76 results on '"Pietro Piazza"'
Search Results
2. Immunohistochemistry analysis of PSMA expression at prostatic biopsy in high-risk prostate cancer: potential implications for PSMA-PET patient selection
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Matteo Droghetti, Lorenzo Bianchi, Massimiliano Presutti, Luigia Vetrone, Andrea Farolfi, Riccardo Mei, Francesca Giunchi, Alessio Degiovanni, Angelo Mottaran, Pietro Piazza, Danilo Cangemi, Paolo Castellucci, Antonietta D’Errico, Riccardo Schiavina, Eugenio Brunocilla, and Stefano Fanti
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PSMA PET ,immunohistochemistry ,prostate cancer ,biopsy ,radical prostatectomy ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
IntroductionProstate-specific membrane antigen (PSMA) is a transmembrane protein expressed by normal prostatic tissue. Therefore, molecular imaging targeting PSMA (PSMA-PET) has gained particular interest and diffusion for PCa staging and restaging. Several factors may affect PSMA-PET results, and many tools have been proposed to improve patient selection. Furthermore, PSMA expression is not homogeneous among different tissues and within the prostate itself. The aims of this study were to evaluate immunohistochemistry (IHC) features of prostate biopsy samples and to assess their correlation with whole-mount specimens and PSMA-PET parameters.MethodsWe included consecutive high-risk PCa patients who underwent PSMA-PET for staging proposal at our institution from January 2022 to December 2022. The PET parameters selected were SUVmax, total volume (TV), and total lesion activity (TL). Each patient underwent multiparametric MRI (mpMRI) and fusion-targeted prostate biopsy prior to surgery. IHC analyses were performed on the index lesion cores. IHC visual score (VS) (1, 2, 3) and visual pattern (VP) (membranous, cytoplasmic, and combined) and the percentage of PSMA-negative tumor areas (PSMA%neg) within biopsy cores were evaluated.ResultsForty-three patients who underwent robotic radical prostatectomy after PSMA-PET were available for analyses. Concordance between VS and VP at biopsy and final pathology showed a Cohen’s kappa coefficient of 0.39 and 0.38, respectively. Patients with PSMA%neg 20% on biopsy cores in terms of SUVmax, PSMA-TL, and PSMA-TV (p = 0.5, p = 0.5, and p = 0.9 respectively).ConclusionsWe found a correlation between IHC VS and VP on targeted biopsy cores and SUVmax at PSMA-PET. However, the correlation between the IHC parameters of biopsy cores and final pathology was not as high as expected. Nevertheless, the presence of PSMA%neg
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- 2024
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3. Digital Therapeutics in Urology: An Innovative Approach to Patient Care and Management
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Severin Rodler, Karl-Friedrich Kowalewski, Henriette Scheibert, Moritz Bensel, Leo Federico Stadelmeier, Amelie Styn, Ines Rivero Belenchon, Mark Taratkin, Stefano Puliatti, Juan Gomez Rivas, Alessandro Veccia, Pietro Piazza, Enrico Checcucci, Maurice S. Michel, Christian G. Stief, and Giovanni Cacciamani
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Digital therapeutics ,Patient perspective ,Urology ,App ,Diseases of the genitourinary system. Urology ,RC870-923 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Digital therapeutics (DTx) are a new class of intervention involving evidence-based software applications and have been used in neurology and psychiatry. To assess the potential of DTx in urology, we conducted a survey to assess the current prevalence of the digital infrastructure required for DTx, areas of support expected by patients, and requirements for uptake. Between November 2022 and January 2023, we conducted an anonymized survey at two German academic centers among patients with urologic conditions. We found that among patients aged
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- 2023
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4. Doryktetos chora. L’iconografia dei sovrano guerriero con la lancia da Alessandro Magno a Carlo V
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Pietro Piazza
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History of the arts ,NX440-632 ,Archaeology ,CC1-960 - Abstract
This contribution focuses on the analysis of the iconography of the kings represented with the spear. An iconography of the sovereign seen as a warrior, wielding a weapon which, from the archaic Greek age, passing through the early Middle Ages and the Renaissance age, becomes emblematic in the depiction of monarchs. The spear, moreover, is the weapon used by the archetype of the universal sovereign par excellence, that is Alexander the Great. In this brief examination, comparatively, we will consider how, from the late imperial age up to Titian's famous portrait of Charles V on horseback, Alexander the Great, in this case the famous statue of the king at the battle of Granico, a work (lost) by the Sicionian sculptor Lisippo, will constitute, a model in the iconography of the sovereigns.
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- 2022
5. New imaging technologies for robotic kidney cancer surgery
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Stefano Puliatti, Ahmed Eissa, Enrico Checcucci, Pietro Piazza, Marco Amato, Stefania Ferretti, Simone Scarcella, Juan Gomez Rivas, Mark Taratkin, Josè Marenco, Ines Belenchon Rivero, Karl-Friedrich Kowalewski, Giovanni Cacciamani, Ahmed El-Sherbiny, Ahmed Zoeir, Abdelhamid M. El-Bahnasy, Ruben De Groote, Alexandre Mottrie, and Salvatore Micali
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Kidney cancer ,Imaging ,Technology ,Robotic ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Objective: Kidney cancers account for approximately 2% of all newly diagnosed cancer in 2020. Among the primary treatment options for kidney cancer, urologist may choose between radical or partial nephrectomy, or ablative therapies. Nowadays, robotic-assisted partial nephrectomy (RAPN) for the management of renal cancers has gained popularity, up to being considered the gold standard. However, RAPN is a challenging procedure with a steep learning curve. Methods: In this narrative review, different imaging technologies used to guide and aid RAPN are discussed. Results: Three-dimensional visualization technology has been extensively discussed in RAPN, showing its value in enhancing robotic-surgery training, patient counseling, surgical planning, and intraoperative guidance. Intraoperative imaging technologies such as intracorporeal ultrasound, near-infrared fluorescent imaging, and intraoperative pathological examination can also be used to improve the outcomes following RAPN. Finally, artificial intelligence may play a role in the field of RAPN soon. Conclusion: RAPN is a complex surgery; however, many imaging technologies may play an important role in facilitating it.
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- 2022
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6. Can the Abdominal Aortic Atherosclerotic Plaque Index Predict Functional Outcomes after Robot-Assisted Partial Nephrectomy?
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Alessandro Veccia, Emanuele Serafin, Alessandro Tafuri, Sarah Malandra, Bogdan Maris, Giulia Tomelleri, Alessandro Spezia, Enrico Checcucci, Pietro Piazza, Severin Rodler, Loic Baekelandt, Karl-Friedrich Kowalewski, Ines Rivero Belenchon, Mark Taratkin, Stefano Puliatti, Pieter De Backer, Juan Gomez Rivas, Giovanni Enrico Cacciamani, Giulia Zamboni, Paolo Fiorini, and Alessandro Antonelli
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robot-assisted partial nephrectomy ,abdominal aortic plaque atherosclerotic index ,chronic kidney disease ,Medicine (General) ,R5-920 - Abstract
This study aims to evaluate the abdominal aortic atherosclerotic plaque index (API)’s predictive role in patients with pre-operatively or post-operatively developed chronic kidney disease (CKD) treated with robot-assisted partial nephrectomy (RAPN) for renal cell carcinoma (RCC). One hundred and eighty-three patients (134 with no pre- and post-operative CKD (no CKD) and 49 with persistent or post-operative CKD development (post-op CKD)) who underwent RAPN between January 2019 and January 2022 were deemed eligible for the analysis. The API was calculated using dedicated software by assessing the ratio between the CT scan atherosclerotic plaque volume and the abdominal aortic volume. The ROC regression model demonstrated the influence of API on CKD development, with an increasing effect according to its value (coefficient 0.13; 95% CI 0.04–0.23; p = 0.006). The Model 1 multivariable analysis of the predictors of post-op CKD found that the following are independently associated with post-op CKD: Charlson Comorbidity Index (OR 1.31; p = 0.01), last follow-up (FU) Δ%eGFR (OR 0.95; p < 0.01), and API ≥ 10 (OR 25.4; p = 0.01). Model 2 showed API ≥ 10 as the only factor associated with CKD development (OR 25.2; p = 0.04). The median follow-up was 22 months. Our results demonstrate API to be a strong predictor of post-operative CKD, allowing the surgeon to tailor the best treatment for each patient, especially in those who might be at higher risk of CKD.
