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Digital surgery for gastroenterological diseases

World Journal of Gastroenterology 2021年第42期27卷 7240-7246页

作者： Niall Philip Hardy ronan Ambrose cahill UCD Centre for Precision Surgery University College DublinDublin D07 Y9AWIreland

Advances in machine learning,computer vision and artificial intelligence methods,in combination with those in processing and cloud computing capability,portend the advent of true decision support during interventions in real-time and soon perhaps in automated surgical *** capability,deployed alongside technology intraoperatively,is termed digital surgery and can be delivered without the need for high-end capital robotic *** area close to clinical usefulness right now harnesses advances in near infrared endolaparoscopy and fluorescence guidance for tissue characterisation through the use of biophysics-inspired *** represents a potential synergistic methodology for the deep learning methods currently advancing in ophthalmology,radiology,and recently gastroenterology via *** databanks of more general surgical videos are created,greater analytic insights can be derived across the operative spectrum of gastroenterological disease and operations(including instrumentation and operative step sequencing and recognition,followed over time by surgeon and instrument performance assessment)and linked to value-based ***,issues of legality,ethics and even morality need consideration,as do the limiting effects of monopolies,cartels and isolated data ***,the role of the surgeon,surgical societies and healthcare institutions in this evolving field needs active deliberation,as the default risks relegation to bystander or passive *** editorial provides insight into this accelerating field by illuminating the nearfuture and next decade evolutionary steps towards widespread clinical integration for patient and societal benefit.

关键词： Digital surgery Artificial intelligence Gastrointestinal disease Biophysics Deep learning Fluorescence-guided surgery

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Single access laparoscopic total colectomy for severe refractory ulcerative colitis

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World Journal of Gastroenterology 2020年第39期26卷 6015-6026页

作者： John Burke Des Toomey Frank Reilly ronan cahill Department of Colorectal Surgery Beaumont HospitalDublin D09Ireland Department of Surgery Mater Misericordiae University HospitalDublin D07Ireland

BACKGROUND Single port laparoscopic surgery allows total colectomy and end ileostomy for medically uncontrolled ulcerative colitis solely via the stoma site *** intuitively appealing,there is sparse evidence for its use beyond *** To examine the usefulness of single access laparoscopy(SAL)in a general series experience of patients sick with ulcerative *** All patients presenting electively,urgently or emergently over a three-year period under a colorectal specialist team were *** was performed via the stoma site on a near-consecutive basis by one surgical team using a“surgical glove port”allowing group-comparative and case-control analysis with a contemporary cohort undergoing conventional multiport ***,straight rigid laparoscopic instrumentation were used without additional *** Of 46 consecutive patients requiring surgery,39(85%)had their procedure begun laparoscopically.27(69%)of these were commenced by single port access with an 89%completion rate thereafter(three were concluded by multi-trocar laparoscopy).SAL proved effective in comparison to multiport access regardless of disease severity providing significantly reduced operative access costs(>100€case)and postoperative hospital stay(median 5 d vs 7.5 d,P=0.045)without increasing operative *** proved especially efficient in those with preoperative albumin>30 g/dL(n=20).Its comparative advantages were further confirmed in ten pairs case-matched for gender,body mass index and preoperative *** outcomes proved durable in the intermediate term(median follow-up=20 mo).CONCLUSION Single port total colectomy proved useful in planned and acute settings for patients with medically refractory *** regarding duration and cost should not be barriers to its implementation.

关键词： Single incision laparoscopy Minimal access surgery Inflammatory bowel disease Ulcerative colitis Total colectomy and end ileostomy Case match analysis

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What's wrong with sentinel node mapping in colon cancer?

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World Journal of Gastroenterology 2007年第47期13卷 6291-6294页

作者： ronan a cahill Department of General Surgery Cork University HospitalWiltonCorkIreland

Despite near-universal embrace of the concept and clinical relevance of lymphatic mapping for sentinel node identification and analysis for cancers of the breast and integument,the same technique has struggled to a find a role in gastrointestinal cancers in general and,perhaps,in colon cancer in particular. Despite many studies demonstrating its feasibility in malignancies of the large bowel,concern is continually aroused by the variable and often unacceptably low sensitivity rates. Additionally,many confess uncertainty as to what benefit it could ever confer to patients even if it were proven sufficiently accurate given that standard surgical resection incorporates mesenteric resection anyway. However,the huge impact sentinel node mapping has had on clinical practice in certain cancers means that each of these aspects merit careful reconsideration,from very first principles.

