Publications
2252 results found
Paloc C, Kitney RI, Bello F, et al., 2001, Virtual reality surgical training and assessment system, 15th International Congress and Exhibition on Computer Assisted Radiology and Surgery, Publisher: ELSEVIER SCIENCE BV, Pages: 207-212, ISSN: 0531-5131
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- Citations: 2
Gillies DF, Datta V, Mackay S, et al., 2001, Motion analysis in the assessment of surgical skill, Computer Methods in Biomechanics and Biomedical Engineering, Vol: 4, Pages: 515-523, ISSN: 1025-5842
Benoist S, Taffinder N, Gould S, et al., 2001, Transanal endoscopic microsurgery; a forgotten minimally invasive technique, Gastroenterol Clin Biol, Vol: 25, Pages: 369-374
Wong T, Darzi A, Foale RA, et al., 2001, A novel computerised virtual reality permanent: Pacing implantation simulator, 28th Annual Meeting on Computers in Cardiology, Publisher: IEEE, Pages: 553-555, ISSN: 0276-6574
Law PR, Danin J, Lamb GM, et al., 2000, Dynamic MR imaging of the pelvic floor using an open configuration magnetic resonance scanner, RADIOLOGY, Vol: 217, Pages: 326-326, ISSN: 0033-8419
Darzi A, 2000, Hand-assisted laparoscopic colorectal surgery, SURGICAL ENDOSCOPY-ULTRASOUND AND INTERVENTIONAL TECHNIQUES, Vol: 14, Pages: 999-1004, ISSN: 0930-2794
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- Citations: 37
Smith S, Torkington J, Taffinder N, et al., 2000, The objective assessment of surgical skill, MINIMALLY INVASIVE THERAPY & ALLIED TECHNOLOGIES, Vol: 9, Pages: 315-319, ISSN: 1364-5706
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- Citations: 3
, 2000, Hand-assisted laparoscopic surgery vs standard laparoscopic surgery for colorectal disease: a prospective randomized trial. HALS Study Group., Surg Endosc, Vol: 14, Pages: 896-901, ISSN: 0930-2794
BACKGROUND: We compare the use of the HandPort(TM)device in hand-assisted laparoscopic surgery (HALS) to standard laparoscopic surgery (SLS) in the treatment of colorectal disease. METHODS: A prospective, randomized, multicenter study was conducted with the participation of 10 advanced laparoscopic surgeons. Forty patients with indications for elective resection of benign colorectal disease or incurable malignant disease were randomized to one of the two treatment arms (22 HALS, 18 SLS). Main outcome measures included operative time, blood loss, HandPort(TM) performance, postoperative pain, time to oral intake, return of bowel function, length of stay, morbidity, and functional recovery. RESULTS: The patients in each group were similar with regard to age, sex, weight, diagnosis, coexisting medical disease, and preoperative functional status. Operative time was comparable for hand-assisted laparoscopy (152 +/- 66 min) and standard laparoscopy (141 +/- 54 min) (p = 0.58). Incision length for specimen extraction/bowel anastomosis was similar (HALS 7.4 cm vs SLS 7.0 cm). Three of 22 HALS cases (14%) were converted, as compared with four of 18 (22%) in the laparoscopy group (p = 0.68). Return of bowel function occurred by the 3rd postoperative day for the majority of patients in both groups (HALS 77%, SLS 78%). There was no difference in length of stay (HALS 7.0 days [range, 2-12] vs SLS 6.0 days [range, 2-10], p = 0.25). Severity of postoperative pain and rate of functional recovery were equivalent. One major complication occurred in each group. There were three wound infections in the laparoscopy group. No patient required reoperation, and there were no deaths. CONCLUSIONS: Hand-assisted laparoscopic surgery is safe and effective for benign and noncurative colorectal resection. As compared to standard laparoscopic surgery, hand-assisted laparoscopy retains the benefits of minimally invasive surgery and may allow the surgeon to perform complex operations more easily.
