28 results found
Van Den Heede K, Chidambaram S, Winter Beatty J, et al., 2021, The PanSurg-PREDICT Study: endocrine surgery during the COVID-19 pandemic, World Journal of Surgery, Vol: 45, Pages: 2315-2324, ISSN: 0364-2313
BACKGROUND: In the midst of the COVID-19 pandemic, patients have continued to present with endocrine (surgical) pathology in an environment depleted of resources. This study investigated how the pandemic affected endocrine surgery practice. METHODS: PanSurg-PREDICT is an international, multicentre, prospective, observational cohort study of emergency and elective surgical patients in secondary/tertiary care during the pandemic. PREDICT-Endocrine collected endocrine-specific data alongside demographics, COVID-19 and outcome data from 11-3-2020 to 13-9-2020. RESULTS: A total of 380 endocrine surgery patients (19 centres, 12 countries) were analysed (224 thyroidectomies, 116 parathyroidectomies, 40 adrenalectomies). Ninety-seven percent were elective, and 63% needed surgery within 4 weeks. Eight percent were initially deferred but had surgery during the pandemic; less than 1% percent was deferred for more than 6 months. Decision-making was affected by capacity, COVID-19 status or the pandemic in 17%, 5% and 7% of cases. Indication was cancer/worrying lesion in 61% of thyroidectomies and 73% of adrenalectomies and calcium 2.80 mmol/l or greater in 50% of parathyroidectomies. COVID-19 status was unknown at presentation in 92% and remained unknown before surgery in 30%. Two-thirds were asked to self-isolate before surgery. There was one COVID-19-related ICU admission and no mortalities. Consultant-delivered care occurred in a majority (anaesthetist 96%, primary surgeon 76%). Post-operative vocal cord check was reported in only 14% of neck endocrine operations. Both of these observations are likely to reflect modification of practice due to the pandemic. CONCLUSION: The COVID-19 pandemic has affected endocrine surgical decision-making, case mix and personnel delivering care. Significant variation was seen in COVID-19 risk mitigation measures. COVID-19-related complications were uncommon. This analysis demonstrates the safety of endocrine surgery during this
Van Den Heede K, Tolley NS, Di Marco AN, et al., 2021, Differentiated Thyroid Cancer: A Health Economic Review, CANCERS, Vol: 13
Gavriilidis P, Camenzuli C, Paspala A, et al., 2020, Posterior Retroperitoneoscopic Versus Laparoscopic Transperitoneal Adrenalectomy: A Systematic Review by an Updated Meta-Analysis, WORLD JOURNAL OF SURGERY, Vol: 45, Pages: 168-179, ISSN: 0364-2313
Di Marco AN, Glover A, Sywak MS, et al., 2020, Letter to the Editor: Reoperation for Bleeding After Thyroid and Parathyroid Surgery: Incidence, Risk Factors, Prevention, and Management, WORLD JOURNAL OF SURGERY, Vol: 44, Pages: 2441-2442, ISSN: 0364-2313
Di Marco AN, Palazzo FF, 2020, Near-infrared autofluorescence in thyroid and parathyroid surgery, GLAND SURGERY, Vol: 9, Pages: S136-S146, ISSN: 2227-684X
Isaacs K, Belete S, Miller B, et al., 2019, Video‐assisted thoracoscopic surgery for ectopic mediastinal parathyroid adenoma, BJS Open, Vol: 3, Pages: 743-749, ISSN: 2474-9842
Background: Primary hyperparathyroidism (pHPT) caused by an ectopic mediastinal parathyroid adenoma is uncommon. In the past, when the adenoma was not accessible from the neck, median sternotomy was advocated for safe and successful parathyroidectomy. Video-assisted thoracoscopic surgical (VATS) parathyroidectomy represents a modern alternative approach for this problem.Methods: Information was obtained related to patients undergoing VATS from a specific database, including clinical presentation, biochemistry, pre-operative imaging, surgical approach and patient outcomes. A comprehensive literature review was undertaken to draw comparisons with other publications.Results: Over a 2-year period, 9 patients underwent VATS parathyroidectomy for sporadic pHPT, of whom five had persistent pHPT following previous unsuccessful parathyroidectomy via cervicotomy, while four had had no previous parathyroid surgery. The mean operating time was 101 minutes (range 60 – 160). 8 patients were biochemically cured, with no major complications. 1 patient required conversion to a median sternotomy for removal of a thymoma that had resulted in false positive preoperative imaging.Conclusion: With appropriate pre-operative imaging, multidisciplinary input and expertise, VATS parathyroidectomy is an effective, safe and well-tolerated approach to an ectopic mediastinal parathyroid adenoma.
