Publications by authors named "Aimee N Di Marco"

7 Publications

  • Page 1 of 1

Differentiated Thyroid Cancer: A Health Economic Review.

Cancers (Basel) 2021 May 7;13(9). Epub 2021 May 7.

Department of Endocrine & Thyroid Surgery, Hammersmith Hospital, London W12 0HS, UK.

The incidence of differentiated thyroid cancer (DTC) is rising, mainly because of an increased detection of asymptomatic thyroid nodularity revealed by the liberal use of thyroid ultrasound. This review aims to reflect on the health economic considerations associated with the increasing diagnosis and treatment of DTC. Overdiagnosis and the resulting overtreatment have led to more surgical procedures, increasing health care and patients' costs, and a large pool of community-dwelling thyroid cancer follow-up patients. Additionally, the cost of thyroid surgery seems to increase year on year even when inflation is taken into account. The increased healthcare costs and spending have placed significant pressure to identify potential factors associated with these increased costs. Some truly ground-breaking work in health economics has been undertaken, but more cost-effectiveness studies and micro-cost analyses are required to evaluate expenses and guide future solutions.
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http://dx.doi.org/10.3390/cancers13092253DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8125846PMC
May 2021

Posterior Retroperitoneoscopic Versus Laparoscopic Transperitoneal Adrenalectomy: A Systematic Review by an Updated Meta-Analysis.

World J Surg 2021 Jan 27;45(1):168-179. Epub 2020 Aug 27.

Department of Endocrine and Thyroid Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London, W12 OHS, UK.

Background: Two main minimal access adrenalectomy techniques are available: laparoscopic transperitoneal (LTA) and posterior retroperitoneoscopic adrenalectomy (PRA). This study aims to compare these approaches in an updated meta-analysis of randomised controlled (RCT) and non-randomised comparative (NRT) trials.

Methods: A systematic search of comparative LTA and PRA studies was performed. Standard demographic and surgical data were recorded. Outcome measures compared included: operative time, estimated blood loss (EBL), conversion to open, post-operative pain, time to oral intake and ambulation, early morbidity, hospital length of stay (HLOS) and mortality. Quality of RCTs and NRTs was assessed using Cochrane and ROBINS-I, respectively, and heterogeneity using the I test. Dichotomous and continuous variables were compared using odds ratios and mean/standard difference. Studies were then combined using the Mantel-Haenszel method. Meta-analysis was performed by fixed- and random-effect models.

Results: Following exclusions, 12 studies were included in the analysis: 3 RCTs and 9 NRTs. These reported a total of 775 patients: 341 (44%) PRA and 434 (56%) LTA. Demographics were similar except for tumour size which was smaller (by 0.78 cm) in PRA (p = 0.003). Significant differences in outcome were seen in EBL (18 mls less in PRA, p = 0.006), time to oral intake (3.4 h sooner in PRA p = 0.009) and HLOS (shorter in PRA by 0.84 day, p = 0.001).

Conclusions: This analysis demonstrates that while PRA tends to be performed for smaller tumours it allows for less EBL, earlier post-operative oral intake and shorter hospital stays. In appropriately selected patients, it represents an invaluable tool in the endocrine surgeon's armamentarium.
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http://dx.doi.org/10.1007/s00268-020-05759-wDOI Listing
January 2021

Near-infrared autofluorescence in thyroid and parathyroid surgery.

Gland Surg 2020 Feb;9(Suppl 2):S136-S146

Department of Endocrine Surgery, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK.

Contrast-free autofluorescence (AF) of the parathyroid glands (PTGs) and thyroid tissue occurs in the near-infrared (NIR) spectrum on excitation by light in the upper range of the visible spectrum or lower NIR spectrum. , PTGs autofluoresce more brightly than thyroid (by a factor of 2-20 times) and appear as a bright spot against surrounding thyroid, muscle or fat on a processed image which is generated in real-time. NIR-AF of PTGs was first described in 2009 although NIR-AF had previously been used in several other clinical applications. Since then there has been a great amount of interest in the use of NIR-AF in thyroid and parathyroid surgery with over 25 published reports of the utilisation of both self-built and proprietary NIR-AF devices in neck endocrine surgery. All of these reports have confirmed the feasibility of NIR-AF intraoperatively and its ability to detect PTGs, although the reported accuracy varies from 90-100%. Reports of the effect of NIR-AF on relevant clinical endpoints i.e., post-operative hypoparathyroidism in thyroidectomy and persistent disease in parathyroidectomy are however scant. There has been one multicentre clinical trial of NIR-AF in thyroidectomy but this did not report clinical outcomes and two single-centre, non-randomised studies which did report post-operative hypoparathyroidism but with differing results: one showing no benefit in 106 NIR-AF . 163 controls and one, a reduction of early hypocalcaemia from 20% to 5% in 93 NIR-AF patients . 420 controls. There were only 2 cases of permanent hypoparathyroidism across both studies and therefore no significant observable difference in this key outcome variable. In parathyroidectomy, possible variability of the AF signal due to composition of a PTG adenoma, secondary/tertiary disease and MEN1 as well as depth-penetration preventing detection of sub-surface PTGs would imply that NIR-AF in its current form is not well-placed to improve cure-rates in hyperparathyroidism, which may already be as high as 98%. Thus far, no study has addressed this. Despite the promising results of NIR-AF, the absence of data demonstrating an improvement in outcomes and the cost of its use currently limit its use in routine clinical practice, especially in a publicly funded healthcare system with budgetary constraints. However, it can be utilised in research settings and this should be undertaken within the context of well-designed and conducted randomised, multi-centre, appropriately powered studies, which will assist in establishing its role in neck endocrine surgery.
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http://dx.doi.org/10.21037/gs.2020.01.04DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7044090PMC
February 2020

