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Awad L, Reed B, Bollen E, Langridge BJ, Jasionowska S, Butler PEM, Ponniah A. The emerging role of robotics in plastic and reconstructive surgery: a systematic review and meta-analysis. J Robot Surg 2024; 18:254. [PMID: 38878229 PMCID: PMC11180031 DOI: 10.1007/s11701-024-01987-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 05/19/2024] [Indexed: 06/19/2024]
Abstract
The role of robotics has grown exponentially. There is an active interest amongst practitioners in the transferability of the potential benefits into plastic and reconstructive surgery; however, many plastic surgeons report lack of widespread implementation, training, or clinical exposure. We report the current evidence base, and surgical opportunities, alongside key barriers, and limitations to overcome, to develop the use of robotics within the field. This systematic review of PubMed, Medline, and Embase has been conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PROSPERO (ID: CRD42024524237). Preclinical, educational, and clinical articles were included, within the scope of plastic and reconstructive surgery. 2, 181, articles were screened; 176 articles met the inclusion criteria across lymph node dissection, flap and microsurgery, vaginoplasty, craniofacial reconstruction, abdominal wall reconstruction and transoral robotic surgery (TOR). A number of benefits have been reported including technical advantages such as better visualisation, improved precision and accuracy, and tremor reduction. Patient benefits include lower rate of complications and quicker recovery; however, there is a longer operative duration in some categories. Cost presents a significant barrier to implementation. Robotic surgery presents an exciting opportunity to improve patient outcomes and surgical ease of use, with feasibility for many subspecialities demonstrated in this review. However, further higher quality comparative research with careful case selection, which is adequately powered, as well as the inclusion of cost-analysis, is necessary to fully understand the true benefit for patient care, and justification for resource utilisation.
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Affiliation(s)
- Laura Awad
- Charles Wolfson Centre of Reconstructive Surgery, University College London, Royal Free Hospital, London, UK.
- Department of Plastic Surgery, Royal Free Hospital, London, UK.
- Department of Surgery and Interventional Sciences, University College London, Royal Free Hospital, London, UK.
| | - Benedict Reed
- Charles Wolfson Centre of Reconstructive Surgery, University College London, Royal Free Hospital, London, UK
- Department of Plastic Surgery, Royal Free Hospital, London, UK
| | - Edward Bollen
- Charles Wolfson Centre of Reconstructive Surgery, University College London, Royal Free Hospital, London, UK
| | - Benjamin J Langridge
- Charles Wolfson Centre of Reconstructive Surgery, University College London, Royal Free Hospital, London, UK
- Department of Plastic Surgery, Royal Free Hospital, London, UK
- Department of Surgery and Interventional Sciences, University College London, Royal Free Hospital, London, UK
| | - Sara Jasionowska
- Charles Wolfson Centre of Reconstructive Surgery, University College London, Royal Free Hospital, London, UK
- Department of Plastic Surgery, Royal Free Hospital, London, UK
| | - Peter E M Butler
- Charles Wolfson Centre of Reconstructive Surgery, University College London, Royal Free Hospital, London, UK
- Department of Plastic Surgery, Royal Free Hospital, London, UK
- Department of Surgery and Interventional Sciences, University College London, Royal Free Hospital, London, UK
| | - Allan Ponniah
- Charles Wolfson Centre of Reconstructive Surgery, University College London, Royal Free Hospital, London, UK
- Department of Plastic Surgery, Royal Free Hospital, London, UK
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van Schaik JE, van der Vegt B, Slagter-Menkema L, van der Laan BFAM, Witjes MJH, Oosting SF, Fehrmann RSN, Plaat BEC. Identification of new head and neck squamous cell carcinoma molecular imaging targets. Oral Oncol 2024; 151:106736. [PMID: 38422829 DOI: 10.1016/j.oraloncology.2024.106736] [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: 12/02/2023] [Revised: 01/23/2024] [Accepted: 02/21/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVES Intraoperative fluorescence imaging (FI) of head and neck squamous cell carcinoma (HNSCC) is performed to identify tumour-positive surgical margins, currently using epidermal growth factor receptor (EGFR) as imaging target. EGFR, not exclusively present in HNSCC, may result in non-specific tracer accumulation in normal tissues. We aimed to identify new potential HNSCC FI targets. MATERIALS AND METHODS Publicly available transcriptomic data were collected, and a biostatistical method (Transcriptional Adaptation to Copy Number Alterations (TACNA)-profiling) was applied. TACNA-profiling captures downstream effects of CNAs on mRNA levels, which may translate to protein-level overexpression. Overexpressed genes were identified by comparing HNSCC versus healthy oral mucosa. Potential targets, selected based on overexpression and plasma membrane expression, were immunohistochemically stained. Expression was compared to EGFR on paired biopsies of HNSCC, adjacent macroscopically suspicious mucosa, and healthy mucosa. RESULTS TACNA-profiling was applied on 111 healthy oral mucosa and 410 HNSCC samples, comparing expression levels of 19,635 genes. The newly identified targets were glucose transporter-1 (GLUT-1), placental cadherin (P-cadherin), monocarboxylate transporter-1 (MCT-1), and neural/glial antigen-2 (NG2), and were evaluated by IHC on samples of 31 patients. GLUT-1 was expressed in 100 % (median; range: 60-100 %) of tumour cells, P-cadherin in 100 % (50-100 %), EGFR in 70 % (0-100 %), MCT-1 in 30 % (0-100 %), and NG2 in 10 % (0-70 %). GLUT-1 and P-cadherin showed higher expression than EGFR (p < 0.001 and p = 0.015). CONCLUSIONS The immunohistochemical confirmation of TACNA-profiling results showed significantly higher GLUT-1 and P-cadherin expression than EGFR, warranting further investigation as HNSCC FI targets.
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Affiliation(s)
- Jeroen E van Schaik
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Bert van der Vegt
- Department of Pathology and Medical Biology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Lorian Slagter-Menkema
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands; Department of Pathology and Medical Biology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Bernard F A M van der Laan
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Max J H Witjes
- Department of Oral & Maxillofacial Surgery, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Sjoukje F Oosting
- Department of Medical Oncology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Rudolf S N Fehrmann
- Department of Medical Oncology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Boudewijn E C Plaat
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands.
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Fernandes JR, Dos Santos LCF, Lamers ML. Applicability of autofluorescence and fluorescent probes in the trans-surgical of oral carcinomas: A systematic review. Photodiagnosis Photodyn Ther 2022; 41:103238. [PMID: 36509404 DOI: 10.1016/j.pdpdt.2022.103238] [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: 07/27/2022] [Revised: 11/07/2022] [Accepted: 12/08/2022] [Indexed: 12/13/2022]
Abstract
Oral cancer represents an important health problem, as it is the sixth most common type of cancer in the world and is associated with high rates of morbidity and mortality. The treatment considered the gold standard for this type of tumor is surgical resection with negative margins, with a distance of at least 5 mm from the tumor. This procedure is strongly associated with local control and disease-specific survival, however, in many cases, large amounts of healthy tissue are removed, resulting in surgical defects, compromising various functions and directly affecting the individual's quality of life. From this perspective, this systematic review aimed to evaluate the use of autofluorescence and fluorescent probes as potential adjuvant techniques to facilitate the delineation of surgical margins for oral cancers. A comprehensive search was performed in Pubmed, Scopus, Web of Science, LIVIVO, Embase, ProQuest Open Access Dissertations & Theses, Open Access Theses and Dissertations, and DART Europe databases, where 1948 articles were found. After the different stages of critical evaluation, 15 articles were selected, eligible for the inclusion criteria. Of these, 7 articles used autofluorescence, 7 used fluorescent probes and 1 article used both methods. As for autofluorescence, the most used device was the VELScope, and indocyanine green was the most used probe. Compared to histopathology, autofluorescence did not obtain significant and/or superiors results. In contrast to fluorescent probes that, most articles showed a good performance of margins during surgical resection, making them a promising alternative. However, it is still necessary to carry out the analysis of more articles, with more significant samples and sensitivity and specificity data to qualify the results.
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Affiliation(s)
- Julia Rodrigues Fernandes
- Department of Oral Pathology, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Marcelo Lazzaron Lamers
- Department of Morphological Sciences, Institute of Basic Health Sciences, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos 2600, Porto Alegre, RS CEP 90035-003, Brazil.