Wan A, Darzi A, 2000, Investigation of colonic disease, HOSPITAL MEDICINE, Vol: 61, Pages: 692-697, ISSN: 1462-3935
Darzi A, Moorthy K, 2000, Fatal and life-threatening complications in antireflux surgery: analysis of 5502 operations., Br J Surg, Vol: 87, Pages: 967-968, ISSN: 0007-1323
Litwin DE, Darzi A, Jakimowicz J, et al., 2000, Hand-assisted laparoscopic surgery (HALS) with the HandPort system: initial experience with 68 patients., Ann Surg, Vol: 231, Pages: 715-723, ISSN: 0003-4932
OBJECTIVE: To evaluate the feasibility and potential benefits of hand-assisted laparoscopic surgery with the HandPort System, a new device. SUMMARY BACKGROUND DATA: In hand-assisted laparoscopic surgery, the surgeon inserts a hand into the abdomen while pneumoperitoneum is maintained. The hand assists laparoscopic instruments and is helpful in complex laparoscopic cases. METHODS: A prospective nonrandomized study was initiated with the participation of 10 laparoscopic surgical centers. Surgeons were free to test the device in any situation where they expected a potential advantage over conventional laparoscopy. RESULTS: Sixty-eight patients were entered in the study. Operations included colorectal procedures (sigmoidectomy, right colectomy, resection rectopexy), splenectomy for splenomegaly, living-related donor nephrectomy, gastric banding for morbid obesity, partial gastrectomy, and various other procedures. Mean incision size for the HandPort was 7.4 cm. Most surgeons (78%) preferred to insert their nondominant hand into the abdomen. Pneumoperitoneum was generally maintained at 14 mmHg, and only one patient required conversion to open surgery as a result of an unmanageable air leak. Hand fatigue during surgery was noted in 20.6%. CONCLUSIONS: The hand-assisted technique appeared to be useful in minimally invasive colorectal surgery, splenectomy for splenomegaly, living-related donor nephrectomy, and procedures considered too complex for a laparoscopic approach. This approach provides excellent means to explore, to retract safely, and to apply immediate hemostasis when needed. Although the data presented here reflect the authors' initial experience, they compare favorably with series of similar procedures performed purely laparoscopically.
Sebire NJ, Osborn M, Darzi A, et al., 2000, Appendiceal adenocarcinoma with ovarian metastases in the third trimester of pregnancy, JOURNAL OF THE ROYAL SOCIETY OF MEDICINE, Vol: 93, Pages: 192-193, ISSN: 0141-0768
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- Citations: 5
Torkington J, Smith SGT, Rees BI, et al., 2000, The role of simulation in surgical training, ANNALS OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND, Vol: 82, Pages: 88-94, ISSN: 0035-8843
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- Citations: 112
Baldota S, Breach C, Murtuza B, et al., 2000, Chicken bone injury of the common bile duct, JOURNAL OF THE ROYAL SOCIETY OF MEDICINE, Vol: 93, Pages: 84-84, ISSN: 0141-0768
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- Citations: 5
Lamb GM, de Jode MG, Gould SW, et al., 2000, Upright dynamic MR defaecating proctography in an open configuration MR system, BRITISH JOURNAL OF RADIOLOGY, Vol: 73, Pages: 152-155, ISSN: 0007-1285
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- Citations: 24
Torkington J, Smith S, Rees B, et al., 2000, Optimising the acquisition of laparoscopic skill, Minimally Invasive Therapy and Allied Technologies, Vol: 9, Pages: 307-309, ISSN: 1364-5706
Minimal-access surgery requires the surgeon to integrate a number of skills that are not normally encountered in conventional open surgery. Any complex motor skill can be broken down into a number of components and it is possible that addressing these individual parts may enhance the overall acquisition of such skills. This article examines the components of what constitutes ability for minimal-access surgery.
