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1. Augmented reality (AR) in minimally invasive surgery (MIS) training: where are we now in Italy? The Italian Society of Endoscopic Surgery (SICE) ARMIS survey

Author

Balla, Andrea, Sartori, Alberto, Botteri, Emanuele, Podda, Mauro, Ortenzi, Monica, Silecchia, Gianfranco, Guerrieri, Mario, Agresta, Ferdinando, Antonino, Agrusa, Daniele, Aguzzi, Mariantonietta, Alagia, Laura, Alberici, Marco Ettore Allaix, Luisa, Ambrosio, Alfonso, Amendola, Michele, Ammendola, Pietro Maria Amodio, Gabriele, Anania, Jacopo, Andreuccetti, Alfredo, Annichiarico, Pietro, Anoldo, Alessandro, Anselmo, Giovanni, Aprea, Giacomo, Arcuri, Alberto, Arezzo, Giulia, Armatura, Giulia, Bagaglini, Francesco, Bagolini, Beatrice, Bailetti, Gianluca, Baiocchi, Edoardo, Baldini, Elisa, Bannone, Mirko, Barone, Gianluca, Baronio, Raffaele, Basile, Bellucci, Marco, Andrea Benedetti Cacciaguerra, Ilaria, Benzoni, Francesco, Bianco, Giuseppe, Boccia, Cristina, Bombardini, Luigi, Boni, Dario, Bono, Luca Domenico Bonomo, Giulia, Bonventre, Andrea, Bottari, Claudio, Botti, Giacomo, Brentegani, Mattia, Buonomo, Umberto, Bracale, Cosimo, Callari, Luca, Calligaris, Pietro Giorgio Calò, Angelo, Cangiano, Lorenzo, Capezzuoli, Gabriella Teresa Capolupo, Marianna, Capuano, Filippo, Carannante, Eugenia, Cardamone, Teresa, Carfora, Chiara, Caricato, Pietro, Carnevali, Francesco Maria Carrano, Lorenzo, Casali, Gianmaria Casoni Pataccini, Gianluca, Cassese, Simone, Castiglioni, Flavia, Cavicchi, Ceccarelli, Graziano, Giovanni, Cestaro, Pasquale, Cianci, Claudio, Cimmino, Marco, Clementi, Coletta, Diego, Riccardo, Conventi, Corallino, Diletta, Maurizio, Costantini, Lorenzo, Crepaz, Diego, Cuccurullo, Curci, FABIO PIO, Giuseppe, Currò, Giorgio, Dalmonte, Giovanni, D'Alterio, Michele, D'Ambra, D'Ambrosio, Giancarlo, Anna, D'Amore, Michele De Capua, Simona, Deidda, Daniele, Delogu, Maurizio De Luca, Nicolò De Manzini, DE STEFANI, Elena, Giuseppe Di Buono, Marcello Di Martino, DI TOMASO, Anna, Ugo, Elmore, CORDOVA HERENCIA, INGRID ELVA, Giovanni, Emiliani, Sofia, Esposito, Fazio, Federico, Federico, Festa, Marcello, Filotico, Fiocca, Fausto, Irene, Fiume, Francesco, Fleres, Giulia, Fontana, Tommaso, Fontana, Edoardo, Forcignanò, Giampaolo, Formisano, Laura, Fortuna, Uberto Fumagalli Romario, Andrea, Galderisi, Raffaele, Galleano, Carlo, Gazia, Alessio, Giordano, Giorgio, Giraudo, Maria Carmela Giuffrida, Simona, Giura, Anna, Guida, Antonio Maria Iannello, Marco, Inama, Sara, Ingallinella, Iossa, Angelo, Livio, Iudici, Laracca, GIOVANNI GUGLIELMO, LARGHI LAUREIRO, Zoe, Saverio, Latteri, Luca, Leonardi, Pasquale, Lepiane, Edelweiss, Licitra, Paolo, Locurto, Sarah Lo Faso, Nicola, Luciani, Luzza, Luigi, Magaletti, Sara, Michele, Manigrasso, Alessandra, Marano, Francesco, Marchetti, Alessandra, Marello, Nicolò, Mariani, Jacopo Nicolò Marin, Gennaro, Martines, Laura, Mastrangelo, Antonio, Matarangolo, Marco, Materazzo, Mazzarella, Gennaro, Giorgio, Mazzarolo, Maria Paola Menna, Meoli, Francesca, Marco, Milone, Elisabetta, Moggia, Davide, Moioli, Sarah, Molfino, Vitantonio, Mongelli, Roberto, Montalti, Giulia, Montori, Luca, Morelli, Gianluigi, Moretto, Muttillo, EDOARDO MARIA, Irnerio, Muttillo, Francesca, Notte, Alessandro, M