scholarly journals V-OG02 Video Demonstration Of Abdominal Lymphadenectomy In A Robotically Assisted Oesophagectomy

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Jakub Chmelo ◽  
Joshua Brown ◽  
Pooja Prasad ◽  
Nick Hayes ◽  
Maziar Navidi ◽  
...  
Keyword(s):  
Lymph Node ◽  
Robotic Assistance ◽  
En Bloc ◽  
Abdominal Lymph Node ◽  
Video Images ◽  
The Common ◽  
Splenic Vessels ◽  
Minimally Invasive Oesophagectomy ◽  
And Training ◽  
Video Demonstration

Abstract Background Lymphadenectomy is essential for adequate oncological clearance and accurate staging during oesophagectomy for malignant disease. Adequate lymph node clearance has implications on patient outcomes and confers a survival benefit. Abdominal lymph node clearance may be technically challenging due to the location of nodes along key structures such as the common hepatic artery and splenic vessels. Robotic assistance during abdominal lymphadenectomy permits improved 3-D visualisation and instrument articulation in a potentially constricted space. This video demonstrates a technique for robotic abdominal lymphadenectomy during oesophagectomy. Methods This video demonstrates a technique for coeliac axis lymph node clearance during the abdominal phase of an oesophagectomy, as practiced at this institution. The intention for such a video is for ongoing appraisal and refinement of robotic techniques within the unit, as well as for teaching and training. The video was edited using iOS software, and text has been used to explain each step in conjunction with the images. Results Dissection of all relevant coeliac axis nodal stations is successfully demonstrated, with the lymph nodes resected en-bloc with the specimen. Text has also been used to explain the steps seen in the video images. Conclusions Robotic assistance permits safe and adequate lymphadenectomy during minimally invasive oesophagectomy, as demonstrated in this video.

scholarly journals Robotic-assisted single-incision gastric mobilization for minimally invasive oesophagectomy for oesophageal cancer: preliminary results

2020 ◽  
Vol 58 (Supplement_1) ◽  
pp. i65-i69
Author(s):  
Yu-Han Huang ◽  
Ke-Cheng Chen ◽  
Sian-Han Lin ◽  
Pei-Ming Huang ◽  
Pei-Wen Yang ◽  
...  
Keyword(s):  
Lymph Node ◽  
Minimally Invasive ◽  
Lymph Node Dissection ◽  
Oesophageal Cancer ◽  
Single Incision ◽  
Single Port ◽  
Node Dissection ◽  
Abdominal Lymph Node ◽  
Robotic Assisted ◽  
Minimally Invasive Oesophagectomy

Abstract OBJECTIVES With the gradual acceptance of robotic-assisted surgery to treat oesophageal cancer and the application of a single-port approach in several abdominal procedures, we adopted a single-port technique in robotic-assisted minimally invasive oesophagectomy during the abdominal phase for gastric mobilization and abdominal lymph node dissection. METHODS Robotic-assisted oesophagectomy and mediastinal lymph node dissection in the chest were followed by robotic-assisted gastric mobilization and conduit creation with abdominal lymph node dissection, which were performed via a periumbilicus single incision. The oesophagogastrostomy was accomplished either in the chest (Ivor Lewis procedure) or neck (McKeown procedure) depending on the status of the proximal resection margin. RESULTS The procedure was successfully performed on 11 patients with oesophageal cancer from January 2017 to December 2018 in our institute. No surgical or in-hospital deaths occurred, though we had one case each of anastomotic leakage, pneumonia and hiatal hernia (9%). CONCLUSIONS Robotic single-incision gastric mobilization for minimally invasive oesophagectomy for treating oesophageal cancer seems feasible. Its value in terms of perioperative outcome and long-term survival results awaits future evaluation.

The Science of Wisdom in a Polarized World: Knowns and Unknowns

2020 ◽  
Author(s):  
Igor Grossmann ◽  
Nic M. Weststrate ◽  
Monika Ardelt ◽  
Justin Peter Brienza ◽  
Mengxi Dong ◽  
...  
Keyword(s):  
Individual Differences ◽  
Problem Solving ◽  
Best Practices ◽  
Cognitive Sciences ◽  
Methodological Challenges ◽  
The Common ◽  
Empirical Approaches ◽  
And Training ◽  
Contextual Differences

