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Chatterjee S, Patel Z, Thaha MA, Kyriacou PA. In silico and in vivo investigations using an endocavitary photoplethysmography sensor for tissue viability monitoring. JOURNAL OF BIOMEDICAL OPTICS 2020; 25:1-16. [PMID: 32112542 PMCID: PMC7048241 DOI: 10.1117/1.jbo.25.2.027001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 02/18/2020] [Indexed: 06/10/2023]
Abstract
SIGNIFICANCE Colorectal cancer is one of the major causes of cancer-related deaths worldwide. Surgical removal of the cancerous growth is the primary treatment for this disease. A colorectal cancer surgery, however, is often unsuccessful due to the anastomotic failure that may occur following the surgical incision. Prevention of an anastomotic failure requires continuous monitoring of intestinal tissue viability during and after colorectal surgery. To date, no clinical technology exists for the dynamic and continuous monitoring of the intestinal perfusion. AIM A dual-wavelength indwelling bowel photoplethysmography (PPG) sensor for the continuous monitoring of intestinal viability was proposed and characterized through a set of in silico and in vivo investigations. APPROACH The in silico investigation was based on a Monte Carlo model that was executed to quantify the variables such as penetration depth and detected intensity with respect to the sensor-tissue separations and tissue perfusion. Utilizing the simulated information, an indwelling reflectance PPG sensor was designed and tested on 20 healthy volunteers. Two sets of in vivo studies were performed using the driving current intensities 20 and 40 mA for a comparative analysis, using buccal tissue as a proxy tissue-site. RESULTS Both simulated and experimental results showed the efficacy of the sensor to acquire good signals through the "contact" to a "noncontact" separation of 5 mm. A very slow wavelength-dependent variation was shown in the detected intensity at the normal and hypoxic states of the tissue, whereas a decay in the intensity was found with the increasing submucosal-blood volume. The simulated detected-to-incident-photon-ratio and the experimental signal-to-noise ratio exhibited strong positive correlations, with the Pearson product-moment correlation coefficient R ranging between 0.65 and 0.87. CONCLUSIONS The detailed feasibility analysis presented will lead to clinical trials utilizing the proposed sensor.
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Affiliation(s)
- Subhasri Chatterjee
- City, University of London, Research Centre for Biomedical Engineering, London, United Kingdom
| | - Zaibaa Patel
- City, University of London, Research Centre for Biomedical Engineering, London, United Kingdom
| | - Mohamed A. Thaha
- Queen Mary, University of London, National Bowel Research Centre, Blizard Institute, Barts and the London School of Medicine and Dentistry, London, United Kingdom
- The Royal London Hospital, Barts Health NHS Trust, Department of Colorectal Surgery, London, United Kingdom
| | - Panayiotis A. Kyriacou
- City, University of London, Research Centre for Biomedical Engineering, London, United Kingdom
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Aly M, O'Brien JW, Clark F, Kapur S, Stearns AT, Shaikh I. Does intra-operative flexible endoscopy reduce anastomotic complications following left-sided colonic resections? A systematic review and meta-analysis. Colorectal Dis 2019; 21:1354-1363. [PMID: 31243879 DOI: 10.1111/codi.14740] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 06/10/2019] [Indexed: 02/06/2023]
Abstract
AIM Postoperative anastomotic leakage (AL) or bleeding (AB) significantly impacts on patient outcome following colorectal resection. To minimize such complications, surgeons can utilize different techniques perioperatively to assess anastomotic integrity. We aim to assess published anastomotic complication rates following left-sided colonic resection, comparing the use of intra-operative flexible endoscopy (FE) against conventional tests used to assess anastomotic integrity. METHODS PubMed/MEDLINE and Embase online databases were searched for non-randomized and randomized case-control studies that investigated postoperative AL and/or AB rates in left-sided colonic resections, comparing intra-operative FE against conventional tests. Data from eligible studies were pooled, and a meta-analysis using Review Manager 5.3 software was performed to assess for differences in AL and AB rates. RESULTS Data from six studies were analysed to assess the impact of FE on postoperative AL and AB rates (1084 and 751 patients respectively). Use of FE was associated with reduced postoperative AL and AB rates, from 6.9% to 3.5% and 5.8% to 2.4% respectively. Odds ratios favoured intra-operative FE: 0.37 (95% CI 0.21-0.68, P = 0.001) for AL and 0.35 (95% CI 0.15-0.82, P = 0.02) for AB. CONCLUSION This meta-analysis showed that the use of intra-operative FE is associated with a reduced rate of postoperative AL and AB, compared to conventional anastomotic testing methods.
