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Same-Day Procedure to Diagnose and Treat Lung Cancer Combines CT Scan and Robotic Video-Assisted Thoracic Surgery

By MedImaging International staff writers
Posted on 22 Feb 2022

Image: Ion robot bronchoscope (Photo courtesy of MedStar Georgetown University Hospital)

A new approach combines the use of a robot for minimally invasive bronchoscopy for early lung cancer detection with same-day surgery to remove lung tumor.

A team of pulmonary and thoracic experts at MedStar Georgetown University Hospital (Washington, DC, USA) has adoped this new approach for lung cancer diagnosis and surgical removal of the tumor on the same day, thereby increasing the opportunity for limited follow-up therapy – or even curing the cancer. Previously this process of diagnosis and treatment could take several weeks - a critical time when cancer can continue to grow, and patients can experience increased anxiety about their health and prognosis.

In this new approach – Combined Robotic Assisted Thoracic Surgery (CRATS) – high-risk lung cancer patients first undergo a low dose CT scan of the lung to monitor for tumors. If a tumor is detected, the Ion robot bronchoscope is used to biopsy the lung tumor. If the lung tumor is found – through real-time biopsy – to be cancer, then the endobronchial ultrasound is used to determine if the cancer has spread to lymph nodes. If the lymph nodes are normal, then the patient undergoes surgery to remove the portion of the lung with the cancerous tumor using the DaVinci robotic video-assisted thoracic surgery system during the same anesthesia procedure. This new process – diagnosing lung cancer and removing the tumor at the same time - saves valuable time by removing the cancer right when it is detected, thereby limiting the opportunity for spread of disease and allowing for the start of additional therapies sooner if needed. In some instances, this approach can be curative of the cancer.

The Ion robot is a “game-changing” tool that enables surgeons to reach peripheral nodules in the lung to diagnose lung cancer sooner, thereby increasing the opportunity for earlier diagnosis and treatment of lung cancer, the leading cause of cancer deaths worldwide for both men and women. Ion endoluminal is a minimally invasive robotic-assisted system that helps address a challenging aspect of lung biopsy by enabling physicians to obtain tissue samples from deep within the lung. While survival rates for lung cancer have improved over the past decade in part due to early screening, physicians know that improved outcomes are directly linked to early detection. Coupled with regular screening for those at high risk, the Ion system makes possible earlier and more accurate detection of cancer, especially for small nodules.

In addition to giving surgeons real-time guidance for improved accuracy, the Ion robot can navigate through small and tortuous airways to reach nodules in any airway segment within the lung with its flexible biopsy needle that can pass through very tight bends to collect tissue in the peripheral lung. The catheter’s 2 mm working channel can also accommodate other biopsy tools, such as biopsy forceps and cytology brushes, if necessary. The system’s fiber optic shape sensor technology, developed by Intuitive, is to provide the physician with the precise location and shape information of the catheter throughout the navigation and biopsy process.

“Coupling this early diagnosis with same-day surgery for lung cancer is a win for patients,” said Eric D. Anderson, MD, director of Interventional Pulmonology at MedStar Georgetown University Hospital. “We know that the earlier we find the nodule in the lung and the smaller it is, that has the greatest impact on mortality. If we find the nodule at 1 mm, there is 90% chance of survival. At 2 mm, there is 80%, and at 3 mm 70%. Combine those odds with the potential immediate removal of the tumor, and the Ion robot gives patients a real chance for better outcomes.”

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58 (617.98095703125): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294791707 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

59 (!!!!! 3892.8985595703): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791707 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791707 AND published='1' LIMIT 1

60 (158.07151794434): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791707 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791707 AND published='1' LIMIT 1

61 (482.08236694336): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791707 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791707 AND published='1' LIMIT 1

62 (!!!!! 3371.000289917): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791707 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791707 AND published='1' LIMIT 1

63 (146.86584472656): select cover from jos_number where journalid in (5) and cover is not null order by left(issue,2)+right(issue,2)*12 desc limit 1

64 (488.9965057373): SELECT fid FROM jos_deeppockets WHERE id=294791707 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294791707 AND published='1' LIMIT 1

65 (291.10908508301): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=215 ORDER BY `ordering`

66 (72.002410888672): select jos_twitters.link from jos_twitters where cat=10

67 (26.941299438477): select jos_facebook.link from jos_facebook where cat=10

68 (26.941299438477): select jos_google_plus.link from jos_google_plus where cat=10

69 (25.98762512207): select jos_linkedin.link from jos_linkedin where cat=10

70 (77.009201049805): SELECT fid FROM jos_deeppockets WHERE id=294791707 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294791707 AND published='1' LIMIT 1

