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Article: Should Robotic Surgery Simulation Be Introduced in the Core Surgical Training Curriculum?

Bhakhri, Kunal / Harrison-Phipps, K / Harling, Leanne / Routledge, T

2021 Volume 8, Page(s) 595203

Abstract: Introduction: ...

Abstract	Introduction:
Language	English
Publishing date	2021-03-10
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2773823-1
ISSN	2296-875X
ISSN	2296-875X
DOI	10.3389/fsurg.2021.595203
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Article ; Online: Massive thymoma mimicking a pleural mass.

Palazzo, Stefano / Rahman, Zaid / Femia, Federico / Harrison-Phipps, Karen / Simpson, Thomas

Thorax

2024 Volume 79, Issue 4, Page(s) 382–383

MeSH term(s)	Humans ; Thymoma/diagnostic imaging ; Thymus Neoplasms/diagnostic imaging ; Pleural Neoplasms/diagnostic imaging ; Pleural Diseases
Language	English
Publishing date	2024-03-15
Publishing country	England
Document type	Journal Article
ZDB-ID	204353-1
ISSN	1468-3296 ; 0040-6376
ISSN (online)	1468-3296
ISSN	0040-6376
DOI	10.1136/thorax-2023-221296
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Article ; Online: Predictors of the need for an extracervical approach to intrathoracic goitre.

Tikka, T / Nixon, I J / Harrison-Phipps, K / Simo, R

BJS open

2018 Volume 3, Issue 2, Page(s) 174–179

Abstract: Background: Sternotomy and lateral thoracotomy are required infrequently to remove an intrathoracic goitre (ITG). As few studies have explored the need for an extracervical approach (ECA), the aim of this study was to examine this in a large cohort of ... ...

Abstract	Background: Sternotomy and lateral thoracotomy are required infrequently to remove an intrathoracic goitre (ITG). As few studies have explored the need for an extracervical approach (ECA), the aim of this study was to examine this in a large cohort of patients. Methods: A prospective database of all patients who had surgery for ITG between 2004 and 2016 was interrogated. Patient demographics, preoperative characteristics and type of operation were analysed to identify factors associated with an ECA. Results: Of 237 patients who had surgery for ITG, 29 (12·2 per cent) required an ECA. ITGs below the aortic arch (odds ratio (OR) 10·84; Conclusion: The extent of intrathoracic extension in relation to the aortic arch, iceberg goitre shape and revisional surgery were independent risk factors for ECA. Careful preoperative assessment should take these factors into consideration when determining the optimal surgical approach to ITG.
MeSH term(s)	Aged ; Aorta, Thoracic/diagnostic imaging ; Clinical Decision-Making ; Endoscopic Ultrasound-Guided Fine Needle Aspiration ; Female ; Goiter, Substernal/diagnosis ; Goiter, Substernal/surgery ; Humans ; Laryngoscopy ; Likelihood Functions ; Logistic Models ; Male ; Middle Aged ; Patient Selection ; Preoperative Period ; Prospective Studies ; Risk Assessment ; Risk Factors ; Sternotomy/methods ; Sternotomy/statistics & numerical data ; Thoracotomy/methods ; Thoracotomy/statistics & numerical data ; Thyroid Gland/diagnostic imaging ; Thyroid Gland/pathology ; Thyroid Gland/surgery ; Thyroidectomy/methods ; Thyroidectomy/statistics & numerical data
Language	English
Publishing date	2018-12-26
Publishing country	England
Document type	Journal Article
ISSN	2474-9842
ISSN (online)	2474-9842
DOI	10.1002/bjs5.50123
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Article ; Online: Impact of the TNM staging system for thymoma.

Smith, Alex / Cavalli, Camilla / Harling, Leanne / Harrison-Phipps, Karen / Routledge, Tom / Pilling, John / King, Juliet / Bille, Andrea / Nonaka, Daisuke

Mediastinum (Hong Kong, China)

2021 Volume 5, Page(s) 32

Abstract: Background: Masaoka-Koga staging system remains the most frequently applied clinical staging system for thymic malignancy. However, the International Association for the Study of Lung Cancer (IASLC)/International Thymic Malignancy Interest Group (ITMIG) ...