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Affiliation(s)
- M Aly
- Department of Colorectal Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.,Norwich Surgical Training and Research Academy, Level 3 Centre, Norfolk and Norwich University Hospital, Norwich, UK
| | - J W O'Brien
- Department of Colorectal Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.,Norwich Surgical Training and Research Academy, Level 3 Centre, Norfolk and Norwich University Hospital, Norwich, UK
| | - F Clark
- Department of Colorectal Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.,Norwich Surgical Training and Research Academy, Level 3 Centre, Norfolk and Norwich University Hospital, Norwich, UK
| | - S Kapur
- Department of Colorectal Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.,Norwich Surgical Training and Research Academy, Level 3 Centre, Norfolk and Norwich University Hospital, Norwich, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - A T Stearns
- Department of Colorectal Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.,Norwich Surgical Training and Research Academy, Level 3 Centre, Norfolk and Norwich University Hospital, Norwich, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - I Shaikh
- Department of Colorectal Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.,Norwich Surgical Training and Research Academy, Level 3 Centre, Norfolk and Norwich University Hospital, Norwich, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
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Mari G, Maggioni D, Costanzi A, Miranda A, Rigamonti L, Crippa J, Magistro C, Di Lernia S, Forgione A, Carnevali P, Nichelatti M, Carzaniga P, Valenti F, Rovagnati M, Berselli M, Cocozza E, Livraghi L, Origi M, Scandroglio I, Roscio F, De Luca A, Ferrari G, Pugliese R. "High or low Inferior Mesenteric Artery ligation in Laparoscopic low Anterior Resection: study protocol for a randomized controlled trial" (HIGHLOW trial). Trials 2015; 16:21. [PMID: 25623323 PMCID: PMC4311448 DOI: 10.1186/s13063-014-0537-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 12/19/2014] [Indexed: 02/08/2023] Open
Abstract
Background The position of arterial ligation during laparoscopic anterior rectal resection with total mesorectal excision can affect genito-urinary function, bowel function, oncological outcomes, and the incidence of anastomotic leakage. Ligation to the inferior mesenteric artery at the origin or preservation of the left colic artery are both widely performed in rectal surgery. The aim of this study is to compare the incidence of genito-urinary dysfunction, anastomotic leak and oncological outcomes in laparoscopic anterior rectal resection with total mesorectal excision with high or low ligation of the inferior mesenteric artery in a controlled randomized trial. Methods/design The HIGHLOW study is a multicenter randomized controlled trial in which patients are randomly assigned to high or low inferior mesenteric artery ligation during laparoscopic anterior rectal resection with total mesorectal excision for rectal cancer. Inclusion criteria are middle or low rectal cancer (0 to 12 cm from the anal verge), an American Society of Anesthesiologists score of I, II, or III, and a body mass index lower than 30. The primary end-point measure is the incidence of post-operative genito-urinary dysfunction. The secondary end-point measure is the incidence of anastomotic leakage in the two groups. A total of 200 patients (100 per arm) will reliably have 84.45 power in estimating a 20% difference in the incidence of genito-urinary dysfunctions. With a group size of 100 patients per arm it is possible to find a significant difference (α = 0.05, β = 0.1555). Allowing for an estimated dropout rate of 5%, the required sample size is 212 patients. Discussion The HIGHLOW trial is a randomized multicenter controlled trial that will provide evidence on the merits of the level of arterial ligation during laparoscopic anterior rectal resection with total mesorectal excision in terms of better preserved post-operative genito-urinary function. Trial registration ClinicalTrials.gov Identifier: NCT02153801 Protocol Registration Receipt 29/5/2014. Electronic supplementary material The online version of this article (doi:10.1186/s13063-014-0537-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Giulio Mari
- Dipartimento di Chirurgia Generale, AO Vimercate, Ospedale di Desio, Vimercate, Italy.
| | - Dario Maggioni
- Dipartimento di Chirurgia Generale, AO Vimercate, Ospedale di Desio, Vimercate, Italy.
| | - Andrea Costanzi
- Dipartimento di Chirurgia Generale, AO Vimercate, Ospedale di Desio, Vimercate, Italy.
| | - Angelo Miranda
- Dipartimento di Chirurgia Generale, AO Vimercate, Ospedale di Desio, Vimercate, Italy.
| | - Luca Rigamonti
- Dipartimento di Chirurgia Generale, AO Vimercate, Ospedale di Desio, Vimercate, Italy.
| | - Jacopo Crippa
- Dipartimento di Chirurgia Generale, AO Vimercate, Ospedale di Desio, Vimercate, Italy.
| | - Carmelo Magistro
- Dipartimento di Chirurgia Generale e Videolaparoscopia, Ospedale Niguarda Ca' Granda di Milano, Milan, Italy.
