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7. Optimal anesthetic conduct regarding immediate and short‐term outcomes after liver transplantation – Systematic review of the literature and expert panel recommendations

Author

Chadha, Ryan, Patel, Dhupal, Bhangui, Pooja, Blasi, Annabel, Xia, Victor, Parotto, Matteo, Wray, Christopher, Findlay, James, Spiro, Michael, Raptis, Dimitri Aristotle, Niemann, Claus, Pollok, Joerg‐Matthias, Berenguer, Marina, Tinguely, Pascale, Fan, Ka Hay, and Farrer, Giselle

Subjects
Liver Disease, Transplantation, Clinical Research, Clinical Trials and Supportive Activities, Digestive Diseases, Patient Safety, Evaluation of treatments and therapeutic interventions, 6.4 Surgery, Good Health and Well Being, Humans, Liver Transplantation, Prospective Studies, Retrospective Studies, Anesthetics, Anesthesia, General, bispectral index, depth of anesthesia, liver transplantation, minimum alveolar concentration, oxygen management, positive end-expiratory pressure, total intravenous anesthesia, ventilation, volatile or inhalational anesthesia, ERAS4OLT.org Working Group, Clinical Sciences, Surgery
Abstract

BackgroundIn the era of enhanced recovery after surgery, there is significant discussion regarding the impact of intraoperative anesthetic management on short-term outcomes following liver transplantation (LT), with no clear consensus in the literature.ObjectivesTo identify whether or not intraoperative anesthetic management affects short-term outcomes after liver transplantation.Data sourcesOvid MEDLINE, Embase, Scopus, Google Scholar, and Cochrane Central.MethodsA systematic review following PRISMA guidelines was undertaken. The systematic review was registered on PROSPERO (CRD42021239758). An international expert panel made recommendations for clinical practice using the GRADE approach.ResultsAfter screening, 14 studies were eligible for inclusion in this systematic review. Six were prospective randomized clinical trials, three were prospective nonrandomized clinical trials, and five were retrospective studies. These manuscripts were reviewed to look at five questions regarding anesthetic care and its impact on short term outcomes following liver transplant. After review of the literature, the quality of evidence according to the following outcomes was as follows: intraoperative and postoperative morbidity and mortality (low), early allograft dysfunction (low), and hospital and ICU length of stay (moderate).ConclusionsFor optimal short term outcomes after liver transplantation, the panel recommends the use of volatile anesthetics in preference to total intravenous anesthesia (TIVA) (Level of Evidence: Very low; Strength of Recommendation: Weak) and minimum alveolar concentration (MAC) versus bispectral index (BIS) for depth of anesthesia monitoring (Level of Evidence: Very low; Strength of Recommendation: Weak). Regarding ventilation and oxygenation, the panel recommends a restrictive oxygenation strategy targeting a PaO2 of 70-120 mmHg (10-14 kPa), a tidal volume of 6-8 ml/kg ideal body weight (IBW), administration of positive end expiratory pressure (PEEP) tailored to patient intraoperative physiology, and recruitment maneuvers. (Level of evidence: Very low; Strength of Recommendation: Strong). Finally, the panel recommends the routine use of antiemetic prophylaxis. (Level of evidence: low; Strength of Recommendation: Strong).

Published
2022

10. Safety and Feasibility of a Fast-Track Pathway for Neurosurgical Craniotomy Patients: Bypassing the Intensive Care Unit

Author

Mooney, Lesia H., Jerreld, Daniel J., Waters, Karen G., Coltvet, Greg, Nottmeier, Eric W., Huang, Josephine F., Perez-Vega, Carlos, Sanghavi, Devang K., Moreno Franco, Pablo, Chadha, Ryan M., Ardon, Alberto E., Bojaxhi, Elird, Torp, Klaus D., Marshall, Lisa A., Halstead, Tiffany M., Ford, Valentino E., Christel, Lynda M., Grewal, Sanjeet S., Chaichana, Kaisorn L., Quinones-Hinojosa, Alfredo, Howard, Levi W., Fox, W. Christopher, and Freeman, William D.