关键词： Sentinel node Lymphatic mapping Colon cancer

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Cytokine orchestration in post-operative peritoneal adhesion formation

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World Journal of Gastroenterology 2008年第31期14卷 4861-4866页

作者： ronan a cahill H Paul Redmond Department of General Surgery Cork University Hospital Wilton Cork Ireland

Peritoneal adhesions are a near inevitable occurrence after laparotomy and a major cause of both patient and physician misery. To date, clinical attempts at their amelioration have concentrated on manipulating the physical factors that affect their development despite a wealth of experimental data elucidating the molecular mechanisms that underlie their initiation, development and maturation. However, the advent of targeted, specific anti-cytokine agents as directed therapy for inflammatory and neoplastic conditions raises the prospect of a new era for anti-adhesion strategies. To harness this potential will require considerable cross-disciplinary collaboration and that surgeon-scientists propel themselves to the forefront of this emerging fi eld.

关键词： Postoperative peritoneal adhesion formation Cytokines Vascular endothelial growth factor

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Natural orifice transluminal endoscopic surgery and localized resection for colorectal neoplasia

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World Journal of Gastrointestinal Surgery 2010年第6期2卷 199-202页

作者： ronan a cahill Neil J Mortensen Department of Colorectal Surgery John Radcliffe Hospital

Modern methods of surgical intervention have the potential to provide effective,definitive management of early stage colorectal neoplasia by truly minimally invasive ***-free clearance of early colonic neoplasia from within the intestinal lumen can already now be effected by endoscopic submucosal dissection in the colon and transluminal endoscopic microsurgery(TEM) in the *** orifice transluminal endoscopic surgery(NOTES) offers the potential for providing transmural,full thickness excision as TEM does but at sites in the colon proximal to the *** next conceptual advance required to make this practice an effective reality lies in evolving surgical regional staging strategies to effectively partner localized resective approaches and allow their deployment as definitive curative *** the most compelling modality for nodal status ascertainment in the absence of lymphatic basin excision for other malignant disease processes,it seems timely to reconsider sentinel node biopsy in cancer of the colon and *** by this means or indeed any other,such an ability to confidently identify patients with node negative disease would allow nascent innovative techniques flourish as definitive management for confined(N0) T1 and T2 cancers and so allow the application of available advanced technology for clinical ***,the development of a specific clinical niche for NOTES(whether,as here,for full thickness localized colonic excision or nodal staging alone) would greatly benefit the evolution and incorporation of this surgical strategy into clinical care paradigms.

关键词： Natural orifice transluminal endoscopy Early stage colorectal neoplasia Colorectal cancer Minimal invasive surgery Laparoendoscopic surgery Endoscopy

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Symptomatic pneumatosis intestinalis(including portal venous gas) after laparoscopic total colectomy

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World Journal of Gastrointestinal Endoscopy 2014年第11期6卷 564-567页

作者： Aneela Shah Hazar Al Furajii ronan a cahill Departments of Colorectal Surgery and Radiology Beaumont Hospital Beau-mont Dublin 9 Ireland

The development of intramural intestinal gas may indi-cate a serious postoperative complication and thereforeany radiological indication of such "pneumatosis intes-tinalis"(PI) in an unwell patient after surgery shouldput the clinical team on high-alert. However immedi-ate recourse to relook laparotomy may not be alwaysnecessary and, further, in some cases may possiblyaccelerate the deterioration especially if it proves to benon-therapeutic. Careful and close clinical monitoring,as is described in this clinical report, may allow discrimi-native identification of those in whom this finding is infact transient and therefore benign and who thereforecan be successfully treated without operative re-inter-vention. We describe the presenting features and back-ground scenario of PI early after laparoscopic total col-ectomy for medically refractory, severe ulcerative colitisand detail the critical postoperative decision pivots.

