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1. Recurrent acute pancreatitis prevention by the elimination of alcohol and cigarette smoking (REAPPEAR): protocol of a randomised controlled trial and a cohort study

Author

Klementina Ocskay, Márk Félix Juhász, Nelli Farkas, Noémi Zádori, Lajos Szakó, Zsolt Szakács, Andrea Szentesi, Bálint Erőss, Emőke Miklós, Antal Zemplényi, Béla Birkás, Árpád Csathó, István Hartung, Tamás Nagy, László Czopf, Ferenc Izbéki, László Gajdán, Mária Papp, László Czakó, Dóra Illés, Marco V Marino, Antonello Mirabella, Ewa Małecka-Panas, Hubert Zatorski, Yaroslav Susak, Kristina Opalchuk, Gabriele Capurso, Laura Apadula, Cristian Gheorghe, Ionut Adrian Saizu, Ole H Petersen, Enrique de-Madaria, Jonas Rosendahl, Andrea Párniczky, and Péter Hegyi

Subjects
substance misuse, Gastroenterology and Hepatology, General Medicine, preventive medicine, pancreatic disease
Abstract

Background/objectivesAcute recurrent pancreatitis (ARP) due to alcohol and/or tobacco abuse is a preventable disease which lowers quality of life and can lead to chronic pancreatitis. The REAPPEAR study aims to investigate whether a combined patient education and cessation programme for smoking and alcohol prevents ARP.Methods and analysisThe REAPPEAR study consists of an international multicentre randomised controlled trial (REAPPEAR-T) testing the efficacy of a cessation programme on alcohol and smoking and a prospective cohort study (REAPPEAR-C) assessing the effects of change in alcohol consumption and smoking (irrespective of intervention). Daily smoker patients hospitalised with alcohol-induced acute pancreatitis (AP) will be enrolled. All patients will receive a standard intervention priorly to encourage alcohol and smoking cessation. Participants will be subjected to laboratory testing, measurement of blood pressure and body mass index and will provide blood, hair and urine samples for later biomarker analysis. Addiction, motivation to change, socioeconomic status and quality of life will be evaluated with questionnaires. In the trial, patients will be randomised either to the cessation programme with 3-monthly visits or to the control group with annual visits. Participants of the cessation programme will receive a brief intervention at every visit with direct feedback on their alcohol consumption based on laboratory results. The primary endpoint will be the composite of 2-year all-cause recurrence rate of AP and/or 2-year all-cause mortality. The cost-effectiveness of the cessation programme will be evaluated. An estimated 182 participants will be enrolled per group to the REAPPEAR-T with further enrolment to the cohort.Ethics and disseminationThe study was approved by the Scientific and Research Ethics Committee of the Hungarian Medical Research Council (40394-10/2020/EÜIG), all local ethical approvals are in place. Results will be disseminated at conferences and in peer-reviewed journals.Trial registration numberNCT04647097

Published
2022

2. Safety and Feasibility of Robotic-Assisted Drainage of Symptomatic Pancreatic Pseudocysts: A Case-Series Analysis (with video)

Author

Marco Vito Marino, Antonello Mirabella, O.A. Potapov, Mario Adelfio Latteri, Gianpaolo Vaccarella, Andrzej L. Komorowski, Adrian Chiow Kah Heng, Marino M.V., Chiow A.K.H., Mirabella A., Potapov O., Vaccarella G., Latteri M., and Komorowski A.L.

Subjects
medicine.medical_specialty, Pancreatic pseudocyst, Robotic assisted, Robotic cystogastrostomy, Pancreatic fluid collections, Robotic Surgical Procedures, Cystogastrostomy, Pancreatic Pseudocyst, medicine, Humans, Cyst, Robotic surgery, Drainage, Retrospective Studies, business.industry, Mortality rate, medicine.disease, Pancreatic pseudocysts, Surgery, Settore MED/18 - Chirurgia Generale, Treatment Outcome, Pancreatitis, Feasibility Studies, Neoplasm Recurrence, Local, business
Abstract

Background: The surgical treatment of pancreatic pseudocysts (PPs) in patients who fail nonoperative management has evolved from aggressive open to a minimally invasive approach. The application of robotic surgery in this setting is scarcely reported. The aim of this study is to analyze the safety and feasibility of the robotic approach to pancreatic pseudocyst drainage. Methods: A single centre retrospective review of consecutive patients undergoing robotic-assisted pancreatic pseudocyst surgeries in an academic tertiary institution was performed. Results: There were 14 patients studied, of whom 10 underwent cystogastrostomy and 4 Roux-En- Y cystojejunostomy. Eight patients had gallstone pancreatitis and 3 patients alcoholic pancreatitis. The mean size of cyst was 8.9 +-1cm and 57.1% located at the pancreatic body. The overall operative time of the procedure was 135 +-34 minutes. There were no open conversions. The overall success rate was 92.8%, while the primary success rate 85.7%. The major morbidity rate was 14.3% and there was no 30-day mortality. The mean post-operative hospital stay was 7 +-3 days with one recurrence of the pancreatic pseudocyst on follow-up requiring endoscopic drainage without further recurrence. Conclusions: The robotic approach for the drainage of symptomatic pancreatic pseudocyst is safe and feasible and can be considered as a viable modality for operative intervention in well-selected patients.

Published
2021

3. Rate of Post-Operative Pancreatic Fistula after Robotic-Assisted Pancreaticoduodenectomy with Pancreato-Jejunostomy versus Pancreato-Gastrostomy: A Retrospective Case Matched Comparative Study

Author

Antonello Mirabella, Marco Vito Marino, Adrian Kah Heng Chiow, Andrzej L. Komorowski, and Gianpaolo Vaccarella

Subjects
medicine.medical_specialty, Robotic assisted, medicine.medical_treatment, Anastomosis, Article, robotic pancreatic surgery, 03 medical and health sciences, 0302 clinical medicine, pancreatic fistula, Blood loss, Medicine, Post operative, business.industry, General Medicine, Pancreaticoduodenectomy, medicine.disease, Gastrostomy, Surgery, Pancreatic fistula, pancreato-gastrostomy, 030220 oncology & carcinogenesis, Jejunostomy, 030211 gastroenterology & hepatology, business
Abstract

Background: Different techniques of pancreatic anastomosis have been described, with inconclusive results in terms of pancreatic fistula reduction. Studies comparing robotic pancreaticogastrostomy (PG) and pancreaticojejunostomy (PJ) are scarcely reported. Methods: The present study analyzes the outcomes of two case-matched groups of patients who underwent PG (n = 20) or PJ (n = 40) after pancreaticoduodenectomy. The primary aim was to compare the rate of post-operative pancreatic fistula. Results: Operative time (375 vs. 315 min, p = 0.34), estimated blood loss (270 vs. 295 mL, p = 0.44), and rate of clinically relevant post-operative pancreatic fistula (12.5% vs. 10%, p = 0.82) were similar between the two groups. PJ was associated with a higher rate of intra-abdominal collections (7.5% vs. 0%, p = 0.002), but lower post-pancreatectomy hemorrhage (2.5% vs. 10%, p = 0.003). PG was associated with a lower rate of post-operative pancreatic fistula (POPF) (33.3% vs. 50%, p = 0.003) in the high-risk group of patients. Conclusions: The outcomes of post-operative pancreatic fistula are comparable between the two reconstruction techniques. PG may have a lower incidence of POPF in patients with high-risk of pancreatic fistula.