Passmore PJ, Read OJ, Nielsen CF, et al., 2000, Effects of perspective and stereo on depth judgements in virtual reality laparoscopy simulation., Pages: 243-245, ISSN: 0926-9630
Taffinder N, Smith SGT, Huber J, et al., 1999, The effect of a second-generation 3D endoscope on the laparoscopic precision of novices and experienced surgeons, SURGICAL ENDOSCOPY-ULTRASOUND AND INTERVENTIONAL TECHNIQUES, Vol: 13, Pages: 1087-1092, ISSN: 0930-2794
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- Citations: 186
Crowhurst J, Plaat F, 1999, A reply, Anaesthesia, Vol: 54, Pages: 1117-1118, ISSN: 0003-2409
Smith SG, Torkington J, Darzi A, 1999, Objective assessment of surgical dexterity using simulators., Hosp Med, Vol: 60, Pages: 672-675, ISSN: 1462-3935
Surgical skill, like training for any craft, has traditionally been learnt as an apprenticeship. However, whereas carpenters learn on wood that is never displayed, operative training is done on real clinical cases. Over recent years surgical skills training laboratories have in part, replaced the apprenticeship. This article discusses some of the tools used within such laboratories to ensure optimal surgical performance.
Smith SGT, Torkington J, Darzi A, 1999, Objective assessment of surgical dexterity using simulators, HOSPITAL MEDICINE, Vol: 60, Pages: 672-+, ISSN: 1462-3935
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- Citations: 20
Gul YA, Wan ACT, Darzi A, 1999, Undergraduate surgical teaching utilizing telemedicine, MEDICAL EDUCATION, Vol: 33, Pages: 596-599, ISSN: 0308-0110
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- Citations: 42
Taffinder NJ, Gould SW, Wan AC, et al., 1999, Rigid videosigmoidoscopy vs conventional sigmoidoscopy. A randomized controlled study., Surg Endosc, Vol: 13, Pages: 814-816, ISSN: 0930-2794
BACKGROUND: Not only is rigid sigmoidoscopy uncomfortable for patients, but visualisation of the rectosigmoid junction and sigmoid colon is successful in only 40-70% of examinations. A novel fine-bore rigid videosigmoidoscope is described and then compared with a rigid conventional sigmoidoscope for patient discomfort and length of insertion. METHOD: A total of 58 patients were examined with both sigmoidoscopes in a random order. Discomfort was scored on a visual analogue scale; length of insertion was scored by the surgeon. Patients were blinded to which sigmoidoscope was being used. The images from the video examination were transmitted in real time for a second opinion in a different hospital. RESULTS: The mean (SD) insertion distance of the videosigmoidoscope was 23.2 (5.9) cm, which was significantly further than with the conventional sigmoidosocpe 16.5 (3.8) cm (p < 0.01). The discomfort on a visual analogue score for the videosigmoidoscope was 3.0 (1.8), which was significantly less than for the conventional sigmoidoscope 5.5 (2.7) (p < 0.01). The five users of the equipment (four surgeons and one colorectal nurse practitioner) preferred the videosigmoidoscope for image quality and ease of examination. CONCLUSIONS: A thinner, longer, rigid videosigmoidoscope is a more effective means of looking at the proximal sigmoid colon. Despite being inserted further, it caused less discomfort than the conventional sigmoidoscope. High-quality video images can be recorded or transmitted for real-time teleconsultation.
, 1999, Laparoscopic versus open repair of groin hernia: a randomised comparison. The MRC Laparoscopic Groin Hernia Trial Group., Lancet, Vol: 354, Pages: 185-190, ISSN: 0140-6736
BACKGROUND: Repair of a groin hernia is one of the most common elective operations performed in general surgery. Our aim was to compare laparoscopic repair with open repair of groin hernia. METHODS: 928 patients with groin hernia, from 26 hospitals in the UK and Ireland, were randomly assigned to laparoscopic repair (n=468) or to open hernia repair (n=460, of which 433 were tension-free mesh repairs). Patients were clinically assessed at 1 week and 1 year after surgery, and were sent questionnaires at 3 months and 1 year. The primary endpoints were: complications; return to usual activities of social life (as the most generally applicable example of return to usual activities); hernia recurrence; groin pain that persisted at 1 year; and costs to the health services. All analyses were by intention to treat. FINDINGS: At 1 week, at least one complication was found in 108 (29.9%) patients allocated to laparoscopic repair and in 155 (43.5%) patients allocated to open repair (95% CI for difference -20.6% to -6.6%, p<0.001). There were three serious surgical complications all of which occurred in the laparoscopic group. Patients in the laparoscopic group returned to the usual activities of social life sooner than the patients in the open repair group (10 [IQR 7-21] vs 14 [7-28] days, p=0.004). At 1 year after the operation, the laparoscopic group had a lower rate of persistent groin pain than those who had open repair (28.7% vs 36.7% [95% CI for difference -14.7% to -1.4%], p=0.018). However, all seven hernia recurrences occurred in the laparoscopic group and not in the open repair group (1.9% vs 0.0% [95% CI for difference 0.5% to 3.4%], p=0.017). INTERPRETATION: Although laparoscopic hernia repair has advantages for patients, concerns about safety indicate that open repair is the more appropriate option for the general surgeon. Our findings lend support to the move towards laparoscopic hernia surgery becoming part of the domain of specialist surgeons.
