Minerva Chirurgica[JOURNAL]
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200 papers
The role of laparoscopic Nissen, Hill, and Nissen-Hill hybrid repairs for uncomplicated gastroesophageal reflux disease.
Shemmeri E, Aye RW
Minerva Chir · 2019 Aug · PMID 30037181 · Publisher ↗
There are several elements that constitute the lower esophageal barrier against reflux. What characterizes the abnormality seen in gastroesophageal reflux disease (GERD) is the loss of an effective barrier combined with...
There are several elements that constitute the lower esophageal barrier against reflux. What characterizes the abnormality seen in gastroesophageal reflux disease (GERD) is the loss of an effective barrier combined with refluxed gastric contents. Several techniques including those described by Nissen, Toupet, and Hill have become options for reconstructing the physiologic barrier. In this paper, we describe our technique of performing laparoscopic Nissen, Hill, and a combined Nissen-Hill hybrid repair for the management of uncomplicated GERD. In a randomized study comparing 46 laparoscopic Nissen to 56 laparoscopic Hill repairs, subjective and objective short term and long term (13 months) outcomes including use of antisecretory agents were equivalent. The number of failures requiring reoperation were also the same but the difference in failure types prompted us to examine the two techniques and fuse them into one to maximize the integrity of the lower esophageal barrier. A comparative study of the Nissen, Hill, and hybrid repairs with 15-month follow-up showed similar subjective and objective outcomes and specifically no increase in dysphagia for the combined repair. There was also a trend towards less recurrence the hybrid group. More recently, we studied our Nissen repairs and compared them to hybrid repairs over a 22-month median follow-up period. Quality of life outcomes were superior for the hybrid group in all domains. For the subset of patients with a mean follow-up of 60 months the anatomic recurrence rate was 5% in the hybrid group compared to 45% in the Nissen group. These data strongly suggest that the anchoring of gastroesophageal junction with Hill sutures reduces the axial stresses on the Nissen wrap to maintain its integrity. The laparoscopic Nissen, and laparoscopic Hill procedures have been proven to have excellent results for the treatment of GERD. Larger studies are underway to demonstrate the long-term durability of the hybrid Nissen-Hill procedure in the management of GERD.
Robotic right colectomy with complete mesocolic excision and indocyanine green guidance.
Spinoglio G, Petz W, Borin S … +2 more , Piccioli AN, Bertani E
Minerva Chir · 2019 Apr · PMID 30037180 · Publisher ↗
BACKGROUND: Robotic complete mesocolic excision (CME) has recently emerged as promising technique to enhance oncologic results in hemicolectomy for cancer. The potential near-infrared (NIR) fluorescence with indocyanine-...
BACKGROUND: Robotic complete mesocolic excision (CME) has recently emerged as promising technique to enhance oncologic results in hemicolectomy for cancer. The potential near-infrared (NIR) fluorescence with indocyanine-green (ICG) dye for lymphatic mapping is under investigation and few small case-series are reported. METHODS: ICG solution was endoscopically injected the day before surgery in patients undergoing robotic right colectomy with CME using the Da Vinci Xi® system and the bottom to up technique. During surgery the ICG was excited by light in the near-infrared (NIR) spectrum of the Firefly™ system, of the Da Vinci Xi® system for image comparison in standard white light and NIR, and real-time visualization of the lymphatic drainage. RESULTS: Twenty patients affected by right colon cancer underwent robotic right colectomy with the bottom to up technique. No cases converted to open surgery were observed. During surgery, a fluorescent mapping of draining lymph nodes, was visualized in all the 20 patients. In seven patients (35%), lymph nodes outside the standard lymphatic basin were identified and removed. CONCLUSIONS: The association of robotic right colectomy with the bottom to up technique and ICG-guided lymphadenectomy is a feasible and safe procedure. ICG lymphatic mapping may help to perform a correct CME, although the independent impact of these procedures on oncologic outcome deserves further investigations.
Non-anatomical colonic resections: splenic flexure and transverse colectomy. Central vascular ligation is crucial for survival.
