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Role of artificial intelligence in colorectal cancer

Artificial Intelligence in Gastrointestinal Endoscopy 2024年第2期5卷 31-40页

作者： Gita Lingam Taner Shakir Rawen Kader Manish Chand Department of General Surgery Princess Alexandra HospitalHarlow CM201QXUnited Kingdom Department of Colorectal Surgery University College LondonLondon W1W 7TYUnited Kingdom Department of Gastroenterology University College LondonUniversity College London Hospitals Nhs Foundation TrustLondon W1BUnited Kingdom Gastroenterological Intervention Centre University College LondonLondon W1W 7TSUnited Kingdom

The sphere of artificial intelligence(AI)is ever expanding.Applications for clinical practice have been emerging over recent years.Although its uptake has been most prominent in endoscopy,this represents only one aspect of holistic patient care.There are a multitude of other potential avenues in which gastrointestinal care may be involved.We aim to review the role of AI in colorectal cancer as a whole.We performed broad scoping and focused searches of the applications of AI in the field of colorectal cancer.All trials including qualitative research were included from the year 2000 onwards.Studies were grouped into pre-operative,intra-operative and post-operative aspects.Preoperatively,the major use is with endoscopic recognition.Colonoscopy has embraced the use for human derived classifications such as Narrow-band Imaging International Colorectal Endoscopic,Japan Narrow-band Imaging Expert Team,Paris and Kudo.However,novel detection and diagnostic methods have arisen from advances in AI classification.intra-operatively,adjuncts such as image enhanced identification of structures and assessment of perfusion have led to improvements in clinical outcomes.Post-operatively,monitoring and surveillance have taken strides with potential socioeconomic and environmental savings.The uses of AI within the umbrella of colorectal surgery are multiple.We have identified existing technologies which are already augmenting cancer care.The future applications are exciting and could at least match,if not surpass human standards.

关键词： Artificial intelligence Colorectal cancer Pre-operative intra-operative Post-operative Adjuncts Colonoscopy

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Influential factors and effect evaluation of the intra-operative puncture biopsy for pancreatic masses

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Chinese Medical Journal 2012年第2期125卷 182-187页

作者： Zhuang Yan Yang Yin-mo Wang Wei-min Gao Hong-qiao Wan Yuan-lian Peking Univ First Hosp Dept Gen Surg Beijing 100034 Peoples R China

Background It is a challenge for the surgeons to accurately diagnose the pancreatic masses preoperatively,which decides the choice of surgical managements and subsequently results in different survivor outcomes,operative complications,and mortality rates.The purposes of this study were to evaluate the diagnostic role that intra-operative puncture biopsy may play in pancreatic masses and to explore the relevant factors influencing the diagnosis.Methods A retrospective study was performed on 94 in-patients admitted to Peking University First Hospital for pancreatic masses during the period from June 1994 to December 2007.They all underwent intra-operative puncture biopsy during exploratory laparotomy.The sensitivity and specificity of intra-operative puncture biopsy were calculated and the relevant factors to the diagnosis of biopsy were selected for the statistical analysis.Results The overall sensitivity,specificity,positive predictive value,and negative predictive value of intra-operative puncture biopsy were 76.0%,94.7%,98.3% and 50.0%,respectively.The analysis of bivariate correlations showed that the size of the pancreatic masses （P=-0.000）,the number of puncture biopsies （P=0.000）,and the presence of pancreatic fibrosis （P=-0.012） had statistic significance for the diagnosis.But the multivariate analysis identified the size of the pancreatic masses （P=0.004） and the number of puncture biopsies （P=0.000） as independent predictive factors for intra-operative puncture biopsy.In addition,as the number of puncture biopsies increased,the sensitivity and specificity of diagnosis was improved （P=0.000）.The sensitivity and specificity of intra-operative puncture biopsy were found to be lower for the pancreatic masses less than 25 mm compared with the masses larger than 25 mm （P=0.000）.It was noted,however,that even if the masses were less than 25 mm,the sensitivity and specificity could be improved significantly as the number of puncture biopsies reached 3 to 6 （P=0.007）.Conclusions intra-operative puncture biopsy is