Published
2021
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4. Complications profile after robotic pancreatic surgery

Author

Marino, Marco V., Mitus, Jerzy, Gianpaolo Vaccarella, Potapov, Oleksii, and Antonello Mirabella

Subjects
Zdrowie, chirurgia robotowa, Medycyna, complications, robotic surgery, powikłania, chirurgia trzustki, pancreatic surgery, Psychologia
Abstract

Introduction: General acceptance of the robotic platform in pancreatic surgery is poor. One of the main concerns regarding this technique is that the likelihood of complications is greater compared to other approaches. Material and Methods: We performed a retrospective analysis of our database on robotic pancreatic surgery. Results: A total of 22 patients (12 male) underwent robotic pancreatic surgery. 6 pancreatoduodenectomies (PD 27.3%), 12 distal pancreatectomies (DP 54.5%), 2 tumor enucleations (9.1%) and 2 pseudocyst-gastrostomy (9.1%) were performed. The overall operative time was 425 (390–620) min, the median blood loss was 150 ml (70–600). We observed 10/22 (45.4%) overall postoperative morbidity, with 4 grade III to V complications according to the Clavien-Dindo classifi cation system. The Clinically relevant pancreatic fi stula rate was 3/22 (13.6%): 2 in DP group, 1 in the PD group. The reoperation rate was 2/22, one in the PD group, the other in the PG group; while the readmission rate was 18.6%. There was no postoperative death during the 30 days post surgery. Conclusion: Robotic pancreatic surgery seems to be safe and feasible and it is associated with an acceptable risk of complications, low estimated blood loss and low conversion rate. Wprowadzenie: Ogólny stopień akceptacji dla stosowania chirurgii robotowej w chirurgii trzustki jest niski. Jedną z podstawowych barier dla wprowadzania tej techniki jest obawa przed większym niż w przypadku innych technik operacyjnych ryzykiem wystąpienia powikłań pooperacyjnych. Materiał i metody: Przeprowadzono retrospektywną analizę danych szpitalnych dotyczących zabiegów operacyjnych trzustki z dostępu robotowego. Wyniki: Ogółem operowano 22 chorych (w tym 12 mężczyzn) z zastosowaniem systemu robotowego do operacji trzustki. Wykonano 6 pankreatoduodenektomii (27,3%), 12 pankreatektomii obwodowych (54,5%), 2 wyłuszczenia guza (9,1%) oraz 2 zespolenia pseudotorbieli trzustki ze światłem żołądka (9,1%). Czas operacji wyniósł średnio 425 min (390–620 min), a mediana utraty krwi – 150 ml (70–600 ml). Powikłania pooperacyjne stwierdzono u 10 z 22 chorych (45,4%) przy czym u 4 wystąpiły powikłania w stopniu III–V według skali Claviena-Dindo. Klinicznie istotna przetoka trzustkowa wystąpiła u 3 z 22 chorych (13,6%), w tym u 2 chorych po resekcji obwodowej trzustki i u 1 po pankreatoduodenektomii. Reoperacje były konieczne u 2 z 22 chorych: jedna po zabiegu pankreatoduodenektomii i jedna po zespoleniu pseudotorbieli ze światłem żołądka. Odsetek ponownych przyjęć do szpitala wyniósł 18,6%. Nie stwierdzono zgonów w okresie 30 dni po zabiegu operacyjnym. Wnioski: Robotowa chirurgia trzustki wydaje się być techniką bezpieczną i wykonalną przy akceptowalnym ryzyku powikłań pooperacyjnych, niskiej śródoperacyjnej utracie krwi oraz niskim ryzyku konwersji.

Published
2020

5. Robotic‐assisted repair of iatrogenic common bile duct injury after laparoscopic cholecystectomy: Surgical technique and outcomes

Author

Marco Marino, Antonello Mirabella, Domenico Guarrasi, Andrzej L. Komorowski, and Massimo Lupo

Subjects
Adult, Male, Reoperation, medicine.medical_specialty, Robotic assisted, medicine.medical_treatment, Biophysics, Biliary injury, 03 medical and health sciences, 0302 clinical medicine, Robotic Surgical Procedures, medicine, Humans, Cholecystectomy, Robotic surgery, Prospective Studies, Intraoperative Complications, Laparoscopic cholecystectomy, Aged, Common Bile Duct, Common bile duct, business.industry, Bile duct, Middle Aged, Computer Science Applications, Surgery, Treatment Outcome, medicine.anatomical_structure, Cholecystectomy, Laparoscopic, 030220 oncology & carcinogenesis, Female, 030211 gastroenterology & hepatology, Tomography, X-Ray Computed, business, Complication
Abstract

Background Bile duct injury after cholecystectomy can be a life-threatening complication. Use of robotic approach to manage a complex biliary injury is in an early phase. Methods We have performed an analysis of our prospectively maintained database that included 12 patients who underwent robotic-assisted repair of bile duct injury after laparoscopic cholecystectomy between 2014 and 2017. Results All patients underwent robotic biliary repair within 2 weeks after primary injury. No conversion to open surgery was necessary, the estimated mean blood loss was 252 mL, and the mean operative time was 260 minutes. The mean length of stay was 9.4 days. The 30-day complication events were a subhepatic abscess and a recurrent episode of cholangitis. One patient underwent the reoperation. The mortality was null. Conclusion Robotic-assisted bile duct injury repair seems to be safe and feasible. It offers promising results, thus potentially capable of modifying the management of biliary injury.

