scholarly journals Communicating imaging findings in peritoneal mesothelioma: the impact of ‘PAUSE’ on surgical decision-making

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Anuradha Chandramohan ◽  
Nehal Shah ◽  
Andrew Thrower ◽  
Norman John Carr ◽  
Rohin Mittal ◽  
...  
Keyword(s):  
Decision Making ◽  
Peritoneal Mesothelioma ◽  
High Morbidity ◽  
Low Grade ◽  
Imaging Findings ◽  
Term Survival ◽  
Surgical Decision ◽  
Crs And Hipec ◽  
The Impact ◽  
Surgical Decision Making

AbstractThe peritoneal cavity is the second commonest site of mesothelioma after the pleural cavity. There are five histological types of peritoneal mesothelioma with variable symptomatology, clinical presentation and prognosis. Cystic mesothelioma is a borderline malignant neoplasm with a favourable prognosis, well-differentiated papillary mesothelioma is generally a low-grade malignancy, and all other varieties such as epithelioid, sarcomatoid and biphasic mesothelioma are highly malignant types of peritoneal mesothelioma with poor prognosis. Malignant peritoneal mesothelioma was considered inevitably fatal prior to the introduction of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in selected cases where long-term survival and cure could be achieved. However, the survival benefits following CRS and HIPEC mainly depend on completeness of cytoreduction, which come at the cost of high morbidity and potential mortality. Using the acronym ‘PAUSE’, we aimed at describing the key imaging findings that impact surgical decision-making in patients with peritoneal mesothelioma. PAUSE stands for peritoneal cancer index, ascites and abdominal wall disease, unfavourable sites of involvement, small bowel and mesenteric disease and extraperitoneal disease. Reporting components of ‘PAUSE’ is crucial for patient selection. Despite limitations of CT in accurately depicting the volume of disease, describing findings in terms of PAUSE plays an important role in excluding patients who might not benefit from CRS and HIPEC.

scholarly journals Understanding Surgical Decision Making in Early Hepatocellular Carcinoma

2011 ◽  
Vol 29 (6) ◽  
pp. 619-625 ◽  
Author(s):  
Hari Nathan ◽  
John F.P. Bridges ◽  
Richard D. Schulick ◽  
Andrew M. Cameron ◽  
Kenzo Hirose ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Decision Making ◽  
Independent Effect ◽  
Clinical Factors ◽  
Surgical Decision ◽  
Early Hepatocellular Carcinoma ◽  
Early Hcc ◽  
The Impact ◽  
Surgical Decision Making ◽  
Choice Of Therapy

Purpose The choice between liver transplantation (LT), liver resection (LR), and radiofrequency ablation (RFA) as initial therapy for early hepatocellular carcinoma (HCC) is controversial, yet little is known about how surgeons choose therapy for individual patients. We sought to quantify the impact of both clinical factors and surgeon specialty on surgical decision making in early HCC by using conjoint analysis. Methods Surgeons with an interest in liver surgery were invited to complete a Web-based survey including 10 case scenarios. Choice of therapy was then analyzed by using regression models that included both clinical factors and surgeon specialty (non-LT v LT). Results When assessing early HCC occurrences, non-LT surgeons (50% LR; 41% LT; 9% RFA) made significantly different recommendations compared with LT surgeons (63% LT; 31% LR; 6% RFA; P < .001). Clinical factors, including tumor number and size, type of resection required, and platelet count, had significant effects on the choice between LR, LT, and RFA. After adjusting for clinical factors, non-LT surgeons remained more likely than LT surgeons to choose LR compared with LT (relative risk ratio [RRR], 2.67). When the weight of each clinical factor was allowed to vary by surgeon specialty, the residual independent effect of surgeon specialty on the decision between LR and LT was negligible (RRR, 0.93). Conclusion The impact of surgeon specialty on choice of therapy for early HCC is stronger than that of some clinical factors. However, the influence of surgeon specialty does not merely reflect an across-the-board preference for one therapy over another. Rather, certain clinical factors are weighed differently by surgeons in different specialties.

