Imperial College London

DrDipankarNandi

Faculty of MedicineDepartment of Brain Sciences

Professor of Practice (Neurosurgery)
 
 
 
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Contact

 

+44 (0)20 3311 1182d.nandi

 
 
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Location

 

Lab BlockCharing Cross Campus

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Summary

 

Publications

Publication Type
Year
to

96 results found

Camp SJ, Apostolopoulos V, Raptopoulos V, Mehta A, O'Neill K, Awad M, Vaqas B, Peterson D, Roncaroli F, Nandi Det al., 2017, Objective image analysis of real-time three-dimensional intraoperative ultrasound for intrinsic brain tumour surgery, JOURNAL OF THERAPEUTIC ULTRASOUND, Vol: 5, Pages: 1-8, ISSN: 2050-5736

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

Yousif N, Mace M, Pavese N, Borisyuk R, Nandi D, Bain Pet al., 2017, A network model of local field potential activity in essential tremor and the impact of deep brain stimulation., Plos Computational Biology, Vol: 13, ISSN: 1553-7358

Essential tremor (ET), a movement disorder characterised by an uncontrollable shaking of the affected body part, is often professed to be the most common movement disorder, affecting up to one percent of adults over 40 years of age. The precise cause of ET is unknown, however pathological oscillations of a network of a number of brain regions are implicated in leading to the disorder. Deep brain stimulation (DBS) is a clinical therapy used to alleviate the symptoms of a number of movement disorders. DBS involves the surgical implantation of electrodes into specific nuclei in the brain. For ET the targeted region is the ventralis intermedius (Vim) nucleus of the thalamus. Though DBS is effective for treating ET, the mechanism through which the therapeutic effect is obtained is not understood. To elucidate the mechanism underlying the pathological network activity and the effect of DBS on such activity, we take a computational modelling approach combined with electrophysiological data. The pathological brain activity was recorded intra-operatively via implanted DBS electrodes, whilst simultaneously recording muscle activity of the affected limbs. We modelled the network hypothesised to underlie ET using the Wilson-Cowan approach. The modelled network exhibited oscillatory behaviour within the tremor frequency range, as did our electrophysiological data. By applying a DBS-like input we suppressed these oscillations. This study shows that the dynamics of the ET network support oscillations at the tremor frequency and the application of a DBS-like input disrupts this activity, which could be one mechanism underlying the therapeutic benefit.

Journal article

Fountain DM, Allen D, Joannides AJ, Nandi D, Santarius T, Chari Aet al., 2016, Reporting of patient-reported health-related quality of life in adults with diffuse low-grade glioma: a systematic review, NEURO-ONCOLOGY, Vol: 18, Pages: 1475-1486, ISSN: 1522-8517

Journal article

Marcus HJ, Payne CJ, Kailaya-Vasa A, Griffiths S, Clark J, Yang GZ, Darzi A, Nandi Det al., 2016, A "smart" force-limiting instrument for microsurgery: laboratory and in vivo validation, PLOS One, Vol: 11, ISSN: 1932-6203

Residents are required to learn a multitude of skills during their microsurgical training. One such skill is the judicious application of force when handling delicate tissue. An instrument has been developed that indicates to the surgeon when a force threshold has been exceeded by providing vibrotactile feedback. The objective of this study was to validate the use of this "smart" force-limiting instrument for microsurgery. A laboratory and an in vivo experiment were performed to evaluate the force-limiting instrument. In the laboratory experiment, twelve novice surgeons were randomly allocated to use either the force-limiting instrument or a standard instrument. Surgeons were then asked to perform microsurgical dissection in a model. In the in vivo experiment, an intermediate surgeon performed microsurgical dissection in a stepwise fashion, alternating every 30 seconds between use of the force-limiting instrument and a standard instrument. The primary outcomes were the forces exerted and the OSATS scores. In the laboratory experiment, the maximal forces exerted by novices using the force-limiting instrument were significantly less than using a standard instrument, and were comparable to intermediate and expert surgeons (0.637N versus 4.576N; p = 0.007). In the in vivo experiment, the maximal forces exerted with the force-limiting instrument were also significantly less than with a standard instrument (0.441N versus 0.742N; p <0.001). Notably, use of the force-limiting instrument did not significantly impede the surgical workflow as measured by the OSATS score (p >0.1). In conclusion, the development and use of this force-limiting instrument in a clinical setting may improve patient safety.