Paganini, Gianluca, Pagano, Palmieri, Livia, Giuseppe, Palomba, Valentina, Palumbo, Panetta, Cristina, Giulia, Paradiso, Beniamino, Pascotto, Passannanti, Daniele, Renato, Patrone, Francesca, Pecchini, Francesca, Pego, Fabio, Pelle, Perrotta, Nicola, Wanda, Petz, Biagio, Picardi, Picchetto, Andrea, Chiara, Piceni, Pietricola, Giulia, Enrico, Pinotti, Felice, Pirozzi, Paolo, Pizzini, Poillucci, Gaetano, Ilaria, Puccica, Lorenzo, Ramaci, Rapanotti, Eleonora, Daniela, Rega, Angelica, Reggiani, Giorgio, Romano, Gregorio, Romeo, Luigi, Romeo, Gianluca, Rompianesi, Stefano, Rossi, Edoardo, Saladino, Roberto, Santambrogio, Federica, Saraceno, Giuliano, Sarro, Diego, Sasia, Grazia, Savino, Rosa, Scaramuzzo, Antonio, Sciuto, Michela, Scollica, Giovanni, Scudo, Ardit, Seitaj, Carlo, Serra, Francesco, Serra, Pierpaolo, Sileri, Leandro, Siragusa, Carmen, Sorrentino, Giuseppe, Surfaro, Ernesto, Tartaglia, Beatrice, Torre, Andrea, Tufo, Matteo, Uccelli, Alessandro, Ussia, Vaccari, Samuele, Marina, Valente, Sara, Vertaldi, Alessandro, Vitali, Luca, Zaccherini, Luigi, Zorcolo, Noemi, Zorzetti, Balla, A., Sartori, A., Botteri, E., Podda, M., Ortenzi, M., Silecchia, G., Guerrieri, M., Agresta, F., Agrusa, A., Aguzzi, D., Alagia, M., Alberici, L., Allaix, M. E., Ambrosio, L., Amendola, A., Ammendola, M., Amodio, P. M., Anania, G., Andreuccetti, J., Annichiarico, A., Anoldo, P., Anselmo, A., Aprea, G., Arcuri, G., Arezzo, A., Armatura, G., Bagaglini, G., Bagolini, F., Bailetti, B., Baiocchi, G., Baldini, E., Bannone, E., Barone, M., Baronio, G., Basile, R., Bellucci, M., Cacciaguerra, A. B., Benzoni, I., Bianco, F., Boccia, G., Bombardini, C., Boni, L., Bono, D., Bonomo, L. D., Bonventre, G., Bottari, A., Botti, C., Brentegani, G., Buonomo, M., Bracale, U., Callari, C., Calligaris, L., Calo, P. G., Cangiano, A., Capezzuoli, L., Capolupo, G. T., Capuano, M., Carannante, F., Cardamone, E., Carfora, T., Caricato, C., Carnevali, P., Carrano, F. M., Casali, L., Pataccini, G. C., Cassese, G., Castiglioni, S., Cavicchi, F., Ceccarelli, G., Cestaro, G., Cianci, P., Cimmino, C., Clementi, M., Coletta, D., Conventi, R., Corallino, D., Costantini, M., Crepaz, L., Cuccurullo, D., Curci, F. P., Curro, G., Dalmonte, G., D'Alterio, G., D'Ambra, M., D'Ambrosio, G., D'Amore, A., De Capua, M., Deidda, S., Delogu, D., De Luca, M., De Manzini, N., De Stefani, E., Di Buono, G., Di Martino, M., Di Tomaso, A., Elmore, U., Herencia, I. E. C., Emiliani, G., Esposito, S., Fazio, F., Festa, F., Filotico, M., Fiocca, F., Fiume, I., Fleres, F., Fontana, G., Fontana, T., Forcignano, E., Formisano, G., Fortuna, L., Romario, U. F., Galderisi, A., Galleano, R., Gazia, C., Giordano, A., Giraudo, G., Giuffrida, M. C., Giura, S., Guida, A., Iannello, A. M., Inama, M., Ingallinella, S., Iossa, A., Iudici, L., Laracca, G. G., Laureiro, Z. L., Latteri, S., Leonardi, L., Lepiane, P., Licitra, E., Locurto, P., Faso, S. L., Luciani, N., Luzza, L., Magaletti, S., Manigrasso, M., Marano, A., Marchetti, F., Marello, A., Mariani, N., Marin, J. N., Martines, G., Mastrangelo, L., Matarangolo, A., Materazzo, M., Mazzarella, G., Mazzarolo, G., Menna, M. P., Meoli, F., Milone, M., Moggia, E., Moioli, D., Molfino, S., Mongelli, V., Montalti, R., Montori, G., Morelli, L., Moretto, G., Muttillo, E. M., Muttillo, I., Notte, F., Paganini, A. M., Pagano, G., Palmieri, L., Palomba, G., Palumbo, V., Panetta, C., Paradiso, G., Pascotto, B., Passannanti, D., Patrone, R., Pecchini, F., Pego, F., Pelle, F., Perrotta, N., Petz, W., Picardi, B., Picchetto, A., Piceni, C., Pietricola, G., Pinotti, E., Pirozzi, F., Pizzini, P., Poillucci, G., Puccica, I., Ramaci, L., Rapanotti, E., Rega, D., Reggiani, A., Romano, G., Romeo, G., Romeo, L., Rompianesi, G., Rossi, S., Saladino, E., Santambrogio, R., Saraceno, F., Sarro, G., Sasia, D., Savino, G., Scaramuzzo, R., Sciuto, A., Scollica, M., Scudo, G., Seitaj, A., Serra, C., Serra, F., Sileri, P., Siragusa, L., Sorrentino, C., Surfaro, G., Tartaglia, E., Torre, B., Tufo, A., Uccelli, M., Ussia, A., Vaccari, S., Valente, M., Vertaldi, S., Vitali, A., Zaccherini, L., Zorcolo, L., Zorzetti, N., Balla, Andrea, Sartori, Alberto, Botteri, Emanuele, Podda, Mauro, Ortenzi, Monica, Silecchia, Gianfranco, Guerrieri, Mario, Agresta, Ferdinando, de Manzini, Nicolo, and ARMIS (Augmented Reality in Minimally Invasive Surgery) Collaborative, Group