Reddavid R, Esposito L, Evangelista A … +2 more , Sofia S, Degiuli M
Minerva Chir · 2019 Apr · PMID 30037179 · Publisher ↗
BACKGROUND: Cancers of the transverse colon (TC) and of the splenic flexure (SF) are rather uncommon and their prognosis has been reported significantly poorer as compared to right- and left-sided colon cancers. Several...
BACKGROUND: Cancers of the transverse colon (TC) and of the splenic flexure (SF) are rather uncommon and their prognosis has been reported significantly poorer as compared to right- and left-sided colon cancers. Several studies tried to investigate which is the optimal surgery for oncological and survival outcomes reporting extended colectomies as more effective than limited resections. METHODS: All consecutive patients with diagnosis of colorectal cancer submitted to surgical resection with anastomosis between January 2005 and December 2016 at the Division of Surgical Oncology and Digestive Surgery, Department of Oncology, at the University of Turin, were included. Based on tumor location, patients were enrolled in arm A (cancer of the ascending colon, right (hepatic) flexure, left and sigmoid colon) or arm B (cancer of the transverse colon and of the left (splenic) flexure). RESULTS: Out of 1433 patients registered, 500 patients fulfilled all inclusion and exclusion criteria and were allocated in arm A (N.=425) or in arm B (N.=75). Central vascular ligation and the achievement of at least 5 cm of healthy margin were always performed in all procedures of both arms. Patients' population of the two arms was homogeneous as concerns demographic characteristics and stage of the disease. In arm A, resections were performed more frequently by mini-invasive approach as compared to arm B. Operative time was statistically longer in arm B. Postoperative complications rate was extremely low and comparable in both arms (13.4 and 8.0 in arms A and B, respectively). No postoperative mortality was observed. Overall 5-year survival rates were similar in arm A and B (82.3% and 73.05%, respectively; P=0.29). Arm B patients were treated either with more limited resections (resection of the TC and of the SF) or with extended colectomies (right- and left-sided, standard or enlarged, hemicolectomies), both associated with central vascular ligation. Despite a shorter length of surgical specimen after limited resections, postoperative complications, lymph node yield, and survival were absolutely comparable in both types of surgical treatments. CONCLUSIONS: Limited resections for TC and SF cancers can be performed with the same clinical, oncological and survival outcomes as compared to more extended colectomies if an adequate size of the specimen for the achievement of at least 5 cm of health margin is associated to Central Vascular Ligation.
Robot-assisted extended lymphadenectomy in prostate cancer.
Tyritzis SI, Kalampokis N, Grivas N … +2 more , van der Poel H, Wiklund NP
Minerva Chir · 2019 Feb · PMID 30037178 · Publisher ↗
INTRODUCTION: The extent of lymph node dissection (LND) and its potential survival benefit are still a matter of debate. Aim of our review was to summarize the latest literature data regarding the surgical templates, the...
INTRODUCTION: The extent of lymph node dissection (LND) and its potential survival benefit are still a matter of debate. Aim of our review was to summarize the latest literature data regarding the surgical templates, the potential oncological benefits, the functional outcomes and the complications of extended lymph node dissection (eLND) during robot-assisted radical prostatectomy (RARP). EVIDENCE ACQUISITION: We systematically reviewed all relevant studies using PubMed, MEDLINE, Embase, American Urological Association (AUA), European Society of Medical Oncology (ESMO) and European Association of Urology (EAU) guidelines. EVIDENCE SYNTHESIS: A narrative synthesis of all relevant publications on surgical templates, complications, oncological and functional outcomes of robot assisted eLND was undertaken. CONCLUSIONS: A great deal of evidence supports that an extended template of LND is not only technically feasible but also safe in the context of RARP. It is really promising that in the era of minimally invasive surgery, parameters like the lymph node yield and the detection rates of positive lymph nodes during LND have become highly comparable with open series. The extended approach has already proved its benefits in terms of proper patient staging but more studies are needed with regard to functional outcomes and oncological benefits of this procedure.
Complete mesocolic excision for colonic cancer.
