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6. Multi-institutional Expert Update on the Use of Laparoscopic Bile Duct Exploration in the Management of Choledocholithiasis: Lesson Learned from 3950 Procedure

Author

Lopez-Lopez, V., primary, Gil Vazquez, P.J., additional, Ferreras, D., additional, Nassar, A.H., additional, Bansal, V.K., additional, Topal, B., additional, Zhu, J., additional, Chuang, S.-H., additional, Jorba, R., additional, Bekheit, M., additional, Martinez-Cecilia, D., additional, Parra-Membrives, P., additional, Sgourakis, G., additional, Mattila, A., additional, Bove, A., additional, Quaresima, S., additional, Barreras González, J.E., additional, Sharma, A., additional, Ruiz Manzanera, J.J., additional, Sánchez-Bueno, F., additional, Robles-Campos, R., additional, and Martinez-Isla, A., additional

Published
2022
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9. Results after laparoscopic left anterior transperitoneal submesocolic adrenalectomy for the treatment of pheochromocytoma

Author

Andrea Balla, Quaresima, S., Ortenzi, M., Palmieri, L., Meoli, F., Corallino, D., Guerrieri, M., Ursi, P., and Paganini, A. M.

Subjects
Male, Laparoscopic left anterior transperitoneal submesocolic adrenalectomy (LLATSA), Adrenal Gland Neoplasms, Laparoscopic adrenalectomy, Adrenalectomy, Adrenal tumors, Adrenal lesions, Pheochromocytoma, Transperitoneal anterior approach, Middle Aged, Adrenal tumors, Adrenal lesions, Laparoscopic adrenalectomy, Pheochromocytoma, Transperitoneal anterior approach, Laparoscopic left anterior transperitoneal submesocolic adrenalectomy (LLATSA), Treatment Outcome, Humans, Female, Laparoscopy, Mesocolon, Retrospective Studies
Abstract

Minimally invasive adrenalectomy is the treatment of choice for benign adrenal lesions including pheocromocytoma (PHE) and in selected patients with malignant lesions. The aim of the present study is to evaluate the authors' results after laparoscopic left anterior transperitoneal submesocolic adrenalectomy (LLATSA) for unilateral PHE.This study is a retrospective analysis of prospectively collected data. From 1994 to 2018, 552 patients underwent laparoscopic adrenalectomy (LA). Of these, 34 patients (14 men, 20 women, mean age 52.8 years) underwent LLATSA for PHE.Mean operative time was 93.1 ± 44.9 minutes. Conversion to open surgery occurred in two patients due to difficult identification of the anatomy. Intraoperative blood pressure and heart rate instability were observed in four cases, but with no need for conversion. Postoperative morbidity was nil. One American Society of Anesthesiologists (ASA) III patient died on postoperative day 4 from acute myocardial infarction. Mean postoperative hospital stay was 3.8 ± 1.8 days (range 2 - 8).The main advantage of this approach is the early ligation of the main adrenal vein prior to any gland manipulation. This reduces the risk of catecholamines' spread and consequently the risk of hemodynamic instability. Intraperitoneal dissection is limited and there is no need to mobilize the colon or pancreas, with a lower risk of complications from organ manipulation.LLATSA is feasible and safe for the treatment of PHE. A randomized trial design and a larger cohort of patients would be required to confirm these conclusions.Adrenal tumors, Adrenal lesions, Laparoscopic adrenalectomy, Pheochromocytoma, Transperitoneal anterior approach, Laparoscopic left anterior transperitoneal submesocolic adrenalectomy (LLATSA).L'adrenalectomia mini-invasiva è il trattamento di scelta per le lesioni surrenaliche benigne incluso il feocromocitoma (PHE) e in pazienti selezionati con lesioni maligne. Lo scopo del presente studio è quello di valutare i risultati degli autori dopo la surrenalectomia sottomesocolica transperitoneale anteriore sinistra (SSTAS) per il PHE unilaterale.Questo studio è un’analisi retrospettiva di dati raccolti in modo prospettico. Dal 1994 al 2018, 552 pazienti sono stati sottoposti a surrenalectomia laparoscopica (SL). Di questi, 34 pazienti (14 uomini, 20 donne, età media 52.8 anni) sono stati sottoposti a SSTAS per PHE.Il tempo operativo medio è stato di 93.1 ± 44.9 minuti. La conversione a chirurgia aperta si è verificata in due pazienti a causa della difficile identificazione dell’anatomia. La pressione sanguigna intraoperatoria e l’instabilità della frequenza cardiaca sono state osservate in quattro pazienti, ma senza necessità di conversione. Non sono state osservate complicanze postoperatorie. Un paziente American Society of Anesthesiologists (ASA) III è deceduto in quarta giornata postoperatoria per infarto acuto del miocardico. La degenza postoperatoria media è stata di 3.8 ± 1.8 giorni (range 2 - 8).Il principale vantaggio di questo approccio è la legatura precoce della vena surrenalica principale prima di qualsiasi manipolazione della ghiandola. Ciò riduce il rischio di diffusione delle catecolamine e di conseguenza il rischio di instabilità emodinamica. La dissezione intraperitoneale è limitata e non è necessario mobilizzare il colon o il pancreas, con un minor rischio di complicazioni dovute alla manipolazione di organi.SSTAS è fattibile e sicuro per il trattamento del PHE. Per confermare queste conclusioni è necessario uno studio randomizzato controllato e una coorte di pazienti più ampia.

Published
2019

10. How I do it: laparoscopic implantation of lower esophageal sphincter stimulator for the treatment of gastro-esophageal reflux disease

Author

Diletta Corallino, Maria Carlotta Sacchi, Andrea Balla, Quaresima S, Alessandro M. Paganini, Danilo Badiali, Francesca Meoli, and Livia Palmieri

Subjects
medicine.medical_specialty, business.industry, Internal medicine, medicine, Esophageal sphincter, Radiology, Nuclear Medicine and imaging, Surgery, Gastro-esophageal reflux disease, business, Gastroenterology
Published
2020

12. Gastrointestinal metastasis from primary lung cancer. Case series and systematic literature review

Author

Balla, A, Subiela, JD, Bollo, J, Martinez, C, Luppi, CR, Hernandez, P, Pascual-Gonzalez, Y, Quaresima, S, and Targarona, EM

Subjects
Gastrointestinal metastasis, Systematic literature review, Surgical management, Lung cancer
Abstract

Aim of the present study is to report clinical characteristics and outcomes of patients treated in authors' hospital for GI metastasis from primary lung cancer, and to report and analyse the same data concerning patients retrieved from a systematic literature review. We performed a retrospective analysis of prospectively collected data, and a systematic review using the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines. Ninety-one patients were included, 5 patients from the authors' hospital and 86 through PubMed database using the keywords "intestinal metastasis'' AND "lung cancer''. The median time between primary lung cancer diagnosis and GI metastasis diagnosis was 2 months and the median overall survival was 4 months. This group of patients present a poor prognosis and the gold standard treatment is not defined. None of the reported treatments had a significant impact on survival. (C) 2018 AEC. Published by Elsevier Espana, S.L.U. All rights reserved.

