BMJ Surgery Interventions Health Technologies最新文献

{"title":"'Rise of the Machines': Human Factors and training for robotic-assisted surgery.","authors":"Fiona Kerray, Steven Yule","doi":"10.1136/bmjsit-2021-000100","DOIUrl":"https://doi.org/10.1136/bmjsit-2021-000100","url":null,"abstract":"© Author(s) (or their employer(s)) 2021. Reuse permitted under CC BYNC. No commercial reuse. See rights and permissions. Published by BMJ. Surgery is perpetually at the cutting edge of innovation. And like in other innovative industries, the rate of uptake of new technology often outstrips comprehensive understanding of the systems changes and safety implications encountered. Roboticassisted surgery (RAS) presents potential benefits to patients, including shorter hospital stays, reduced postoperative pain, and quicker recovery time. However, patient safety incidents may be as high as double compared with traditional open surgery, revealing the cost of new technology integration, and reminiscent of the rise of laparoscopic surgery in the early 1990s. Along with a supportive culture and effective systems, highquality training is one of the foundations of successful technology adoption. In the present issue of BMJ Surgery, Interventions & Health Technologies, Butterworth et al present an indepth training programme for roboticassisted surgery, focusing on one specific surgical robot. The authors have developed what appears to be a comprehensive hybrid training programme, combining online education followed by facetoface simulations and cadaver sessions with real surgical teams. This study provides initial validity evidence which is important for technology implementation with the ultimate aim to have a training programme that equips surgeons to expertly embed robotic surgery within their practice. The aim of our editorial is to provide a helpful critique regarding validity, and introduce the role of Human Factors to the successful implementation and evaluation of RAS training. Like many applied studies of this type there are some conceptual and methodological limitations which limit the validity of findings and also broadly applicable to surgical education research. Butterworth et al aimed to evaluate the effectiveness of the training programme, however without defined standards it is unclear whether the training was aimed at improving surgeons’ technical ability or whether it was to train them to proficiency. Implementing a validity framework such as Kirkpatrick’s can be invaluable in this respect, as it allows researchers to evaluate both formal and informal training methods against four levels of criteria: reactions (did the training meet surgeons’ needs?), learning (has knowledge or skill increased?), behaviour (can surgeons now apply robotic surgical skills in real life?), and results (has training improved outcomes and safety?). By applying Kirkpatrick’s lens to the present study, we can say that the highest level of validity is at level 2: learning; as there is some evidence of participant skill improving. However, 2 of the 17 surgeons moved from intermediate to novice level which means that the training was not universally successful and may even have been counterproductive. Heterogeneity in prior experience of surgery and robotics of partici","PeriodicalId":33349,"journal":{"name":"BMJ Surgery Interventions Health Technologies","volume":"3 1","pages":"e000100"},"PeriodicalIF":0.0,"publicationDate":"2021-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2d/ea/bmjsit-2021-000100.PMC8647617.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39699148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to: “Rise of the machines”: human factors and training for robotic-assisted surgery","authors":"Jane R. Butterworth, Margaux Sadry, Danielle Julian, Fiona Haig","doi":"10.1136/bmjsit-2021-000115","DOIUrl":"https://doi.org/10.1136/bmjsit-2021-000115","url":null,"abstract":"© Author(s) (or their employer(s)) 2021. Reuse permitted under CC BYNC. No commercial reuse. See rights and permissions. Published by BMJ. We thank Kerray and Yule for their Editorial on our evaluation of a training program developed specifically for Versius, a nextgeneration system for robotassisted minimal access surgery (MAS). We have found the points raised, particularly those