Interest in wisdom in the cognitive sciences, psychology, and education has been paralleled by conceptual confusions about its nature and assessment. To clarify these issues and promote consensus in the field, wisdom researchers met in Toronto in July of 2019, resolving disputes through discussion. Guided by a survey of scientists who study wisdom-related constructs, we established a common wisdom model, observing that empirical approaches to wisdom converge on the morally-grounded application of metacognition to reasoning and problem-solving. After outlining the function of relevant metacognitive and moral processes, we critically evaluate existing empirical approaches to measurement and offer recommendations for best practices. In the subsequent sections, we use the common wisdom model to selectively review evidence about the role of individual differences for development and manifestation of wisdom, approaches to wisdom development and training, as well as cultural, subcultural, and social-contextual differences. We conclude by discussing wisdom’s conceptual overlap with a host of other constructs and outline unresolved conceptual and methodological challenges.

The Anatomical and Biomechanical Superiority of Novel Posterior En Bloc Elevation Cervical Laminoplasty

2021 ◽  
pp. 155335062098465
Author(s):  
Dong-Lai Wang ◽  
Guo-Qing Zhu ◽  
An-Quan Huang ◽  
Hong Zhang ◽  
Chuan Feng ◽  
...  
Keyword(s):  
Biomechanical Testing ◽  
Cervical Laminoplasty ◽  
Open Door ◽  
Lateral Bending ◽  
En Bloc ◽  
Cross Sectional ◽  
Expansion Pattern ◽  
Intact Condition ◽  
Axial Symptoms ◽  
The Common

Objectives. In this study, we performed a novel type of posterior en bloc elevation cervical laminoplasty (PEEL) to keep the integrity of the posterior structure, aiming to reduce axial symptoms complicated by a conventional cervical laminoplasty procedure. Methods. Twelve human cervical cadaveric spines (C2-T1) were sequentially tested in the following order: intact condition, open-door laminoplasty (ODL) through bilateral intermuscular approach (mini-invasive ODL), PEEL, and laminectomy (LN). After bilateral transecting at the junction of lamina and lateral mass through the tubular retraction system, the PEEL procedure symmetrically elevated all the posterior structure which was further stabilized with bone grafts and titanium plates. Computed tomography (CT) scan and biomechanical testing were performed after each condition. Results. Both mini-invasive ODL and PEEL procedures were accomplished with 2 small incisions on each side. Two types of laminoplasties could enlarge the spinal canal significantly both in cross-sectional area and anteroposterior diameter comparing with intact condition. The PEEL procedure demonstrated a significantly higher enlargement rate on a canal area and a symmetrical expansion pattern. Compared with intact condition, mini-invasive ODL performed from C3-C7 demonstrated significantly decreased motion in all testing directions except the flexion range of motion (ROM); the PEEL procedure showed mild and insignificant decrease on ROM in all directions. Laminectomy resulted in a statistically significant increase in all directions except the lateral bending ROM. Conclusions. Posterior en bloc elevation cervical laminoplasty can enlarge the canal more effectively and preserve better ROM after operation than the ODL procedure. Although technically challenging, the PEEL procedure probably would decrease the common complications associated with ODL laminoplasty.

Lymph node yield in treatment naïve cases of head and neck squamous cell carcinoma: en bloc lymphadenectomy versus level-by-level dissection

2021 ◽  
pp. 1-8
Author(s):  
K Devaraja ◽  
K Pujary ◽  
B Ramaswamy ◽  
D R Nayak ◽  
N Kumar ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Lymph Node ◽  
Cell Carcinoma ◽  
Head And Neck ◽  
Neck Dissection ◽  
Squamous Cell ◽  
Neck Squamous Cell Carcinoma ◽  
En Bloc ◽  
Lymph Node Yield ◽  
Node Yield

Abstract Background Lymph node yield is an important prognostic factor in head and neck squamous cell carcinoma. Variability in neck dissection sampling techniques has not been studied as a determinant of lymph node yield. Methods This retrospective study used lymph node yield and average nodes per level to compare level-by-level and en bloc neck dissection sampling methods, in primary head and neck squamous cell carcinoma cases operated between March 2017 and February 2020. Results From 123 patients, 182 neck dissections were analysed, of which 133 were selective and the rest were comprehensive: 55 had level-by-level sampling and 127 had undergone en bloc dissection. The level-by-level method yielded more nodes in all neck dissections combined (20 vs 17; p = 0.097), but the difference was significant only for the subcohort of selective neck dissection (18.5 vs 15; p = 0.011). However, the gain in average nodes per level achieved by level-by-level sampling was significant in both groups (4.2 vs 3.33 and 4.4 vs 3, respectively; both p < 0.001). Conclusion Sampling of cervical lymph nodes level-by-level yields more nodes than the en bloc technique. Further studies could verify whether neck dissection sampling technique has any impact on survival rates.

