ORASIS in Breast Reconstruction
ORASIS and Microsurgical Anastomosis Outcomes in DIEP Flap Breast Reconstruction: A Crossover Randomized Controlled Trial
Visão geral do estudo
Status
Status
Condições
Condições
Intervenção / Tratamento
Intervenção / Tratamento
Tipo de estudo
Tipo de estudo
Inscrição (Estimado)
Inscrição
Estágio
Estágio
- Não aplicável
Contactos e Locais
Contato de estudo
Contato de estudo
- Nome: Joey Liang
- Número de telefone: 4252097705
- E-mail: joey.liang@duke.edu
Estude backup de contato
- Nome: Ash Patel, MB ChB
- E-mail: ash.patel@duke.edu
Locais de estudo
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North Carolina
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Durham, North Carolina, Estados Unidos, 27710
- Duke University Medical Center
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Contato:
- Joey Liang
- Número de telefone: 425-209-7705
- E-mail: joey.liang@duke.edu
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Raleigh, North Carolina, Estados Unidos, 27609
- Duke Raleigh Hospital
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Contato:
- Joey Liang
- Número de telefone: 425-209-7705
- E-mail: joey.liang@duke.edu
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Critérios de participação
Critérios de elegibilidade
Critérios de elegibilidade
Idades elegíveis para estudo
- Adulto
- Adulto mais velho
Aceita Voluntários Saudáveis
Descrição
Inclusion:
- Female Deep Inferior Epigastric Perforator (DIEP) flap breast reconstruction patients who have received a prior mastectomy (either unilateral or bilateral) on the breast undergoing reconstruction
- Patients who received mastectomies for oncologic or prophylactic indications
- Patients receiving either immediate or delayed DIEP flap breast reconstruction
- Age 18 or older at the time of patient consent and DIEP flap surgery
Exclusion:
- History of any prior tissue expander placement or breast reconstruction on the breast undergoing DIEP flap reconstruction
- Patients receiving DIEP flap breast reconstruction for indications other than oncologic or prophylactic post-mastectomy breast reconstruction
- Under the age of 18 at the time of patient consent or DIEP flap surgery
Plano de estudo
Como o estudo é projetado?
Detalhes do projeto
- Finalidade Principal: Tratamento
- Alocação: Randomizado
- Modelo Intervencional: Atribuição cruzada
- Mascaramento: Solteiro
Número de braços
Armas e Intervenções
Grupo de Participantes / BraçoGrupo de Participantes / Braço |
Intervenção / TratamentoIntervenção / Tratamento |
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Sem intervenção: Control Arm
In the control arm, surgeons will perform two microsurgical anastomoses without the use of ORASIS in either bilateral or unilateral Deep Inferior Epigastric Perforator (DIEP) flap reconstruction.
If bilateral DIEP flap reconstruction is performed in the control arm, only the first microsurgical anastomosis for each bilateral DIEP flap reconstruction will be assessed.
In both study arms, surgeons will perform end-to-end anastomosis using current standard-of-care techniques.
This will include the formation of anastomoses between the deep inferior epigastric artery (DIEA) perforators and internal mammary artery (IMA) in the antegrade direction of blood flow using 8-0 nylon sutures, as well as the deep inferior epigastric vein (DIEV) perforators and internal mammary vein (IMV).
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Experimental: ORASIS Arm
In the ORASIS arm, surgeons will perform two microsurgical anastomoses with the use of ORASIS in either bilateral or unilateral Deep Inferior Epigastric Perforator (DIEP) flap reconstruction.
If bilateral DIEP flap reconstruction is performed in the treatment arm, ORASIS will only be used in the first microsurgical anastomosis performed in each bilateral DIEP flap reconstruction; only the breast reconstructed with the use of ORASIS will be assessed.
In both study arms, surgeons will perform end-to-end anastomosis using current standard-of-care techniques.
This will include the formation of anastomoses between the deep inferior epigastric artery (DIEA) and internal mammary artery (IMA) in the antegrade direction of blood flow using 8-0 nylon sutures, as well as the deep inferior epigastric vein (DIEV) perforators and internal mammary vein (IMV).
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The study intervention is the use of the ORASIS device during Deep Inferior Epigastric Perforator (DIEP) flap breast reconstruction.
ORASIS is a dual irrigation and suction device that can be placed in the surgical field during the formation of microsurgical anastomoses.
The device was previously registered with the Food and Drug Administration (FDA) under registration number 878.4200; the device is currently not registered with the FDA as it is pending renewal.
The device is manufactured by a partner company (Spectroplast/Ricoh UK) with compliance to international quality standards.
The manufacturer has successfully implemented the ISO 9001 Quality Management System across operational areas following a comprehensive audit process that supports compliance with FDA Current Good Manufacturing Practice (cGMP) requirements (21 CFR Part 820) for Class I medical devices.
Spectroplast/Ricoh UK is certified under FDA ISO 10993 standards for biological evaluation of medical devices.
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O que o estudo está medindo?
