS A systematic review of studies that reported outcomes for transsphenoidal surgery for pituitary adenoma 1990-2021 were examined. The protocol was registered a priori and adhered to the PRISMA statement. Studies in English with > 10 patients (prospective) or > 500 patients (retrospective) were included. RESULTS 178 studies comprising 427,659 patients were included. 91 studies reported 2 or more adenoma pathologies within the same study; 53 studies reported a single pathology. The most common adenomas reported were growth hormone-secreting (n = 106), non-functioning (n = 101), and ACTH-secreting (n = 95); 27 studies did not state a pathology. Surgical complications were the most reported outcome (n = 116, 65%). Other domains included endocrine (n = 104, 58%), extent of resection (n = 81, 46%), ophthalmic (n = 66, 37%), recurrence (n = 49, 28%), quality of life (n = 25, 19%); and nasal (n = 18, 10%). Defined follow up time points were most reported for endocrine (n = 56, 31%), extent of resection (n = 39, 22%), and recurrence (n = 28, 17%). There was heterogeneity in the follow up reported for all outcomes at different time points: discharge (n = 9), < 30 days (n = 23), < 6 months (n = 64), < 1 year (n = 23), and > 1 year (n = 69). CONCLUSION Outcomes and follow up reported for transsphenoidal surgical resection of pituitary adenoma are heterogenous over the last 30 years. This study highlights the necessity to develop a robust, consensus-based, minimum, core outcome set. The next step is to develop a Delphi survey of essential outcomes, followed by a consensus meeting of interdisciplinary experts. Patient representatives should also be included. An agreed core outcome set will enable homogeneous reporting and meaningful research synthesis, ultimately improving patient care.
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Affiliation(s)
- Hugo Layard Horsfall
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
- Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London, W1CN 3BG, UK.
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK.
| | | | - Ashwin Venkatesh
- Clinical School of Medicine, University of Cambridge, Cambridge, UK
| | - Ryan T S Loh
- Clinical School of Medicine, University of Cambridge, Cambridge, UK
| | - Ronie Jayapalan
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Olympia Koulouri
- Metabolic Research Laboratories, Institute of Metabolic Science and Department of Medicine, University of Cambridge and Addenbrooke's Hospital, Cambridge, UK
| | - Rishi Sharma
- Department of Otolaryngology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Thomas Santarius
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Mark Gurnell
- Metabolic Research Laboratories, Institute of Metabolic Science and Department of Medicine, University of Cambridge and Addenbrooke's Hospital, Cambridge, UK
| | - Neil Dorward
- Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London, W1CN 3BG, UK
| | - Richard Mannion
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Hani J Marcus
- Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London, W1CN 3BG, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Angelos G Kolias
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
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17
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Layard Horsfall H, Salvadores Fernandez C, Bagchi B, Datta P, Gupta P, Koh CH, Khan D, Muirhead W, Desjardins A, Tiwari MK, Marcus HJ. A Sensorised Surgical Glove to Analyze Forces During Neurosurgery. Neurosurgery 2023; 92:639-646. [PMID: 36729776 PMCID: PMC10508368 DOI: 10.1227/neu.0000000000002239] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/15/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Measuring intraoperative forces in real time can provide feedback mechanisms to improve patient safety and surgical training. Previous force monitoring has been achieved through the development of specialized and adapted instruments or use designs that are incompatible with neurosurgical workflow. OBJECTIVE To design a universal sensorised surgical glove to detect intraoperative forces, applicable to any surgical procedure, and any surgical instrument in either hand. METHODS We created a sensorised surgical glove that was calibrated across 0 to 10 N. A laboratory experiment demonstrated that the sensorised glove was able to determine instrument-tissue forces. Six expert and 6 novice neurosurgeons completed a validated grape dissection task 20 times consecutively wearing the sensorised glove. The primary outcome was median and maximum force (N). RESULTS The sensorised glove was able to determine instrument-tissue forces reliably. The average force applied by experts (2.14 N) was significantly lower than the average force exerted by novices (7.15 N) ( P = .002). The maximum force applied by experts (6.32 N) was also significantly lower than the maximum force exerted by novices (9.80 N) ( P = .004). The sensorised surgical glove's introduction to operative workflow was feasible and did not impede on task performance. CONCLUSION We demonstrate a novel and scalable technique to detect forces during neurosurgery. Force analysis can provide real-time data to optimize intraoperative tissue forces, reduce the risk of tissue injury, and provide objective metrics for training and assessment.