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

Bal J, Camp SJ, Nandi D, 2016, The use of ultrasound in intracranial tumor surgery, ACTA NEUROCHIRURGICA, Vol: 158, Pages: 1179-1185, ISSN: 0001-6268

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

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

Yousif N, Bhatt H, Bain P, Nandi, Seemungalet al., 2016, The effect of Pedunculopontine nucleus deep brain stimulation on postural sway and vestibular perception, European Journal of Neurology, Vol: 23, Pages: 668-670, ISSN: 1468-1331

Background and purposeDeep brain stimulation (DBS) of the pedunculopontine nucleus (PPN) reduces the number of falls in patients with Parkinson's disease (PD). It was hypothesized that enhanced sensory processing contributes to this PPN-mediated gait improvement.MethodsFour PD patients (and eight matched controls) with implanted bilateral PPN and subthalamic nucleus DBS electrodes were assessed on postural (with/without vision) and vestibular perceptual threshold tasks.ResultsPedunculopontine nucleus ON stimulation (compared to OFF) lowered vestibular perceptual thresholds but there was a disproportionate increase in the normal sway increase on going from light to dark.ConclusionsThe disproportionate increased sway with PPN stimulation in the dark may paradoxically improve balance function since mechanoreceptor signals rapidly adapt to continuous pressure stimulation from postural akinesia. Additionally, the PPN-mediated vestibular signal enhancement also improves the monitoring of postural sway. Overall, PPN stimulation may improve sensory feedback and hence balance performance.

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

Marcus HJ, 2015, The Application of Robotics to Keyhole Transcranial Endoscopic Microsurgery

Over the last decade, there has been a resurgence of clinical interest in keyhole transcranial endoscopic microsurgery as an alternative to conventional microsurgery in carefully selected cases. The supraorbital approach through an eyebrow incision may be considered one of the best examples of the keyhole concept. Although keyhole neurosurgery offers the possibility of reduced approach-related morbidity, it can also present substantial technical challenges. This thesis investigates the potential for robotic platforms to improve the safety and effectiveness of such keyhole approaches. A qualitative survey of neurosurgeons was performed to identify the major technical challenges of keyhole neurosurgery, and a quantitative study of patents and publications performed to determine the technological innovations that might overcome these barriers. Three clear themes emerged: first, surgical approach and better integration with image guidance systems; second, intra-operative visualisation and improvements in endoscopes; and third, surgical manipulation and improvements in instruments. A community survey suggested that robotic platforms incorporating these technologies would be acceptable to patients and their relatives.Existing robotic platforms were reviewed against the aforementioned requirements for keyhole neurosurgery. In a cadaver study, it was demonstrated that most frequently used surgical robot today, the da VinciTM platform, was neither safe nor feasible to use in keyhole neurosurgery, providing justification for further research.Technological innovations were sought to address each of the identified barriers to keyhole neurosurgery, including: an on-demand augmented reality system; a 3-Dimensional and High-Definition endoscope; and articulated robotic instruments. In a series of laboratory studies, each proposed technological innovation was compared against the current gold standard using a validated model. These technologies were then integrated into a robotic

Thesis dissertation

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

Kirkman MA, Muirhead W, Sevdalis N, Nandi Det al., 2015, Simulated Ventriculostomy Training With Conventional Neuronavigational Equipment Used Clinically in the Operating Room: Prospective Validation Study, JOURNAL OF SURGICAL EDUCATION, Vol: 72, Pages: 704-716, ISSN: 1931-7204

Journal article

Vakharia VN, Tai D, Marcus H, Vakharia NN, Nandi Det al., 2015, New oral anti-coagulants: Implications for neurosurgery., Br J Neurosurg, Vol: 29, Pages: 182-188