Abstract	Background: Masaoka-Koga staging system remains the most frequently applied clinical staging system for thymic malignancy. However, the International Association for the Study of Lung Cancer (IASLC)/International Thymic Malignancy Interest Group (ITMIG) proposed a tumor-node-metastasis (TNM) staging system in 2014. This study aims to evaluate its impact on stage distribution, clinical implementation, and prognosis for thymomas. Methods: We performed a single institution, retrospective analysis of 245 consecutive patients who underwent surgical resection for thymoma. 9 patients with thymic carcinoma were excluded. No patients were lost to follow up. Kaplan-Meier survival analysis was used to calculate overall survival. Results: Median age was 62 years; 129 patients (53%) were female. The median overall survival was 158 months (range, 108-208 months), and disease-free survival 194 months (range, 170-218 months). At the end of follow up 63 patients were dead. Early Masaoka-Koga stages I (n=74) and II (n=129) shifted to the IASLC/ITMIG stage I (n=203). 8 patients were down staged from Masaoka-Koga stage III to IASLC/ITMIG stage II because of pericardial involvement. Advanced stages III (Masaoka-Koga: n=30; IASLC/ITMIG: n=22) and IV (Masaoka-Koga: n=12; IASLC/ITMIG: n=12) remained similar and were associated with more aggressive WHO thymoma histotypes (B2/B3). Masaoka-Koga (P=0.004), IASLC/ITMIG staging (P<0.0001) and complete surgical resection (P<0.0001) were statistically associated with survival. At multivariate analysis only R status was an independent prognostic factor for survival. Conclusions: The proportion of patients with stage I disease increased significantly when IASLC/ITMIG system used, whilst the proportion with stages III and IV were similar in both systems. Completeness of resection, Masaoka-Koga and the IASLC/ITMIG staging system are strong predictors of survival. The TNM staging system is useful in disease management and a strong predictor of overall survival.
Language	English
Publishing date	2021-12-25
Publishing country	China
Document type	Journal Article
ISSN	2522-6711
ISSN (online)	2522-6711
DOI	10.21037/med-21-24
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Article ; Online: Preoperative Physical Activity Predicts Surgical Outcomes Following Lung Cancer Resection.

Billé, Andrea / Buxton, James / Viviano, Alessandro / Gammon, David / Veres, Lukacs / Routledge, Tom / Harrison-Phipps, Karen / Dixon, Allison / Minetto, Marco A

Integrative cancer therapies

2021 Volume 20, Page(s) 1534735420975853

Abstract: Objectives: To assess whether preoperative levels of physical activity predict the incidence of post-operative complications following anatomical lung resection.: Methods: Levels of physical activity (daily steps) were measured for 15 consecutive ... ...

Abstract	Objectives: To assess whether preoperative levels of physical activity predict the incidence of post-operative complications following anatomical lung resection. Methods: Levels of physical activity (daily steps) were measured for 15 consecutive days using pedometers in 90 consecutive patients (prior to admission). Outcomes measured were cardiac and respiratory complications, length of stay, and 30-day re-admission rate. Results: A total of 78 patients' datasets were analysed (12 patients were excluded due to non-compliance). Based on steps performed they were divided into quartiles; 1 (low physical activity) to 4 (high physical activity). There were no significant differences in age, smoking history, COPD, BMI, percentage predicted FEV1 and KCO and cardiovascular risk factors between the groups. There were significantly fewer total complications in quartiles 3 and 4 (high physical activity) compared to quartiles 1 and 2 (low physical activity) (8 vs 22; Conclusions: Preoperative physical activity can help to predict postoperative outcome and can be used to stratify risk of postoperative complications and to monitor impact of preoperative interventions, ultimately improving short term outcomes.
MeSH term(s)	Exercise ; Humans ; Length of Stay ; Lung ; Lung Neoplasms/surgery ; Pneumonectomy ; Treatment Outcome
Language	English
Publishing date	2021-04-09
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2182320-0
ISSN	1552-695X ; 1534-7354
ISSN (online)	1552-695X
ISSN	1534-7354
DOI	10.1177/1534735420975853
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Article ; Online: Salvage pulmonary resection in stages IIIb-IV lung cancer after treatment with immune checkpoint inhibitors case series and literature review.

