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Félix C, Barreiro P, Mendo R, Mascarenhas A, Chagas C. Outcomes and Learning Curve in Endoscopic Submucosal Dissection of Rectal Neoplasms with Severe Fibrosis: Experience of a Western Center. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2022. [DOI: 10.1159/000522579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
<b><i>Introduction:</i></b> Endoscopic submucosal dissection (ESD) of lesions with severe submucosal fibrosis has been associated with worse outcomes, such as lower curative resection rate and higher incidence of adverse events. This study aims to investigate its true impact on rectal ESD performed in the West and to assess predictive factors of severe fibrosis. <b><i>Methods:</i></b> We conducted a retrospective study including all rectal ESDs performed at our tertiary center from January 2013 to January 2021. Lesions were grouped as nonsevere fibrosis or severe fibrosis. ESD outcomes, predictors of severe fibrosis, and the learning curve were evaluated. <b><i>Results:</i></b> ESD was performed in 195 lesions, 45 with severe fibrosis. Three resections were interrupted (one due to severe fibrosis). The presence of severe fibrosis was related to a significantly lower resection speed (16.93 mm<sup>2</sup>/min vs. 24.66 mm<sup>2</sup>/min, <i>p</i> = 0.007), en bloc (86.4% vs. 96.6%, <i>p</i> = 0.019), R0 (61.4% vs. 79.7%, <i>p</i> = 0.013), and curative (54.5% vs. 78.4%, <i>p</i> = 0.003) resection rates and a higher rate of hybrid ESD required to complete resection (13.6% vs. 2.0%, <i>p</i> = 0.005). No significant difference was noted regarding adverse events rate (18.2% vs. 8.1%, <i>p</i> = 0.09). Male sex, ulcerative colitis, pelvic radiotherapy, a lesion on the anastomotic site, previous manipulation, and deep submucosal invasion were independent predictors for severe fibrosis. En bloc resection rate improved during time (60.0% vs. 94.1%, <i>p</i> = 0.018). <b><i>Conclusions:</i></b> Severe submucosal fibrosis is an important factor related to noncurative resections and challenging rectal ESD. Factors predicting its severity are extremely important and could allow more experienced endoscopists to be assigned to more difficult cases, allowing safer procedures.
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Santos-Antunes J, Marques M, Morais R, Carneiro F, Macedo G. Colorectal Endoscopic Submucosal Dissection in a Western Center: Analysis of Outcomes and Safety Profile. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2021; 28:319-327. [PMID: 34604463 DOI: 10.1159/000514797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/22/2021] [Indexed: 11/19/2022]
Abstract
Introduction Endoscopic submucosal dissection (ESD) is a well-established endoscopic technique for the treatment of gastrointestinal lesions. Colorectal ESD outcomes are less reported in the Western literature, and Portuguese data are still very scarce. Our aim was to describe our experience on colorectal ESD regarding its outcomes and safety profile. Methods We conducted a retrospective evaluation of recorded data on ESDs performed between 2015 and 2020. Only ESDs performed on epithelial neoplastic lesions were selected for further analysis. Results Of a total of 167 colorectal ESDs, 153 were included. Technical success was achieved in 147 procedures (96%). The lesions were located in the colon (n = 24) and rectum (n = 123). The en bloc resection rate was 92% and 97%, the R0 resection rate was 83% and 82%, and the curative resection rate was 79% and 78% for the colon and the rectum, respectively. The need for a hybrid technique was the only risk factor for piecemeal or R1 resection. We report a perforation rate of 3.4% and a 4.1% rate of delayed bleeding; all the adverse events were manageable endoscopically, without the need of blood transfusions or surgery. Most of the lesions were laterally spreading tumours of the granular mixed type (70%), and 20% of the lesions were malignant (12% submucosal and 8% intramucosal cancer). Conclusion Our series on colorectal ESD reports a very good efficacy and safety profile. This technique can be applied by endoscopists experienced in ESD.