Evaluating a Novel 3D Stereoscopic Visual Display for Transanal Endoscopic Surgery: A Randomized Controlled Crossover Study.

Ann Surg 2016 Jan;263(1):36-42

*Hamlyn Centre for Robotic Surgery, Imperial College, London, UK †Guy's, King's & St. Thomas' School of Medicine, King's College, London, UK ‡Department of Surgery & Cancer, Imperial College, London, UK.

Objective: To compare surgical performance with transanal endoscopic surgery (TES) using a novel 3-dimensional (3D) stereoscopic viewer against the current modalities of a 3D stereoendoscope, 3D, and 2-dimensional (2D) high-definition monitors.

Background: TES is accepted as the primary treatment for selected rectal tumors. Current TES systems offer a 2D monitor, or 3D image, viewed directly via a stereoendoscope, necessitating an uncomfortable operating position. To address this and provide a platform for future image augmentation, a 3D stereoscopic display was created.

Methods: Forty participants, of mixed experience level, completed a simulated TES task using 4 visual displays (novel stereoscopic viewer and currently utilized stereoendoscope, 3D, and 2D high-definition monitors) in a randomly allocated order. Primary outcome measures were: time taken, path length, and accuracy. Secondary outcomes were: task workload and participant questionnaire results.

Results: Median time taken and path length were significantly shorter for the novel viewer versus 2D and 3D, and not significantly different to the traditional stereoendoscope. Significant differences were found in accuracy, task workload, and questionnaire assessment in favor of the novel viewer, as compared to all 3 modalities.

Conclusions: This novel 3D stereoscopic viewer allows surgical performance in TES equivalent to that achieved using the current stereoendoscope and superior to standard 2D and 3D displays, but with lower physical and mental demands for the surgeon. Participants expressed a preference for this system, ranking it more highly on a questionnaire. Clinical translation of this work has begun with the novel viewer being used in 5 TES patients.
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http://dx.doi.org/10.1097/SLA.0000000000001261DOI Listing
January 2016

Giant left paraduodenal hernia.

BMJ Case Rep 2014 May 2;2014. Epub 2014 May 2.

Department of Surgery and Cancer, St Mary's Hospital, Imperial College, London, UK.

Left paraduodenal hernia (LPDH) is a retrocolic internal hernia of congenital origin that develops through the fossa of Landzert, and extends into the descending mesocolon and left portion of the transverse mesocolon. It carries significant overall risk of mortality, yet delay in diagnosis is not unusual due to subtle and elusive features. Familiarisation with the embryological and anatomical features of this rare hernia is essential for surgical management. This is especially important with respect to vascular anatomy as major mesenteric vessels form intimate relationships with the ventral rim and anterior portion of the hernia. As an illustrative case, we describe our experience with a striking example of LPDH, particularly focusing on the inherent diagnostic challenges and associated critical vascular anatomy. We advocate the role of diagnostic laparoscopy; however caution that decision to safely proceed with laparoscopic repair must occur only with confident identification of the vascular anatomy involved.
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http://dx.doi.org/10.1136/bcr-2013-202465DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4025259PMC
May 2014

Intussusception of the small bowel secondary to an enterolith from a jejunal diverticulum.

Updates Surg 2012 Sep 22;64(3):231-3. Epub 2011 Jul 22.

Department of BioSurgery and Surgical Technology, Imperial College, St Mary's Hospital, London, UK.

We report a case of acute, small bowel obstruction secondary to intussusception caused by an enterolith from a jejunal diverticulum, in an elderly female with a history of chronic, intermittent abdominal pain. Diagnostic work-up of the patient included a computed tomographic (CT) scan which demonstrated the intussusception, but not the enterolith, which was characteristically radiolucent. A laparotomy was performed and the enterolith was found and delivered. A fistula between the gallbladder and small bowel was sought, but not found. Multiple diverticulae were found throughout the small bowel. Although small bowel diverticulosis is rare, it should be considered in the differential diagnosis of the acute abdomen and chronic abdominal pain, especially in those with known colonic diverticulosis, in whom this condition is more common.
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http://dx.doi.org/10.1007/s13304-011-0092-5DOI Listing
September 2012
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