Volume Of Resected Specimen Research Articles

Prediction of Posthepatectomy Liver Failure with a Combination of Albumin-Bilirubin Score and Liver Resection Percentage

Posthepatectomy liver failure (PHLF) is a main cause of death after partial hepatectomy. The aim of this study was to develop a practical stratification system using the albumin-bilirubin (ALBI) score and liver resection percentage to predict severe PHLF and conduct safe hepatectomy. Between January 2002 and March 2021, 361 hepatocellular carcinoma (HCC) patients who underwent partial hepatectomy were enrolled. Medical image analysis software was applied postoperatively to accurately simulate hepatectomy. The liver resection percentage was calculated as follows: (postoperatively reconstructed resected specimen volume [ml] - tumor volume [ml])/total functional liver volume (ml) × 100. Multivariate analysis was performed to identify risk factors for PHLF grade B/C. A heatmap for predicting grade B/C PHLF was generated by combining the ALBI score and liver resection percentage. Thirty-nine patients developed grade B/C PHLF; 2 of these patients (5.1%) died. Multivariate analysis demonstrated that a high ALBI score and high liver resection percentage were independent predictors of severe PHLF (odds ratio [OR], 8.68, p < 0.001; OR, 1.10, p < 0.001). With a threshold PHLF probability of 50% for the heatmap, hepatectomy was performed for 346 patients meeting our criteria (95.8%) and 325 patients meeting the Makuuchi criteria (90.0%). The positive predictive value and negative predictive value for severe PHLF were 91.6% and 66.7% for our system and 91.7% and 33.3% for the Makuuchi criteria. Our stratification system could increase the number of hepatectomy candidates and is practical for deciding the surgical indications and determining the upper limit of the liver resection percentage corresponding to each patient's liver function reserve, which could prevent PHLF and yield better postoperative outcomes.

Outcome Following Breast Conservative Surgery for Early Breast Cancer at NICRH

1. Introduction: Breast cancer is diagnosed at an early stage as a result of population screening programs, which facilitate the possibility of organ- preservation. One of the methods of breast cancer control is a breast conserving surgery (BCS). Aim of the study: The aim of this study was to assess the early outcome following breast conservative surgery for early breast cancer. Methods: This observational study was conducted in the Department of Surgical Oncology at National Institute of Cancer Research and Hospital, Dhaka from January 2018 to December 2019. Within the period, total 46 cases of early breast cancer that has the inclusion criteria were taken as sample after informed consent. All the data were compiled and sorted properly and the quantitative data were analyzed statistically by using Statistical Package for Social Science (SPSS-26). Result: In present study, mean (±SD) volume of resected specimen was 49.54(±8.51) cm, mean (±SD) volume of tumor 20.22(±5.04) cm and mean (±SD) margin was 0.65 (40.24) cm. Only 2 (4.35%) subjects had developed wounds infection, 1 (2.17%) had hematoma and 2 (4.35%) had seroma. All of study people were treated conservatively. Among the study subjects, disfigurements of breast were developed in 7 (15.22%) cases. Locoregional recurrence was noted in 3 (6.52%) cases and locoregional with lung metastasis was noted in 1 (2.17%) case. Of the 46 patients was assessed using BRA, the scores were good to excellent, fair and poor 30 (65.22%), 15 (32.61%) and 1(1%) respectively. ND scored 19. (41.30%) as good to excellent, 13 (28.26%) as fair and 14 (30.43%) as poor. Using panel assessment 26 (56.52%) scored good to excellent, 16 (34.78%) scored fair and 4 (8.69%) scored poor. Conclusion: Itcan be concluded that breast conservative surgery gives satisfactory outcome in early breast cancer.