Published
2018

18. Quality of Life after Endoluminal Loco-Regional Resection (ELRR) by Transanal Endoscopic Microsurgery (TEM)

Author

D Ambrosio, G., Andrea Balla, Mattei, F., Quaresima, S., Laurentis, F., and Paganini, A. M.

Subjects
Adult, Aged, 80 and over, Male, Transanal Endoscopic Microsurgery, Time Factors, Rectal Neoplasms, Chemoradiotherapy, Adenocarcinoma, Middle Aged, Neoadjuvant Therapy, Postoperative Complications, Treatment Outcome, Surveys and Questionnaires, Quality of Life, Humans, Female, Aged, Follow-Up Studies
Abstract

Endoluminal Loco-Regional Resection (ELRR) by Transanal Endoscopic Microsurgery (TEM) may be considered a valid alternative surgical treatment in patients with rectal cancer. Aim of this study is to evaluate the short and medium term Quality of Life (QoL) from prospectively collected data in patients who underwent ELRR by TEM.From May 2010 to June 2013, 31 patients with iT1-iT2-iT3N0 rectal cancer were enrolled in this study. Patients with T1 rectal cancer underwent ELRR by TEM. Patients with iT2-iT3 rectal cancer underwent neoadjuvant radio-chemoterapy (n-RCT) before surgery. QoL was evaluated by EORTC QLQ-C30 and QLQ-CR38 questionnaires before surgery and 1, 6, and 12 months after surgery.Mean distance from the anal verge was 5.4 cm (range 1-10). Mean operative time was 145.8 minutes (range 60-300). Pathological staging was as follows: pT0N0 (6), pT1N0 (18), pT2N0 (7). At 1 month after surgery, in QLQC30 questionnaire, significant worsening was observed in Global Health Status (p=0.0028), Physical Functioning (p=0.0016), Role Functioning (p=0.0004), Fatigue (p=0.0024), Pain (p=0.0003) and Dyspnoea (p=0.0192). In QLQCR38 questionnaire significant worsening at 1 month was observed in Defecation Problems (p=0.0005) and Weight Loss (p=0.0008). At six and twelve months after surgery, no significant differences were observed in QLQ-C30 and in QLQCR38 questionnaires.QoL evaluation showed worsening results at 1 month after ELRR by TEM, in QLQ-C30 and in QLQCR38 questionnaires.At 6 and 12 months after surgery, no significant differences in QoL as compared to preoperative status were observed.Endoluminal Loco-Regional Resection (ELRR) mediante Transanal Endoscopic Microsurgery (TEM) può essere considerata come una valida alternativa chirurgica al trattamento dei pazienti con cancro del retto. Scopo di questo studio è valutare la Qualità di vita a breve e medio termine nei pazienti sottoposti a ELRR mediante TEM con dati raccolti in modo prospettico.Da Maggio 2010 a Giugno 2013, 31 pazienti con cancro del retto iT1-iT2-iT3N0 sono stati arruolati in questo studio. I pazienti affetti da cancro del retto iT1 sono stati sottoposti a ELRR mediante TEM. I pazienti con cancro del retto iT2-iT3 sono stati sottoposti a radio-chemioterapia neoadiuvante prima dell’intervento chirurgico. La Qualità di vita è stata valutata mediante i questionari EORTC QLQ-C30 e QLQ-CR38 prima della chirurgia e a 1, 6, e 12 mesi dopo l’intervento.La distanza media dal margine anale era di 5.4 cm (range 1-10). Il tempo operatorio medio è stato di 145.8 minuti (range 60-300). La stadiazione istologica definitiva era: pT0N0 (6), pT1N0 (18), pT2N0 (7). Ad 1 mese dopo la chirurgia, nel questionario QLQC30, un peggioramento significativo è stato osservato in Global Health Status (p=0.0028), Physical Functioning (p=0.0016), Role Functioning (p=0.0004), Fatigue (p=0.0024), Pain (p=0.0003) e Dyspnoea (p=0.0192). Nel questionario QLQ-CR38 un peggioramento significativo è stato osservato ad 1 mese in Defecation Problems (p=0.0005) e Weight Loss (p=0.0008). A 6 e 12 mesi dopo chirurgia, non sono state osservate differenze statisticamente significative in entrambi i questionari QLQC30 e QLQ-CR38.La valutazione della Qualità di vita mostrava un peggioramento dei risultati ad 1 mese dopo ELRR mediante TEM, nei questionari QLQ-C30 e QLQ-CR38.A 6 e 12 mesi dopo chirurgia, non sono state osservate differenze statisticamente significative nella Qualità di vita se comparate con lo stato preoperatorio dei pazienti.

Published
2015

19. Agroscenari e il programma di sviluppo rurale 2014-2020

Author

Vento D.(1), Ammassari P.(2), Dal Monte G.(1), De Lorenzi F.(3), Donatelli M.(4), Dono G.(5), Esposito S.(1), Marletto V.(6), Masoero F.(7), Pasqui M.(8), Pellegrini S.(9), Perini L.(1), Quaresima S.(1), Roggero P.P.(10), Servadio P.(11), and Zucaro R.(12)

Subjects
climate change, Italy, 2014-2020 RDP, SWOT analysis, adaptation, agriculture
Abstract

Agroscenari is a multiannual research project, funded and coordinated at the national level, supporting Italian agriculture adaptation to climate change and developing decision-making tools for public administrations and stakeholders. The project was active in six representative areas: Po Valley, Oristano, Benevento, Destra Sele, Faenza and two small basins in the Marche region. Climate change scenarios were created for every area to assess impacts on the main cropping systems and to identify adaptation options. In the last year of the project (2014) a policy brief (PB) for each test area was prepared in order to promote the transfer of scientific results. In addition to summarizing expected climate change, methods and results, PBs contain a SWOT analysis relating strengths and weaknesses internal to the agricultural production systems with the opportunities and threats from climate change, and suggesting adaptation measures for the Italian Rural Development Programme 2014-2020.