Published
2019

6. Robotic-Assisted versus Laparoscopic Distal Pancreatectomy: The Results of a Case-Matched Analysis from a Tertiary Care Center

Author

Marco Marino, Antonello Mirabella, Marcos Gómez Ruiz, and Andrzej L. Komorowski

Subjects
Laparoscopic surgery, Adult, Male, medicine.medical_specialty, Robotic assisted, medicine.medical_treatment, 030230 surgery, Tertiary care, 03 medical and health sciences, 0302 clinical medicine, Pancreatectomy, Blood loss, Robotic Surgical Procedures, medicine, Humans, Aged, Retrospective Studies, Computer-assisted surgery, business.industry, Mortality rate, Gastroenterology, Middle Aged, Surgery, Pancreatic Neoplasms, 030220 oncology & carcinogenesis, Operative time, Female, Laparoscopy, Distal pancreatectomy, business
Abstract

Background: Laparoscopic distal pancreatectomy (LDP) has been adopted relatively slowly despite the benefits of minimally invasive approach. The robotic approach can overcome the limitations of LDP, thus increasing the acceptance of minimally invasive distal pancreatectomy. Methods: We performed a 1:1 retrospective case-matched comparison among 2 groups of 35 patients who underwent robotic-assisted distal pancreatectomy (RDP) or LDP from August 2014 to April 2017. Results: The operative time was similar in both groups (230 RDP vs. 205 LDP min, p = 0.382). The robotic group had a lower estimated blood loss (95 vs. 275 mL, p = 0.035). The spleen preservation rate was higher in the RDP group (100 vs. 66.7%, p = 0.027), while the conversion rate to open surgery was higher in the laparoscopic group (14.3 vs. 2.9%, p = 0.048). The overall complication rate was lower in the robotic group (25.7 vs. 37.1%, p = 0.044). There was no statistically significant difference in oncologic outcomes between the groups in terms of R0 resection rate (100% RDP vs. 85% LDP, p = 0.233) and number of harvested lymph nodes (14.4 RDP vs. 10.8 LDP, p = 0.678). Conclusions: The RDP showed a lower estimated blood loss, conversion, and morbidity rate. It offered a higher spleen preservation rate in comparison to LDP while maintaining comparable oncologic outcomes.

Published
2019

7. Diagnostic Laparoscopy in Abdominal Emergencies

Author

Vincenzo Mandalà, Ferdinando Agresta, Antonello Mirabella, and N. Bedin

Subjects
medicine.medical_specialty, medicine.diagnostic_test, business.industry, General surgery, medicine.medical_treatment, Projectional radiography, Diagnostic laparoscopy, medicine.disease, Physical limitations, Mesenteric ischemia, Acute abdomen, Patient age, Laparotomy, Bowel distension, medicine, medicine.symptom, business
Abstract

Acute emergency situations often pose a diagnostic challenge to the general surgeon. The diagnosis is important due to the different pathologic conditions that might be responsible for the acute situation and therefore important for planning the correct abdominal incision or avoiding an unnecessary laparotomy. There are several noninvasive diagnostic procedures — such as ultrasonography and CT scanning — which can be performed along with plain film radiography on patients with an acute abdomen to aid the surgeon in establishing a preoperative diagnosis [1–12]. In experienced hands, which are not always available around the clock in every hospital setting, the results of these methods are quite good, but in general practice they are not completely accurate and conclusive (partly due to the patients’ physical limitations, e.g. obesity or massive bowel distension, and partly because, as already stated, they are dependent on operator skills) and they might be time-consuming and expensive (such as CT scanning) [13–15]. Another factor to keep in mind is that nowadays the mean patient age is increasing and, as a consequence, there is an increasing possibility of being confronted with emergency abdominal situations in the elderly with many co-morbidities which complicate not only the therapeutic strategy but the diagnostic approach as well.

