Saied Froghi

Learning curves for urological procedures: a systematic review

To determine the number of cases a urological surgeon must complete to achieve proficiency for various urological procedures.

Learning curves for urological procedures

To determine the number of cases a urological surgeon must complete to achieve proficiency for various urological procedures.

Evaluation of robotic and laparoscopic partial nephrectomy for small renal tumours (T1a)

To compare laparoscopic partial nephrectomy (LPN) with robotic PN (RPN) using meta‐analytical techniques, since there has been a rise in the incidence of small renal masses (SRM; <4 cm) minimally invasive approaches are becoming more popular in dealing with such pathologies.

Comparing robotic, laparoscopic and open cystectomy: a systematic review and meta-analysis

OBJECTIVE To conduct a systematic review and meta-analysis comparing outcomes between Open Radical Cystectomy (ORC), Laparoscopic Radical Cystectomy (LRC) and Robot-assisted Radical Cystectomy (RARC). RARC is to be compared to LRC and ORC and LRC compared to ORC. MATERIAL AND METHODS A systematic review of the literature was conducted, collating studies comparing RARC, LRC and ORC. Surgical and oncological outcome data were extracted and a meta-analysis was performed. RESULTS Twenty-four studies were selected with total of 2,104 cases analyzed. RARC had a longer operative time (OPT) compared to LRC with no statistical difference between length of stay (LOS) and estimated blood loss (EBL). RARC had a significantly shorter LOS, reduced EBL, lower complication rate and longer OPT compared to ORC. There were no significant differences regarding lymph node yield (LNY) and positive surgical margins (PSM.) LRC had a reduced EBL, shorter LOS and increased OPT compared to ORC. There was no significant difference regarding LNY. CONCLUSION RARC is comparable to LRC with better surgical results than ORC. LRC has better surgical outcomes than ORC. With the unique technological features of the robotic surgical system and increasing trend of intra-corporeal reconstruction it is likely that RARC will become the surgical option of choice.

INDICATORS FOR RESEARCH PERFORMANCE EVALUATION: AN OVERVIEW

Reuters, Australia , and † Mater Misericordiae Hospital and University College Dublin, Ireland Since the advent of Garfi eld ’ s science citation index in the 1950s [ 1 ] , bibliometrics have been formally used to assess academic productivity and performance [ 2 ] . Although the use of bibliometric studies predates Garfi eld, the need to assess mathematically and statistically the quantity and quality of published work did not arise until the 1960s. This was attributable to the exponential growth in scientifi c publications resulting from the culture of ‘ publish or perish ’ [ 3,4 ] that overwhelmed different scientifi c fi elds, and the need to identify top quality research. With the development of many performance indices over the years, bibliometrics are increasingly becoming a political tool among scientists and policymakers [ 5 ] , to the extent that they can be used in important decisions regarding appointments [ 6 ] , promotions and funding.

Construct validation of the key components of Fundamental Skills of Robotic Surgery (FSRS) curriculum--a multi-institution prospective study.

BACKGROUND Recent incorporation of simulation in surgical training necessitates developing validated platforms for training and assessment. A tool should fulfill the fundamental criteria of validation. OBJECTIVE To report the ability of a simulation-based robotic training curriculum-Fundamental Skills of Robotic Surgery (FSRS)-to assess and distinguish between different performance levels of operator experience (construct validity). MATERIALS AND METHODS This is a prospective multicenter observational study. Participants were classified as novice (0 robotic cases performed) and experts (>150 robotic cases performed). All participants were required to complete 4 key tasks in a previously validated FSRS curriculum: ball placement, coordinated tool control, fourth arm control, and needle handling and exchange. Using the metrics available in the simulator software, the performances of each group were compared to evaluate construct validation. RESULTS A convenience cohort of 61 surgeons participated. Novice group (n = 49) consisted of 41 fellows/residents/medical students and 8 trained open/laparoscopic surgeons, whereas expert group consisted of 12 surgeons. The novice group had no previous robotic console experience, whereas the expert group had >150 prior robotic cases experience. An overall significant difference was observed in favor of the expert group in 4 skill sets (p < 0.05). Time to complete all 4 tasks was significantly shorter in the expert group (p < 0.001). The expert group displayed significantly lesser tool collision (p = 0.002) and reduced tissue damage (p < 0.001). In performing most tasks, the expert groups camera (p < 0.001) and clutch usage (p < 0.001) was significantly greater when compared with the novice group. CONCLUSION The components of the FSRS curriculum showed construct validity. This validation would help in effectively implementing this curriculum for robot-assisted surgical training.