Subjects
Virtual reality (VR), minimally invasive surgery (MIS), Augmented reality (AR), Minimally invasive surgery (MIS), Mixed reality (MR), Survey, Training, training, augmented reality (AR), mixed reality (MR), survey, virtual reality (VR), Settore MED/18 - Chirurgia Generale, Surgery
Abstract

Minimally invasive surgery (MIS) is a widespread approach in general surgery. Computer guiding software, such as the augmented reality (AR), the virtual reality (VR) and mixed reality (MR), has been proposed to help surgeons during MIS. This study aims to report these technologies' current knowledge and diffusion during surgical training in Italy. A web-based survey was developed under the aegis of the Italian Society of Endoscopic Surgery (SICE). Two hundred and seventeen medical doctors' answers were analyzed. Participants were surgeons (138, 63.6%) and residents in surgery (79, 36.4%). The mean knowledge of the role of the VR, AR and MR in surgery was 4.9 ± 2.4 (range 1-10). Most of the participants (122, 56.2%) did not have experience with any proposed technologies. However, although the lack of experience in this field, the answers about the functioning of the technologies were correct in most cases. Most of the participants answered that VR, AR and MR should be used more frequently for the teaching and training and during the clinical activity (170, 80.3%) and that such technologies would make a significant contribution, especially in training (183, 84.3%) and didactic (156, 71.9%). Finally, the main limitations to the diffusion of these technologies were the insufficient knowledge (182, 83.9%) and costs (175, 80.6%). Based on the present study, in Italy, the knowledge and dissemination of these technologies are still limited. Further studies are required to establish the usefulness of AR, VR and MR in surgical training.