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Affiliation(s)
- Hugo Layard Horsfall
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Carmen Salvadores Fernandez
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
- Nanoengineered Systems Laboratory, UCL Mechanical Engineering, London, UK
| | - Biswajoy Bagchi
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
- Nanoengineered Systems Laboratory, UCL Mechanical Engineering, London, UK
| | - Priyankan Datta
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
- Nanoengineered Systems Laboratory, UCL Mechanical Engineering, London, UK
| | - Priya Gupta
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
- Nanoengineered Systems Laboratory, UCL Mechanical Engineering, London, UK
| | - Chan Hee Koh
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Danyal Khan
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - William Muirhead
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Adrien Desjardins
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
- Nanoengineered Systems Laboratory, UCL Mechanical Engineering, London, UK
| | - Manish K. Tiwari
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
- Nanoengineered Systems Laboratory, UCL Mechanical Engineering, London, UK
| | - Hani J. Marcus
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
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18
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CSF rhinorrhoea after endonasal intervention to the skull base (CRANIAL): A multicentre prospective observational study. Front Oncol 2023; 12:1049627. [PMID: 36688936 PMCID: PMC9846732 DOI: 10.3389/fonc.2022.1049627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 10/24/2022] [Indexed: 01/09/2023] Open
Abstract
Objective Despite progress in endonasal skull-base neurosurgery, cerebrospinal fluid (CSF) rhinorrhoea remains common and significant. The CRANIAL study sought to determine 1) the scope of skull-base repair methods used, and 2) corresponding rates of postoperative CSF rhinorrhoea in the endonasal transsphenoidal approach (TSA) and the expanded endonasal approach (EEA) for skull-base tumors. Methods A prospective observational cohort study of 30 centres performing endonasal skull-base neurosurgery in the UK and Ireland (representing 91% of adult units). Patients were identified for 6 months and followed up for 6 months. Data collection and analysis was guided by our published protocol and pilot studies. Descriptive statistics, univariate and multivariable logistic regression models were used for analysis. Results A total of 866 patients were included - 726 TSA (84%) and 140 EEA (16%). There was significant heterogeneity in repair protocols across centres. In TSA cases, nasal packing (519/726, 72%), tissue glues (474/726, 65%) and hemostatic agents (439/726, 61%) were the most common skull base repair techniques. Comparatively, pedicled flaps (90/140, 64%), CSF diversion (38/140, 27%), buttresses (17/140, 12%) and gasket sealing (11/140, 9%) were more commonly used in EEA cases. CSF rhinorrhoea (biochemically confirmed or requiring re-operation) occurred in 3.9% of TSA (28/726) and 7.1% of EEA (10/140) cases. A significant number of patients with CSF rhinorrhoea (15/38, 39%) occurred when no intraoperative CSF leak was reported. On multivariate analysis, there may be marginal benefits with using tissue glues in TSA (OR: 0.2, CI: 0.1-0.7, p<0.01), but no other technique reached significance. There was evidence that certain characteristics make CSF rhinorrhoea more likely - such as previous endonasal surgery and the presence of intraoperative CSF leak. Conclusions There is a wide range of skull base repair techniques used across centres. Overall, CSF rhinorrhoea rates across the UK and Ireland are lower than generally reported in the literature. A large proportion of postoperative leaks occurred in the context of occult intraoperative CSF leaks, and decisions for universal sellar repairs should consider the risks and cost-effectiveness of repair strategies. Future work could include longer-term, higher-volume studies, such as a registry; and high-quality interventional studies.
