Imperial College London

MrArchieHughes-Hallett

Faculty of MedicineDepartment of Surgery & Cancer

Honorary Clinical Research Fellow
 
 
 
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a.hughes-hallett

 
 
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Queen Elizabeth the Queen Mother Wing (QEQM)St Mary's Campus

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Summary

 

Publications

Publication Type
Year
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43 results found

Hyde ER, Berger LU, Ramachandran N, Hughes-Hallett A, Pavithran NP, Tran MGB, Ourselin S, Bex A, Mumtaz FHet al., 2019, Interactive virtual 3D models of renal cancer patient anatomies alter partial nephrectomy surgical planning decisions and increase surgeon confidence compared to volume-rendered images, INTERNATIONAL JOURNAL OF COMPUTER ASSISTED RADIOLOGY AND SURGERY, Vol: 14, Pages: 723-732, ISSN: 1861-6410

Journal article

Dilley J, Hughes-Hallett A, Pratt P, Pucher P, Camara M, Darzi A, Mayer Eet al., 2019, Perfect registration leads to imperfect performance: a randomised trial of multimodal intraoperative image guidance, Annals of Surgery, Vol: 269, Pages: 236-242, ISSN: 0003-4932

Objective – To compare surgical safety and efficiency of two image guidance modalities, perfect augmented reality (AR) and side-by-side unregistered image guidance (IG), against a no guidance control (NG), when performing a simulated laparoscopic cholecystectomy (LC).Background – Image guidance using AR offers the potential to improve understanding of subsurface anatomy, with positive ramifications for surgical safety and efficiency. No intra-abdominal study has demonstrated any advantage for the technology. Perfect AR cannot be provided in the operative setting in a patient, however it can be generated in the simulated setting. Methods – Thirty six experienced surgeons performed a baseline LC using the LapMentor™ simulator before randomisation to one of three study arms: AR, IG or NG. Each performed three further LC. Safety and efficiency-related simulator metrics, and task workload (SURG-TLX) were collected. Results –The IG group had a shorter total instrument path length and fewer movements than NG and AR groups. Both IG and NG took a significantly shorter time than AR to complete dissection of Calot’s triangle. Use of IG and AR resulted in significantly fewer perforations and serious complications than the NG group. IG had significantly fewer perforations and serious complications than AR group. Compared to IG, AR guidance was found to be significantly more distracting. Conclusion – Side-by-side unregistered image guidance (IG) improved safety and surgical efficiency in a simulated setting when compared to AR or NG. IG provides a more tangible opportunity for integrating image guidance into existing surgical workflow as well as delivering the safety and efficiency benefits desired.

Journal article

Cundy TP, Harley SJD, Marcus HJ, Hughes-Hallett A, Khurana Set al., 2018, Global trends in paediatric robot-assisted urological surgery: a bibliometric and Progressive Scholarly Acceptance analysis, JOURNAL OF ROBOTIC SURGERY, Vol: 12, Pages: 109-115, ISSN: 1863-2483

Journal article

Marcus HJ, Hughes-Hallett A, Payne CJ, Cundy TP, Nandi D, Yang GZ, Darzi Aet al., 2017, Trends in the diffusion of robotic surgery: A retrospectiveobservational study, International Journal of Medical Robotics and Computer Assisted Surgery, Vol: 13, ISSN: 1478-5951

BackgroundRecent studies have suggested that the use of robotic surgery for prostatectomy has been increasing, but characterization of the diffusion of robotic surgery in other procedures has not been available.MethodsData were analysed for the years 2006–2014 using hospital episode statistics (HES), a database of all admissions to National Health Service (NHS) hospitals in England. OPCS codes were used to determine the annual number of prostatectomy, partial nephrectomy, and total abdominal hysterectomy procedures. Concurrent OPCS codes were then used to identify whether these procedures were robotic, conventional laparoscopic or open surgery.ResultsThe proportion of robotic cases varied depending on the surgical procedure. Diffusion of robotic surgery was relatively rapid in prostatectomy, moderate in partial nephrectomy, and slow in total abdominal hysterectomy.ConclusionsAlthough high institutional cost might explain the earliest delays in diffusion, this barrier does not fully account for the different rates of diffusion among surgical procedures.