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- 2023
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7. Artificial Intelligence in Surgical Training for Kidney Cancer: A Systematic Review of the Literature
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Natali Rodriguez Peñaranda, Ahmed Eissa, Stefania Ferretti, Giampaolo Bianchi, Stefano Di Bari, Rui Farinha, Pietro Piazza, Enrico Checcucci, Inés Rivero Belenchón, Alessandro Veccia, Juan Gomez Rivas, Mark Taratkin, Karl-Friedrich Kowalewski, Severin Rodler, Pieter De Backer, Giovanni Enrico Cacciamani, Ruben De Groote, Anthony G. Gallagher, Alexandre Mottrie, Salvatore Micali, and Stefano Puliatti
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RAPN ,partial nephrectomy ,radical nephrectomy ,kidney cancer ,renal cancer ,annotation ,Medicine (General) ,R5-920 - Abstract
The prevalence of renal cell carcinoma (RCC) is increasing due to advanced imaging techniques. Surgical resection is the standard treatment, involving complex radical and partial nephrectomy procedures that demand extensive training and planning. Furthermore, artificial intelligence (AI) can potentially aid the training process in the field of kidney cancer. This review explores how artificial intelligence (AI) can create a framework for kidney cancer surgery to address training difficulties. Following PRISMA 2020 criteria, an exhaustive search of PubMed and SCOPUS databases was conducted without any filters or restrictions. Inclusion criteria encompassed original English articles focusing on AI’s role in kidney cancer surgical training. On the other hand, all non-original articles and articles published in any language other than English were excluded. Two independent reviewers assessed the articles, with a third party settling any disagreement. Study specifics, AI tools, methodologies, endpoints, and outcomes were extracted by the same authors. The Oxford Center for Evidence-Based Medicine’s evidence levels were employed to assess the studies. Out of 468 identified records, 14 eligible studies were selected. Potential AI applications in kidney cancer surgical training include analyzing surgical workflow, annotating instruments, identifying tissues, and 3D reconstruction. AI is capable of appraising surgical skills, including the identification of procedural steps and instrument tracking. While AI and augmented reality (AR) enhance training, challenges persist in real-time tracking and registration. The utilization of AI-driven 3D reconstruction proves beneficial for intraoperative guidance and preoperative preparation. Artificial intelligence (AI) shows potential for advancing surgical training by providing unbiased evaluations, personalized feedback, and enhanced learning processes. Yet challenges such as consistent metric measurement, ethical concerns, and data privacy must be addressed. The integration of AI into kidney cancer surgical training offers solutions to training difficulties and a boost to surgical education. However, to fully harness its potential, additional studies are imperative.
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- 2023
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8. A Systematic Review of New Imaging Technologies for Robotic Prostatectomy: From Molecular Imaging to Augmented Reality
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Severin Rodler, Marc Anwar Kidess, Thilo Westhofen, Karl-Friedrich Kowalewski, Ines Rivero Belenchon, Mark Taratkin, Stefano Puliatti, Juan Gómez Rivas, Alessandro Veccia, Pietro Piazza, Enrico Checcucci, Christian Georg Stief, and Giovanni Enrico Cacciamani
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robotic prostatectomy ,imaging ,new technologies ,augmented reality ,molecular imaging ,Medicine - Abstract
New imaging technologies play a pivotal role in the current management of patients with prostate cancer. Robotic assisted radical prostatectomy (RARP) is a standard of care for localized disease and through the already imaging-based console subject of research towards combinations of imaging technologies and RARP as well as their impact on surgical outcomes. Therefore, we aimed to provide a comprehensive analysis of the currently available literature for new imaging technologies for RARP. On 24 January 2023, we performed a systematic review of the current literature on Pubmed, Scopus and Web of Science according to the PRISMA guidelines and Oxford levels of evidence. A total of 46 studies were identified of which 19 studies focus on imaging of the primary tumor, 12 studies on the intraoperative tumor detection of lymph nodes and 15 studies on the training of surgeons. While the feasibility of combined approaches using new imaging technologies including MRI, PSMA-PET CT or intraoperatively applied radioactive and fluorescent dyes has been demonstrated, the prospective confirmation of improvements in surgical outcomes is currently ongoing.
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- 2023
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9. Robotic-assisted versus open simple prostatectomy: Results from a systematic review and meta-analysis of comparative studies
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Simone Scarcella, Daniele Castellani, Vineet Gauhar, Jeremy Yuen-Chun Teoh, Carlo Giulioni, Pietro Piazza, Carlo Andrea Bravi, Ruben De Groote, Geert De Naeyer, Stefano Puliatti, Andrea Benedetto Galosi, and Alexandre Mottrie
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patient outcome assessment ,postoperative complications ,prostatectomy ,prostatic hyperplasia ,robotic surgical procedures ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Purpose: To review safety and efficacy of robotic-assisted simple prostatectomy (RASP) compared to open simple prostatectomy (OP). Materials and Methods: A comprehensive literature search was performed to assess the differences in perioperative course and functional outcomes in patients with benign prostatic hyperplasia and surgical indication. The incidences of complications were pooled using the Cochran–Mantel–Haenszel Method and expressed as odds ratio (OR), 95% confidence interval (CI), and p-values. Perioperative course and functional outcomes were pooled using the inverse variance of the mean difference (MD), 95% CI, and p-values. Analyses were two-tailed and the significance was set at p
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- 2021
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10. 3D renal model for surgical planning of partial nephrectomy: A way to improve surgical outcomes
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Lorenzo Bianchi, Laura Cercenelli, Barbara Bortolani, Pietro Piazza, Matteo Droghetti, Sara Boschi, Caterina Gaudiano, Giulia Carpani, Francesco Chessa, Simone Lodi, Lorenzo Tartarini, Alessandro Bertaccini, Rita Golfieri, Emanuela Marcelli, Riccardo Schiavina, and Eugenio Brunocilla
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3D model ,surgical planning ,surgical outcomes ,renal cancer ,partial nephrectomy ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Objectiveto evaluate the impact of 3D model for a comprehensive assessment of surgical planning and quality of partial nephrectomy (PN).Materials and methods195 patients with cT1-T2 renal mass scheduled for PN were enrolled in two groups: Study Group (n= 100), including patients referred to PN with revision of both 2D computed tomography (CT) imaging and 3D model; Control group (n= 95), including patients referred to PN with revision of 2D CT imaging. Overall, 20 individuals were switched to radical nephrectomy (RN). The primary outcome was the impact of 3D models-based surgical planning on Trifecta achievement (defined as the contemporary absence of positive surgical margin, major complications and ≤30% postoperative eGFR reduction). The secondary outcome was the impact of 3D models on surgical planning of PN. Multivariate logistic regressions were used to identify predictors of selective clamping and Trifecta’s achievement in patients treated with PN (n=175).ResultsOverall, 73 (80.2%) patients in Study group and 53 (63.1%) patients in Control group achieved the Trifecta (p=0.01). The preoperative plan of arterial clamping was recorded as clampless, main artery and selective in 22 (24.2%), 22 (24.2%) and 47 (51.6%) cases in Study group vs. 31 (36.9%), 46 (54.8%) and 7 (8.3%) cases in Control group, respectively (p
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- 2022
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11. Feasibility and optimal setting of robot-assisted partial nephrectomy with the novel 'hugo' robotic system: a pre-clinical study
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Carlo Andrea Bravi, Luca Sarchi, Angelo Mottaran, Marco Paciotti, Rui Farinha, Pietro Piazza, Pieter De Backer, Stefano Puliatti, Ruben De Groote, Geert De Naeyer, Anthony Gallagher, Alberto Breda, and Alexandre Mottrie
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Robotic surgery ,Urological procedures ,Robot-assisted partial nephrectomy ,Pre-clinical study ,Feasibility ,HUGO robotic platform ,Surgery ,RD1-811 ,Diseases of the genitourinary system. Urology ,RC870-923 - Published
- 2022
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12. The Impact on Urology Residents’ Learning of Social Media and Web Technologies after the Pandemic: A Step Forward through the Sharing of Knowledge
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Severin Rodler, Cristina Eliza Bujoreanu, Loic Baekelandt, Gabriele Volpi, Stefano Puliatti, Karl-Friedrich Kowalewski, Ines Rivero Belenchon, Mark Taratkin, Juan Gomez Rivas, Alessandro Veccia, Pietro Piazza, Diego M. Carrion, Giovanni Enrico Cacciamani, Francesco Esperto, and Enrico Checcucci
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surgical training ,residents ,urology ,simulation ,surgery ,Medicine - Abstract
The COVID-19 pandemic has impacted urology residents and their training. However, several new technologies or knowledge platforms as social media (SoMe) and web-based learning solutions have filled this gap. Therefore, we aimed to analyze resident’s learning curves of new learning modalities, identify the evidence that is provided in the literature, and evaluate the possible impact of such solutions in the future. We conducted a non-systematic literature search using Medline, PubMed, and Embase. In addition, online resources of national and international urology resident societies were queried. The identified paper described SoMe, webinars, podcasts, pre-recorded surgical videos, educational platforms, and mobile apps in the field of urology that are used to gain access to information, teach and provide feedback to residents, and were used under the conditions of the pandemic. The application of those technologies harbors the risk of mis- and disinformation, but have the potential to provide access to education and validated knowledge, training, and feedback and thereby might democratize training of residents in urology globally.
