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H. Jokinen työryhmän jäsenenä. Introduction: Numerous diagnostic criteria have tried to tackle the variability in clinical manifestations and problematic diagnosis of vascular cognitive impairment (VCI) but none have been universally accepted. These criteria have not been readily comparable, impacting on clinical diagnosis rates and in turn prevalence estimates, research, and treatment. Methods: The Vascular Impairment of Cognition Classification Consensus Study (VICCCS) involved participants (81% academic researchers) from 27 countries in an online Delphi consensus study. Participants reviewed previously proposed concepts to develop new guidelines. Results: VICCCS had a mean of 122 (98-153) respondents across the study and a 67% threshold to represent consensus. VICCCS redefined VCI including classification of mild and major forms of VCI and subtypes. It proposes new standardized VCI-associated terminology and future research priorities to address gaps in current knowledge. Discussion: VICCCS proposes a consensus-based updated conceptualization of VCI intended to facilitate standardization in research. (C) 2016 the Alzheimer's Association. Published by Elsevier Inc. All rights reserved.

Robotic surgery has gained acceptance for surgical use but few data exist regarding its value in thoracic procedures. The aim of this study is to report our experience with totally robotic thoracic resections. From June 2001 to June 2009, 38 consecutive totally robotic lung resections were performed in two different hospitals by a single surgeon. All data was prospectively collected in a dedicated database, and reviewed retrospectively. A total of 32 lobectomies, three bilobectomies, and three pneumonectomies were performed. The indication was a malignant tumor in 28 cases. There were nine cases with benign pathology. Mean operating time was 209 min (range: 105-380 min). Six conversions were required (15.8%) and there was one postoperative death (2.6%). Four postoperative complications occurred (10.5%). Median hospital stay was 10 days (range: 3-24 days). After a median follow-up of 42 months, 80% of patients with stage I disease are alive without recurrence. Advanced thoracic procedures can be performed safely using the robotic system. In this heterogeneous series of lung resections, we report low mortality and morbidity. The robotic approach can achieve a good dissection in difficult to reach areas, making it particularly useful for oncologic resections.

Hypothesis Robotic technology is the most advanced development of minimally invasive surgery, but there are still some unresolved issues concerning its use in a clinical setting. Design The study describes the clinical experience of the Department of General Surgery, Misericordia Hospital, Grosseto, Italy, in robot-assisted surgery using the da Vinci Surgical System. Results Between October 2000 and November 2002, 193 patients underwent a minimally invasive robotic procedure (74 men and 119 women; mean age, 55.9 years [range, 16-91 years]). A total of 207 robotic surgical operations, including abdominal, thoracic and vascular procedures, were performed; 179 were single procedures, and 14 were double (2 operations on the same patient). There were 4 conversions to open surgery and 3 to conventional laparoscopy (conversion rate, 3.6%; 7 of 193 patients). The perioperative morbidity rate was 9.3% (18 of 193 patients), and 6 patients (3.1%) required a reoperation. The postoperative mortality rate was 1.5% (3 of 193 patients). Conclusions Our preliminary experience at a large community hospital suggests that robotic surgery is feasible in a clinical setting. Its daily use is safe and easily managed, and it expands the applications of minimally invasive surgery. However, the best indications still have to be defined, and the cost-benefit ratio must be evaluated. This report could serve as a basis for a future prospective, randomized trial.