Publications
239 results found
Hughes-Hallett A, Pratt P, Dilley J, et al., 2015, Augmented reality: 3D image-guided surgery, Cancer Imaging, Vol: 15
Pratt P, Hughes-Hallett A, Zhang L, et 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.
Leff DR, Bottle A, Mayer E, et al., 2015, Trends in immediate postmastectomy breast reconstruction in the United Kingdom, Plastic and Reconstructive Surgery, Global Open, Vol: 3, ISSN: 2169-7574
Background: The study aimed to evaluate local and national trends in immediate breast reconstruction (IBR) using the national English administrative records, Hospital Episode Statistics. Our prediction was an increase in implant-only and free flap procedures and a decline in latissimus flap reconstructions.Methods: Data from an oncoplastic center were interrogated to derive numbers of implant-only, autologous latissimus dorsi (LD), LD-assisted, and autologous pedicled or free flap IBR procedures performed between 2004 and 2013. Similarly, Hospital Episode Statistics data were used to quantify national trends in these procedures from 1996 to 2012 using a curve fitting analysis.Results: National data suggest an increase in LD procedures between 1996 (n = 250) and 2002 (n = 958), a gradual rise until 2008 (n = 1398) followed by a decline until 2012 (n = 1090). As a percentage of total IBR, trends in LD flap reconstruction better fit a quadratic (R2 = 0.97) than a linear function (R2 = 0.63), confirming a proportional recent decline in LD flap procedures. Conversely, autologous (non-LD) flap reconstructions have increased (1996 = 0.44%; 2012 = 2.76%), whereas implant-only reconstructions have declined (1996 = 95.42%; 2012 = 84.92%). Locally, 70 implant-assisted LD procedures were performed in 2003 -2004, but only 2 were performed in 2012 to 2013.Conclusions: Implants are the most common IBR technique; autologous free flap procedures have increased, and pedicled LD flap procedures are in decline.
Pratt P, Jaeger A, Hughes-Hallett A, et 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.
Hughes-Hallett A, Browne D, Mensah E, et 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
Mason SE, Scott AJ, Mayer E, et al., 2015, Patient-related risk factors for urinary retention following ambulatory general surgery: Asystematic review and meta-analysis, American Journal of Surgery, Vol: 211, Pages: 1126-1134, ISSN: 0002-9610
Background: Postoperative urinary retention (POUR) is a source of avoidable patient harm. The aim of this review is to identify and quantify the role of patient-related risk factors in the development of POUR following ambulatory general surgery. Methods: Studies published until December 2014 were identified by searching MEDLINE, EMBASE, and PsycINFO databases. Risk factors assessed in 3 or more studies were meta-analyzed. Results: Twenty-one studies were suitable for inclusion consisting of 7,802 patients. The incidence of POUR was 14%. Increased age and the presence of lower urinary tract symptoms significantly increased risk with odds ratios [ORs] of 2.11 (95% confidence interval [CI] 1.15 to 3.86) and 2.83 (1.57 to 5.08), respectively. Male sex was not associated with developing POUR (OR .96, 95% CI .62 to 1.50). Preoperative α-blocker use significantly decreased the incidence of POUR with an OR of .37(95% CI .15 to .91). Conclusions: Increased age and the presence of lower urinary tract symptoms increase the risk of POUR, while α-blocker use confers protection. Male sex was not associated with POUR. These findings assist in preoperative identification of patients at high risk of POUR.