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De Ravin E, Venkatesh S, Harmsen S, Delikatny EJ, Husson MA, Lee JYK, Newman JG, Rajasekaran K. Indocyanine green fluorescence-guided surgery in head and neck cancer: A systematic review. Am J Otolaryngol 2022; 43:103570. [PMID: 35939987 DOI: 10.1016/j.amjoto.2022.103570] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 07/31/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the feasibility and effectiveness of indocyanine green (ICG) for image-guided resection of head and neck cancer (HNC). DATA SOURCES PubMed, Embase, and Scopus databases. REVIEW METHODS Searches were conducted from database inception to February 2022. Patient and study characteristics, imaging parameters, and imaging efficacy data were extracted from each study. RESULTS Nine studies met inclusion criteria, representing 103 head and neck tumors. Weighted mean ICG dose and imaging time were 1.27 mg/kg and 11.77 h, respectively. Among the five studies that provided quantitative metrics of imaging efficacy, average ICG tumor-to-background ratio (TBR) was 1.56 and weighted mean ONM-100 TBR was 3.64. Pooled sensitivity and specificity across the five studies were 91.7 % and 71.9 %, respectively. CONCLUSION FGS with ICG may facilitate real-time tumor-margin delineation to improve margin clearance rates and progression-free survival. Future studies with validated, quantitative metrics of imaging success are necessary to further evaluate the prognostic benefit of these techniques.
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Affiliation(s)
- Emma De Ravin
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, United States of America; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America
| | - Sanjena Venkatesh
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America
| | - Stefan Harmsen
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Edward J Delikatny
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Michael A Husson
- Department of Pathology, University of Pennsylvania, Philadelphia, PA, United States of America
| | - John Y K Lee
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Jason G Newman
- Department of Otolaryngology - Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, United States of America
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, United States of America.
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Young K, Ma E, Kejriwal S, Nielsen T, Aulakh SS, Birkeland AC. Intraoperative In Vivo Imaging Modalities in Head and Neck Cancer Surgical Margin Delineation: A Systematic Review. Cancers (Basel) 2022; 14:cancers14143416. [PMID: 35884477 PMCID: PMC9323577 DOI: 10.3390/cancers14143416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/06/2022] [Accepted: 07/12/2022] [Indexed: 11/16/2022] Open
Abstract
Surgical margin status is one of the strongest prognosticators in predicting patient outcomes in head and neck cancer, yet head and neck surgeons continue to face challenges in the accurate detection of these margins with the current standard of care. Novel intraoperative imaging modalities have demonstrated great promise for potentially increasing the accuracy and efficiency in surgical margin delineation. In this current study, we collated and analyzed various intraoperative imaging modalities utilized in head and neck cancer to evaluate their use in discriminating malignant from healthy tissues. The authors conducted a systematic database search through PubMed/Medline, Web of Science, and EBSCOhost (CINAHL). Study screening and data extraction were performed and verified by the authors, and more studies were added through handsearching. Here, intraoperative imaging modalities are described, including optical coherence tomography, narrow band imaging, autofluorescence, and fluorescent-tagged probe techniques. Available sensitivities and specificities in delineating cancerous from healthy tissues ranged from 83.0% to 100.0% and 79.2% to 100.0%, respectively, across the different imaging modalities. Many of these initial studies are in small sample sizes, with methodological differences that preclude more extensive quantitative comparison. Thus, there is impetus for future larger studies examining and comparing the efficacy of these intraoperative imaging technologies.
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Affiliation(s)
- Kurtis Young
- John A. Burns School of Medicine, Honolulu, HI 96813, USA; (K.Y.); (E.M.); (S.K.); (T.N.)
| | - Enze Ma
- John A. Burns School of Medicine, Honolulu, HI 96813, USA; (K.Y.); (E.M.); (S.K.); (T.N.)
| | - Sameer Kejriwal
- John A. Burns School of Medicine, Honolulu, HI 96813, USA; (K.Y.); (E.M.); (S.K.); (T.N.)
| | - Torbjoern Nielsen
- John A. Burns School of Medicine, Honolulu, HI 96813, USA; (K.Y.); (E.M.); (S.K.); (T.N.)