Published
2012

8. Changes in surgicaL behaviOrs dUring the CoviD-19 pandemic. The SICE CLOUD19 Study

Author

Bracale, U., Podda, Maria Vittoria, Castiglioni, S., Peltrini, R., Sartori, Alessandra, Arezzo, A., Corcione, F., Agresta, F., Antonucci, A., Zanframundo, C., Cavallo, F., Mazzarolo, G., Agrusa, A., Di Buono, G., Aldrighetti, L., Fiorentini, G., Lucianetti, A., Magnone, S., Alfieri, Sergio, Rosa, Fausto, Altomare, D. F., Picciariello, A., Parisi, Carmelo Maria Antonio, Di Cintio, A., Amisano, M. F., Cravero, F., Ammendola, M., Ammerata, G., Anastasi, A., Canonico, G., Gattolin, A., Travaglio, E., De Palma, M., Angelini, P., Galante, F., Benevento, A., Rausei, S., Serao, A., Abbatini, F., Annecchiarico, M., Varricchio, A., Annessi, V., Tumiati, D., Annicchiarico, A., Mirabella, A., Marino, M. V., Spinelli, A., Braun, A., Santi, H. T., Romano, L., Antoniutti, M., Armellino, M. F., Argenio, G., Verzelli, A., Budassi, A., Baiocchi, G., Alfano, M. S., Balani, A., Barone, M., Baldazzi, G., Cassini, D., Canger, R. C. B., Zabbialini, G., Belli, Andrea, Izzo, Filippo, Bertolino, F., Brunetti, Maria Mercede, Bianco, Flaviana, Cappiello, A., Boccia, L., Boffi, B., Perna, Francesco, Bonilauri, S., Frazzetta, G., Bordoni, P., Fleres, F., Borghi, F., Giraudo, G., Bottino, V., Canfora, A., Piccoli, F. B., Calligaris, L., Nipote, B., Nasti, A. G., Bufalari, A., Bettarini, F., Buononato, M., Greco, M., Calo, P. G., Medas, F., Cardamone, E., Castaldo, P., Carlini, M., Spoletini, D., De Nisco, C., Pulighe, F., Feo, C. V., Fabbri, N., Antropoli, C., Foroni, F., Carnazza, M., Ragazzi, S., Cassinotti, E., Boni, L., Catena, F., Giuffrida, M., Perrone, Giuseppe, Ccotsoglou, C., Granieri, S., Ceccarelli, G., Bugiantella, W., Cedolini, C., Seriau, L., Cesari, Matteo, Contine, A., Chiara, Osvaldo, Cimbanassi, S., Cocozza, E., Berselli, M., Fantini, C., Costi, R., Casali, L., Morini, A., Crafa, F., Vanela, S., Curro, G., Orsini, V., Da Lio, C., Biral, Maria Francesca, Danelli, P., Guerci, C., Scala, D., Marino, Giuseppe, De Carlis, L., Lauterio, A., De Giorgi, D., Sciannamea, G., De Manzini, N., Losurdo, P., Sangiuliano, N., Degiuli, M., Caterina, F., Del Rio, P., Bonati, E., Di Lernia, S., Ardizzone, M. V. R., Di Saverio, S., Franchi, C., Di Venere, B., Miglio, R., Cuccurullo, D., Sagnelli, C., Docimo, L., Tolone, S., Longoni, M., Faillace, G., Rondelli, F., Pennella, F. P., Colucci, V., Carfora, T., Muttillo, I. A., Picardi, B., Stefano, R., Campagnacci, R., Maurizi, A., Tricarico, F., Montagna, M., Amedeo, E., Scollica, M. C., Lauro, E., Laterza, E., Molinari, E., Berta, G., Bono, D., Fabozzi, Simone Michele, Romano, M., Facci, E., Parini, D., Farfaglia, R., Arizzi, V., Farsi, M., Miranda, E., Fei, L., Flavio, G., Pirozzi, F., Sciuto, A., Ferrero, A., Palisi, M., Filauro, M., Barberis, A., Azzinnaro, A., Fiscon, V., Vigna, S., D'Ambra, M., Pontecorvi, E., Anania, G., Bombardini, C., Galizia, G., Auricchio, Anna Maria, Cardella, F., Genna, M., Gentilli, S., Herald, N., Castagnoli, G., Bartoli, A., Gianotti, L., Garancini, M., Bellanova, G., Palazzo, P., De Palma, G., Milone, Maria, Ferrari, G., Magistro, C., Giuliani, Antonio, Di Natale, Maria Grazia, Brisinda, Giuseppe, Cavallaro, G., Sammarco, G., Gallo, Giuseppe, Goletti, O., Macchini, D., Greco, Viviana, Amoroso, V., Guercioni, G., Benedetti, M., Guzzo, G., Pata, F., Scandroglio, I., Roscio, F., Jovine, E., Lombardi, Roberto, La Rocca, F., Di Capua, F., Lanci, C., Leli, R., Borasi, A., Lepiane, P., Balla, A., Liberatore, E., Morelli, L., Di Franco, G., Lucchi, A., Vittori, L., Bonavina, L., Asti, Emilio Fabrizio, Maggioni, D., Martino, G., Manca, Gavina, Delvecchio, A., Tedesco, M., Gambardella, D., Marafioti, S., De Marco, M. L., Guicciardi, M. A., Motta, M., Calgaro, M., Adamo, V., Guerrieri, Maria Chiara, Coletta, P., Ortenzi, M., Martines, G., Lantone, G., Martinotti, M., Fassardi, G., Castriconi, M., Squillante, S., De Luca, M., Pavanello, M., Di Marco, C., Ronconi, M., Casiraghi, Maria Stella, Mazzaferro, V., Battiston, C., Perrotta, M., Ripa, C., Giancarlo, M., Panizzo, V., Millo, P., Contul, R. B., Ferraro, V., Molino, C., Crolla, E., Moretto, G., Bacchion, M., Morino, M., Allaix, M. E., Motterlini, E., Petracca, Martina, Muratore, A., Musella, Martina, Vitiello, A., Nardo, B., Crocco, V., Navarra, G., Lazzara, S., Navarra, G. G., Cuoghi, M., Olmi, S., Oldani, Alberto, Uccelli, M., Opocher, E., Giovenzana, M., De Paolis, P., Santarelli, M., Delrio, P., Carbone, F., Bianchi, P. P. G., Formisano, Capelli, P., Baldini, E., Festa, P., Mottola, Armando, Merola, G., Perrotta, N., Celiento, M., Personnettaz, E., Muzio, S., Petitti, T., Melchiorre, A., Piccoli, M., Pecchini, F., Frontali, A., Maffioli, A., Maida, P., Tammaro, P., Pignata, G., Andreuccetti, J., Pilone, V., Renzulli, M., Pintaldi, S., Ceretti, A. P., Mariani, N. M., Pisanu, A., Polastri, R., Maiello, F., Porcu, A., Perra, T., Mucilli, F., Troisi, R., Montalti, R., Scognamillo, F., Delogu, D., Galleano, R., Malerba, M., Salfi, R., Pisano, M., Sechi, R., Cillara, N., Ramuscello, S., De Leo, E., Restini, E., Tumolo, R., Cianci, P., Capuzzolo, S., Rizzo, M., Recordare, A., Santoro, Roberto, Amodio, P. M., Rocca, A., Cecere, G., Romito, R., Portigliotti, L., Rosati, R., Elmore, U., Russello, D., Latteri, S., Costarella, S. M., Massa, S., Capasso, L., Santangelo, M., Sodo, M., Sarro, G., Rivolta, U., Scabini, S., Pertile, D., Selvaggi, F., Rossi, S., Pellino, G., Sganga, Gabriele, Fransvea, P., Testa, S., De Rosa, Maria Cristina, Siquini, W., Trana, C., Solej, M., Bolzon, S., Guerra, Eliana, Stella, M., Ferrara, F., Stipa, F., Stringhi, E., Celotti, A., Taglietti, L., Del Giudice, R., Talarico, C. A., Ruggiero, Miriam, Tirone, G., Romario, U. F., Petz, W., Caracino, V., Rossetti, V., Verza, L. A., Vescovi, L., Marini, M., Vettoretto, N., Botteri, E., Vincenti, L., Giannandrea, G., Viora, T., Maganuco, L., Veronesi, P., Zani, B., Zanus, G., Brizzolari, M., Zanzi, F., Guariniello, A., Zappa, M. A., Galfrascoli, E., Zonta, S., Oragano, L., Zuliani, W., Chiari, D., Bracale, Umberto, Podda, Mauro, Castiglioni, Simone, Peltrini, Roberto, Sartori, Alberto, Arezzo, Alberto, Corcione, Francesco, Agresta, Ferdinando, Rosati, Riccardo, Umberto, Bracale, Mauro, Podda, Simone, Castiglioni, Roberto, Peltrini, Alberto, Sartori, Alberto, Arezzo, Francesco, Corcione, Ferdinando, Agresta, CLOUD-19 