Published
2023
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11. Procedural-Related Bleeding in Hospitalized Patients With Liver Disease (PROC-BLeeD): An International, Prospective, Multicenter Observational Study

Author

Intagliata, Nicolas M., Rahimi, Robert S., Higuera-de-la-Tijera, Fatima, Simonetto, Douglas A., Farias, Alberto Queiroz, Mazo, Daniel F., Boike, Justin R., Stine, Jonathan G., Serper, Marina, Pereira, Gustavo, Mattos, Angelo Z., Marciano, Sebastian, Davis, Jessica P.E., Benitez, Carlos, Chadha, Ryan, Méndez-Sánchez, Nahum, deLemos, Andrew S., Mohanty, Arpan, Dirchwolf, Melisa, Fortune, Brett E., Northup, Patrick G., Patrie, James T., and Caldwell, Stephen H.

Published
2023
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12. Enhanced recovery for liver transplantation: recommendations from the 2022 International Liver Transplantation Society consensus conference

Author

Mayr, Andreas, Dominguez, Beatriz, Muller, Elmi, Rando, Karina, Enoch, Mary Anne, Tamir, Noam, Healy, Pamela, Manser, Tanja, Briggs, Tim, Chaudhary, Abhideep, Humar, Abhinav, Jafarian, Ali, Soin, Arvinder Singh, Eghtesad, Bijan, Miller, Charles, Cherqui, Daniel, Samuel, Didier, Broering, Dieter, Pomfret, Elizabeth, Villamil, Federico, Durand, Francois, Berlakovich, Gabriela, McCaughan, Geoffrey, Auzinger, Georg, Testa, Giuliano, Klintmalm, Goran, Belghiti, Jacques, Findlay, James, Lai, Jennifer, Fung, John, Klinck, John, Roberts, John, Liu, Linda, Cattral, Mark, Ghobrial, Mark, Selzner, Markus, Ramsay, Michael, Rela, Mohamed, Ascher, Nancy, Man, Nancy Kwan, Selzner, Nazia, Burra, Patrizia, Friend, Peter, Busuttil, Ronald, Hwang, Shin, McCluskey, Stuart, Mas, Valeria, Vohra, Vijay, Vij, Vivek, Merritt, William, Tokat, Yaman, Kang, Yoogoo, Chan, Albert, Mazzola, Alessandra, Hessheimer, Amelia, Rammohan, Ashwin, Hogan, Brian, Vinaixa, Carmen, Nasralla, David, Victor, David, De Martin, Eleonora, Alconchel, Felipe, Roll, Garrett, Kabacam, Gokhan, Sapisochin, Gonzalo, Campos-Varela, Isabel, Liu, Jiang, Patel, Madhukar S., Izzy, Manhal, Kalisvaart, Marit, Adams, Megan, Goldaracena, Nicholas, Tinguely, Pascale, Hernandez-Alejandro, Roberto, Chadha, Ryan, Shaker, Tamer Mahmoud, Klair, Tarunjeet S., Pan, Terry, Tanaka, Tomohiro, Yoon, Uzung, Kirchner, Varvara, Hannon, Vivienne, Cheah, Yee Lee, Frola, Carlo, Morkane, Clare, Milliken, Don, Lurje, Georg, Potts, Jonathan, Fernandez, Thomas, Badenoch, Adam, Mukhtar, Ahmed, Zanetto, Alberto, Montano-Loza, Aldo, Chieh, Alfred Kow Wei, Shetty, Amol, DeWolf, Andre, Olmos, Andrea, Mrzljak, Anna, Blasi, Annabel, Berzigotti, Annalisa, Malik, Ashish, Rajakumar, Akila, Davidson, Brian, O'Farrell, Bryan, Kotton, Camille, Imber, Charles, Kwon, Choon Hyuck David, Wray, Christopher, Ahn, Chul-Soo, Krenn, Claus, Quintini, Cristiano, Maluf, Daniel, Mina, Daniel