Published
2014

21. [Bodypackers syndrome. A case report and review of the literature]

Author

Rossi, P, Manzelli, A, Ricciardi, E, Quaresima, S, Boi, L, Simonetti, Gme, and Petrella, G

Subjects
Adult, Radiography, Settore MED/18 - Chirurgia Generale, Travel, Settore MED/36 - Diagnostica per Immagini e Radioterapia, Cocaine, female, humans, radiography, syndrome, travel, cocaine, colon, foreign bodies, Colon, Humans, Female, Syndrome, Foreign Bodies
Abstract

With the term Body packers we identify people who carry drugs hidden in their bodies especially on international flights. These event are constantly increasing all over the world. The accidental spontaneous opening of the drug packers is the major risk for patient's life, because the release cocaine inside the bowel can stir up the Body packers Syndrome. This eventuality is a medical surgical emergency that needs a wel timed diagnosis and a sudden treatment.We report a case of a 31 years old Caucasian woman, admitted from Rome International Airport to the nearest Emergency Unit and then moved to our Department because of suspected epilepsy hiding a diagnosis of Body packers Syndrome in acute phase. When the diagnosis was made, the woman was submitted to a colonoscopy and ciecotomy, and fifty-three packets were removed. In intensive care any complication occurred after surgery.The Body packing of drugs it's constantly a going problem. In Italy currently there aren't shared guide lines about the management of these patients. The international experience reports that in asymptomatic patients is enough a conservative treatment to help the spontaneous evacuation of packets but if the Body packers Syndrome is already present the best treatment is the surgical one. Quickness, accuracy and right use of radiology are the main factors to reach a correct diagnosis and to obtain a good result.

Published
2011

27. An ICP-MS and HPLC application

Author

Passariello B., Quaresima S., Santarsiero A., and Barbaro M.

Subjects
mercury, water, ICP-MS, methylmercury, HPLC
Abstract

The technique high-performance liquid chromatography (HPLC) coupled, not automatically, to inductively coupled plasma mass-spectrometry ICP-MS was performed for mercury speciation in practical analyses. In order to prove the system can be used in practical analysis, water samples were collected in a mining area, where the presence of mercury was known. Three types of water were analysed on the basis of the expected content of mercury(Hg) (wastewater, surface water, and drinking water). Total mercury and methylmercury were determined in the investigated samples, and preliminary results are reported in this paper. The performed technique may be advantageous, since it permits both instruments (HPLC and ICP-MS) to be used, and not exclusively to each other in this determination, as HPCL is not automatically coupled to ICP-MS that would prevent the instruments use for other analyses. The performed technique using HPLC-ICP-MS for methylmercury separation/detection results in a fast and easy-to-use method that permits the determination at both low and high levels (from 0.01 to 0.25 ppm) of methylmercury. ICP-MS allows a direct determination of ultratrace total mercury with the detection limit for mercury being 0.01 ppb.

Published
2006

34. Treatment of recto-vesical fistula by transanal endoscopic microsurgery approach

Author

D Ambrosio, G., Intini, G., Picchetto, A., Campo, S., Balla, A., Quaresima, S., ALESSANDRO MARIA PAGANINI, and Lezoche, E.

Subjects
Male, Prostatectomy, Transanal Endoscopic Microsurgery, Ileostomy, Urinary Bladder Fistula, Suture Techniques, Prostatic Neoplasms, Chemoradiotherapy, Middle Aged, Combined Modality Therapy, Anti-Bacterial Agents, Postoperative Complications, Urinary Tract Infections, Humans, Rectal Fistula, Urinary Catheterization
Abstract

Rectovesical Fistula (RVF) is a rare major surgery complication. Despite different techniques have been proposed as yet there is still no standard treatment. Transanal Endoscopic Microsurgery provides a magnified three-dimensional vision and it is less invasive than the traditional surgical procedure used in RVF treatment.A 62 years-old man, who developed a rectovesical fistula after laparoscopic radical prostatectomy, underwent TEM-assisted RVF repair by full-thickness excision and both bladder and rectal wall suture. The patients had a temporary ileostomyThe patient could ambulate on day one, was fed on day three and was discharged on day 10 with the indwelling bladder catheter left in place. The ileostomy was taken down and the catheter removed three months later when colonoscopy and cystoscopy showed no rvf recurrence.From 2004, only ten cases of TEM-assisted treatment of RVF are reported with three recurrences and good results even in patients who had already undergone previous surgical attempts. TEM is safe and effective. It provides a tension free suture line on healthy tissue with adequate hemostasis and it may be a good alternative in the treatment of rectovesical fistula.Endoscopic Surgery, Microsurgery, Recto-vesical Fistula, Transanal Endoscopic.Le fistole rettovescicali sono una complicanza rara della chirurgia maggiore. Nonostante il corso degli anni siano state proposte diverse tecniche chirurgiche, non vi è ancora un trattamento standard e riconosciuto. La Transanal Endoscopic Microsurgery (TEM) permette di operare in un campo operatorio magnificato e tridimensionale; inoltre è una tecnica meno invasiva rispetto agli approcci tradizionali usati nel trattamento delle fistole rettovescicali.Abbiamo sottoposto ad intervento chirurgico di riparazione mediante TEM un uomo di 62 anni, portatore di ileostomia, il quale ha sviluppato una fistola rettovescicale dopo prostatectomia radicale laparoscopica. L’intervento ha previsto l’escissione a tutto spessore del tessuto sclerotico intorno alla fistola e la sutura della parete vescicale e della parete del retto.Il paziente ha ripreso la deambulazione in prima giornata; è stato in grado di alimentarsi in terza giorgiornata ed è stato dimesso in decima giornata con il catetere vescicale in sede. Tre mesi dopo una colonscopia e una cistoscopia hanno dimostrato l’assenza di recidiva e la ricanalizzazione intestinale è stata, quindi, ripristinata tramite intervento di chiusura di ileostomia e il catetere vescicale è stato rimosso.In Letteratura, dal 2004 a oggi, sono stati riportati solo dieci casi di trattamento di fistula rettovescicale, mediante TEM, con tre casi di recidiva. Sono stati riportati buoni risultati anche nei pazienti che avevano già subito precedenti tentativi di riparazione chirurgica. La TEM si è dimostrata essere sicura ed efficace; permette l’esito di una linea di sutura priva di tensione su tessuto sano con emostasi adeguata e sembra essere un’ottima alternativa, rispetto alle metodiche tradizionali, nel trattamento delle fistole rettovescicali.

38. Solitary skin metastasis from sarcomatoid carcinoma of the bladder: a case report

Author

Kontos Michael, Brennan Nicholas, Ricciardi Edoardo, Petrou Athanasios, Rossi Piero, Quaresima Silvia, Manzelli Antonio, and Petrella Giuseppe

Subjects
Medicine
Abstract

Abstract Introduction Cutaneous metastases from carcinomas of the bladder are very rare. They are related to advanced stages of the disease and have poor prognosis with low survival rates. The common treatment modality of cutaneous metastases from a primary bladder cancer is wide local excision followed by chemotherapy. Case presentation We report a case of solitary skin metastasis from a rare type of urinary bladder carcinoma in a 68 year-old Caucasian man. Urinary bladder carcinoma metastasizing to the skin is an uncommon finding despite the high incidence of this tumor. Skin metastasis generally presents in the late stages of this disease and indicates a poor outcome. Conclusions Because of the extremely aggressive malignant potential of sarcomatoid carcinomas, the indications for a transurethral resection of the bladder should be carefully assessed and suitable therapeutic strategies should be examined further.

