Evaluation of Vectra® XT 3D Surface Imaging Technology in Measuring Breast Symmetry and Breast Volume.

BACKGROUND: Breast symmetry is an essential component of breast cosmesis. The Harvard Cosmesis scale is the most widely adopted method of breast symmetry assessment. However, this scale lacks reproducibility and reliability, limiting its application in clinical practice. The VECTRA® XT 3D (VECTRA®) is a novel breast surface imaging system that, when combined with breast contour measuring software (Mirror®), aims to produce a more accurate and reproducible measurement of breast contour to aid operative planning in breast surgery. OBJECTIVES: This study aims to compare the reliability and reproducibility of subjective (Harvard Cosmesis scale) with objective (VECTRA®) symmetry assessment on the same cohort of patients. METHODS: Patients at a tertiary institution had 2D and 3D photographs of their breasts. Seven assessors scored the 2D photographs using the Harvard Cosmesis scale. Two independent assessors used Mirror® software to objectively calculate breast symmetry by analysing 3D images of the breasts. RESULTS: Intra-observer agreement ranged from none to moderate (kappa - 0.005-0.7) amongst the assessors using the Harvard Cosmesis scale. Inter-observer agreement was weak (kappa 0.078-0.454) amongst Harvard scores compared to VECTRA® measurements. Kappa values ranged 0.537-0.674 for intra-observer agreement (p < 0.001) with Root Mean Square (RMS) scores. RMS had a moderate correlation with the Harvard Cosmesis scale (rs = 0.613). Furthermore, absolute volume difference between breasts had poor correlation with RMS (R2 = 0.133). CONCLUSION: VECTRA® and Mirror® software have potential in clinical practice as objectifying breast symmetry, but in the current form, it is not an ideal test. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Complications of Robotic Video-Assisted Thoracoscopic Surgery Compared to Open Thoracotomy for Resectable Non-Small Cell Lung Cancer.

(1) Background: Conventional open thoracotomy has been the accepted surgical treatment for resectable non-small cell lung cancer. However, newer, minimally invasive approaches, such as robotic surgery, have demonstrated similar safety and efficacy with potentially superior peri-operative outcomes. The present study aimed to quantitatively assess these outcomes through a meta-analysis. (2) Methods: A systematic review was performed using electronic databases to identify all of the relevant studies that compared robotic surgery with open thoracotomy for non-small cell lung cancer. Pooled data on the peri-operative outcomes were then meta-analyzed. (3) Results: Twenty-two studies involving 12,061 patients who underwent robotic lung resection and 92,411 patients who underwent open thoracotomy were included for analysis. Mortality rates and length of hospital stay were significantly lower in patients who underwent robotic resection. Compared to open thoracotomy, robotic surgery was also associated with significantly lower rates of overall complications, including atrial arrhythmia, post-operative blood transfusions, pneumonia and atelectasis. However, the operative times were significantly longer with robotic lung resection. (4) Conclusions: The present meta-analysis demonstrated superior post-operative morbidity and mortality outcomes with robotic lung resection compared to open thoracotomy for non-small cell lung cancer.