Publications by authors named "Niall P Hardy"

4 Publications

  • Page 1 of 1

Sigmoid volvulus: definitive surgery is safe and should be considered in all instances.

Ir J Med Sci 2021 Jul 29. Epub 2021 Jul 29.

Department of Colorectal Surgery, St James's Hospital, Dublin 8, Ireland.

Background: Acute sigmoid volvulus (ASV) represents a small but significant portion of cases of large bowel obstruction, especially in the elderly and co-morbid. Given the characteristics of the patient cohort most commonly affected, a non-operative/conservative approach is often undertaken but is associated with a high rate of recurrence.

Objective: We sought to evaluate outcomes for those patients who underwent non-operative management, emergency surgery or staged, semi-elective surgery following decompression for ASV at our institution.

Methods: Hospital in-patient enquiry (HIPE) data were used to identify all patients who presented with sigmoid volvulus between January 2005 and June 2020 inclusive. Patient notes were interrogated, including surgical and endoscopic procedures performed. Patient demographics and co-morbidities were recorded.

Results: Thirty-nine patients were treated over a 15-year period with a mean age of 73 years at first presentation (range 36-93). Twenty-two patients (56%) had just a single admission for ASV with three deaths in this group. Seventeen patients (44%) had more than one admission with volvulus due to recurrence after a decompression-only strategy on the index admission. Of these, three succumbed to complications of their subsequent episodes of volvulus. Twenty-five patients underwent surgical intervention (fifteen on, or shortly following, their first admission and ten following at least two admissions for ASV). The overall mortality in the operative group was 2/25 (8%) with both deaths in those undergoing emergency surgeries. Five patients were treated successfully with endoscopic measures alone and had required no further interventions at the time of compiling data.

Conclusion: There is a high recurrence rate following non-operative management of acute sigmoid volvulus and consequently, a cumulative increase in the attendant significant morbidity and mortality with subsequent episodes. Given the relatively low complication rate of definitive surgery, even in those patients perceived to be high risk, we contend that all patients should be considered for early surgery to prevent the likely recurrence of sigmoid volvulus.
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http://dx.doi.org/10.1007/s11845-021-02713-0DOI Listing
July 2021

Intraprocedural Artificial Intelligence for Colorectal Cancer Detection and Characterisation in Endoscopy and Laparoscopy.

Surg Innov 2021 Feb 26:1553350621997761. Epub 2021 Feb 26.

UCD Centre for Precision Surgery, School of Medicine, 58041University College Dublin, Dublin, Ireland.

In this article, we provide an evidence-based primer of current tools and evolving concepts in the area of intraprocedural artificial intelligence (AI) methods in colonoscopy and laparoscopy as a 'procedure companion', with specific focus on colorectal cancer recognition and characterisation. These interventions are both likely beneficiaries from an impending rapid phase in technical and technological evolution. The domains where AI is most likely to impact are explored as well as the methodological pitfalls pertaining to AI methods. Such issues include the need for large volumes of data to train AI systems, questions surrounding false positive rates, explainability and interpretability as well as recent concerns surrounding instabilities in current deep learning (DL) models. The area of biophysics-inspired models, a potential remedy to some of these pitfalls, is explored as it could allow our understanding of the fundamental physiological differences between tissue types to be exploited in real time with the help of computer-assisted interpretation. Right now, such models can include data collected from dynamic fluorescence imaging in surgery to characterise lesions by their biology reducing the number of cases needed to build a reliable and interpretable classification system. Furthermore, instead of focussing on image-by-image analysis, such systems could analyse in a continuous fashion, more akin to how we view procedures in real life and make decisions in a manner more comparable to human decision-making. Synergistical approaches can ensure AI methods usefully embed within practice thus safeguarding against collapse of this exciting field of investigation as another 'boom and bust' cycle of AI endeavour.
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http://dx.doi.org/10.1177/1553350621997761DOI Listing
February 2021

Inter-user variation in the interpretation of near infrared perfusion imaging using indocyanine green in colorectal surgery.

Surg Endosc 2021 Jan 4. Epub 2021 Jan 4.

UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland.

Introduction: Despite increasing endorsement of near-infrared perfusion assessment using indocyanine green (ICG) during colorectal surgery, little work has yet been done regarding learning curve and interobserver variation most especially on surgical video reflective of real-world usage.

Methods: Surgeons with established expertise in ICG usage were invited to participate in the study along with others without such experience including trainees. All participants completed an opinion questionnaire and interpreted video presentations of fluorescence angiograms in a variety of colorectal case scenarios. An interactive video platform (Mindstamp) enabled dynamic annotation. Statistical analysis of data was performed using Kruskal-Wallis and Mann-Whitney testing as well as Intraclass Correlation Coefficients and Fleiss Multi-rater Kappa Scoring.

Results: Forty participants (six experts) completed questionnaire data and provided judgement of 14 videos (nine showing proximal colonic transection site perfusion, four showing completed anastomoses and one an acutely strangulated bowel). 70% felt > 10 cases were needed for competency in use with the majority of experts advocating > 50 (p < 0.05). Overall agreement among experts was "good" for videos showing colonic transection perfusion (versus "moderate" among in-experts) with experts clustering more distally. In contrast, there was no interpretation concordance among experts or in-experts when judging ICG perfusion sufficiency on a yes/no basis.

Conclusion: Significant experience is recommended before reliance on ICG perfusion angiograms. ICG fluorescence assessment is prone to variable interpretation and influenced by experience and, perhaps, knowledge of preassessment operative steps suggesting a role for objective flow analysis with artificial intelligence methods as the next phase of this technology.
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http://dx.doi.org/10.1007/s00464-020-08223-xDOI Listing
January 2021

In vivo assessment of cervical movement in surgeons-results from open and laparoscopic procedures.

Ir J Med Sci 2021 Feb 4;190(1):269-273. Epub 2020 Jun 4.

Midlands Regional Hospital Tullamore, Tullamore, Ireland.

Background: Musculoskeletal pain is commonly described in surgeons. Research suggests that 21-60% of at-risk physicians may experience significant work-related pain in their back, shoulders, neck or upper extremity and the consequences of this may impact negatively on patient care. Laparoscopic surgery in particular has become increasingly associated with musculoskeletal pain, especially in the cervical spine. Due to a number of constraints, however, it is difficult to evaluate musculoskeletal movement (particularly cervical spine motion) in the operating room environment.

Study Design: Three consultant general surgeons were fitted with an ambulatory strain gauge in an attempt to accurately measure and compare cervical motility during open and laparoscopic surgeries. Intraoperative figures pertaining to neck flexion, extension and rotation during forty surgical procedures were collected. The completed data consisted of twenty open and twenty laparoscopic procedures, and the results were compared.

Results: There was a statistically significant reduction (21.38%) in measured neck movement in laparoscopic surgery when compared with open surgery p = 0.004 (Table 2). A standard deviation of 18.97 was computed for open surgery indicating a larger variability in results deviation from the mean when compared with a value of 8.92 for laparoscopic surgery. Mean rotational neck movement was also reduced during laparoscopic procedures (23.5%) when compared with open procedures (87.9%).

Conclusion: Based on our results, we believe that laparoscopic surgery requires more prolonged periods of static neck posture when compared with open surgery. This difference may assist in understanding the contributing factors for musculoskeletal (in particular cervical) pain encountered in minimally invasive surgeons. Further investigation of static posture in the operating surgeon is warranted.
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http://dx.doi.org/10.1007/s11845-020-02255-xDOI Listing
February 2021
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