Fingerhut A, Tzu-Liang Chen W, Boni L … +1 more , Uranues S
Minerva Chir · 2019 Apr · PMID 30037177 · Publisher ↗
INTRODUCTION: Complete mesocolic excision for colonic cancer is similar in concept to total mesorectal excision for rectal cancer. This review aims to provide the embryological and anatomical rationale behind CME, and to...
INTRODUCTION: Complete mesocolic excision for colonic cancer is similar in concept to total mesorectal excision for rectal cancer. This review aims to provide the embryological and anatomical rationale behind CME, and to review the current literature on CME, relative to the feasibility via laparoscopy, the oncological adequacy and outcomes. EVIDENCE ACQUISITION: A literature search was performed at the end of 2017 according the PRISMA guidelines for systematic reviews. Of 3980 articles found, we analyzed 96 articles. Of note, many case series had overlapping populations; there were five review articles, two consensus conference proceedings, six comparative but only one randomized trial. EVIDENCE SYNTHESIS: The embryonic and anatomical rationale is well described. CME is feasible via laparoscopy, which may facilitate dissection and anatomic precision: no statistically significant differences were found when compared to open CME regarding overall survival. However, morbidity may be higher in the hands of non-expert laparoscopic surgeons. CONCLUSIONS: Oncological adequacy can be obtained with laparoscopic CME, with increased lymph node retrieval. However, until now, there is no formal proof that CME improves local recurrence or survival.
Technical details to achieve perfect early continence after radical prostatectomy.
Manfredi M, Fiori C, Amparore D … +2 more , Checcucci E, Porpiglia F
Minerva Chir · 2019 Feb · PMID 30037176 · Publisher ↗
Urinary incontinence after radical prostatectomy (RP) is still an issue and may compromise patient quality of life and psychosocial behavior, regardless of oncologic outcomes. As this condition usually resolves by the en...
Urinary incontinence after radical prostatectomy (RP) is still an issue and may compromise patient quality of life and psychosocial behavior, regardless of oncologic outcomes. As this condition usually resolves by the end of the first postoperative year, many surgeons focused their attention on "early" return of urinary continence (UC). The aim of this non-systematic review is to present an overview of the current knowledge on the anatomy and the surgical techniques addressed to early functional recovery of continence after RP. The available literature data suggest that the preservation of bladder neck, pubo-prostatic ligaments, endopelvic fascia and vesico-urethral complex may play a role in recovery of early UC. Similarly, bladder neck reconstruction, anterior and/or posterior myo-fascio-ligamentous support to the anastomosis and tension-free watertight vesico-urethral anastomosis can improve early UC recovery post RP. More recently surgical approaches (i.e. Retzius-sparing technique) seem to add a piece in the jigsaw in the scenario of the early recovery of UC. Notwithstanding the efforts of the surgeons, more evidence from randomized studies is required to prove benefits of the different approaches and the "ideal" RP is far to be standardized.
Indications, surgical technique, and long-term results of nerve sparing.
Türkeri L
Minerva Chir · 2019 Feb · PMID 30037175 · Publisher ↗
Radical prostatectomy is frequently performed as a curative approach for clinically localized prostate cancer. In order to reduce the adverse effects of this operation on erectile function, preservation of neurovascular...
Radical prostatectomy is frequently performed as a curative approach for clinically localized prostate cancer. In order to reduce the adverse effects of this operation on erectile function, preservation of neurovascular bundles was introduced as part of this operation. The decision of nerve sparing must be carefully tailored in each patient according to the stage of the disease. Patient selection has a critical importance in performing nerve sparing radical prostatectomy. In organ-confined cancers a nerve sparing surgery can be performed in the majority of the cases without jeopardizing tumor control. Individualized decision making in each case may allow more patients to receive a nerve sparing approach, and therefore, better functional outcomes. However, it continues to be difficult to predict postoperative functional outcomes accurately due to many influencing factors.
Right colectomy: a New York state of mind.
