Publications
46 results found
Marcus HJ, Cundy TP, Hughes-Hallett A, et 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.
Cundy TP, Harling L, Hughes-Hallett A, et 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
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- Citations: 92
Hughes-Hallett A, Mayer E, Marcus HJ, et 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.
Cundy TP, Marcus HJ, Hughes-Hallett A, et al., 2014, International attitudes of early adopters to current and future robotic technologies in pediatric surgery, Journal of Pediatric Surgery
Hughes-Hallett A, Pratt P, Mayer E, et al., 2014, Image guidance for all-tilepro display of 3-dimensionally reconstructed images in robotic partial nephrectomy, Urology, Vol: 84, Pages: 237-242, ISSN: 0090-4295
ObjectiveTo determine the feasibility of a novel low-barrier-to-entry image guidance system.MethodsInitially a randomized crossover study was performed to establish the interface (iPad or 3-dimensional mouse) that minimized both the amount of time required to perform a manual image registration and the error of that registration. A subsequent clinical feasibility study was undertaken on 5 patients undergoing robot-assisted partial nephrectomy. Randomized crossover study primary outcomes were time to task completion, NASA–Task Load Index score, and alignment error (translational and rotational). The Mann-Whitney U test was used to compare groups. Surgeon feedback was sought when assessing the system in a clinical setting.ResultsIn the initial randomized crossover study, the iPad-based system was able to achieve adequate alignment accuracy (Frobenius norm of 0.3; total error of 20.8 mm) in significantly less time (33 seconds; P <.01) than the 3-dimensional mouse interface. The platform received good feedback from the operating surgeon in all instances with the surgeon commenting particularly on the improved appreciation of hilar vascular anatomy.ConclusionIn this study, we have demonstrated the feasibility of a “low-barrier-to-entry” image guidance system in a clinical setting. The system was able to achieve swift and sufficiently accurate alignment, with little impact on the surgical workflow.
Hughes-Hallett A, Pratt P, Mayer E, et al., 2014, Image guidance for all-tilepro display of 3-dimensionally reconstructed images in robotic partial nephrectomy - REPLY, Urology, Vol: 84, Pages: 243-243, ISSN: 0090-4295
Hughes-Hallett A, Mayer EK, Pratt P, et al., 2014, The current and future use of imaging in urological robotic surgery: a survey of the European Association of Robotic Urological Surgeons, International Journal of Medical Robotics and Computer Assisted Surgery, Vol: 11, Pages: 8-14, ISSN: 1478-596X
BackgroundWith the development of novel augmented reality operating platforms the way surgeons utilise imaging as a real-time adjunct to surgical technique is changing.MethodsA questionnaire was distributed via the European Robotic Urological Society mailing list. The questionnaire had three themes: surgeon demographics, current use of imaging and potential uses of an augmented reality operating environment in robotic urological surgery.Results117 of the 239 respondents (48.9%) were independently practising robotic surgeons. 74% of surgeons reported having imaging available in theatre for prostatectomy 97% for robotic partial nephrectomy and 95% cystectomy. 87% felt there was a role for augmented reality as a navigation tool in robotic surgery.ConclusionsThis survey has revealed the contemporary robotic surgeon to be comfortable in the use of imaging for intraoperative planning it also suggests that there is a desire for augmented reality platforms within the urological community.
Cundy TP, Marcus HJ, Clark J, et al., 2014, Robot-Assisted Minimally Invasive Surgery for Pediatric Solid Tumors: A Systematic Review of Feasibility and Current Status, EUROPEAN JOURNAL OF PEDIATRIC SURGERY, Vol: 24, Pages: 127-135, ISSN: 0939-7248
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- Citations: 20
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) [1]. 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 [2]. 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 [2]. Table 1 summarises the system hardware.
Hughes-Hallett A, Mayer EK, Marcus HJ, et al., 2014, Augmented reality partial nephrectomy: examining the current status and future perspectives, Urology, Vol: 83, Pages: 266-273, ISSN: 0090-4295
A minimal access approach to partial nephrectomy has historically been under-utilized, but is now becoming more popular with the growth of robot-assisted laparoscopy. One of the criticisms of minimal access partial nephrectomy is the loss of haptic feedback. Augmented reality operating environments are forecast to play a major enabling role in the future of minimal access partial nephrectomy by integrating enhanced visual information to supplement this loss of haptic sensation. In this article, we systematically examine the current status of augmented reality in partial nephrectomy by identifying existing research challenges and exploring future agendas for this technology to achieve wider clinical translation.
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
Hughes-Hallett A, Patki P, Patel N, et al., 2013, Robot-Assisted Partial Nephrectomy: A Comparison of the Transperitoneal and Retroperitoneal Approaches, JOURNAL OF ENDOUROLOGY, Vol: 27, Pages: 869-874, ISSN: 0892-7790
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- Citations: 52
Sridhar AN, Hughes-Hallett A, Mayer EK, et al., 2013, Image-guided robotic interventions for prostate cancer, Nat Rev Urol, Vol: advance online publication, ISSN: 1759-4820
Robotic prostatectomy is a common surgical treatment for men with prostate cancer, with some studies estimating that 80% of prostatectomies now performed in the USA are done so robotically. Despite the technical advantages offered by robotic systems, functional and oncological outcomes of prostatectomy can still be improved further. Alternative minimally invasive treatments that have also adopted robotic platforms include brachytherapy and high-intensity focused ultrasonography (HIFU). These techniques require real-time image guidance-such as ultrasonography or MRI-to be truly effective; issues with software compatibility as well as image registration and tracking currently limit such technologies. However, image-guided robotics is a fast-growing area of research that combines the improved ergonomics of robotic systems with the improved visualization of modern imaging modalities. Although the benefits of a real-time image-guided robotic system to improve the precision of surgical interventions are being realized, the clinical usefulness of many of these systems remains to be seen.
Marcus HJ, Hughes-Hallett A, Cundy TP, et al., 2013, Robotic Surgery. Not everything that counts can be easily counted., BMJ, Vol: 346
Hughes-Hallett A, Patki P, Nuttall M, et al., 2012, Robotic assisted laparoscopic partial nephrectomy: a prospective analysis of feasibility, operative and perioperative outcomes, Annual Scientific Meeting of the British-Association-of-Urological-Surgeons (BAUS), Publisher: WILEY-BLACKWELL, Pages: 39-40, ISSN: 1464-4096
Crowhurst J, Plaat F, 1999, A reply, Anaesthesia, Vol: 54, Pages: 1117-1118, ISSN: 0003-2409
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