Santa, Sellers, Daniel, Balci, Deniz, Patel, Dhupal, Rudow, Dianne LaPointe, Monbaliu, Diethard, Bezinover, Dmitri, Krzanicki, Dominik, Kim, Dong-Sik, Brombosz, Elizabeth, Blumberg, Emily, Weiss, Emmanuel, Wey, Emmanuel, Kaldas, Fady, Saliba, Faouzi, Pittau, Gabriella, Wagener, Gebhard, Song, Gi-Won, Biancofiore, Gianni, Crespo, Gonzalo, Rodríguez, Gonzalo, Palli, Graciela Martinez, McKenna, Gregory, Petrowsky, Henrik, Egawa, Hiroto, Montasser, Iman, Pirenne, Jacques, Eason, James, Guarrera, James, Pomposelli, James, Lerut, Jan, Emond, Jean, Boehly, Jennifer, Towey, Jennifer, Hillingsø, Jens G, de Jonge, Jeroen, Caicedo, Juan, Heimbach, Julie, Emamaullee, Juliet Ann, Bartoszko, Justyna, Ma, Ka Wing, Kronish, Kate, Forkin, Katherine T., Chok, Kenneth Siu Ho, Olthoff, Kim, Reyntjens, Koen, Lee, Kwang-Woong, Suh, Kyung-Suk, Denehy, Linda, van der Laan, Luc J.W., McCormack, Lucas, Gorvin, Lucy, Ruffolo, Luis, Bhat, Mamatha, Ramírez, María Amalia Matamoros, Londoño, Maria-Carlota, Gitman, Marina, Levstik, Mark, de Santibañes, Martin, Lindsay, Martine, Parotto, Matteo, Armstrong, Matthew, Kasahara, Mureo, Schofield, Nick, Rizkalla, Nicole, Akamatsu, Nobuhisa, Scatton, Olivier, Keskin, Onur, Imventarza, Oscar, Andacoglu, Oya, Muiesan, Paolo, Giorgio, Patricia, Northup, Patrick, Matins, Paulo, Abt, Peter, Newsome, Philip N, Dutkowski, Philipp, Bhangui, Pooja, Bhangui, Prashant, Tandon, Puneeta, Brustia, Raffaele, Planinsic, Raymond, Brown, Robert, Porte, Robert, Barth, Rolf, Ciria, Rubén, Florman, Sander, Dharancy, Sebastien, Pai, Sher-Lu, Yagi, Shintaro, Nadalin, Silvio, Chinnakotla, Srinath, Forbes, Stuart J, Rahman, Suehana, Hong, Suk Kyun, Liying, Sun, Orloff, Susan, Rubman, Susan, Eguchi, Susumu, Ikegami, Toru, Reichman, Trevor, Settmacher, Utz, Aluvihare, Varuna, Xia, Victor, Yoon, Young-In, Soejima, Yuji, Genyk, Yuri, Jalal, Arif, Borakati, Aditya, Gustar, Adrian, Mohamed, Ahmed, Ramirez, Alejandro, Rothnie, Alex, Scott, Aneya, Sharma, Anika, Munro, Annalise, Mahay, Arun, Liew, Belle, Hidalgo, Camila, Crouch, Cara, Yan, Cheung Tsz, Tschuor, Christoph, Shaw, Conrad, Schizas, Dimitrios, Fritche, Dominic, Huda, Fabia Ferdousi, Wells, Gemma, Farrer, Giselle, Kwok, Hiu Tat, Kostakis, Ioannis, Mestre-Costa, Joao, Fan, Ka Hay, Fan, Ka Siu, Fraser, Kyra, Jeilani, Lelia, Pang, Li, Lenti, Lorenzo, Kathirvel, Manikandan, Zachiotis, Marinos, Vailas, Michail, Milan, Michele Mazza, Elnagar, Mohamed, Alradhawi, Mohammad, Dimitrokallis, Nikolaos, Machairas, Nikolaos, Morare, Nolitha, Yeung, Oscar, Khanal, Pragalva, Satish, Pranav, Ghani, Shahi Abdul, Makhdoom, Shahroo, Arulrajan, Sithhipratha, Bogan, Stephanie, Pericleous, Stephanos, Blakemore, Timon, Otti, Vanessa, Lam, Walter, Jackson, Whitney, Abdi, Zakee, Pollok, Joerg M, Berenguer, Marina, Niemann, Claus U, Raptis, Dimitri A, and Spiro, Michael