关键词： pancreas puncture biopsy intra-operative neoplasms

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Impact of intra-operative cholangiography and parenchymal resection to donor liver function in living donor liver transplantation

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Hepatobiliary & Pancreatic Diseases International 2014年第3期13卷 259-263页

作者： Feng Gao Xiao Xu Yang-Bo Zhu Qiang Wei Bin Zhou Xiao-Yong Shen Qi Ling Hai-Yang Xie Jian Wu Wei-Lin Wang Shu-Sen Zheng Division of Hepatobiliary and Pancreatic Surgery Department of Surgery Zhejiang University School of Medicine Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases Zhejiang University School of Medicine Department of General Surgery The Second Hospital of Ningbo City Department of Radiology Zhejiang University School of Medicine Key Lab of Combined Multi-Organ Transplantation Ministry of Public HealthFirst Affiliated Hospital Zhejiang University School of Medicine

BACKGROUND: Living donor liver transplantation(LDLT)has been widely accepted over the past decade, and hepatic dysfunction often occurs in the donor in the early stage after liver donation. The present study aimed to evaluate the effect of intraoperative cholangiography(IOC) and parenchymal resection on liver function of donors in LDLT, and to assess the role of IOC in influencing the biliary complications and improving the overall outcome.METHODS: Data from 40 patients who had donated their right lobes for LDLT were analyzed. Total bilirubin(TB), alanine aminotransferase(ALT), aspartate aminotransferase(AST),alkaline phosphatase(ALP) and γ-glutamyl transpeptidase(GGT)at different time points were compared, and the follow-up data and the biliary complications were also analyzed.RESULTS: The ALT and AST values were significantly increased after IOC(P0.05) or parenchymal resection(P>0.05). The biochemical changes caused by IOC or parenchymal resection were not correlated with the degree of post-operative liver injury or the recovery of liver function. The liver functions of the donors after operation were stable, and none of the donors suffered from biliary stenosis or leakage during the follow-up.CONCLUSIONS: IOC and parenchymal resection may induce a transient increase in liver enzymes of donors in LDLT, but do not affect the recovery of liver function after operation. Moreover,the routine IOC is helpful to clarify the division line of the hepatic duct, thus reducing the biliary complication rate.

关键词： living donor liver transplantation intra-operative liver imaging liver function hepatectomy

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Role of intra-operative Nerve Monitoring in Thyroidectomies: An Institutional Review

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International Journal of Otolaryngology and Head & Neck Surgery 2014年第4期3卷 154-160页

作者： Naren N. Venkatesan Sharon H. Gnagi Michael P. Underbrink Department of Otolaryngology—Head and Neck Surgery University of Texas-Medical Branch at Galveston School of Medicine Galveston USA

Injury to the Recurrent Laryngeal Nerve (RLN) is a worrisome complication of a thyroidectomy. intra-operative nerve monitoring (IONM) of the RLN has gained prevalence as an aid to prevent injury. We reviewed our series and other studies in literature for insight. A chart review was carried out to identify all patients who underwent a thyroidectomy between 2005 and 2010. IONM was implemented by the Otolaryngology service in 2007. All identified patients were separated into three groups: 1) Otolaryngology service with IONM, 2) Otolaryngology service without IONM, and 3) General Surgery service without IONM. Several factors were noted, including age, sex, thyroid disease, extent of thyroidectomy, and RLN injury along with recovery. 230 patients underwent thyroidectomy from 2005-2010. 60 patients were isolated in the IONM-Otolaryngology group with 3 patients suffering injury. 109 patients underwent a thyroidectomy by the Otolaryngology service without IONM with 8 patients suffering nerve damage. In the third group, 61 patients underwent a thyroidectomy by General Surgery without IONM with 4 patients suffering damage. Of the thyroid pathology, 10 patients had Multinodular Goiter while 4 had Papillary Cancer and 1 had a Follicular Adenoma. The most severe complication of a thyroidectomy is RLN injury. In order to further decrease the risk of RLN injury, IONM has been employed. From our review and other studies, there does not appear to be a significant difference in rates of RLN injury with or without use of nerve monitoring. An interesting note is the increased prevalence of nerve injuries in Multinodular Goiter—a finding that merits further study to evaluate the role of IONM.