O'Dwyer P, Macintyre I, Grant A, et al., 1999, Laparoscopic versus open repair of groin hernia: a randomised comparison, LANCET, Vol: 354, Pages: 185-190, ISSN: 0140-6736
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- Citations: 229
Darzi A, 1999, Minimal access surgery. Welded bliss?, Health Serv J, Vol: 109, Pages: suppl 6-7-9, ISSN: 0952-2271
Gould SW, Gedroyc W, Darzi A, 1999, Laparoscopic surgery in a 0.5-t interventional magnetic resonance unit., Surg Endosc, Vol: 13, Pages: 604-610, ISSN: 0930-2794
BACKGROUND: Intraoperative imaging using magnetic resonance imaging (MRI) is now possible in interventional MR (IMR) units. Magnetic resonance imaging has potential advantages over other methods used to guide surgery. These advantages include visualization of structures deep to the two-dimensional endoscopic image and clarification of surgical anatomy. This study investigates the feasibility of laparoscopic surgery with intraoperative imaging within an IMR unit. METHODS: The procedures were performed in a 0. 5-T General Electric IMR scanner. Surgical ergonomics and intraoperative imaging were investigated by performing 10 laparoscopic cholecystectomies on porcine livers in a simulator using magnet-safe laparoscopic instruments and an ultrasonic scalpel for dissection. Intraoperative MR cholangiography (MRC) was performed using T2-weighted fast-spin-echo (FSE) and single-shot fast-spin-echo (ssFSE) techniques with maximal intensity projection (MIP) reconstruction. Two laparoscopic cholecystectomies then were performed on human patients with intraoperative MRC using similar techniques. RESULTS: The simulated procedures allowed the development of surgical techniques appropriate to this environment. Both FSE and ssFSE produced reasonable quality intraoperative images. Both patient procedures were performed without complication. The FSE imaging was of poor quality. However, ssFSE produced intraoperative images of the gallbladder with partial visualization of the extrahepatic biliary tree. CONCLUSIONS: Laparoscopic surgery in an IMR unit is technically possible. Currently, intraoperative MRC is difficult, and FSE imaging is very subject to movement artifact. However, the faster ssFSE, with further development, may be a useful technique for intraoperative imaging of the biliary tree during MR-guided surgery.
Puttick MI, Scott-Coombes DM, Dye J, et al., 1999, Comparison of immunologic and physiologic effects of CO<sub>2</sub> pneumoperitoneum at room and body temperatures, SURGICAL ENDOSCOPY-ULTRASOUND AND INTERVENTIONAL TECHNIQUES, Vol: 13, Pages: 572-575, ISSN: 0930-2794
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- Citations: 53
Darzi A, Smith S, Taffinder N, 1999, Assessing operative skill - Needs to become more objective, BRITISH MEDICAL JOURNAL, Vol: 318, Pages: 887-888, ISSN: 0959-8138
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- Citations: 272
Darzi A, Smith S, Taffinder N, 1999, Assessing operative skill, British Medical Journal, Vol: 318, Pages: 887-888, ISSN: 0959-8146
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- Citations: 307
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