DiMarco AN, Wong MS, Jayasekara J, et al., 2019, Risk of needing completion thyroidectomy for low‐risk papillary thyroid cancers treated by lobectomy, BJS Open, Vol: 3, Pages: 299-304, ISSN: 2474-9842
BackgroundLow‐risk differentiated thyroid cancers may, according to the American Thyroid Association (ATA) 2015 guidelines, be managed initially with lobectomy. However, definitive risk categorization requires pathological assessment of the specimen, resulting in completion thyroidectomy being recommended when discordance between preoperative and postoperative staging occurs. This study sought to establish the expected rate of completion thyroidectomy in patients with papillary thyroid cancer (PTC) treated by lobectomy.MethodsPatients with PTC treated over 5 years (2013–2017 inclusive) and meeting the ATA criteria for lobectomy were identified from the prospectively developed database of a high‐volume, university department of endocrine surgery. Concordance between the ATA initial and final recommendation, and the putative rate of completion thyroidectomy were calculated. Multivariable analysis was used to assess preoperative factors as predictors of the need for total thyroidectomy.ResultsOf 275 patients with PTC who met ATA preoperative criteria for lobectomy there was concordance between this and the final recommendation in 158 (57·5 per cent) and discordance in 117 (43·5 per cent). Most common reasons for discordance were: angioinvasion (30·8 per cent), local invasion (23·9 per cent) or both (20·5 per cent). Four patients (1·5 per cent) had permanent hypoparathyroidism. On multivariable analysis, age, sex, tumour size and family history did not independently predict the final treatment required.ConclusionAlthough many patients may be treated adequately with lobectomy, just under half would require completion thyroidectomy. Further work is needed on preoperative risk stratification but, before this, total thyroidectomy remains the treatment of choice for low‐risk 1–4‐cm PTC in the hands of high‐volume thyroid surgeons who can demonstrate low complication rates.
Di Marco A, Chotalia R, Bloxham R, et al., 2019, Autofluorescence in parathyroidectomy: signal intensity correlates with serum calcium and parathyroid hormone but routine clinical use is not justified, World Journal of Surgery, Vol: 43, Pages: 1532-1537, ISSN: 1432-2323
BACKGROUND: The inability to identify the pathological gland at surgery results in failure to cure hyperparathyroidism in 2-5%. The poorly understood characteristic of parathyroid tissue to manifest autofluorescence (AF) under near-infrared (NIR) light has been promoted as an intraoperative adjunct in parathyroid surgery. This study sought to explore potential clinical correlates for AF and assess the clinical utility of AF in parathyroid surgery. METHODS: Consecutive patients undergoing parathyroid surgery for primary and renal disease were included. NIR imaging was used intraoperatively and the degree of AF of parathyroid glands graded by the operating surgeon. Variables assessed for correlation with AF were: pre-operative serum calcium and PTH, SestaMIBI positivity, gland weight and histological composition. RESULTS: Ninety-six patients underwent parathyroidectomy over an 8-month period: 49 bilateral explorations, 41 unilateral and 6 focussed lateral approaches: 284 potentially 'visualisable' glands in total. Two hundred and fifty-seven glands (90.5%) were visualised with NIR. Correlation was found between the degree of fluorescence and pre-operative serum calcium and PTH, but not between gland weight and SestaMIBI positivity. In those with renal hyperparathyroidism, a predominance of oxyphil cells correlated with increased AF. CONCLUSION: Autofluorescence intensity correlates with serum calcium, PTH and gland composition. Further refinements would be required for this information to be of value in a clinical setting. Improvements allowing NIR to visualise the additional 9.5% of parathyroids and overcome the variation in signal intensity due to depth of access are required for the routine adoption of this technology. At present, its routine use in a clinical setting cannot be justified.
