Imperial College London

Mr Daniel Richard Leff

Faculty of MedicineDepartment of Surgery & Cancer

Reader in Breast Surgery
 
 
 
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Contact

 

+44 (0)20 3312 1947d.leff

 
 
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Location

 

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

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Summary

 

Publications

Publication Type
Year
to

163 results found

Leff DR, Nortley M, Dang V, Bhutiani RPet al., 2007, The effect of local cooling on pain perception during infiltration of local anaesthetic agents, a prospective randomised controlled trial, ANAESTHESIA, Vol: 62, Pages: 677-682, ISSN: 0003-2409

Journal article

Leff DR, Kaura T, Agarwal T, Davies SC, Howard J, Chang ACet al., 2007, A nontransfusional perioperative management regimen for patients with sickle cell disease undergoing laparoscopic cholecystectomy, SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, Vol: 21, Pages: 1117-1121, ISSN: 0930-2794

Journal article

Massey RM, Warren OJ, Szczeklik M, Wallace S, Leff DR, Kokotsakis J, Darzi Aet al., 2007, Skeletonization of radial and gastroepiploic conduits in coronary artery bypass surgery, Journal of Cardiothoracic Surgery, Vol: 2, ISSN: 1749-8090

The use of a skeletonized internal thoracic artery in coronary artery bypass graft surgery has been shown to confer certain advantages over a traditional pedicled technique, particularly in certain patient groups. Recent reports indicate that radial and gastroepiploic arteries can also be harvested using a skeletonized technique. The aim of this study is to systematically review the available evidence regarding the use of skeletonized radial and gastroepiploic arteries within coronary artery bypass surgery, focusing specifically on it's effect on conduit length and flow, levels of endothelial damage, graft patency and clinical outcome. Four electronic databases were systematically searched for studies reporting the utilisation of the skeletonization technique within coronary revascularisation surgery in humans. Reference lists of all identified studies were checked for any missing publications. There appears to be some evidence that skeletonization may improve angiographic patency, when compared with pedicled vessels in the short to mid-term. We have found no suggestion of increased complication rates or increased operating time. Skeletonization may increase the length of the conduit, and the number of sequential graft sites, but no clear clinical benefits are apparent. Our study suggests that there is not enough high quality or consistent evidence to currently advocate the application of this technique to radial or gastroepiploic conduits ahead of a traditional pedicled technique.

Journal article

Warren O, Alexiou C, Massey R, Leff D, Purkayastha S, Kinross J, Darzi A, Athanasiou Tet al., 2007, The effects of various leukocyte filtration strategies in cardiac surgery, EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, Vol: 31, Pages: 665-676, ISSN: 1010-7940

Journal article

Leff DR, Orihuela-Espina F, Atallah L, Darzi A, Yang GZet al., 2007, Functional near infrared spectroscopy in novice and expert surgeons - A manifold embedding approach, Lecture Notes in Computer Science (including subseries Lecture Notes in Artificial Intelligence and Lecture Notes in Bioinformatics), Vol: 4792 LNCS, Pages: 270-277, ISSN: 0302-9743

Monitoring expertise development in surgery is likely to benefit from evaluations of cortical brain function. Brain behaviour is dynamic and nonlinear. The aim of this paper is to evaluate the application of a nonlinear dimensionality reduction technique to enhance visualisation of multidimensional functional Near Infrared Spectroscopy (fNIRS) data. Manifold embedding is applied to prefrontal haemodynamic signals obtained during a surgical knot tying task from a group of 62 healthy subjects with varying surgical expertise. The proposed method makes no assumption about the functionality of the data set and is shown to be capable of recovering the intrinsic low dimensional structure of in vivo brain data. After manifold embedding, Earth Mover's Distance (EMD) is used to quantify different patterns of cortical behaviour associated with surgical expertise and analyse the degree of inter-hemispheric channel pair symmetry. © Springer-Verlag Berlin Heidelberg 2007.