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Affiliation(s)
- João Santos-Antunes
- Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar S. João, Porto, Portugal.,Ipatimup/i3S (Instituto de Investigação e Inovação em Saúde da Universidade do Porto), Porto, Portugal
| | - Margarida Marques
- Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar S. João, Porto, Portugal
| | - Rui Morais
- Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar S. João, Porto, Portugal
| | - Fátima Carneiro
- Department of Pathology, Faculty of Medicine, Centro Hospitalar S. João, Porto, Portugal.,Ipatimup/i3S (Instituto de Investigação e Inovação em Saúde da Universidade do Porto), Porto, Portugal
| | - Guilherme Macedo
- Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar S. João, Porto, Portugal
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Santos-Antunes J, Morais R, Marques M, Macedo G. Underwater Duodenal ESD of a Large Adenoma Using the Pocket-Creation Method. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2021; 28:367-369. [PMID: 34604470 DOI: 10.1159/000512360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 09/17/2020] [Indexed: 11/19/2022]
Affiliation(s)
- João Santos-Antunes
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar S. João, Porto, Portugal.,i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,IPATIMUP - Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal
| | - Rui Morais
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar S. João, Porto, Portugal
| | - Margarida Marques
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar S. João, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Faculty of Medicine, Centro Hospitalar S. João, Porto, Portugal
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Ahn J, Kim J, Lee H, Hwang M, Kwon DS. A highly intuitive and ergonomic redundant joint master device for four-degrees of freedom flexible endoscopic surgery robot. Int J Med Robot 2020; 17:1-14. [PMID: 32794625 DOI: 10.1002/rcs.2147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Studies have been conducted on slave-specific master devices with a similar kinematic structure to the slave to enhance intuitiveness. However, for the four-degrees of freedom (DOFs) slave of a flexible endoscopic surgery robot, only four DOFs in the master device causes low ergonomic performance. METHODS To enhance ergonomic performance, a second yaw joint was added as a redundant joint after considering the range of wrist motion and the workspace shape. Three experiments were performed to compare the intuitiveness and ergonomic performance of the proposed device with four-DOFs slave-specific and six-DOFs general-purpose master devices. RESULTS Significant differences were observed in terms of intuitiveness performance between the slave-specific and the general-purposed master device. On the other hand, there was no significant difference in ergonomic performance between the master devices with redundant joint. CONCLUSIONS Compared with a general-purpose master device, the proposed one exhibited noticeably improved intuitiveness performance and comparable ergonomic performance.
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Affiliation(s)
- Jeongdo Ahn
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
| | - Joonhwan Kim
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
| | - Hyunyoung Lee
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
| | - Minho Hwang
- Department of Electrical Engineering and Computer Sciences, University of California Berkeley, Berkeley, California, USA
| | - Dong-Soo Kwon
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
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Santos-Antunes J, Marques M, Macedo G. Endoscopic Submucosal Dissection: Experience in Portugal. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2020; 27:71-72. [PMID: 31970249 DOI: 10.1159/000501808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 06/27/2019] [Indexed: 12/26/2022]
Affiliation(s)
| | - Margarida Marques
- Gastroenterology Department, Centro Hospitalar S. João, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar S. João, Porto, Portugal
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Kim H, Hwang M, Kim J, You JM, Lim CS, Kwon DS. Effect of backlash hysteresis of surgical tool bending joints on task performance in teleoperated flexible endoscopic robot. Int J Med Robot 2019; 16:e2047. [PMID: 31675461 DOI: 10.1002/rcs.2047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/03/2019] [Accepted: 10/04/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND The tendon-sheath mechanism provides flexibility but degrades the task performance of the flexible endoscopic robot because of the inherent backlash hysteresis problem. Previous studies have only focused on reducing backlash hysteresis. The goal of this study is to identify the backlash hysteresis criteria of surgical tool bending joints to maintain efficient surgical performance. METHODS A test platform for a surgical tool has been developed that has initial backlash hysteresis under 5° and can adjust the backlash hysteresis intentionally. Performance variation has been investigated in three bench-top endoscopic tasks in which various backlash hysteresis conditions were intentionally adjusted. RESULTS A clear drop-off in task performance has been observed when the backlash hysteresis of the bending joints was greater than 10° regardless of the type of task and link length. CONCLUSIONS The backlash hysteresis of surgical tool bending joints should be reduced to at least 10° to maintain efficient performance in robotic endoscopic surgery.