Smith, Alex / Wali, Anuj / Montes, Ana / Hadaki, Maher / Harrison-Phipps, Karen / Karapanagiotou, Eleni M / Bille, Andrea

Journal of surgical oncology

2021 Volume 125, Issue 2, Page(s) 290–298

Abstract: Background and objectives: The role of salvage thoracic surgery in managing advanced-stage lung cancer following treatment with immune checkpoint inhibitors is currently unclear. We present a series of nine patients with advanced non-small-cell lung ... ...

Abstract	Background and objectives: The role of salvage thoracic surgery in managing advanced-stage lung cancer following treatment with immune checkpoint inhibitors is currently unclear. We present a series of nine patients with advanced non-small-cell lung cancer who underwent pulmonary resection following treatment with pembrolizumab. Methods: We performed a single-institution retrospective analysis of pulmonary resection undertaken following treatment with pembrolizumab for advanced-stage lung cancer. Nine patients met the inclusion criteria. Results: In six cases, surgery was indicated for persistent localized disease after treatment, and in three cases for nonresponsive synchronous/metachronous lung nodules while on treatment for stage IV lung cancer. Dense hilar fibrosis was present in all patients. Minimal access surgery was achieved in five cases (video-assisted n = 2, robotic-assisted n = 3). There was no in-hospital mortality. One patient died within 60 days from community-acquired COVID-19 pneumonitis. Seven patients remain free of disease between 5 and 22 months follow-up. Conclusions: Pulmonary resection is safe and technically feasible following treatment with immune checkpoint inhibitors. Surgical challenges relate to postimmunotherapy fibrosis, but with increased experience and a robotic approach, minimal access surgery is achievable. Further prospective studies are required to assess the surgical impact on disease control and overall survival in this patient cohort.
MeSH term(s)	Aged ; Carcinoma, Non-Small-Cell Lung/drug therapy ; Carcinoma, Non-Small-Cell Lung/pathology ; Carcinoma, Non-Small-Cell Lung/surgery ; Female ; Humans ; Immune Checkpoint Inhibitors/therapeutic use ; Lung Neoplasms/drug therapy ; Lung Neoplasms/pathology ; Lung Neoplasms/surgery ; Male ; Middle Aged ; Neoplasm Staging ; Pneumonectomy ; Retrospective Studies ; Salvage Therapy
Chemical Substances	Immune Checkpoint Inhibitors
Language	English
Publishing date	2021-09-27
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	82063-5
ISSN	1096-9098 ; 0022-4790
ISSN (online)	1096-9098
ISSN	0022-4790
DOI	10.1002/jso.26691
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Article: Clinical and quality of life outcomes following anatomical lung resection for lung cancer in high-risk patients.

Wilson, Henrietta / Gammon, David / Routledge, Tom / Harrison-Phipps, Karen

Annals of thoracic medicine

2017 Volume 12, Issue 2, Page(s) 83–87

Abstract: Background: Surgery remains the gold standard for patients with resectable nonsmall cell lung cancer. Current guidance identifies patients with poor pulmonary reserve to fall within a high-risk cohort. The aim of this study was to determine the clinical ...

Abstract	Background: Surgery remains the gold standard for patients with resectable nonsmall cell lung cancer. Current guidance identifies patients with poor pulmonary reserve to fall within a high-risk cohort. The aim of this study was to determine the clinical and quality of life outcomes of anatomical lung resection in patients deemed high risk based on pulmonary function measurements. Methods: A retrospective review of patients undergoing anatomical lung resection for nonsmall cell lung cancer between January 2013 and January 2015 was performed. All patients with limited pulmonary reserve defined as predicted postoperative forced expiratory volume in 1 s or transfer factor of the lung for carbon monoxide of <40% were included in the study. Postoperative complications, admission to the Intensive Care Unit, length of stay, and 30-day in-hospital mortality were recorded. The European Organization for Research and Treatment of Cancer quality of life questionnaire lung cancer 13 questionnaire was used to assess quality of life outcomes. Results: Fifty-three patients met the inclusion criteria. There was no in-hospital mortality, and 30-day mortality was 1.8%. No complications were seen in 64% ( Conclusion: Anatomical lung resection can be performed safely in selected high-risk patients based on pulmonary function without significant increase in morbidity or mortality and with acceptable quality of life outcomes. Given that complications following lung resection are multifactorial, fitness for surgery should be thoroughly assessed in all patients with resectable disease within a multidisciplinary setting. High operative risk by pulmonary function tests alone should not preclude surgical resection.
Language	English
Publishing date	2017-04-13
Publishing country	India
Document type	Journal Article
ZDB-ID	2241287-6
ISSN	1998-3557 ; 1817-1737
ISSN (online)	1998-3557
ISSN	1817-1737
DOI	10.4103/atm.ATM_385_16
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Article ; Online: New N1/N2 classification and lobe specific lymphatic drainage: Impact on survival in patients with non-small cell lung cancer treated with surgery.

