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Saied Froghi

Bio: Saied Froghi is an academic researcher from Royal Free Hospital. The author has contributed to research in topics: Medicine & Transplantation. The author has an hindex of 9, co-authored 24 publications receiving 415 citations. Previous affiliations of Saied Froghi include Imperial College London & University of Düsseldorf.

Papers
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Journal ArticleDOI
01 Oct 2014-BJUI
TL;DR: To determine the number of cases a Urological surgeon must complete to achieve proficiency for various urological procedures, a computer program is used.
Abstract: Objective To determine the number of cases a urological surgeon must complete to achieve proficiency for various urological procedures. Patient and Methods The MEDLINE, EMBASE and PsycINFO databases were systematically searched for studies published up to December 2011. Studies pertaining to learning curves of urological procedures were included. Two reviewers independently identified potentially relevant articles. Procedure name, statistical analysis, procedure setting, number of participants, outcomes and learning curves were analysed. Results Forty-four studies described the learning curve for different urological procedures. The learning curve for open radical prostatectomy ranged from 250 to 1000 cases and for laparoscopic radical prostatectomy from 200 to 750 cases. The learning curve for robot-assisted laparoscopic prostatectomy (RALP) has been reported to be 40 procedures as a minimum number. Robot-assisted radical cystectomy has a documented learning curve of 16–30 cases, depending on which outcome variable is measured. Irrespective of previous laparoscopic experience, there is a significant reduction in operating time (P = 0.008), estimated blood loss (P = 0.008) and complication rates (P = 0.042) after 100 RALPs. Conclusions The available literature can act as a guide to the learning curves of trainee urologists. Although the learning curve may vary among individual surgeons, a consensus should exist for the minimum number of cases to achieve proficiency. The complexities associated with defining procedural competence are vast. The majority of learning curve trials have focused on the latest surgical techniques and there is a paucity of data pertaining to basic urological procedures.

172 citations

Journal ArticleDOI
01 Aug 2013-BJUI
TL;DR: To compare laparoscopic partial nephrectomy (LPN) with robotic PN (RPN) using meta‐analytical techniques, since there has been a rise in the incidence of small renal masses (SRM), minimally invasive approaches are becoming more popular in dealing with such pathologies.
Abstract: Objective To compare laparoscopic partial nephrectomy (LPN) with robotic PN (RPN) using meta-analytical techniques, since there has been a rise in the incidence of small renal masses (SRM; <4 cm) minimally invasive approaches are becoming more popular in dealing with such pathologies. Materials and Methods A systematic review of the literature was performed to identify studies comparing LPN and RPN. Comparative studies evaluating RPN and LPN that fulfilled the inclusion criteria were selected. Data on preoperative, operative (operative time, estimated blood loss [EBL], and warm ischaemia time [WIT]), postoperative (length of stay [LOS]) variables and complications were collected. A meta-analysis using random effect model was performed. A further Bland–Altman analysis of some of the operative variables was done to compare their reproducibility and mean difference in techniques. Results Six studies matched the selection criteria. In all, 256 patients were analysed (40% RPN and 60% LPN). There was no significant different in EBL (P = 0.12, 95% confidence interval [CI] –12.01 to 104.26). Similarly, there was no significant different in WIT between the groups (P = 0.23, 95% CI –15.22 to 3.70). Also, LOS (P = 0.22, 95% CI –0.38 to 0.09) and overall postoperative complication rates were not significantly different between the groups (P = 0.84, 95% CI –0.05 to 0.06). Conclusions Despite multiple studies reporting better perioperative variables for RPN, the present study found no significant differences between RPN and LPN. This has implications for both the surgeon and the patient. Lack of randomised controlled trials in addition to a lack of long-term oncological data for RPN are current limitations.

55 citations

Journal ArticleDOI
TL;DR: RARC is comparable to LRC with better surgical results than ORC and LRC has better surgical outcomes than OrC.
Abstract: Objective: To conduct a systematic review and meta-analysis comparing outcomes between Open Radical Cystectomy (ORC), Laparoscopic Radical Cystectomy (LRC) and Robot-assisted Radical Cystectomy (RARC). RARC is to be compared to LRC and ORC and LRC compared to ORC. Material and methods: A systematic review of the literature was conducted, collating studies comparing RARC, LRC and ORC. Surgical and oncological outcome data were extracted and a meta-analysis was performed. Results: Twenty-four studies were selected with total of 2,104 cases analyzed. RARC had a longer operative time (OPT) compared to LRC with no statistical difference between length of stay (LOS) and estimated blood loss (EBL). RARC had a significantly shorter LOS, reduced EBL, lower complication rate and longer OPT compared to ORC. There were no significant differences regarding lymph node yield (LNY) and positive surgical margins (PSM.) LRC had a reduced EBL, shorter LOS and increased OPT compared to ORC. There was no significant difference regarding LNY. Conclusion: RARC is comparable to LRC with better surgical results than ORC. LRC has better surgical outcomes than ORC. With the unique technological features of the robotic surgical system and increasing trend of intra-corporeal reconstruction it is likely that RARC will become the surgical option of choice.