Lee H, Chudner A, Gachabayov M … +2 more , Dyatlov A, Bergamaschi R
Minerva Chir · 2019 Apr · PMID 30037174 · Publisher ↗
Although mortality rates attributable to colon cancer have significantly improved over the past decades, it is still one of the leading causes of death in the USA. As newer technology and surgical techniques and concepts...
Although mortality rates attributable to colon cancer have significantly improved over the past decades, it is still one of the leading causes of death in the USA. As newer technology and surgical techniques and concepts are being introduced, substantial confusion and dissenting opinions have come into fray as well. Naturally, different practice patterns emerged in Asia, Western Europe as well as in the USA. In this special article, we focus on the right colon and examine the unique challenges and oddities of practicing academic colorectal surgery in the New York metropolitan area.
One anastomosis gastric bypass: key technical features, and prevention and management of procedure-specific complications.
Mahawar KK, Parmar C, Graham Y
Minerva Chir · 2019 Apr · PMID 30019880 · Publisher ↗
INTRODUCTION: One anastomosis gastric bypass (OAGB) is now a recognized mainstream bariatric procedure being adopted by an increasing number of surgeons. The purpose of this review was to present an evidence-based summar...
INTRODUCTION: One anastomosis gastric bypass (OAGB) is now a recognized mainstream bariatric procedure being adopted by an increasing number of surgeons. The purpose of this review was to present an evidence-based summary of its key technical aspects and prevention and management of its specific complications. EVIDENCE ACQUISITION: We examined PubMed for all published articles on OAGB, including the ones published under one of its various other names. EVIDENCE SYNTHESIS: An ideal OAGB procedure has a long, narrow pouch constructed carefully to avoid going too close to the greater curvature of the stomach especially at the bottom of the pouch and maintains a safe distance from the angle of His. A bilio-pancreatic limb length of 150 cm appears to be safest and a limb length of >200 cm is associated with a significantly increased incidence of protein-calorie malnutrition. We recommend routine closure of Petersen's space to prevent Petersen's hernia and suggest a protocol for micronutrient supplementation. This review also presents evidence-based algorithms for prevention and management of marginal ulcers, protein-calorie malnutrition, and gastroesophageal reflux disease after OAGB. We suggest lifelong supplementation with two multivitamin/mineral supplements (each containing at least 1.0 mg copper and 15 mg zinc) daily, 1.5 mg vitamin B12 orally daily or 3-monthly injection with 1 mg vitamin B12, 120 mg elemental iron daily, 1500 mg elemental calcium daily, and 3000 international units of vitamin D daily. CONCLUSIONS: This review examines key technical steps of OAGB. We also discuss how to prevent and manage its specific complications.
"Wandering spleen" as a rare cause of recurrent abdominal pain: a systematic review.
Barabino M, Luigiano C, Pellicano R … +10 more , Giovenzana M, Santambrogio R, Pisani A, Ierardi AM, Palamara MA, Consolo P, Giacobbe G, Fagoonee S, Eusebi LH, Opocher E
Minerva Chir · 2019 Aug · PMID 30019879 · Publisher ↗
INTRODUCTION: Wandering spleen (WS) is a rare and generally acquired condition, resulting from abnormal ligamentous laxity failing to fixate the spleen in its normal location in the left upper quadrant, thus leading to i...
INTRODUCTION: Wandering spleen (WS) is a rare and generally acquired condition, resulting from abnormal ligamentous laxity failing to fixate the spleen in its normal location in the left upper quadrant, thus leading to its migration to the pelvis due to gravity. Such migration leads to an elongated vascular pedicle, which is prone to torsion causing splenic infarction; thus, a prompt surgical intervention is recommended. Since this adverse event affects childbearing women or children, it is crucial to choose the most appropriate surgical strategy, such as splenectomy or splenopexy, both effective and widely diffused options. The aim of this paper is to perform a literature review on WS reports treated by surgery. We also present a case of symptomatic WS migrated in pelvis in a young female treated by splenectomy. EVIDENCE ACQUISITION: All relevant articles from 1895 up to December 2017 were identified by literature searches in PubMed, Scopus and Google Scholar. EVIDENCE SYNTHESIS: A total of 376 patients treated with surgical approach for WS were identified. The most common presentations were abdominal pain and abdominal mass, and approximately half of the patients had an acute clinical onset. Radiology is essential for the diagnosis. Surgical strategy changed over the time; splenectomy is the most reported treatment although in the last years there is an increasing trend towards a more conservative strategy, preferring splenopexy or a laparoscopic approach. CONCLUSIONS: Surgery is the gold standard strategy, and laparoscopic approach is recommended, for the treatment of wandering spleen. Both splenopexy or splenectomy are effective and safe surgical options.
