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Wu Y, Guo J, Peng W. Application of the IDEAL framework in hepatopancreatobiliary surgery: a review of the literature. Langenbecks Arch Surg 2023; 409:20. [PMID: 38153558 DOI: 10.1007/s00423-023-03211-w] [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: 08/09/2023] [Accepted: 12/20/2023] [Indexed: 12/29/2023]
Abstract
PURPOSE To evaluate every stage of surgical innovation and generate high-quality research evidence, the IDEAL (Idea, Development, Exploration, Assessment, Long-term study) framework was developed. This study aimed to explore the application of the IDEAL framework in hepatopancreatobiliary surgery and identify factors limiting its dissemination. METHODS We conducted a citation search of 8 core IDEAL framework articles in PubMed, Embase, Web of Science, and Scopus databases from 2009 to 2022. Two independent reviewers screened and selected articles related to hepatopancreatobiliary surgery. RESULTS A total of 1621 articles were identified through citation search. Following screening, 132 articles were finally retained, including 75 original studies (57%) and 57 secondary studies (43%). Of the original studies, only 10 articles (13%) accurately applied the IDEAL framework in methodology, distributed as follows: 1 in pre-IDEAL stage (0), 2 in Idea stage (1), 7 in Development stage (2a), 1 in Exploration stage (2b), and no articles in Assessment and Long-term study stages (3, 4). In the secondary studies, 36 articles (63%) mentioned and discussed the IDEAL framework, and all supported its application. CONCLUSIONS The application of the IDEAL framework in hepatopancreatobiliary surgery is increasingly widespread, as evidenced by its substantial citation in numerous articles. However, the utilization of the IDEAL framework remains predominantly confined to the early stages of innovation in hepatopancreatobiliary surgery, coupled with instances of misapplication stemming from insufficient comprehension of the framework. Further efforts are necessary to extend the impact of the IDEAL framework and provide surgeons with comprehensive guidance for its judicious implementation.
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Affiliation(s)
- Youwei Wu
- Division of Liver Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Jiulin Guo
- Department of Information, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Peng
- Division of Liver Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China.
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China.
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Privett BJ, Perini MV, Weinberg L, Fink MA, Muralidharan V, Lee E, Starkey G, Jones R, Lin YJ, Nikfarjam M. Reduction in post-operative pancreatic fistula with polyethylene glycol and recombinant human albumin sealant following stapled distal pancreatectomy. ANZ J Surg 2021; 91:2459-2465. [PMID: 34514684 DOI: 10.1111/ans.17181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 08/11/2021] [Accepted: 08/20/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Postoperative pancreatic fistula (POPF) remains a significant cause of morbidity in patients undergoing distal pancreatectomy (DP). The use of polyethylene glycol (PEG) and recombinant human albumin sealant gel applied to the transected pancreatic margin in DP may reduce POPF rates and was assessed. METHODS A retrospective single centre cohort study of patient undergoing DP at an Australian high volume tertiary institution between January 2015 and January 2021. Rates of POPF in patients undergoing stapled pancreatic transection with PEG sealant were compared to other methods. RESULTS A total of 54 cases were identified for analysis, with 16 undergoing stapled DP combined with staple line application of PEG (PEG group). Most patients in the control group had stapled DP 92% (35 of 38), with 47% (18 of 38) combined with a reinforcing buttress, with or without the use other glue types. Overall, 28 of 54 (52%) developed a POPF, with a significantly lower rate in the PEG group (3 of 16 vs. 25 of 38 in the Control group; p = 0.003). Clinically significant Grade B/C POPF was lower in the PEG group (0 of 16 vs. 9 of 28 in the Control group; p = 0.045), and patients in the PEG group had a shorter median (range) length of hospital stay (6 [4-14] days vs. 10 [6-41] days p = 0.04). CONCLUSION Stapled DP with the application of PEG and recombinant human albumin sealant to the transection line appears to be associated with a lower rate of clinically significant POPF.