Jilka SR, Callahan R, Sevdalis N, et al., 2015, "Nothing About Me Without Me": An Interpretative Review of Patient Accessible Electronic Health Records, Journal of Medical Internet Research, Vol: 17, ISSN: 1439-4456
BackgroundPatient accessible electronic health records (PAEHRs) enable patients to access and manage personalclinical information that is made available to them by their health care providers (HCPs). It is thought thatthe shared management nature of medical record access improves patient outcomes and improves patientsatisfaction. However, recent reviews have found that this is not the case. Furthermore, little research hasfocused on PAEHRs from the HCP viewpoint. HCPs include physicians, nurses, and service providers.ObjectiveWe provide a systematic review of reviews of the impact of giving patients record access from both apatient and HCP point of view. The review covers a broad range of outcome measures, including patientsafety, patient satisfaction, privacy and security, self-efficacy, and health outcome.MethodsA systematic search was conducted using Web of Science to identify review articles on the impact ofPAEHRs. Our search was limited to English-language reviews published between January 2002 andNovember 2014. A total of 73 citations were retrieved from a series of Boolean search terms including“review*” with “patient access to records”. These reviews went through a novel scoring system analysiswhereby we calculated how many positive outcomes were reported per every outcome measureinvestigated. This provided a way to quantify the impact of PAEHRs.Results1 1 2 1112Ten reviews covering chronic patients (eg, diabetes and hypertension) and primary care patients, as well asHCPs were found but eight were included for the analysis of outcome measures. We found mixedoutcomes across both patient and HCP groups, with approximately half of the reviews showing positivechanges with record access. Patients believe that record access increases their perception of control;however, outcome measures thought to create psychological concerns (such as patient anxiety as a result ofseeing their medical record) are still unanswered. Nurses are more likely th
Mensah EE, Hounsome LH, Verne JV, et al., 2015, Cardiovascular outcomes in kidney cancer patients, Annual Meeting of the British-Association-of-Urological-Surgeons (BAUS), Publisher: WILEY-BLACKWELL, Pages: 47-48, ISSN: 1464-4096
Kockelbergh R, Mayer E, Hounsome L, et al., 2015, Bladder cancer recurrence; evidence of wide variation in England, Publisher: WILEY-BLACKWELL, Pages: 75-76, ISSN: 0961-5423
Mensah E, Hounsome L, Verne J, et al., 2015, Cardiovascular outcomes inkidney cancer patients, Publisher: WILEY-BLACKWELL, Pages: 23-23, ISSN: 0961-5423
Cooper CS, Eeles R, Wedge DC, et al., 2015, Analysis of the genetic phylogeny of multifocal prostate cancer identifies multiple independent clonal expansions in neoplastic and morphologically normal prostate tissue (vol 47, pg 367, 2015), NATURE GENETICS, Vol: 47, Pages: 689-689, ISSN: 1061-4036
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- Citations: 5
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
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- Citations: 2
Hughes-Hallett A, Pratt P, Mayer E, et 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.
Mayer EK, Sevdalis N, Rout S, et al., 2015, Surgical checklist implementation project: the impact of variable WHO checklist compliance on risk-adjusted clinical outcomes after national implementation: a longitudinal study, Annals of Surgery, Vol: 263, Pages: 58-63, ISSN: 1528-1140
OBJECTIVE: To evaluate impact of WHO checklist compliance on risk-adjusted clinical outcomes, including the influence of checklist components (Sign-in, Time-out, Sign-out) on outcomes. BACKGROUND: There remain unanswered questions surrounding surgical checklists as a quality and safety tool, such as the impact in cases of differing complexity and the extent of checklist implementation. METHODS: Data were collected from surgical admissions (6714 patients) from March 2010 to June 2011 at 5 academic and community hospitals. The primary endpoint was any complication, including mortality, occurring before hospital discharge. Checklist usage was recorded as checklist completed in full/partly. Multilevel modeling was performed to investigate the association between complications/mortality and checklist completion. RESULTS: Significant variability in checklist usage was found: although at least 1 of the 3 components was completed in 96.7% of cases, the entire checklist was only completed in 62.1% of cases. Checklist completion did not affect mortality reduction, but significantly lowered risk of postoperative complication (16.9% vs. 11.2%), and was largely noticed when all 3 components of the checklist had been completed (odds ratio = 0.57, 95% confidence interval: 0.37-0.87, P < 0.01). Calculated population-attributable fractions showed that 14% (95% confidence interval: 7%-21%) of the complications could be prevented if full completion of the checklist was implemented. CONCLUSIONS: Checklist implementation was associated with reduced case-mix-adjusted complications after surgery and was most significant when all 3 components of the checklist were completed. Full, as opposed to partial, checklist completion provides a health policy opportunity to improve checklist impact on surgical safety and quality of care.