A Validation Study of Liver Volumetry Estimation by a Semiautomated Software in Patients Undergoing Hepatic Resections

AbstractPurpose The purpose of this study was to validate the use of a semiautomated software for liver volumetry preoperatively by comparing it with the volume of resected specimen in patients undergoing hepatic resections.Materials and Methods This is a single-center retrospective study of patients who underwent estimation of future liver remnant (FLR) using Myrian XP-Liver which is a semiautomated software for hepatectomy. The estimated resection volume, which is the sum of volume of normal liver to be resected and tumor volume, was compared with actual specimen weight to calculate the accuracy of the software. The statistical analysis was performed with SPSS software version 24.Results Data on FLR estimation using the semiautomated software was available for 200 out of 388 patients who underwent formal hepatic resections. The median resected volume of surgical specimen was 650 mL (interquartile range [IQR] 364–950), while the median estimated volume using the Myrian software was 617 mL (IQR 362–979). There was significant correlation between estimated resection volume calculated using the semiautomated method and actual specimen weight (p-value &lt; 0.0001) with the Spearman’s correlation value of 0.956.Conclusion The estimated volume of liver to be resected as calculated by the semiautomated software was accurate and correlated significantly with the volume of resected specimen, and hence, the estimation of FLR volume may likely correlate with the true postoperative residual liver volume. In addition, the software-based liver segmentation, FLR estimation, and color-coded three-dimensional images provide a clear road map to the surgeon to facilitate safe resection.

Endoscopic endonasal resection of orbital schwannoma assisted with small-incision medial orbitotomy: case series and surgical technique

ABSTRACT Purpose To describe a surgical approach for the resection of schwannomas occurring in the medial aspect of the orbit and to review a series of patients who underwent this novel technique. Methods This retrospective, non-comparative case series presents the surgical technique and outcomes of patients who underwent removal of a medial orbital schwannoma via an endoscopic endonasal approach combined with a small-incision medial orbitotomy by a team of two surgeons (BSB and SKF). Patient demographics, pre- and post-operative clinical examination findings, visual field testing, and radiographic studies were reviewed. Operative reports were reviewed for technical details and complications. Results The patients included a 12 year-old male, 73 year-old female and 8 year-old male. Indications for surgery included: decreased visual acuity, diplopia, proptosis and Humphrey visual field (HVF) deficit, in the presence of a medial orbital biopsy-proven schwannoma. The surgical approach in all three patients was primarily endoscopic endonasal. Additionally, two had transcaruncular orbitotomies and one had a small-incision medial lid crease orbitotomy to assist with lateral tumor dissection. Tumor resection was complete in one case and near-total in two cases. There were no intra-operative surgical complications. Average resected specimen volume was 3.41 cm3 ± 2.20. All patients had post-operative improvement in visual acuity (VA) and proptosis. Post-operative follow-up intervals were 27.5 months, 12.3 months and 3.5 months, respectively. Conclusion Resection of orbital schwannomas using an endoscopic endonasal approach with small-incision medial transorbital assistance is a safe and effective option for a multidisciplinary surgical team.

Generalized linear model (GLM) analysis: Multivariables of microcalcification specimens obtained via X-ray guided by stereotactic wire localization biopsy.

To retrospectively explore correlation of the resected specimen volume of breast microcalcification lesions and endogenous and exogenous factors of stereotactic needle localization biopsy (SNLB). Totally 214 patients underwent SNLB for non-palpable breast lesion with microcalcification lesions. Of 211 patients, 198 patients underwent single needle localization and 13 patients underwent multi-needle localization (26 lesions). Lesion sizes, distribution characteristics, lesion localization accuracy and resected specimen volumes were recorded and analyzed using a generalized linear model (GLM). The average lesion diameter is 2.63±1.73 cm. The localization accuracy of 187 lesions were moderate, 26 were too deep and 11 were too superficial. The mean resected specimen volume (V) was 17.51±5.14 cm3. One-way ANOVA analysis showed that 3 factors, including lesion sizes, distribution characteristics and the localization accuracy were associated with resected specimen volume (F = 67.56-112.78, P < 0.001). GLM revealed that lesion sizes, single clustered distribution and accurate localization were significant factors for resected specimen volume (F = -4.82-11.36, P < 0.05). The ratio (%) of the resected specimen volume to the involved breast volume (V0) was defined as the degree of breast defect. The mean breast defect of 125 benign patients (V/V0) was 27.5% ranging from 10.1% to 42.3%. Average lesion diameter and localization accuracy are highly significant variables for the resected specimen volume. Localization accuracy as a subjective controllable variable is one of the important factors that determine the volume of lesion resection. Single clustered distribution was more susceptible localization accuracy than other characteristic distributions. Improving localization accuracy can reduce resected specimen volume, which can reduce breast defect to a certain extent.

Influence of lung resection volume on risk of primary spontaneous pneumothorax recurrence.