Published
2023

2. Benchmarking postoperative outcomes after open liver surgery for cirrhotic patients with hepatocellular carcinoma in a national cohort

Author

Simone Famularo, Nadia Russolillo, Matteo Donadon, Federica Cipriani, Francesco Ardito, Pasquale Perri, Alessandro Giani, Francesca De Stefano, Quirino Lai, Sarah Molfino, Matteo Zanello, Maurizio Iaria, Giuliano La Barba, Enrico Pinotti, Paola Germani, Simone Conci, Cecilia Ferrari, Luca Fumagalli, Maurizio Romano, Adelmo Antonucci, Giuseppe Zimmitti, Albert Troci, Antonio Floridi, Valentina Ferraro, Stefan Patauner, Antonio Frena, Riccardo Memeo, Michele Crespi, Mohammed A. Hilal, Giacomo Zanus, Marco Chiarelli, Andrea Percivale, Andrea Ruzzenente, Paola Tarchi, Mauro Zago, Giorgio Ercolani, Raffaele Dalla Valle, Elio Jovine, Gian Luca Baiocchi, Massimo Rossi, Marcello Maestri, Fabrizio Romano, Gian Luca Grazi, Felice Giuliante, Luca Aldrighetti, Alessandro Ferrero, Guido Torzilli, Guido Costa, Flavio Milana, Federico Fazio, Francesca Ratti, Francesco Razionale, Valerio De Peppo, Francesca Carissimi, Giorgio M. Paolo Graziano, Zoe Larghi Laurerio, Mario Giuffrida, Alessandro Cucchetti, Mauro Montuori, Davide Cosola, Pio Corleone, Giovanni Lazzari, Angelo Franceschi, Pietro Calcagno, Luca Salvador, Alberto Manzoni, Luca Pennacchi, Annarita Libia, Francesca Notte, Davide P. Bernasconi, Silvia Mori, Davide Gaudesi, Famularo, Simone, Russolillo, Nadia, Donadon, Matteo, Cipriani, Federica, Ardito, Francesco, Perri, Pasquale, Giani, Alessandro, De Stefano, Francesca, Lai, Quirino, Molfino, Sarah, Zanello, Matteo, Iaria, Maurizio, La Barba, Giuliano, Pinotti, Enrico, Germani, Paola, Conci, Simone, Ferrari, Cecilia, Fumagalli, Luca, Romano, Maurizio, Antonucci, Adelmo, Zimmitti, Giuseppe, Troci, Albert, Floridi, Antonio, Ferraro, Valentina, Patauner, Stefan, Frena, Antonio, Memeo, Riccardo, Crespi, Michele, Hilal, Mohammed A, Zanus, Giacomo, Chiarelli, Marco, Percivale, Andrea, Ruzzenente, Andrea, Tarchi, Paola, Zago, Mauro, Ercolani, Giorgio, Dalla Valle, Raffaele, Jovine, Elio, Baiocchi, Gian Luca, Rossi, Massimo, Maestri, Marcello, Romano, Fabrizio, Grazi, Gian Luca, Giuliante, Felice, Aldrighetti, Luca, Ferrero, Alessandro, and Torzilli, Guido

Subjects
Liver Cirrhosis, Carcinoma, Hepatocellular, Hepatology, Settore MED/18 - CHIRURGIA GENERALE, Carcinoma, Liver Neoplasms, Gastroenterology, Achievable Benchmark of Care, Hepatocellular, hepatocellular carcinoma, NO, Benchmarking, Postoperative Complications, Cirrhosis, Liver, best achievable results, Hepatectomy, Humans, cirrhotic patients, liver surgery, Liver Failure, LS7_4, Retrospective Studies
Abstract