Di Marco A, Meeran K, Christakis I, et al., 2019, Seventeen cases of primary hyperparathyroidism in pregnancy: a call for management guidelines, Journal of the Endocrine Society, Vol: 3, Pages: 1009-1021, ISSN: 2472-1972
IntroductionThe risks of primary hyperparathyroidism (pHPT) to pregnant women and their fetuses are well-reported and appear to increase commensurate with serum calcium. The management strategy of pHPT must be adapted in pregnancy and should reflect the severity of hypercalcaemia. However, no guidelines exist to assist clinicians facing this dilemma.MethodsThe experience of a high-volume multidisciplinary endocrine surgical service in managing a consecutive series of pregnant women with pHPT referred for parathyroidectomy is presented and compared to a non-pregnant cohort with pHPT. Evidence in the published literature is explored via a review on pHPT and pregnancy outcomes.ResultsSeventeen pregnant women and 247 age range-matched non-pregnant women with pHPT were referred for surgery over 11 years. Serum calcium was higher in the pregnant cohort 2.89mmol/l vs 2.78mmol/l (p=0.03). Pre-operative localisation with ultrasound succeeded in 8(47%) pregnant women and SestaMIBI in 2/6(33% imaged pre-conception) compared to 84(34%) and 102(42%) controls (NS at 0.36 and 0.59). Parathyroidectomy was performed under general anaesthesia between 12 and 28 weeks gestation, with no adverse pregnancy outcomes resulting. Cure rate was 100% vs 96% in controls.ConclusionspHPT in pregnancy is a threat to mother and child. Medical management may be appropriate in mild disease (serum calcium <0.25mmol/l above the normal range) but in moderate-severe disease, parathyroidectomy under general anaesthesia in the second trimester is safe. Localisation using ionising radiation/MRI is unnecessary as surgical intervention in a high-volume multi-disciplinary setting has excellent outcomes. Guidelines on the topic would assist clinicians in this complex decision-making process.
Di Marco AN, Chotalia R, Bloxham R, et al., 2018, Autofluorescence in Parathyroidectomy: Clinically Valuable Correlations?, European Society of Endocrine Surgeons
DiMarco A, Christakis I, Constantinides V, et al., 2018, Undiagnosed Primary Hyperparathyroidism and Recurrent Miscarriage: The First Prospective Pilot Study., World Journal of Surgery, Vol: 42, Pages: 639-645, ISSN: 1432-2323
BACKGROUND: Primary hyperparathyroidism (pHPT) in pregnancy is reported to be associated with significant maternal and foetal complications and an up to threefold increase in the risk of miscarriage. However, the true incidence of pHPT in pregnancy, complete and miscarried, is unknown and there are no data on the prevalence of undiagnosed pHPT in recurrent miscarriage (RM) (≥3 consecutive miscarriages under 24-week gestation). This is the first prospective study aiming to establish the prevalence of undiagnosed pHPT in RM. METHODS: Following UK National ethics committee approval, women who had experienced 3 or more consecutive miscarriages were recruited from a nationwide RM clinic. Serum corrected calcium, phosphate, PTH and vitamin D were evaluated. Patients with raised serum calcium and/or PTH were recalled for confirmatory tests. Power calculations suggested that a minimum of 272 patients were required to demonstrate a clinically significant incidence of pHPT. RESULTS: Three hundred women were recruited, median age 35 years (range 19-42). Eleven patients had incomplete data, leaving 289 patients suitable for analysis; 50/289 patients (17%) with abnormal tests were recalled. The prevalence of vitamin D deficiency (<25 nmol/l) and insufficiency (25-75 nmol/l) was 8.7 and 67.8%, respectively. One patient was diagnosed with pHPT (0.34%) and underwent successful parathyroidectomy. CONCLUSIONS: The prevalence of undiagnosed pHPT (0.34%) in RM in this study appears to be many times greater than the 0.05% expected in this age group. The findings of this pilot study merit follow-up with a larger-scale study. Routine serum calcium estimation is not currently undertaken in RM and should be considered.