Transanal transabdominal TME: how far can we push it?
Rowen RK, Kelly J, Motl J … +1 more , Monson JR
Minerva Chir · 2018 Dec · PMID 30019878 · Publisher ↗
Over many decades, advances in surgical technology, such as the use of the electrocautery Bovie, development of minimally invasive and advanced endoscopic platforms and the ability to create and maintain pneumorectum hav...
Over many decades, advances in surgical technology, such as the use of the electrocautery Bovie, development of minimally invasive and advanced endoscopic platforms and the ability to create and maintain pneumorectum have propelled surgical techniques forward to today, with development of the transanal total mesorectal excision TME (taTME) for en bloc resection of rectal cancers. The transanal platform offers, for now, a viable alternative to perform safe and oncologically sound TME, especially favorable in cases of low rectal lesions in a narrow pelvis post neoadjuvant treatment. The aspiration of the colorectal community remains to continue to push the operative boundaries whilst maintaining safe oncological principals with the best possible functional outcomes for patients. In this article we review this evolving technique and focus on future directions.
Role of endosonography prior to endoscopic treatment of esophageal cancer.
Hucl T
Minerva Chir · 2018 Aug · PMID 29963792 · Publisher ↗
Esophageal cancer is a common disease with poor survival rates. The treatment and prognosis of patients with esophageal cancer depend on the stage of the disease. Accurate clinical staging is critical for stratifying pat...
Esophageal cancer is a common disease with poor survival rates. The treatment and prognosis of patients with esophageal cancer depend on the stage of the disease. Accurate clinical staging is critical for stratifying patients for treatment. While advanced cancers are generally treated by neoadjuvant chemoradiotherapy and surgery, early cancers may be amendable to endoluminal, minimally invasive treatments, thus saving patients from unnecessary surgery. Endoscopic ultrasonography has a major role in loco-regional staging of esophageal cancer and should be performed in all patients after excluding significant comorbidities and distant metastases. However, the role of endosonography seems to be limited in early cancer, since it does not determine the depth of invasion with sufficient accuracy. This can prove decisive for treatment planning. Despite substantial efforts, its main role in early cancer is still confined to ruling out the deeper involvement or lymph node metastasis. A preferable treatment is for patients to undergo a diagnostic endoscopic resection, which facilitates correct pathological staging and final treatment decision.
Results following laparoscopic sleeve gastrectomy in elderly obese patients: a single center experience with follow-up at three years.
Bianco P, Rizzuto A, Velotti N … +9 more , Bocchetti A, Manzolillo D, Maietta P, Milone M, Amato M, Conzo G, Buonomo O, Petrella G, Musella M
Minerva Chir · 2020 Apr · PMID 29963791 · Publisher ↗
BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) represents the most performed bariatric surgical procedure worldwide. Morbid Overweight in elderly patients is becoming a significant health problem even in Italy. As wel...
BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) represents the most performed bariatric surgical procedure worldwide. Morbid Overweight in elderly patients is becoming a significant health problem even in Italy. As well as in younger age groups, bariatric surgery could be indicated even in this subset of patients. However the advantages and results of LSG in patients over 60 years old have received minimal attention. METHODS: The records of 375 patients underwent LSG between 2008 and 2016 were reviewed. In the entire series 18 patients were aged 60 years or older at the time of surgery. Since a 3 years follow-up was available for 12 patients out of the 18 aged over 60 we included in the study only these. General epidemiologic data, clinical findings, BMI and comorbidities surgical treatment and follow-up data were collected; postoperative measurements such as operative time, intraoperative complications, mortality rate, length of stay, incidence of early and late complications, Body mass Index (BMI), excess weight loss rate (EWL%) and comorbidities resolution were also recorded. RESULTS: LSG was successfully performed for all geriatric patients. Global complications rate was 16.6% At 3 years mean BMI was 34.4±3.8 with a mean EWL% 66.1±31.9. Postoperative resolution of obesity comorbidities was observed; Hypertension (71.4%), type 2 Diabetes Mellitus (T2DM) (50.0%), obstructive sleep apnea syndrome (OSAS) (66.6%) respectively. No intraoperative complications or mortality were recorded. CONCLUSIONS: LSG offered cure in geriatric patients affected by morbid obesity for weight loss and comorbidities resolution. Larger studies are necessary to analyze and minimize the incidence of postoperative complications associated to this surgical procedure in elderly patients.
The main participation of the enterohormone GLP-1 after bariatric surgery.
Moreno-Arciniegas A, Falckenheiner-Soria J, Bancalero-De Los Reyes J … +5 more , Camacho-Ramírez A, de Los Angeles Mayo-Ossorio M, Pacheco-García JM, Pérez-Arana GM, Prada-Oliveira JA
Minerva Chir · 2019 Feb · PMID 29963790 · Publisher ↗
BACKGROUND: Numerous hypotheses are called to explain the beneficial effect on glucose metabolism after bariatric surgery. Some authors advocate for the secretion and release of various substances with endocrine function...
BACKGROUND: Numerous hypotheses are called to explain the beneficial effect on glucose metabolism after bariatric surgery. Some authors advocate for the secretion and release of various substances with endocrine functions for the explanation on this event. One of the substances most marked as effector, with contrasting effects but controversial data, is GLP-1. METHODS: Our study was performed in healthy male Wistar rats, to avoid the absence of confounding factors such as T2DM and obesity. In order to know the adaptation of GLP-1 secretion after surgery 5 groups were designated: two control groups (fasting and surgical stress), and three surgical groups (gastric sleeve, 50% resection of the midgut and the Roux en Y gastric bypass). After three months the GLP-1 synthesis in the different portions of the small intestine and the expression of the membrane receptors in pancreatic islet cells were studied by immunohistochemical techniques. RESULTS: There was a significant increase in the number of secretory cells in ileum, duodenum and jejunum in mixed (RYGB) and malabsorptive (RI50) surgical groups. An elevation of pancreatic receptors signal was also observed in the same techniques versus controls. CONCLUSIONS: Our data indicate that intestinal secretion of GLP-1 and its sensitivity to the pancreatic changes were increased like a response of an adaptive effect to the mechanical aggression of the digestive tube and as alteration of nutrient flow after surgery.
Combined rectal and gynecologic surgery in complex pelvic floor dysfunction: clinical outcomes and quality of life of patients treated by a multidisciplinary group.
Ascanelli S, Morganti L, Martinello R … +5 more , Borghi C, Forini E, Greco P, Occhionorelli S, Feo CV
Minerva Chir · 2018 Jun · PMID 29911796 · Publisher ↗
Abstract loading — click title to view on PubMed.
Current knowledge and future perspectives in breast surgery: an overview.
Nava MB, Catanuto G, Rocco N
Minerva Chir · 2018 Jun · PMID 29911795 · Publisher ↗
Abstract loading — click title to view on PubMed.
Supplementation with Robuvit® in post-mastectomy post-radiation arm lymphedema.
Belcaro G, Dugall M, Cotellese R … +3 more , Feragalli B, Cianchetti E, Cesarone MR
Minerva Chir · 2018 Jun · PMID 29911794 · Publisher ↗
BACKGROUND: Post-mastectomy lymphedema is one of the most significant, non-life-threatening complications following breast cancer surgery and radiotherapy. Post-mastectomy post-radiotherapy (PMPR) lymphedema is related t...