Journal article

Marcus HJ, Williams S, Hughes-Hallett A, Camp SJ, Nandi D, Thorne Let al., 2017, Predicting surgical outcome in patients with glioblastoma multiforme using pre-operative magnetic resonance imaging: development and preliminary validation of a grading system., Neurosurgical Review, Vol: 40, Pages: 621-631, ISSN: 1437-2320

The lack of a simple, objective and reproducible system to describe glioblastoma multiforme (GBM) represents a major limitation in comparative effectiveness research. The objectives of this study were therefore to develop such a grading system and to validate it on patients who underwent surgical resection. A systematic review of the literature was performed to identify features on pre-operative magnetic resonance imaging (MRI) that predict the surgical outcome of patients with GBM. In all, the five most important features of GBM on pre-operative MRI were as follows: periventricular or deep location, corpus callosum or bilateral location, eloquent location, size and associated oedema. These were then used to develop a grading system. To validate this grading system, a retrospective cohort study of all adult patients with supratentorial GBM who underwent surgical resection between the 1 January 2014 and the 31 June 2015 was performed. There was a substantial agreement between the two neurosurgeons grading GBM (Cohen's κ was 0.625; standard error 0.066). High-complexity lesions were significantly less likely to result in complete resection of contrast-enhancing tumour than low-complexity lesions (50.0 versus 3.4%; p = 0.0007). The proposed grading system may allow for the standardised communication of anatomical features of GBM identified on pre-operative MRI.

Journal article

Marcus HJ, Payne CJ, Hughes-Hallett A, Gras G, Leibrandt K, Nandi D, Yang GZet al., 2016, Making the leap: the translation of innovative surgical devices from the laboratory to the operating room, Annals of Surgery, Vol: 263, Pages: 1077-1078, ISSN: 1528-1140

Journal article

Marcus HJ, Payne CJ, Hughes-Hallett A, Marcus AP, Yang GZ, Darzi A, Nandi Det al., 2016, REGULATORY APPROVAL OF NEW MEDICAL DEVICES: A CROSS SECTIONAL STUDY, British Medical Journal, Vol: 353, ISSN: 1756-1833

Objective To investigate the regulatory approval of new medical devices.Design Cross sectional study of new medical devices reported in the biomedical literature.Data sources PubMed was searched between 1 January 2000 and 31 December 2004 to identify clinical studies of new medical devices. The search was carried out during this period to allow time for regulatory approval.Eligibility criteria for study selection Articles were included if they reported a clinical study of a new medical device and there was no evidence of a previous clinical study in the literature. We defined a medical device according to the US Food and Drug Administration as an “instrument, apparatus, implement, machine, contrivance, implant, in vitro reagent, or other similar or related article.”Main outcome measures Type of device, target specialty, and involvement of academia or of industry for each clinical study. The FDA medical databases were then searched for clearance or approval relevant to the device.Results 5574 titles and abstracts were screened, 493 full text articles assessed for eligibility, and 218 clinical studies of new medical devices included. In all, 99/218 (45%) of the devices described in clinical studies ultimately received regulatory clearance or approval. These included 510(k) clearance for devices determined to be “substantially equivalent” to another legally marketed device (78/99; 79%), premarket approval for high risk devices (17/99; 17%), and others (4/99; 4%). Of these, 43 devices (43/99; 43%) were actually cleared or approved before a clinical study was published.Conclusions We identified a multitude of new medical devices in clinical studies, almost half of which received regulatory clearance or approval. The 510(k) pathway was most commonly used, and clearance often preceded the first published clinical study.

Journal article

Kwasnicki, Hughes-Hallett, Marcus HJ, Yang GZ, Darzi A, Hettiaratchy Set al., 2016, Fifty Years of Innovation in Plastic Surgery, Archives of Plastic Surgery, Vol: 43, Pages: 145-152, ISSN: 2234-6171

AbstractBackgroundInnovation has molded the current landscape of plastic surgery. However, documentation of this process only exists scattered throughout the literature as individual articles. The few attempts made to profile innovation in plastic surgery have been narrative, and therefore qualitative and inherently biased. Through the implementation of a novel innovation metric, this work aims to identify and characterise the most prevalent innovations in plastic surgery over the last 50 years.MethodsPatents and publications related to plastic surgery (1960 to 2010) were retrieved from patent and MEDLINE databases, respectively. The most active patent codes were identified and grouped into technology areas, which were subsequently plotted graphically against publication data. Expert-derived technologies outside of the top performing patents areas were additionally explored.ResultsBetween 1960 and 2010, 4,651 patents and 43,118 publications related to plastic surgery were identified. The most active patent codes were grouped under reconstructive prostheses, implants, instruments, non-invasive techniques, and tissue engineering. Of these areas and other expert-derived technologies, those currently undergoing growth include surgical instruments, implants, non-invasive practices, transplantation and breast surgery. Innovations related to microvascular surgery, liposuction, tissue engineering, lasers and prostheses have all plateaued.ConclusionsThe application of a novel metric for evaluating innovation quantitatively outlines the natural history of technologies fundamental to the evolution of plastic surgery. Analysis of current innovation trends provides some insight into which technology domains are the most active.