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- 2023
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13. PSMA-PET Guided Treatment in Prostate Cancer Patients with Oligorecurrent Progression after Previous Salvage Treatment
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Lorenzo Bianchi, Francesco Ceci, Eleonora Balestrazzi, Francesco Costa, Matteo Droghetti, Pietro Piazza, Alessandro Pissavini, Massimiliano Presutti, Andrea Farolfi, Riccardo Mei, Paolo Castellucci, Giorgio Gandaglia, Alessandro Larcher, Daniele Robesti, Alexandre Mottrie, Alberto Briganti, Alessio Giuseppe Morganti, Stefano Fanti, Francesco Montorsi, Riccardo Schiavina, and Eugenio Brunocilla
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PSMA-PET ,hormone sensitive prostate cancer ,oligorecurrent prostate cancer ,metastasis-directed therapy ,survival ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Background: Prostate Specific Membrane Antigen-Positron Emission Tomography (PSMA-PET) is used to select recurrent prostate cancer (PCa) patients for metastases-directed therapy (MDT). We aimed to evaluate the oncologic outcomes of second-line PSMA-guided MDT in oligo-recurrent PCa patients. Methods: we performed a retrospective analysis of 113 recurrent PCa after previous radical prostatectomy and salvage therapies with oligorecurrent disease at PSMA-PET (≤3 lesions in N1/M1a-b) in three high-volume European centres. Patients underwent second-line salvage treatments: MDT targeted to PSMA (including surgery and/or radiotherapy), and the conventional approach (observation or Androgen Deprivation Therapy [ADT]). Patients were stratified according to treatments (MDT vs. conventional approach). Patients who underwent MDT were stratified according to stage in PSMA-PET (N1 vs. M1a-b). The primary outcome of the study was Progression-free survival (PFS). Secondary outcomes were Metastases-free survival (MFS) and Castration Resistant PCa free survival (CRPC-FS). Kaplan-Meier analyses assessed PFS, MFS and CRPC-FS. Multivariable Cox regression models identified predictors of progression and metastatic disease. Results: Overall, 91 (80%) and 22 (20%) patients were treated with MDT and the conventional approach, respectively. The median follow-up after PSMA-PET was 31 months. Patients who underwent MDT had a similar PFS compared to the conventional approach (p = 0.3). Individuals referred to MDT had significantly higher MFS and CRPC-FS compared to those who were treated with the conventional approach (73.5% and 94.7% vs. 30.5% and 79.5%; all p ≤ 0.001). In patients undergoing MDT, no significant differences were found for PFS and MFS according to N1 vs. M1a-b disease, while CRPC-FS estimates were significantly higher in patients with N1 vs. M1a-b (100% vs. 86.1%; p = 0.02). At multivariable analyses, age (HR = 0.96) and ADT during second line salvage treatment (HR = 0.5) were independent predictors of PFS; MDT (HR 0.27) was the only independent predictor of MFS (all p ≤ 0.04) Conclusion: Patients who underwent second-line PSMA-guided MDT experienced higher MFS and CRPC-FS compared to men who received conventional management.
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- 2023
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14. Twenty Years’ Experience in Retroperitoneal Lymph Node Dissection for Testicular Cancer in a Tertiary Referral Center
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Angelo Mottaran, Amelio Ercolino, Lorenzo Bianchi, Pietro Piazza, Francesco Manes, Sasan Amirhassankhani, Marco Salvador, Francesco Chessa, Beniamino Corcioni, Alessandro Bertaccini, Riccardo Schiavina, and Eugenio Brunocilla
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retroperitoneal lymph node dissection ,open approach ,testicular cancer ,primary setting ,secondary setting ,RPLND ,Medicine (General) ,R5-920 - Abstract
Background and Objectives: The aim of this article is to present a single-surgeon, open retroperitoneal lymph node dissection (RPLND) series for testicular cancer in a high-volume center. Materials and Methods: We reviewed data from patients who underwent RPLND performed by an experienced surgeon at our institution between 2000 and 2019. We evaluated surgical and perioperative outcomes, complications, Recurrence-Free Survival (RFS), Overall Survival (OS), and Cancer-Specific Survival (CSS). Results: RPLND was performed in primary and secondary settings in 21 (32%) and 44 (68%) patients, respectively. Median operative time was 180 min. Median hospital stay was 6 days. Complications occurred in 23 (35%) patients, with 9 (14%) events reported as Clavien grade ≥ 3. Patients in the primary RPLND group were significantly younger, more likely to have NSGCT, had higher clinical N0 and M0, and had higher nerve-sparing RPLND (all p ≤ 0.04) compared to those in the secondary RPLND group. In the median follow-up of 120 (56–180) months, 10 (15%) patients experienced recurrence. Finally, 20-year OS, CSS, and RFS were 89%, 92%, and 85%, respectively, with no significant difference in survival rates between primary vs. secondary RPLND subgroups (p = 0.64, p = 0.7, and p = 0.31, respectively). Conclusions: Open RPLND performed by an experienced high-volume surgeon achieves excellent oncological and functional outcomes supporting the centralization of these complex procedures.
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- 2023
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15. The Impact of PSMA-PET on Oncologic Control in Prostate Cancer Patients Who Experienced PSA Persistence or Recurrence
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Lorenzo Bianchi, Francesco Ceci, Francesco Costa, Eleonora Balestrazzi, Matteo Droghetti, Pietro Piazza, Alessandro Pissavini, Riccardo Mei, Andrea Farolfi, Paolo Castellucci, Stefano Puliatti, Alessandro Larcher, Giorgio Gandaglia, Daniele Robesti, Alexandre Mottrie, Alberto Briganti, Alessio Giuseppe Morganti, Stefano Fanti, Francesco Montorsi, Riccardo Schiavina, and Eugenio Brunocilla
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PSMA-PET ,hormone sensitive prostate cancer ,recurrent prostate cancer ,PSMA-guided salvage treatment ,survival ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Background: Prostate Specific Membrane Antigen-Positron Emission Tomography (PSMA-PET) is currently recommended to restage prostate cancer (PCa) and to guide the delivery of salvage treatments. We aim to evaluate the oncologic outcomes of patients with recurrent PCa who received PSMA-PET. Methods: 324 hormone-sensitive PCa with PSA relapse after radical prostatectomy who underwent PSMA-PET in three high-volume European Centres. Patients have been stratified as pre-salvage who never received salvage treatments (n = 134), and post-salvage, including patients who received previous salvage therapies (n = 190). Patients with oligorecurrent (≤3 lesions), PSMA-positive disease underwent PSMA-directed treatments: salvage radiotherapy (sRT) or Metastases-directed therapy (MDT). Patients with polirecurrent (>3 lesions) PSMA-positive disease were treated with systemic therapy. Patients with negative PSMA-PET were treated with sRT or systemic therapies or observation. The primary outcome of the study was Progression-free survival (PFS). Secondary outcomes were: Metastases-free survival (MFS) and Castration Resistant Pca free survival (CRPC-FS). Results: median follow up was 23 months. In the pre-salvage setting, the PFS, MFS and CRPC-FS estimates at 3 years were 66.2% vs. 38.9%, 95.2% vs. 73.7% and 94.9% vs. 93.1% in patients with negative vs. positive PSMA-PET, respectively (all p ≥ 0.2). In the post-salvage setting, the PFS, MFS and CRPC-FS estimates at 3 years were 59.5% vs. 29.1%, 92.7% vs. 65.1% and 98.8% vs. 88.8% in patients with negative vs. positive PSMA-PET, respectively (all p ≤ 0.01). At multivariable analyses, a positive PSMA-PET was an independent predictor of progression (HR = 2.15) and metastatic disease (HR 2.37; all p ≤ 0.03). Conclusion: PSMA-PET in recurrent PCa detects the site of recurrence guiding salvage treatments and has a prognostic role in patients who received previous salvage treatments.
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- 2022
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16. The Role of miRNA in the Management of Localized and Advanced Renal Masses, a Narrative Review of the Literature
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Luigi Napolitano, Luca Orecchia, Carlo Giulioni, Umberto Carbonara, Giovanni Tavella, Leonardo Lizzio, Deborah Fimognari, Antonio De Palma, Alberto Gheza, Antonio Andrea Grosso, Ugo Falagario, Stefano Parodi, Vittorio Fasulo, Federico Romantini, Giuseppe Rosiello, Silvia Viganò, Salvatore Rabito, Tommaso Ceccato, Mirko Pinelli, Graziano Felici, Francesco De Vita, Francesco Prata, Francesco Dibitetto, Matteo Tedde, Federico Piramide, Fabio Traunero, Mario De Michele, Michele Morelli, Pietro Piazza, and Rocco Simone Flammia
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renal cell carcinoma ,miRNA ,metastatic ,cancer ,biomarker ,Technology ,Engineering (General). Civil engineering (General) ,TA1-2040 ,Biology (General) ,QH301-705.5 ,Physics ,QC1-999 ,Chemistry ,QD1-999 - Abstract
Renal cell carcinoma (RCC) is the most common form of kidney cancer with 403,262 diagnoses and 170,000 deaths worldwide in 2018. Although partial or radical nephrectomy can be considered a successful treatment in early-stage or localized RCC, in advanced-stage disease, there is a high risk of metastasis or recurrence with a significantly poorer prognosis. Metastatic RCC is generally resistant to both chemotherapy and radiotherapy, and, despite several novel therapeutic agents, disease progression and mortality rates remain high. It is necessary to identify new diagnostic and therapeutic strategies for the management of this cancer. Knowledge of microRNA (miRNA) has consistently increased in the last year. miRNAs play an important role in several biological processes, such as cell proliferation, differentiation, and cell death. Due to this, miRNAs have been identified as an important key in different diseases, especially in cancer, and several studies show miRNAs as attractive tools and targets for novel therapeutic approaches. Recently several miRNAs (including miR-22, miR-203, miR-301 and miR-193a-3p) have been linked to dysregulated molecular pathways involved with the proliferation of cancerous cells and resistance to therapeutic agents. In the present study, recent data from studies assessing the application of miRNAs as biomarkers, therapeutic targets, or modulators of response to treatment modalities in RCC patients are analyzed.