Benchmark analysis for open liver surgery for cirrhotic patients with hepatocellular carcinoma (HCC) is still undefined.Patients were identified from the Italian national registry HE.RC.O.LE.S. The Achievable Benchmark of Care (ABC) method was employed to identify the benchmarks. The outcomes assessed were the rate of complications, major comorbidities, post-operative ascites (POA), post-hepatectomy liver failure (PHLF), 90-day mortality. Benchmarking was stratified for surgical complexity (CP1, CP2 and CP3).A total of 978 of 2698 patients fulfilled the inclusion criteria. 431 (44.1%) patients were treated with CP1 procedures, 239 (24.4%) with CP2 and 308 (31.5%) with CP3 procedures. Patients submitted to CP1 had a worse underlying liver function, while the tumor burden was more severe in CP3 cases. The ABC for complications (13.1%, 19.2% and 28.1% for CP1, CP2 and CP3 respectively), major complications (7.6%, 11.1%, 12.5%) and 90-day mortality (0%, 3.3%, 3.6%) increased with the surgical difficulty, but not POA (4.4%, 3.3% and 2.6% respectively) and PHLF (0% for all groups).We propose benchmarks for open liver resections in HCC cirrhotic patients, stratified for surgical complexity. The difference between the benchmark values and the results obtained during everyday practice reflects the room for potential growth, with the aim to encourage constant improvement among liver surgeons.

Published
2022

3. The largest western experience on salvage hepatectomy for recurrent hepatocellular carcinoma: propensity score-matched analysis on behalf of He.RC.O.Le.Study Group

Author

Iaria, M, Bianchi, G, Fazio, F, Ardito, F, Perri, P, Pontarolo, N, Conci, S, Donadon, M, Zanello, M, Lai, Q, Famularo, S, Molfino, S, Sciannamea, I, Fumagalli, L, Germani, P, Floridi, A, Ferrari, C, Zimmitti, G, Troci, A, Zago, M, Ferraro, V, Cipriani, F, Patauner, S, La Barba, G, Romano, M, Zanus, G, Ercolani, G, Frena, A, Aldrighetti, L, Memeo, R, Pinotti, E, Crespi, M, Hilal, Ma, Griseri, G, Tarchi, P, Chiarelli, M, Antonucci, A, Baiocchi, Gl, Romano, F, Rossi, M, Jovine, E, Torzilli, G, Ruzzenente, A, Maestri, M, Grazi, Gl, Giuliante, F, Ferrero, A, Dalla Valle, R, Group, HE. RC. O. LE. S., HERCOLES GROUP Contributors: Mario Giuffrida, Nadia, Russolillo, Francesco, Razionale, DE PEPPO, Valerio, Matteo, Tomasoni, Ivan, Marchitelli, Guido, Costa, LARGHI LAUREIRO, Zoe, Mauro, Scotti, Pietro, Calcagno, Davide, Cosola, Angelo, Franceschi, Alberto, Manzoni, Luca, Pennacchi, Mauro, Montuori, Maria, Conticchio, Francesca, Ratti, Francesca, Notte, Alessandro, Cucchetti, Luca, Salvador, Pio, Corleone, Mattia, Garancini, and Cristina, Ciulli.

Subjects
long-term outcome, recurrence, Carcinoma, Hepatocellular, Hepatology, Liver resection, Hepatocellular carcinoma, Settore MED/18 - CHIRURGIA GENERALE, Carcinoma, Liver Neoplasms, Gastroenterology, Hepatocellular, NO, Neoplasm Recurrence, Treatment Outcome, Local, Recurrent disease, Hepatectomy, Humans, HCC, Neoplasm Recurrence, Local, Liver surgery, Propensity Score, Retrospective Studies
Abstract

We aimed to evaluate, in a large Western cohort, perioperative and long-term oncological outcomes of salvage hepatectomy (SH) for recurrent hepatocellular carcinoma (rHCC) after primary hepatectomy (PH) or locoregional treatments.Data were collected from the Hepatocarcinoma Recurrence on the Liver Study Group (He.RC.O.Le.S.) Italian Registry. After 1:1 propensity score-matched analysis (PSM), two groups were compared: the PH group (patients submitted to resection for a first HCC) and the SH group (patients resected for intrahepatic rHCC after previous HCC-related treatments).2689 patients were enrolled. PH included 2339 patients, SH 350. After PSM, 263 patients were selected in each group with major resected nodule median size, intraoperative blood loss and minimally invasive approach significantly lower in the SH group. Long-term outcomes were compared, with no difference in OS and DFS. Univariate and multivariate analyses revealed only microvascular invasion as an independent prognostic factor for OS.SH proved to be equivalent to PH in terms of safety, feasibility and long-term outcomes, consistent with data gathered from East Asia. In the awaiting of reliable treatment-allocating algorithms for rHCC, SH appears to be a suitable alternative in patients fit for surgery, regardless of the previous therapeutic modality implemented.

Published
2021

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