Journal article

Marcus HJ, Seneci CA, Hughes-Hallett A, Cundy TP, Nandi D, Yang GZ, Darzi Aet al., 2016, Comparative Performance in Single-Port Versus Multiport Minimally Invasive Surgery, and Small Versus Large Operative Working Spaces: A Preclinical Randomized Crossover Trial, Surgical Innovation, Vol: 23, Pages: 148-155, ISSN: 1553-3514

Background. Surgical approaches such as transanal endoscopic microsurgery, which utilize small operative working spaces, and are necessarily single-port, are particularly demanding with standard instruments and have not been widely adopted. The aim of this study was to compare simultaneously surgical performance in single-port versus multiport approaches, and small versus large working spaces. Methods. Ten novice, 4 intermediate, and 1 expert surgeons were recruited from a university hospital. A preclinical randomized crossover study design was implemented, comparing performance under the following conditions: (1) multiport approach and large working space, (2) multiport approach and intermediate working space, (3) single-port approach and large working space, (4) single-port approach and intermediate working space, and (5) single-port approach and small working space. In each case, participants performed a peg transfer and pattern cutting tasks, and each task repetition was scored. Results. Intermediate and expert surgeons performed significantly better than novices in all conditions (P < .05). Performance in single-port surgery was significantly worse than multiport surgery (P < .01). In multiport surgery, there was a nonsignificant trend toward worsened performance in the intermediate versus large working space. In single-port surgery, there was a converse trend; performances in the intermediate and small working spaces were significantly better than in the large working space. Conclusions. Single-port approaches were significantly more technically challenging than multiport approaches, possibly reflecting loss of instrument triangulation. Surprisingly, in single-port approaches, in which triangulation was no longer a factor, performance in large working spaces was worse than in intermediate and small working spaces.

Journal article

Marcus HJ, Hughes-Hallett A, Kwasnicki RM, Darzi A, Yang GZ, Nandi Det al., 2016, Response, Journal of neurosurgery, Vol: 124

Journal article

Marcus HJ, Hughes-Hallett A, Kwasnicki RM, Darzi A, Yang GZ, Nandi Det al., 2016, Letter to the Editor: Evaluation of neurosurgical innovation using patent database. And Response, Journal of Neurosurgery, Vol: 124, Pages: 881-883, ISSN: 1933-0693

Journal article

Marcus HJ, Hughes-Hallett A, Kwasnicki RM, Darzi A, Yang GZ, Nandi Det al., 2015, Letter to the Editor: Innovations in neurosurgery: Response, Journal of Neurosurgery, ISSN: 1933-0693

Journal article

Pratt P, Hughes-Hallett A, Zhang L, Patel N, Mayer E, Darzi A, Yang G-Zet al., 2015, Autonomous Ultrasound-Guided Tissue Dissection, 18th International Conference on Medical Image Computing and Computer-Assisted Intervention (MICCAI), Publisher: SPRINGER INT PUBLISHING AG, Pages: 249-257, ISSN: 0302-9743

Intraoperative ultrasound imaging can act as a valuable guide during minimally invasive tumour resection. However, contemporaneous bimanual manipulation of the transducer and cutting instrument presents significant challenges for the surgeon. Both cannot occupy the same physical location, and so a carefully coordinated relative motion is required. Using robotic partial nephrectomy as an index procedure, and employing PVA cryogel tissue phantoms in a reduced dimensionality setting, this study sets out to achieve autonomous tissue dissection with a high velocity waterjet under ultrasound guidance. The open-source da Vinci Research Kit (DVRK) provides the foundation for a novel multimodal visual servoing approach, based on the simultaneous processing and analysis of endoscopic and ultrasound images. Following an accurate and robust Jacobian estimation procedure, dissections are performed with specified theoretical tumour margin distances. The resulting margins, with a mean difference of 0.77mm, indicate that the overall system performs accurately, and that future generalisation to 3D tumour and organ surface morphologies is warranted.