Cooper CS, Eeles R, Wedge DC, et al., 2015, Analysis of the genetic phylogeny of multifocal prostate cancer identifies multiple independent clonal expansions in neoplastic and morphologically normal prostate tissue., Nature Genetics, Vol: 47, Pages: 367-372, ISSN: 1546-1718
Genome-wide DNA sequencing was used to decrypt the phylogeny of multiple samples from distinct areas of cancer and morphologically normal tissue taken from the prostates of three men. Mutations were present at high levels in morphologically normal tissue distant from the cancer, reflecting clonal expansions, and the underlying mutational processes at work in morphologically normal tissue were also at work in cancer. Our observations demonstrate the existence of ongoing abnormal mutational processes, consistent with field effects, underlying carcinogenesis. This mechanism gives rise to extensive branching evolution and cancer clone mixing, as exemplified by the coexistence of multiple cancer lineages harboring distinct ERG fusions within a single cancer nodule. Subsets of mutations were shared either by morphologically normal and malignant tissues or between different ERG lineages, indicating earlier or separate clonal cell expansions. Our observations inform on the origin of multifocal disease and have implications for prostate cancer therapy in individual cases.
Cundy TP, Mayer EK, Camps JI, et al., 2015, Education and training in pediatric robotic surgery: lessons learned from and inaugural multinational workshop, JOURNAL OF ROBOTIC SURGERY, Vol: 9, Pages: 57-63, ISSN: 1863-2483
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- Citations: 7
Saleh A, Abboudi H, Ghazal-Aswad M, et al., 2015, Management of erectile dysfunction post-radical prostatectomy, Research and Reports in Urology, Vol: 7, Pages: 19-33, ISSN: 2253-2447
Radical prostatectomy is a commonly performed procedure for the treatment of localized prostate cancer. One of the long-term complications is erectile dysfunction. There is little consensus on the optimal management; however, it is agreed that treatment must be prompt to prevent fibrosis and increase oxygenation of penile tissue. It is vital that patient expectations are discussed, a realistic time frame of treatment provided, and treatment started as close to the prostatectomy as possible. Current treatment regimens rely on phosphodiesterase 5 inhibitors as a first-line therapy, with vacuum erection devices and intraurethral suppositories of alprostadil as possible treatment combination options. With nonresponders to these therapies, intracavernosal injections are resorted to. As a final measure, patients undergo the highly invasive penile prosthesis implantation. There is no uniform, objective treatment program for erectile dysfunction post-radical prostatectomy. Management plans are based on poorly conducted and often underpowered studies in combination with physician and patient preferences. They involve the aforementioned drugs and treatment methods in different sequences and doses. Prospective treatments include dietary supplements and gene therapy, which have shown promise with there proposed mechanisms of improving erectile function but are yet to be applied successfully in human patients.
Yu AW, Abboudi H, Mayer E, et al., 2015, Three-dimensional printing in urological surgery: What are the possibilities?, International Journal of Urology, Vol: 22, Pages: 423-423, ISSN: 1442-2042
Hughes-Hallett A, Mayer EK, Pratt PJ, et 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.