Thoracoscopic stapled bullectomy is a popular procedure for the treatment of primary spontaneous pneumothorax (PSP) that has a relatively high postoperative recurrence rate. One reason for PSP recurrence is the formation of a new bulla around the staple line. We hypothesized that different resected specimen volumes might cause differences in staple line tension. In this study, we analyzed the relationship between postoperative pneumothorax recurrence and resected lung volume. Between April, 2009 and December 2013, 360 cases which underwent video-assisted thoracoscopic surgery (VATS) for PSP were selected. Recurrence after VATS was examined by electronic medical records and telephone survey. Resected volume and vertical area of specimen were calculated with the size of pathologic specimen. A mean follow up period was 44.5±24.4 months and recurrence rate was 11.1% (40/360). Large volume of resected specimen (≥16 cm3) (P=0.027 by the log-rank test) and larger vertical area of resected specimen (≥2.0 cm2) (P=0.003 by the log-rank test) showed significantly high recurrence rate. Cox regression analysis demonstrated that age [hazard ratio (HR), 0.083, P=0.006], vertical section area of resected specimen (HR, 1.239, P=0.020) and volume of resected pathology specimen (HR, 1.039, P=0.009) were independent risk factors of recurrence. Bulky resection during VATS for PSP increases the risk of recurrence. Large volume and vertical area of resected specimen are associated with greater tension in stapling line. Avoidance of wide resection and the firing of stapler after full collapse of lung are recommended for reducing the pneumothorax recurrence after VATS.

A transanal procedure using TST STARR Plus for the treatment of Obstructed Defecation Syndrome: ‘A mid-term study’

PurposeThe aim of this study was to assess the safety, efficacy and outcomes of TST STARR (Stapled Transanal Rectal Resection) plus to treat Obstructed Defecation Syndrome (ODS) at mid-term follow-up. MethodsFrom April 2013 to September 2014, 50 cases (7 male patients) with ODS caused by rectocele and/or internal rectal prolapse were treated with the new TST STARR Plus. Clinical data from the 18 month mid-term follow up, including efficacy and constipations were recorded. ResultsThe average duration of surgery was 21 ± 4 min (range 12–35 min). The average postoperative hospital stay was 5 days (range 4–8 days). The pathological findings showed that the specimens contained full-thickness rectal tissue in all patients. The mean volume of resected specimen was 12.3 cm3. Postoperative complications included five cases with transient faecal urgency that dissipated after 3 months; one patient suffered anastomotic bleeding on the sixth day after surgery, with successful haemostasis achieved through conservative therapy. The Wexner constipation score improved in patients affected by ODS from 13.96 ± 2.37 preoperatively to 7.00 ± 3.90, 7.28 ± 3.91, 8.10 ± 4.05 and 8.44 ± 4.08 at 3,6,12 and 18 months postoperatively, respectively, with all p < 0.05. Overall outcome was reported as ‘‘excellent’’ in 42% of patients, ‘‘good’’ in 36% of patients, ‘‘adequate’’ in 12% of patients, and ‘‘poor’’ in 10% of patients after 18 months of follow-up. ConclusionsThe TST STARR Plus is a simple, safe, and effective option for selected patients with ODS. Long-term prospective clinical studies are needed to validate the advantages of this emerging, novel procedure.

Feasibility and accuracy of computational robot-assisted partial nephrectomy planning by virtual partial nephrectomy analysis.

To evaluate the feasibility and accuracy of virtual partial nephrectomy analysis, including a color-coded three-dimensional virtual surgical planning and a quantitative functional analysis, in predicting the surgical outcomes of robot-assisted partial nephrectomy. Between 2012 and 2014, 20 patients underwent virtual partial nephrectomy analysis before undergoing robot-assisted partial nephrectomy. Virtual partial nephrectomy analysis was carried out with the following steps: (i) evaluation of the arterial branch for selective clamping by showing the vascular-supplied area; (ii) simulation of the optimal surgical margin in precise segmented three-dimensional model for prediction of collecting system opening; and (iii) detailed volumetric analyses and estimates of postoperative renal function based on volumetric change. At operation, the surgeon identified the targeted artery and determined the surgical margin according to the virtual partial nephrectomy analysis. The surgical outcomes between the virtual partial nephrectomy analysis and the actual robot-assisted partial nephrectomy were compared. All 20 patients had negative cancer surgical margins and no urological complications. The tumor-specific renal arterial supply areas were shown in color-coded three-dimensional model visualization in all cases. The prediction value of collecting system opening was 85.7% for sensitivity and 100% for specificity. The predicted renal resection volume was significantly correlated with actual resected specimen volume (r(2) = 0.745, P < 0.001). The predicted estimated glomerular filtration rate was significantly correlated with actual postoperative estimated glomerular filtration rate (r(2) = 0.736, P < 0.001). Virtual partial nephrectomy analysis is able to provide the identification of tumor-specific renal arterial supply, prediction of collecting system opening and prediction of postoperative renal function. This technique might allow urologists to compare various arterial clamping methods and resection margins with surgical outcomes in a non-invasive manner.