Di Marco AN, Chotalia R, Bloxham R, et al., 2017, Can near infrared autofluorescent imaging prevent inadvertent parathyroidectomy? A pilot study, British Association of Endocrine and Thyroid Surgeons
Di Marco AN, Halle Y, Sam A, et al., 2017, Subclinical hypercortisolaemia in patients undergoing adrenal surgery: What is the clinical relevance?, British Association of Endocrine and Thyroid Surgeons
Di Marco AN, Palazzo F, 2017, Goitre and Thyroid Cancer, Medicine, ISSN: 1357-3039
Di Marco AN, Jeyakumar J, Pratt PJ, et al., 2016, Evaluating a novel 3D stereoscopic visual display for transanal endoscopic surgery: a randomized controlled crossover study, Annals of Surgery, Vol: 263, Pages: 36-42, ISSN: 1528-1140
King HK, Shang JS, Liu JL, et al., 2015, Micro-IGES Robot for Transanal Robotic Microsurgery., In The Hamlyn Symposium on Medical Robotics.
Left paraduodenal hernia (LPDH) is a retrocolic internal hernia of congenital origin that develops through the fossa of Landzert, and extends into the descending mesocolon and left portion of the transverse mesocolon. It carries significant overall risk of mortality, yet delay in diagnosis is not unusual due to subtle and elusive features. Familiarisation with the embryological and anatomical features of this rare hernia is essential for surgical management. This is especially important with respect to vascular anatomy as major mesenteric vessels form intimate relationships with the ventral rim and anterior portion of the hernia. As an illustrative case, we describe our experience with a striking example of LPDH, particularly focusing on the inherent diagnostic challenges and associated critical vascular anatomy. We advocate the role of diagnostic laparoscopy; however caution that decision to safely proceed with laparoscopic repair must occur only with confident identification of the vascular anatomy involved.
Hughes-Hallett A, Pratt P, Mayer E, et al., 2014, Intraoperative Ultrasound Overlay in Robot-assisted Partial Nephrectomy: First Clinical Experience, European Urology, Vol: 65, Pages: 671-672, ISSN: 1421-993X
Intraoperative ultrasound facilitates the localisation of partially or entirely endophytic renal tumours during laparoscopic or robot-assisted partial nephrectomy (RAPN) . A current limitation of intraoperative ultrasound is the requirement on the surgeon to relate the subsurface ultrasound image to the separate endoscopic view. Here we present the first clinical experience of live registered intraoperative ultrasound overlay.Registered ultrasound overlay was achieved using an approach previously described by our group, where the use of ultrasound in an ex vivo model for transanal microsurgery was examined . This method of live image registration can be best described as a three-step process of calibration, image registration, and finally image overlay, and it has demonstrated a registration accuracy <0.5 mm . Table 1 summarises the system hardware.
Granados A, Hald N, Di Marco A, et al., 2014, Real-Time Visualisation and Analysis of Internal Examinations - Seeing the Unseen, MEDICAL IMAGE COMPUTING AND COMPUTER-ASSISTED INTERVENTION - MICCAI 2014, PT I, Vol: 8673, Pages: 617-+, ISSN: 0302-9743
Granados A, Hald N, Di Marco A, et al., 2014, Real-time visualisation and analysis of internal examinations - Seeing the unseen, Pages: 617-625, ISSN: 0302-9743
Internal examinations such as Digital Rectal Examination (DRE) and bimanual Vaginal Examination (BVE) are routinely performed for early diagnosis of cancer and other diseases. Although they are recognised as core skills to be taught on a medical curriculum, they are difficult to learn and teach due to their unsighted nature. We present a framework that combines a visualisation and analysis tool with position and pressure sensors to enable the study of internal examinations and provision of real-time feedback. This approach is novel as it allows for real-time continuous trajectory and pressure data to be obtained for the complete examination, which may be used for teaching and assessment. Experiments were conducted performing DRE and BVE on benchtop models, and BVE on Gynaecological Teaching Assistants (GTA). The results obtained suggest that the proposed methodology may provide an insight into what constitutes an adequate DRE or BVE, provide real-time feedback tools for learning and assessment, and inform haptics-based simulator design. © 2014 Springer International Publishing.