Conference paper

Cundy TP, Marcus HJ, Hughes-Hallett A, Khurana S, Darzi Aet al., 2015, Robotic surgery in children: adopt now, await, or dismiss?, PEDIATRIC SURGERY INTERNATIONAL, Vol: 31, Pages: 1119-1125, ISSN: 0179-0358

The role of robot-assisted surgery in children remains controversial. This article aims to distil this debate into an evidence informed decision-making taxonomy; to adopt this technology (1) now, (2) later, or (3) not at all. Robot-assistance is safe, feasible and effective in selected cases as an adjunctive tool to enhance capabilities of minimally invasive surgery, as it is known today. At present, expectations of rigid multi-arm robotic systems to deliver higher quality care are over-estimated and poorly substantiated by evidence. Such systems are associated with high costs. Further comparative effectiveness evidence is needed to define the case-mix for which robot-assistance might be indicated. It seems unlikely that we should expect compelling patient benefits when it is only the mode of minimally invasive surgery that differs. Only large higher-volume institutions that share the robot amongst multiple specialty groups are likely to be able to sustain higher associated costs with today’s technology. Nevertheless, there is great potential for next-generation surgical robotics to enable better ways to treat childhood surgical diseases through less invasive techniques that are not possible today. This will demand customized technology for selected patient populations or procedures. Several prototype robots exclusively designed for pediatric use are already under development. Financial affordability must be a high priority to ensure clinical accessibility.

Journal article

Pratt P, Jaeger A, Hughes-Hallett A, Mayer E, Vale J, Darzi A, Peters T, Yang G-Zet al., 2015, Robust ultrasound probe tracking: initial clinical experiences during robot-assisted partial nephrectomy, International Journal of Computer Assisted Radiology and Surgery, Vol: 10, Pages: 1905-1913, ISSN: 1861-6410

PurposeIn order to assist in the identification of renal vasculature and tumour boundaries in robot-assisted partial nephrectomy, robust ultrasound probe calibration and tracking methods are introduced. Contemporaneous image guidance during these crucial stages of the procedure should ultimately lead to improved safety and quality of outcome for the patient, through reduced positive margin rates, segmental clamping, shorter ischaemic times and nephron-sparing resection.MethodsSmall KeyDot markers with circular dot patterns are attached to a miniature pickup ultrasound probe. Generic probe calibration is superseded by a more robust scheme based on a sequence of physical transducer measurements. Motion prediction combined with a reduced region-of-interest in the endoscopic video feed facilitates real-time tracking and registration performance at full HD resolutions.ResultsQuantitative analysis confirms that circular dot patterns result in an improved translational and rotational working envelope, in comparison with the previous chessboard pattern implementation. Furthermore, increased robustness is observed with respect to prevailing illumination levels and out-of-focus images due to relatively small endoscopic depths of field.ConclusionCircular dot patterns should be employed in this context as they result in improved performance and robustness. This facilitates clinical usage and interpretation of the combined video and ultrasound overlay. The efficacy of the overall system is demonstrated in the first human clinical case.

Journal article

Cundy TP, Marcus HJ, Hughes-Hallett A, MacKinnon T, Najmaldin AS, Yang GZ, Darzi Aet al., 2015, Robotic versus Non-Robotic Instruments in Spatially Constrained Operative Workspaces - A Pre-Clinical Randomised Crossover Study, BJU International, Vol: 116, Pages: 415-422, ISSN: 1464-4096

ObjectiveTo compare the effectiveness of robotic and non‐robotic laparoscopic instruments in spatially constrained workspaces.Materials and MethodsSurgeons performed intracorporeal sutures with various instruments within three different cylindrical workspace sizes. Three pairs of instruments were compared: 3‐mm non‐robotic mini‐laparoscopy instruments; 5‐mm robotic instruments; and 8‐mm robotic instruments. Workspace diameters were 4, 6 and 8 cm, with volumes of 50, 113 and 201 cm3 respectively. Primary outcomes were validated objective task performance scores and instrument workspace breach counts.ResultsA total of 23 participants performed 276 suture task repetitions. The overall median task performance scores for the 3‐, 5‐ and 8‐mm instruments were 421, 398 and 402, respectively (P = 0.12). Task scores were highest (best) for the 3‐mm non‐robotic instruments in all workspace sizes. Scores were significantly lower when spatial constraints were imposed, with median task scores for the 4‐, 6‐ and 8‐cm diameter workspaces being 388, 415 and 420, respectively (P = 0.026). Significant indirect relationships were seen between boundary breaches and workspace size (P < 0.001). Higher breach counts occurred with the robotic instruments.ConclusionsSmaller workspaces limit the performance of both robotic and non‐robotic instruments. In operating workspaces <200 cm3, 3‐mm non‐robotic instruments are better suited for advanced bimanual operative tasks such as suturing. Future robotic instruments need further optimization if this technology is to be uniquely advantageous for clinical roles that involve endoscopic access to workspace‐restricted anatomical areas.