pertaining to validity frameworks and human factors, to be constructive, providing valuable guidance for future studies evaluating the effectiveness of trainings in the surgical setting. The program we described is intended to provide surgeons with practical experience operating the system in a simulated environment and is not focused on a specific surgical specialty or procedure. As such, the aim of the study was to monitor performance using the system as surgeons became more familiar and practiced using the system over the course of the program. The use of Global Evaluative Assessment of Robotic Skills (GEARS) scoring provided a validated means of quantifying performance across a range of tasks to allow comparison between surgeon subgroups and timepoints. The proficiency levels were determined from the literature only to help contextualize GEARS scores, not to ascertain operating proficiency for individual surgeons using the system. The features of the device noted in the study publication provide specific examples of how aspects of the design may help remove some of the barriers to uptake of MAS by minimizing the limitations often associated with conventional MAS instruments. Increasing uptake of MAS by incorporating robotic assistance to help improve patient outcomes compared with open surgery was the fundamental driver behind the device’s conception and development; the advantages of MAS over open surgery are numerous and well established, yet MAS utilization has been lower than anticipated hitherto across several common procedures. Cooper et al also note that lack of specific training and exposure to MAS techniques may be partly attributable to the low uptake. We anticipate that purposedesigned training programs such as this one will play an important role in realizing the vast potential of robotic systems as the field evolves. While implementation of Kirkpatrick’s validity framework could have informed the study design to help better address criteria within levels 1 and 3, level 4, assessing the impact of the training on surgical outcomes and safety, was not within the scope of this study as this is only possible in the clinical setting. Ongoing systematic collection of clinical effectiveness and safety data into a purpose designed registry will facilitate longerterm monitoring and largescale analyses of outcomes, in line with IDEALD recommendations. As noted by Kerray and Yule, surgeons with experience using other robotic systems may require more training to adjust to a new platform compared with surgeons with no prior robotics experience. As this surgical syste","PeriodicalId":33349,"journal":{"name":"BMJ Surgery Interventions Health Technologies","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46608767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cohort study of impact on length of stay of individual enhanced recovery after surgery protocol components.","authors":"Rachel C Sisodia,&nbsp;Dan Ellis,&nbsp;Michael Hidrue,&nbsp;Pamela Linov,&nbsp;Elena Cavallo,&nbsp;Allison S Bryant,&nbsp;May Wakamatsu,&nbsp;Marcela G Del Carmen","doi":"10.1136/bmjsit-2021-000087","DOIUrl":"https://doi.org/10.1136/bmjsit-2021-000087","url":null,"abstract":"<p><strong>Objective: </strong>The goal of this study was to explore which enhanced recovery after surgery (ERAS) bundle items were most associated with decreased length of stay after surgery, most likely associated with decreased length of stay after surgery.</p><p><strong>Design: </strong>A cohort study.</p><p><strong>Setting: </strong>Large tertiary academic medical centre.</p><p><strong>Participants: </strong>The study included 1318 women undergoing hysterectomy as part of our ERAS pathway between 1 February 2018 and 30 January 2020 and a matched historical cohort of all hysterectomies performed at our institution between 3 October 2016 and 30 January 2018 (n=1063).</p><p><strong>Intervention: </strong>The addition of ERAS to perioperative care.This is a cohort study of all patients undergoing hysterectomy at an academic medical centre after ERAS implementation on 1 February 2018. Compliance and outcomes after ERAS roll out were monitored and managed by a centralised team. Descriptive statistics, multivariate regression, interrupted time series analysis were used as indicated.