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Das A, Khan DZ, Hanrahan JG, Marcus HJ, Stoyanov D. Automatic generation of operation notes in endoscopic pituitary surgery videos using workflow recognition. INTELLIGENCE-BASED MEDICINE 2023; 8:100107. [PMID: 38523618 PMCID: PMC10958393 DOI: 10.1016/j.ibmed.2023.100107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/20/2023] [Accepted: 07/27/2023] [Indexed: 03/26/2024]
Abstract
Operation notes are a crucial component of patient care. However, writing them manually is prone to human error, particularly in high pressured clinical environments. Automatic generation of operation notes from video recordings can alleviate some of the administrative burdens, improve accuracy, and provide additional information. To achieve this for endoscopic pituitary surgery, 27-steps were identified via expert consensus. Then, for the 97-videos recorded for this study, a timestamp of each step was annotated by an expert surgeon. To automatically determine whether a step is present in a video, a three-stage architecture was created. Firstly, for each step, a convolution neural network was used for binary image classification on each frame of a video. Secondly, for each step, the binary frame classifications were passed to a discriminator for binary video classification. Thirdly, for each video, the binary video classifications were passed to an accumulator for multi-label step classification. The architecture was trained on 77-videos, and tested on 20-videos, where a 0.80 weighted-F1 score was achieved. The classifications were inputted into a clinically based predefined template, and further enriched with additional video analytics. This work therefore demonstrates automatic generation of operative notes from surgical videos is feasible, and can assist surgeons during documentation.
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Affiliation(s)
- Adrito Das
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, United Kingdom
| | - Danyal Z. Khan
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, United Kingdom
- National Hospital for Neurology and Neurosurgery, University College London, United Kingdom
| | - John G. Hanrahan
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, United Kingdom
- National Hospital for Neurology and Neurosurgery, University College London, United Kingdom
| | - Hani J. Marcus
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, United Kingdom
- National Hospital for Neurology and Neurosurgery, University College London, United Kingdom
| | - Danail Stoyanov
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, United Kingdom
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20
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Proceedings of the 2022 British Neurosurgical Research Group Meeting. Br J Neurosurg 2022. [DOI: 10.1080/02688697.2022.2157943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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21
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Newall N, Khan DZ, Hanrahan JG, Booker J, Borg A, Davids J, Nicolosi F, Sinha S, Dorward N, Marcus H. High fidelity simulation of the endoscopic transsphenoidal approach: Validation of the UpSurgeOn TNS Box. Front Surg 2022; 9:1049685. [PMID: 36561572 PMCID: PMC9764859 DOI: 10.3389/fsurg.2022.1049685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/04/2022] [Indexed: 12/12/2022] Open
Abstract
Objective Endoscopic endonasal transsphenoidal surgery is an established technique for the resection of sellar and suprasellar lesions. The approach is technically challenging and has a steep learning curve. Simulation is a growing training tool, allowing the acquisition of technical skills pre-clinically and potentially resulting in a shorter clinical learning curve. We sought validation of the UpSurgeOn Transsphenoidal (TNS) Box for the endoscopic endonasal transsphenoidal approach to the pituitary fossa. Methods Novice, intermediate and expert neurosurgeons were recruited from multiple centres. Participants were asked to perform a sphenoidotomy using the TNS model. Face and content validity were evaluated using a post-task questionnaire. Construct validity was assessed through post-hoc blinded scoring of operative videos using a Modified Objective Structured Assessment of Technical Skills (mOSAT) and a Task-Specific Technical Skill scoring system. Results Fifteen participants were recruited of which n = 10 (66.6%) were novices and n = 5 (33.3%) were intermediate and expert neurosurgeons. Three intermediate and experts (60%) agreed that the model was realistic. All intermediate and experts (n = 5) strongly agreed or agreed that the TNS model was useful for teaching the endonasal transsphenoidal approach to the pituitary fossa. The consensus-derived mOSAT score was 16/30 (IQR 14-16.75) for novices and 29/30 (IQR 27-29) for intermediate and experts (p < 0.001, Mann-Whitney U). The median Task-Specific Technical Skill score was 10/20 (IQR 8.25-13) for novices and 18/20 (IQR 17.75-19) for intermediate and experts (p < 0.001, Mann-Whitney U). Interrater reliability was 0.949 (CI 0.983-0.853) for OSATS and 0.945 (CI 0.981-0.842) for Task-Specific Technical Skills. Suggested improvements for the model included the addition of neuro-vascular anatomy and arachnoid mater to simulate bleeding vessels and CSF leak, respectively, as well as improvement in materials to reproduce the consistency closer to that of human tissue and bone. Conclusion The TNS Box simulation model has demonstrated face, content, and construct validity as a simulator for the endoscopic endonasal transsphenoidal approach. With the steep learning curve associated with endoscopic approaches, this simulation model has the potential as a valuable training tool in neurosurgery with further improvements including advancing simulation materials, dynamic models (e.g., with blood flow) and synergy with complementary technologies (e.g., artificial intelligence and augmented reality).