Published
2011
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39. Spontaneous intraperitoneal rupture of pyonephrosis in a patient with unknown kidney carcinosarcoma: a case report

Author

Brennan Nicholas, Petrou Athanasios, Ricciardi Edoardo, Manzelli Antonio, Quaresima Silvia, Mauriello Alessandro, and Rossi Piero

Subjects
Surgery, RD1-811, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Abstract Seventeen cases of peritonitis due to rupture of a pyonephrosis have been reported. The majority of these cases occur secondary to renal stones. Only two cases of ruptured pyonephrosis with concurrent kidney neoplasm have been described and only one of these presented as an acute peritonitis. In this presentation we discuss an unusual case of a 68 year old man with a chronic history of bilateral nephrolithiasis and recent pyonephrosis. He presented acutely with peritonitis and was later found to have a carcinosarcoma of the kidney. The case highlights the importance of recognizing the possibility of underling renal carcinoma in patients presenting with a ruptured pyonephrosis and discuss steps to avoid this serious complication.

Published
2011
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40. Surgeons' perspectives on artificial intelligence to support clinical decision-making in trauma and emergency contexts: results from an international survey

Author

Cobianchi, Lorenzo, Piccolo, Daniele, Dal Mas, Francesca, Agnoletti, Vanni, Ansaloni, Luca, Balch, Jeremy, Biffl, Walter, Butturini, Giovanni, Catena, Fausto, Coccolini, Federico, Denicolai, Stefano, De Simone, Belinda, Frigerio, Isabella, Fugazzola, Paola, Marseglia, Gianluigi, Marseglia, Giuseppe Roberto, Martellucci, Jacopo, Modenese, Mirko, Previtali, Pietro, Ruta, Federico, Venturi, Alessandro, Kaafarani, Haytham M, Loftus, Tyler J, Kenneth Lyle Abbott, Abubaker Abdelmalik, Nebyou Seyoum Abebe, Fikri Abu-Zidan, Yousif Abdallah Yousif Adam, Harissou Adamou, Dmitry Mikhailovich Adamovich, Ferdinando Agresta, Antonino Agrusa, Emrah Akin, Mario Alessiani, Henrique Alexandrino, Syed Muhammad Ali, Vasilescu Alin Mihai, Pedro Miguel Almeida, Mohammed Mohammed Al-Shehari, Michele Altomare, Francesco Amico, Michele Ammendola, Jacopo Andreuccetti, Elissavet Anestiadou, Peter Angelos, Alfredo Annicchiarico, Amedeo Antonelli, Daniel Aparicio-Sanchez, Antonella Ardito, Giulio Argenio, Catherine Claude Arvieux, Ingolf Harald Askevold, Boyko Tchavdarov Atanasov, Goran Augustin, Selmy Sabry Awad, Giulia Bacchiocchi, Carlo Bagnoli, Hany Bahouth, Efstratia Baili, Lovenish Bains, Gian Luca Baiocchi, Miklosh Bala, Carmen Balagué, Dimitrios Balalis, Edoardo Baldini, Oussama Baraket, Suman Baral, Mirko Barone, Alberto Gonzãlez Barranquero, Jorge Arturo Barreras, Gary Alan Bass, Zulfu Bayhan, Giovanni Bellanova, Offir Ben-Ishay, Fabrizio Bert, Valentina Bianchi, Helena Biancuzzi, Chiara Bidoli, Raluca Bievel Radulescu, Mark Brian Bignell, Alan Biloslavo, Daniele Bissacco, Roberto Bini, Paolo Boati, Guillaume Boddaert, Branko Bogdanic, Cristina Bombardini, Luigi Bonavina, Luca Bonomo, Andrea Bottari, Konstantinos Bouliaris, Gioia Brachini, Antonio Brillantino, Giuseppe Brisinda, Maloni Mamada Bulanauca, Luis Antonio Buonomo, Jakob Burcharth, Salvatore Buscemi, Francesca Calabretto, Giacomo Calini, Valentin Calu, Fabio Cesare Campanile, Riccardo Campo Dall Orto, Andrea Campos-Serra, Stefano Campostrini, Recayi Capoglu, Joao Miguel Carvas, Marco Cascella, Gianmaria Casoni Pattacini, Valerio Celentano, Danilo Corrado Centonze, Marco Ceresoli, Dimitrios Chatzipetris, Antonella Chessa, Maria Michela Chiarello, Mircea Chirica, Serge Chooklin, Christos Chouliaras, Sharfuddin Chowdhury, Pasquale Cianci, Nicola Cillara, Stefania Cimbanassi, Stefano Piero Bernardo Cioffi, Elif Colak, Enrique Colás Ruiz, Luigi Conti, Alessandro Coppola, Tiago Correia De Sa, Silvia Dantas Costa, Valerio Cozza, Giuseppe Curro', Kirsten Felicia Ann-Sophie Aimee Dabekaussen, Fabrizio D'Acapito, Dimitrios Damaskos, Giancarlo D'Ambrosio, Koray Das, Richard Justin Davies, Andrew Charles De Beaux, Sara Patricia De Lebrusant Fernandez, Alessandro De Luca, Francesca De Stefano, Luca Degrate, Zaza Demetrashvili, Andreas Kyriacou Demetriades, Dzemail Smail Detanac, Agnese Dezi, Giuseppe Di Buono, Isidoro Di Carlo, Pierpaolo Di Lascio, Marcello Di Martino, Salomone Di Saverio, Bogdan Diaconescu, Jose J Diaz, Rigers Dibra, Evgeni Nikolaev Dimitrov, Vincenza Paola Dinuzzi, Sandra Dios-Barbeito, Jehangir Farman Ali Diyani, Agron Dogjani, Maurizio Domanin, Mario D'Oria, Virginia Duran Munoz-Cruzado, Barbora East, Mikael Ekelund, Gerald Takem Ekwen, Adel