Published
2023
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13. List of contributors

Author

Abraldes, Juan Gonzalez, primary, Altieri, Mario, additional, Arroyo, Vicente, additional, Attia, Dina, additional, Baiges, Anna, additional, Baik, Soon Koo, additional, Betancourt, Fabian, additional, Chadha, Ryan, additional, Chahal, Daljeet, additional, Chen, Po-Hung, additional, Desai, Moreshwar S., additional, Doycheva, Iliana, additional, Fernandez, Javier, additional, Fouad, Yasser, additional, García-Pagán, Juan Carlos, additional, Gorgis, Noelle, additional, Gurram, Harini, additional, Hernández-Gea, Virginia, additional, Iqbal, Shaz, additional, Izzy, Manhal, additional, Jo, Jennifer, additional, Kang, Seong Hee, additional, Khalifa, Rofida, additional, Koseki, Masahiro, additional, Kuwabara, Masanari, additional, Lee, Samuel S., additional, Lisman, Ton, additional, Liu, Hongqun, additional, Luo, Xuefeng, additional, Magaz, Marta, additional, Marquez, Vladimir, additional, Moreau, Richard, additional, Nicoar-Farcu, Oana, additional, Niwa, Koichiro, additional, Okada, Atsushi, additional, Pollak, P. Timothy, additional, Saito, Yuki, additional, Singu, Bonifasius S., additional, Soy, Guillem, additional, Taniguchi, Tatsunori, additional, Turon, Fanny, additional, Valérie, Paradis, additional, VanWagner, Lisa B., additional, Verbeeck, Roger K., additional, Watt, Kymberly D., additional, Wong, Florence, additional, and Wray, Christopher L., additional

Published
2023
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15. Anesthesia and Critical Care for the Prediction and Prevention for Small-for-size Syndrome: Guidelines from the ILTS-iLDLT-LTSI Consensus Conference

Author

Chadha, Ryan, Sakai, Tetsuro, Rajakumar, Akila, Shingina, Alexandra, Yoon, Uzung, Patel, Dhupal, Spiro, Michael, Bhangui, Pooja, Sun, Li-Ying, Humar, Abhinav, Bezinover, Dmitri, Findlay, James, Saigal, Sanjiv, Singh, Shweta, Yi, Nam-Joon, Rodriguez-Davalos, Manuel, Kumar, Lakshmi, Kumaran, Vinay, Agarwal, Shaleen, Berlakovich, Gabriela, Egawa, Hiroto, Lerut, Jan, Clemens Broering, Dieter, Berenguer, Marina, Cattral, Mark, Clavien, Pierre-Alain, Chen, Chao-Long, Shah, Samir, Zhu, Zhi-Jun, Ascher, Nancy, Bhangui, Prashant, Rammohan, Ashwin, Emond, Jean, and Rela, Mohamed

Published
2023
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22. Proceedings of the 26th Annual Virtual Congress of the International Liver Transplantation Society