关键词： Recurrent Laryngeal Nerve Injruy Vocal Cord Paralysis Thyroidectomy intra-operative Nerve Monitoring

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Brain tumor surgery:supplemental intra-operative imaging techniques and future challenges

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Journal of Cancer Metastasis and Treatment 2016年第1期2卷 70-79页

作者： Telmo Augusto Barba Belsuzarri Raphael Martinelli Anson Sangenis João Flavio Mattos Araujo Department of Neurosurgery Pontifical Catholic University of CampinasCampinasSão Paulo 13060-803Brazil

Modern brain tumor surgery stands in the pillar of maximum safe resection.Tumor borders are always challenging,especially infiltration zones in malignant brain tumors.Novel technologies are designed for a better delineation and to increase the extent of resection(EOR)in brain tumor surgery,such as:cortical and sub-cortical mapping strategies with somatosensory-evoked potentials,awake stimulation mapping and cortical/sub-cortical stimulation for motor pathways,important for resection in eloquent areas;intra-operative imaging as functional and intra-operative magnetic resonance imaging,diffusion tensor imaging and intra-operative ultrasound are important for the tumor borders and to achieve the gross total resection;neurochemical navigation methods as 5-aminolevulinic and sodium fluorescein are important for the non-contrast-enhanced tumor border;future methods can be achieved with augmented reality surgery,new intra-operative chemical markers,and visualization methods.Nevertheless all these techniques seem to be promising,the real challenge in the future will be held in how to apply them and how they really affect the prognosis of the patients.Also,new concepts in tumor genetics will provide knowledge for the tumor behavior and will guide resection.Despite all limitations,the increasing importance of safe EOR shows the possible benefits of the novel technologies and surgical advances in brain tumor surgery,taking it to a new step of the neuronavigation era.

关键词： Brain tumor fluorescein intra-operative neuronavigation novel technology

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The Dosimetric Characteristics and Potential Limitation in Clinical Application of a Low Energy Photon intra-operative Radiotherapy System

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International Journal of Medical Physics, Clinical Engineering and Radiation Oncology 2015年第2期4卷 184-195页

作者： Zhenhua Xiao Ouyang Bin Zhenyu Wang Botian Huang Bixiu Wen Department of Radiation Oncology The First Affiliated Hospital of Sun Yat-sen University Guangzhou China

Purpose: To investigate the dosimetric characteristics of a low energy photon intra-operative radiotherapy (IORT) system and explore its potential limitation in clinical application. Methods: A special water phantom, a parallel-plate ionization chamber and an electrometer were used to measure the depth dose rate, isotropy of dose distribution in X/Y plane, dosimetry reproducibility of bare probe and spherical applicators of different size which were used in comparison with the system data. Results: The difference in depth dose rate between the measurement and system data for bare probe is -2.16% ± 1.36%, the range of the relative deviation for isotropy in the X/Y plane is between -1.9% and 2.1%. The difference in depth dose rate, transfer coefficient, isotropy in X/Y plane between the measurement and system data for the whole set of spherical applicators is -10.0% - 2.3%, -8.9% - 4.2% and -1.6% - 2.6%, respectively. Higher surface dose rate and steeper gradient depth dose are observed in smaller spherical applicators. The depth dose rate and isotropy for bare probe and spherical applicators have been shown good reproducibility. The uncertainty of measurement is associated with the positioning accuracy, energy response, noise current and correction function f’(R). Conclusions: Thorough commissioning of the low energy photon IORT system helps us better understand the dosimetry characteristics, verify the system data, obtain adequate data for clinical application and routine quality assurance. The steep gradient depth dose and limited treatment range may restrain its potential in clinical application.

