Publications
269 results found
Erridge S, Chidambaram S, Leff DR, et al., 2018, Validating touch surgery for training in laparoscopic cholecystectomies: a randomised controlled trial, Annual Meeting of the Society-of-Academic-and-Research-Surgery (SARS), Publisher: Wiley, Pages: 30-30, ISSN: 1365-2168
Background: Surgical training has traditionally involved teaching trainees in the operating theatre. However, this method is associated with longer operating times and complications, which is cost-inefficient and exposes patients to errors. Simulation modalities such as Touch Surgery, which utilises cognitive task analysis (CTA), have been designed to overcome these issues.Methods: Participants performed a laparoscopic cholecystectomy procedure using a box simulator and porcine liver and gall bladder. They were randomly allocated to either the control or the intervention group. Each group received the same preparation prior to intervention, including a 10-minute introduction to laparoscopic equipment and a 15-minute educational tutorial on laparoscopic cholecystectomies. The participants then received CTA training via either Touch Surgery (intervention) or via written information (control).Results: 40 participants were recruited to take part in the study and randomly assigned to either intervention (n=22) or control (n=18). There was no significant difference between age (p=0.320), year of medical school (p=0.322), handedness (p=1.000) or gender (p=0.360) of the groups. The overall mean performance score was higher for intervention (41.9±22.5) than control (24.7±19.6; p=0.016). The intervention group had consistently higher scores throughout all intraoperative segments although this was not statistically significant (p>0.050). Conclusion: This study shows that Touch Surgery is effective for providing cognitive training in laparoscopic cholecystectomies to medical students. It is likely that this effect will be seen across modules and other platforms that utilise CTA alongside high fidelity animation. Further work is necessary to extend this to other surgical procedures for evaluating its longitudinal effectiveness.Take Home Message: CTA training provided via high fidelity simulation is an effective and inexpensive method of providing surgical educat
Modi HN, Singh H, Yang G, et al., 2018, Robotic surgery improves attention and concentration during times of intraoperative temporal stress, Association of Surgeons of Great Britain & Ireland International Surgical Congress, Publisher: Wiley, ISSN: 1365-2168
Leiloglou M, Qi J, Rees Whippey D, et al., 2018, Guiding Fluorescence-Augmented Imaging System for Breast Cancer Surgery, BMES Annual Meeting
Leiloglou M, Qi J, Rees Whippey D, et al., 2018, Guiding Fluorescence-Augmented Imaging System for Breast Cancer Surgery, EPSRC Image Guided Therapies Young Investigators
Stebbing J, Baranau Y, Manikhas A, et al., 2018, Total pathological complete response versus breast pathological complete response in clinical trials of reference and biosimilar trastuzumab in the neoadjuvant treatment of breast cancer, EXPERT REVIEW OF ANTICANCER THERAPY, Vol: 18, Pages: 531-541, ISSN: 1473-7140
Modi HN, Singh H, Yang G, et al., 2017, A decade of imaging surgeons' brain function (Part II): a systematic review of applications for technical and non-technical skills assessment, Surgery, Vol: 162, Pages: 1130-1139, ISSN: 1532-7361
Background: Functional neuroimaging technologies enable assessment of operator brain function, and can deepen our understanding of skills learning, ergonomic optima and cognitive processes in surgeons. Whilst there has been a critical mass of data detailing surgeons’ brain function, this literature has not been systematically reviewed.Methods: A systematic search of original neuroimaging studies assessing surgeons’ brain function, and published up until November 2016, was conducted using Medline, Embase and PsycINFO databases.Results: Twenty-seven studies fulfilled the inclusion criteria, including three feasibility studies, fourteen studies exploring the neural correlates of technical skill acquisition, and the remainder investigating brain function in the context of intraoperative decision-making (n=1), neurofeedback training (n=1), robot-assisted technology (n=5), and surgical teaching (n=3). Early stages of learning open surgical tasks (knot-tying) are characterised by prefrontal cortical (PFC) activation which subsequently attenuates with deliberate practice. However, with complex laparoscopic skills (intra-corporeal suturing), PFC engagement requires substantial training and attenuation occurs over a longer time-course, following years of refinement. Neurofeedback and interventions that improve neural efficiency may enhance technical performance and skills learning. Conclusions: Imaging surgeons’ brain function has identified neural signatures of expertise which might help inform objective assessment and selection processes. Interventions which improve neural efficiency may target skill-specific brain regions and augment surgical performance.