Journal article

Marcus HJ, Pratt P, Hughes-Hallett A, Cundy TP, Marcus AP, Yang GZ, Darzi A, Nandi Det al., 2015, Comparative effectiveness and safety of image guidance systems in neurosurgery: a preclinical randomized study, Journal of Neurosurgery, Vol: 123, Pages: 307-313, ISSN: 1933-0693

OBJECT: Over the last decade, image guidance systems have been widely adopted in neurosurgery. Nonetheless, the evidence supporting the use of these systems in surgery remains limited. The aim of this study was to compare simultaneously the effectiveness and safety of various image guidance systems against that of standard surgery.METHODS: In this preclinical, randomized study, 50 novice surgeons were allocated to one of the following groups: 1) no image guidance, 2) triplanar display, 3) always-on solid overlay, 4) always-on wire mesh overlay, and 5) on-demand inverse realism overlay. Each participant was asked to identify a basilar tip aneurysm in a validated model head. The primary outcomes were time to task completion (in seconds) and tool path length (in mm). The secondary outcomes were recognition of an unexpected finding (i.e., a surgical clip) and subjective depth perception using a Likert scale.RESULTS: The time to task completion and tool path length were significantly lower when using any form of image guidance compared with no image guidance (p < 0.001 and p = 0.003, respectively). The tool path distance was also lower in groups using augmented reality compared with triplanar display (p = 0.010). Always-on solid overlay resulted in the greatest inattentional blindness (20% recognition of unexpected finding). Wire mesh and on-demand overlays mitigated, but did not negate, inattentional blindness and were comparable to triplanar display (40% recognition of unexpected finding in all groups). Wire mesh and inverse realism overlays also resulted in better subjective depth perception than always-on solid overlay (p = 0.031 and p = 0.008, respectively).CONCLUSIONS: New augmented reality platforms may improve performance in less-experienced surgeons. However, all image display modalities, including existing triplanar displays, carry a risk of inattentional blindness.

Journal article

Hughes-Hallett A, Browne D, Mensah E, Vale J, Mayer Eet al., 2015, Assessing the impact of mass media public health campaigns. Be Clear on Cancer ‘blood in pee’: a case in point, BJU International, Vol: 117, Pages: 570-575, ISSN: 1464-4096

Journal article

Rafii-Tari H, Vandini A, Zhang L, Hughes-Hallett A, Yang G-Zet al., 2015, Vision-guided Learning by Demonstration for Adaptive Surgical Robot Control., Hamlyn Symposium, Pages: 39-40

Conference paper

Hughes-Hallett A, Vale J, Mayer E, 2015, Editorial Comment to Feasibility and accuracy of computational robot-assisted partial nephrectomy planning by virtual partial nephrectomy analysis, INTERNATIONAL JOURNAL OF UROLOGY, Vol: 22, Pages: 446-446, ISSN: 0919-8172

Journal article

Hughes-Hallett A, Pratt P, Mayer E, Clark M, Vale J, Darzi Aet al., 2015, Using preoperative imaging for intraoperative guidance: a case of mistaken identity, International Journal of Medical Robotics and Computer Assisted Surgery, Vol: 12, Pages: 262-267, ISSN: 1478-596X

BACKGROUND: Surgical image guidance systems to date have tended to rely on reconstructions of preoperative datasets. This paper assesses the accuracy of these reconstructions to establish whether they are appropriate for use in image guidance platforms. METHODS: Nine raters (two experts in image interpretation and preparation, three in image interpretation, and four in neither interpretation nor preparation) were asked to perform a segmentation of ten renal tumours (four cystic and six solid tumours). These segmentations were compared with a gold standard consensus segmentation generated using a previously validated algorithm. RESULTS: Average sensitivity and positive predictive value (PPV) were 0.902 and 0.891, respectively. When assessing for variability between raters, significant differences were seen in the PPV, sensitivity and incursions and excursions from consensus tumour boundary. CONCLUSIONS: This paper has demonstrated that the interpretation required for the segmentation of preoperative imaging of renal tumours introduces significant inconsistency and inaccuracy. Copyright © 2015 John Wiley & Sons, Ltd.

