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Intraoperative Ultrasound Good for Open, Laparoscopic, and Robotic Surgery

By MedImaging International staff writers
Posted on 23 Mar 2017

As the only established cross-section imaging tool in the operation room for diagnosis and image-guided treatment, intraoperative ultrasound (IOUS) is honed to the demands of open, laparoscopic, and robotic surgery where continuous monitoring is needed to guide operations and update diagnostic information for the surgical team.

Images provided through IOUS scanning have a limited field of view of the anatomy, but through real-time, high-resolution, and magnification, a diagnosis can be made or confirmed for a pre-surgical impression using a percutaneous scanning approach.

SonoScape produces the S9 portable US unit that can be used intraoperatively. More...

This unit incorporates recent advances in IOUS including broadband transducers with high-resolution imaging and specially designed smaller footprint probes, which enable IOUS to acquire the best possible image within a limited space. In addition, software-driven techniques specifically for US provide better imaging and a greater range of applications than in previous generations.

Dr. Ji-Bin Liu, MD, Professor of Radiology, and Director, Special Training Programs at Jefferson Ultrasound and Radiology Education Institute, Philadelphia, PA, is an expert in the use of IOUS. He points out that current US machines are smaller, more portable and technologically superior. He has recently used the S9 portable US unit from SonoScape for ultrasound-guided research project in the operating room at the Thomas Jefferson University Hospital.

“The use of dynamic scanning techniques with superior imaging quality can overcome any limitation that might be associated with IOUS requiring a small opening and area,” he said, adding that, “If a more complete image of a larger structure is sought, multiple images acquired using IOUS can be combined to create a larger and more complete picture.”

Fewer Artifacts and Spotting Sub-Milliliter Tumors

Unlike conventional pre-surgical imaging, the unique and superior imaging produced by IOUS as used on SonoScape equipment, is associated with fewer artifacts to hinder the image display because the transducer is placed directly on the surface of the organ. By doing so, IOUS visually displaces other organs and avoids bowel gases as well as bone structures.

One of the most common applications of IOUS is in imaging the liver, which is commonly done through open-surgery. Dr. Liu explains that, “When scanning the liver with the transabdominal method, chest ribs and bowel gases can increase the difficulty of seeing it clearly, but with an intraoperative probe it can be placed directly on the liver during open surgery and provide a complete and detailed image of the liver, biliary duct, and pancreas associated with surrounding structures.”

IOUS also facilitates the radiologist and surgeon for answering questions about the tumor during the management of hepatic neoplasms. Because IOUS helps detect exact tumor location, margin, invasion of major blood vessels or not, and feasibility of resection, sub-milliliter tumors and tumor thrombosis in the portal vein to be spotted that could otherwise be missed by transabdominal ultrasound, or other modalities.

Detecting tumors that are often missed has particular relevance to pancreatic tumors that can be late to show symptoms, grow rapidly and be too deep for transabdominal US transducers to image. These tumors also prove difficult to confirm for resection by pre-surgical scanning, however, IOUS provides a means of determining if the tumor resection is possible or whether it has invaded a major blood vessel, aiding decision-making.

Another application of IOUS that can be used on SonoScape’s equipment is in detecting tumor thrombosis in the portal vein, which could be missed by other modalities and transabdominal US. Detection of such tumors by IOUS would change the operation procedure and prognosis, Dr. Liu pointed out.

“For example, if a tumor thrombosis of the vessels is detected, it implies that the tumor has already spread through that blood vessel to another location, increasing the staging for that tumor,” he said.

Likewise, efficient detection can ensure resection is confined to tumor and not healthy tissue. Renal tumors may have multiple focal lesions that can be small and subcapsular, and due to tumor location, damage to the kidney during partial nephrectomy is a real concern. “IOUS, mitigates this fear significantly by accurately localizing tumor for resection,” he added.

As minimally invasive procedures become more commonplace, laparoscopic IOUS is made possible with specially designed transducers that are both rigid and flexible. Although the probe is harder to maneuver once inside the body cavities, this method provides the same imaging capabilities as open-surgery IOUS and is minimally invasive for the patient as an important benefit.

Finally, considerable advances are being made with IOUS being introduced into robotic surgery and sharing the same benefits as seen in laparoscopic and open surgery. Robotic surgery is now at the point where small, highly manipulative and specialized instruments can be inserted into the operational field including use of a robotic US probe. This technique using smaller, robotically controlled instruments offers a less invasive procedure for the patient with more accuracy and capabilities by these. The Thomas Jefferson University Hospital has successfully applied robotic ultrasound in robotic surgery during partial nephrectomy. “No doubt, we will see the continued evolution and development of IOUS in surgical applications for the ultimate goal of improving patient care,” Dr. Liu commented.