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Affiliation(s)
- Nicola Newall
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom,Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, United Kingdom,Correspondence: Nicola Newall
| | - Danyal Z. Khan
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom,Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, United Kingdom
| | - John G. Hanrahan
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom,Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, United Kingdom
| | - James Booker
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom,Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, United Kingdom
| | - Anouk Borg
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Joseph Davids
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Federico Nicolosi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Siddharth Sinha
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom,Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, United Kingdom
| | - Neil Dorward
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Hani J. Marcus
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom,Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, United Kingdom
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22
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Baiano C, Somma T, Franca RA, Di Costanzo M, Scala MR, Cretella P, Esposito F, Cavallo LM, Cappabianca P, Solari D. Evolution in endoscopic endonasal approach for the management of hypothalamic–pituitary region metastasis: A single-institution experience. Front Oncol 2022; 12:975738. [PMID: 35965539 PMCID: PMC9366217 DOI: 10.3389/fonc.2022.975738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionEndonasal endoscopic surgery has changed the treatment perspectives for different lesions of the hypothalamic–pituitary region. The metastases of the hypothalamic–pituitary region represent 0.4% of all intracranial metastatic tumors and account for only 1.8% of surgically managed pituitary lesions. The aim of tshis study is to describe a single-center institutional experience with 13 cases of hypothalamic–pituitary metastasis focused on presurgical workup, the evolution of the surgical technique, and postsurgical management according to our protocols, showing effects on progression-free and overall survival rates for this relatively uncommon location.Material and MethodsWe retrospectively reviewed the whole series of patients that received the endoscopic endonasal approach at the Division of Neurosurgery at the University of Naples “Federico II” undergoing surgery from January 1997 to December 2021. We identified 13 cases whose pathology reports revealed a metastatic lesion. Statistical analysis was performed to determine the Kaplan–Meier survival function and assess for log-rank differences in survival based on gender, surgical treatment, and postoperative therapy (p-value < 0.02*).ResultsThe pathology report disclosed lung adenocarcinoma (six cases, 46%), breast adenocarcinoma (two cases, 15.4%), clear cell renal carcinoma (one case, 7%), melanoma (one case, 7%), colorectal adenocarcinoma (one case, 7%), uterine cervix carcinoma (one case, 7%), and follicular thyroid carcinoma (one case, 7%). A standard endoscopic endonasal approach was performed in 10 patients (76.9%), while an extended endonasal procedure was performed in only three cases (23%). Biopsy was the surgical choice in five patients with infiltrative and invasive lesions and a poor performance status (38%), while in the cases where neurovascular decompression was necessary, a subtotal resection was achieved in five patients (38%) and partial resection in three patients (23%). Recovery of visual field defect was observed in six of seven patients with visual loss (85.7%), improvement of oculomotor nerve palsy occurred in four of seven patients with this defect (57.1%), while the impairment of oculomotor palsy was observed in three patients (42.9%). Visual function was stable in the other patients. The median progression-free survival and overall survival were 14 and 18 months, respectively. There were statistically significant differences in PFS and OS in patients who underwent adjuvant radiotherapy (p=0.019 is referred to OS and p=0.017 to PFS, respectively; p-value = 0.02).ConclusionsThe endoscopic endonasal approach is a viable approach for the management of hypothalamic–pituitary metastases as this surgery provides an adequate opportunity to obtain tissue sample and neurovascular decompression, both being crucial for continuing the integrated adjuvant therapy protocols.