52 citations

Journal ArticleDOI
TL;DR: This study aims to synthesise results from several of the most recent studies in humans on the effect of artificial sweetener consumption on cancer risk in humans.
Abstract: SummaryBackground The effect of artificial sweetener consumption on cancer risk has been debated in animal models for over four decades. To further investigate this relationship, this study aims to synthesise results from several of the most recent studies in humans. Methods An online literature search was performed in MEDLINE from 2003 to 2014 using Ovid, PubMed, Web of Science, and Scopus using keywords ‘artificial’, ‘sweetener’ and ‘cancer’. Ninety-two results were then manually assessed for eligibility. Studies were included if the relationship between artificial sweeteners and cancer was their central hypothesis, and if they adjusted for age, gender, smoking status and body mass index. Extracted data included study design, patient characteristics, outcome measure and results. Results In the five publications that satisfied the inclusion criteria, significant direct associations with artificial consumption were found for laryngeal (odds ratio, OR 2.34, 95% CI: 1.20–4.55), urinary tract tumours (OR 2.12, 95% CI: 1.22–3.89), non-Hodgkin lymphoma in men (RR 1.31, 95% CI: 1.01–1.72), multiple myeloma in men (RR 2.02, 95% CI: 1.20–3.40) and leukaemia (RR 1.42, 95% CI: 1.00–2.02). Inverse relationships were found in breast (OR 0.70, 95% CI: 0.54–0.91, p trend = 0.015) and ovarian (OR 0.56, 95% CI: 0.38–0.81, p trend < 0.001) cancers. Conclusion The statistical value of this review is limited by the heterogeneity and observational designs of the included studies. Although there is limited evidence to suggest that heavy consumption may increase the risk of certain cancers, overall the data presented are inconclusive as to any relationship between artificial sweeteners and cancer.

35 citations


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Journal ArticleDOI
TL;DR: This meta-analysis shows that RPN is associated with more favorable results than LPN in conversion rate to open or radical surgery, WIT, change of eGFR, and shorter LOS.

281 citations

Journal ArticleDOI
TL;DR: Recommendations On the basis of tumor-specific findings and competing risks of mortality, all patients with an SRM should be considered for a biopsy when the results may alter management and radical nephrectomy for SRMs should only be reserved for patients who possess a tumor of significant complexity that is not amenable to PN.
Abstract: Purpose To provide recommendations for the management options for patients with small renal masses (SRMs). Methods By using a literature search and prospectively defined study selection, we sought systematic reviews, meta-analyses, randomized clinical trials, prospective comparative observational studies, and retrospective studies published from 2000 through 2015. Outcomes included recurrence-free survival, disease-specific survival, and overall survival. Results Eighty-three studies, including 20 systematic reviews and 63 primary studies, met the eligibility criteria and form the evidentiary basis for the guideline recommendations. Recommendations On the basis of tumor-specific findings and competing risks of mortality, all patients with an SRM should be considered for a biopsy when the results may alter management. Active surveillance should be an initial management option for patients who have significant comorbidities and limited life expectancy. Partial nephrectomy (PN) for SRMs is the standard treatment that should be offered to all patients for whom an intervention is indicated and who possess a tumor that is amenable to this approach. Percutaneous thermal ablation should be considered an option if complete ablation can reliably be achieved. Radical nephrectomy for SRMs should only be reserved for patients who possess a tumor of significant complexity that is not amenable to PN or for whom PN may result in unacceptable morbidity even when performed at centers with expertise. Referral to a nephrologist should be considered if chronic kidney disease (estimated glomerular filtration rate < 45 mL/min/1.73 m2) or progressive chronic kidney disease occurs after treatment, especially if associated with proteinuria.

255 citations

Journal ArticleDOI
TL;DR: There is an urgent need for a large, well-designed, preferably multicenter RCT to study the efficacy of virtual simulation for acquisition competence in and safe execution of clinical robotic-assisted surgery.

224 citations

Journal ArticleDOI
TL;DR: More research is urgently needed to investigate how learning associated morbidity can be reduced to increase patient safety during learning curves.
Abstract: Objective:To investigate the morbidity that is associated with the learning curve of minimally invasive esophagectomy.Background:Although learning curves have been described, it is currently unknown how much extra morbidity is associated with the learning curve of technically challenging surgical pr

181 citations