Accuracy of preoperative automatic measurement of the liver volume by CT-scan combined to a 3D virtual surgical planning software (3DVSP).

Liver volumetry is a critical component of safe hepatic surgery, in order to minimize the risk of postoperative liver failure. Liver volumes can be calculated routinely using the time-consuming gold standard method of manual volumetry. The current work sought to evaluate an alternative automatic technique based on a novel 3D virtual planning software, and to compare it to the manual technique. A prospective study of patients undergoing liver resection was conducted. Every patient had a pre and 2-day postoperative CT-scan. For each patient, total, remnant and resected volumes were calculated manually and automatically. Planes of resection were verified by a hepatobiliary surgeon and compared with postoperative volumes. Paired t-tests and correlation coefficients were calculated. A major hepatectomy was carried out in 36/43 patients. The automatic TLV (1,759 mL) and the manual TLV (1,832 mL) were significantly different (p < 0.001), but extremely highly correlated (r = 0.989). The percentages of preoperative RLV (manual 58.5%, automatic 58.9%) were similar, with an excellent correlation of 0.917. The preoperative RLV were matched with the 2-day postoperative RLV showing a significant difference (p = 0.0301). The resected volumes using both techniques (871 and 832 mL) were compared with the resected specimen volume (670 mL), showing a significant difference (p < 0.001) but a high degree of correlation (r = 0.874). The 3D virtual surgical planning software is accurate and reliable in determining the total liver and future remnant liver volumes. This technique demonstrates a good correlation with the manual technique. Future work will be required to confirm these findings and to evaluate the clinical value of the three-dimensional planning platform.

852 COMPARISON OF TRANSRECTAL AND TRANSVAGINAL HYBRID NATURAL ORIFICE TRANSLUMINAL ENDOSCOPIC SURGERY (NOTES) PARTIAL NEPHRECTOMY IN THE PORCINE MODEL