| | | | - Andrew C. Birkeland
- Department of Otolaryngology—Head and Neck Surgery, University of California, Davis, CA 95817, USA
- Correspondence:
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Choi AM, Brenner MJ, Gorelik D, Erbele ID, Crowson MG, Kadkade P, Takashima M, Santa Maria PL, Hong RS, Rose AS, Ostrander BT, Rabbani CC, Morrison RJ, Weissbrod PA, Tate AD, Kain JJ, Lina IA, Shaffer SR, Ahmed OG. New Medical Device and Therapeutic Approvals in Otolaryngology: State of the Art Review of 2021. OTO Open 2022; 6:2473974X221126495. [PMID: 36171808 PMCID: PMC9511340 DOI: 10.1177/2473974x221126495] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/25/2022] [Indexed: 11/17/2022] Open
Abstract
Objective To evaluate new medical devices and drugs pertinent to otolaryngology–head and neck surgery that were approved by the Food and Drug Administration (FDA) in 2021. Data Sources Publicly available FDA device and drug approvals from ENT (ear, nose, and throat), anesthesia, neurosurgery, plastic surgery, and general surgery FDA committees. Review Methods FDA device and therapeutic approvals were identified and reviewed by members of the American Academy of Otolaryngology–Head and Neck Surgery’s Medical Devices and Drugs Committee. Two independent reviewers assessed the relevance of devices and drugs to otolaryngologists. Medical devices and drugs were then allocated to their respective subspecialty fields for critical review based on available scientific literature. Conclusions The Medical Devices and Drugs Committee reviewed 1153 devices and 52 novel drugs that received FDA approval in 2021 (67 ENT, 106 anesthesia, 618 general surgery and plastic surgery, 362 neurosurgery). Twenty-three devices and 1 therapeutic agent relevant to otolaryngology were included in the state of the art review. Advances spanned all subspecialties, including over-the-counter hearing aid options in otology, expanding treatment options for rhinitis in rhinology, innovative laser-safe endotracheal tubes in laryngology, novel facial rejuvenation and implant technology in facial plastic surgery, and advances in noninvasive and surgical treatment options for obstructive sleep apnea. Implications for Practice FDA approvals for new technology and pharmaceuticals present new opportunities across subspecialties in otolaryngology. Clinicians’ nuanced understanding of the safety, advantages, and limitations of these innovations ensures ongoing progress in patient care.
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Affiliation(s)
- Alexander M. Choi
- Medical Devices and Drugs Committee, American Academy of Otolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
- Department of Otolaryngology–Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Michael J. Brenner
- Medical Devices and Drugs Committee, American Academy of Otolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Daniel Gorelik
- Medical Devices and Drugs Committee, American Academy of Otolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
- Department of Otolaryngology–Head and Neck Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Isaac D. Erbele
- Medical Devices and Drugs Committee, American Academy of Otolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
- Department of Otolaryngology–Head and Neck Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
| | - Matthew G. Crowson
- Medical Devices and Drugs Committee, American Academy of Otolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
- Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Prajoy Kadkade
- Medical Devices and Drugs Committee, American Academy of Otolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
- Department of Otolaryngology–Head and Neck Surgery, North Shore University Hospital, Sunnyside, New York, USA
| | - Masayoshi Takashima
- Medical Devices and Drugs Committee, American Academy of Otolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
- Department of Otolaryngology–Head and Neck Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Peter L. Santa Maria
- Medical Devices and Drugs Committee, American Academy of Otolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
- Department of Otolaryngology–Head and Neck Surgery, Stanford University, Palo Alto, California, USA
| | - Robert S. Hong
- Medical Devices and Drugs Committee, American Academy of Otolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
- Department of Otolaryngology–Head and Neck Surgery, Wayne State University, Detroit, Michigan, USA
- Michigan Ear Institute, Farmington Hills, Michigan, USA
| | - Austin S. Rose
- Medical Devices and Drugs Committee, American Academy of Otolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Benjamin T. Ostrander
- Medical Devices and Drugs Committee, American Academy of Otolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of California San Diego, La Jolla, California, USA
| | - Cyrus C. Rabbani