</p><p><strong>Main outcome measures: </strong>Impact of ERAS process measure adherence on length of stay.</p><p><strong>Results: </strong>After initiation of ERAS pathway, 1318 women underwent hysterectomy. There were more open surgeries after ERAS implementation, but cohorts were otherwise balanced. The impact of process measure adherence on length of stay varied based on surgical approach (minimally invasive vs open). For open surgery, compliance with intraoperative antiemetics (-30%, 95% CI -18% to 40%) and decreased postoperative fluid administration (-12%, 95% CI -1% to 21%) were significantly associated with reduced length of stay. For minimally invasive surgery, ambulation within 8 hours of surgery was associated with reduced length of stay (-53%, 95% CI -55% to 52%).</p><p><strong>Conclusions: </strong>While adherence to overall ERAS protocols decreases length of stay, the specific components of the bundle most significantly impacting this outcome remain elusive. Our data identify early ambulation, use of antiemetics and decreasing postoperative fluid administration to be associated with decreased length of stay.</p>","PeriodicalId":33349,"journal":{"name":"BMJ Surgery Interventions Health Technologies","volume":"3 1","pages":"e000087"},"PeriodicalIF":0.0,"publicationDate":"2021-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/52/4b/bmjsit-2021-000087.PMC8749327.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39834980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Joint effort: a call for standardization in total joint arthroplasty data reporting.","authors":"Alexander Y Liebeskind,&nbsp;Marc Nieuwenhuijse,&nbsp;Jensen H Hyde,&nbsp;Amanda C Chen,&nbsp;Suvekshya Aryal,&nbsp;Per-Henrik Randsborg","doi":"10.1136/bmjsit-2021-000079","DOIUrl":"https://doi.org/10.1136/bmjsit-2021-000079","url":null,"abstract":"","PeriodicalId":33349,"journal":{"name":"BMJ Surgery Interventions Health Technologies","volume":"3 1","pages":"e000079"},"PeriodicalIF":0.0,"publicationDate":"2021-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f5/8e/bmjsit-2021-000079.PMC8647589.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39834978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Call for emergency action to limit global temperature increases, restore biodiversity and protect health.","authors":"Lukoye Atwoli,&nbsp;Abdullah H Baqui,&nbsp;Thomas Benfield,&nbsp;Raffaella Bosurgi,&nbsp;Fiona Godlee,&nbsp;Stephen Hancocks,&nbsp;Richard Horton,&nbsp;Laurie Laybourn-Langton,&nbsp;Carlos Augusto Monteiro,&nbsp;Ian Norman,&nbsp;Kirsten Patrick,&nbsp;Nigel Praities,&nbsp;Marcel Gm Olde Rikkert,&nbsp;Eric J Rubin,&nbsp;Peush Sahni,&nbsp;Richard Smith,&nbsp;Nicholas J Talley,&nbsp;Sue Turale,&nbsp;Damián Vázquez","doi":"10.1136/bmjsit-2021-000112","DOIUrl":"https://doi.org/10.1136/bmjsit-2021-000112","url":null,"abstract":"","PeriodicalId":33349,"journal":{"name":"BMJ Surgery Interventions Health Technologies","volume":"3 1","pages":"e000112"},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8647603/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39924497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How to tie dangerous surgical knots: easily. Can we avoid this?","authors":"Eric Drabble,&nbsp;Sofia Spanopoulou,&nbsp;Eleni Sioka,&nbsp;Ellie Politaki,&nbsp;Ismini Paraskeva,&nbsp;Effrosyni Palla,&nbsp;Lauren Stockley,&nbsp;Dimitris Zacharoulis","doi":"10.1136/bmjsit-2021-000091","DOIUrl":"https://doi.org/10.1136/bmjsit-2021-000091","url":null,"abstract":"<p><strong>Objective: </strong>Secure knots are essential in all areas of surgical, medical and veterinary practice. Our hypothesis was that technique of formation of each layer of a surgical knot was important to its security.</p><p><strong>Design: </strong>Equal numbers of knots were tied, by each of three groups, using three techniques, for each of four suture materials; a standard flat reef knot (FRK), knots tied under tension (TK) and knots laid without appropriate hand crossing (NHCK). Each knot technique was performed reproducibly, and tested by distraction with increasing force, till each material broke or the knot separated completely.</p><p><strong>Setting: </strong>Temporary knot tying laboratory.