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- 2022
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17. Does quality assured eLearning provide adequate preparation for robotic surgical skills; a prospective, randomized and multi-center study.
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Stefano Puliatti, Marco Amato, Rui Farinha, Artur Paludo, Giuseppe Rosiello, Ruben De Groote, Andrea Mari, Lorenzo Bianchi, Pietro Piazza, Ben Van Cleynenbreugel, Elio Mazzone, Filippo Migliorini, Saverio Forte, Bernardo Rocco, Patrick Kiely, Alexandre Mottrie, and Anthony G. Gallagher
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- 2022
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18. Robot-Assisted Sacropexy with the Novel HUGO Robot-Assisted Surgery System: Initial Experience and Surgical Setup at a Tertiary Referral Robotic Center
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Angelo Mottaran, Carlo Andrea Bravi, Luca Sarchi, Marco Paciotti, Luigi Nocera, Adele Piro, Pietro Piazza, Pieter De Backer, Rui Farinha, Ruben De Groote, Geert De Naeyer, and Alexandre Mottrie
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Urology - Published
- 2023
19. Site-specific concordance of targeted and systematic biopsy cores at the index lesion on multiparametric magnetic resonance: can we spare the double-tap?
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Matteo Droghetti, Lorenzo Bianchi, Carlo Beretta, Eleonora Balestrazzi, Francesco Costa, Alberto Feruzzi, Pietro Piazza, Carlo Roveroni, Caterina Gaudiano, Beniamino Corcioni, Francesca Giunchi, Michelangelo Fiorentino, Rita Golfieri, Riccardo Schiavina, and Eugenio Brunocilla
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Urology - Abstract
To define the impact of systematic biopsy (SB) cores directed in the same area of index lesion in patients undergoing targeted biopsy (TB) and SB for prostate cancer (PCa) suspicion.We retrospectively analyzed data of biopsy-naïve patients with one single suspicious lesion at mpMRI who underwent TB plus SB at our institution between January 2015 and September 2021. A convenient sample of 336 patients was available for our analyses. The primary outcome was to evaluate the impact of overlapping SB cores directed to the index lesion at mpMRI. The secondary outcome was to evaluate the SB cores concordance in terms of highest Gleason Score Detection with TB cores.56% of patients were found to have site-specific concordance. SB cores determined disease upgrade in 22.1% patients. Thirty-one (16.4%) site-concordant patients experienced upgrade through overlapping SB cores, while 149 (79.3%) had no benefit by SB cores, and 8 (4.3%) patients had the worst ISUP at TB cores. 50% of the patients with negative-TB were upgraded to insignificant PCa, and 17.5% was upgraded from negative to unfavorable-intermediate- or high-risk PCa. Overall, 14 (19.4%) patients were also upgraded from ISUP 1 on TB to csPCa, with 28.5% of these harboring high-risk PCa. In csPCas at TB, 9 (12.5%) patients were upgraded from intermediate- to high-risk disease by SB.TB alone consents to identify worst ISUP PCa in vast majority of patients scheduled for biopsy. A non-negligible number of patients are upgraded via-SB cores, including also index lesion overlapping cores. Omitting these cores might lead to a suboptimal patient management.
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- 2022
20. A case report of myoid gonadal stromal tumor treated with testis sparing surgery
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Amelio Ercolino, Francesco Manes, Francesco Vasuri, Lorenzo Bianchi, Marco Garofalo, Pietro Piazza, Beniamino Corcioni, Riccardo Schiavina, Rita Golfieri, Michelangelo Fiorentino, Maurizio Colecchia, Eugenio Brunocilla, Ercolino, Amelio, Manes, Francesco, Vasuri, Francesco, Bianchi, Lorenzo, Garofalo, Marco, Piazza, Pietro, Corcioni, Beniamino, Schiavina, Riccardo, Golfieri, Rita, Fiorentino, Michelangelo, Colecchia, Maurizio, and Brunocilla, Eugenio
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Stromal testicular tumor ,Reproductive Medicine ,testis sparing approach ,diagnostic imaging evaluation ,Urology ,case report - Abstract
Background: Myoid gonadal stromal tumors (MGST) of the testis represent a very rare finding. They are an emerging clinicopathological entity with specific features and identity. Nowadays, pathological recognition and diagnosis of MGSTs still represents a difficult challenge in most cases and there are no data of specific radiological features of these tumors expect for what seen by ultrasound; besides a conservative surgical approach was never performed to treat these lesions.Case Description: We present the case of a 20-year-old young man patient with symptoms suspicious for left varicocele, who was incidentally diagnosed with right testicular nodule via scrotal doppler ultrasound powered with contrast enhancement infusion and subsequent multiparametric magnetic resonance imaging. Then, lesion was treated through a testis sparing surgical approach. Histopathology, which included an external revision by an experienced Center, revealed a MGST with benign features, so that no further treatment was considered. 3 and 12 months after surgery a contrast enhancement ultrasound was performed with no evidence of recurrence.Conclusions: Previous reported cases of MGST were all difficult to characterize as a specific pathological entity; treatment usually applied was radical orchiectomy and a subsequent total Body CT was performed for staging purpose. No metastatic spreading nor recurrence were ever reported. Considering the favorable behavior of this pathologic entity, testis-sparing surgery with no radiation exposure during follow-up is a safe and effective strategy.
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- 2022
21. Novel Volumetric and Morphological Parameters Derived from Three-dimensional Virtual Modeling to Improve Comprehension of Tumor’s Anatomy in Patients with Renal Cancer
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Lorenzo Bianchi, Giulia Carpani, Francesco Chessa, Alessandro Bertaccini, E. Balestrazzi, Emanuela Marcelli, A. Mottaran, Eugenio Brunocilla, Rita Golfieri, Laura Cercenelli, Alberta Cappelli, Pietro Piazza, Francesco V. Costa, Barbara Bortolani, Arianna Rustici, Riccardo Schiavina, Caterian Gaudiano, Sara Boschi, Matteo Droghetti, E. Molinaroli, Bianchi, Lorenzo, Schiavina, Riccardo, Bortolani, Barbara, Cercenelli, Laura, Gaudiano, Caterian, Mottaran, Angelo, Droghetti, Matteo, Chessa, Francesco, Boschi, Sara, Molinaroli, Enrico, Balestrazzi, Eleonora, Costa, Francesco, Rustici, Arianna, Carpani, Giulia, Piazza, Pietro, Cappelli, Alberta, Bertaccini, Alessandro, Golfieri, Rita, Marcelli, Emanuela, and Brunocilla, Eugenio
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medicine.medical_specialty ,Urology ,medicine.medical_treatment ,Urinary system ,Kidney Volume ,Logistic regression ,Nephrectomy ,Robotic Surgical Procedures ,medicine.artery ,Linear regression ,medicine ,Humans ,Warm Ischemia ,Renal artery ,Univariate analysis ,business.industry ,Robot-assisted partial nephrectomy ,Three-dimensional parameters ,Kidney Neoplasms ,Renal cancer ,Sample size determination ,Radiology ,Three-dimensional modeling ,Comprehension ,business ,Complication - Abstract
Background Three-dimensional (3D) models improve the comprehension of renal anatomy. Objective To evaluate the impact of novel 3D-derived parameters, to predict surgical outcomes after robot-assisted partial nephrectomy (RAPN). Design, setting, and participants Sixty-nine patients with cT1-T2 renal mass scheduled for RAPN were included. Three-dimensional virtual modeling was achieved from computed tomography. The following volumetric and morphological 3D parameters were calculated: VT (volume of the tumor); VT/VK (ratio between tumor volume and kidney volume); CSA3D (ie, contact surface area); UCS3D (contact to the urinary collecting system); Tumor-Artery3D: tumor’s blood supply by tertiary segmental arteries (score = 1), secondary segmental artery (score = 2), or primary segmental/main renal artery (scoren = 3); ST (tumor’s sphericity); ConvT (tumor’s convexity); and Endophyticity3D (ratio between the CSA3D and the global tumor surface). Intervention RAPN with a 3D model. Outcome measurements and statistical analysis Three-dimensional parameters were compared between patients with and without complications. Univariate logistic regression was used to predict overall complications and type of clamping; linear regression was used to predict operative time, warm ischemia time, and estimated blood loss. Results and limitations Overall, 11 (15%) individuals experienced overall complications (7.2% had Clavien ≥3 complications). Patients with urinary collecting system (UCS) involvement at 3D model (UCS3D = 2), tumor with blood supply by primary or secondary segmentary arteries (Tumor-Artery3D = 1 and 2), and high Endophyticity3D values had significantly higher rates of overall complications (all p ≤ 0.03). At univariate analysis, UCS3D, Tumor-Artery3D, and Endophyticity3D are significantly associated with overall complications; CSA3D and Endophyticity3D were associated with warm ischemia time; and CSA3D was associated with selective clamping (all p ≤ 0.03). Sample size and the lack of interobserver variability are the main limits. Conclusions Three-dimensional modeling provides novel volumetric and morphological parameters to predict surgical outcomes after RAPN. Patient summary Novel morphological and volumetric parameters can be derived from a three-dimensional model to describe surgical complexity of renal mass and to predict surgical outcomes after robot-assisted partial nephrectomy.
