Annals of surgical oncology
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Multicenter Study
Telementoring: a multi-institutional experience with the introduction of a novel surgical approach for adrenalectomy.
Telementoring is a video-conferencing tool which can deliver expert opinion to physicians and their patients in remote locations. We report our experience with the use of telementoring as a technique to instruct in the performance of posterior retroperitoneoscopic adrenalectomy (PRA). Issues regarding utility, regulation, and future directions of telementoring are addressed. ⋯ Telementoring is a technical application with utility in remotely helping and guiding another surgeon through the execution of a novel surgical approach. The cyberspace consultation is safe and enhances patient care through a real-time collaborative approach which extends beyond the confines of one institution and one surgeon. Aspects concerning improvement in both implementation and regulation of telementoring mandate further research and creation of nationwide guidelines.
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Anastomotic leak is a serious complication of low anterior resection (LAR). The risk of leak in stage IV rectal cancer patients treated with synchronous or staged resection of the primary tumour and metastatic sites has not been reported. We measured the incidence of anastomotic leak and its association with clinical outcome. ⋯ In this series of patients with stage IV rectal cancer, anastomotic leak was uncommon. However, patients who developed a clinical leak following surgery had worse survival. This finding was independent of use of diverting stoma or staged resection.
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Comparative Study
Long-term survival outcomes of Video-assisted Thoracic Surgery (VATS) lobectomy after transitioning from open lobectomy.
Open lobectomy continues to be more commonly performed than video-assisted thoracic surgery (VATS) lobectomy. We previously described the short-term safety of an approach for transitioning from open lobectomy to VATS. We now assess its long-term safety by evaluating survival results of the initial VATS cases after transition. ⋯ The transition from open to VATS lobectomy is safe with regards to both short-term morbidity and long-term survival. Surgeons currently performing open lobectomy should consider transitioning to the VATS procedure.
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Posterior retroperitoneoscopic adrenalectomy (PRA) has several benefits compared with transperitoneal adrenalectomy in that it is safe and has a short learning curve. In addition, it provides direct short access to the target organ, prevents irritation to the intraperitoneal space, and does not require retraction of adjacent organs.1 (-) 3 We have performed several cases of robot-assisted PRA using single-port access for small adrenal tumors. This multimedia article introduces the detailed methods and preliminary results of this procedure. ⋯ Our initial experiences with robot-assisted PRA using single-port access assured us of its safety and feasibility for the resection of small adrenal tumors. Although single-port robot-assisted PRA appears to be safe and feasible, further experience and research is required to optimize patient selection criteria and verify its advantages over the traditional three-incision PRA technique.
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Multicenter Study Comparative Study Controlled Clinical Trial
Comparative evaluation of [(99m)tc]tilmanocept for sentinel lymph node mapping in breast cancer patients: results of two phase 3 trials.
Sentinel lymph node (SLN) surgery is used worldwide for staging breast cancer patients and helps limit axillary lymph node dissection. [(99m)Tc]Tilmanocept is a novel receptor-targeted radiopharmaceutical evaluated in 2 open-label, nonrandomized, within-patient, phase 3 trials designed to assess the lymphatic mapping performance. ⋯ [(99m)Tc]Tilmanocept demonstrated success in detecting a SLN while meeting the primary endpoint. Interestingly, [(99m)Tc]tilmanocept was additionally noted to identify more SLNs in more patients. This localization represented a higher number of metastatic breast cancer lymph nodes than that of VBD.