Hamed Elbaih, Muhammed Elhadi, Natalie Enninghorst, Mairam Ernisova, Juan Pablo Escalera-Antezana, Sofia Esposito, Giuseppe Esposito, Mercedes Estaire, Camilla Nikita Farè, Roser Farre, Francesco Favi, Luca Ferrario, Antonjacopo Ferrario di Tor Vajana, Claudia Filisetti, Francesco Fleres, Vinicius Cordeiro Fonseca, Alexander Forero-Torres, Francesco Forfori, Laura Fortuna, Evangelos Fradelos, Gustavo P Fraga, Pietro Fransvea, Simone Frassini, Giuseppe Frazzetta, Erica Pizzocaro, Maximos Frountzas, Mahir Gachabayov, Rita Galeiras, Alain A Garcia Vazquez, Simone Gargarella, Ibrahim Umar Garzali, Wagih Mommtaz Ghannam, Faiz Najmuddin Ghazi, Lawrence Marshall Gillman, Rossella Gioco, Alessio Giordano, Luca Giordano, Carlo Giove, Giorgio Giraudo, Mario Giuffrida, Michela Giulii Capponi, Emanuel Gois Jr, Carlos Augusto Gomes, Felipe Couto Gomes, Ricardo Alessandro Teixeira Gonsaga, Emre Gonullu, Jacques Goosen, Tatjana Goranovic, Raquel Gracia-Roman, Giorgio Maria Paolo Graziano, Ewen Alexander Griffiths, Tommaso Guagni, Dimitar Bozhidarov Hadzhiev, Muad Gamil Haidar, Hytham K S Hamid, Timothy Craig Hardcastle, Firdaus Hayati, Andrew James Healey, Andreas Hecker, Matthias Hecker, Edgar Fernando Hernandez Garcia, Adrien Montcho Hodonou, Eduardo Cancio Huaman, Martin Huerta, Aini Fahriza Ibrahim, Basil Mohamed Salabeldin Ibrahim, Giuseppe Ietto, Marco Inama, Orestis Ioannidis, Arda Isik, Nizar Ismail, Azzain Mahadi Hamid Ismail, Ruhi Fadzlyana Jailani, Ji Young Jang, Christos Kalfountzos, Sujala Niatarika Rajsain Kalipershad, Emmanouil Kaouras, Lewis Jay Kaplan, Yasin Kara, Evika Karamagioli, Aleksandar Karamarkovia, Ioannis Katsaros, Alfie J Kavalakat, Aristotelis Kechagias, Jakub Kenig, Boris Juli Kessel, Jim S Khan, Vladimir Khokha, Jae Il Kim, Andrew Wallace Kirkpatrick, Roberto Klappenbach, Yoram Kluger, Yoshiro Kobe, Efstratios Kofopoulos Lymperis, Kenneth Yuh Yen Kok, Victor Kong, Dimitris P Korkolis, Georgios Koukoulis, Bojan Kovacevic, Vitor Favali Kruger, Igor A Kryvoruchko, Hayato Kurihara, Akira Kuriyama, Aitor Landaluce-Olavarria, Pierfrancesco Lapolla, Ari Leppäniemi, Leo Licari, Giorgio Lisi, Andrey Litvin, Aintzane Lizarazu, Heura Llaquet Bayo, Varut Lohsiriwat, Claudia Cristina Lopes Moreira, Eftychios Lostoridis, Agustãn Tovar Luna, Davide Luppi, Gustavo Miguel Machain V, Marc Maegele, Daniele Maggiore, Stefano Magnone, Ronald V Maier, Piotr Major, Mallikarjuna Manangi, Andrea Manetti, Baris Mantoglu, Chiara Marafante, Federico Mariani, Athanasios Marinis, Evandro Antonio Sbalcheiro Mariot, Gennaro Martines, Aleix Martinez Perez, Costanza Martino, Pietro Mascagni, Damien Massalou, Maurizio Massaro, Belen Matías-García, Gennaro Mazzarella, Giorgio Mazzarolo, Renato Bessa Melo, Fernando Mendoza-Moreno, Serhat Meric, Jeremy Meyer, Luca Miceli, Nikolaos V Michalopoulos, Flavio Milana, Andrea Mingoli, Tushar S Mishra, Muyed Mohamed, Musab Isam Eldin Abbas Mohamed, Ali Yasen Mohamedahmed, Mohammed Jibreel Suliman Mohammed, Rajashekar Mohan, Ernest E Moore, Dieter Morales-Garcia, Mã Ns Muhrbeck, Francesk Mulita, Sami Mohamed Siddig Mustafa, Edoardo Maria Muttillo, Mukhammad David Naimzada, Pradeep H Navsaria, Ionut Negoi, Luca Nespoli, Christine Nguyen, Melkamu Kibret Nidaw, Giuseppe Nigri, Ioannis Nikolopoulos, Donal Brendan O'Connor, Habeeb Damilola Ogundipe, Cristina Oliveri, Stefano Olmi, Ernest Cun Wang Ong, Luca Orecchia, Aleksei V Osipov, Muhammad Faeid Othman, Marco Pace, Mario Pacilli, Leonardo Pagani, Giuseppe Palomba, Desire' Pantalone, Arpad Panyko, Ciro Paolillo, Mario Virgilio Papa, Dimitrios Papaconstantinou, Maria Papadoliopoulou, Aristeidis Papadopoulos, Davide Papis, Nikolaos Pararas, Jose Gustavo Parreira, Neil Geordie Parry, Francesco Pata, Tapan Patel, Simon Paterson-Brown, Giovanna Pavone, Francesca Pecchini, Veronica Pegoraro, Gianluca Pellino, Maria Pelloni, Andrea Peloso, Eduardo Perea Del Pozo, Rita Goncalves Pereira, Bruno Monteiro Pereira, Aintzane Lizarazu Perez, Silvia Pérez, Teresa Perra, Gennaro Perrone, Antonio Pesce, Lorenzo Petagna, Giovanni Petracca, Vorapong Phupong, Biagio Picardi, Arcangelo Picciariello, Micaela Piccoli, Edoardo Picetti, Emmanouil Pikoulis Pikoulis, Tadeja Pintar, Giovanni Pirozzolo, Francesco Piscioneri, Mauro Podda, Alberto Porcu, Francesca Privitera, Clelia Punzo, Silvia Quaresima, Martha Alexa Quiodettis, Niels Qvist, Razrim Rahim, Filipe Ramalho de Almeida, Rosnelifaizur Bin Ramely, Huseyin Kemal Rasa, Martin Reichert, Alexander Reinisch-Liese, Angela Renne, Camilla Riccetti, Maria Rita Rodriguez-Luna, Daniel Roizblatt, Andrea Romanzi, Luigi Romeo, Francesco Pietro Maria Roscio, Ramely