Andrea Bille's research while affiliated with Guy's and St Thomas' NHS Foundation Trust and other places

Publications (23)

Article
Full-text available
Brexit is expected to have a negative impact on the National Health Service (NHS) and the healthcare workforce. As a result, international medical graduates who consider migrating to the United Kingdom (UK) may encounter challenges and uncertainty. Here, we describe the process required to be followed by overseas-qualified doctors who wish to compl...
Article
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Background Diaphragmatic plication can be performed with various surgical approaches. The aim of this study was to assess the safety and effectiveness of robotic-assisted plication. Methods We retrospectively reviewed consecutive patients who underwent diaphragmatic plication from 2017 to 2021. Results Eighteen patients underwent 20 operations, 1...
Article
A 49-year-old male was investigated for symptoms of hypercalcaemia which had been present for 3 months. An initial chest X-ray showed a large anterior mediastinal mass. Subsequent computed tomography (CT) scans also demonstrated a calcified lesion in the uncinate process of the pancreas, and a neck ultrasound showed parathyroid lesions. Given the c...
Article
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Background For stage III or IVa thymic tumours, a multimodality approach is recommended. The role of surgery is to achieve complete resection. Aim To present the outcomes of patients undergoing surgery for stage III or IVa thymoma. Methods Retrospective review of patients undergoing open surgery for stage III or IVa thymoma between 2016 and 2020...
Article
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Patients who have undergone surgical resection of thymoma may present later with recurrence of disease. This is most commonly in the pleural cavity. Surgery for recurrent thymoma has been shown to have a survival advantage. During the COVID-19 pandemic, there has been a reduction in capacity for routine healthcare provision. We present the outcomes...
Article
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A 27-year-old female presented with a ‘missing’ contraceptive implant. Chest imaging demonstrated a 4-cm linear opacity in a subsegmental branch of the pulmonary artery to the left lower lobe consistent with a migrated contraceptive implant. A mini-thoracotomy and arteriotomy was performed. The artery was opened distally to its third division. Howe...
Article
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Background: Advanced thyroid malignancies may invade adjacent structures creating challenging approaches to surgical resection. Methods: We report a 48-year-old gentleman who was found to have a papillary thyroid cancer with invasion of the sternum. Results: The patient presented with pain and swelling in the upper chest. Computed tomography (CT) s...
Article
Bronchopleural fistula (BPF) describes an abnormal connection between a bronchus (main, lobar or segmental) and the pleural cavity. BPF is a recognized complication after pneumonectomy and is associated with significant morbidity and mortality. The risk of post-pneumonectomy BPF (PP-BPF) is greater in right sided operations, male patients, residual...
Article
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The aim of the study was to assess the degree of aerosolisation in different chest drainage systems according to different air leak volumes, in a simulated environment. This novel simulation model was designed to produce an air leak by passing air through and agitating a fluorescent fluid. The air leak volume and amount of fluorescent fluid were te...
Article
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Single-session, dual-site robotic surgery for synchronous malignancies is not widely reported. To our knowledge, there are no previous reports of transoral robotic surgery (TORS) and robot-assisted thoracic surgery (RATS) in a single sitting. A 49-year-old male presented with a neck lump. Biopsies and imaging proved synchronous primaries of the ton...
Article
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Introduction Mesothelioma remains a lethal cancer. To date, systemic therapy with pemetrexed and a platinum drug remains the only licensed standard of care. As the median survival for patients with mesothelioma is 12.1 months, surgery is an important consideration to improve survival and/or quality of life. Currently, only two surgical trials have...
Article
The coronavirus 2019 (COVID-19) pandemic has caused significant mortality around the world and the focus has been on reducing the number of infections. In order not to compromise treatment of oncology patients, reducing the number of patients with COVID-19 undergoing treatment is mandatory. We reviewed the experience of the National Institute of Ca...
Article
To date, 1 million confirmed cases of SARS-CoV-2 virus have been reported worldwide with a death toll of over 50,000.1 Particular concern has been raised regarding the exposure of healthcare professionals. Early reports from the Wuhan province in China described up to 29% infection rates among healthcare professionals before the use of Personal Pro...
Poster
Full-text available
Introduction: There are several methods of chest wall motion analysis in literature with Optoelectronic plethysmography and structured light plethysmography being the most established examples. However, methods currently available are expensive and cumbersome to use. Optotrak Certus, an optical tracking system based method, may offer a new and bet...
Article
Objective: The best strategy of care for biphasic malignant pleural mesothelioma (Biph-MPM) is controversial. In this study, a large dataset of Biph-MPM cases was reviewed to identify prognostic factors and to evaluate the role of a multimodal approach, including cancer-directed surgery. Methods: A total of 213 patients with Biph-MPM treated at...
Article
Pulmonary artery pseudoaneurysm is rare and may cause life-threatening haemoptysis. Coil or stent is the main treatment option. We present a case of intrapulmonary pseudoaneurysm located in the fissure between left upper and lower lobes surgically repaired due to the location and the broad base of the pseudoaneurysm.
Article
Neurogenic tumours are the most common posterior mediastinal masses. They are usually benign, slow‐growing and can be large enough to cause compression symptoms on surrounding structures, including the airway, heart, great vessels, nerves and ganglia. Anaesthetic management of these patients requires anatomical knowledge of adjacent structures, and...
Article
A 98‐year‐old female was referred to our institution for thoracic intervention following the inadvertent aspiration of a button battery. She underwent rigid bronchoscopy using Transnasal Humidified Rapid‐Insufflation Ventilatory Exchange (THRIVE) for oxygenation, rather than traditional techniques, such as jet ventilation or oxygen insufflation via...