71 (65.088272094727): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=215 ORDER BY `ordering`

72 (355.00526428223): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294791707 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

73 (339.98489379883): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294791707 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

74 (41.007995605469): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

75 (66.995620727539): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (61.03515625): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (26.226043701172): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

89 (62.942504882812): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294791707 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

90 (27.894973754883): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294791707 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

91 (31.948089599609): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

92 (591.99333190918): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (494.00329589844): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (511.16943359375): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (334.9781036377): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (385.99967956543): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (302.07633972168): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (623.94142150879): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (220.06034851074): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (119.92454528809): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (226.02081298828): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (274.8966217041): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (258.20732116699): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (277.04238891602): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (246.04797363281): SELECT show_live FROM jos_com_show_setting LIMIT 1

106 (694.99015808105): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791707 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791707 AND published='1' LIMIT 1

107 (316.85829162598): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791707 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791707 AND published='1' LIMIT 1

108 (681.16188049316): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294791707 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

109 (231.98127746582): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294791707 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

110 (!!!!! 1046.895980835): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791707 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791707 AND published='1' LIMIT 1

111 (384.09233093262): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791707 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791707 AND published='1' LIMIT 1

112 (519.99092102051): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294791707 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

113 (422.00088500977): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294791707 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

114 (373.12507629395): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294791702 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

115 (!!!!! 1335.8592987061): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294791702 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

116 (576.01928710938): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

117 (393.15223693848): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

118 (83.92333984375): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791707 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791707 AND published='1' LIMIT 1

119 (43.869018554688): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791707 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791707 AND published='1' LIMIT 1

120 (99.897384643555): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791707 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791707 AND published='1' LIMIT 1

121 (82.969665527344): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791707 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791707 AND published='1' LIMIT 1

122 (75.101852416992): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791707 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791707 AND published='1' LIMIT 1

123 (37.908554077148): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791707 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791707 AND published='1' LIMIT 1

124 (329.97131347656): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

125 (!!!!! 49587.01133728): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

126 (128.03077697754): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791707 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791707 AND published='1' LIMIT 1

127 (63.896179199219): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791707 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791707 AND published='1' LIMIT 1

128 (569.10514831543): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294791707 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294791707 AND type='deeppockets_item' AND published='1' LIMIT 1

129 (!!!!! 932220.93582153): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

130 (73.909759521484): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

131 (38.862228393555): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

132 (30.040740966797): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

133 (43.869018554688): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

134 (28.848648071289): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

135 (29.087066650391): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

136 (38.862228393555): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

137 (435.82916259766): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791707 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

138 (301.83792114258): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791707 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

139 (230.07392883301): SELECT name FROM jos_deeppockets WHERE id=215

140 (33.855438232422): SELECT name FROM jos_deeppockets WHERE id=215

141 (442.9817199707): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))215((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

142 (344.03800964355): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))215((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

143 (56.028366088867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791707 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791707 AND published='1' LIMIT 1

144 (41.961669921875): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791707 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791707 AND published='1' LIMIT 1

145 (!!!!! 7570.0283050537): TRUNCATE TABLE jos_trademed_module

146 (88.930130004883): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294791707 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

147 (51.021575927734): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294791707 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

148 (760.07843017578): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791707 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

149 (61.03515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791707 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

150 (60.081481933594): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791707 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791707 AND published='1' LIMIT 1

151 (42.915344238281): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791707 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791707 AND published='1' LIMIT 1

152 (!!!!! 1034.0213775635): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

153 (53.167343139648): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791707 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791707 AND published='1' LIMIT 1

154 (38.862228393555): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791707 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791707 AND published='1' LIMIT 1

155 (64.849853515625): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294791707 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294791707 AND type='deeppockets_item' AND published='1' LIMIT 1

156 (30.040740966797): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=0 or channel_id is null)

157 (27.179718017578): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=0 or channel_id is null)

158 (28.848648071289): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

159 (292.06275939941): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791707 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791707 AND published='1' LIMIT 1

160 (84.877014160156): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294791707 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294791707 AND published='1' LIMIT 1

161 (36.954879760742): select jos_twitters.link from jos_twitters where cat=10

162 (30.994415283203): select jos_facebook.link from jos_facebook where cat=10

163 (30.040740966797): select jos_google_plus.link from jos_google_plus where cat=10

164 (30.994415283203): select jos_linkedin.link from jos_linkedin where cat=10

165 (258.20732116699): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

166 (!!!!! 1044.0349578857): insert into jos_banners_delta values (14615,'2025-05-02 14:43:26','18.219.43.26','view'),(14202,'2025-05-02 14:43:26','18.219.43.26','view'),(14203,'2025-05-02 14:43:26','18.219.43.26','view')

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