- Medical Devices and Drugs Committee, American Academy of Otolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
- Department of Otolaryngology–Head and Neck Surgery, Case Western Reserve University and University Hospitals, Cleveland, Ohio, USA
| | - Robert J. Morrison
- Medical Devices and Drugs Committee, American Academy of Otolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Philip A. Weissbrod
- Medical Devices and Drugs Committee, American Academy of Otolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of California San Diego, La Jolla, California, USA
| | - Alan D. Tate
- Medical Devices and Drugs Committee, American Academy of Otolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
- Department of Otolaryngology–Head and Neck Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
| | - Joshua J. Kain
- Medical Devices and Drugs Committee, American Academy of Otolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
- Department of Otolaryngology–Head and Neck Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Ioan A. Lina
- Medical Devices and Drugs Committee, American Academy of Otolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
- Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Scott R. Shaffer
- Medical Devices and Drugs Committee, American Academy of Otolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
- Department of Otolaryngology–Head and Neck Surgery, Marlton, New Jersey, USA
| | - Omar G. Ahmed
- Medical Devices and Drugs Committee, American Academy of Otolaryngology–Head and Neck Surgery, Alexandria, Virginia, USA
- Department of Otolaryngology–Head and Neck Surgery, Houston Methodist Hospital, Houston, Texas, USA
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De Ravin E, Carey RM, Stubbs VC, Jaffe S, Lee JYK, Rajasekaran K, Newman JG. Second Window Indocyanine Green for Oropharyngeal Tumors: A Case Series and Comparison of Near-Infrared Camera Systems. Clin Otolaryngol 2022; 47:589-593. [PMID: 35604054 DOI: 10.1111/coa.13945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 01/24/2022] [Accepted: 05/01/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Emma De Ravin
- Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Ryan M Carey
- Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Vanessa C Stubbs
- Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Samantha Jaffe
- Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - John Y K Lee
- Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Jason G Newman
- Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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Sun LF, Wang CX, Cao ZY, Han W, Guo SS, Wang YZ, Meng Y, Hou CX, Zhu QH, Tang YT, Li HQ, Zhang T, Ye JH. Evaluation of autofluorescence visualization system in the delineation of oral squamous cell carcinoma surgical margins. Photodiagnosis Photodyn Ther 2021; 36:102487. [PMID: 34411738 DOI: 10.1016/j.pdpdt.2021.102487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 08/09/2021] [Accepted: 08/13/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Delineating the margins of Oral squamous cell carcinoma (OSCC) is a critical step for optimaltumor resection. The aim of this study was to evaluate the accuracy of lesion surgical margin identification using autofluorescence visualization. MATERIALS AND METHODS Thirty patients with OSCC were included in this study. For each lesion, the fluorescence loss boundary was determined using VELscope before ablative surgical resection (with a 1.5-2cm safety margin) was performed. A total of 126 samples were obtained from 30 surgical specimens, each containing the tissue from the fluorescence loss boundary to surgical margin. The status of each sample was determined by oral pathologists and the staining intensities of Ki-67, E-cadherin, and Vimentin at the fluorescence loss boundary and surgical margin were evaluated by immunohistochemistry. RESULTS Fluorescence loss regions were identified in all patients. Of the 126 samples collected, HE staining identified 77 normal epithelia (61.1%), 26 mild dysplasia (20.6%), 17 severe dysplasia (13.4%) and 6 carcinomas in situ (4.9%). A significant correlation was found between the differentiation grade of tumor cells and the pathological status of the surgical marginal specimens (P<0.05). Forty-two of the 126 samples were randomly selected for further immunohistochemical staining. No significant differences were seen in Ki-67, E-cadherin, or Vimentin expression at the fluorescence loss boundary or surgical margin, however, the proteins' expression level was positively correlated with the degree of dysplasia (P<0.01). CONCLUSION Autofluorescence visualization has potential as a simple surgical margin setting device for OSCC and may help delineate the superficial area of OSCC with acceptable accuracy. However, when considering the inherent limitations of this system, we suggest that the approach should only be applied under certain conditions, such as when dealing with superficial, well-differentiated lesions.