Bin Rosnelifaizur, Stefano Rossi, Andres M Rubiano, Elena Ruiz-Ucar, Boris Evgeniev Sakakushev, Juan Carlos Salamea, Ibrahima Sall, Lasitha Bhagya Samarakoon, Fabrizio Sammartano, Alejandro Sanchez Arteaga, Sergi Sanchez-Cordero, Domenico Pietro Maria Santoanastaso, Massimo Sartelli, Diego Sasia, Norio Sato, Artem Savchuk, Robert Grant Sawyer, Giacomo Scaioli, Dimitrios Schizas, Simone Sebastiani, Barbara Seeliger, Helmut Alfredo Segovia Lohse, Charalampos Seretis, Giacomo Sermonesi, Mario Serradilla-Martin, Vishal G Shelat, Sergei Shlyapnikov, Theodoros Sidiropoulos, Romeo Lages Simoes, Leandro Siragusa, Boonying Siribumrungwong, Mihail Slavchev, Leonardo Solaini, Gabriele Soldini, Andrey Sopuev, Kjetil Soreide, Apostolos Sovatzidis, Philip Frank Stahel, Matt Strickland, Mohamed Arif Hameed Sultan, Ruslan Sydorchuk, Larysa Sydorchuk, Syed Muhammad Ali Muhammad Syed, Luis Tallon-Aguilar, Andrea Marco Tamburini, Nicolò Tamini, Edward C T H Tan, Jih Huei Tan, Antonio Tarasconi, Nicola Tartaglia, Giuseppe Tartaglia, Dario Tartaglia, John Vincent Taylor, Giovanni Domenico Tebala, Michel Teuben, Alexis Theodorou, Matti Tolonen, Giovanni Tomasicchio, Adriana Toro, Beatrice Torre, Tania Triantafyllou, Giuseppe Trigiante Trigiante, Marzia Tripepi, Julio Trostchansky, Konstantinos Tsekouras, Victor Turrado-Rodriguez, Roberta Tutino, Matteo Uccelli, Petar Angelov Uchikov, Bakarne Ugarte-Sierra, Mika Tapani Ukkonen, Michail Vailas, Panteleimon G Vassiliu, Alain Garcia Vazquez, Rita Galeiras Vazquez, George Velmahos, Juan Ezequiel Verde, Juan Manuel Verde, Massimiliano Veroux, Jacopo Viganò, Ramon Vilallonga, Diego Visconti, Alessandro Vittori, Maciej Waledziak, Tongporn Wannatoop, Lukas Werner Widmer, Michael Samuel James Wilson, Sarah Woltz, Ting Hway Wong, Sofia Xenaki, Byungchul Yu, Steven Yule, Sanoop Koshy Zachariah, Georgios Zacharis, Claudia Zaghi, Andee Dzulkarnaen Zakaria, Diego A Zambrano, Nikolaos Zampitis, Biagio Zampogna, Simone Zanghì, Maristella Zantedeschi, Konstantinos Zapsalis, Fabio Zattoni, Monica Zese, Lorenzo, Cobianchi, Daniele, Piccolo, Francesca, Dal Ma, Vanni, Agnoletti, Luca, Ansaloni, Jeremy, Balch, Walter, Biffl, Giovanni, Butturini, Fausto, Catena, Federico, Coccolini, Stefano, Denicolai, Belinda, De Simone, Isabella, Frigerio, Paola, Fugazzola, Gianluigi, Marseglia, Giuseppe Roberto, Marseglia, Jacopo, Martellucci, Mirko, Modenese, Pietro, Previtali, Federico, Ruta, Alessandro, Venturi, Haytham M, Kaafarani, Tyler J, Loftu, Lyle Abbott, Kenneth, Abdelmalik, Abubaker, Seyoum Abebe, Nebyou, Abu-Zidan, Fikri, Abdallah Yousif Adam, Yousif, Adamou, Harissou, Mikhailovich Adamovich, Dmitry, Agresta, Ferdinando, Agrusa, Antonino, Akin, Emrah, Alessiani, Mario, Alexandrino, Henrique, Muhammad Ali, Syed, Alin Mihai, Vasilescu, Miguel Almeida, Pedro, Mohammed Al-Shehari, Mohammed, Altomare, Michele, Amico, Francesco, Ammendola, Michele, Andreuccetti, Jacopo, Anestiadou, Elissavet, Angelos, Peter, Annicchiarico, Alfredo, Antonelli, Amedeo, Aparicio-Sanchez, Daniel, Ardito, Antonella, Argenio, Giulio, Claude Arvieux, Catherine, Harald Askevold, Ingolf, Tchavdarov Atanasov, Boyko, Augustin, Goran, Sabry Awad, Selmy, Bacchiocchi, Giulia, Bagnoli, Carlo, Bahouth, Hany, Baili, Efstratia, Bains, Lovenish, Luca Baiocchi, Gian, Bala, Miklosh, Balagué, Carmen, Balalis, Dimitrio, Baldini, Edoardo, Baraket, Oussama, Baral, Suman, Barone, Mirko, Gonzãlez Barranquero, Alberto, Arturo Barreras, Jorge, Alan Bass, Gary, Bayhan, Zulfu, Bellanova, Giovanni, Ben-Ishay, Offir, Bert, Fabrizio, Bianchi, Valentina, Biancuzzi, Helena, Bidoli, Chiara, Bievel Radulescu, Raluca, Brian Bignell, Mark, Biloslavo, Alan, Bissacco, Daniele, Bini, Roberto, Boati, Paolo, Boddaert, Guillaume, Bogdanic, Branko, Bombardini, Cristina, Bonavina, Luigi, Bonomo, Luca, Bottari, Andrea, Bouliaris, Konstantino, Brachini, Gioia, Brillantino, Antonio, Brisinda, Giuseppe, Mamada Bulanauca, Maloni, Antonio Buonomo, Lui, Burcharth, Jakob, Buscemi, Salvatore, Calabretto, Francesca, Calini, Giacomo, Calu, Valentin, Cesare Campanile, Fabio, Campo Dall Orto, Riccardo, Campos-Serra, Andrea, Campostrini, Stefano, Capoglu, Recayi, Miguel Carvas, Joao, Cascella, Marco, Casoni Pattacini, Gianmaria, Celentano, Valerio, Corrado Centonze, Danilo, Ceresoli, Marco, Chatzipetris, Dimitrio, Chessa, Antonella, Michela Chiarello, Maria, Chirica, Mircea, Chooklin, Serge, Chouliaras, Christo, Chowdhury, Sharfuddin, Cianci, Pasquale, Cillara, Nicola, Cimbanassi, Stefania, Piero Bernardo Cioffi, Stefano, Colak, Elif, Colás Ruiz, Enrique, Conti, Luigi, Coppola, Alessandro, Correia De Sa, Tiago, Dantas