BACKGROUND: Post-mastectomy lymphedema is one of the most significant, non-life-threatening complications following breast cancer surgery and radiotherapy. Post-mastectomy post-radiotherapy (PMPR) lymphedema is related to damages to lymphatics and/or veins during/after axillary surgery and radiotherapy. The management of this condition is very challenging; the comprehensive decongestive therapy (CTD), which combines physiotherapy, self-management, and hygiene, and is currently considered the standard management (SM). The aim of this registry study was to evaluate whether the supplementation with Robuvit® as a lymphedema controlling agent added to CTD over a 2-month period could be more effective than CTD alone. METHODS: A group of 65 patients with PMPR lymphedema was included in this registry study and followed up for 2 months; 33 were treated with current SM only (control group), and 32 were also supplemented with 600 mg/day of Robuvit® (active treatment group). RESULTS: At 1- and 2-month follow-up, the decrease in volume was significantly greater in the supplement group (P<0.05), with a final reduction in volume after two months of 654±21 mL (-19.82%) versus 433±23 mL (-12.81%) in the control group. A more significant decrease in skin thickness and symptoms was also observed in the Robuvit® group. No side effects were reported. CONCLUSIONS: CTD, combined with self-management, can effectively control the excess of limb volume in post-mastectomy lymphedema. Supplementation with Robuvit® is useful to further reduce limb volume. Later stages of lymphedema seem to be more difficult to manage and may require surgery or more invasive treatments.
Robotic right colonic resection. Is the robotic third arm a game-changer?
Mangano A, Gheza F, Bustos R … +5 more , Masrur M, Bianco F, Fernandes E, Valle V, Giulianotti PC
Minerva Chir · 2020 Feb · PMID 29860773 · Publisher ↗
BACKGROUND: Minimally invasive surgery (MIS) approaches have produces relevant advancements in the pre/intra/postoperative outcomes. The conventional laparoscopic approach presents similar oncological results in comparis...
BACKGROUND: Minimally invasive surgery (MIS) approaches have produces relevant advancements in the pre/intra/postoperative outcomes. The conventional laparoscopic approach presents similar oncological results in comparison to laparotomic approaches. Despite these evidences, a considerable part of the colorectal operations are still being performed in an open way. This is in part because traditional laparoscopy may have some hurdles and a long learning curve to reach mastery. The robotic technology may help in increasing the MIS penetrance in colorectal surgery. The use of the R3 can potentially increase the number of surgical options available. METHODS: In this retrospective case series, after a long robotic colorectal experience connected to a robotic program started by Giulianotti et al. in October 2000, we present our results regarding a subset of colorectal patients who underwent robotic right colonic resections performed, all by a single surgeon (P.C.G.), using the R3 according to our standardized technique. RESULTS: Out of all the robotic colorectal operations performed, this sub-sample sample included 33 patients: 21 males and 12 females. The age range was between 51 and 95 years old. The Body Mass Index (BMI) was between 21.6 to 43.1. The conversion rate to laparoscopy or to open surgery has been 0%. No intraoperative complications have been registered. The postoperative complications rates are reported in this manuscript. The perfusion check of the anastomosis by Near-infrared ICG (Indocyanine Green) enhanced fluorescence has been used. In 11.2% of the sample, the site of the anastomosis has been changed after ICG-Test. Moreover, when the ICG perfusion test has been performed no leakage occurred. CONCLUSIONS: This subset of patients suggests the potential role of R3 and the benefits correlated to robotic surgery. In fact, the laparoscopic approach uses mostly a medial to lateral mobilization. Indeed, during laparoscopic surgery an early right colon mobilization may create problems in the surgical field visualization. In robotic surgery, R3 can lift upwards the cecum/ascending colon/hepatic flexure exposing, in doing so, the anatomical structures. Hence, we can use also the same approach of the open surgery (where the first step is usually the mobilization of the ascending colon mesentery). In other words, the R3 offers more operative options in terms of surgical pathways maintaining at the same time good perioperative outcomes. However, more studies are needed to confirm our findings.
Surgical technique in robotic right colonic resection. How we do it: operative steps and surgical video.