| | - Stefano Di Lernia
- Dipartimento di Chirurgia Generale e Videolaparoscopia, Ospedale Niguarda Ca' Granda di Milano, Milan, Italy.
| | - Antonello Forgione
- Dipartimento di Chirurgia Generale e Videolaparoscopia, Ospedale Niguarda Ca' Granda di Milano, Milan, Italy.
| | - Pietro Carnevali
- Dipartimento di Chirurgia Generale e Videolaparoscopia, Ospedale Niguarda Ca' Granda di Milano, Milan, Italy.
| | - Michele Nichelatti
- Dipartimento di Chirurgia Generale e Videolaparoscopia, Ospedale Niguarda Ca' Granda di Milano, Milan, Italy.
| | - Pierluigi Carzaniga
- Dipartimento di Chirurgia Generale, AO Provincia di Lecco, Ospedale di Merate, Lecco, Italy.
| | - Francesco Valenti
- Dipartimento di Chirurgia Generale, AO Provincia di Lecco, Ospedale di Merate, Lecco, Italy.
| | - Marco Rovagnati
- Dipartimento di Chirurgia Generale, AO Vimercate, Ospedale di Desio, Vimercate, Italy.
| | - Mattia Berselli
- Dipartimento di Chirurgia Generale, Ospedale di Circolo di Varese, Varese, Italy.
| | - Eugenio Cocozza
- Dipartimento di Chirurgia Generale, Ospedale di Circolo di Varese, Varese, Italy.
| | - Lorenzo Livraghi
- Dipartimento di Chirurgia Generale, Ospedale di Circolo di Varese, Varese, Italy.
| | - Matteo Origi
- Dipartimento di Chirurgia Generale e Videolaparoscopia, Ospedale Niguarda Ca' Granda di Milano, Milan, Italy.
| | - Ildo Scandroglio
- Dipartimento di Chirurgia Generale, AO Busto Arsizion, Ospedale di Tradate, Tradate, Italy.
| | - Francesco Roscio
- Dipartimento di Chirurgia Generale, AO Busto Arsizion, Ospedale di Tradate, Tradate, Italy.
| | - Antonio De Luca
- Dipartimento di Chirurgia Generale, AO Busto Arsizion, Ospedale di Tradate, Tradate, Italy.
| | - Giovanni Ferrari
- Dipartimento di Chirurgia Generale e Videolaparoscopia, Ospedale Niguarda Ca' Granda di Milano, Milan, Italy.
| | - Raffaele Pugliese
- Dipartimento di Chirurgia Generale e Videolaparoscopia, Ospedale Niguarda Ca' Granda di Milano, Milan, Italy.
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Shogan BD, An GC, Schardey HM, Matthews JB, Umanskiy K, Fleshman JW, Hoeppner J, Fry DE, Garcia-Granereo E, Jeekel H, van Goor H, Dellinger EP, Konda V, Gilbert JA, Auner GW, Alverdy JC. Proceedings of the first international summit on intestinal anastomotic leak, Chicago, Illinois, October 4-5, 2012. Surg Infect (Larchmt) 2014; 15:479-89. [PMID: 25215465 DOI: 10.1089/sur.2013.114] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The first international summit on anastomotic leak was held in Chicago in October, 2012 to assess current knowledge in the field and develop novel lines of inquiry. The following report is a summary of the proceedings with commentaries and future prospects for clinical trials and laboratory investigations. BACKGROUND Anastomotic leakage remains a devastating problem for the patient, and a continuing challenge to the surgeon operating on high-risk areas of the gastrointestinal tract such as the esophagus and rectum. Despite the traditional wisdom that anastomotic leak is because of technique, evidence to support this is weak-to-non-existent. Outcome data continue to demonstrate that expert high-volume surgeons working in high-volume centers continue to experience anastomotic leaks and that surgeons cannot predict reliably which patients will leak. METHODS A one and one-half day summit was held and a small working group assembled to review current practices, opinions, scientific evidence, and potential paths forward to understand and decrease the incidence of anastomotic leak. RESULTS RESULTS of a survey of the opinions of the group demonstrated that the majority of participants believe that anastomotic leak is a complicated biologic problem whose pathogenesis remains ill-defined. The group opined that anastomotic leak is underreported clinically, it is not because of technique except when there is gross inattention to it, and that results from animal models are mostly irrelevant to the human condition. CONCLUSIONS A fresh and unbiased examination of the causes and strategies for prevention of anastomotic leak needs to be addressed by a continuous working group of surgeons, basic scientists, and clinical trialists to realize a real and significant reduction in its incidence and morbidity. Such a path forward is discussed.
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