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Affiliation(s)
- Hansoul Kim
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, South Korea
| | - Minho Hwang
- Department of Electrical Engineering and Computer Sciences, University of California Berkeley, Berkeley, California
| | - Joonhwan Kim
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, South Korea
| | - Jae Min You
- Robotics Program, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, South Korea
| | - Chan-Soon Lim
- Robotics Program, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, South Korea
| | - Dong-Soo Kwon
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, South Korea
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Baldaque-Silva F. The East in the West. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2019; 26:81-82. [PMID: 30976611 PMCID: PMC6454386 DOI: 10.1159/000490923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 06/15/2018] [Indexed: 06/09/2023]
Affiliation(s)
- Francisco Baldaque-Silva
- Endoscopy Unit, Department of Upper Abdominal Diseases, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
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Catalano F, Mengardo V, Trecca A, Tomezzoli A, Rodella L, Cerofolini A, Verlato G, de Manzoni G. The impact of experience on short- and long-term outcomes on gastric ESD: a western series. Updates Surg 2019; 71:359-365. [DOI: 10.1007/s13304-019-00628-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 01/28/2019] [Indexed: 12/18/2022]
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Carvalho L, Barreiro P, Chagas C. Endoscopic Submucosal Dissection of Gastric Adenocarcinoma Involving the Pylorus Circumference. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2018; 25:208-210. [PMID: 29998171 PMCID: PMC6029221 DOI: 10.1159/000481948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 09/22/2017] [Indexed: 06/08/2023]
Affiliation(s)
- Liliana Carvalho
- *Dr. Liliana Carvalho, Gastroenterology Department of Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Rua Da Junqueira 126, PT-1349-019 Lisbon (Portugal), E-Mail
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Costa RS, Ferreira A, Leal T, Costa D, Rolanda C, Gonçalves R. Endoscopic Submucosal Dissection for the Treatment of Superficial Epithelial Gastric Neoplasia in a Portuguese Centre. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2018; 26:90-98. [PMID: 30976613 DOI: 10.1159/000487820] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 02/12/2018] [Indexed: 12/14/2022]
Abstract
Background The emergence of endoscopic submucosal dissection (ESD) made possible en bloc resection of neoplastic gastric lesions, regardless of lesion size, with reduced rates of complications and recurrence. This technique has become the preferred method for curative resection, instead of conventional endoscopic mucosal resection and surgery, when distant metastases have negligible risk. In Western countries experience with this technique has evolved quickly, with an increasing number of case series reported in the literature. This study aims to report the short- and long-term outcomes of ESD in gastric epithelial neoplastic lesions by a single operator in a Portuguese centre. Methods A retrospective analysis of all gastric ESDs in a tertiary specialised unit during a 5-year period, between May 2012 and September 2017, was performed. Results A total of 114 ESDs of gastric epithelial lesions were performed during this period; 96.5% of them were removed en bloc and 87.6% with R0 resection. A curative treatment was achieved in 83.2% of the cases. Complications occurred in 13.2% of the procedures, including early and delayed bleeding in 12 patients (10.5%) and one perforation (0.9%). With a median follow-up period of 12 months (interquartile range [IQR] = 18), 6 cases of recurrence at the previous ESD site were diagnosed: 4 residual lesions and 2 local recurrences in previous R0 resections. Residual lesions occurred more often in patients with larger lesions (median = 40.0 mm, IQR = 26 vs. median = 20.0 mm, IQR = 15, p = 0.008) and with positive horizontal margins (HMs) after resection (50.0 vs. 0.0%, Fisher exact test, p < 0.001). The cumulative incidence of metachronous gastric lesions at 34 months was 16.1%. All new lesions were effectively treated using an endoscopic technique. The disease-specific survival at 12 months was 100%. Conclusion This study showed that ESD is an effective resection technique for gastric lesions with a good safety profile, confirming other European series. Regardless, high en bloc resection positive HM is still a problem in some specimens resected by ESD. Endoscopic surveillance can detect local recurrence and new lesions during early stages, potentially treatable by endoscopy.