</p><p><strong>Materials: </strong>The suture materials were, 2/0 polyglactin 910 (Vicryl), 3/0 polydioxanone, 4/0 poliglecaprone 25 (Monocryl) and 1 nylon (Ethilon).</p><p><strong>Participants: </strong>Three groups comprised, a senior surgeon, a resident surgeon and three medical students.</p><p><strong>Outcome measures: </strong>Proportion of each knot type that slipped, degree of slippage and length of suture held in loop secured by each knot type.</p><p><strong>Results: </strong>20% of FRK tied with all suture materials slipped; all knots tied with the other two techniques, with all materials, slipped, TK (100%) and NHCK (100%). The quantitative degree of slip was significantly less for FRK (mean 6.3%-, 95% CI 2.2% to 10.4%) than for TK (mean 312%, 95% CI 280.0% to 344.0%) and NHCK (mean 113.0%, -95% CI 94.3% to 131.0%).The mean length of suture in loops held within (FRK mean 25.1 mm 95% CI 24.2 to 26.0 mm) was significantly greater than mean lengths held by the other techniques (TK mean 17.0 mm, 95% CI 16.3 to 17.7 mm), (NHCK mean 16.3 mm, 95% CI 15.9 to 16.7 mm). The latter two types of knot may have tightened more than anticipated, in comparison to FRK, with potential undue tissue tension.</p><p><strong>Conclusion: </strong>Meticulous technique of knot tying is essential for secure knots, appropriate tissue tension and the security of anastomoses and haemostasis effected.</p>","PeriodicalId":33349,"journal":{"name":"BMJ Surgery Interventions Health Technologies","volume":"3 1","pages":"e000091"},"PeriodicalIF":0.0,"publicationDate":"2021-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmjsit-2021-000091","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39924495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tissue stress from laparoscopic grasper use and bowel injury in humans: establishing intraoperative force boundaries.","authors":"Amanda Farah Khan,&nbsp;Matthew Kenneth MacDonald,&nbsp;Catherine Streutker,&nbsp;Corwyn Rowsell,&nbsp;James Drake,&nbsp;Teodor Grantcharov","doi":"10.1136/bmjsit-2021-000084","DOIUrl":"https://doi.org/10.1136/bmjsit-2021-000084","url":null,"abstract":"<p><strong>Objectives: </strong>We aim to determine what threshold of compressive stress small bowel and colon tissues display evidence of significant tissue trauma during laparoscopic surgery.</p><p><strong>Design: </strong>This study included 10 small bowel and 10 colon samples from patients undergoing routine gastrointestinal surgery. Each sample was compressed with pressures ranging from 100 kPa to 600 kPa. Two pathologists who were blinded to all study conditions, performed a histological analysis of the tissues. Experimentation: November 2018-February 2019. Analysis: March 2019-May 2020.</p><p><strong>Setting: </strong>An inner-city trauma and ambulatory hospital with a 40-bed inpatient general surgery unit with a diverse patient population.</p><p><strong>Participants: </strong>Patients were eligible if their surgery procured healthy tissue margins for experimentation (a convenience sample). 26 patient samples were procured; 6 samples were unusable. 10 colon and 10 small bowel samples were tested for a total of 120 experimental cases. No patients withdrew their consent.</p><p><strong>Interventions: </strong>A novel device was created to induce compressive \"grasps\" to simulate those of a laparoscopic grasper. Experimentation was performed ex-vivo, in-vitro. Grasp conditions of 0-600 kPa for a duration of 10 s were used.</p><p><strong>Results: </strong>Small bowel (10), M:F was 7:3, average age was 54.3 years. Colon (10), M:F was 1:1, average age was 65.2 years. All 20 patients experienced a significant difference (p<0.05) in serosal thickness post-compression at both 500 and 600 kPa for both tissue types. A logistic regression analysis with a sensitivity of 100% and a specificity of 84.6% on a test set of data predicts a safety threshold of 329-330 kPa.</p><p><strong>Conclusions: </strong>A threshold was discovered that corresponded to both significant serosal thickness change and a positive histological trauma score rating. This \"force limit\" could be used in novel sensorized laparoscopic tools to avoid intraoperative tissue injury.