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Affiliation(s)
- Benjamin J Privett
- The University of Melbourne Department of Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - Marcos V Perini
- The University of Melbourne Department of Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - Laurence Weinberg
- The University of Melbourne Department of Surgery, Austin Health, Heidelberg, Victoria, Australia.,The University of Melbourne Department of Anaesthesia, Austin Health, Heidelberg, Victoria, Australia
| | - Michael A Fink
- The University of Melbourne Department of Surgery, Austin Health, Heidelberg, Victoria, Australia
| | | | - Eunice Lee
- The University of Melbourne Department of Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - Graham Starkey
- The University of Melbourne Department of Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - Robert Jones
- The University of Melbourne Department of Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - Yi-Ju Lin
- The University of Melbourne Department of Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - Mehrdad Nikfarjam
- The University of Melbourne Department of Surgery, Austin Health, Heidelberg, Victoria, Australia
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Serra F, Bonaduce I, Rossi EG, De Ruvo N, Cautero N, Gelmini R. The using of sealants in pancreatic surgery: A Systematic Review. Ann Med Surg (Lond) 2021; 64:102244. [PMID: 33898024 PMCID: PMC8053887 DOI: 10.1016/j.amsu.2021.102244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/15/2021] [Accepted: 03/18/2021] [Indexed: 12/03/2022] Open
Abstract
Background POPF derives from the pancreatic stump, which follows pancreatic resection and the pancreatoenteric anastomosis following pancreaticoduodenectomy. Since 1978 sealants have been used in pancreatic surgery to prevent pancreatic fistula after resection of the pancreatic head and tail or for the management of trauma and the treatment of low-output pancreatic fistula. Different types of fibrin sealants have been evaluated for their potential to reduce the occurrence of POPF. Methods A systematic search of the electronic literature was performed using PubMed, Cochrane Library, and Scopus databases to obtain access to all publications, especially clinical trials, randomised controlled trials, and systematic reviews concerning fibrin sealants pancreatic surgery. Searching for “fibrin sealants pancreas,” we found a total of 73 results on Pubmed, 61 on Scopus, and 14 on Cochrane Library (148 total results). Results Eighteen studies were found on literature, following the criteria already described, concerning the use of fibrin sealants in pancreatic surgery. All articles described were published in the period between 1989 and 2019. Most of these were single centre studies. A total of 1032 patients were enrolled in this review. In the studies, sealants were used to reinforce pancreatic anastomoses and for the occlusion of the main pancreatic duct. Conclusion CR-POPF is a fearful complication of pancreatic surgery; among the possible solutions to reduce the risk of onset, sealants were used on the pancreatic stump; today the sealants should be considered such as an option to reduce the CR-POPF, but the routine use in clinical practice has to be validated. Discuss the use of sealants in pancreatic surgery. Compare the application of sealants on pancreatic stump and the effect on p-popf Describe the previous experiences reported in literature.
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Affiliation(s)
- Francesco Serra
- Department of Surgery, University of Modena and Reggio Emilia, Policlinico of Modena, Via del Pozzo, 71 41100, Modena, Italy
| | - Isabella Bonaduce
- Department of Surgery, University of Modena and Reggio Emilia, Policlinico of Modena, Via del Pozzo, 71 41100, Modena, Italy
| | - Elena Giulia Rossi
- Department of Surgery, University of Modena and Reggio Emilia, Policlinico of Modena, Via del Pozzo, 71 41100, Modena, Italy
| | - Nicola De Ruvo
- Department of Surgery, University of Modena and Reggio Emilia, Policlinico of Modena, Via del Pozzo, 71 41100, Modena, Italy
| | - Nicola Cautero
- Department of Surgery, University of Modena and Reggio Emilia, Policlinico of Modena, Via del Pozzo, 71 41100, Modena, Italy
| | - Roberta Gelmini
- Department of Surgery, University of Modena and Reggio Emilia, Policlinico of Modena, Via del Pozzo, 71 41100, Modena, Italy
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Gillman N, Lloyd D, Bindra R, Ruan R, Zheng M. Surgical applications of intracorporal tissue adhesive agents: current evidence and future development. Expert Rev Med Devices 2020; 17:443-460. [PMID: 32176853 DOI: 10.1080/17434440.2020.1743682] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Introduction: Traditional mechanical closure techniques pose many challenges including the risk of infection, tissue reaction, and injury to both patients and clinicians. There is an urgent need to develop tissue adhesive agents to reform closure technique. This review examined a variety of tissue adhesive agents available in the market in an attempt to gain a better understanding of intracorporal tissue adhesive agents as medical devices.Areas covered: Fundamental principles and clinical determinants of the tissue adhesives were summarized. The available tissue adhesives for intracorporal use and their relevant clinical evidence were then presented. Lastly, the perspective of future development for intracorporal tissue adhesive were discussed. Clinical evidence shows current agents are efficacious as adjunctive measures to mechanical closure and these agents have been trialed outside of clinical indications with varied results.Expert opinion: Despite some advancements in the development of tissue adhesives, there is still a demand to develop novel technologies in order to address unmet clinical needs, including low tensile strength in wet conditions, non-controllable polimerization and sub-optimal biocompatibility. Research trends focus on producing novel adhesive agents to remit these challenges. Examples include the development of biomimetic adhesives, externally activated adhesives, and multiple crosslinking strategies. Economic feasibility and biosafety are limiting factors for clinical implementation.
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Affiliation(s)
- Nicholas Gillman
- School of Medicine, Griffith University School of Medicine, Gold Coast, QLD, Australia.,Centre for Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia
| | - David Lloyd
- Griffith Centre for Orthopaedic Research and Engineering, Menzies Health Institute, Gold Coast, QLD, Australia
| | - Randy Bindra
- School of Medicine, Griffith University School of Medicine, Gold Coast, QLD, Australia.,Department of Plastic and Reconstructive Surgery, Gold Coast University Hospital, Southport, QLD, Australia
| | - Rui Ruan
- Centre for Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia.,Griffith Centre for Orthopaedic Research and Engineering, Menzies Health Institute, Gold Coast, QLD, Australia
| | - Minghao Zheng
- Centre for Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia.,Perron Institute for Neurological and Translational Science, Nedlands, Western Australia, 6009, Australia
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