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- 2022
22. The new classification of renal cell carcinoma: what is the clinical issue?
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Pietro PIAZZA, Lorenzo BIANCHI, Michelangelo FIORENTINO, Caterina GAUDIANO, Francesca GIUNCHI, Eugenio BRUNOCILLA, and Riccardo SCHIAVINA
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Nephrology ,Urology - Published
- 2023
23. MP46-04 THE IMPACT OF CUMULATIVE SMOKING STATUS ON PERIOPERATIVE MORBIDITY AFTER ROBOT-ASSISTED RADICAL CYSTECTOMY
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Pietro Piazza, Carlo Bravi, Adele Piro, Luca Sarchi, Marco Paciotti, Maria Peraire Lores, Eleonora Balestrazzi, Luigi Nocera, null Melle, null Belgium, Angelo Mottaran, Federico Piramide, Ruben De Groote, Geert De Naeyer, Frederiek D'hondt, Rui Farinha, Riccardo Schiavina, Eugenio Brunocilla, and Alexandre Mottrie
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Urology - Published
- 2023
24. MP11-09 SECOND LINE PSMA-TARGETED SALVAGE TREATMENT IN PATIENTS WITH miN1/M1a-b OLIGORECURRENT PCa
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Lorenzo Bianchi, Eleonora Balestrazzi, Francesco Ceci, Francesco Costa, Matteo Droghetti, Alessandro Pissavini, Pietro Piazza, Andrea Farolfi, Riccardo Mei, Paolo Castellucci, Stefano Puliatti, Giorgio Gandaglia, Alessandro Larcher, Alexandre Mottrie, Alberto Briganti, Alessio Giuseppe Morganti, Stefano Fanti, Francesco Montorsi, Riccardo Schiavina, and Eugenio Brunocilla
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Urology - Published
- 2023
25. MP22-09 EXTERNAL VALIDATION OF THE IDENTIFY RISK CALCULATOR
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Sinan Khadhouri, Luca Orecchia, Ravi Banthia, Pietro Piazza, David Mak, Nikolaos Pyrgidis, Prabhat Narayan, Pablo Abad Lopez, Faisal Nawaz, Tran Trung Thanh, Francesco Claps, Donnacha Hogan, Juan Gomez Rivas, Santiago Alonso, Ijeoma Chibuzo, Meghana Kulkarni, Thineskrishna Anbarasan, Kevin Gallagher, and Veeru Kasivisvanathan
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Urology - Published
- 2023
26. MP58-04 PROPOSAL AND INTERNAL VALIDATION OF A NOMOGRAM FOR THE PREDICTION OF LOCAL RECURRENCE FREE-SURVIVAL AFTER PERCUTANEOUS ABLATION FOR CT1 RENAL MASSES
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Angelo Mottaran, Luigi Nocera, Lorenzo Bianchi, Stefano Luzzago, Marco Bandini, Pietro Piazza, Antonio Celia, Carla Serra, Francesco Modestino, Antonio De Cinque, Rita Golfieri, Gennaro Musi, Andrea Gallina, Francesco De Cobelli, Giovanni Mauri, Franco Orsi, Umberto Capitanio, null Milan, null Italy, Riccardo Schiavina, Ottavio De Cobelli, Francesco Montorsi, and Eugenio Brunocilla
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Urology - Published
- 2023
27. MP41-20 EFFECTIVENESS OF RADIOMIC TUMOR ZONE OF TRANSITION (ZOT) FEATURES IN THE AUTOMATED DISCRIMINATION OF ONCOCYTOMA FROM CLEAR CELL RENAL CANCER
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Lorenzo Bianchi, Elena Tonin, Pietro Piazza, Gianluca Carlini, Caterina Gaudiano, Rita Golfieri, Nico Curti, Riccardo Schiavina, Francesca Giunchi, Riccardo Biondi, Damiano Caruso, Enrico Giampieri, Alessandra Merlotti, Daniele Dall'Olio, Claudia Sala, Sara Pandolfi, Daniel Remondini, Arianna Rustici, Luigi Vincenzo Pastore, Leonardo Scarpetti, Barbara Bortolani, Eugenio Brunocilla, Emanuela Marcelli, Francesca Coppola, and Gastone Castellani
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Urology - Published
- 2023
28. MP58-05 THE IMPACT OF HISTOLOGY AND TYPE OF ENERGY USED ON ONCOLOGICAL OUTCOMES AFTER LOCAL TUMOR ABLATION OF SMALL RENAL MASSES
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Pietro Piazza, Lorenzo Bianchi, Stefano Luzzago, Marco Bandini, Angelo Mottaran, Sasan Amirhassankhani, Stefano Puliatti, Bernardino De Concilio, Antonio Celia, Carla Serra, Alberta Cappelli, Francesco Modestino, Antonio De Cinque, Rita Golfieri, Gennaro Musi, Andrea Gallina, null Lugano, null Switzerland, Francesco De Cobelli, Giovanni Mauri, Franco Orsi, Umberto Capitanio, Riccardo Schiavina, Ottavio De Cobelli, Francesco Montorsi, and Eugenio Brunocilla
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Urology - Published
- 2023
29. PD40-12 FUNCTIONAL OUTCOMES PREDICTION AFTER ROBOTIC PARTIAL NEPHRECTOMY USING PADUA SCORE ASSESSED WITH 3D VIRTUAL MODELS: PRELIMINARY RESULTS OF A COLLABORATIVE ERUS STUDY
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Daniele Amparore, Federico Piramide, Alberto Piana, Enrico Checcucci, Giuseppe Basile, Alessandro Larcher, Andrea Gallioli, Angelo Territo, Josep Maria Gaya, Pietro Piazza, Stefano Puliatti, Antonio Grosso, Andrea Mari, Riccardo Campi, Sergio Serni, Umberto Capitanio, Francesco Montorsi, Alex Mottrie, Cristian Fiori, Andrea Minervini, Alberto Breda, and Francesco Porpiglia
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Urology - Published
- 2023
30. Improving Augmented Reality Through Deep Learning: Real-time Instrument Delineation in Robotic Renal Surgery
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Pieter De Backer, Charles Van Praet, Jente Simoens, Maria Peraire Lores, Heleen Creemers, Kenzo Mestdagh, Charlotte Allaeys, Saar Vermijs, Pietro Piazza, Angelo Mottaran, Carlo A. Bravi, Marco Paciotti, Luca Sarchi, Rui Farinha, Stefano Puliatti, Francesco Cisternino, Federica Ferraguti, Charlotte Debbaut, Geert De Naeyer, Karel Decaestecker, and Alexandre Mottrie
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Urology - Published
- 2023
31. Comparison of prostate cancer detection rate at targeted biopsy of hub and spoke centers mpMRI: experience matters
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Matteo DROGHETTI, Lorenzo BIANCHI, Caterina GAUDIANO, Beniamino CORCIONI, Arianna RUSTICI, Pietro PIAZZA, Carlo BERETTA, Eleonora BALESTRAZZI, Francesco COSTA, Alberto FERUZZI, Marco SALVADOR, Francesca GIUNCHI, Michelangelo FIORENTINO, Rita GOLFIERI, Riccardo SCHIAVINA, and Eugenio BRUNOCILLA
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Nephrology ,Urology - Abstract
Latest changes in European guidelines on prostate cancer determined a widespread of multiparametric magnetic resonance imaging (mpMRI) even in less experienced centers due to an increased demand. This could decrease diagnostic accuracy of targeted biopsy (TB) since image interpretation can be challenging and requires adequate and supervised training. Therefore we aimed to evaluate the PCa detection rate on TB according to mpMRI center's volume and experience.We retrospectively analyzed data of 737 patients who underwent mpMRI-TB at our institution. Patients were stratified according to mpMRI center: Hub (high volume100 exams/year with dedicated radiologists and supervised training) and Spoke center (low volume100 exams/year without dedicated radiologists and/or supervised training). Detection rate of PCa at TB and possible predictors of clinically significant PCa (csPCa) at TB. Differences in detection rate were explored using Chi-square test. Predictors of csPCa were evaluated through uni and multivariable logistic regression. The adjustment for casemix included: age, PSA, mpMRI center,lesion's location, PSA density, PI-RADS score and index lesion's size.449 (60.9%) and 288 (39.1%) patients underwent mpMRI at a Hub or Spoke center, respectively. Hub group had higher detection rate for both any (60.3% vs 48.1%) and csPCa (46.9% vs 38.7%; all p≤0.001). After stratifying for PI-RADS score, Hub group had higher detection rate for PI-RADS score 3 (csPCA 25.2% vs. 15.7%; p 0.04) and 4 (csPCa 65.7% vs. 45.7%; p 0.001). At multivariable analyses, receiving an mpMRI scan at a Spoke center was an independent predictor for csPCa on TB (OR 0.65; p 0.04).mpMRI performed in Hub centers provided a significantly higher PCa yield on TB. A dedicated team of experienced radiologist, a supervised training for mpMRI and a central revision of mpMRI performed in non-experienced centres are essential to avoid unnecessary and potentially harmful procedures.