You have accessJournal of UrologyTechnology & Instruments: Laparoscopy - Malignant Disease1 Apr 2012852 COMPARISON OF TRANSRECTAL AND TRANSVAGINAL HYBRID NATURAL ORIFICE TRANSLUMINAL ENDOSCOPIC SURGERY (NOTES) PARTIAL NEPHRECTOMY IN THE PORCINE MODEL Wassim M. Bazzi, Sean P. Stroup, Takayuki Dotai, Seth A. Cohen, Ryan P. Kopp, Omer Raheem, James Masterson, Suzanne Gudeman, Caroline Colangelo, Santiago Horgan, Christopher J. Kane, and Ithaar H. Derweesh Wassim M. BazziWassim M. Bazzi San Diego, CA More articles by this author , Sean P. StroupSean P. Stroup San Diego, CA More articles by this author , Takayuki DotaiTakayuki Dotai San Diego, CA More articles by this author , Seth A. CohenSeth A. Cohen San Diego, CA More articles by this author , Ryan P. KoppRyan P. Kopp San Diego, CA More articles by this author , Omer RaheemOmer Raheem San Diego, CA More articles by this author , James MastersonJames Masterson San Diego, CA More articles by this author , Suzanne GudemanSuzanne Gudeman San Diego, CA More articles by this author , Caroline ColangeloCaroline Colangelo San Diego, CA More articles by this author , Santiago HorganSantiago Horgan San Diego, CA More articles by this author , Christopher J. KaneChristopher J. Kane San Diego, CA More articles by this author , and Ithaar H. DerweeshIthaar H. Derweesh San Diego, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.944AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Transrectal Natural Orifice Transluminal Endoscopic Surgery (NOTES) nephrectomy has recently been performed in the porcine model. We compared feasibility of porcine Transrectal (TR) and Transvaginal (TV) hybrid NOTES partial nephrectomy (NOTES-PN). METHODS 8 female pigs (45 kg) underwent TR (n=4) or TV (n=4) NOTES-PN. In both pneumoperitoneum was created by periumbilical 12-mm trocar, through which a laparoscope was advanced for intra-abdominal visualization. For TV-NOTES-PN: A gastroscope (Olympus, Center Valley, PA) was used to obtain transvaginal peritoneal access. For TR-NOTES-PN: horizontal incision was made 2-cm above the dentate line and a submucosal tunnel was created in the posterior rectal wall. Gastroscope was advanced through the submucosal tunnel and retroperitoneum to the kidney. A peritoneal window was created. For both TR- and TV-NOTES-PN, the gastroscope was exchanged for the SPIDER System (TransEnterix, Morrisville, NC) TR, Figure 1). Flexible dissecting instruments and hook cautery introduced through the SPIDER arms were used to mobilize kidney (TR, Figure 2) and hilum. Periumbilical-introduced harmonic scalpel (Ethicon, Cincinnati, OH) and scissors were used to excise a portion of the lower pole. Lapra-Ty secured (Ethicon) sutured renorrhaphy was performed, followed by completion nephrectomy, TR or TV specimen extraction and rectotomy/vaginotomy closure. RESULTS TR-and TV-NOTES-PN was successfully performed in all 8 pigs. Comparison of TR and TV approaches revealed no significant difference in mean: access time (33.5 vs. 30.8 min, p=0.626), operative time (212.5 vs. 197.5 min, p=0.561), estimated blood loss (68.8 vs. 66.3 mL, p=0.943), and volume of resected specimen (p=0.763). Necropsy did not demonstrate abdominal injuries. CONCLUSIONS We demonstrate proof-of-principle for TR and TV-NOTES-PN in swine, with comparable perioperative parameters. Preclinical survival studies are requisite to assess potential of TR NOTES to be an alternative to TV. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e347 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Wassim M. Bazzi San Diego, CA More articles by this author Sean P. Stroup San Diego, CA More articles by this author Takayuki Dotai San Diego, CA More articles by this author Seth A. Cohen San Diego, CA More articles by this author Ryan P. Kopp San Diego, CA More articles by this author Omer Raheem San Diego, CA More articles by this author James Masterson San Diego, CA More articles by this author Suzanne Gudeman San Diego, CA More articles by this author Caroline Colangelo San Diego, CA More articles by this author Santiago Horgan San Diego, CA More articles by this author Christopher J. Kane San Diego, CA More articles by this author Ithaar H. Derweesh San Diego, CA More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

The Effect of Simultaneous Peripheral Excision in Breast Conservation upon Margin Status

Negative margins in breast conservation therapy (BCT) decrease local recurrence risk. Excision may be performed via two techniques: either as a single lumpectomy specimen or as a central segment with simultaneously resected peripheral segments (PSs). There is little data directly comparing these methods for their effect on margin status. A retrospective review of all patients undergoing BCT for invasive breast cancer was conducted to evaluate and compare the two techniques. Presentation, pathologic characteristics, surgical technique, specimen volume, and final margin status were recorded. Among 259 cancers in 257 women, 33 had positive margins. A single segment was removed in 69 patients, while 190 patients had 1-6 PSs simultaneously removed. By univariate analysis, smaller tumor size (P=.017) and greater numbers of segments removed (P=.01) lowered the risk of positive margins. In a multivariate model, smaller tumor size (P=.0024), lack of EIC (P=.049), and greater numbers of segments removed (P=.0061) lowered the risk of margin positivity. Despite this last predictor, the total resected specimen volume did not increase with the number of PSs removed (P=.4). There was no residual tumor in 49.2% of PSs despite a compromised primary segment margin. Smaller tumor size, lack of EIC, and greater numbers of simultaneous PSs excised decrease the likelihood of positive margins, despite a lack of correlation between segment numbers and excised volume. These findings suggest that excision of simultaneous PSs may assist in achieving negative margins, in part, because of avoidance of pathologic artifact.