Modi HN, Singh H, Yang G, et al., 2017, Neural markers of sensitivity to intraoperative temporal stress in surgeons, Mexican Symposium on NIRS Neuroimaging, Publisher: MEXNIRS
Orihuela-Espina F, Leff DR, James DRC, et al., 2017, Imperial College near infrared spectroscopy neuroimaging analysis framework., Neurophotonics, Vol: 5, ISSN: 2329-4248
This paper describes the Imperial College near infrared spectroscopy neuroimaging analysis (ICNNA) software tool for functional near infrared spectroscopy neuroimaging data. ICNNA is a MATLAB-based object-oriented framework encompassing an application programming interface and a graphical user interface. ICNNA incorporates reconstruction based on the modified Beer-Lambert law and basic processing and data validation capabilities. Emphasis is placed on the full experiment rather than individual neuroimages as the central element of analysis. The software offers three types of analyses including classical statistical methods based on comparison of changes in relative concentrations of hemoglobin between the task and baseline periods, graph theory-based metrics of connectivity and, distinctively, an analysis approach based on manifold embedding. This paper presents the different capabilities of ICNNA in its current version.
Ranjan S, Modi HN, Singh H, et al., 2017, The impact of time pressure on prefrontal cortical activation and technical performance during robotic suturing, 11th London Surgical Symposium
Ranjan S, Modi HN, Singh H, et al., 2017, The impact of 3D vision on prefrontal activation and technical performance during a robotic suturing task, 11th London Surgical Symposium
Modi HN, Singh H, Yang G, et al., 2017, A decade of imaging surgeons' brain function (Part I): terminology, techniques and clinical translation, Surgery, Vol: 162, Pages: 1121-1130, ISSN: 1532-7361
Functional neuroimaging has the potential to deepen our understanding of technical and non-technical skill acquisition in surgeons, particularly as established assessment tools leave unanswered questions about inter-operator differences in ability that seem independent of experience. In this first of a two-part article, we aim to utilise our experience in neuroimaging surgeons to orientate the non-specialist reader to the principles of brain imaging. Terminology commonly used in brain imaging research is explained, placing emphasis on the “activation response” to a surgical task and its effect on local cortical haemodynamic parameters (neurovascular coupling). Skills learning and subsequent consolidation and refinement through practice lead to reorganisation of the functional architecture of the brain (known as “neuroplasticity”), evidenced by changes in the strength of regional activation as well as alterations in connectivity between brain regions, culminating in more efficient use of neural resources during task performance. Currently available neuroimaging techniques that either directly (i.e. measure electrical activity) or indirectly (i.e. measure tissue haemodynamics) assess brain function are discussed. Finally, we highlight the important practical considerations when conducting brain imaging research in surgeons.
St John ER, Scott AJ, Irvine TE, et al., 2017, Completion of hand-written surgical consent forms is frequently suboptimal and could be improved by using electronically generated, procedure-specific forms, SURGEON-JOURNAL OF THE ROYAL COLLEGES OF SURGEONS OF EDINBURGH AND IRELAND, Vol: 15, Pages: 190-195, ISSN: 1479-666X
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- Citations: 23
Qi J, Nabavi E, Hu Y, et al., 2017, A light-weight near infrared fluorescence endoscope based on a single color camera: a proof-of-concept study, Conference on Lasers and Electro-Optics Pacific Rim (CLEO-PR), Publisher: IEEE
Singh H, Modi HN, Yang GZ, et al., 2017, “Losing Your Nerve in the Operating Room” – Prefrontal Attenuation is Associated with Performance Degradation under Temporal Demands, 10th Hamlyn Symposium on Medical Robotics, Pages: 55-56
St John ERC, Leff D, takats Z, et al., 2017, Rapid Evaporative Ionisation Mass Spectrometry of Electrosurgical Vapours for the Identification of Breast Pathology: Towards an Intelligent Knife for Breast Cancer Surgery, Breast Cancer Research, Vol: 19, ISSN: 1465-542X
Background:Re-operation for positive resection margins following breast-conserving surgery occurs frequently (average = 20–25%), is cost-inefficient, and leads to physical and psychological morbidity. Current margin assessment techniques are slow and labour intensive. Rapid evaporative ionisation mass spectrometry (REIMS) rapidly identifies dissected tissues by determination of tissue structural lipid profiles through on-line chemical analysis of electrosurgical aerosol toward real-time margin assessment.Methods:Electrosurgical aerosol produced from ex-vivo and in-vivo breast samples was aspirated into a mass spectrometer (MS) using a monopolar hand-piece. Tissue identification results obtained by multivariate statistical analysis of MS data were validated by histopathology. Ex-vivo classification models were constructed from a mass spectral database of normal and tumour breast samples. Univariate and