Marcus HJ, Hughes-Hallett A, Cundy TP, et al., 2013, Comparative Effectiveness of 3-D versus 2-D and HD versus SD Neuroendoscopy: A Preclinical Randomized Crossover Study, Neurosurgery
Di Marco AN, Lee HA, Darzi AW, 2013, Foundation year one knowledge of NHS structure and finances: A questionnaire study., Int J Surg, Vol: 11
Clancy NT, Stoyanov D, James DRC, et al., 2012, Multispectral image alignment using a three channel endoscope in vivo during minimally invasive surgery, BIOMEDICAL OPTICS EXPRESS, Vol: 3, Pages: 2567-2578, ISSN: 2156-7085
di Marco AN, Purkayastha S, Zacharakis E, 2012, Intussusception of the small bowel secondary to an enterolith from a jejunal diverticulum., Updates Surg, Vol: 64, Pages: 231-233, ISSN: 2038-131X
We report a case of acute, small bowel obstruction secondary to intussusception caused by an enterolith from a jejunal diverticulum, in an elderly female with a history of chronic, intermittent abdominal pain. Diagnostic work-up of the patient included a computed tomographic (CT) scan which demonstrated the intussusception, but not the enterolith, which was characteristically radiolucent. A laparotomy was performed and the enterolith was found and delivered. A fistula between the gallbladder and small bowel was sought, but not found. Multiple diverticulae were found throughout the small bowel. Although small bowel diverticulosis is rare, it should be considered in the differential diagnosis of the acute abdomen and chronic abdominal pain, especially in those with known colonic diverticulosis, in whom this condition is more common.
Kwasnicki RM, Lewis TM, Jordan SJ, et al., 2012, Junior doctors about to start core surgical training are no more technically prepared than medical students, International Surgical Congress of the Association-of-Surgeons-of-Great-Britain-and-Ireland (ASGBI), Publisher: WILEY-BLACKWELL, Pages: 139-139, ISSN: 0007-1323
Pratt P, Di Marco A, Payne C, et al., 2012, Intraoperative ultrasound guidance for transanal endoscopic microsurgery, Med Image Comput Comput Assist Interv, Vol: 15, Pages: 463-470
Local excision of rectal cancer with transanal endoscopic microsurgery has proved to be a viable alternative to conventional, more radical techniques, but the reduced sensory experience presents significant challenges for the surgeon. Accurate identification and complete removal of lesions and subsurface targets is currently a difficult task, often exacerbated by intraoperative tissue deformation. This work describes novel ultrasound calibration and effective visualisation methods designed to meet these requirements, relying solely on optical measurements and pattern tracking. Detailed quantitative phantom and porcine validation experiments confirm that the technique is both practical and an accurate means for assessing lesion thickness intraoperatively, leading directly to human clinical trials.
Win Tun Latt, Tou Pin Chang, di Marco A, et al., 2012, A hand-held instrument for in vivo probe-based confocal laser endomicroscopy during minimally invasive surgery, Intelligent Robots and Systems (IROS), 2012 IEEE/RSJ International Conference on, Pages: 1982-1987, ISSN: 2153-0858
Di Marco AN, Pal S, Whately-Smith C, et al., 2002, Evaluation of nocturnal pain symptoms in Parkinson's disease using the Parkinson's Disease Sleep Scale. A case control study, 7th International Congress of Parkinsons Disease and Movement Disorders, Publisher: WILEY-LISS, Pages: S224-S224, ISSN: 0885-3185
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