Collaborative Group Adelmo Antonucci, Claudia, Zanframundo, Fabio, Cavallo, Giorgio, Mazzarolo, Antonio, Agrusa, Giuseppe Di Buono, Luca, Aldrighetti, Guido, Fiorentini, Alessandro, Lucianetti, Stefano, Magnone, Sergio, Alfieri, Fausto, Rosa, Altomare, Donato F., Arcangelo, Picciariello, Amilcare, Parisi, Antonio Di Cintio, Marco Francesco Amisano, Francesca, Cravero, Michele, Ammendola, Giorgio, Ammerata, Alessandro, Anastasi, Giuseppe, Canonico, Andra, Gattolin, Elisabetta, Travaglio, Andrea, Sartori, Massimiliano De Palma, Pierluigi, Angelini, Francesco, Galante, Angelo, Benevento, Stefano, Rausei, Angelo, Serao, Francesca, Abbatini, Mario, Annecchiarico, Antonio, Varricchio, Valerio, Annessi, David, Tumiati, Alfredo, Annicchiarico, Antonello, Mirabella, Marino, Marco V., Antonino, Spinelli, Antonio, Braun, Hong Tham Santi, Lucia, Romano, Michele, Antoniutti, Mariano Fortunato Armellino, Giulio, Argenio, Augusto, Verzelli, Andrea, Budassi, Gianluca, Baiocchi, Marie Sophie Alfano, Alessandro, Balani, Marco, Barone, Gianandrea, Baldazzi, Diletta, Cassini, Ruben Carlo Balzarotti Canger, Gianpietro, Zabbialini, Andrea, Belli, Francesco, Izzo, Franco, Bertolino, Marco, Brunetti, Francesco, Bianco, Antonio, Cappiello, Luigi, Boccia, Bernardo, Boffi, Federico, Perna, Stefano, Bonilauri, Giuseppe, Frazzetta, Pierpaolo, Bordoni, Francesco, Flere, Felice, Borghi, Giorgio, Giraudo, Vincenzo, Bottino, Alfonso, Canfora, Fabrizio Briganti Piccoli, Luca, Calligari, Bruno, Nipote, Aniello Gennaro Nasti, Andrea, Bufalari, Francesca, Bettarini, Massimo, Buononato, Marco, Greco, Pietro Giorgio Calò, Fabio, Meda, Eugenia, Cardamone, Pasquale, Castaldo, Massimo, Carlini, Domenico, Spoletini, Carlo De Nisco, Fabio, Pulighe, Feo, Carlo V., Nicolò, Fabbri, Carmine, Antropoli, Fabrizio, Foroni, Maurizio, Carnazza, Salvatore, Ragazzi, Elisa, Cassinotti, Luigi, Boni, Fausto, Catena, Mario, Giuffrida, Gennaro, Perrone, Christian, Ccotsoglou, Stefano, Granieri, Graziano, Ceccarelli, Walter, Bugiantella, Carla, Cedolini, Luca, Seriau, Maurizio, Cesari, Alessandro, Contine, Osvaldo, Chiara, Stefania, Cimbanassi, Eugenio, Cocozza, Mattia, Berselli, Corrado, Fantini, Renato, Costi, Lorenzo, Casali, Andrea, Morini, Francesco, Crafa, Serafino, Vanela, Giuseppe, Currò, Vincenzo, Orsini, Corrado Da Lio, Mario, Biral, Piergiorgio, Danelli, Claudio, Guerci, Dario, Scala, Graziella, Marino, Luciano De Carlis, Andrea, Lauterio, Donato De Giorgi, Gianluca, Sciannamea, Nicolo De Manzini, Pasquale, Losurdo, Maurizio De Palma, Nicola, Sangiuliano, Maurizio, Degiuli, Franco, Caterina, Paolo Del Rio, Elena, Bonati, Stefano Di Lernia, Marco Vittorio Rossi Ardizzone, Salomone Di Saverio, Caterina, Franchi, Beatrice Di Venere, Rosanna, Miglio, Diego, Cuccurullo, Carlo, Sagnelli, Docimo, Ludovico, Tolone, Salvatore, Mauro, Longoni, Giuseppe, Faillace, Fabio, Rondelli, Francesca Pennetti Pennella, Vincenzo, Colucci, Teresa, Carfora, Irnerio Angelo Muttillo, Biagio, Picardi, Rossi, Stefano, Roberto, Campagnacci, Angela, Maurizi, Fausto, Tricarico, Marco, Montagna, Elio, Amedeo, Scollica, Michela C., Enrico, Lauro, Ernesto, Laterza, Enrico, Molinari, Berta, G., Dario, Bono, Massimiliano, Fabozzi, Mafalda, Romano, Enzo, Facci, Dario, Parini, Roberto, Farfaglia, Valeria, Arizzi, Marco, Farsi, Egidio, Miranda, Fei, Landino, Giordano, Flavio, Felice, Pirozzi, Antonio, Sciuto, Alessandro, Ferrero, Marco, Palisi, Marco, Filauro, Andrea, Barberi, Antonio, Azzinnaro, Valentino, Fiscon, Silvia, Vigna, Michele, D’Ambra, Emanuele, Pontecorvi, Gabriele, Anania, Cristina, Bombardini, Galizia, Gennaro, Auricchio, Annamaria, Cardella, Francesca, Michele, Genna, Sergio, Gentilli, Nikaj, Herald, Giampaolo, Castagnoli, Alberto, Bartoli, Luca, Gianotti, Mattia, Garancini, Giovanni, Bellanova, Paola, Palazzo, Giovanni De Palma, Marco, Milone, Giovanni, Ferrari, Carmelo, Magistro, Antonio, Giuliani, Giuseppe Di Natale, Giuseppe, Brisinda, Giuseppe, Cavallaro, Giuseppe, Sammarco, Gaetano, Gallo, Orlando, Goletti, Daniele, Macchini, Vincenzo, Greco, Vincenzo, Amoroso, Gianluca, Guercioni, Michele, Benedetti, Guglielmo, Guzzo, Francesco, Pata, Ildo, Scandroglio, Francesco, Roscio, Elio, Jovine, Raffaele, Lombardi, Francesco La Rocca, Francesca Di Capua, Carmine, Lanci, Renzo, Leli, Andrea, Borasi, Pasquale, Lepiane, Andrea, Balla, Edoardo, Liberatore, Luca, Morelli, Gregorio Di Franco, Andrea, Lucchi, Laura, Vittori, Luigi, Bonavina, Emanuele, Asti, Dario, Maggioni, Gerosa, Martino, Giuseppe, Manca, Antonella, Delvecchio, Manfredo, Tedesco, Denise, Gambardella, Salvatore, Marafioti, Maria Luisa De Marco, Marco Azzola Guicciardi, Massimo, Motta, Marco, Calgaro, Vincenzo, Adamo, Mario, Guerrieri, Pietro, Coletta, Monica, Ortenzi, Gennaro, Martine, Giuliano, Lantone, Mario, Martinotti, Giuseppe, Fassardi, Maurizio, Castriconi, Simone, Squillante, Maurizio De Luca, Maurizio, Pavanello, Carlo Di Marco, Maurizio, Ronconi, Silvia, Casiraghi, Vincenzo, Mazzaferro, Carlo, Battiston, Michele, Perrotta, Carmine, Ripa, Micheletto, Giancarlo, Valerio, Panizzo, Paolo, Millo, Riccardo Brachet Contul, Valentina, Ferraro, Carlo, Molino, Enrico, Crolla, Gianluigi, Moretto, Matilde, Bacchion, Mario, Morino, Marco Ettore Allaix, Enrico, Motterlini, Michele, Petracca, Andrea, Muratore, Mario, Musella, Antonio, Vitiello, Bruno, Nardo, Veronica, Crocco, Giuseppe, Navarra, Salvatore, Lazzara, Giuseppe Giovanni Navarra, Manuela, Cuoghi, Stefano, Olmi, Alberto, Oldani, Matteo, Uccelli, Enrico, Opocher, Marco, Giovenzana, Paolo De Paolis, Mauro, Santarelli, Paolo, Delrio, Fabio, Carbone, Paolo Pietro Giampaolo Bianchi, Formisano, Patrizio, Capelli, Edoardo, Baldini, Patrizio, Festa, Arianna, Mottola, Giovanni, Merola, Nicola, Perrotta, Marta, Celiento, Eraldo, Personnettaz, Stefania, Muzio, Tommaso, Petitti, Antonietta, Melchiorre, Micaela, Piccoli, Francesca, Pecchini, Alice, Frontali, Anna, Maffioli, Pietro, Maida, Pasquale, Tammaro, Giusto, Pignata, Jacopo, Andreuccetti, Vincenzo, Pilone, Michele, Renzulli, Salvatore, Pintaldi, Andrea Pisani Ceretti, Nicolò Maria