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S K Sarker

Publications and source records attributed to S K Sarker.

18 recordsLinked to original sources
PubMed2006

Self-appraisal hierarchical task analysis of laparoscopic surgery performed by expert surgeons.

BACKGROUND: Evaluation of technical skill is notoriously difficult because of the subjectivity and time-consuming expert analysis. No ongoing evaluation scheme exists to assess the continuing competency of surgeons. This study examined whether surgeons' self-assessment accurately reflects their actual surgical technique. METHODS: Hierarchical task analysis (HTA) of laparoscopic cholecystectomy was constructed. Ten expert surgeons were asked to modify the HTA for their own technique. The HTAs of these surgeons then were compared with their actual operations, which had been recorded and assessed by two observers. RESULTS: A total of 40 operations were assessed. All the gallbladders subjected to surgery were classified as grades 1 to 3. The mean interrater reliability for the two observers had a k value of 0.84 (p < 0.05), and the mean intrarater reliability between surgeons and observers had a k value of 0.79 (p < 0.05). CONCLUSIONS: Surgeons' self-evaluation is accurate for technical skills aspects of their operations. This study demonstrates that self-appraisal using HTA is feasible, accurate, and practical. The authors aim to increase the numbers in their study and also to recruit residents.

Adult↗
PubMed2005

Technical skills errors in laparoscopic cholecystectomy by expert surgeons.

BACKGROUND: Performing laparoscopic surgery involves a complex cascade of cognitive skills, which may inherently have a constant technical error rate. We assess generic and specific minor and major error rates in laparoscopic cholecystectomies (LCs) performed by consultant surgeons. METHODS: Checklists of generic (11) and specific technical minor (six) and major events (eight) were devised for LCs. Two experienced surgeons assessed each full-length operation blindly and independently. RESULTS: A total of 37 LCs were performed by eight consultants. There were no major intraoperative or postoperative complications. Mean inter-rater reliability was kappa = 0.91 (range 0.80-0.98) for each of the error categories. Error rates were generic (27/407) 6.6%, minor (59/222) 26.6%, and major (8/296) 2.7%, respectively. There was a significant statistical difference between the minor error group and the other groups, p <or= 0.05. CONCLUSIONS: Performing laparoscopic surgery may always have a background technical error rate. Our present study demonstrates a migration of surgical technical errors in expert laparoscopic surgeons. The surgeons migrate technically when they execute a high rate of procedure-specific minor errors. However, when it comes to the major fundamental aspects of the operation, they dynamically adapt and migrate away from performing major technical errors. We aim to continue the study to increase cases, assess trainees as well, and also explore other factors that may affect the surgeon when executing surgical technical tasks.

Adult↗
PubMed2001

Surgical technique: submuscular placement of breast implant ports with delayed expansion following ultrasound localization.

Immediate or delayed reconstruction is offered to most women after mastectomy as standard care in the UK. Many women choose breast reconstruction with an implant alone or in conjunction with a myocutaneous flap. The most recent generation of biodimensional anatomical permanent expanders has permanent ports for delayed saline inflation. In slim women, the subcutaneous placement of the port and tubing may be unsightly and cause symptoms of pain and chaffing. We describe a technique of inserting the permanent port deep to a muscular layer on the chest wall to avoid these problems. This technique has been used in five satisfied patients, with a mean body mass index of 24.0 (range 21.7-25.5) kg/m(2). The mean follow-up was 9.4 (range 5-14) months with no complications or problems. The port placement technique we describe is effective and facilitates permanent implantation for long-term access.

Adult↗
PubMed2001

Mean nuclear area of squamous cell carcinomas of the head and neck using image cytometry.

OBJECTIVE: To determine if mean nuclear area (MNA) in squamous cell carcinomas of the head and neck (SCCHN) correlate with the TNM system and histologic grade. STUDY DESIGN: We measured MNA by image cytometry on 74 primary SCCHN. Fify-five had primary surgery, 16 had radiotherapy, and 3 and both as their primary treatment. RESULTS: The mean MNA was 47.85 microm2 (range, 20.5-84.8). Tumor size, nodal status and histologic grade were, respectively: T1 = 13, T2 = 29, T3 = 18, T4 = 14; N0 = 53, N1 = 15, N2 = 5, N3 = 1; 17 = well, 38 = moderate, 19 = poorly differentiated. Spearman rank and Kruskal-Wallis tests for MNA/histologic grade, MNA/tumor size, MNA/nodal status and MNA/site were calculated; only MNA/node was statistically significant (P<.05). CONCLUSION: MNA increases in primary SCCHN as nodal involvement increases. This may reflect that high MNA may be a biologic marker of primary SCCHN with a poorer prognosis.