Medidas de resultados primários
Medidas de resultados primários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
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Mean anastomosis time (minutes)
Prazo: From first suture placement to anastomosis completion
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Total anastomosis time will be defined as the number of minutes from first suture placement to anastomosis completion.
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From first suture placement to anastomosis completion
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Mean ischemia time (minutes)
Prazo: From pedicle transection to anastomosis completion
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Total ischemia time will be defined as the number of minutes from flap division to flap reperfusion.
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From pedicle transection to anastomosis completion
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Medidas de resultados secundários
Medidas de resultados secundários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
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Mean number of interruptions per procedure
Prazo: From beginning of microsurgical anastomosis to end of microsurgical anastomosis
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Interruptions will be defined as instances where the surgeon pauses for suction/irrigation in the control arm vs. automatic suction/irrigation in the ORASIS arm.
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From beginning of microsurgical anastomosis to end of microsurgical anastomosis
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Surgeon Survey
Prazo: Within 1 month after conclusion of DIEP flap surgery procedure
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A post-procedure survey (Likert scale) will be administered after each procedure assessing ease of use, surgeon perception of precision, and overall satisfaction with the ORASIS device.
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Within 1 month after conclusion of DIEP flap surgery procedure
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Incidence of postoperative complications 0-48 hours after procedure
Prazo: Within 48 hours after DIEP flap surgery
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Notable complications include flap failure, re-operation/take-back and wound dehiscence, seroma, hematoma, and surgical site infection.
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Within 48 hours after DIEP flap surgery
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Mean NASA-TLX (Task Load Index) score
Prazo: From beginning of microsurgical anastomosis to end of microsurgical anastomosis
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The NASA Task Load Index (NASA-TLX) is a validated tool to measure cognitive and physical workload for surgeons, reported as a score between 0 to 100.
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From beginning of microsurgical anastomosis to end of microsurgical anastomosis
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Mean Surgical Assessment Metric Scale (SAMS) overall scores
Prazo: From beginning of microsurgical anastomosis to end of microsurgical anastomosis
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The Surgical Assessment Metric Scale (SAMS) is a validated tool that assesses proficiency across key technical metrics such as suture placement, knot quality, and overall flow of the procedure on a scale of 1-5.
Performed anastomoses will be recorded by the digital microscope, and the quality and precision of the anastomosis will be assessed by a blinded rater using the previously validated SAMS score checklist.
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From beginning of microsurgical anastomosis to end of microsurgical anastomosis
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Outras medidas de resultado
Outras medidas de resultado
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
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Number of surgeons per case
Prazo: During the entirety of the DIEP flap procedure
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Number of surgeons per case, stratified by level of training (i.e. 1 vs 2 microsurgeons required +/- residents).
For example, allowing a microsurgeon to perform the anastomosis alone as opposed to a co-surgeon case would reduce operative costs.
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During the entirety of the DIEP flap procedure
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Estimated cost difference per case (economic impact metrics)
Prazo: During the entirety of the DIEP flap procedure
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Based on average operating room (OR) time cost for plastic surgery procedures at Duke (dollars per minute).
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During the entirety of the DIEP flap procedure
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Colaboradores e Investigadores
Patrocinador
Patrocinador
Datas de registro do estudo
Datas Principais do Estudo
Início do estudo (Estimado)
Início do estudo
Conclusão Primária (Estimado)
Conclusão Primária
Conclusão do estudo (Estimado)
Conclusão do estudo
Datas de inscrição no estudo
Enviado pela primeira vez
Enviado pela primeira vez
Enviado pela primeira vez que atendeu aos critérios de CQ
Enviado pela primeira vez que atendeu aos critérios de CQ
Primeira postagem (Real)
Primeira postagem
Atualizações de registro de estudo
Última Atualização Postada (Real)
Última Atualização Postada
Última atualização enviada que atendeu aos critérios de controle de qualidade
Última atualização enviada que atendeu aos critérios de controle de qualidade
Última verificação
Última verificação
Mais Informações
Termos relacionados a este estudo
Palavras-chave
Termos MeSH relevantes adicionais
Outros números de identificação do estudo
Outros números de identificação do estudo
- Pro00118006
Plano para dados de participantes individuais (IPD)
Planeja compartilhar dados de participantes individuais (IPD)?
Descrição do plano IPD
Confidentiality of subject data will be ensured by de-identification of subject data. During data collection, subject identifiers and relevant data elements will be recorded in the database. Then, study-specific identification numbers will be assigned to each subject. Prior to dissemination of any information in this database beyond the DUMC's secure servers or firewall, all identifiers will be stripped from the database and data will only be referenced by the study-specific identification numbers.
The adequacy of the Duke Research Data Lifecycle will be evaluated and approved by the Surgery CRU and IT personnel prior to study conduct. Any publications or presentations that result from this research will not identify any subjects individually and will present data in aggregate form only. Data collected as part of this study will not be submitted to the FDA; data collected will only be used for publication as part of an assessment of device efficacy.
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