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Affiliation(s)
- Cinzia Baiano
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy
- *Correspondence: Cinzia Baiano,
| | - Teresa Somma
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | - Raduan Ahmed Franca
- Pathology Section, Department of Advanced Biomedical Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | - Marianna Di Costanzo
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | - Maria Rosaria Scala
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | - Pasquale Cretella
- Pathology Section, Department of Advanced Biomedical Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | - Felice Esposito
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | - Luigi Maria Cavallo
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | - Paolo Cappabianca
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | - Domenico Solari
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy
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Cossu G, Turin-Huet V, Garvayo Navarro M, Papadakis G, Daniel RT, Dunet V, Messerer M. Radiological evolution of autograft fat used for skull base reconstruction after transsphenoidal surgery for pituitary adenomas. Pituitary 2022; 25:468-473. [PMID: 35194708 PMCID: PMC9170666 DOI: 10.1007/s11102-022-01210-6] [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] [Accepted: 02/09/2022] [Indexed: 10/26/2022]
Abstract
PURPOSE Cerebro-spinal fluid leak after transsphenoidal surgery for pituitary adenomas may be prevented by skull base reconstruction with fat autograft. However, graft changes may interfere with the interpretation of postoperative images. Our aim is to describe the radiological evolution of the fat autograft. METHODS A retrospective analysis was performed, including patients undergoing a transsphenoidal surgery for pituitary adenomas with a fat autograft for skull base reconstruction. Clinical and radiological data were collected, with assessment of fat autograft and extent of resection. Statistical analysis was performed using Kruskal-Wallis and Wilcoxon signed-rank test while Spearman's Rho was used to analyze the relationship between variables. RESULTS Seventy-two patients were included. Macroadenomas were diagnosed in 62 cases (86.1%) and in 21 cases an invasion of the cavernous sinus was described (29%). Gross total resection was achieved in 84.7% of cases. The volume of the fat graft significantly decreased between 3 months and 1 year after surgery (p = 0.01) and between 1 year and the last follow-up (mean 4.63 years, p < 0.01). Fat signal ratio significantly diminished between 3 months and 1 year in unenhanced and enhanced T1-weighted sequences (p = 0.04 and p = 0.02 respectively). Volume reduction was related to the decrease in signal ratio in unenhanced T1 sequences (p = 0.008). CONCLUSION Fat resorbs with time: almost 50% of the fat volume is lost during the first year after surgery and 60% is resorbed at 4.6 years. T1-signal, before and after gadolinium injection, also decreases during the first year, probably because of the progressive fibrosis of the graft. This information will contribute to the interpretation of postoperative images.
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Affiliation(s)
- Giulia Cossu
- Department of Neurosurgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Victoire Turin-Huet
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Marta Garvayo Navarro
- Department of Neurosurgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Georgios Papadakis
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Department of Endocrinology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Roy Thomas Daniel
- Department of Neurosurgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Vincent Dunet
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Department of Medical Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Mahmoud Messerer
- Department of Neurosurgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.
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24
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Kelly AP, Greenfield JP, Dobri GA, Schwartz TH. Pediatric pituitary adenomas are more aggressive, more likely to be hormone producing and are more difficult to cure than adult pituitary adenomas: case series and systematic literature review. Childs Nerv Syst 2022; 38:729-738. [PMID: 35048170 DOI: 10.1007/s00381-022-05445-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 01/06/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Pediatric pituitary adenomas (pPAs) are uncommon. Thus, their presentation and outcomes after treatment are less well-understood than those of pituitary adenomas in adulthood (aPAs). METHODS A retrospective chart review was conducted for all patients who underwent endoscopic endonasal transsphenoidal surgery (EETS) for pPA at NewYork-Presbyterian Hospital/Weill Cornell Medicine (NYP/WCM) from 2005-2020. Eleven patients were identified, and information pertaining to age, sex, adenoma characteristics, procedural details, and outcomes was reviewed. A systematic review of the literature was also performed to compare outcomes of EETS versus microscopic endonasal transsphenoidal surgery (METS) for pPA. RESULTS From 2005-2020, 11 patients underwent EETS for pPA at NYP/WCM. Mean age at operation was 14.9 ± 2.7 years, and 5 patients (45.5%) were male. 10 adenomas (90.9%) were hormone-producing. Of the functional adenomas, 8 (80.0%) were PRL-secreting and 2 (20.0%) were GH-secreting. Maximum adenoma diameter (MAD) ranged from 1.2-5.1 cm, with a median of 1.55 cm. Cavernous sinus invasion (CSI) occurred in 2 patients with macroprolactinoma. Gross total resection (GTR) was achieved in 10 (90.9%). Biochemical remission occurred in 5/10 (50.0%). Post-operative complications were documented in 8 cases (72.7%) and included diabetes insipidus, hypopituitarism, sinusitis, weight gain, cerebrospinal fluid leak, meningitis, and hydrocephalus. Systematic literature review of 105 microscopic and 175 endoscopic cases revealed high frequency of hormone-producing tumors (83.6%) and similar rates of GTR (82.4% vs 85.1%) and biochemical cure (75.8% vs 64.3%). CONCLUSIONS pPAs are more likely to be hormone producing and may be more aggressive and difficult to cure than aPAs. EETS is an effective treatment, although complication rates may be higher than in adult populations.