tandem MS analysis of significant peaks was conducted to identify biochemical differences between normal and cancerous tissues. An ex-vivo classification model was used in combination with bespoke recognition software, as an intelligent knife (iKnife), to predict the diagnosis for an ex-vivo validation set. Intraoperative REIMS data were acquired during breast surgery and time-synchronized to operative videos.Results:A classification model using histologically validated spectral data acquired from 932 sampling points in normal tissue and 226 in tumour tissue provided 93.4% sensitivity and 94.9% specificity. Tandem MS identified 63 phospholipids and 6 triglyceride species responsible for 24 spectral differences between tissue types. iKnife recognition accuracy with 260 newly acquired fresh and frozen breast tissue specimens (normal n = 161, tumour n = 99) provided sensitivity of 90.9% and specificity of 98.8%. The ex-vivo and intra-operative method produced visually comparable high intensity spectra. iKnife interpretation
Modi HN, SIngh H, Orihuela-Espina F, et al., 2017, Temporal stress in the operating room: brain engagement promotes "coping" and disengagement prompts "choking", Annals of Surgery, Vol: 267, Pages: 683-691, ISSN: 1528-1140
Objective:To investigate the impact of time pressure (TP) on prefrontalactivation and technical performance in surgical residents during a laparo-scopic suturing task.Background:Neural mechanisms enabling surgeons to maintain perform-ance and cope with operative stressors are unclear. The prefrontal cortex(PFC) is implicated due to its role in attention, concentration, and perform-ance monitoring.Methods:A total of 33 residents [Postgraduate Year (PGY)1 – 2¼15,PGY3– 4¼8, and PGY5¼10] performed a laparoscopic suturing taskunder ‘‘self-paced’’ (SP) and ‘‘TP’’ conditions (TP¼maximum 2 minutes perknot). Subjective workload was quantified using the Surgical Task LoadIndex. PFC activation was inferred using optical neuroimaging. Technicalskill was assessed using progression scores (au), error scores (mm), leakvolumes (mL), and knot tensile strengths (N).Results:TP led to greater perceived workload amongst all residents (meanSurgical Task Load Index score SD: PGY1 – 2: SP¼160.3 24.8 vs TP¼202.1 45.4,P<0.001; PGY3 – 4: SP¼123.0 52.0 vs TP¼172.5 43.1,P<0.01; PGY5: SP¼105.8 55.3 vs TP¼159.1 63.1,P<0.05).Amongst PGY1– 2 and PGY3– 4, deterioration in task progression, errorscores and knot tensile strength (P<0.05), and diminished PFC activationwas observed under TP. In PGY5, TP resulted in inferior task progression anderror scores (P<0.05), but preservation of knot tensile strength. Furthermore,PGY5 exhibited less attenuation of PFC activation under TP, and greateractivation than either PGY1 – 2 or PGY3 – 4 under both experimental con-ditions (P<0.05).Conclusions:Senior residents cope better with temporal demands and exhibitgreater technical performance stability under pressure, possibly due to
Grant Y, St John E, Carter A, et al., 2017, Patient level re-operative costs for oncological margin control following breast conserving surgery, Association of Breast Surgery 2017
Gambini J, Quinn T, Vila R, et al., 2017, Upgraded portable Indocyanine Green (ICG) detection system - towards Image Guided Cancer Surgery, Annual Meeting of the Society-of-Nuclear-Medicine-and-Molecular-Imaging (SNMMI), Publisher: SOC NUCLEAR MEDICINE INC, ISSN: 0161-5505
Thiruchelvam P, Hadjiminas D, Cleator S, et al., 2017, Primary Radiotherapy And DIEP flAp reconstruction: The PRADA study, American Society of Breast Surgeons Annual Meeting, Publisher: SPRINGER, Pages: 199-200, ISSN: 1068-9265
St John E, White E, Balog J, et al., 2017, The intelligent knife for detection of invasive breast cancer at radial margins: An intraoperative feasibility trial, Publisher: SPRINGER, Pages: 194-195, ISSN: 1068-9265
Leff DR, St John ER, Takats Z, 2017, Reducing the Margins of Error During Breast-Conserving Surgery Disruptive Technologies or Traditional Disruptions?, JAMA SURGERY, Vol: 152, Pages: 517-518, ISSN: 2168-6254
Vyas K, hughes M, leff DANIEL, et al., 2017, Methylene-blue aided rapid confocal laser endomicroscopy of breast cancer, Journal of Biomedical Optics, Vol: 22, ISSN: 1083-3668
Breast conserving surgery allows complete tumor resection while maintaining acceptable cosmesis for patients. Safe and rapid intraoperative margin assessment during the procedure is important to establish the completeness of tumor excision and minimizes the need for reoperation. Confocal laser endomicroscopy has demonstrated promise for real-time intraoperative margin assessment using acriflavine staining, but it is not approved for routine in-human use. We describe a custom high-speed line-scan confocal laser endomicroscopy (LS-CLE) system at 660 nm that enables high-resolution histomorphological imaging of breast tissue stained with methylene-blue, an alternative fluorescent stain for localizing sentinel nodes during breast surgery. Preliminary imaging results on freshly excised human breast tissue specimens are presented, demonstrating the potential of methylene-blue aided rapid LS-CLE to determine the oncological status of surgical margins in-vivo.