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Affiliation(s)
- Rita Seara Costa
- aDepartment of Gastroenterology, Braga Hospital, Braga, Portugal
| | - Aníbal Ferreira
- aDepartment of Gastroenterology, Braga Hospital, Braga, Portugal
| | - Tiago Leal
- aDepartment of Gastroenterology, Braga Hospital, Braga, Portugal
| | - Dalila Costa
- aDepartment of Gastroenterology, Braga Hospital, Braga, Portugal.,bLife and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,cICVS/3B's - PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - Carla Rolanda
- aDepartment of Gastroenterology, Braga Hospital, Braga, Portugal.,bLife and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,cICVS/3B's - PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - Raquel Gonçalves
- aDepartment of Gastroenterology, Braga Hospital, Braga, Portugal
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Safety analysis of laparoscopic endoscopic cooperative surgery versus endoscopic submucosal dissection for selected gastric gastrointestinal stromal tumors: a propensity score-matched study. Surg Endosc 2016; 31:843-851. [PMID: 27492430 DOI: 10.1007/s00464-016-5042-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 06/11/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Laparoscopic endoscopic cooperative surgery (LECS) is a safe alternative to endoscopic submucosal dissection (ESD) for select gastric gastrointestinal stromal tumors (GISTs) that are <2 cm in size. To date, there have been no randomized studies comparing the feasibility of these two techniques. Therefore, we compared their feasibility and safety using the propensity score matching method in this study. METHODS This was a single-center, retrospective, propensity score-matched study of patients who underwent resection of selected gastric GISTs between 2004 and 2014. All patients underwent curative resection for pathologically diagnosed small gastric GISTs. The primary aim was to determine intraoperative complications and postoperative courses. To overcome selection biases, we performed a 1:1 match using five covariates, including age, gender, body mass index, Charlson comorbidity index, and tumor location, to generate propensity scores. RESULTS In total, 32 patients treated with LECS and 102 patients treated with ESD were balanced into 30 pairs. The rate of intraoperative complications was significantly lower in the LECS group than in the ESD group (P = 0.029). LECS patients had less intraoperative bleeding than did ESD patients (15.0 ml [range 9.5-50.0 ml] vs. 43.5 ml [range 22.3-56.0 ml], P = 0.004). The two groups had similar postoperative courses. There was no difference in the reoperation rate between the two groups (P = 0.112). The ESD group had a shorter operating time than did the LECS group (41.5 min vs. 96.5 min, P < 0.001). However, during a follow-up of 57.9 (±28.9) months, the recurrence rate did not differ significantly between the two groups (0.0 vs. 6.7 %, respectively; P = 0.256). CONCLUSIONS LECS for selected gastric GIST patients is feasible and is associated with a better intraoperative outcome and an equal postoperative course compared with the results of ESD.
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Pimentel-Nunes P, Dinis-Ribeiro M. Endoscopic Submucosal Dissection in the Treatment of Gastrointestinal Superficial Lesions: Follow the Guidelines! GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2015; 22:184-186. [PMID: 28868405 PMCID: PMC5580126 DOI: 10.1016/j.jpge.2015.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Pedro Pimentel-Nunes
- Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal.,Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, Porto, Portugal
| | - Mário Dinis-Ribeiro
- Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal.,Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, Porto, Portugal
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