Mangano A, Bustos R, Fernandes E … +4 more , Masrur M, Valle V, Aguiluz G, Giulianotti PC
Minerva Chir · 2020 Feb · PMID 29843501 · Publisher ↗
Minimally invasive surgery (MIS) has produced an important improvement in terms of peri-operative outcomes. Laparoscopic colorectal surgery presents comparable outcomes vs. open approach from an oncological standpoint. H...
Minimally invasive surgery (MIS) has produced an important improvement in terms of peri-operative outcomes. Laparoscopic colorectal surgery presents comparable outcomes vs. open approach from an oncological standpoint. However, there are some technical challenges/hurdles that laparoscopy may have. Worldwide there are still too many colonic/rectal operations carried out by the open approach. The robotic technology may be useful in solving some of the potential laparoscopic issues and potentially it may increase the number of procedures performed in a minimally invasive way. This is a description of our standardized operative technique for Robotic Right Colonic Resection. Conceivably, this manuscript may be useful to collect more repeatable data in the future. Moreover, it might be a guide to learn the robotic technique and also for the expert surgeons as an additional tool which they may find useful during their teaching activity. In this manuscript, taking advantage of the long and extensive expertise in minimally invasive colorectal resections, connected to a robotic experience started by Giulianotti in October 2000, we present our standardized technique for the robotic right colonic resection. The currently available literature data have proven that robotic colorectal surgery is safe/feasible. From the literature data, and from our experience as well, we think that these are the following main points: 1) the right colectomy is often an operation which can be performed in a relatively simple way even with traditional laparoscopy. However, the robotic approach is easier to standardize and this operation is very useful from a teaching standpoint in order to master multiple robotic surgical skills (that can be applied in more complex colorectal operations); 2) the robotic surgery may increase the MIS penetrance in this field. 3) the robotic third arm (R3) is an important technical advantage which can potentially increase the range of surgical options available; 4) the robotic technology is relatively recent. Most of the available data are retrospective and there is literature heterogenity (this affects also the conclusions of the currently available meta-analysis results, which sometimes are conflicting); 5) we need more data from prospective randomized well-powered studies (with standardized technique). Achieving a standardized technical approach will be essential in robotic colorectal surgery.
Percutaneous catheter drainage combined with peritoneal dialysis for treating acute severe pancreatitis: a single-center prospective study.
Zhang W, Sun J, Shen X … +3 more , Xue Y, Meng C, Yuan S
Minerva Chir · 2019 Jun · PMID 29843500 · Publisher ↗
BACKGROUND: To investigate the efficacy of percutaneous catheter drainage (PCD) and peritoneal dialysis (PD) in the treatment of severe acute pancreatitis (SAP) and its underlying mechanism. METHODS: Totally 64 SAP patie...
BACKGROUND: To investigate the efficacy of percutaneous catheter drainage (PCD) and peritoneal dialysis (PD) in the treatment of severe acute pancreatitis (SAP) and its underlying mechanism. METHODS: Totally 64 SAP patients were included in our study and randomly assigned into PCD+PD group (the combination group, N.=32) and convention group (N.=32). SAP patients in the combination group were treated with percutaneous catheter drainage combined with peritoneal dialysis, while those in the convention group were treated with conventional method. The treatment efficacy of both methods were evaluated by comparing levels of plasma inflammatory cytokines (IL-6, IL-8, TNF-α, C-reactive protein, procalcitonin and leukocyte count), relative indexes of important organs (aspartate aminotransferase, alanine aminotransferase, creatinine and urea nitrogen) and other clinical data (amelioration time of abdominal pain and abdominal distension, Balthazar CT scores, acute physiology and chronic health enquiry II score, length of hospital stay, complications and prognosis). RESULTS: The expression levels of inflammatory cytokines were significantly decreased in the combination group in a time-dependent manner in comparison with those of the convention group. In addition, the amelioration time of abdominal pain and abdominal distension, length of hospital stay, Balthazar CT scores and the acute physiology and chronic health care II scores in the combination group were also significantly decreased in comparison with those of the convention group. CONCLUSIONS: The combination treatment of PCD and PD effectively relieves the clinical symptoms of SAP by clearing plasma inflammatory cytokines.
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