Tsitsias, Thomas / Okiror, Lawrence / Veres, Lukacs / King, Juliet / Harrison-Phipps, Karen / Routledge, Tom / Pilling, John / Bille, Andrea

Lung cancer (Amsterdam, Netherlands)

2020 Volume 151, Page(s) 84–90

Abstract: Objective: to validate the proposed N descriptor revision on a large cohort of patients and assess the impact of tumour location on the distribution pattern of lymph node metastases for patients with NSCLC.: Methods: This is a retrospective review of ...

Abstract	Objective: to validate the proposed N descriptor revision on a large cohort of patients and assess the impact of tumour location on the distribution pattern of lymph node metastases for patients with NSCLC. Methods: This is a retrospective review of a consecutive series of patients who had anatomical lung resections. Systematic lymph node dissection was done for all patients. Results: Between January 2009 and December 2019 2566 patients had surgical resection for NSCLC. 448 patients (17.5%) had histologically confirmed lymph node metastases: 257 (57.4 %) had pN1 and 191 pN2. Median age of the study population was 69.1 years. Overall survival (OS) for study population was 37.3 months with 5-year survival rate of 35.7 %. The survival analysis of the N subgroups showed the pN2 patients had a median OS of 27.9 months vs. 41.7 months for pN1 patients (p = 0.013). Analysis as per the new proposal of the N subgroups N1a vs N1b vs N2a1 vs N2a2 vs N2b showed that median survival OS was 41.7 vs. 39.2 mo vs. 33.3 mo vs. 28.9 mo vs. 24.6 mo (p = 0.099). There was statistically significant difference in survival between N2 patients with skip metastasis and N2 patients without skip metastases: OS 32.2 (95 % CI: 16.8-47.6) months vs. 24.2 months (p = 0.024). On multivariate analysis only pathological N (p = 0.011) and the new proposed N classification (p = 0.006) were independent prognostic factors for survival. Conclusions: N1 and N2 disease are heterogeneous groups and require further stratification. The number of N2 lymph node stations involved and the presence or not of N1 disease translated to significant differences in survival and therefore have to be included in N staging.
MeSH term(s)	Aged ; Carcinoma, Non-Small-Cell Lung/pathology ; Carcinoma, Non-Small-Cell Lung/surgery ; Humans ; Lung Neoplasms/pathology ; Lung Neoplasms/surgery ; Lymph Nodes/pathology ; Neoplasm Staging ; Prognosis ; Retrospective Studies
Language	English
Publishing date	2020-11-16
Publishing country	Ireland
Document type	Journal Article
ZDB-ID	632771-0
ISSN	1872-8332 ; 0169-5002
ISSN (online)	1872-8332
ISSN	0169-5002
DOI	10.1016/j.lungcan.2020.11.005
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Article ; Online: Does Previous Surgical Training Impact the Learning Curve in Video-Assisted Thoracic Surgery Lobectomy for Trainees?

Billè, Andrea / Okiror, Lawrence / Harrison-Phipps, Karen / Routledge, Tom

The Thoracic and cardiovascular surgeon

2016 Volume 64, Issue 4, Page(s) 343–347

Abstract: Background To analyze if the number of open lung resections performed by trainees before starting video-assisted thoracic surgery (VATS) lobectomy training program has any impact on intraoperative and postoperative outcomes. Materials and Methods ... ...