Leff DR, Yongue G, Vlaev I, et al., 2017, "Contemplating the next maneuver": functional neuroimaging reveals intraoperative decision-making strategies, Annals of Surgery, Vol: 265, Pages: 320-330, ISSN: 1528-1140
OBJECTIVE: To investigate differences in the quality, confidence, and consistency of intraoperative surgical decision making (DM) and using functional neuroimaging expose decision systems that operators use. SUMMARY BACKGROUND DATA: Novices are hypothesized to use conscious analysis (effortful DM) leading to activation across the dorsolateral prefrontal cortex, whereas experts are expected to use unconscious automation (habitual DM) in which decisions are recognition-primed and prefrontal cortex independent. METHODS: A total of 22 subjects (10 medical student novices, 7 residents, and 5 attendings) reviewed simulated laparoscopic cholecystectomy videos, determined the next safest operative maneuver upon video termination (10 s), and reported decision confidence. Video paradigms either declared ("primed") or withheld ("unprimed") the next operative maneuver. Simultaneously, changes in cortical oxygenated hemoglobin and deoxygenated hemoglobin inferring prefrontal activation were recorded using Optical Topography. Decision confidence, consistency (primed vs unprimed), and quality (script concordance) were assessed. RESULTS: Attendings and residents were significantly more certain (P < 0.001), and decision quality was superior (script concordance: attendings = 90%, residents = 78.3%, and novices = 53.3%). Decision consistency was significantly superior in experts (P < 0.001) and residents (P < 0.05) than novices (P = 0.183). During unprimed DM, novices showed significant activation of the dorsolateral prefrontal cortex, whereas this activation pattern was not observed among residents and attendings. During primed DM, significant activation was not observed in any group. CONCLUSIONS: Expert DM is characterized by improved quality, consistency, and confidence. The findings imply attendings use a habitual decision system, whereas novices use an effortful approach under uncertainty. In the presence of operative cues (primes), novices disengage
Qi J, Nabavi E, Hu Y, et al., 2017, A Light‐weight Near Infrared Fluorescence Endoscope Based On A Single Color Camera: A Proof‐of‐concept Study, CLEO Pacific Rim
Nabavi E, Qi J, Leiloglou M, et al., 2017, Preliminary Studies Of Simultaneous RGB And NIR Fluorescence Imaging Of Ex Vivo Human Breast Tissue Using Indocyanine Green (ICG), CLEO Pacific Rim
Qi J, Nabavi E, Hu Y, et al., 2017, A light-weight near infrared fluorescence endoscope based on a single color camera: A proof-of-concept study
Here we demonstrated a light-weight near infrared fluorescence endoscope based on a low-cost single color camera to perform real time white light and fluorescence imaging, thanks to advances in image sensors and electronically controllable LED light sources. We further explored frame interpolation to facilitate the reduction of frame rate of this endoscope system, compared to a typical dual camera based NIRF endoscope system.
Modi HN, Leff DR, Singh H, et al., 2016, Cognitive mechanisms of workload-related performance decline in surgical residents, American College of Surgeons Clinical Congress 2016, Publisher: Elsevier, Pages: S124-S125, ISSN: 1072-7515
Modi HN, Singh H, Athanasiou T, et al., 2016, Random effect modelling of prefrontal cortical haemodynamics to determine the influence of surgical expertise on executive control during temporal stress in the operating room, The Society for Functional Near-Infrared Spectroscopy, Publisher: fNIRS
Modi HN, Leff D, Singh H, et al., 2016, Time in training does not predict performance deterioration under pressure, Association for Medical Education in Europe, Publisher: AMEE
Modi HN, Leff DR, Singh H, et al., 2016, Temporal Demands Increase Workload and Degrade Surgical Performance, International Surgical Congress of the Association of Surgeons of Great Britain and Ireland, Publisher: Wiley, Pages: 52-53, ISSN: 1365-2168
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