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Affiliation(s)
- Li-Fan Sun
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing 210029, China; Depatment of Oral and Maxillofacial Surgery, Huaxia Stomatological Hospital Affiliated to Suzhou Health College, Suzhou 215000, China
| | - Chen-Xing Wang
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing 210029, China; Depatment of Oral and Maxillofacial Surgery, The Affiliated Stomatology Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Zheng-Yao Cao
- Depatment of Stomatology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi 214023, China
| | - Wei Han
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing 210029, China; Depatment of Oral and Maxillofacial Surgery, The Affiliated Stomatology Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Song-Song Guo
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing 210029, China; Depatment of Oral and Maxillofacial Surgery, The Affiliated Stomatology Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yi-Zhou Wang
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing 210029, China; Depatment of Oral and Maxillofacial Surgery, The Affiliated Stomatology Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Ying Meng
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing 210029, China; Depatment of Oral and Maxillofacial Surgery, The Affiliated Stomatology Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Chen-Xing Hou
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing 210029, China; Depatment of Oral and Maxillofacial Surgery, The Affiliated Stomatology Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Qing-Hai Zhu
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing 210029, China; Depatment of Oral and Maxillofacial Surgery, The Affiliated Stomatology Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yu-Ting Tang
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing 210029, China; Depatment of Oral and Maxillofacial Surgery, The Affiliated Stomatology Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Huai-Qi Li
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing 210029, China; Depatment of Oral and Maxillofacial Surgery, The Affiliated Stomatology Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Tianzhu Zhang
- National Key Bioelectronics Stomatology Laboratory, School of Biological Sciences & Medical Engineering, Southeast University, Nanjing 210096, China
| | - Jin-Hai Ye
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing 210029, China; Depatment of Oral and Maxillofacial Surgery, The Affiliated Stomatology Hospital of Nanjing Medical University, Nanjing 210029, China.
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Shaikh N, O'Brien D, Makary C, Turner M. Intraoperative Indocyanine Green Angiography for Assessing Flap Perfusion in Skull Base Reconstruction: A Systematic Review. J Neurol Surg B Skull Base 2021; 83:e492-e500. [PMID: 35832991 DOI: 10.1055/s-0041-1732309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/06/2021] [Indexed: 10/20/2022] Open
Abstract
Abstract
Objective This study was aimed to study the current use of intraoperative indocyanine green (ICG) angiography during skull base reconstruction and understand its efficacy in predicting postoperative magnetic resonance imaging (MRI) enhancement and flap.
Study Design The Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and Google Scholar databases were searched from the date of inception until August 2020 for studies of ICG flap perfusion assessment during skull base reconstruction. The primary outcome of interest was the development of cerebrospinal fluid (CSF) leak after skull base reconstruction. Secondary outcomes of interest included postoperative meningitis, flap MRI enhancement, flap necrosis, flap perfusion measurements, and total complications.
Results Search results yielded 189 studies, from which seven studies with a total of 104 patients were included in the final analysis. There were 44 nasoseptal flaps (NSF), two lateral nasal wall flaps (LNWF), 14 pericranial flaps (PCF), and 44 microvascular free flaps. The rates of CSF leak and postoperative MRI enhancement were 11 and 94%, respectively. There was one case of postoperative meningitis. Pooled analysis of the available data showed that intraoperative ICG flap perfusion was associated with flap enhancement on postoperative MRI (p = 0.008) and CSF leak (p = 0.315) by Fisher's exact test.
Conclusion The available literature suggests intraoperative ICG enhancement is associated with postoperative MRI enhancement. Given the small sample sizes in the literature and the rarity of complications associated with skull base reconstruction, intraoperative ICG enhancement has not been predictive of flap necrosis or postoperative complications such as CSF leak or meningitis.
Level of Evidence This study presents level 3 evidence as a systematic review of case studies, case reports, and retrospective and prospective trials with no blinding, controls, and inconsistently applied reference standards.
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Affiliation(s)
- Noah Shaikh
- Department of Otolaryngology, West Virginia University, Morgantown, West Virginia, United States
| | - Daniel O'Brien
- Division of Otolaryngology, University of Alberta, Edmonton, Alberta, Canada
| | - Chadi Makary
- Department of Otolaryngology, West Virginia University, Morgantown, West Virginia, United States
| | - Meghan Turner
- Department of Otolaryngology, West Virginia University, Morgantown, West Virginia, United States
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10
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Abstract
Technological developments have disrupted the practice of medicine throughout history. Endoscopic and robotic techniques in head and neck surgery have emerged over the past half-century and have been incrementally adapted to expanding indications within otolaryngology. Robotic and endoscopic surgery have an established role in treatment of oropharyngeal and laryngeal cancers, reducing surgical morbidity and improving survival relative to traditional open approaches. Surgical treatment of human papillomavirus-mediated oropharyngeal cancer via transoral robotic surgery offers equivalent oncologic and functional outcomes relative to radiotherapy. Newer iterations of single-port robotic systems continue to expand the scope of robotics in head and neck surgery.