Hughes-Hallet A, Mayer EK, Marcus HJ, et al., 2015, Inattention blindness in surgery, Surgical Endoscopy and Other Interventional Techniques, Vol: 29, Pages: 3184-3189, ISSN: 1432-2218
Russ SJ, Sevdalis N, Moorthy K, et al., 2015, A Qualitative evaluation of the barriers and facilitators toward implementation of the WHO surgical safety checklist across hospitals in England lessons from the "Surgical Checklist Implementation Project", Annals of Surgery, Vol: 261, Pages: 81-91, ISSN: 0003-4932
Objectives: To evaluate how the World Health Organization (WHO) surgical safety checklist was implemented across hospitals in England; to identify barriers and facilitators toward implementation; and to draw out lessons for implementing improvement initiatives in surgery/health care more generally.Background: The WHO checklist has been linked to improved surgical outcomes and teamwork, yet we know little about the factors affecting its successful uptake.Methods: A longitudinal interview study with operating room personnel was conducted across a representative sample of 10 hospitals in England between March 2010 and March 2011. Interviews were audio recorded over the phone. Interviewees were asked about their experience of how the checklist was introduced and the factors that hindered or aided this process. Transcripts were submitted to thematic analysis.Results: A total of 119 interviews were completed. Checklist implementation varied greatly between and within hospitals, ranging from preplanned/phased approaches to the checklist simply “appearing” in operating rooms, or staff feeling it had been imposed. Most barriers to implementation were specific to the checklist itself (eg, perceived design issues) but also included problematic integration into preexisting processes. The most common barrier was resistance from senior clinicians. The facilitators revealed some positive steps that can been taken to prevent/address these barriers, for example, modifying the checklist, providing education/training, feeding-back local data, fostering strong leadership (particularly at attending level), and instilling accountability.Conclusions: We identified common themes that have aided or hindered the introduction of the WHO checklist in England and have translated these into recommendations to guide the implementation of improvement initiatives in surgery and wider health care systems.
Russ S, Rout S, Caris J, et al., 2015, Measuring variation in use of the WHO surgical safety checklist in the operating room: a multicenter prospective cross-sectional study, Journal of the American College of Surgeons, Vol: 220, Pages: 1-11.e4, ISSN: 1072-7515
BackgroundFull implementation of safety checklists in surgery has been linked to improved outcomes and team effectiveness; however, reliable and standardized tools for assessing the quality of their use, which is likely to moderate their impact, are required.Study DesignThis was a multicenter prospective study. A standardized observational instrument, the “Checklist Usability Tool” (CUT), was developed to record precise characteristics relating to the use of the WHO's surgical safety checklist (SSC) at “time-out” and “sign-out” in a representative sample of 5 English hospitals. The CUT was used in real-time by trained assessors across general surgery, urology, and orthopaedic cases, including elective and emergency procedures.ResultsWe conducted 565 and 309 observations of the time-out and sign-out, respectively. On average, two-thirds of the items were checked, team members were absent in more than 40% of cases, and they failed to pause or focus on the checks in more than 70% of cases. Information sharing could be improved across the entire operating room (OR) team. Sign-out was not completed in 39% of cases, largely due to uncertainty about when to conduct it. Large variation in checklist use existed between hospitals, but not between surgical specialties or between elective and emergency procedures. Surgical safety checklist performance was better when surgeons led and when all team members were present and paused.ConclusionsWe found large variation in WHO checklist use in a representative sample of English ORs. Measures sensitive to checklist practice quality, like CUT, will help identify areas for improvement in implementation and enable provision of comprehensive feedback to OR teams.
Hughes-Hallett A, Mayer E, Pratt P, et 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.
Mayer E, 2014, Processes of Care and the Impact of Surgical Volumes on Cancer-specific Survival: A Population-based Study in Bladder Cancer COMMENT, UROLOGY, Vol: 84, Pages: 1056-1056, ISSN: 0090-4295
Russ SJ, Rout S, Caris J, et al., 2014, The WHO surgical safety checklist: survey of patients' views, BMJ QUALITY & SAFETY, Vol: 23, Pages: 939-946, ISSN: 2044-5415
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- Citations: 17
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
Mayer EK, 2014, Long-term Outcomes in Severe Lower Urinary Tract Symptoms in Men Undergoing Robotic-assisted Radical Prostatectomy COMMENT, UROLOGY, Vol: 84, Pages: 831-831, ISSN: 0090-4295
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.
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
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