Journal article

Marcus HJ, Pratt P, Hughes-Hallett A, Cundy TP, Marcus AP, Yang G-Z, Darzi A, Nandi Det al., 2015, Comparative effectiveness and safety of image guidance systems in surgery: a preclinical randomised study., Spring Meeting for Clinician Scientists in Training 2015, Publisher: Elsevier, Pages: S64-S64, ISSN: 0140-6736

BACKGROUND: Over the past decade image guidance systems have been widely adopted in specialties such as neurosurgery and otorhinolaryngology. Nonetheless, the evidence supporting the use of image guidance systems in surgery remains limited. New augmented reality systems offer the possibility of enhanced operating room workflow compared with existing triplanar image displays, but recent studies have highlighted several concerns, particularly the risk of inattentional blindness and impaired depth perception. The aim of this study was to compare simultaneously the effectiveness and safety of various image guidance systems against standard surgery. METHODS: In this preclinical randomised study design 50 novice surgeons were allocated to no image guidance, triplanar display, always-on solid overlay, always-on wire mesh overlay, or on-demand inverse realism overlay. Each participant was asked to identify a basilar tip aneurysm in a validated model head. The primary outcomes were time to task completion, and tool path length. The secondary outcomes were recognition of an unexpected finding (a surgical clip) and subjective depth perception (using a Likert scale). FINDINGS: Surgeons' time to task completion and tool path length were significantly lower in groups using any form of image guidance than in groups with no image guidance (p<0·001 and p=0·003, respectively). The tool path distance was also lower in groups using augmented reality than in those using triplanar display (p=0·010). Always-on solid overlay resulted in the greatest inattentional blindness (20% recognition of unexpected finding by all surgeons). Wire mesh and on-demand overlays mitigated but did not negate inattentional blindness, and were comparable with triplanar display (40% recognition of unexpected finding in all groups). Wire mesh and inverse realism overlays also resulted in better subjective depth perception than always-on solid overlay (p=0·031 and p=0·008, re

Conference paper

Marcus HJ, Hughes-Hallett A, Kwasnicki RM, Darzi A, Yang GZ, Nandi Det al., 2015, Technological innovation in neurosurgery: a quantitative study, Journal of Neurosurgery, Vol: 123, Pages: 174-181, ISSN: 1933-0693

Object Technological innovation within health care may be defined as the introduction of a new technology thatinitiates a change in clinical practice. Neurosurgery is a particularly technology-intensive surgical discipline, and newtechnologies have preceded many of the major advances in operative neurosurgical techniques. The aim of the presentstudy was to quantitatively evaluate technological innovation in neurosurgery using patents and peer-reviewed publicationsas metrics of technology development and clinical translation, respectively.Methods The authors searched a patent database for articles published between 1960 and 2010 using the Booleansearch term “neurosurgeon OR neurosurgical OR neurosurgery.” The top 50 performing patent codes were then groupedinto technology clusters. Patent and publication growth curves were then generated for these technology clusters. A topperformingtechnology cluster was then selected as an exemplar for a more detailed analysis of individual patents.Results In all, 11,672 patents and 208,203 publications related to neurosurgery were identified. The top-performingtechnology clusters during these 50 years were image-guidance devices, clinical neurophysiology devices, neuromodulationdevices, operating microscopes, and endoscopes. In relation to image-guidance and neuromodulation devices,the authors found a highly correlated rapid rise in the numbers of patents and publications, which suggests that theseare areas of technology expansion. An in-depth analysis of neuromodulation-device patents revealed that the majority ofwell-performing patents were related to deep brain stimulation.Conclusions Patent and publication data may be used to quantitatively evaluate technological innovation in neurosurgery.