Mariani, Adolfo, Pisanu, Roberto, Polastri, Fabio, Maiello, Alberto, Porcu, Teresa, Perra, Felice, Mucilli, Mirko, Barone, Roberto, Troisi, Roberto, Montalti, Fabrizio, Scognamillo, Daniele, Delogu, Raffaele, Galleano, Michele, Malerba, Raffaele, Salfi, Marcello, Pisano, Raffaele, Sechi, Nicola, Cillara, Salvatore, Ramuscello, Eugenio De Leo, Enrico, Restini, Rocco, Tumolo, Pasquale, Cianci, Sabino, Capuzzolo, Maurizio, Rizzo, Alfonso, Recordare, Roberto, Santoro, Pietro Maria Amodio, Aldo, Rocca, Giuseppe, Cecere, Raffaele, Romito, Luca, Portigliotti, Riccardo, Rosati, Ugo, Elmore, Domenico, Russello, Saverio, Latteri, Salvatore Maria Costarella, Salvatore, Massa, Lorenzo, Capasso, Michele, Santangelo, Maurizio, Sodo, Giuliano, Sarro, Umberto, Rivolta, Stefano, Scabini, Davide, Pertile, Federico, Selvaggi, Selene, Rossi, Selvaggi, Francesco, Pellino, Gianluca, Gabriele, Sganga, Pietro, Fransvea, Silvio, Testa, Clemente De Rosa, Walter, Siquini, Cristian, Tranà, Mario, Solej, Stefano, Bolzon, Enrico, Guerra, Marco, Stella, Francesco, Ferrara, Francesco, Stipa, Enrico, Stringhi, Andrea, Celotti, Lucio, Taglietti, Roberto Del Giudice, Carlo Alessandro Talarico, Michele, Ruggiero, Giuseppe, Tirone, Uberto Fumagalli Romario, Wanda, Petz, Valerio, Caracino, Valentina, Rossetti, Luca Andrea Verza, Lorenzo, Vescovi, Michele, Marini, Nereo, Vettoretto, Emanuele, Botteri, Leonardo, Vincenti, Giusy, Giannandrea, Tiziana, Viora, Lorenzo, Maganuco, Paolo, Veronesi, Bruno, Zani, Giacomo, Zanu, Marco, Brizzolari, Federico, Zanzi, Anna, Guariniello, Marco Antonio Zappa, Elisa, Galfrascoli, Sandro, Zonta, Luigi, Oragano, Walter Zuliani &amp, Damiano, Chiari, de Manzini, Nicolo', Agresta, Ferdinando, Agrusa, Antonino, Di Buono, Giuseppe, Bracale, U., Podda, M., Castiglioni, S., Peltrini, R., Sartori, A., Arezzo, A., Corcione, F., Agresta, F., Antonucci, A., Zanframundo, C., Cavallo, F., Mazzarolo, G., Agrusa, A., Di Buono, G., Aldrighetti, L., Fiorentini, G., Lucianetti, A., Magnone, S., Alfieri, S., Rosa, F., Altomare, D. F., Picciariello, A., Parisi, A., Di Cintio, A., Amisano, M. F., Cravero, F., Ammendola, M., Ammerata, G., Anastasi, A., Canonico, G., Gattolin, A., Travaglio, E., De Palma, M., Angelini, P., Galante, F., Benevento, A., Rausei, S., Serao, A., Abbatini, F., Annecchiarico, M., Varricchio, A., Annessi, V., Tumiati, D., Annicchiarico, A., Mirabella, A., Marino, M. V., Spinelli, A., Braun, A., Santi, H. T., Romano, L., Antoniutti, M., Armellino, M. F., Argenio, G., Verzelli, A., Budassi, A., Baiocchi, G., Alfano, M. S., Balani, A., Barone, M., Baldazzi, G., Cassini, D., Canger, R. C. B., Zabbialini, G., Belli, A., Izzo, F., Bertolino, F., Brunetti, M., Bianco, F., Cappiello, A., Boccia, L., Boffi, B., Perna, F., Bonilauri, S., Frazzetta, G., Bordoni, P., Fleres, F., Borghi, F., Giraudo, G., Bottino, V., Canfora, A., Piccoli, F. B., Calligaris, L., Nipote, B., Nasti, A. G., Bufalari, A., Bettarini, F., Buononato, M., Greco, M., Calo, P. G., Medas, F., Cardamone, E., Castaldo, P., Carlini, M., Spoletini, D., De Nisco, C., Pulighe, F., Feo, C. V., Fabbri, N., Antropoli, C., Foroni, F., Carnazza, M., Ragazzi, S., Cassinotti, E., Boni, L., Catena, F., Giuffrida, M., Perrone, G., Ccotsoglou, C., Granieri, S., Ceccarelli, G., Bugiantella, W., Cedolini, C., Seriau, L., Cesari, M., Contine, A., Chiara, O., Cimbanassi, S., Cocozza, E., Berselli, M., Fantini, C., Costi, R., Casali, L., Morini, A., Crafa, F., Vanela, S., Curro, G., Orsini, V., Da Lio, C., Biral, M., Danelli, P., Guerci, C., Scala, D., Marino, G., De Carlis, L., Lauterio, A., De Giorgi, D., Sciannamea, G., De Manzini, N., Losurdo, P., Sangiuliano, N., Degiuli, M., Caterina, F., Del Rio, P., Bonati, E., Di Lernia, S., Ardizzone, M. V. R., Di Saverio, S., Franchi, C., Di Venere, B., Miglio, R., Cuccurullo, D., Sagnelli, C., Docimo, L., Tolone, S., Longoni, M., Faillace, G., Rondelli, F., Pennella, F. P., Colucci, V., Carfora, T., Muttillo, I. A., Picardi, B., Stefano, R., Campagnacci, R., Maurizi, A., Tricarico, F., Montagna, M., Amedeo, E., Scollica, M. C., Lauro, E., Laterza, E., Molinari, E., Bono, D., Fabozzi, M., Romano, M., Facci, E., Parini, D., Farfaglia, R., Arizzi, V., Farsi, M., Miranda, E., Fei, L., Flavio, G., Pirozzi, F., Sciuto, A., Ferrero, A., Palisi, M., Filauro, M., Barberis, A., Azzinnaro, A., Fiscon, V., Vigna, S., D'Ambra, M., Pontecorvi, E., Anania, G., Bombardini, C., Galizia, G., Auricchio, A., Cardella, F., Genna, M., Gentilli, S., Herald, N., Castagnoli, G., Bartoli, A., Gianotti, L., Garancini, M., Bellanova, G., Palazzo, P., De Palma, G., Milone, M., Ferrari, G., Magistro, C., Giuliani, A., Di Natale, G., Brisinda, G., Cavallaro, G., Sammarco, G., Gallo, G., Goletti, O., Macchini, D., Greco, V., Amoroso, V., Guercioni, G., Benedetti, M., Guzzo, G., Pata, F., Scandroglio, I., Roscio, F., Jovine, E., Lombardi, R., La Rocca, F., Di Capua, F., Lanci, C., Leli, R., Borasi, A., Lepiane, P., Balla, A., Liberatore, E., Morelli, L., Di Franco, G., Lucchi, A., Vittori, L., Bonavina, L., Asti, E., Maggioni, D., Martino, G., Manca, G., Delvecchio, A., Tedesco, M., Gambardella, D., Marafioti, S., De Marco, M. L., Guicciardi, M. A., Motta, M., Calgaro, M., Adamo, V., Guerrieri, M., Coletta, P., Ortenzi, M., Martines, G., Lantone, G., Martinotti, M., Fassardi, G., Castriconi, M., Squillante, S., De Luca, M., Pavanello, M., Di Marco, C., Ronconi, M., Casiraghi, S., Mazzaferro, V., Battiston, C., Perrotta, M., Ripa, C., Giancarlo, M., Panizzo, V., Millo, P., Contul, R. B., Ferraro, V., Molino, C., Crolla, E., Moretto, G., Bacchion, M., Morino, M., Allaix, M. E., Motterlini, E., Petracca, M., Muratore, A., Musella, M., Vitiello, A., Nardo, B., Crocco, V., Navarra, G., Lazzara, S., Navarra, G. G., Cuoghi, M., Olmi, S., Oldani, A., Uccelli, M., Opocher, E., Giovenzana, M., De Paolis, P., Santarelli, M., Delrio, P., Carbone, F., Bianchi, P. P. G., Capelli, P., Baldini, E., Festa, P., Mottola, A., Merola, G., Perrotta, N., Celiento, M., Personnettaz, E., Muzio, S., Petitti, T., Melchiorre, A., Piccoli, M., Pecchini, F., Frontali, A., Maffioli, A., Maida, P., Tammaro, P., Pignata, G., Andreuccetti, J., Pilone, V., Renzulli, M., Pintaldi, S., Ceretti, A. P., Mariani, N. M., Pisanu, A., Polastri, R., Maiello, F., Porcu, A., Perra, T., Mucilli, F., Troisi, R., Montalti, R., Scognamillo, F., Delogu, D., Galleano, R., Malerba, M., Salfi, R., Pisano, M., Sechi, R., Cillara, N., Ramuscello, S., De