Abstract	Background To analyze if the number of open lung resections performed by trainees before starting video-assisted thoracic surgery (VATS) lobectomy training program has any impact on intraoperative and postoperative outcomes. Materials and Methods Retrospective analysis of 46 consecutive patients who underwent VATS lobectomies between December 2011 and September 2012 by two trainees (A.B. and L.O.). The previous surgical experience of the two trainees was evaluated to assess for any difference in terms of learning curve. Group A comprised 25 VATS lobectomies performed by one trainee (A.B.) and group B comprised 21 VATS lobectomies performed by the other trainee (L.O.). Results There was no statistical difference in terms of operating time and intraoperative bleeding between the two groups (p = 0.16 and p = 0.6). The conversion rate was 8% (2 out of 25 cases) in group A and 23.8% (5 out of 21 cases) in group B (p = 0.002). Evaluation of vascular injury showed no difference in the conversion rate (p = 0.56). The median length of the drainage and of hospital stay were 4 days and 7 days in group A and 4 days and 8 days in group B, respectively (p = 0.36 and p = 0.24). The complication rate was 44% in group A and 47.6% in group B (p = 0.52). A.B. had performed 139 and L.O. 70 operations as first operator before starting their VATS lobectomy training; the surgical experience had an impact only on the conversion rate. Conclusion Our study showed that a training program in VATS lobectomy is feasible, and previous surgical training has a minimal impact on intraoperative and postoperative outcomes.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Blood Loss, Surgical ; Clinical Competence ; Curriculum ; Drainage ; Education, Medical, Graduate/methods ; Feasibility Studies ; Female ; Humans ; Internship and Residency ; Learning Curve ; Length of Stay ; Male ; Middle Aged ; Operative Time ; Pneumonectomy/adverse effects ; Pneumonectomy/education ; Pneumonectomy/methods ; Postoperative Complications/etiology ; Retrospective Studies ; Thoracic Surgery, Video-Assisted/adverse effects ; Thoracic Surgery, Video-Assisted/education ; Thoracic Surgery, Video-Assisted/methods ; Time Factors ; Treatment Outcome
Keywords	covid19
Language	English
Publishing date	2016-06
Publishing country	Germany
Document type	Comparative Study ; Journal Article
ZDB-ID	800050-5
ISSN	1439-1902 ; 0171-6425 ; 0946-4778 ; 0172-6137
ISSN (online)	1439-1902
ISSN	0171-6425 ; 0946-4778 ; 0172-6137
DOI	10.1055/s-0034-1396094
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Article ; Online: An Unusual Case of Needle Embolus Presenting With Delayed Spontaneous Pneumothorax.

Al-Sahaf, May / Harling, Leanne / Harrison-Phipps, Karen / Bille, Andrea

The Annals of thoracic surgery

2016 Volume 102, Issue 3, Page(s) e201–e203

Abstract: We report the case of a 39-year-old man presenting with an acute right-sided traumatic pneumothorax secondary to migration of a hypodermic needle fractured during intravenous drug use. We discuss the unusual passage of this foreign body from the left ... ...

Abstract	We report the case of a 39-year-old man presenting with an acute right-sided traumatic pneumothorax secondary to migration of a hypodermic needle fractured during intravenous drug use. We discuss the unusual passage of this foreign body from the left groin to the right ventricular wall and into the mediastinum, ultimately presenting with a right pneumothorax 1 year later.
MeSH term(s)	Adult ; Chest Pain/diagnosis ; Chest Pain/etiology ; Delayed Diagnosis ; Echocardiography/methods ; Embolism/diagnostic imaging ; Embolism/etiology ; Embolism/surgery ; Emergency Service, Hospital ; Foreign Bodies/surgery ; Foreign-Body Migration/diagnostic imaging ; Foreign-Body Migration/surgery ; Heart Ventricles/diagnostic imaging ; Heart Ventricles/surgery ; Humans ; Male ; Needles/adverse effects ; Pneumothorax/diagnostic imaging ; Pneumothorax/etiology ; Rare Diseases ; Risk Assessment ; Substance Abuse, Intravenous/complications ; Thoracotomy/methods ; Tomography, X-Ray Computed/methods ; Treatment Outcome
Language	English
Publishing date	2016-09
Publishing country	Netherlands
Document type	Case Reports ; Journal Article
ZDB-ID	211007-6
ISSN	1552-6259 ; 0003-4975
ISSN (online)	1552-6259
ISSN	0003-4975
DOI	10.1016/j.athoracsur.2016.01.083
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