Journal article

Hughes-Hallett A, Mayer EK, Pratt PJ, Vale JA, Darzi AWet al., 2015, Quantitative analysis of technological innovation in minimally invasive surgery, British Journal of Surgery, Vol: 102, Pages: e151-e157, ISSN: 1365-2168

BackgroundIn the past 30 years surgical practice has changed considerably owing to the advent of minimally invasive surgery (MIS). This paper investigates the changing surgical landscape chronologically and quantitatively, examining the technologies that have played, and are forecast to play, the largest part in this shift in surgical practice.MethodsElectronic patent and publication databases were searched over the interval 1980–2011 for (‘minimally invasive’ OR laparoscopic OR laparoscopy OR ‘minimal access’ OR ‘key hole’) AND (surgery OR surgical OR surgeon). The resulting patent codes were allocated into technology clusters. Technology clusters referred to repeatedly in the contemporary surgical literature were also included in the analysis. Growth curves of patents and publications for the resulting technology clusters were then plotted.ResultsThe initial search revealed 27 920 patents and 95 420 publications meeting the search criteria. The clusters meeting the criteria for in-depth analysis were: instruments, image guidance, surgical robotics, sutures, single-incision laparoscopic surgery (SILS) and natural-orifice transluminal endoscopic surgery (NOTES). Three patterns of growth were observed among these technology clusters: an S-shape (instruments and sutures), a gradual exponential rise (surgical robotics and image guidance), and a rapid contemporaneous exponential rise (NOTES and SILS).ConclusionTechnological innovation in MIS has been largely stagnant since its initial inception nearly 30 years ago, with few novel technologies emerging. The present study adds objective data to the previous claims that SILS, a surgical technique currently adopted by very few, represents an important part of the future of MIS.

Journal article

Hughes-Hallet A, Mayer EK, Marcus HJ, Pratt P, Mason S, Darzi AW, Vale JAet al., 2015, Inattention blindness in surgery, Surgical Endoscopy and Other Interventional Techniques, Vol: 29, Pages: 3184-3189, ISSN: 1432-2218

Journal article

Marcus HJ, Hughes-Hallett A, Cundy TP, Yang GZ, Darzi A, Nandi Det al., 2014, da Vinci robot-assisted keyhole neurosurgery: a cadaver study on feasibility and safety, Neurosurgical Review, Vol: 38, Pages: 367-371, ISSN: 1437-2320

The goal of this cadaver study was to evaluate the feasibility and safety of da Vinci robot-assisted keyhole neurosurgery. Several keyhole craniotomies were fashioned including supraorbital subfrontal, retrosigmoid and supracerebellar infratentorial. In each case, a simple durotomy was performed, and the flap was retracted. The da Vinci surgical system was then used to perform arachnoid dissection towards the deep-seated intracranial cisterns. It was not possible to simultaneously pass the 12-mm endoscope and instruments through the keyhole craniotomy in any of the approaches performed, limiting visualization. The articulated instruments provided greater dexterity than existing tools, but the instrument arms could not be placed in parallel through the keyhole craniotomy and, therefore, could not be advanced to the deep cisterns without significant clashing. The da Vinci console offered considerable ergonomic advantages over the existing operating room arrangement, allowing the operating surgeon to remain non-sterile and seated comfortably throughout the procedure. However, the lack of haptic feedback was a notable limitation. In conclusion, while robotic platforms have the potential to greatly enhance the performance of transcranial approaches, there is strong justification for research into next-generation robots, better suited to keyhole neurosurgery.

Journal article

Hughes-Hallett A, Mayer E, Pratt P, Mottrie A, Darzi A, Vale Jet al., 2014, A census of robotic urological practice and training: a survey of the robotic section of the European Association of Urology., Journal of Robotic Surgery, Vol: 8, Pages: 349-355, ISSN: 1863-2483

To determine the current state of robotic urological practice, to establish how robotic training has been delivered and to ascertain whether this training was felt to be adequate. A questionnaire was emailed to members of the European Association of Urology robotic urology section mailing list. Outcomes were subdivided into three groups: demographics, exposure and barriers to training, and delivery of training. A comparative analysis of trainees and independently practising robotic surgeons was performed. 239 surgeons completed the survey, of these 117 (48.9 %) were practising robotic surgeons with the remainder either trainees or surgeons who had had received training in robotic surgery. The majority of robotic surgeons performed robotic-assisted laparoscopic prostatectomy (90.6 %) and were undertaking >50 robotic cases per annum (55.6 %). Overall, only 66.3 % of respondents felt their robotic training needs had been met. Trainee satisfaction was significantly lower than that of independently practising surgeons (51.6 versus 71.6 %, p = 0.01). When a subgroup analysis of trainees was performed examining the relationship between regular simulator access and satisfaction, simulator access was a positive predictor of satisfaction, with 87.5 % of those with regular access versus 36.8 % of those without access being satisfied (p < 0.01). This study reveals that a significant number of urologists do not feel that their robotic training needs have been met. Increased access to simulation, as part of a structured curriculum, appears to improve satisfaction with training and, simultaneously, allows for a proportion of a surgeon's learning curve to be removed from the operating room.