关键词： intra-operative Radiotherapy Low Energy Photon Dosimetry Isotropy Limitation

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Role of artificial intelligence in hepatobiliary and pancreatic surgery

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World Journal of Gastrointestinal Surgery 2021年第1期13卷 7-18页

作者： Hassaan Bari Sharan Wadhwani Bobby V M Dasari Department of HPB and Liver Transplantation Surgery Queen Elizabeth HospitalBirmingham B152THUnited Kingdom Department of Radiology Queen Elizabeth HospitalBirmingham B152THUnited Kingdom

Over the past decade,enhanced preoperative imaging and visualization,improved delineation of the complex anatomical structures of the liver and pancreas,and intra-operative technological advances have helped deliver the liver and pancreatic surgery with increased safety and better postoperative outcomes.Artificial intelligence(AI)has a major role to play in 3D visualization,virtual simulation,augmented reality that helps in the training of surgeons and the future delivery of conventional,laparoscopic,and robotic hepatobiliary and pancreatic(HPB)surgery;artificial neural networks and machine learning has the potential to revolutionize individualized patient care during the preoperative imaging,and postoperative surveillance.In this paper,we reviewed the existing evidence and outlined the potential for applying AI in the perioperative care of patients undergoing HPB surgery.

关键词： Artificial intelligence Liver surgery Pancreatic surgery Augmented reality Virtual reality intra-operative

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Surgical treatment of Lipodermoids - Case Report

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Open Journal of Ophthalmology 2020年第1期10卷 1-9页

作者： Shoshi Flaka Hoxha-Shoshi Mire Shoshi Fitore Shoshi Fjolla Shoshi Avdyl Department of Clinical Medicine Faculty of Medicine University of Prishtina Prishtina Republic of Kosova College of Medical Sciences “REZONANCA” Prishtina Republic of Kosova AAB College Prishtina Republic of Kosova

Lipodermoids are abnormal epibulbar growths of the adipose tissue. A conjunctival lesion, the lipodermoid (dermolipoma) is usually located near the temporal fornix and is composed of adipose tissue and dense connective tissue. The overlying conjunctival epithelium is normal, and hair follicles are absent. Lipodermoids may be extensive, sometimes involving orbital tissue, lacrimal gland, and extraocular muscle. Surgical treatment is only indicated when the existing lipodermoid disturbs the patient either functionally or aesthetically. Purpose The main purpose of this study is to present our experience on the surgical treatment of lipodermoids in those cases when lipodermoids cause functional and aesthetic problem to the patient. Materials and Methods In our study we have included two cases of male gender, one with bilateral lipodermoid (in both eyes) while the other with a mono lateral lipodermoid (only in one eye). The treatment was surgical, where we carefully removed the lipodermoid lesion inside palpebral fissures, to fully preserve the bulbar conjunctiva and Tenon’s membrane during the removal of the conjunctival lipodermoid.Surgery was performed under local anesthesia (lidocaine 2% and adrenaline). The surgical area was set ready by using betadine 5%. Results In both cases there were neither intra-operative nor extra-operative complications and the results were positive.Also the functional and aesthetic problems were corrected. There was no recurrence encountered.Conclusions In conclusion, based on the results of this study, in the rare cases of lipodermoids where surgical treatment is necessary, it is very important to perform a careful surgical intervention, in order to prevent any intra-operative injuries of the lacrimal gland and the lateral and superior rectus muscles. In general the surgical treatment is a successful method on treating lipodermoids, in cases when they concern the patient both functionally and aesthetically.

关键词： Lipodermoids intra-operative Injuries Treatment

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Lithium Associated Hyperparathyroidism: An Evidence Based Surgical Approach

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Surgical Science 2011年第10期2卷 468-475页