Journal article

Leff DR, Orihuela-Espina F, Darzi LAA, Darzi A, Yang G-Zet al., 2007, Functional near infrared spectroscopy in novice and expert surgeons - A manifold embedding approach, 10th International Conference on Medical Image Computing and Computer-Assisted Intervention (MICCAI 2007), Publisher: SPRINGER-VERLAG BERLIN, Pages: 270-+, ISSN: 0302-9743

Conference paper

Leff DR, Chen A, Roberts D, Grant K, Western C, Windsor ACJ, Cohen CRGet al., 2007, Colorectal cancer in the young patient, AMERICAN SURGEON, Vol: 73, Pages: 42-47, ISSN: 0003-1348

Journal article

Leff D, Nortley M, Melly L, Bhutiani RPet al., 2007, Ruptured spleen following laparoscopic cholecystectomy., JSLS, Vol: 11, Pages: 157-160, ISSN: 1086-8089

BACKGROUND: Laparoscopic cholecystectomy is generally a safe and well-accepted procedure. However, in a small percentage of patients, it is associated with complications, such as bleeding and injury to the bile duct and other viscera. Splenic injury as a result of laparoscopic surgery has been reported only in the context of direct trauma, for example due to retraction in hand-assisted urologic surgery. To date, there have been no reported cases of patients requiring splenectomy following laparoscopic cholecystectomy. We report an unusual case of ruptured spleen presenting less than 28 days following "uncomplicated" laparoscopic cholecystectomy. RESULTS: A 52-year-old female presented to our Accident and Emergency department 3 weeks following "uncomplicated" laparoscopic cholecystectomy, complaining of severe left upper quadrant pain radiating to the left shoulder tip. Clinical examination revealed a patient in hypovolemic shock, with localized left upper quadrant peritonism. Abdominal computed tomography supported a diagnosis of splenic rupture, and the patient required an emergency splenectomy. DISCUSSION: Splenic injury rarely complicates laparoscopic cholecystectomy. We postulate that either congenital or posttraumatic adhesions of the parietal peritoneum to the spleen may have caused the capsule to tear away from the spleen when the pneumoperitoneum was established, resulting in subcapsular hematoma and subsequent rupture in this patient. Videoscopic assessment of the spleen at the end of laparoscopic cholecystectomy might be a worthwhile exercise to aid early recognition and management in such cases.

Journal article

Chen AM, Leff DR, Simpson J, Chadwick SJD, McDonald PJet al., 2006, Variations in consenting practice for laparoscopic cholecystectomy., Ann R Coll Surg Engl, Vol: 88, Pages: 482-485

INTRODUCTION: To compare the variations in consenting practice amongst trainees and consultant surgeons for laparoscopic cholecystectomy with specific reference to the documentation of significant risks of surgery. PATIENTS AND METHODS: A proforma was devised which included significant and/or commonly recognised complications of laparoscopic cholecystectomy. This was then cross-referenced with the consent forms for the 80 patients included in the study and the documented risks explained in each case were noted. RESULTS: The results showed that there is considerable variation between the three grades of clinicians involved in obtaining a patient's consent for laparoscopic cholecystectomy. There was a clear difference in emphasis of the significant complications depending on the seniority of the consenter. Over 80% of the consents in this study were still being obtained by junior staff. CONCLUSIONS: More often than not, patients are not provided with consistent information to make an informed choice. We suggest that a preprinted consent form will provide a more uniform approach to consenting practice for laparoscopic cholecystectomy.

Journal article

Leff DR, Bhutiani RP, 2006, Give the patient the choice – the walk in walk out hernia clinic., Ambulatory Surgery, Vol: 12, Pages: 125-129

Journal article

Leff DR, Koh P, Aggarwal R, Deligiani F, Elwell C, Delpy D, Darzi A, Yang GZet al., 2006, Optical mapping of the left frontal cortex during a surgical knot tying task, a feasibility study., LNCS, Vol: 4091, Pages: 140-147

Journal article

Leff DR, Willis A, Menzies D, 2004, A denture in a small bowel stricture., Journal of the Royal Society of Medicine., Vol: 97, Pages: 72-75

Journal article

Nduka C, Leff DR, 2001, Mistaken Identity., BMJ, Vol: 323

Journal article

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