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Affiliation(s)
- Alexander P Kelly
- Weill Cornell Medical College, Weill Cornell Medicine, New York, NY, USA
| | - Jeffrey P Greenfield
- Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, NY, USA
| | - Georgiana A Dobri
- Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, NY, USA
| | - Theodore H Schwartz
- Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, NY, USA.
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Das A, Bano S, Vasconcelos F, Khan DZ, Marcus HJ, Stoyanov D. Reducing Prediction volatility in the surgical workflow recognition of endoscopic pituitary surgery. Int J Comput Assist Radiol Surg 2022; 17:1445-1452. [PMID: 35362848 PMCID: PMC9307536 DOI: 10.1007/s11548-022-02599-y] [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] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 03/08/2022] [Indexed: 11/25/2022]
Abstract
Purpose: Workflow recognition can aid surgeons before an operation when used as a training tool, during an operation by increasing operating room efficiency, and after an operation in the completion of operation notes. Although several methods have been applied to this task, they have been tested on few surgical datasets. Therefore, their generalisability is not well tested, particularly for surgical approaches utilising smaller working spaces which are susceptible to occlusion and necessitate frequent withdrawal of the endoscope. This leads to rapidly changing predictions, which reduces the clinical confidence of the methods, and hence limits their suitability for clinical translation. Methods: Firstly, the optimal neural network is found using established methods, using endoscopic pituitary surgery as an exemplar. Then, prediction volatility is formally defined as a new evaluation metric as a proxy for uncertainty, and two temporal smoothing functions are created. The first (modal, \documentclass[12pt]{minimal}
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\begin{document}$$M_n$$\end{document}Mn) mode-averages over the previous n predictions, and the second (threshold, \documentclass[12pt]{minimal}
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\begin{document}$$T_n$$\end{document}Tn) ensures a class is only changed after being continuously predicted for n predictions. Both functions are independently applied to the predictions of the optimal network. Results: The methods are evaluated on a 50-video dataset using fivefold cross-validation, and the optimised evaluation metric is weighted-\documentclass[12pt]{minimal}
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\begin{document}$$F_1$$\end{document}F1 score. The optimal model is ResNet-50+LSTM achieving 0.84 in 3-phase classification and 0.74 in 7-step classification. Applying threshold smoothing further improves these results, achieving 0.86 in 3-phase classification, and 0.75 in 7-step classification, while also drastically reducing the prediction volatility. Conclusion: The results confirm the established methods generalise to endoscopic pituitary surgery, and show simple temporal smoothing not only reduces prediction volatility, but actively improves performance.
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Affiliation(s)
- Adrito Das
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom.
| | - Sophia Bano
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
| | - Francisco Vasconcelos
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
| | - Danyal Z Khan
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Hani J Marcus
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Danail Stoyanov
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
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Chari A. A standardised protocol for neuro-endoscopic lavage for post-haemorrhagic ventricular dilatation: A Delphi consensus approach. Childs Nerv Syst 2022; 38:2181-2187. [PMID: 36207447 PMCID: PMC9617835 DOI: 10.1007/s00381-022-05632-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 07/19/2022] [Indexed: 02/05/2023]
Abstract
Neuro-endoscopic lavage (NEL) has shown promise as an emerging procedure for intraventricular haemorrhage (IVH) and post-haemorrhagic ventricular dilatation (PHVD). However, there is considerable variation with regard to the indications, objectives, and surgical technique in NEL. There is currently no randomised trial evidence that supports the use of NEL in the context of PHVD. This study aims to form a consensus on technical variations in the indications and procedural steps of NEL. A mixed-methods modified Delphi consensus process was conducted between consultant paediatric neurosurgeons across the UK. Stages involved literature review, survey, focused online consultation, and iterative revisions until > 80% consensus was achieved. Twelve consultant paediatric neurosurgeons from 10 centres participated. A standardised protocol including indications, a 3-phase operative workflow (pre-ventricular, intraventricular, post-ventricular), and post-operative care was agreed upon by 100% of participants. Case- and surgeon-specific variation was considered and included through delineation of mandatory, optional, and not recommended steps. Expert consensus on a standardised protocol for NEL was achieved, delineating the surgical workflow into three phases such as pre-ventricular, intraventricular, and post-ventricular, each consisting of mandatory, optional, and not recommended steps. The work provides a platform for future trials, training, and implementation of NEL.