Costa, Silvia, Cozza, Valerio, Curro', Giuseppe, Felicia Ann-Sophie Aimee Dabekaussen, Kirsten, D'Acapito, Fabrizio, Damaskos, Dimitrio, D'Ambrosio, Giancarlo, Das, Koray, Justin Davies, Richard, Charles De Beaux, Andrew, Patricia De Lebrusant Fernandez, Sara, De Luca, Alessandro, De Stefano, Francesca, Degrate, Luca, Demetrashvili, Zaza, Kyriacou Demetriades, Andrea, Smail Detanac, Dzemail, Dezi, Agnese, Di Buono, Giuseppe, Di Carlo, Isidoro, Di Lascio, Pierpaolo, Di Martino, Marcello, Di Saverio, Salomone, Diaconescu, Bogdan, J Diaz, Jose, Dibra, Riger, Nikolaev Dimitrov, Evgeni, Paola Dinuzzi, Vincenza, Dios-Barbeito, Sandra, Farman Ali Diyani, Jehangir, Dogjani, Agron, Domanin, Maurizio, D'Oria, Mario, Duran Munoz-Cruzado, Virginia, East, Barbora, Ekelund, Mikael, Takem Ekwen, Gerald, Hamed Elbaih, Adel, Elhadi, Muhammed, Enninghorst, Natalie, Ernisova, Mairam, Pablo Escalera-Antezana, Juan, Esposito, Sofia, Esposito, Giuseppe, Estaire, Mercede, Nikita Farè, Camilla, Farre, Roser, Favi, Francesco, Ferrario, Luca, Ferrario di Tor Vajana, Antonjacopo, Filisetti, Claudia, Fleres, Francesco, Cordeiro Fonseca, Viniciu, Forero-Torres, Alexander, Forfori, Francesco, Fortuna, Laura, Fradelos, Evangelo, P Fraga, Gustavo, Fransvea, Pietro, Frassini, Simone, Frazzetta, Giuseppe, Pizzocaro, Erica, Frountzas, Maximo, Gachabayov, Mahir, Galeiras, Rita, A Garcia Vazquez, Alain, Gargarella, Simone, Umar Garzali, Ibrahim, Mommtaz Ghannam, Wagih, Najmuddin Ghazi, Faiz, Marshall Gillman, Lawrence, Gioco, Rossella, Giordano, Alessio, Giordano, Luca, Giove, Carlo, Giraudo, Giorgio, Giuffrida, Mario, Giulii Capponi, Michela, Gois Jr, Emanuel, Augusto Gomes, Carlo, Couto Gomes, Felipe, Alessandro Teixeira Gonsaga, Ricardo, Gonullu, Emre, Goosen, Jacque, Goranovic, Tatjana, Gracia-Roman, Raquel, Maria Paolo Graziano, Giorgio, Alexander Griffiths, Ewen, Guagni, Tommaso, Bozhidarov Hadzhiev, Dimitar, Gamil Haidar, Muad, S Hamid, Hytham K, Craig Hardcastle, Timothy, Hayati, Firdau, James Healey, Andrew, Hecker, Andrea, Hecker, Matthia, Fernando Hernandez Garcia, Edgar, Montcho Hodonou, Adrien, Cancio Huaman, Eduardo, Huerta, Martin, Fahriza Ibrahim, Aini, Mohamed Salabeldin Ibrahim, Basil, Ietto, Giuseppe, Inama, Marco, Ioannidis, Oresti, Isik, Arda, Ismail, Nizar, Mahadi Hamid Ismail, Azzain, Fadzlyana Jailani, Ruhi, Young Jang, Ji, Kalfountzos, Christo, Niatarika Rajsain Kalipershad, Sujala, Kaouras, Emmanouil, Jay Kaplan, Lewi, Kara, Yasin, Karamagioli, Evika, Karamarkovia, Aleksandar, Katsaros, Ioanni, J Kavalakat, Alfie, Kechagias, Aristoteli, Kenig, Jakub, Juli Kessel, Bori, S Khan, Jim, Khokha, Vladimir, Il Kim, Jae, Wallace Kirkpatrick, Andrew, Klappenbach, Roberto, Kluger, Yoram, Kobe, Yoshiro, Kofopoulos Lymperis, Efstratio, Yuh Yen Kok, Kenneth, Kong, Victor, P Korkolis, Dimitri, Koukoulis, Georgio, Kovacevic, Bojan, Favali Kruger, Vitor, A Kryvoruchko, Igor, Kurihara, Hayato, Kuriyama, Akira, Landaluce-Olavarria, Aitor, Lapolla, Pierfrancesco, Leppäniemi, Ari, Licari, Leo, Lisi, Giorgio, Litvin, Andrey, Lizarazu, Aintzane, Llaquet Bayo, Heura, Lohsiriwat, Varut, Cristina Lopes Moreira, Claudia, Lostoridis, Eftychio, Tovar Luna, Agustãn, Luppi, Davide, V, Gustavo Miguel Machain, Maegele, Marc, Maggiore, Daniele, Magnone, Stefano, V Maier, Ronald, Major, Piotr, Manangi, Mallikarjuna, Manetti, Andrea, Mantoglu, Bari, Marafante, Chiara, Mariani, Federico, Marinis, Athanasio, Antonio Sbalcheiro Mariot, Evandro, Martines, Gennaro, Martinez Perez, Aleix, Martino, Costanza, Mascagni, Pietro, Massalou, Damien, Massaro, Maurizio, Matías-García, Belen, Mazzarella, Gennaro, Mazzarolo, Giorgio, Bessa Melo, Renato, Mendoza-Moreno, Fernando, Meric, Serhat, Meyer, Jeremy, Miceli, Luca, V Michalopoulos, Nikolao, Milana, Flavio, Mingoli, Andrea, S Mishra, Tushar, Mohamed, Muyed, Isam Eldin Abbas Mohamed, Musab, Yasen Mohamedahmed, Ali, Jibreel Suliman Mohammed, Mohammed, Mohan, Rajashekar, E Moore, Ernest, Morales-Garcia, Dieter, Ns Muhrbeck, Mã, Mulita, Francesk, Mohamed Siddig Mustafa, Sami, Maria Muttillo, Edoardo, David Naimzada, Mukhammad, H Navsaria, Pradeep, Negoi, Ionut, Nespoli, Luca, Nguyen, Christine, Kibret Nidaw, Melkamu, Nigri, Giuseppe, Nikolopoulos, Ioanni, Brendan O'Connor, Donal, Damilola Ogundipe, Habeeb, Oliveri, Cristina, Olmi, Stefano, Cun Wang Ong, Ernest, Orecchia, Luca, V Osipov, Aleksei, Faeid Othman, Muhammad, Pace, Marco, Pacilli, Mario, Pagani, Leonardo, Palomba, Giuseppe, Pantalone, Desire', Panyko, Arpad, Paolillo, Ciro, Virgilio Papa, Mario, Papaconstantinou, Dimitrio, Papadoliopoulou, Maria, Papadopoulos, Aristeidi, Papis, Davide, Pararas, Nikolao, Gustavo