Author

Kalisvaart, Marit, Chadha, Ryan, De Martin, Eleonora, Alconchel, Felipe, Goldaracena, Nicolas, Keskin, Onur, Liu, Jiang, Nasralla, David, Mazzola, Alessandra, Rammohan, Ashwin, Spiro, Michael, Tanaka, Tomohiro, Campos-Varela, Isabel, Victor, David, Vinaixa, Carmen, Yoon, Uzung, Yoon, Young-in, Hessheimer, Amelia, Kabacam, Gokhan, Sapisochin, Gonzalo, Shaker, Tamer, Bhangui, Prashant, Chan, Albert, and Kirchner, Varvara

Published
2022
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27. The perioperative care in liver transplantation multicenter database: Building the foundation for research collaboration in liver transplantation

Author

Adelmann, Dieter, Reddy, Mallika, Zhou, George P., Fukazawa, Kyota, Wang, Ryan, Kassel, Cale, Nguyen-Buckley, Christine, Bastidas, Javier, De Marchi, Lorenzo, Wilson, Elizabeth A., Nazemian, Ryan, Fernandez-Bustamante, Ana, Anderson, Alexandra, Chadha, Ryan M., Huang, Jiapeng, Moguilevitch, Marina, Townsend, Elizabeth, Rosenfeld, David M., and Kothari, Rishi P.

Published
2024
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30. Proceedings of the 28th Annual Congress of the International Liver Transplantation Society

Author

Shaji Mathew, Johns, primary, Shingina, Alexandra, additional, Khan, Mohammad Qasim, additional, Wilson, Elizabeth, additional, Syn, Nicholas, additional, Rammohan, Ashwin, additional, Alconchel, Felipe, additional, Hakeem, Abdul Rahman, additional, Shankar, Sadhana, additional, Patel, Dhupal, additional, Keskin, Onur, additional, Liu, Jiang, additional, Nasralla, David, additional, Mazzola, Alessandra, additional, Patel, Madhukar S., additional, Tanaka, Tomohiro, additional, Victor, David, additional, Yoon, Uzung, additional, Yoon, Young-in, additional, Vinaixa, Carmen, additional, Kirchner, Varvara, additional, De Martin, Eleonora, additional, Ghobrial, R. Mark, additional, and Chadha, Ryan, additional

Published
2024
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31. Shape-Sensing Robotic-Assisted Bronchoscopy in the Multiple Pulmonary Nodule Diagnosis during a Single Anesthetic Event.

Author

Fernandez-Bussy, Sebastian, Garza-Salas, Ana, Barrios-Ruiz, Alanna, Balasubramanian, Prasanth, Yu Lee-Mateus, Alejandra, Koirala, Tapendra, Hazelett, Britney N., Chadha, Ryan, Patel, Neal M., Reisenauer, Janani S., and Abia-Trujillo, David

Subjects
SAFETY, BIOPSY, THREE-dimensional imaging, COMPUTED tomography, RETROSPECTIVE studies, DECISION making, DESCRIPTIVE statistics, PNEUMOTHORAX, LUNG tumors, ROBOTICS, BRONCHOSCOPY, TUMOR classification, DATA analysis software, TIME, FLUOROSCOPY
Abstract

Introduction: The widespread use of computed tomography as a screening tool for early lung cancer has increased detection of pulmonary lesions. It is common to encounter patients with more than one peripheral pulmonary nodule (PPN) of uncertain etiology. Shape-sensing robotic-assisted bronchoscopy (ssRAB) emerges as a potential alternative to biopsy multiple PPN, in addition to mediastinal staging in single anesthetic procedure. Methods: This is a single-center, retrospective review of 22 patients who underwent ssRAB for evaluation of two or more PPN, between November 2021 and April 2023 at Mayo Clinic, FL, USA. Results: A total of 46 PPNs were biopsied in 22 patients. All lesions were ≤2 cm with a median minimum and maximum cross-sectional lesion size of 1.40 cm and 1.05 cm, respectively. Diagnostic yield was 86.9% (n = 40), and target reach was 91.3% (n = 42). Most lesions were in the upper lobes, a solid pattern was found in 78.3% (n = 36), bronchus sign was present in 82.6% of cases (n = 38), 54.4% (n = 25) were malignant nodules, and 32.6% (n = 15) were benign. Fourteen patients had at least one malignant lesion out of two or more nodules sampled, and 10 patients had a malignant diagnosis for all sampled lesions. The complication rate was 9% (n = 2) with one case of bleeding and one of pneumothorax. Conclusion: This study is, to our knowledge, the first to assess the use and safety of ssRAB for diagnosis of multiple PPN in a single anesthetic event. This procedure will mainly impact management decisions and subsequently shorten the time from diagnosis to treatment. [ABSTRACT FROM AUTHOR]