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- 2023
32. Selective Suturing or Sutureless Technique in Robot-assisted Partial Nephrectomy: Results from a Propensity-score Matched Analysis
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Ruben De Groote, Peter Schatteman, Alexandre Mottrie, Marco Amato, Giuseppe Rosiello, Artur de Oliveira Paludo, Geert De Naeyer, Pietro Piazza, Elio Mazzone, Francesco Montorsi, Frederiek D'Hondt, Stefano Puliatti, Rui Farinha, and Camille Berquin
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medicine.medical_specialty ,Urology ,medicine.medical_treatment ,030232 urology & nephrology ,Renal function ,Nephron-sparing surgery ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Kidney cancer ,Renal cancer ,Renal mass ,Robotics ,Medicine ,Robotic surgery ,business.industry ,Acute kidney injury ,Perioperative ,medicine.disease ,Nephrectomy ,Surgery ,030220 oncology & carcinogenesis ,Propensity score matching ,business - Abstract
Background Despite efforts aimed at preserving renal function, the functional decline after robot-assisted partial nephrectomy (RAPN) is not negligible. To address the risk of intraparenchymal vessel injuries during renorrhaphy, with consequent loss of functional renal parenchyma, we introduced a new surgical technique for RAPN. Objective To compare perioperative patient outcomes between selective-suturing or sutureless RAPN (suRAPN) and standard RAPN (stRAPN). Design, setting, and participants Ninety-two consecutive patients undergoing RAPN for a renal mass performed by a high-volume surgeon at a European tertiary center were included. Propensity-score matching was used to account for baseline differences between suRAPN and stRAPN patients. Intervention RAPN using a selective-suturing or sutureless technique versus standard RAPN. Outcome measurements and statistical analysis Perioperative outcomes included operative time, blood loss, length of stay, and intraoperative and 30-d postoperative complications. We also evaluated trifecta achievement (warm ischemia time ≤25 min, negative surgical margins, and no perioperative complications) and the incidence of postoperative acute kidney injury (AKI). We applied χ2 tests, t tests, and Kruskal-Wallis tests to assess differences in perioperative outcomes between suRAPN and stRAPN. Results and limitations Overall, 29 patients (31%) were treated with suRAPN. Only one suRAPN patient experienced intraoperative complications (p = 0.9). Two suRAPN patients (6.9%) and four stRAPN patients (13.8%) experienced 30-d postoperative complications (p = 0.3). Operative time (110 vs 150 min; p Conclusions A selective-suturing or sutureless technique in RAPN is feasible and safe. Moreover, suRAPN is a lower-impact surgical procedure. We obtained promising results for trifecta and functional outcomes, but prospective randomized trials are needed to validate the impact of selective suturing or a sutureless technique on long-term functional outcomes. Patient summary We assessed a new technique in robotic surgery to remove part of the kidney because of kidney cancer. Our new technique involves selective suturing or no suturing of the area from where the tumor is removed. We found that the rate of complications did not increase and the operating time and length of hospital stay were shorter using this new technique.
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- 2022
33. The Use of Augmented Reality to Guide the Intraoperative Frozen Section During Robot-assisted Radical Prostatectomy
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Carlo Casablanca, Francesco Chessa, Michelangelo Fiorentino, Stefano Diciotti, Daniele Romagnoli, Simone Lodi, Riccardo Schiavina, A. Mottaran, Alexandre Mottrie, Stefano Puliatti, Caterina Gaudiano, Lorenzo Bianchi, Angelo Porreca, Matteo Droghetti, E. Molinaroli, Andrea Angiolini, Pietro Piazza, Emanuela Marcelli, Francesca Giunchi, Rita Golfieri, Laura Cercenelli, Barbara Bortolani, Bianchi L., Chessa F., Angiolini A., Cercenelli L., Lodi S., Bortolani B., Molinaroli E., Casablanca C., Droghetti M., Gaudiano C., Mottaran A., Porreca A., Golfieri R., Romagnoli D., Giunchi F., Fiorentino M., Piazza P., Puliatti S., Diciotti S., Marcelli E., Mottrie A., and Schiavina R.
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medicine.medical_specialty ,Surgical margin ,Intraoperative frozen section ,Prostate cancer ,Index Lesion ,Prostatectomy ,business.industry ,Urology ,medicine.medical_treatment ,Augmented reality ,Three-dimensional reconstruction ,medicine.disease ,Dissection ,Propensity score matching ,Robot-assisted radical prostatectomy ,medicine ,Radiology ,Positive Surgical Margin ,Stage (cooking) ,business - Abstract
Background Multiparametric magnetic resonance imaging (mpMRI) can guide the surgical plan during robot-assisted radical prostatectomy (RARP), and intraoperative frozen section (IFS) can facilitate real-time surgical margin assessment. Objective To assess a novel technique of IFS targeted to the index lesion by using augmented reality three-dimensional (AR-3D) models in patients scheduled for nerve-sparing RARP (NS-RARP). Design, setting, and participants Between March 2019 and July 2019, 20 consecutive prostate cancer patients underwent NS-RARP with IFS directed to the index lesion with the help of AR-3D models (study group). Control group consists of 20 patients matched with 1:1 propensity score for age, clinical stage, Prostate Imaging Reporting and Data System score v2, International Society of Urological Pathology grade, prostate volume, NS approach, and prostate-specific antigen in which RARP was performed by cognitive assessment of mpMRI. Surgical procedure In the study group, an AR-3D model was superimposed to the surgical field to guide the surgical dissection. Tissue sampling for IFS was taken in the area in which the index lesion was projected by AR-3D guidance. Measurements Chi-square test, Student t test, and Mann-Whitney U test were used to compare, respectively, proportions, means, and medians between the two groups. Results and limitations Patients in the AR-3D group had comparable preoperative characteristics and those undergoing the NS approach were referred to as the control group (all p ≥ 0.06). Overall, positive surgical margin (PSM) rates were comparable between the two groups; PSMs at the level of the index lesion were significantly lower in patients referred to AR-3D guided IFS to the index lesion (5%) than those in the control group (20%; p = 0.01). Conclusions The novel technique of AR-3D guidance for IFS analysis may allow for reducing PSMs at the level of the index lesion. Patient summary Augmented reality three-dimensional guidance for intraoperative frozen section analysis during robot-assisted radical prostatectomy facilitates the real-time assessment of surgical margins and may reduce positive surgical margins at the index lesion.
- Published
- 2021
34. Does using a laser improve outcomes of conventional circumcision in adult and children populations? Results from a systematic review and meta-analysis
- Author
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Simone Scarcella, Yu Xi Terence Law, Carlo Andrea Bravi, Pietro Piazza, Flavio L. Heldwein, Piero Ronchi, Vito Lacetera, Valerio Beatrici, Vineet Gauhar, and Daniele Castellani
- Subjects
Endocrinology ,Reproductive Medicine ,Urology ,Endocrinology, Diabetes and Metabolism - Abstract
Male circumcision is a well-known old surgery, and several recently developed techniques have been scaled up, including the introduction of laser technology, as alternative approaches to overcome morbidity of conventional surgery scalpel/suture method OBJECTIVES: We aimed to perform a systematic review and meta-analysis of studies comparing laser circumcision versus conventional circumcision technique in terms of perioperative outcomes and efficacy (complications, unacceptable appearance, reoperation rate) both in children and adults.This review was performed following the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework. Continuous variables were analyzed using the inverse variance of the mean difference with a random effect, 95% confidence interval (CI), and p-value. The incidence of complications, unacceptable appearance, and reoperation rate were pooled using the Cochran-Mantel-Haenszel Method with the random effect model and reported as odds ratio (OR), 95% CI, and p-value. Significance was set at p-value ≤0.05 and 95%CI.Seven studies were included. In comparison to the conventional circumcision, laser circumcision shoved lower visual analogue score at 24-h, and 7 days after surgery, a lower rate of overall complication rate (OR 0.33, 95% CI 0.24-0.47, p 0.001), scarring (OR 0.09, 95% CI 0.02, 0.41, p = 0.002), and unacceptable appearance (OR 0.09, 95% CI 0.05, 0.15, p 0.001). We found no statistically significant difference in surgical time, and incidence of bleeding, infection, wound dehiscence, and reoperation rate.Our review infers that laser-assisted circumcision is certainly a safe and strong contender as the procedure of choice in both children and adult populations.
- Published
- 2022
35. Robot-assisted simple prostatectomy with the novel HUGO™ RAS System: feasibility, setting, and perioperative outcomes
- Author
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Angelo MOTTARAN, Marco PACIOTTI, Carlo A. BRAVI, Luca SARCHI, Luigi NOCERA, Adele PIRO, Rui FARINHA, Pieter DE BACKER, Pietro PIAZZA, Kim PAUWAERT, Manoe van HERWAARDEN, Ruben DE GROOTE, Alexandre MOTTRIE, and Geert De NAEYER
- Subjects
Nephrology ,Urology - Abstract
Robot-assisted simple prostatectomy (RASP) has demonstrated better peri-operative outcomes as compared to open simple prostatectomy. However, RASP is still limited by platform availability and cost-effectiveness issues. The new surgical robots increasing competition may spread the robotic approach also in non-oncological fields.We reported the first RASP executed in Europe at OLV Hospital (Aalst, BE) performed with the novel HUGO™ Robot-Assisted Surgery (RAS) System. The platform consists of four independent carts, an open console, and a system tower equipped for both laparoscopic and robotic surgery. Our main goal was to demonstrate the technical feasibility of RASP with the novel HUGO™ RAS along with its safety in terms of perioperative outcomes and complications. We also aimed to describe our surgical setup. We collected patient's baseline characteristics, intraoperative and perioperative complications, postoperative outcomes, docking time, operative time, clashing of the instruments, or technical errors of the system.The procedure was performed in a 72 years old male with a prostate volume of 155g at preoperative imaging. No need for conversion to open/laparoscopic surgery and/or for additional port placement was required. No intraoperative complications, instrument clashes, or failure of the system that compromised the completion of the surgery were recorded. Docking, operative, and console times were 9, 150, and 120 minutes, respectively. The catheter was removed on the second postoperative day. No postoperative complications occurred. The postoperative uroflowmetry revealed a maximum flow of 26.2 ml/s, without post-void residual volume.Robot-assisted simple prostatectomy with the HUGO™ RAS System is a feasible and safe procedure in terms of perioperative outcomes and complications. Our setup allowed for a rapid docking procedure and a smoothly completion of the surgery.