Adult↗
PubMed1997

Nuclear DNA content using computerized image cytometry of squamous cell carcinomas of the head and neck.

Ploidy status using flow cytometry of head and neck cancers may be of prognostic value. We describe the use of image cytometry in ploidy measurement of squamous cell carcinomas of the head and neck (SCCHN). This technique allows only tumour cells to be measured, thereby rejecting debris, artefact and benign cells. Tissue sections were cut from tumours and then Feulgen stained. A total of 60 patients were included in this study, 23 females and 37 males. The data reveals a relationship between ploidy status and the histological differentiation. However, the ploidy status and histological differentiation do not appear to correlate to the clinical stage of the disease. This method of measuring ploidy may be more accurate than flow cytometry and may have a prognostic role in head and neck cancer patients. A study comparing both methods may demonstrate this and we aim to evaluate this in the future.

Adult↗
PubMed1997

Mean nuclear area and chromosomal DNA content of squamous cell carcinomas of the oral cavity using computerized image analysis.

Morphometric measurements of nuclei may be of prognostic value in some cancers. In this present study we have evaluated the mean nuclear area (MNA) of 50 squamous cell carcinomas of the oral cavity (SCCOC) using computerized image analysis. Since chromosomal DNA content is a reflection of the DNA content in the nucleus, we have evaluated the relationship between MNA and chromosomal DNA. Thirteen tumours had a MNA greater than 49.9 microns2 and 37 had a MNA less than this. Six tumours were classified as hypodiploid, 29 as diploid and 15 as aneuploid. There were 44 node-negative patients and six node-positive. When comparing MNA in these groups, 50 per cent of node-positive patients had a larger MNA whilst only 20 per cent of the node-negative group had a large MNA. The correlation coefficient between MNA and DNA indices was r = 0.75. The greater nuclear size is possibly a reflection of a more aggressive tumour biology in the node-positive patients. We conclude that a large MNA may be a marker of aggressive tumour biology in this group. In the future, we aim to evaluate the prognostic significance of MNA in patients with SCCOC.

Adult↗
PubMed1997

Quantitative measurement of estrogen and progesterone receptors in breast lumps using image cytometry.

OBJECTIVE: To evaluate image cytometry for detecting estrogen (ER) and progesterone receptors (PR) in breast lumps quantitatively. STUDY DESIGN: Fifty consecutive breast lumps were analyzed for ER and PR using the avidin-biotin complex on tissue sections. RESULTS: Mean ER-positive nuclear area percentage (PA%) for 25 invasive ductal carcinomas was 47.81% and for PR was 57.83%. Mean ER PA% was 40.78% and PR 58.91% for seven invasive lobular carcinomas. There were two papillary carcinomas and one in situ ductal carcinoma. Fourteen of 15 benign breast lumps were benign breast lesions. Mean ER PA% was 65.95% and PR 73.43% for 10 fibroadenomas and for 4 fibrocystic lesions was 51.57% and 44.13%, respectively. CONCLUSION: Quantitative detection of ER and PR can be achieved by image cytometry. We aim in the future to assess this method in prognostic studies and the preoperative cytology of breast cancers.

Adult↗
PubMed1996

DNA indices of primary and recurrent squamous cell carcinomas of the tongue and tonsil using image cytometry.

Ploidy status of squamous cell carcinomas of the head and neck (SCCHN) from primary and recurrent tonsillar and tongue lesions has not been compared using image cytometry. We have measured and compared the DNA indices in 41 cases. There were 29 tongue SCCHN, 20/29 were primary and 9/29 were recurrent. Mean DNA index (DI) was 1.19 (range 0.70-1.81) and 1.28 (range 0.79-1.94) respectively. There were 12 tonsillar cases, 10/12 primary and two out of 12 recurrent. Mean DI was 0.84 (range 0.57-1.09) and 1.00 (range 0.98-1.02) respectively. Mean DNA indices of both primary carcinomas were lower than the mean DNA indices of the recurrent carcinomas. This difference between the two groups may be a reflection of their tumour biology. However, since our study is small no definite conclusions can be made at this stage. We aim in the future to evaluate the prognostic role of DNA indices of patients with paired primary and recurrent SCCHN. This may be of clinical value and improve the treatment modalities available to this group.

