A randomized comparison of conventional vs articulating laparoscopic needle-drivers for performing standardized suturing tasks by laparoscopy-naive subjects

Associate Editor Ash Tewari Editorial Board Ralph Clayman, USA Inderbir Gill, USA Roger Kirby, UK Mani Menon, USA

OBJECTIVES

To compare the efficacy of conventional and articulating laparoscopic needle‐drivers for performing standardized laparoscopic tasks by medical students with no previous surgical experience.

SUBJECTS AND METHODS

Twenty medical students with no surgical experience were randomly assigned to two equal groups, one using a conventional laparoscopic needle‐holder (Karl Storz, Tuttlingen, Germany) and the other using a first‐generation articulating laparoscopic needle‐holder (Cambridge Endo, Framingham, MA, USA). Each student performed a series of four standardized laparoscopic tasks, during which speed and accuracy were assessed. The tasks tested needle passage through rings (1), an oblique running suture model (2), a urethrovesical anastomosis model (3) and a model simulating renal parenchymal reconstruction following partial nephrectomy (4).

RESULTS

Tasks 1 and 3 were completed significantly more quickly by those using the conventional instruments (P < 0.05), but there was no statistically significant difference for task 2 and 4 (P > 0.05). Those using conventional instruments were significantly more accurate in all of the tasks than those using the articulated instruments (P < 0.05).

CONCLUSIONS

The conventional laparoscopic needle‐driver allowed laparoscopy‐naive medical students to complete a series of standardized suturing tasks more rapidly and accurately than with the novel articulating needle‐driver. Laparoscopic suturing with first‐generation articulating needle‐drivers might be more difficult to learn, secondary to the complexity of physical manoeuvres required for their use.     

Spectrum of head and neck lesions diagnosed by fine‐needle aspiration cytology in the pediatric population

Fine‐needle aspiration cytology (FNAC) of the head and neck region is well accepted as a diagnostic procedure in the adult population. FNAC in the pediatric population is gaining acceptance as clinicians add this technique to the diagnostic armamentarium. An experience with FNAC of the head and neck region in the pediatric population is described from 2 large inner‐city hospitals. Eighty‐five cases were retrieved from patients age <18 years. In 52 cases, clinical or surgical follow‐up was obtained and among these cases the specificity and sensitivity of FNA was 93% and 100%, respectively. The high specificity of FNAC allows the clinician to be confident of malignancy in a clinically suspicious lesion of the head and neck in a pediatric patient. Cancer (Cancer Cytopathol) 2007. © 2007 American Cancer Society.     

Reliability of prognostic factors in breast carcinoma determined by core needle biopsy

OBJECTIVE: The aim of this study was to evaluate the reliability of information obtained by core needle biopsy (CNB). METHODS: We studied 111 women (112 lesions) with breast cancer who underwent CNB and subsequent surgical excision. Six factors (histological type, nuclear grade, histological grade, estrogen receptor (ER) status, progesterone receptor (PR) status, and human epidermal growth factor receptor-2 (HER2) status) were evaluated in a blinded fashion at CNB and at surgical excision. RESULTS: The histological type at CNB correlated exactly with that of the excisional specimen in 83% (87/105) of the cases. Of the 45 in situ lesions at CNB, 16 (36%) were found to have invasive carcinoma at surgical excision. The difference between the specimens from CNB and those from surgery in terms of the absolute concordance rate and kappa statistic value were 61% with a fair kappa value (0.26) in the nuclear grade, 75% with a moderate kappa value (0.55) in the histological grade, 95% with an almost perfect kappa value (0.84) in ER, 88% with a substantial kappa value (0.70) in PR and 88% with a substantial kappa value (0.65) in HER2. Regarding the evaluation of nuclear and histological grades, a trend toward greater accuracy was observed when thicker specimens were used. CONCLUSIONS: CNB provided reliable information on the histological type of invasive carcinoma. It also evaluated ER, PR and HER2 (only in cases where the score was 3+) accurately in spite of the limited quantity of the specimen obtained with the thin (16-gauge) needle.     

Evaluation and indications of ultrasound-guided vacuum-assisted core needle breast biopsy

BACKGROUND: The Mammotome is a diagnostic tool used under stereotactic or with ultrasound guidance. A clear indication for Mammotome use under stereotactic guidance is when a non-palpable microcalcification is a target. However, the indications for the use of the Mammotome under ultrasound guidance vary among institutions, and it is difficult to find a place for the Mammotome among conventional biopsy techniques. The Mammotome biopsy has been available in our hospital since July 1999. We assessed the effectiveness and indications of ultrasound-guided Mammotome biopsy. METHODS: We performed Mammotome biopsies in 433 cases requiring histological diagnosis from July 1999 to September 2006, using an 11-gauge articulated arm-type Mammotome under ultrasound guidance. There were 377 mass lesions including 83 non-palpable cases and 56 hypoechoic lesions. RESULTS: The indications for Mammotome biopsy were 162 cases with inconsistent fine needle aspiration (FNA) and imaging findings, 114 cases indeterminate by FNA, 68 cases of an identified pathological type before neoadjuvant chemotherapy and confirmation of hormone receptor status, 36 inadequate cases by FNA, 20 cases of confirmation of fibroadenoma and other benign tumors, 8 removal cases of fibroadenoma, 8 microcalcification cases, and 17 others. The target lesion was obtained in 99.5% of the cases. CONCLUSIONS: Ultrasound-guided Mammotome biopsy is an accurate and useful diagnostic method that enables sufficient amounts of tissue to be obtained with minimal invasion and few complications. The Mammotome is the first choice for obtaining a definitive pathological diagnosis in breast lesions.     