Leo, E., Restini, E., Tumolo, R., Cianci, P., Capuzzolo, S., Rizzo, M., Recordare, A., Santoro, R., Amodio, P. M., Rocca, A., Cecere, G., Romito, R., Portigliotti, L., Rosati, R., Elmore, U., Russello, D., Latteri, S., Costarella, S. M., Massa, S., Capasso, L., Santangelo, M., Sodo, M., Sarro, G., Rivolta, U., Scabini, S., Pertile, D., Selvaggi, F., Rossi, S., Pellino, G., Sganga, G., Fransvea, P., Testa, S., De Rosa, C., Siquini, W., Trana, C., Solej, M., Bolzon, S., Guerra, E., Stella, M., Ferrara, F., Stipa, F., Stringhi, E., Celotti, A., Taglietti, L., Del Giudice, R., Talarico, C. A., Ruggiero, M., Tirone, G., Romario, U. F., Petz, W., Caracino, V., Rossetti, V., Verza, L. A., Vescovi, L., Marini, M., Vettoretto, N., Botteri, E., Vincenti, L., Giannandrea, G., Viora, T., Maganuco, L., Veronesi, P., Zani, B., Zanus, G., Brizzolari, M., Zanzi, F., Guariniello, A., Zappa, M. A., Galfrascoli, E., Zonta, S., Oragano, L., Zuliani, W., Chiari, D., Bracale, U, Podda, M, Castiglioni, S, Peltrini, R, Sartori, A, Arezzo, A, Corcione, F, Agresta, F, Antonucci, A, Zanframundo, C, Cavallo, F, Mazzarolo, G, Agrusa, A, Di Buono, G, Aldrighetti, L, Fiorentini, G, Lucianetti, A, Magnone, S, Alfieri, S, Rosa, F, Altomare, D, Picciariello, A, Parisi, A, Di Cintio, A, Amisano, M, Cravero, F, Ammendola, M, Ammerata, G, Anastasi, A, Canonico, G, Gattolin, A, Travaglio, E, De Palma, M, Angelini, P, Galante, F, Benevento, A, Rausei, S, Serao, A, Abbatini, F, Annecchiarico, M, Varricchio, A, Annessi, V, Tumiati, D, Annicchiarico, A, Mirabella, A, Marino, M, Spinelli, A, Braun, A, Santi, H, Romano, L, Antoniutti, M, Armellino, M, Argenio, G, Verzelli, A, Budassi, A, Baiocchi, G, Alfano, M, Balani, A, Barone, M, Baldazzi, G, Cassini, D, Canger, R, Zabbialini, G, Belli, A, Izzo, F, Bertolino, F, Brunetti, M, Bianco, F, Cappiello, A, Boccia, L, Boffi, B, Perna, F, Bonilauri, S, Frazzetta, G, Bordoni, P, Fleres, F, Borghi, F, Giraudo, G, Bottino, V, Canfora, A, Piccoli, F, Calligaris, L, Nipote, B, Nasti, A, Bufalari, A, Bettarini, F, Buononato, M, Greco, M, Calo, P, Medas, F, Cardamone, E, Castaldo, P, Carlini, M, Spoletini, D, De Nisco, C, Pulighe, F, Feo, C, Fabbri, N, Antropoli, C, Foroni, F, Carnazza, M, Ragazzi, S, Cassinotti, E, Boni, L, Catena, F, Giuffrida, M, Perrone, G, Ccotsoglou, C, Granieri, S, Ceccarelli, G, Bugiantella, W, Cedolini, C, Seriau, L, Cesari, M, Contine, A, Chiara, O, Cimbanassi, S, Cocozza, E, Berselli, M, Fantini, C, Costi, R, Casali, L, Morini, A, Crafa, F, Vanela, S, Curro, G, Orsini, V, Da Lio, C, Biral, M, Danelli, P, Guerci, C, Scala, D, Marino, G, De Carlis, L, Lauterio, A, De Giorgi, D, Sciannamea, G, De Manzini, N, Losurdo, P, Sangiuliano, N, Degiuli, M, Caterina, F, Del Rio, P, Bonati, E, Di Lernia, S, Ardizzone, M, Di Saverio, S, Franchi, C, Di Venere, B, Miglio, R, Cuccurullo, D, Sagnelli, C, Docimo, L, Tolone, S, Longoni, M, Faillace, G, Rondelli, F, Pennella, F, Colucci, V, Carfora, T, Muttillo, I, Picardi, B, Stefano, R, Campagnacci, R, Maurizi, A, Tricarico, F, Montagna, M, Amedeo, E, Scollica, M, Lauro, E, Laterza, E, Molinari, E, Berta, G, Bono, D, Fabozzi, M, Romano, M, Facci, E, Parini, D, Farfaglia, R, Arizzi, V, Farsi, M, Miranda, E, Fei, L, Flavio, G, Pirozzi, F, Sciuto, A, Ferrero, A, Palisi, M, Filauro, M, Barberis, A, Azzinnaro, A, Fiscon, V, Vigna, S, D'Ambra, M, Pontecorvi, E, Anania, G, Bombardini, C, Galizia, G, Auricchio, A, Cardella, F, Genna, M, Gentilli, S, Herald, N, Castagnoli, G, Bartoli, A, Gianotti, L, Garancini, M, Bellanova, G, Palazzo, P, De Palma, G, Milone, M, Ferrari, G, Magistro, C, Giuliani, A, Di Natale, G, Brisinda, G, Cavallaro, G, Sammarco, G, Gallo, G, Goletti, O, Macchini, D, Greco, V, Amoroso, V, Guercioni, G, Benedetti, M, Guzzo, G, Pata, F, Scandroglio, I, Roscio, F, Jovine, E, Lombardi, R, La Rocca, F, Di Capua, F, Lanci, C, Leli, R, Borasi, A, Lepiane, P, Balla, A, Liberatore, E, Morelli, L, Di Franco, G, Lucchi, A, Vittori, L, Bonavina, L, Asti, E, Maggioni, D, Martino, G, Manca, G, Delvecchio, A, Tedesco, M, Gambardella, D, Marafioti, S, De Marco, M, Guicciardi, M, Motta, M, Calgaro, M, Adamo, V, Guerrieri, M, Coletta, P, Ortenzi, M, Martines, G, Lantone, G, Martinotti, M, Fassardi, G, Castriconi, M, Squillante, S, De Luca, M, Pavanello, M, Di Marco, C, Ronconi, M, Casiraghi, S, Mazzaferro, V, Battiston, C, Perrotta, M, Ripa, C, Giancarlo, M, Panizzo, V, Millo, P, Contul, R, Ferraro, V, Molino, C, Crolla, E, Moretto, G, Bacchion, M, Morino, M, Allaix, M, Motterlini, E, Petracca, M, Muratore, A, Musella, M, Vitiello, A, Nardo, B, Crocco, V, Navarra, G, Lazzara, S, Cuoghi, M, Olmi, S, Oldani, A, Uccelli, M, Opocher, E, Giovenzana, M, De Paolis, P, Santarelli, M, Delrio, P, Carbone, F, Bianchi, P, Capelli, P, Baldini, E, Festa, P, Mottola, A, Merola, G, Perrotta, N, Celiento, M, Personnettaz, E, Muzio, S, Petitti, T, Melchiorre, A, Piccoli, M, Pecchini, F, Frontali, A, Maffioli, A, Maida, P, Tammaro, P, Pignata, G, Andreuccetti, J, Pilone, V, Renzulli, M, Pintaldi, S, Ceretti, A, Mariani, N, Pisanu, A, Polastri, R, Maiello, F, Porcu, A, Perra, T, Mucilli, F, Troisi, R, Montalti, R, Scognamillo, F, Delogu, D, Galleano, R, Malerba, M, Salfi, R, Pisano, M, Sechi, R, Cillara, N, Ramuscello, S, De Leo, E, Restini, E, Tumolo, R, Cianci, P, Capuzzolo, S, Rizzo, M, Recordare, A, Santoro, R, Amodio, P, Rocca, A, Cecere, G, Romito, R, Portigliotti, L, Rosati, R, Elmore, U, Russello, D, Latteri, S, Costarella, S, Massa, S, Capasso, L, Santangelo, M, Sodo, M, Sarro, G, Rivolta, U, Scabini, S, Pertile, D, Selvaggi, F, Rossi, S, Pellino, G, Sganga, G, Fransvea, P, Testa, S, De Rosa, C, Siquini, W, Trana, C, Solej, M, Bolzon, S, Guerra, E, Stella, M, Ferrara, F, Stipa, F, Stringhi, E, Celotti, A, Taglietti, L, Del Giudice, R, Talarico, C, Ruggiero, M, Tirone, G, Romario, U, Petz, W, Caracino, V, Rossetti, V, Verza, L, Vescovi, L, Marini, M, Vettoretto, N, Botteri, E, Vincenti, L, Giannandrea, G, Viora, T, Maganuco, L, Veronesi, P, Zani, B, Zanus, G, Brizzolari, M, Zanzi, F, Guariniello, A, Zappa, M, Galfrascoli, E, Zonta, S, Oragano, L, Zuliani, W, and Chiari, D

