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.

scholarly journals Assessment of Preoperative Liver Function for Surgical Decision Making in Patients with Hepatocellular Carcinoma

Liver Cancer ◽  
2019 ◽  
Vol 8 (6) ◽  
pp. 447-456 ◽  
Author(s):  
Takashi Kokudo ◽  
Kiyoshi Hasegawa ◽  
Chikara Shirata ◽  
Meguri Tanimoto ◽  
Takeaki Ishizawa ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Decision Making ◽  
Liver Function ◽  
Surgical Decision ◽  
Surgical Decision Making ◽  
Preoperative Liver Function

Intraoperative contrast-enhanced ultrasound can have a crucial role in surgical decision-making during hepato-pancreatico-biliary surgery –Analysis of impact and input

2021 ◽  
pp. 1-14
Author(s):  
Jens Martin Werner ◽  
Martin Zidek ◽  
Sylvia Kammerer ◽  
Natascha Platz Batista da Silva ◽  
Friedrich Jung ◽  
...  
Keyword(s):  
Decision Making ◽  
Malignant Lesion ◽  
Ultrasound Elastography ◽  
Contrast Enhanced Ultrasound ◽  
Benign Lesions ◽  
Surgical Decision ◽  
Contrast Enhanced ◽  
Significant Difference ◽  
The Impact ◽  
Surgical Decision Making

OBJECTIVE: To assess the impact and procedural input of intraoperative ultrasound (IOUS) with contrast-enhanced ultrasound (CEUS) and ultrasound elastography on surgical decision making during the procedure and consequently the out-come after hepato-pancreatico-biliary (HPB) surgery. MATERIALS AND METHODS: Data of 50 consecutive patients, who underwent HPB surgery from 04/2018 to 07/2018 were prospectively collected for this study. During surgery, IOUS with a high-resolution ultrasound device using CEUS after bolus injection of 2.4–5 ml Sulphur hexafluoride microbubbles using a 6–9 MHz probe and a share wave and strain elastography was performed by an experienced examiner. Process and time analysis were carried out using mobile phone timer. RESULTS: The IOUS with CEUS and elastography correctly identified 42 malignant tumors and 4 benign lesions. In 3 cases, the examination provided false positive result (identifying 3 benign lesions as malignant) and in 1 case a malignant lesion was incorrectly assessed as benign (sensitivity 97,7%, specificity 57,1%, PPV 93,3% and NPV 80%). The specific question by the surgeon could be answered successfully in 98% of the cases. In 76% of the cases, there was a modification (42%) or a fundamental change (34%) of the planned surgical approach due to the information provided by the IOUS. Within the last group, the IOUS had a major impact on therapy outcome. In 7 patients an additional tumor resection was required, in 5 patients the tumor was assessed as inoperable, and in total in 5 patients an intraoperative RFA (4/5) or postoperative RITA (1/5) was required. Regarding procedural input, there was only a slight, but significant difference between the transport and set-up times before the intraoperative use (mean: 14 min 22 s) and the return transport (mean 13 min 6 s), (p = 0,038). The average examination time was 14 minutes, which makes only one third of the overall time demand. CONCLUSION: Combination of IOUS with CEUS and elastography in oncological HPB surgery provides valuable information that affects surgical decision-making. The procedural input of about 45 minutes seems to be a good investment considering the improvement of the surgical procedure and a significant modification of the therapy approach in the majority of the cases.

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