Mitral valve repair or replacement in native valve endocarditis? Systematic review and meta-analysis

The objective of this study is to review the morbidity and mortality associated with mitral valve repair versus replacement in infective endocarditis patients.

Systematic review of the relationship between artificial sweetener consumption and cancer in humans: analysis of 599,741 participants

The effect of artificial sweetener consumption on cancer risk has been debated in animal models for over four decades. To further investigate this relationship, this study aims to synthesise results from several of the most recent studies in humans.

Effect of tranexamic acid use on blood loss and thromboembolic risk in hip fracture surgery: systematic review and meta-analysis

Introduction: Intravenous tranexamic acid (IV TXA) is a recognised pharmaceutical intervention utilised to minimise blood loss and allogenic blood transfusion. However, the use of IV TXA in hip fracture surgery remains inconclusive. We conducted a meta-analysis to investigate the role of TXA in operative hip fracture management on operative and total blood loss, allogenic blood transfusion requirements and impact on venous thromboembolic (VTE) event incidence. Methods: A systematic computerised literature search of PubMed, Medline, Embase, Ovid, The Cochrane Controlled Trials Register, Trip and Google was conducted. We reviewed the efficacy of IV TXA on perioperative blood loss, total blood loss, pre- and postoperative haemoglobin differences, duration of surgery, allogenic blood transfusion requirements and VTE events. Results: 8 studies were eligible including 6 randomised control trials and 2 cohort studies. Patients receiving IV TXA had reduced mean total blood loss of 442.9 mls (95% CI, 426.5-459.3; p<0.00001), reduced operative blood loss of 88.5 mls (95% CI, 59.9-117.2; p<0.00001), a decrease in the need for allogenic blood transfusion (OR 0.37; 95% CI, 0.26-0.53; p<0.00001) and a reduction in pre- and postoperative haemoglobin difference (p = 0.013.) There was no significant increase in VTE risk (OR 1.59; 95% CI 0.67-3.75; p>0.29) or significant difference on duration of surgery seen with IV TXA usage (p>0.06). Conclusions: Our review demonstrated the efficacy of IV TXA in minimising perioperative, reducing total blood loss and lowering the necessity for allogenic blood transfusions with no significant increased risk in VTE events.

A systematic review and meta-analysis of mechanical vs biological composite aortic root replacement, early and 1-year results

ObjectiveComposite aortic root replacement is a standard procedure for various aortic root pathologies. This systematic review was set to identify the postoperative outcomes for composite mechanical root replacement (mCRR) compared to composite biological root replacement (bCRR).MethodsWe systematically reviewed four major databases for all papers assessing outcomes in composite root replacement. Articles selected were chosen by two reviewers. Amongst our inclusion and exclusion criteria, all pediatric populations were excluded as were studies with a cohort less than 50 patients.ResultsWe identified seven studies that conformed to our inclusion criteria and incorporated 2240 patients. In-hospital mortality was higher but non-significant in the mechanical group (6.1 vs 4.2% respectively). There was no significant difference demonstrated in the risk of in-hospital stroke, late stroke and re-operation in either groups. Additionally, there was no significant difference in: endocarditis, 1-year mortality, 5-year mortality, mean cardiopulmonary or aortic cross-clamp time.ConclusionsComposite mechanical root offers no superiority to composite biological root. There is a significant increase in the perioperative bleeding amongst composite mechanical root cohort. There is a need for further randomized control trail to assess the efficacy of either methods.