Published
2024
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32. Safety and Feasibility of a Fast-Track Pathway for Neurosurgical Craniotomy Patients: Bypassing the Intensive Care Unit

Author

Perez-Vega, Carlos, primary, Sanghavi, Devang K., additional, Moreno Franco, Pablo, additional, Chadha, Ryan M., additional, Ardon, Alberto E., additional, Bojaxhi, Elird, additional, Torp, Klaus D., additional, Marshall, Lisa A., additional, Halstead, Tiffany M., additional, Ford, Valentino E., additional, Christel, Lynda M., additional, Grewal, Sanjeet S., additional, Chaichana, Kaisorn L., additional, Quinones-Hinojosa, Alfredo, additional, Howard, Levi W., additional, Fox, W. Christopher, additional, and Freeman, William D., additional

Published
2023
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35. Mobile cone‐beam computed tomography complementing shape‐sensing robotic‐assisted bronchoscopy in the small pulmonary nodule sampling: A multicentre experience

Author

Abia‐Trujillo, David, primary, Folch, Erik E., additional, Yu Lee‐Mateus, Alejandra, additional, Balasubramanian, Prasanth, additional, Kheir, Fayez, additional, Keyes, Colleen M., additional, Villalobos, Regina, additional, Chadha, Ryan M., additional, Hazelett, Britney N., additional, and Fernandez‐Bussy, Sebastian, additional

Published
2023
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37. SHAPE-SENSING ROBOTIC-ASSISTED BRONCHOSCOPY AND NOVEL 1.1 MM CRYOPROBE FOR DIAGNOSING PERIPHERAL PULMONARY NODULES

Author

YU LEE MATEUS, ALEJANDRA, primary, BARRIOS-RUIZ, ALANNA, additional, GARZA, ANA K, additional, C. CHANDRA, NIKITHA, additional, KORATALA, ANOOP, additional, ABIA-TRUJILLO, DAVID, additional, PATEL, NEAL M, additional, CHADHA, RYAN, additional, HAZELETT, BRITNEY N, additional, REISENAUER, JANANI, additional, and FERNANDEZ-BUSSY, SEBASTIAN, additional

Published
2023
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41. 195: Utilization of ECMO in liver transplant patients: Pre-emptive vs rescue strategy, jury is still out!

Author

Guru, Pramod, primary, Moreno Franco, Pablo, additional, Bhattacharyya, Anirban, additional, Jena, Anek, additional, Tawk, Rhoda, additional, Kiley, Sean, additional, Sanghavi, Devang, additional, Lowman, Philip, additional, Canabal, Juan, additional, Chadha, Ryan, additional, Aniskevich, Stephen, additional, Archer, Martin, additional, Thomas, Mathew, additional, Landolfo, Kevin, additional, Taner, Burcin, additional, Sareyyupoglu, Basar, additional, Pham, Si, additional, and Chaudhary, Sanjay, additional

Published
2023
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42. Intraoperative Cardiac Arrest During Adult Liver Transplantation: Incidence and Risk Factor Analysis From 7 Academic Centers in the United States