- Published
- 2022
36. A prospective, randomized, multi-centre trial on the efficiency and effectiveness of proficiency based progression robotic surgical skills training
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R. De Groote, M. Lassel, F. Migliorini, Andrea Mari, Rui Farinha, Giuseppe Rosiello, S. Forte, P. Kiely, S. Puliatti, L. Langhendries, Alexandre Mottrie, Bernardo Rocco, Marco Amato, Luca Bianchi, Artur de Oliveira Paludo, Pietro Piazza, Anthony G. Gallagher, B. Van Cleynenbreugel, and E. Mazzone
- Subjects
medicine.medical_specialty ,business.industry ,Urology ,Surgical skills ,Medicine ,Medical physics ,Multi centre ,business - Published
- 2021
37. The Surgical Learning Curve for Biochemical Recurrence After Robot-assisted Radical Prostatectomy
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Carlo A, Bravi, Paolo, Dell'Oglio, Elio, Mazzone, Marcio C, Moschovas, Ugo, Falagario, Pietro, Piazza, Simone, Scarcella, Christopher, Bednarz, Luca, Sarchi, Stefano, Tappero, Sophie, Knipper, Ruben, De Groote, Daniel, Sjoberg, Riccardo, Schiavina, Nazareno, Suardi, Carlo, Terrone, Riccardo, Autorino, Giuseppe, Carrieri, Andrea, Galosi, Antonio, Galfano, Alberto, Briganti, Francesco, Montorsi, Vipul, Patel, Andrew, Vickers, and Alexandre, Mottrie
- Subjects
Oncology ,Urology ,Radiology, Nuclear Medicine and imaging ,Surgery - Abstract
Improved cancer control with increasing surgical experience-the learning curve-was demonstrated for open and laparoscopic prostatectomy. In a prior single-center study, we found that this might not be the case for robot-assisted radical prostatectomy (RARP).To investigate the relationship between prior experience of a surgeon and biochemical recurrence (BCR) after RARP.We retrospectively analyzed the data of 8101 patients with prostate cancer treated with RARP by 46 surgeons at nine institutions between 2003 and 2021. Surgical experience was coded as the total number of robotic prostatectomies performed by the surgeon before the patient operation.We evaluated the relationship of prior surgeon experience with the probability of BCR adjusting for preoperative prostate-specific antigen, pathologic stage, grade, lymph-node involvement, and year of surgery.Overall, 1047 patients had BCR. The median follow-up for patients without BCR was 33 mo (interquartile range: 14, 61). After adjusting for case mix, the relationship between surgical experience and the risk of BCR after surgery was not statistically significant (p = 0.2). The 5-yr BCR-free survival rates for a patient treated by a surgeon with prior 10, 250, and 1000 procedures performed were, respectively, 82.0%, 82.7%, and 84.8% (absolute difference between 10 and 1000 prior procedures: 1.6% [95% confidence interval: 0.4%, 3.3%). Results were robust to a number of sensitivity analyses.These findings suggest that, as opposed to open and laparoscopic radical prostatectomy, surgeons performing RARP achieve adequate cancer control in the early phase of their career. Further research should explore why the learning curve for robotic surgery differs from prior findings for open and laparoscopic radical prostatectomy. We hypothesize that surgical education, including simulation training and the adoption of objective performance metrics, is an important mechanism for flattening the learning curve.We investigated the relationship between biochemical recurrence after robot-assisted radical prostatectomy and surgeon's experience. Surgeons at an early stage of their career had similar outcomes to those of more experienced surgeons, and we hypothesized that surgical education in robotics might be an important determinant of such a finding.
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- 2022
38. Robot-assisted radical prostatectomy feasibility and setting with the Hugo™ robot-assisted surgery system
- Author
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Luca Sarchi, Angelo Mottaran, Carlo Andrea Bravi, Marco Paciotti, Rui Farinha, Pietro Piazza, Stefano Puliatti, Ruben De Groote, Geert De Naeyer, Anthony Gallagher, Alberto Breda, and Alexandre Mottrie
- Subjects
Male ,Prostatectomy ,robot-assisted surgery ,Urology ,docking ,feasibility ,Hugo RAS ,RARP ,Prostate ,Robotics ,Treatment Outcome ,Robotic Surgical Procedures ,Humans ,Feasibility Studies - Published
- 2022
39. Assessing pentafecta achievement after robot-assisted radical cystectomy and its association with surgical experience: Results from a high-volume institution
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Pietro Piazza, Carlo Andrea Bravi, Stefano Puliatti, Giovanni Enrico Cacciamani, Sophie Knipper, Marco Amato, Paolo Dell'Oglio, Elio Mazzone, Giuseppe Rosiello, Rui Farinha, Luca Sarchi, Simone Scarcella, Pawel Wisz, Riccardo Schiavina, Dries Develtere, Pieter De Backer, Ruben De Groote, Frederiek D'Hondt, and Alexandre Mottrie
- Subjects
Male ,Pentafecta ,Complications ,Urology ,Margins of Excision ,Robot assisted cystectomy ,Robotics ,Urinary Diversion ,Cystectomy ,Oncologic outcomes ,Postoperative Complications ,Treatment Outcome ,Oncology ,Robotic Surgical Procedures ,Urinary Bladder Neoplasms ,Surgical experience ,Intracorporeal urinary diversion ,Minimally invasive surgery ,Female ,Humans ,Retrospective Studies - Abstract
Objectives: Radical cystectomy (RC) represents the gold standard treatment for high-risk bladder cancer. Despite evidence suggesting that surgical experience correlates with perioperative and oncologic outcomes of robot-assisted RC (RARC), validated tools to assess its quality objectively are lacking. We aimed to evaluate the impact of RC-Pentafecta (absence of early major complications, absence of urinary diversion related sequelae at = 16 lymph nodes at final pathology and absence of clinical recurrence at = 3 (HR 1.71, P = 0.04) and current smoking status (HR 2.4, P = 0.006) were significant predictors of overall mortality. At multivariable logistic regression surgical experience (OR 1.2, P < 0.001), age (OR 0.93, P = 0.04), previous prostate surgery (OR 0.7, P = 0.02) and pT >= 3 (OR 0.8, P = 0.03) were independent predictors of RC-Pentafecta achievement. A linear relationship between surgical experience and RC-Pentafecta achievement, without reaching a plateau, was observed. Conclusions: RC-Pentafecta is a valuable tool to assess surgical quality of RARC and the experience of the center where the surgery is performed and may be used to identify "referral" centers for treatment of high-risk bladder cancer. (c) 2022 Elsevier Inc. All rights reserved.