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Affiliation(s)
| | - Aswin Chari
- Department of Neurosurgery, Great Ormond Street Hospital, London, UK
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Williams S, Layard Horsfall H, Funnell JP, Hanrahan JG, Khan DZ, Muirhead W, Stoyanov D, Marcus HJ. Artificial Intelligence in Brain Tumour Surgery-An Emerging Paradigm. Cancers (Basel) 2021; 13:cancers13195010. [PMID: 34638495 PMCID: PMC8508169 DOI: 10.3390/cancers13195010] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/02/2021] [Accepted: 10/03/2021] [Indexed: 01/01/2023] Open
Abstract
Artificial intelligence (AI) platforms have the potential to cause a paradigm shift in brain tumour surgery. Brain tumour surgery augmented with AI can result in safer and more effective treatment. In this review article, we explore the current and future role of AI in patients undergoing brain tumour surgery, including aiding diagnosis, optimising the surgical plan, providing support during the operation, and better predicting the prognosis. Finally, we discuss barriers to the successful clinical implementation, the ethical concerns, and we provide our perspective on how the field could be advanced.
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Affiliation(s)
- Simon Williams
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK; (H.L.H.); (J.P.F.); (J.G.H.); (D.Z.K.); (W.M.); (H.J.M.)
- Wellcome/Engineering and Physical Sciences Research Council (EPSRC) Centre for Interventional and Surgical Sciences (WEISS), London W1W 7TY, UK;
- Correspondence:
| | - Hugo Layard Horsfall
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK; (H.L.H.); (J.P.F.); (J.G.H.); (D.Z.K.); (W.M.); (H.J.M.)
- Wellcome/Engineering and Physical Sciences Research Council (EPSRC) Centre for Interventional and Surgical Sciences (WEISS), London W1W 7TY, UK;
| | - Jonathan P. Funnell
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK; (H.L.H.); (J.P.F.); (J.G.H.); (D.Z.K.); (W.M.); (H.J.M.)
- Wellcome/Engineering and Physical Sciences Research Council (EPSRC) Centre for Interventional and Surgical Sciences (WEISS), London W1W 7TY, UK;
| | - John G. Hanrahan
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK; (H.L.H.); (J.P.F.); (J.G.H.); (D.Z.K.); (W.M.); (H.J.M.)
- Wellcome/Engineering and Physical Sciences Research Council (EPSRC) Centre for Interventional and Surgical Sciences (WEISS), London W1W 7TY, UK;
| | - Danyal Z. Khan
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK; (H.L.H.); (J.P.F.); (J.G.H.); (D.Z.K.); (W.M.); (H.J.M.)
- Wellcome/Engineering and Physical Sciences Research Council (EPSRC) Centre for Interventional and Surgical Sciences (WEISS), London W1W 7TY, UK;
| | - William Muirhead
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK; (H.L.H.); (J.P.F.); (J.G.H.); (D.Z.K.); (W.M.); (H.J.M.)
- Wellcome/Engineering and Physical Sciences Research Council (EPSRC) Centre for Interventional and Surgical Sciences (WEISS), London W1W 7TY, UK;
| | - Danail Stoyanov
- Wellcome/Engineering and Physical Sciences Research Council (EPSRC) Centre for Interventional and Surgical Sciences (WEISS), London W1W 7TY, UK;
| | - Hani J. Marcus
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK; (H.L.H.); (J.P.F.); (J.G.H.); (D.Z.K.); (W.M.); (H.J.M.)
- Wellcome/Engineering and Physical Sciences Research Council (EPSRC) Centre for Interventional and Surgical Sciences (WEISS), London W1W 7TY, UK;
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