Aneuploidy↗
PubMed1996

DNA ploidy on cytologic and tissue sections of breast lumps. A comparison using image analysis.

OBJECTIVE: Ploidy correlation between cytologic and histologic breast specimens would permit preoperative measurement of ploidy and may assist in patient management. STUDY DESIGN: DNA indices were measured on fine needle aspirates (FNAs) of 50 breast lumps and the results compared with ploidy of histologic specimens from the same lump. RESULTS: Thirty-six of 50 were histologically malignant, and 14/50 were benign. The mean DNA index of malignant tissue sections was 1.23 (range, 0.61-2.62) and on corresponding cytology was 1.49 (range, 0.79-3.18). Fourteen benign tissue sections had a mean DNA index of 0.94 (range, 0.51-1.37) and a mean DNA index of 1.06 (range, 0.74-2.13) on cytology. DNA indices of FNAs and corresponding tissue sections revealed a correlation between the two (Pearson's correlation coefficient = .386, P value = .006). CONCLUSION: Our results show that the DNA indices are comparable using image analysis on FNAs and tissue sections on the same surgical breast specimens. This demonstrates that ploidy can be achieved on cytologic breast material and may have a role in the preoperative assessment of breast cancers.

Breast Neoplasms↗
PubMed1994

A comparison of stapled vs handsewn anastomosis in anterior resection for carcinoma rectum.

The merits of stapled versus hand sewn anastomosis were evaluated in a prospective randomized study of 60 patients undergoing resection for rectal cancer. The analysed factors included the time required for construction of anastomosis, post operative complications, local recurrence, disease free state and survival. Hand sewn anastomosis was performed in two layers with 3/0 silk in 30 cases and the stapled anastomosis with EEA staplers in 30 cases. The anastomosis time averaged 24 minutes in the suture group and 16 minutes in the stapling group. Five post-operative complications occurred in each group. Six patients of the hand sewn group developed local recurrence as a first sign of treatment failure compared to four patients in the stapled group. The average time of study was 41 months. No significant difference was found in the overall survival pattern of the two groups.

Adenocarcinoma↗
PubMed1993

Experience in elective hepatic resection.

A study was conducted on 35 elective hepatic resections performed by one surgical team over a period of 5 years with 14% postoperative mortality. The indications for hepatic resection were primary hepatocellular carcinoma in 20 cases (57%) and metastatic tumours from colorectal cancer in 12 cases (34%). Underlying cirrhosis of liver was found co-existent in 35% of patients of hepatocellular carcinoma. The 3-year actuarial survival rate after resection for HCC and metastatic tumour was 30% and 42% respectively.

Adolescent↗
PubMed1992

Gastric cancer: a critical analysis of surgical treatment and long term survival.

Results of consecutive study of 120 cases of carcinoma stomach treated by one surgical team over a period of 10 years (1980-89) are presented. Maximum cases were in the sixth and seventh decades with male to female sex ratio of 2.5:1. The lesion in most cases were in the gastric antrum. Distal tumours were more of poorly differentiated histology compared to proximal tumours. Eighty-three out of 120 (69%) patients underwent surgical resection. In 50 patients it was in the form of a subtotal and distal gastrectomy. Only 5 patients underwent a total gastrectomy. In 70 cases the resection which involved en bloc removal of involved part of stomach including adequate proximal and distal free margins, omenta and perigastric lymph nodes and considered absolutely curative in 8 cases being no disease. The overall 5-year-survival figure was 18%. However, taking only the resected cases into account, the 5-year survival rate was 27%. The low survival figure can be attributed to a very small number of early cases encountered.

Adenocarcinoma↗
PubMed1980

Hemiagenesis of the thyroid gland.

Three cases of hemiagenesis of the thyroid gland are reported and the literature reviewed. It is emphasized that this rare congenital anomaly is seldom diagnosed except by thyroid scanning or at surgery. If the clinician is aware of it, the diagnosis presents little difficulty and an unnecessary operation may be avoided. All our cases were discovered as a result of an associated thyroid disorder. In 2 cases there was an adenoma and in 1 a papillary adenocarcinoma.

Adenocarcinoma, Papillary↗