- Published
- 2022
40. MP57-17 THE COLLAR TECHNIQUE FOR APICAL DISSECTION DURING ROBOT-ASSISTED RADICAL PROSTATECTOMY: UPDATED SERIES AFTER FIVE YEARS FROM ITS INTRODUCTION
- Author
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Angelo Mottaran, Carlo Andrea Bravi, Luca Sarchi, Pietro Piazza, Fernando Gonzalez Meza, Marco Corsetti, Sophie Knipper, Marco Paciotti, Marco Amato, Rui Farinha, Stefano Puliatti, Simone Scarcella, Celine Sinatti, Geert De Naeyer, Ruben De Groote, and Alexandre Mottrie
- Subjects
Urology - Published
- 2022
41. MP41-06 A PROSPECTIVE, RANDOMIZED, MULTI-CENTRE TRIAL ON THE EFFICIENCY AND EFFECTIVENESS OF PROFICIENCY BASED PROGRESSION ROBOTIC SURGICAL SKILLS TRAINING
- Author
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Stefano Puliatti, Marco Amato, Rui Farinha, Artur Paludo, Giuseppe Rosiello, Ruben De Groote, Laura Langhendries, Maxime Lassel, Andrea Mari, Lorenzo Bianchi, Pietro Piazza, Ben Van Cleynenbreugel, Elio Mazzone, Kobe Van Hove, Simon Meganck, Léonore Maertens, Louis-Philippe Boret, Filippo Migliorini, Saverio Forte, Bernardo Rocco, Salvatore Micali, Alexandre Mottrie, and Anthony Gallagher
- Subjects
Urology - Published
- 2022
42. PD37-08 3D MODELING OF RENAL TUMORS FOR PLANNING AND GUIDANCE OF SELECTIVE CLAMPING AND UCS SUTURE
- Author
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Riccardo Schiavina, Lorenzo Bianchi, Laura Cercenelli, Barbara Bortolani, Pietro Piazza, Sara Boschi, Matteo Droghetti, Angelo Mottaran, Francesco Costa, Francesco Chessa, Amelio Ercolino, Andrea Angiolini, Simone Lodi, Alessandro Pissavini, Luca Fontanella, Luca Spinozzi, Riccardo Melloni, Federico Bevilacqua, Danilo Cangemi, Caterina Gaudiano, Beniamino Corcioni, Rita Golfieri, Emanuala Marcelli, and Eugenio Brunocilla
- Subjects
Urology - Published
- 2022
43. MP50-12 BODY MASS INDEX, OBESITY AND ACUTE KIDNEY INJURY AFTER ROBOT-ASSISTED PARTIAL NEPHRECTOMY: RESULTS FROM A HIGH-VOLUME ROBOTIC CENTER
- Author
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Marco Paciotti, Carlo Andrea Bravi, Luca Sarchi, Angelo Mottaran, Pietro Piazza, Alberto Martini, Fernando Gonzalez Meza, Marco Corsetti, Sophie Knipper, Marco Amato, Rui Farinha, Stefano Puliatti, Simone Scarcella, Celine Sinatti, Geert De Naeyer, Ruben De Groote, and Alexandre Mottrie
- Subjects
Urology - Published
- 2022
44. MP41-13 DOES QUALITY ASSURED ELEARNING PROVIDE ADEQUATE PREPARATION FOR ROBOTIC SURGICAL SKILLS; A PROSPECTIVE, RANDOMIZED AND MULTI-CENTER STUDY
- Author
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Stefano Puliatti, Marco Amato, Rui Farinha, Artur Paludo, Giuseppe Rosiello, Ruben De Groote, Andrea Mari, Lorenzo Bianchi, Pietro Piazza, Ben Van Cleynenbreugel, Elio Mazzone, Simon Meganck, Léonore Maertens, Louise Callens, Filippo Migliorini, Saverio Forte, Bernardo Rocco, Salvatore Micali, Alexandre Mottrie, and Anthony Gallagher
- Subjects
Urology - Published
- 2022
45. PD45-11 PERI-OPERATIVE OUTCOMES OF OPEN VERSUS ROBOT-ASSISTED SIMPLE PROSTATECTOMY: RESULTS FROM TWO HIGH-VOLUME CENTRES
- Author
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Simone Scarcella, Angelo Mottaran, Carlo Andrea Bravi, Luca Sarchi, Pietro Piazza, Marco Paciotti, Marco Amato, Stefano Puliatti, Paolo Umari, Carlo Giuloni, Giulio Milanese, Lucio Dell’Atti, Daniele Castellani, Edward Lambert, Jonathan Vollemaere, Dries Develtere, Ralf Veys, Marijn Goossens, Jolien Van der Jeugt, Andrea Galosi, and Alexandre Mottrie
- Subjects
Urology - Published
- 2022
46. MP50-13 FEASIBILITY AND OPTIMAL SETTING OF ROBOT-ASSISTED PARTIAL NEPHRECTOMY USING A NOVEL MULTI-ARM, MODULAR ROBOTIC PLATFORM
- Author
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Carlo Andrea Bravi, Luca Sarchi, Angelo Mottaran, Pietro Piazza, Fernando Gonzalez Meza, Marco Corsetti, Sophie Knipper, Marco Paciotti, Marco Amato, Rui Farinha, Stefano Puliatti, Simone Scarcella, Geert De Naeyer, Ruben De Groote, and Alexandre Mottrie
- Subjects
Urology - Published
- 2022
47. MP48-17 ONCOLOGICAL OUTCOMES IN PATIENTS WITH RECURRENT PROSTATE CANCER STAGED WITH PSMA PET/CT: RESULTS FROM 3 EUROPEAN TERTIARY CENTERS
- Author
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Matteo Droghetti, Lorenzo Bianchi, Francesco Costa, Eleonora Balestrazzi, Francesco Chessa, Francesco Ceci, Riccardo Mei, Andrea Farolfi, Paolo Castellucci, Pietro Piazza, Stefano Puliatti, Alessandro Larcher, Giorgio Gandaglia, Alexandre Mottrie, Alberto Briganti, Stefano Fanti, Francesco Montorsi, Riccardo Schiavina, and Eugenio Brunocilla
- Subjects
Urology - Published
- 2022
48. Clamping Techniques for Partial Nephrectomy
- Author
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Ruben De Groote, Pietro Piazza, Rui Farinha, and Alexandre Mottrie
- Published
- 2022
49. Concomitant robot-assisted laparoscopic surgeries for upper and lower urinary tract malignancies: a comprehensive literature review
- Author
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Dries Develtere, Jeremy Yuen-Chun Teoh, Hannah Van Puyvelde, Ruben De Groote, Marco Amato, Alexandre Mottrie, Rui Farinha, L. Sarchi, Camille Berquin, Geert De Naeyer, Sophie Knipper, Sérgio Augusto Skrobot, Simone Scarcella, E. Palagonia, Giulio Milanese, P. Umari, Daniele Castellani, Carlo Giulioni, Lucio Dell'Atti, Stefano Puliatti, Carlo Andrea Bravi, Pietro Piazza, Maria Peraire Lores, Celine Sinatti, and Andrea B. Galosi
- Subjects
Laparoscopic surgery ,medicine.medical_specialty ,Robotic Surgery ,medicine.medical_treatment ,Urinary system ,Health Informatics ,Cystectomy ,Surgical planning ,Nephrectomy ,Robotic Surgical Procedures ,medicine ,Humans ,Robotic surgery ,Combined Surgery ,Prostatectomy ,Partial Nephrectomy ,business.industry ,Robotic Multi-visceral Resections ,General surgery ,Robotics ,Urinary Bladder Neoplasms ,Concomitant ,Laparoscopy ,Surgery ,business - Abstract
Worldwide, we have witnessed an expansion of robot-assisted laparoscopic surgery (RALS) and thanks to the global adoption of high-resolution diagnostic imaging technologies, an increased incidence of newly diagnosed prostatic, renal and bladder cancers has been recorded with concurrent second primary urological cancer diagnoses increasing by 1.5%. Diverse authors have reported their findings concerning synchronous multi-visceral malignances robotic treatment within the scientific literature. The aim of this study is to comprehensively review all reported articles describing concurrent upper and lower RALS using a singular robotic port scheme within the same intervention for renal malignances and concomitant prostatic or bladder cancers. To the best of our knowledge and vigorous literature search, this is the first study that comprehensively evaluates and reports all combined upper and lower urinary tract surgeries published so far. In carefully selected patients, thanks to multidisciplinary preoperative assessment and surgical planning a combined robotic approach can reduce the morbidity, complications, hospital admissions and the overall length of hospitalization.
- Published
- 2022
50. A nomogram to predict pathologic T2 stage in candidates to robot-assisted radical prostatectomy with iT3 prostate cancer on preoperative multiparametric MRI: results from a multi-institutional collaboration
- Author
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Carlo A. BRAVI, Elio MAZZONE, Paolo DELL’OGLIO, Marcio COVAS MOSCHOVAS, Alberto MARTINI, Giuseppe ROSIELLO, Pietro PIAZZA, Angelo MOTTARAN, Marco PACIOTTI, Luca SARCHI, Stefano PULIATTI, Sophie KNIPPER, Ruben DE GROOTE, Riccardo SCHIAVINA, Bernando ROCCO, Antonio GALFANO, Alberto BRIGANTI, Francesco MONTORSI, Vipul PATEL, and Alexandre MOTTRIE
- Subjects
Nephrology ,Urology - Abstract
In candidates to robot-assisted radical prostatectomy (RARP) for locally advanced (iT3) prostate cancer on preoperative MRI, the performance of MRI for local staging is demonstrably suboptimal, and currently no prediction tools that might help surgeons in preoperative planning are available. We analyzed data of 685 patients with iT3 prostate cancer (PCa) who received RARP at five participating institutions between 2012 and 2020. Multivariable logistic regression model investigated predictors of pT2 disease among variables available before surgery (i.e: preoperative PSA, biopsy ISUP group, clinical T stage on digital rectal examination-DRE, prostate volume on MRI, PIRADS score of index lesion, seminal vesicles invasion on MRI, location suspicious for T3 disease on MRI). Coefficients from such model were used to build a nomogram to predict organ-confined (i.e. pT2) disease on final pathology. Internal validation was performed using the leave-one-out cross-validation. Median (interquartile range) preoperative PSA was 7.5 (5.2, 11.9) ng/ml, and 280 (41%) and 216 (32%) had biopsy ISUP group 4-5 disease and palpable disease on DRE, respectively. Preoperative MRI was suspicious for iT3 disease on the mid-posterior part of the gland in 485 (71%) men, and 527 (77%) men had a PIRADS 5 lesion. After surgery, a total of 192 (28%) patients had organ-confined disease (i.e. pT2). All variables fitted into the model and were considered to build the nomogram. After internal validation, the AUC was 73% (95% confidence interval: 69%, 77%). Awaiting external validation, we provided data that is relevant to optimize surgical strategy in men diagnosed with iT3 PCa who are scheduled for RARP.
- Published
- 2022
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