Author

Smith, Natalie K, Zerillo, Jeron, Kim, Sang Jo, Efune, Guy E., Wang, Cynthia, Pai, Sher-Lu, Chadha, Ryan, Kor, Todd M., Wetzel, David R., Hall, Michael A., Burton, Kristen K., Fukazawa, Kyota, Hill, Bryan, Spad, Mia-Ashley, Wax, David B., Lin, Hung-Mo, Liu, Xiaoyu, Odeh, Jaffer, Torsher, Laurence, Kindscher, James D., Mandell, M. Susan, Sakai, Tetsuro, and DeMaria, Samuel, Jr

Published
2021
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43. Shape-Sensing Robotic-Assisted Bronchoscopy versus Computed Tomography-Guided Transthoracic Biopsy for the Evaluation of Subsolid Pulmonary Nodules.

Author

Fernandez-Bussy, Sebastian, Yu Lee-Mateus, Alejandra, Reisenauer, Janani, Balasubramanian, Prasanth, Barrios-Ruiz, Alanna, Garza-Salas, Ana, Chandra, Nikitha C., Koratala, Anoop, Nadrous, Anthony, Edell, Eric S., Bowman, Andrew W., Grage, Rolf A., Reisenauer, Chris J., Kurup, Anil N., Patel, Neal M., Chadha, Ryan, Hazelett, Britney N., and Abia-Trujillo, David

Subjects
BIOPSY, COMPUTED tomography, CHEST X rays, RETROSPECTIVE studies, DESCRIPTIVE statistics, LUNG tumors, ROBOTICS, SOLITARY pulmonary nodule, RESEARCH, MEDICAL records, ACQUISITION of data, BRONCHOSCOPY, COMPARATIVE studies, SENSITIVITY & specificity (Statistics)
Abstract

Introduction: Lung cancer remains the leading cause of cancer death worldwide. Subsolid nodules (SSN), including ground-glass nodules (GGNs) and part-solid nodules (PSNs), are slow-growing but have a higher risk for malignancy. Therefore, timely diagnosis is imperative. Shape-sensing robotic-assisted bronchoscopy (ssRAB) has emerged as reliable diagnostic procedure, but data on SSN and how ssRAB compares to other diagnostic interventions such as CT-guided transthoracic biopsy (CTTB) are scarce. In this study, we compared diagnostic yield of ssRAB versus CTTB for evaluating SSN. Methods: A retrospective study of consecutive patients who underwent either ssRAB or CTTB for evaluating GGN and PSN with a solid component less than 6 mm from February 2020 to April 2023 at Mayo Clinic Florida and Rochester. Clinicodemographic information, nodule characteristics, diagnostic yield, and complications were compared between ssRAB and CTTB. Results: A total of 66 nodules from 65 patients were evaluated: 37 PSN and 29 GGN. Median size of PSN solid component was 5 mm (IQR: 4.5, 6). Patients were divided into two groups: 27 in the ssRAB group and 38 in the CTTB group. Diagnostic yield was 85.7% for ssRAB and 89.5% for CTTB (p = 0.646). Sensitivity for malignancy was similar between ssRAB and CTTB (86.4% vs. 88.5%; p = 0.828), with no statistical difference. Complications were more frequent in CTTB with no significant difference (8 vs. 2; p = 0.135). Conclusion: Diagnostic yield for SSN was similarly high for ssRAB and CTTB, with ssRAB presenting less complications and allowing mediastinal staging within the same procedure. [ABSTRACT FROM AUTHOR]

Published
2024
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45. Mobile cone‐beam computed tomography complementing shape‐sensing robotic‐assisted bronchoscopy in the small pulmonary nodule sampling: A multicentre experience.