Influential Forces in Breast Cancer Surgical Decision Making and the Impact on Body Image and Sexual Function

2016 ◽  
Vol 23 (10) ◽  
pp. 3403-3411 ◽  
Author(s):  
Rebecca M. Kwait ◽  
Sarah Pesek ◽  
Michaela Onstad ◽  
David Edmonson ◽  
Melissa A. Clark ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Body Image ◽  
Sexual Function ◽  
Surgical Decision ◽  
The Impact ◽  
Surgical Decision Making

The Impact of Preoperative Angiographic Identification of the Artery of Adamkiewicz on Surgical Decision Making in Patients Undergoing Thoracolumbar Corpectomy

Spine ◽  
2015 ◽  
Vol 40 (15) ◽  
pp. 1194-1199 ◽  
Author(s):  
Andrew A. Fanous ◽  
Lindsay J. Lipinski ◽  
Chandan Krishna ◽  
Eric P. Roger ◽  
Adnan H. Siddiqui ◽  
...  
Keyword(s):  
Decision Making ◽  
Surgical Decision ◽  
Artery Of Adamkiewicz ◽  
The Impact ◽  
Surgical Decision Making

scholarly journals Understanding the impact of breast reconstruction on the surgical decision-making process for breast cancer

Cancer ◽  
2008 ◽  
Vol 112 (3) ◽  
pp. 489-494 ◽  
Author(s):  
Amy K. Alderman ◽  
Sarah T. Hawley ◽  
Jennifer Waljee ◽  
Mahasin Mujahid ◽  
Monica Morrow ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Breast Reconstruction ◽  
Decision Making Process ◽  
Surgical Decision ◽  
The Impact ◽  
Surgical Decision Making

The impact of radioimmunoguided surgery (RIGSTM) on surgical decision-making in colorectal cancer

1989 ◽  
Vol 32 (11) ◽  
pp. 927-932 ◽  
Author(s):  
Carol A. Nieroda ◽  
Cathy Mojzisik ◽  
Armando Sardi ◽  
Peter Ferrara ◽  
George Hinkle ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Decision Making ◽  
Radioimmunoguided Surgery ◽  
Surgical Decision ◽  
The Impact ◽  
Surgical Decision Making

scholarly journals The Click-On gamma probe, a second-generation tethered robotic gamma probe that improves dexterity and surgical decision-making

2021 ◽  
Author(s):  
Samaneh Azargoshasb ◽  
Simon van Alphen ◽  
Leon J. Slof ◽  
Giuseppe Rosiello ◽  
Stefano Puliatti ◽  
...  
Keyword(s):  
Decision Making ◽  
Invasive Surgery ◽  
Gamma Probe ◽  
Minimal Invasive ◽  
Task Completion ◽  
Computer Assisted ◽  
Surgical Decision ◽  
Press Fit ◽  
The Impact ◽  
Surgical Decision Making

Abstract Purpose Decision-making and dexterity, features that become increasingly relevant in (robot-assisted) minimally invasive surgery, are considered key components in improving the surgical accuracy. Recently, DROP-IN gamma probes were introduced to facilitate radioguided robotic surgery. We now studied if robotic DROP-IN radioguidance can be further improved using tethered Click-On designs that integrate gamma detection onto the robotic instruments themselves. Methods Using computer-assisted drawing software, 3D printing and precision machining, we created a Click-On probe containing two press-fit connections and an additional grasping moiety for a ProGrasp instrument combined with fiducials that could be video tracked using the Firefly laparoscope. Using a dexterity phantom, the duration of the specific tasks and the path traveled could be compared between use of the Click-On or DROP-IN probe. To study the impact on surgical decision-making, we performed a blinded study, in porcine models, wherein surgeons had to identify a hidden 57Co-source using either palpation or Click-On radioguidance. Results When assembled onto a ProGrasp instrument, while preserving grasping function and rotational freedom, the fully functional prototype could be inserted through a 12-mm trocar. In dexterity assessments, the Click-On provided a 40% reduction in movements compared to the DROP-IN, which converted into a reduction in time, path length, and increase in straightness index. Radioguidance also improved decision-making; task-completion rate increased by 60%, procedural time was reduced, and movements became more focused. Conclusion The Click-On gamma probe provides a step toward full integration of radioguidance in minimal invasive surgery. The value of this concept was underlined by its impact on surgical dexterity and decision-making.

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