Higher accuracy of surgical over core needle biopsy for the diagnosis of lymphoproliferative disorders

Introduction

The diagnosis of lymphoproliferative disorders (LPDs) is based on histological evaluation of representative tissue samples. Despite surgical excision biopsies (SEBs) are reference procedures for such diagnoses, lymph node core needle biopsies (LNCBs) are increasingly performed. The diagnostic yield of LNCB is, however, debated and few studies have compared the reproducibility of LNCB and SEB findings.

Methods

To address the diagnostic value of LNCB and SEB, the present study considered a retrospective series of 43 paired LNCB/SEB samples. After histological revision, concordance rates between matched LNCB/SEB samples were evaluated, assuming SEB as gold standard procedure. The actionability of LNCB and SEB-based diagnoses (i.e., relevance for planning further medical interventions) was also assessed.

Results

Overall, LNCB provided actionable diagnoses in 39/43 (90.7%) cases, but a consistent subset of them (7/39 [17.9%]) turned out to be wrong at SEB. The cumulative diagnostic inaccuracy of LNCB (i.e., inadequate samples plus wrong diagnoses) was 25.6% and the mean diagnostic delay in such cases was 54.2 days.

Conclusions

Although limited by selection biases due to its retrospective nature, this study highlights the intrinsic limitations of LNCB for the diagnosis of LPDs. SEB remains the gold standard procedure and should be performed in all suitable cases.     

超声引导下经皮肺穿刺组织学活检对周围型肺病变的诊断价值

目的探讨超声引导下经皮肺穿刺组织学活检在周围型肺病变（PPL）中的应用价值。 方法回顾性选取2015年1月至2019年12月就诊于西安交通大学第二附属医院,具有完整病例资料的PPL患者176例。所有患者均经胸部CT等影像学检查明确诊断为PPL,均进行超声引导下经皮肺穿刺活检术,并均行手术治疗取得最终病理学诊断结果。分析超声引导下穿刺取材成功率,以手术后病理结果为金标准,计算超声引导下经皮肺穿刺活检诊断PPL的效能,并观察穿刺术后并发症发生率。 结果176例患者中,172例取材成功,取材成功率为97.72%（172/176）。与术后病理结果比较,超声引导下穿刺活检诊断正确168例,诊断准确性为97.67%（168/172）,余4例肺腺癌伴坏死感染穿刺活检诊断为炎性坏死组织。以外科手术后病理结果为金标准,超声引导经皮肺穿刺诊断肺周围型恶性肿瘤的敏感度为96.77%（120/124）,特异度100%（48/48）,阴性预测值为92.31%（48/52）,阳性预测值为100%（120/120）。超声引导经皮肺穿刺活检术后出现少量气胸9例,少量胸腔积液8例,痰中带血丝6例,并发症发生率为13.07%（23/176）。 结论超声引导下经皮肺穿刺活检是一种微创、便捷、安全的检查技术,对PPL具有较高的诊断价值,值得临床推广应用。     

Brain metastases from urachal carcinoma

We present a case of brain metastases of the urachal carcinoma, which is extremely rare and malignant. Contrast-enhanced MRI was employed to detect them. A large mass was removed surgically and 4 other small metastases were treated by gamma knife radiosurgery. Six weeks after radiosurgery, the 4 lesions had disappeared on MRI. We emphasise the importance of early diagnosis using MRI and treatment by radiosurgery for this rare condition.     

Enhancement of granulocyte chemotaxis in Behçet's disease

Summary The humoral and cellular immune status, the cutaneous pathergy, PMNL in vitro function tests as well as clinical and general laboratory examinations were performed and evaluated on ten patients suffering from Behçet's disease (BD) and ten other patients with benign recurrent aphthosis (RA). The same set of in vitro tests (except PMNL exposure to solutions of copper sulfate or DDT) was carried out on a control group consisting of more than 100 healthy male and female individuals of various ages. Apart from general signs of inflammatory activity (leukocytosis, elevation of ESR, increased IgG serum levels), cutaneous pathergy to mild local injuries and marked enhancement of PMNL chemotaxis proved to be highly significant symptoms in acute phases of BD in contrast to benign RA. Both Symptoms, in particular the hyperchemotaxis of PMNL, can be regarded as valuable diagnostic means in the early detection of beginning or atypical BD.Supported by grant Dj 2/2 of the Deutsche Forschungsgemeinschaft     

Five-in-one: a novel, cost-effective yet simple use of micro needle holder

AIM: To achieve a balance between efficiency and cost in the management of medical instrument by the use of micro needle holder. METHODS: In this study, the novel multifunctional use of micro needle holders was performed between 2018 and 2019 at the Department of Ophthalmology in the 4 hospitals in Shaanxi Province. In this innovation, the micro needle holders were initially used as micro forceps to remove sutures, as eye spud to safety extract foreign body from cornea, as ciliary forceps to remove trichiasis, as well as punctal dilator to dilate most small puncta. RESULTS: Using this technique, the medical costs of both procurement and sterilization were cut off in the selected 4 hospitals. The purchase cost has dropped by roughly 50%. The sterilization cost was decreased by about 30%. CONCLUSION: The innovation in the five-in-one multifunctional use of micro needle holders saves the medical costs.