</p>","PeriodicalId":33349,"journal":{"name":"BMJ Surgery Interventions Health Technologies","volume":"3 1","pages":"e000084"},"PeriodicalIF":0.0,"publicationDate":"2021-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmjsit-2021-000084","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39834979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVIDTrach: a prospective cohort study of mechanically ventilated patients with COVID-19 undergoing tracheostomy in the UK.","authors":"","doi":"10.1136/bmjsit-2020-000077","DOIUrl":"https://doi.org/10.1136/bmjsit-2020-000077","url":null,"abstract":"<p><strong>Objectives: </strong>COVIDTrach is a UK multicentre prospective cohort study project that aims to evaluate the outcomes of tracheostomy in patients with COVID-19 receiving mechanical ventilation and record the incidence of SARS-CoV-2 infection among healthcare workers involved in the procedure.</p><p><strong>Design: </strong>Data on patient demographic, clinical history and outcomes were entered prospectively and updated over time via an online database (REDCap). Clinical variables were compared with outcomes, with logistic regression used to develop a model for mortality. Participants recorded whether any operators tested positive for SARS-CoV-2 within 2 weeks of the procedure.</p><p><strong>Setting: </strong>UK National Health Service departments involved in treating patients with COVID-19 receiving mechanical ventilation.</p><p><strong>Participants: </strong>The cohort comprised 1605 tracheostomy cases from 126 UK hospitals collected between 6 April and 26 August 2020.</p><p><strong>Main outcome measures: </strong>Mortality following tracheostomy, successful wean from mechanical ventilation and length of time from tracheostomy to wean, discharge from hospital, complications from tracheostomy, reported SARS-CoV-2 infection among operators.</p><p><strong>Results: </strong>The median time from intubation to tracheostomy was 15 days (IQR 11, 21). 285 (18%) patients died following the procedure. 1229 (93%) of the survivors had been successfully weaned from mechanical ventilation at censoring and 1049 (81%) had been discharged from hospital. Age, inspired oxygen concentration, positive end-expiratory pressure setting, fever, number of days of ventilation before tracheostomy, C reactive protein and the use of anticoagulation and inotropic support independently predicted mortality. Six reports were received of operators testing positive for SARS-CoV-2 within 2 weeks of the procedure.</p><p><strong>Conclusions: </strong>Tracheostomy appears to be safe in mechanically ventilated patients with COVID-19 and to operators performing the procedure and we identified clinical parameters that are predictive of mortality.</p><p><strong>Trial registration number: </strong>The study is registered with ClinicalTrials.Gov (NCT04572438).</p>","PeriodicalId":33349,"journal":{"name":"BMJ Surgery Interventions Health Technologies","volume":"3 1","pages":"e000077"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmjsit-2020-000077","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39202021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Meta-analysis with individual data of functional outcomes following Aquablation for lower urinary tract symptoms due to BPH in various prostate anatomies.","authors":"Dean Elterman,&nbsp;Peter Gilling,&nbsp;Claus Roehrborn,&nbsp;Neil Barber,&nbsp;Vincent Misrai,&nbsp;Kevin C Zorn,&nbsp;Naeem Bhojani,&nbsp;Alexis Te,&nbsp;Mitch Humphreys,&nbsp;Steven Kaplan,&nbsp;Mihir Desai,&nbsp;Thorsten Bach","doi":"10.1136/bmjsit-2021-000090","DOIUrl":"https://doi.org/10.1136/bmjsit-2021-000090","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate functional outcomes following Aquablation in various prostate volume and anatomical subgroups.</p><p><strong>Design: </strong>A meta-analysis with individual patient data undergoing Aquablation therapy from four prospective, global, clinical studies that have been conducted with Aquablation; WATER, WATER II, FRANCAIS WATER and OPEN WATER.</p><p><strong>Setting: </strong>Australia, Canada, Lebanon, Germany, New Zealand, UK and the USA.</p><p><strong>Participants: </strong>425 men with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) with 1-year follow-up.</p><p><strong>Interventions: </strong>Aquablation therapy is an ultrasound guided, robotically executed waterjet ablative procedure for the prostate.