The Behavioral Response to Heat in the Common Bed Bug,Cimex lectularius (Hemiptera: Cimicidae)

2021 ◽  
Author(s):  
Raymond Berry
Keyword(s):  
Petri Dish ◽  
Cimex Lectularius ◽  
Bed Bugs ◽  
Bed Bug ◽  
Host Interaction ◽  
Video Images ◽  
Spherical Ball ◽  
The Common ◽  
Vertebrate Hosts

AbstractThe bed bug, Cimex lectularius L., is a common ectoparasite found to live among its vertebrate hosts. Antennal segments in bugs are critical for sensing multiple cues in the environment for survival. To determine whether the thermo receptors of bed bugs are located on their antennae; innovative bioassays were created to observe the choice between heated and unheated stimuli and to characterize the response of bugs to a heat source. Additionally, the effect of complete antenectomized segments on heat detection were evaluated. Heat, carbon dioxide, and moisture are cues that are found to activate bed bug behavior; a temperature at 38°C was used to assess the direction/degree at which the insect reacts to the change in distance from said stimulus. Using a lightweight spherical ball suspended by air through a vacuum tube, bed bugs and other insects are able to move in 360° while on a stationary point. Noldus EthoVision XT was used to capture video images and to track the bed bugs during 5-min bioassays. A bioassay was created using four Petri dish arenas to observe bed bug attraction to heat based on antennae segments at 40°C. The purpose of this study was to evaluate the effects of heat on complete antenectomized segments of the antennae. The results in this experiment suggest that bed bugs detect and are attracted to heat modulated by nutritional status. Learning the involvement of antennae segments in heat detection will help identify the location and role of thermoreceptors for bed bug host interaction.

Communication Theory and Training Approaches for Multiculturally Diverse Organizations: Have Academics and Practitioners Missed the Connection?

2001 ◽  
Vol 30 (4) ◽  
pp. 445-455 ◽  
Author(s):  
Marguerite Arai ◽  
Maryanne Wanca-Thibault ◽  
Pamela Shockley-Zalabak
Keyword(s):  
Communication Theory ◽  
Diversity Training ◽  
Multicultural Training ◽  
Theory And Practice ◽  
Important Research ◽  
Human Communication ◽  
The Past ◽  
The Common ◽  
Multiculturally Diverse ◽  
And Training

While a number of articles have looked at the importance of multicultural training in the workplace over the past 30 years, there is little concrete agreement that documents the common fundamental elements of a “successful” diversity initiative. A review of the training literature suggests the importance of human communication theory and practice without including important research, methodologies, and practice from the communication discipline. This article examines formal diversity approaches, provides examples from the literature of several successful diversity initiatives in larger organizations, identifies the limited use of communication-based approaches in diversity training, and discusses the importance of integrating communication theory and practice in future training efforts.

scholarly journals Hepatic Artery Embolization prior to En Bloc Resection of an Encased Common Hepatic Artery in Adenocarcinoma of the Head of the Pancreas

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Gregory Sergeant ◽  
Erik Schadde ◽  
Geert Maleux ◽  
Raymond Aerts
Keyword(s):  
Portal Vein ◽  
Hepatic Artery ◽  
Balloon Dilation ◽  
En Bloc Resection ◽  
Common Hepatic Artery ◽  
Pathological Examination ◽  
Periampullary Cancer ◽  
En Bloc ◽  
Head Of The Pancreas ◽  
The Common

A 64-year-old female patient with adenocarcinoma of the head of the pancreas with encasement of the common hepatic artery and portal vein stenosis was reexplored after six cycles of gemcitabine (1000 mg/m2). Prior to surgery, the patient underwent balloon dilation and stenting of the portal vein in addition to successful coil embolisation of the common hepatic artery, proper hepatic artery, and proximal gastroduodenal artery. After embolisation, a pylorus-preserving pancreaticoduodenectomy was performed with resection of the common hepatic artery and portal vein confluens. Pathological examination showed a moderately differentiated pT3N0 (Stage IIa, TNM 7th edition) tumor with negative section margins. We show with this case that in selected cases of periampullary cancer with encasement of the common hepatic artery, it is technically feasible to perform pancreaticoduodenectomy with hepatic artery resection and negative surgical margins. Nevertheless, the oncological benefit of extended arterial resections remains controversial.

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