Author

Abia‐Trujillo, David, Folch, Erik E., Yu Lee‐Mateus, Alejandra, Balasubramanian, Prasanth, Kheir, Fayez, Keyes, Colleen M., Villalobos, Regina, Chadha, Ryan M., Hazelett, Britney N., and Fernandez‐Bussy, Sebastian

Subjects
CONE beam computed tomography, PULMONARY nodules, BRONCHOSCOPY
Abstract

Background and Objective: Shape‐sensing robotic‐assisted bronchoscopy (ssRAB) has expanded as an important diagnostic tool for peripheral pulmonary nodules (PPNs), with diagnostic yields ranging from 60% to 88%. However, sampling and diagnosing PPN less than 2 cm in size has historically been challenging. Mobile cone‐beam computed tomography (mCBCT) has been recently integrated into ssRAB to improve diagnostic accuracy, but its added value remains uncertain. We aim to describe the role of mCBCT and determine if it provides any diagnostic advantage. Methods: A multicentre, retrospective study on the use of ssRAB and mCBCT in two tertiary care institutions: Mayo Clinic Florida and Massachusetts General Hospital. The primary outcome was diagnostic yield and sensitivity for malignancy of ssRAB complemented with mCBCT, compared to ssRAB with the standard 2D fluoroscopy. Results: A total of 192 nodules were biopsied from 173 patients. mCBCT was used in 117 (60.9%) nodules. The overall diagnostic yield was 85.4%. Diagnostic yield between subgroups with and without mCBCT was 83.8% and 88% (p = 0.417), respectively. The mCBCT group had fewer solid nodules (65.8% vs. 81.3%, p = 0.020) and a higher number of ground‐glass nodules (10.3% vs. 1.3%, p = 0.016). Conclusion: Overall, diagnostic yield between subgroups with and without mCBCT was similar. The complementary use of mCBCT to ssRAB allows proceduralists to target more complex and subsolid PPNs with a diagnostic yield comparable to simple solid PPNs while maintaining an excellent safety profile. While the overall diagnostic yield with and without mobile cone‐beam CT for sampling small pulmonary nodules with shape‐sensing robotic bronchoscopy was similar, the use of mobile cone‐beam CT allows for safely biopsying more complex and subsolid nodules. See relatededitorial [ABSTRACT FROM AUTHOR]

Published
2024
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46. Impact of Body Mass Index ≥35 kg/m2 on Minimally Invasive Adrenalectomy.

Author

Knewitz, Daniel K., Castillo-Larios, Rocio, Evans, Lorna A., Cornejo, Jorge, Fullerton, Shalyn M., Rao, Sarika N., Chadha, Ryan N., and Elli, Enrique F.

Subjects
PREOPERATIVE risk factors, MINIMALLY invasive procedures, BARIATRIC surgery, LENGTH of stay in hospitals, ADRENAL tumors
Abstract

Introduction: Obesity is associated with numerous chronic conditions and an increased risk for surgical complications. Laparoscopic and robotic adrenalectomy have proven effective in the resection of adrenal tumors. This study analyzes the outcomes of severely obese patients (body-mass index [BMI] ≥35 kg/m2) following minimally invasive adrenalectomy. Materials and Methods: A retrospective analysis of patients who underwent minimally invasive adrenalectomy at our institution between 2010 and 2023 was conducted. Two matching analyses were performed. The first analysis compared patients with BMI greater versus lower than 35 kg/m2. The second analysis compared outcomes between robotic and laparoscopic adrenalectomy in patients with a BMI ≥35 kg/m2. Results: A total of 278 patients were included in the study. The median tumor size was 29 mm. Adrenal tumors had similar laterality, and most were hormonally active (66.2%). The most common pathological diagnosis was pheochromocytoma (25.5%). No statistical difference was found in peri- and postoperative outcomes between patients with BMI ≥35 and <35 kg/m2 who underwent minimally invasive adrenalectomy. When the surgical approach was compared in severely obese patients, robotic adrenalectomy was associated with shorter hospital length of stay with similar operative time as the laparoscopic approach. Conclusions: Minimally invasive adrenalectomy is safe and feasible in patients with BMI ≥35 kg/m2. Robotic and laparoscopic approaches are both safe and efficient for the resection of adrenal tumors in severely obese patients. [ABSTRACT FROM AUTHOR]

Published
2024
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