Citations

... The comparison of the preoperative and postoperative PFTs demonstrated significant improvement in FEV 1 % of 19.9 ± 22.0 (P < 0.05) and the mean increase in FEV 1 /FVC of 5.7% ± 2.5% (P = 0.225) without a significant difference between groups (FEV 1 % improvement, 22.1% ± 23.8% vs 10.9% ± 17.5%, for the laparoscopic and thoracoscopic approach, respectively, P = 0.3661). Another retrospective single-center study comparing the robot-assisted thoracoscopic (n = 11) and open transthoracic (n = 9) approach was published recently by Lampridis et al. 39 There were no conversions from robot-assisted to open approach. Two patients (10%) after robot-assisted surgery were represented with partial recurrence of diaphragmatic elevation and underwent further surgery with the open approach and diaphragmatic plication reinforcement with mesh. ...
... To this date, RT is recommended for inoperable patients, in the adjuvant setting after surgery in cases of R1-R2 residue and possibly after R0 surgery (depending on stage and histology); RT can be combined with chemotherapy (2). Surgical techniques are rapidly evolving (59), and the indications for adjuvant RT might consequently evolve. In addition, clear selection criteria for TET hadrontherapy (over photon RT) are still to be precisely defined, but Glimelius et al. (60) grossly estimated that 50% of TET patients could benefit from proton therapy to reduce acute and long-term side effects. ...
... our case, because the proximal end of the device was deep into the lung vasculature with artery thrombosis, arteriotomy in the fissure could not be performed. [3][4][5] We decided on a transparenchymal approach (Video 1). Blood loss was 30 mL. ...
... Many thoracic surgical patients have the requirement for intercostal chest drainage which is connected to a drainage system in the immediate postoperative period. A bubbling chest drain with an ambient air exhaust can generate aerosols [55]. The British Thoracic Society suggests mitigating this risk by constant connection of chest drains to wall suction, use of a digital chest drain system, or use of an anti-viral filter attached to a standard chest drainage system [56]. ...
... However, since prospective randomized trials are difficult to perform due to the heterogeneity of the disease, there is still no solid evidence regarding the optimal combination of treatment modalities within the multimodal approach (neoadjuvant or adjuvant chemotherapy, lung-preserving or -destroying surgery, neoadjuvant or adjuvant radiotherapy) [22,23] or regarding which patients are most likely to benefit from which treatment [1]. The ongoing multicentric, prospective and randomized MARS-2 trial attempts to answer these questions by comparing the overall survival of MPM patients after (extended) pleurectomy/decortication and chemotherapy with chemotherapy alone [24]. In anticipation of the upcoming results of the MARS-2 trial, in the present study, we attempted to answer the question whether a favorable survival outcome of MPM could be achieved by a standardized institutional treatment algorithm, based on an analysis of 112 consecutive patients treated at our referral center. ...
Reference: MPM Cancers
... Because there is no treatment for COVID-19 [1], the only way to reduce perioperative morbidity and mortality related to COVID-19 in patients undergoing surgery for NSCLC is to identify symptomatic COVID-19 patients before surgery and postpone surgery accordingly. In addition, to hasten time to operation, Bilkhu R et al. advised considering performing all elective non-oncologic surgeries in private hospitals, while continuing to operate on patients with cancer in non-private institutions [12]. Kapetanakis El et al. recommended postponing surgery in stage Ia-IIa NSCLC patients for 8 weeks, with new imaging obtained every 6 weeks [13]. ...
... As reported by Sugarbaker (22), the reliability of lung-sparing surgery in achieving the MCR has always been a matter of debate, regarding the risk of recurrence due to the minor control of the margins of resection (32). This was attributable to the variability of the nomenclature for lung-sparing procedures and to the different attitudes of the operators (17,33,34). Some surgeons are more inclined to resect systematically diaphragm and pericardium, conversely, other surgeons plan the standard P/D only for patients at lower stage. ...
... 1 There are limited reports suggesting means to prevent viral spread by modifying the chest drain systems for patients with COVID-19. 2 The chest drain system used in our unit is the Atrium Ocean (MAQUET Medical Systems, United States). This system has three main chambers-a fluid collection chamber, a chamber with water-seal to monitor degree of air-leak, and a suction control chamber. ...
... MPM is associated with chronic asbestos exposure. Its widespread use in the 20th century and the long latency makes MPM a current clinical challenge (1)(2)(3)(4). ...
... Other causes of central PAP include pulmonary hypertension, congenital heart anomalies, endocarditis, septic emboli and cardiac surgery (3,6) . Occasionally, no clear cause for PAP is identified (7) . Infectious organisms associated with PAP include S. aureus, S. pyogenes, Klebsiella, Pseudomonas aeruginosa, Actinomyces, Salmonella, Enterococcus, Mycobacterium tuberculosis and various fungi (Mucor, Aspergillus, and Candida) (5,8,9) . ...