作者： Umashankar K Ballehaninna Steven M. Nguyen Ronald S. Chamberlain 不详

Background: Long-term lithium use in psychiatric patients may lead to lithium associated hyperparathyroidism (LAH). Although anecdotal case reports have appeared, an evidence based algorithm for management of LAH is lacking. Methods: A comprehensive literature search was performed (1973-2010) using PubMed with keywords;“lithium” “hypercalcemia” “hyperparathyroidism” “sestamibi” “intra-operative parathyroid hormone (IOPTH) monitoring” “parathyroidectomy” and “medical management”. All English language publications addressing etiology and clinical management issues concerning LAH were critically analyzed. Results: Lithium associated hyperparathyroidism occurs in 4.3% - 6.3% of chronic lithium users compared to the general population which has an incidence of 0.5% - 1%. 194 cases of LAH have been reported which includes 10 patients (5%) treated medically and 170 patients (88%) who underwent parathyroidectomy. No details were available for 14 patients (7%). Among parathyroidectomy patients, 104 (59%) had adenomatous disease and 66 (39%) had multiglandular hyperplasia. Preoperative localization studies were utilized in only 22 patients (13%) and IOPTH monitoring was reported in only 3 studies (32 patients, 19%). Among surgical patients, bilateral neck exploration (BNE) was the most common approach performed in 162 patients (95%);focused neck exploration was utilized in only 8 patients (5%). Parathyroidectomy normalized LAH biochemical changes in nearly all patients (90% - 97%) in the early post-operative period, but recurrent hyperparathyroidism occurred in 8% - 42% of patients. Conclusion: LAH is an under appreciated and poorly understood endocrine disorder. LAH has a higher incidence of multiglandular disease and bilateral neck exploration is mandatory in majority for disease control. Nonsurgical approaches may be useful in select patients on short-term lithium therapy.

关键词： Lithium Hypercalcemia Hyperparathyroidism Sestamibi intra-operative Parathyroid Hormone (IOPTH) Monitoring Parathyroidectomy Medical Management

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Cavernosal nerve functionality evaluation after magnetic resonance imaging-guided transurethral ultrasound treatment of the prostate

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World Journal of Radiology 2015年第12期7卷 521-530页

作者： Steffen Sammet Ari Partanen Ambereen Yousuf Christina L Sammet Emily V Ward Craig Wardrip Marek Niekrasz Tatjana Antic Aria Razmaria Keyvan Farahani Shunmugavelu Sokka Gregory Karczmar Aytekin Oto Department of Radiology University of Chicago Committee on Medical Physics University of Chicago Department of Medical Imaging Lurie Children’s Hospital Department of Surgery University of Chicago Department of Pathology University of Chicago National Cancer Institute

AIM: To evaluate the feasibility of using therapeutic ultrasound as an alternative treatment option for organconfined prostate cancer. METHODS: In this study, a trans-urethral therapeutic ultrasound applicator in combination with 3T magnetic resonance imaging(MRI) guidance was used for realtime multi-planar MRI-based temperature monitoring and temperature feedback control of prostatic tissue thermal ablation in vivo. We evaluated the feasibility and safety of MRI-guided trans-urethral ultrasound to effectively and accurately ablate prostate tissue while minimizing the damage to surrounding tissues in eight canine prostates. MRI was used to plan sonications, monitor temperature changes during therapy, and to evaluate treatment outcome. Real-time temperature and thermal dose maps were calculated using the proton resonance frequency shift technique and were displayed as two-dimensional color-coded overlays on top of the anatomical images. After ultrasound treatment, an evaluation of the integrity of cavernosal nerves was performed during prostatectomy with a nerve stimulator that measured tumescence response quantitatively and indicated intact cavernous nerve functionality. Planned sonication volumes were visually correlated to MRI ablation volumes and corresponding histo-pathological sections after prostatectomy. RESULTS: A total of 16 sonications were performed in 8 canines. MR images acquired before ultrasound treatment were used to localize the prostate and to prescribe sonication targets in all canines. Temperature elevations corresponded within 1 degree of the targeted sonication angle, as well as with the width and length of the active transducer elements. The ultrasound treatment procedures were automatically interrupted when the temperature in the target zone reached 56 ℃. In all canines erectile responses were evaluated with a cavernous nerve stimulator post-treatment and showed a tumescence response after stimulation with an electric current. These results indicated intact cavernous nerve functionality. I

关键词： Ultrasound therapy Thermal tissue ablation Prostate Magnetic resonance imaging guided therapy intra-operative Histology Validation

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