New oral anti-coagulants such as the direct thrombin inhibitor, Dabigatran, and the activated factor X inhibitors, Rivaroxaban and Apixaban, are rapidly gaining clinical popularity in North America and Europe following a number of seminal randomised control trials comparing their efficacy to Warfarin and Enoxaparin. In the coming years these agents are set to replace Warfarin use for the primary prevention of stroke in non-valvular atrial fibrillation, post-operative thromboprophylaxis and the treatment of deep vein thrombosis. The main trials have shown superior anti-coagulant effects over warfarin and low-molecular-weight heparin with the added benefits of lower bleeding complications (including intracranial haemorrhages) and no requirement for monitoring. Case reports are now appearing in the literature, highlighting some of the complications of their use, namely the lack of a uniform normalised anti-coagulation test and the paucity in clinical experience with reversing the anti-coagulant effects when emergent surgery is mandated. This review has been written for the neurosurgeon who will shortly be confronted with increasing numbers of patients taking new oral anti-coagulants and intracranial complications. Hospital clinicians will need to understand the pharmacokinetics of drug administration, the laboratory tests to measure the level of anti-coagulation and the treatment of patients who are therapeutically anti-coagulated and require urgent surgical intervention.

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

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

Apostolopoulos V, 2014, Real time intraoperative three dimensional ultrasound in biopsy and resection of intrinsic brain tumours

Thesis dissertation

Saleh Y, Marcus HJ, Iorga R, Nouraei R, Carpenter RH, Nandi Det al., 2014, Bedside saccadometry as an objective and quantitative measure of hemisphere-specific neurological function in patients undergoing cranial surgery, Journal of Clinical Neuroscience

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

Kirkman MA, Muirhead W, Nandi D, Sevdalis Net al., 2014, Development and Psychometric Evaluation of the "Neurosurgical Evaluation of Attitudes towards Simulation Training" (NEAT) Tool for Use in Neurosurgical Education and Training, WORLD NEUROSURGERY, Vol: 82, Pages: 284-291, ISSN: 1878-8750

Journal article

Mace M, Yousif N, Naushahi M, Abdullah-Al-Mamun K, Wang S, Nandi D, Vaidyanathan Ret al., 2014, An automated approach towards detecting complex behaviours in deep brain oscillations, JOURNAL OF NEUROSCIENCE METHODS, Vol: 224, Pages: 66-78, ISSN: 0165-0270

Journal article

Marcus HJ, Seneci CA, Payne CJ, Nandi D, Darzi A, Yang G-Zet al., 2014, Robotics in keyhole transcranial endoscope-assisted microsurgery: a critical review of existing systems and proposed specifications for new robotic platforms, Operative Neurosurgery, Vol: 10, Pages: 84-96, ISSN: 2332-4252

BACKGROUND:Over the past decade, advances in image guidance, endoscopy, and tube-shaft instruments have allowed for the further development of keyhole transcranial endoscope-assisted microsurgery, utilizing smaller craniotomies and minimizing exposure and manipulation of unaffected brain tissue. Although such approaches offer the possibility of shorter operating times, reduced morbidity and mortality, and improved long-term outcomes, the technical skills required to perform such surgery are inevitably greater than for traditional open surgical techniques, and they have not been widely adopted by neurosurgeons. Surgical robotics, which has the ability to improve visualization and increase dexterity, therefore has the potential to enhance surgical performance.OBJECTIVE:To evaluate the role of surgical robots in keyhole transcranial endoscope-assisted microsurgery.METHODS:The technical challenges faced by surgeons utilizing keyhole craniotomies were reviewed, and a thorough appraisal of presently available robotic systems was performed.RESULTS:Surgical robotic systems have the potential to incorporate advances in augmented reality, stereoendoscopy, and jointed-wrist instruments, and therefore to significantly impact the field of keyhole neurosurgery. To date, over 30 robotic systems have been applied to neurosurgical procedures. The vast majority of these robots are best described as supervisory controlled, and are designed for stereotactic or image-guided surgery. Few telesurgical robots are suitable for keyhole neurosurgical approaches, and none are in widespread clinical use in the field.CONCLUSION:New robotic platforms in minimally invasive neurosurgery must possess clear and unambiguous advantages over conventional approaches if they are to achieve significant clinical penetration.