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11
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Pogue BW, Rosenthal EL. Review of successful pathways for regulatory approvals in open-field fluorescence-guided surgery. JOURNAL OF BIOMEDICAL OPTICS 2021; 26:JBO-210023VR. [PMID: 33715318 PMCID: PMC7955139 DOI: 10.1117/1.jbo.26.3.030901] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 02/23/2021] [Indexed: 06/12/2023]
Abstract
SIGNIFICANCE The modern use of fluorescence in surgery came iteratively through new devices and pre-existing imaging agents, with indications that were paved via regulatory approvals and device clearances. These events led to a growing set of surgery subspecialty uses. AIM This article outlines the key milestones that initiated commercially marketed systems and agents by highlighting temporal sequences and strategic decisions between them, with the goal of helping to inform future successes. APPROACH A review of successful regulatory approvals and the sequences between them was completed for companies that achieved US Food and Drug Administration (FDA) premarket approval or new drug approvals (NDAs) or device clearances in the fields of fluorescent imaging agents, open surgery imaging devices, and their approved medical indications. RESULTS Angiography agents, indocyanine green and fluorescein, were approved for human use as absorbing dyes, and this use in retinal imaging was the precursor to lateral translation into tissue perfusion imaging in the last two decades with a growing number of devices. Many FDA cleared devices for open fluorescence-guided surgery used the predicate created by the SPY SP2000 system. This first system was 510(k) cleared for angiography imaging with a unique split predicate from x-ray imaging of vasculature and retinal fluorescence angiography. Since that time, the lateral spread of open surgery devices being cleared for new indications has been occurring with a growth of adoption in surgical subspecialties. Growth into new surgical subspecialties has been achieved by leveraging different NDAs and clearances between indications, such that medical uses have broadened over time. CONCLUSIONS Key decisions made by developers to advance specific device clearances and NDAs have been based upon existing optical fluorescent agents. The historical lessons and regulatory trends in newer indications and contrast agents can help the field evolve via successful investment in new systems and applications.
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Affiliation(s)
- Brian W. Pogue
- Thayer School of Engineering at Dartmouth, Center for Imaging Medicine, Hanover, New Hampshire, United States
- Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States
| | - Eben L. Rosenthal
- Stanford University School of Medicine, Palo Alto, California, United States
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12
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Lee YJ, Krishnan G, Nishio N, van den Berg NS, Lu G, Martin BA, van Keulen S, Colevas AD, Kapoor S, Liu JTC, Rosenthal EL. Intraoperative Fluorescence-Guided Surgery in Head and Neck Squamous Cell Carcinoma. Laryngoscope 2021; 131:529-534. [PMID: 33593036 DOI: 10.1002/lary.28822] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 05/15/2020] [Indexed: 02/06/2023]
Abstract
The rate of positive margins in head and neck cancers has remained stagnant over the past three decades and is consistently associated with poor overall survival. This suggests that significant improvements must be made intraoperatively to ensure negative margins. We discuss the important role of fluorescence imaging to guide surgical oncology in head and neck cancer. This review includes a general overview of the principles of fluorescence, available fluorophores used for fluorescence imaging, and specific clinical applications of fluorescence-guided surgery, as well as challenges and future directions in head and neck surgical oncology. Laryngoscope, 131:529-534, 2021.