</p><p><strong>Main outcome measures: </strong>The analyses focus International Prostate Symptom Score (IPSS), uroflowmetry, postoperative Incontinence Severity Index (ISI) and surgical retreatment.</p><p><strong>Results: </strong>425 men with prostates ranging in size from 20 to 150 mL underwent Aquablation therapy. The outcomes from the seven questions in the IPSS questionnaire were grouped by the following; prostates <100 mL, prostates ≥100 mL, prostate anatomy with an obstructive median lobe identifed by imaging, and prostate anatomy without an obstructive median lobe. Regardless of subgroup, all outcomes are consistent and demonstrate a significant improvement from baseline. Specifically, improvements in frequency, urgency and nocturia demonstrated bladder function improvement. Patients entering treatment with severe incontinence, ISI score >4, and regardless of prostate size, showed a reduction in incontinence during patient follow-up. Surgical retreatment due to BPH symptoms occurred in 0.7% (95% CI 0.1%-2.0%).</p><p><strong>Conclusions: </strong>Across a variety of prostate anatomies, Aquablation therapy showed remarkable functional improvements following the index procedure. Additionally, men with moderate to severe LUTS/BPH and overactive bladder resulting in urge incontinence showed a reduction in incontinence symptoms postprocedure.</p>","PeriodicalId":33349,"journal":{"name":"BMJ Surgery Interventions Health Technologies","volume":"3 1","pages":"e000090"},"PeriodicalIF":0.0,"publicationDate":"2021-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmjsit-2021-000090","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39924494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceptions of partial gland ablation for prostate cancer among men on active surveillance: A qualitative study.","authors":"Sonia S Hur, Michael Tzeng, Eliza Cricco-Lizza, Spyridon P Basourakos, Miko Yu, Jessica Ancker, Erika Abramson, Christopher Saigal, Ashley Ross, Jim Hu","doi":"10.1136/bmjsit-2020-000068","DOIUrl":"10.1136/bmjsit-2020-000068","url":null,"abstract":"<p><strong>Objectives –: </strong>Partial gland ablation (PGA) therapy is an emerging treatment modality that targets specific areas of biopsy proven prostate cancer (PCa) to minimize treatment-related morbidity by sparing benign prostate. This qualitative study aims to explore and characterize perceptions and attitudes toward PGA in men with very-low-risk, low-risk, and favorable intermediate-risk PCa on active surveillance (AS).</p><p><strong>Design –: </strong>92 men diagnosed with very-low-risk, low-risk, and favorable intermediate-risk PCa on AS were invited to participate in semi-structured telephone interviews on PGA.</p><p><strong>Setting –: </strong>Single tertiary care center located in New York City.</p><p><strong>Participants –: </strong>20 men with very-low-risk, low-risk, and favorable intermediate-risk PCa on AS participated in the interviews.</p><p><strong>Main outcome measures –: </strong>Emerging themes on perceptions and attitudes toward PGA were developed from transcripts inductively coded and analyzed under standardized methodology.</p><p><strong>Results –: </strong>Four themes were derived from twenty interviews that represent the primary considerations in treatment decision-making: (1) the feeling of psychological safety associated with low-risk disease; (2) preference for minimally invasive treatments; (3) the central role of the physician; (4) and the pursuit of treatment options that align with disease severity. Eleven men (55%) expressed interest in pursuing PGA only if their cancer were to progress, while 9 men (45%) expressed interest at the current moment.</p><p><strong>Conclusions –: </strong>Though an emerging treatment modality, patients were broadly accepting of PGA for PCa with men primarily debating the risks versus benefits of proactively treating low-risk disease. Additional research on men's preferences and attitudes toward PGA will further guide counseling and shared decision-making for PGA.</p>","PeriodicalId":33349,"journal":{"name":"BMJ Surgery Interventions Health Technologies","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/05/13/bmjsit-2020-000068.PMC8388575.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39365863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}