Journal article

Marcus HJ, Cundy TP, Nandi D, Yang G-Z, Darzi Aet al., 2014, Robot-assisted and fluoroscopy-guided pedicle screw placement: a systematic review, European Spine Journal, Vol: 23, Pages: 291-297, ISSN: 0940-6719

PurposeAt present, most spinal surgeons undertake pedicle screw implantation using either anatomical landmarks or C-arm fluoroscopy. Reported rates of screw malposition using these techniques vary considerably, though the evidence generally favors the use of image-guidance systems. A miniature spine-mounted robot has recently been developed to further improve the accuracy of pedicle screw placement. In this systematic review, we critically appraise the perceived benefits of robot-assisted pedicle screw placement compared to conventional fluoroscopy-guided technique.MethodsThe Cochrane Central Register of Controlled Trials, PubMed, and EMBASE databases were searched between January 2006 and January 2013 to identify relevant publications that (1) featured placement of pedicle screws, (2) compared robot-assisted and fluoroscopy-guided surgery, (3) assessed outcome in terms of pedicle screw position, and (4) present sufficient data in each arm to enable meaningful comparison (>10 pedicle screws in each study group).ResultsA total of 246 articles were retrieved, of which 5 articles met inclusion criteria, collectively reporting placement of 1,308 pedicle screws (729 robot-assisted, 579 fluoroscopy-guided). The findings of these studies are mixed, with limited higher level of evidence data favoring fluoroscopy-guided procedures, and remaining comparative studies supporting robot-assisted pedicle screw placement.ConclusionsThere is insufficient evidence to unequivocally recommend one surgical technique over the other. Given the high cost of robotic systems, and the high risk of spinal surgery, further high quality studies are required to address unresolved clinical equipoise in this field.

Journal article

Kirkman MA, Ahmed M, Albert AF, Wilson MH, Nandi D, Sevdalis Net al., 2014, The use of simulation in neurosurgical education and training: A systematic review, Journal of neurosurgery, Vol: 121, Pages: 228-246

Journal article

Khan A, Naushad Chaudhry M, Khalid S, Nandi Det al., 2014, Improvement of patient satisfaction with the neurosurgery service at a large tertiary care, London-based hospital., BMJ Qual Improv Rep, Vol: 3, ISSN: 2050-1315

Patient satisfaction is central to healthcare provision and the effective running of any surgical unit. Following on from both formal and informal feedback, we decided to look objectively at patient satisfaction with the neurosurgery service at a large tertiary care hospital in London and identify areas that needed improvement within the unit. Patient satisfaction was looked at with respect to four different aspects of the neurosurgery service: the surgeons, ward doctors, nurses, and hospital services. A questionnaire-based cross-sectional study was conducted and once the data were collected a plan of action to improve service provision was put into place. Data were collected from 150 patients over a 3 month period from September to November 2012. Interventions were made and data re-collected from 150 patients from January to March 2013. With regards to satisfaction with the neurosurgery service, 76.7% (n=115) were satisfied; following implementation of our measures for improvement, which included staff education, meetings and posters, this figure increased to 90.6% (n=136, p<0.001 on Chi-square testing). In conclusion, patient satisfaction should be at the crux of patient care, with a strong focus on effective communication skills, and can be improved by identification of issues by direct patient feedback and subsequent action based on this.

Journal article

Marcus HJ, Hughes-Hallett A, Cundy TP, Di Marco A, Pratt P, Nandi D, Darzi A, Yang GZet al., 2013, Comparative Effectiveness of 3-D versus 2-D and HD versus SD Neuroendoscopy: A Preclinical Randomized Crossover Study, Neurosurgery

Journal article

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