Journal article

Cundy TP, Harling L, Hughes-Hallett A, Mayer EK, Najmaldin AS, Athanasiou T, Yang G-Z, Darzi Aet al., 2014, Meta-analysis of robot-assisted vs conventional laparoscopic and open pyeloplasty in children, BJU INTERNATIONAL, Vol: 114, Pages: 582-594, ISSN: 1464-4096

Journal article

Marcus HJ, Cundy TP, Hughes-Hallett A, Yang GZ, Darzi A, Nandi Det al., 2014, Endoscopic and keyhole endoscope-assisted neurosurgical approaches: a qualitative survey on technical challenges and technological solutions, British Journal of Neurosurgery, Vol: 28, Pages: 606-610, ISSN: 0268-8697

The literature reflects a resurgence of interest in endoscopic and keyhole endoscope-assisted neurosurgical approaches as alternatives to conventional microsurgical approaches in carefully selected cases. The aim of this study was to assess the technical challenges of neuroendoscopy, and the scope for technological innovations to overcome these barriers. Materials and methods. All full members of the Society of British Neurosurgeons (SBNS) were electronically invited to participate in an online survey. The open-ended structured survey asked three questions; firstly, whether the surgeon presently utilises or has experience with endoscopic or endoscope-assisted approaches; secondly, what they consider to be the major technical barriers to adopting such approaches; and thirdly, what technological advances they foresee improving safety and efficacy in the field. Responses were subjected to a qualitative research method of multi-rater emergent theme analysis. Results. Three clear themes emerged: 1) surgical approach and better integration with image-guidance systems (20%), 2) intra-operative visualisation and improvements in neuroendoscopy (49%), and 3) surgical manipulation and improvements in instruments (74%). Discussion. The analysis of responses to our open-ended survey revealed that although opinion was varied three major themes could be identified. Emerging technological advances such as augmented reality, high-definition stereo-endoscopy, and robotic joint-wristed instruments may help overcome the technical difficulties associated with neuroendoscopic approaches. Conclusions. Results of this qualitative survey provide consensus amongst the technology end-user community such that unambiguous goals and priorities may be defined. Systems integrating these advances could improve the safety and efficacy of endoscopic and endoscope-assisted neurosurgical approaches.

Journal article

Hughes-Hallett A, Mayer E, Marcus HJ, Cundy T, Pratt PJ, Parston G, Vale JA, Darzi Aet al., 2014, Quantifying innovation in surgery, Annals of Surgery, Vol: 260, Pages: 205-211, ISSN: 1528-1140

Objectives: The objectives of this study were to assess the applicability of patents and publications as metrics of surgical technology and innovation; evaluate the historical relationship between patents and publications; develop a methodology that can be used to determine the rate of innovation growth in any given health care technology.Background: The study of health care innovation represents an emerging academic field, yet it is limited by a lack of valid scientific methods for quantitative analysis. This article explores and cross-validates 2 innovation metrics using surgical technology as an exemplar.Methods: Electronic patenting databases and the MEDLINE database were searched between 1980 and 2010 for “surgeon” OR “surgical” OR “surgery.” Resulting patent codes were grouped into technology clusters. Growth curves were plotted for these technology clusters to establish the rate and characteristics of growth.Results: The initial search retrieved 52,046 patents and 1,801,075 publications. The top performing technology cluster of the last 30 years was minimally invasive surgery. Robotic surgery, surgical staplers, and image guidance were the most emergent technology clusters. When examining the growth curves for these clusters they were found to follow an S-shaped pattern of growth, with the emergent technologies lying on the exponential phases of their respective growth curves. In addition, publication and patent counts were closely correlated in areas of technology expansion.Conclusions: This article demonstrates the utility of publically available patent and publication data to quantify innovations within surgical technology and proposes a novel methodology for assessing and forecasting areas of technological innovation.

Journal article

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