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53 (66.995620727539): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294768596 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294768596 AND published='1' LIMIT 1

54 (355.00526428223): SELECT name FROM jos_deeppockets WHERE id=294768596 LIMIT 1

55 (227.92816162109): SELECT name FROM jos_deeppockets_archive WHERE id=294768596 LIMIT 1

56 (86.069107055664): SELECT a.* FROM jos_components AS a WHERE ( a.admin_menu_link = 'option=com_syndicate' OR a.admin_menu_link = 'option=com_syndicate&hidemainmenu=1' ) AND a.option = 'com_syndicate'

57 (72.002410888672): 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=294768596 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

58 (494.00329589844): 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=294768596 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

59 (!!!!! 1512.0506286621): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294768596 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294768596 AND published='1' LIMIT 1

60 (70.810317993164): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294768596 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294768596 AND published='1' LIMIT 1

61 (164.03198242188): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294768596 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294768596 AND published='1' LIMIT 1

62 (74.863433837891): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294768596 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294768596 AND published='1' LIMIT 1

63 (161.88621520996): 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 (627.99453735352): SELECT fid FROM jos_deeppockets WHERE id=294768596 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294768596 AND published='1' LIMIT 1

65 (52.928924560547): 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=214 ORDER BY `ordering`

66 (41.961669921875): select jos_twitters.link from jos_twitters where cat=10

67 (30.994415283203): select jos_facebook.link from jos_facebook where cat=10

68 (31.948089599609): select jos_google_plus.link from jos_google_plus where cat=10

69 (30.994415283203): select jos_linkedin.link from jos_linkedin where cat=10

70 (34.093856811523): SELECT fid FROM jos_deeppockets WHERE id=294768596 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294768596 AND published='1' LIMIT 1

71 (34.093856811523): 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=214 ORDER BY `ordering`

72 (396.9669342041): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294768596 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

73 (278.94973754883): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294768596 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 (67.949295043945): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (49.114227294922): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (45.061111450195): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (45.061111450195): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (42.915344238281): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (45.061111450195): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (42.915344238281): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

89 (67.949295043945): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294768596 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

90 (32.901763916016): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294768596 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

91 (35.04753112793): 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 (51.975250244141): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (45.061111450195): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

106 (82.015991210938): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294768596 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294768596 AND published='1' LIMIT 1

107 (59.843063354492): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294768596 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294768596 AND published='1' LIMIT 1

108 (81.062316894531): 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=294768596 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

109 (70.095062255859): 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=294768596 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

110 (108.95729064941): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294768596 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294768596 AND published='1' LIMIT 1

111 (53.882598876953): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294768596 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294768596 AND published='1' LIMIT 1

112 (52.928924560547): 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=294768596 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

113 (611.0668182373): 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=294768596 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

114 (792.9801940918): 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

115 (378.84712219238): 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

116 (88.930130004883): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294768596 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294768596 AND published='1' LIMIT 1

117 (90.122222900391): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294768596 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294768596 AND published='1' LIMIT 1

118 (48.160552978516): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294768596 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294768596 AND published='1' LIMIT 1

119 (55.074691772461): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294768596 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294768596 AND published='1' LIMIT 1

120 (73.909759521484): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294768596 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294768596 AND published='1' LIMIT 1

121 (57.93571472168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294768596 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294768596 AND published='1' LIMIT 1

122 (72.002410888672): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294768596 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294768596 AND published='1' LIMIT 1

123 (57.220458984375): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294768596 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294768596 AND published='1' LIMIT 1

124 (523.09036254883): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294768596 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294768596 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 7914.0663146973): ( 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

126 (103.95050048828): ( 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

127 (46.968460083008): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

128 (33.855438232422): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

129 (96.797943115234): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

130 (30.994415283203): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

131 (415.08674621582): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

132 (58.889389038086): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

133 (48.160552978516): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

134 (34.809112548828): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

135 (589.84756469727): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294768596 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (447.98851013184): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294768596 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (50.067901611328): SELECT name FROM jos_deeppockets WHERE id=214

138 (33.140182495117): SELECT name FROM jos_deeppockets WHERE id=214

139 (666.85676574707): 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 '((;)|(^))214((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

140 (575.06561279297): 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 '((;)|(^))214((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

141 (73.19450378418): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294768596 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294768596 AND published='1' LIMIT 1

142 (48.87580871582): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294768596 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294768596 AND published='1' LIMIT 1

143 (462.05520629883): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294768596 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

144 (56.982040405273): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294768596 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

145 (76.055526733398): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294768596 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294768596 AND published='1' LIMIT 1

146 (50.067901611328): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294768596 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294768596 AND published='1' LIMIT 1

147 (!!!!! 1340.1508331299): 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

148 (107.0499420166): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294768596 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294768596 AND published='1' LIMIT 1

149 (80.108642578125): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294768596 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294768596 AND published='1' LIMIT 1

150 (63.180923461914): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294768596 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294768596 AND type='deeppockets_item' AND published='1' LIMIT 1

151 (47.922134399414): 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=214 or channel_id is null)

152 (39.100646972656): 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=214 or channel_id is null)

153 (62.942504882812): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

154 (621.08039855957): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294768596 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294768596 AND published='1' LIMIT 1

155 (126.83868408203): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294768596 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294768596 AND published='1' LIMIT 1

156 (39.100646972656): select jos_twitters.link from jos_twitters where cat=10

157 (41.961669921875): select jos_facebook.link from jos_facebook where cat=10

158 (30.040740966797): select jos_google_plus.link from jos_google_plus where cat=10

159 (33.855438232422): select jos_linkedin.link from jos_linkedin where cat=10

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