Subjects
Laparoscopic surgery, Settore MED/18 - CHIRURGIA GENERALE, medicine.medical_treatment, laparoscopy, COVID-19, Elective surgery, Emergency surgery, Survey, Oral Health, cross infection (MeSH), Surveys and Questionnaires, Epidemiology, Pandemic, Infection control, Practice Patterns, Physicians', emergency surgery, Laparoscopy, humans, medicine.diagnostic_test, General Commentary, laparoscopic surgery, infection control, Italy, physicians', Original Article, Elective Surgical Procedure, Human, heating ventilation air conditioning, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), fallow period, elective surgical procedures, pandemics, NO, aerosol generating procedures, elective surgery, survey, practice patterns, physicians', SARS-CoV-2, surveys and questionnaires, medicine, Infection Control, business.industry, General surgery, practice patterns, Surgery, business
Abstract

Background The spread of the SARS-CoV2 virus, which causes COVID-19 disease, profoundly impacted the surgical community. Recommendations have been published to manage patients needing surgery during the COVID-19 pandemic. This survey, under the aegis of the Italian Society of Endoscopic Surgery, aims to analyze how Italian surgeons have changed their practice during the pandemic. Methods The authors designed an online survey that was circulated for completion to the Italian departments of general surgery registered in the Italian Ministry of Health database in December 2020. Questions were divided into three sections: hospital organization, screening policies, and safety profile of the surgical operation. The investigation periods were divided into the Italian pandemic phases I (March–May 2020), II (June–September 2020), and III (October–December 2020). Results Of 447 invited departments, 226 answered the survey. Most hospitals were treating both COVID-19-positive and -negative patients. The reduction in effective beds dedicated to surgical activity was significant, affecting 59% of the responding units. 12.4% of the respondents in phase I, 2.6% in phase II, and 7.7% in phase III reported that their surgical unit had been closed. 51.4%, 23.5%, and 47.8% of the respondents had at least one colleague reassigned to non-surgical COVID-19 activities during the three phases. There has been a reduction in elective (> 200 procedures: 2.1%, 20.6% and 9.9% in the three phases, respectively) and emergency ( Conclusion This survey offers three faithful snapshots of how the surgical community has reacted to the COVID-19 pandemic during its three phases. The significant reduction in surgical activity indicates that better health policies and more evidence-based guidelines are needed to make up for lost time and surgery not performed during the pandemic.

Published
2021

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