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Affiliation(s)
- Yu-Jin Lee
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, U.S.A
| | - Giri Krishnan
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, U.S.A.,Department of Otolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, SA, Australia
| | - Naoki Nishio
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, U.S.A
| | - Nynke S van den Berg
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, U.S.A
| | - Guolan Lu
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, U.S.A
| | - Brock A Martin
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, U.S.A
| | - Stan van Keulen
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, U.S.A
| | - Alexander D Colevas
- Department of Medicine, Division of Oncology, Stanford University School of Medicine, Stanford, CA, U.S.A
| | - Shrey Kapoor
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, U.S.A
| | - Jonathan T C Liu
- Department of Mechanical Engineering, University of Washington, Seattle, WA, U.S.A.,Department of Bioengineering, University of Washington, Seattle, WA, U.S.A.,Department of Pathology, University of Washington, Seattle, WA, U.S.A
| | - Eben L Rosenthal
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, U.S.A.,Department of Radiology, Stanford University School of Medicine, Stanford, CA, U.S.A
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13
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Demétrio de Souza França P, Guru N, Roberts S, Kossatz S, Mason C, Abrahão M, Ghossein RA, Patel SG, Reiner T. Fluorescence-guided resection of tumors in mouse models of oral cancer. Sci Rep 2020; 10:11175. [PMID: 32636416 PMCID: PMC7341853 DOI: 10.1038/s41598-020-67958-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 05/18/2020] [Indexed: 12/18/2022] Open
Abstract
Complete removal and negative margins are the goal of any surgical resection of primary oral cavity carcinoma. Current approaches to determine tumor boundaries rely heavily on surgeons' expertise, and final histopathological reports are usually only available days after surgery, precluding contemporaneous re-assessment of positive margins. Intraoperative optical imaging could address this unmet clinical need. Using mouse models of oral cavity carcinoma, we demonstrated that PARPi-FL, a fluorescent PARP inhibitor targeting the enzyme PARP1/2, can delineate oral cancer and accurately identify positive margins, both macroscopically and at cellular resolution. PARPi-FL also allowed identification of compromised margins based on fluorescence hotspots, which were not seen in margin-negative resections and control tongues. PARPi-FL was further able to differentiate tumor from low-grade dysplasia. Intravenous injection of PARPi-FL has significant potential for clinical translation and could aid surgeons in assessing oral cancer margins in vivo.
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Affiliation(s)
- Paula Demétrio de Souza França
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
- Department of Otorhinolaryngology and Head and Neck Surgery, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Navjot Guru
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Sheryl Roberts
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Susanne Kossatz
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
- Department of Nuclear Medicine, School of Medicine, Technische Universität München, Munich, Germany
| | - Christian Mason
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Marcio Abrahão
- Department of Otorhinolaryngology and Head and Neck Surgery, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Ronald A Ghossein
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Snehal G Patel
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Otorhinolaryngology, Weill Cornell Medical College, New York, NY, USA
| | - Thomas Reiner
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
- Department of Otorhinolaryngology, Weill Cornell Medical College, New York, NY, USA.
- Chemical Biology Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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14
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Kain JJ, Birkeland AC, Udayakumar N, Morlandt AB, Stevens TM, Carroll WR, Rosenthal EL, Warram JM. Surgical margins in oral cavity squamous cell carcinoma: Current practices and future directions. Laryngoscope 2019; 130:128-138. [PMID: 31025711 DOI: 10.1002/lary.27943] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 02/09/2019] [Accepted: 03/01/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To discuss the current available techniques for intraoperative margin assessment in the surgical treatment of oral squamous cell carcinoma (OSCC) through a review of the available literature. METHODS A systematic review was undertaken of the available English literature between 2008 through 2018 regarding surgical margins in OCSS. A total of 893 relevant articles were returned; 144 met criteria for review; and 64 articles were included. RESULTS In this review, we discuss the data surrounding the use of frozen section in OCSS. Additionally, alternative techniques for margin assessment are discussed, including Mohs, molecular analysis, nonfluorescent dyes, fluorescent dyes, autofluorescent imaging, narrow-band imaging, optical coherence tomography, confocal microscopy, high-resolution microendoscopy, and spectroscopy. For each technique, particular emphasis is placed on the local recurrence, disease-free survival, and overall survival rates when available. CONCLUSION This review provides support for the practice of specimen-driven margin assessment when using frozen section analysis to improve the utility of the results. Finally, several alternatives for intraoperative margin assessment currently under investigation, including pathologic, wide-field imaging and narrow-field imaging techniques, are presented. We aim to fuel further investigation into methods for margin assessment that will improve survival for patients with OSCC through a critical analysis of the available techniques. LEVEL OF EVIDENCE NA Laryngoscope, 130:128-138, 2020.
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Affiliation(s)
- Joshua J Kain
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
| | - Andrew C Birkeland
- Department of Otolaryngology, Stanford University, Stanford, California, U.S.A
| | - Neha Udayakumar
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
| | - Anthony B Morlandt
- Department of Oral & Maxillofacial Surgery, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
| | - Todd M Stevens
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
| | - William R Carroll
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
| | - Eben L Rosenthal
- Department of Otolaryngology, Stanford University, Stanford, California, U.S.A
| | - Jason M Warram
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
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