关键词： Pneumatosis intestinalis Laparoscopic total colectomy Ulcerative colitis Severe acute colitis Portal venous gas

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Penetrating ectopic peptic ulcer in the absence of Meckel's diverticulum ultimately presenting as small bowel obstruction

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World Journal of Gastroenterology 2007年第46期13卷 6281-6283页

作者： Hilary Hurley ronan a cahill Paul Ryan Ashraf I Morcos Henry P Redmond Helen M Kiely Department of Surgery Cork University HospitalCorkIreland Department of Pathology Cork University HospitalCorkIreland Department of Gastroenterology Mercy University HospitalCorkIreland

We report here how a heterotopic penetrating peptic ulcer progressed to cause small bowel obstruction in a pa- tient with multiple previous negative investigations. The clinical presentation, radiographic features and patho- logical findings of this case are described, along with the salient lessons learnt. The added value of wireless cap- sule endoscopy （WCE） in such circumstances is debated.

关键词： Non-Meckelean ectopic peptic ulcer Bowel obstruction

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NOTES:The question for minimal resection and sentinel node in early gastric cancer

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World Journal of Gastrointestinal Surgery 2010年第6期2卷 203-206页

作者： Mitsuhiro Asakuma ronan a cahill Sang-Woong Lee Eiji Nomura Nobuhiko Tanigawa Department of General and Gastroenterological Surgery

Surgical therapy for gastric cancer involves both removal of the cancer lesion and complete lymph node *** orifice transluminal endoscopic surgery(NOTES) is considered to represent the next revolution in *** surgeons and endoscopists believe that NOTES may be a superior alternative for early gastric cancer *** node(SN) navigation surgery for gastric cancer:Single institution results of SN mapping for early gastric cancer are increasingly being considered ***,a major large-scale clinical trial of SN mapping for gastric cancer has recently been completed by The Japan Society of SN Navigation Surgery study *** reported false negative rate of 7.0 while the sensitivity of metastasis detection based on SN status was *** of SN biopsy and NOTES:This concept was first described by cahill et al who proved the feasibility of lymphatic mapping and SN biopsy by *** channel filling was immediately observable via the intraperitoneal *** resection of the stomach by hybrid NOTES:Several centers have already reported gastrectomy assisted by NOTES using the transvaginal ***,the main problem of full-thickness resection of gastric wall remains endoscopic gastric *** an endoscopic suturing method would be an important step toward expanding potential *** is met with both enthusiasm and skepticism but will gain its own place as human creativity eventually provides solutions to its technical *** the near future,NOTES can evolve the capacity to complement the existing armamentarium for gastric cancer surgery.

关键词： Early gastric cancer Lymphatic mapping Endoscopic submucosal dissection Sentinel node biopsy Natural orifice transluminal endoscopic surgery

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Biophysics inspired artificial intelligence for colorectal cancer characterization

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Artificial Intelligence in Gastroenterology 2021年第3期2卷 77-84页

作者： Niall P Hardy Jeffrey Dalli Pól Mac Aonghusa Peter M Neary ronan a cahill UCD Centre for Precision Surgery Dublin 7 D07 Y9AWIreland IBM Research IBM Research IrelandDublin 15 D15 HN66Ireland Department of Surgery University Hospital WaterfordUniversity College CorkWaterford X91 ER8EIreland Department of Surgery Mater Misericordiae University Hospital(MMUH)Dublin 7Ireland

Over the last ten years artificial intelligence(AI)methods have begun to pervade even the most common everyday tasks such as email filtering and mobile *** the necessary quality and safety standards may have understandably slowed the introduction of AI to healthcare when compared with other industries,we are now beginning to see AI methods becoming more available to the clinician in select *** this paper we discuss current AI methods as they pertain to gastrointestinal procedures including both gastroenterology and gastrointestinal *** current state of the art for polyp detection in gastroenterology is explored with a particular focus on deep leaning,its strengths,as well as some of the factors that may limit its application to the field of *** use of biophysics(utilizing physics to study and explain biological phenomena)in combination with more traditional machine learning is also discussed and proposed as an alternative approach that may solve some of the challenges associated with deep *** and present uses of biophysics inspired AI methods,such as the use of fluorescence guided surgery to aid in the characterization of colorectal lesions,are used to illustrate the role biophysicsinspired AI can play in the exciting future of the gastrointestinal proceduralist.

关键词： Gastroenterology Artificial intelligence Gastrointestinal surgery Deep learning Biophysics Machine learning

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