Parreira, Jose, Geordie Parry, Neil, Pata, Francesco, Patel, Tapan, Paterson-Brown, Simon, Pavone, Giovanna, Pecchini, Francesca, Pegoraro, Veronica, Pellino, Gianluca, Pelloni, Maria, Peloso, Andrea, Perea Del Pozo, Eduardo, Goncalves Pereira, Rita, Monteiro Pereira, Bruno, Lizarazu Perez, Aintzane, Pérez, Silvia, Perra, Teresa, Perrone, Gennaro, Pesce, Antonio, Petagna, Lorenzo, Petracca, Giovanni, Phupong, Vorapong, Picardi, Biagio, Picciariello, Arcangelo, Piccoli, Micaela, Picetti, Edoardo, Pikoulis Pikoulis, Emmanouil, Pintar, Tadeja, Pirozzolo, Giovanni, Piscioneri, Francesco, Podda, Mauro, Porcu, Alberto, Privitera, Francesca, Punzo, Clelia, Quaresima, Silvia, Alexa Quiodettis, Martha, Qvist, Niel, Rahim, Razrim, Ramalho de Almeida, Filipe, Bin Ramely, Rosnelifaizur, Kemal Rasa, Huseyin, Reichert, Martin, Reinisch-Liese, Alexander, Renne, Angela, Riccetti, Camilla, Rita Rodriguez-Luna, Maria, Roizblatt, Daniel, Romanzi, Andrea, Romeo, Luigi, Pietro Maria Roscio, Francesco, Bin Rosnelifaizur, Ramely, Rossi, Stefano, M Rubiano, Andre, Ruiz-Ucar, Elena, Evgeniev Sakakushev, Bori, Carlos Salamea, Juan, Sall, Ibrahima, Bhagya Samarakoon, Lasitha, Sammartano, Fabrizio, Sanchez Arteaga, Alejandro, Sanchez-Cordero, Sergi, Pietro Maria Santoanastaso, Domenico, Sartelli, Massimo, Sasia, Diego, Sato, Norio, Savchuk, Artem, Grant Sawyer, Robert, Scaioli, Giacomo, Schizas, Dimitrio, Sebastiani, Simone, Seeliger, Barbara, Alfredo Segovia Lohse, Helmut, Seretis, Charalampo, Sermonesi, Giacomo, Serradilla-Martin, Mario, G Shelat, Vishal, Shlyapnikov, Sergei, Sidiropoulos, Theodoro, Lages Simoes, Romeo, Siragusa, Leandro, Siribumrungwong, Boonying, Slavchev, Mihail, Solaini, Leonardo, Soldini, Gabriele, Sopuev, Andrey, Soreide, Kjetil, Sovatzidis, Apostolo, Frank Stahel, Philip, Strickland, Matt, Arif Hameed Sultan, Mohamed, Sydorchuk, Ruslan, Sydorchuk, Larysa, Muhammad Ali Muhammad Syed, Syed, Tallon-Aguilar, Lui, Marco Tamburini, Andrea, Tamini, Nicolò, H Tan, Edward C T, Huei Tan, Jih, Tarasconi, Antonio, Tartaglia, Nicola, Tartaglia, Giuseppe, Tartaglia, Dario, Vincent Taylor, John, Domenico Tebala, Giovanni, Teuben, Michel, Theodorou, Alexi, Tolonen, Matti, Tomasicchio, Giovanni, Toro, Adriana, Torre, Beatrice, Triantafyllou, Tania, Trigiante Trigiante, Giuseppe, Tripepi, Marzia, Trostchansky, Julio, Tsekouras, Konstantino, Turrado-Rodriguez, Victor, Tutino, Roberta, Uccelli, Matteo, Angelov Uchikov, Petar, Ugarte-Sierra, Bakarne, Tapani Ukkonen, Mika, Vailas, Michail, G Vassiliu, Panteleimon, Garcia Vazquez, Alain, Galeiras Vazquez, Rita, Velmahos, George, Ezequiel Verde, Juan, Manuel Verde, Juan, Veroux, Massimiliano, Viganò, Jacopo, Vilallonga, Ramon, Visconti, Diego, Vittori, Alessandro, Waledziak, Maciej, Wannatoop, Tongporn, Werner Widmer, Luka, Samuel James Wilson, Michael, Woltz, Sarah, Hway Wong, Ting, Xenaki, Sofia, Yu, Byungchul, Yule, Steven, Koshy Zachariah, Sanoop, Zacharis, Georgio, Zaghi, Claudia, Dzulkarnaen Zakaria, Andee, A Zambrano, Diego, Zampitis, Nikolao, Zampogna, Biagio, Zanghì, Simone, Zantedeschi, Maristella, Zapsalis, Konstantino, Zattoni, Fabio, Zese, Monica, Cobianchi L., Piccolo D., Mas F.D., Agnoletti V., Ansaloni L., Balch J., Biffl W., Butturini G., Catena F., Coccolini F., Denicolai S., De Simone B., Frigerio I., Fugazzola P., Marseglia G., Marseglia G.R., Martellucci J., Modenese M., Previtali P., Ruta F., Venturi A., Kaafarani H.M., Loftus T.J., Laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie (ICube), École Nationale du Génie de l'Eau et de l'Environnement de Strasbourg (ENGEES)-Université de Strasbourg (UNISTRA)-Institut National des Sciences Appliquées - Strasbourg (INSA Strasbourg), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de Recherche en Informatique et en Automatique (Inria)-Les Hôpitaux Universitaires de Strasbourg (HUS)-Centre National de la Recherche Scientifique (CNRS)-Matériaux et Nanosciences Grand-Est (MNGE), Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Réseau nanophotonique et optique, Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS), Team Dynamics Study Group, Cobianchi, L, Piccolo, D, Dal Mas, F, Agnoletti, V, Ansaloni, L, Balch, J, Biffl, W, Butturini, G, Catena, F, Coccolini, F, Denicolai, S, De Simone, B, Frigerio, I, Fugazzola, P, Marseglia, G, Martellucci, J, Modenese, M, Previtali, P, Ruta, F, Venturi, A, Kaafarani, H, Loftus, T, Abbott, K, Abdelmalik, A, Abebe, N, Abu-Zidan, F, Adam, Y, Adamou, H, Adamovich, D, Agresta, F, Agrusa, A, Akin, E, Alessiani, M, Alexandrino, H, Ali, S, Mihai, V, Almeida, P, Al-Shehari, M, Altomare, M, Amico, F, Ammendola, M, Andreuccetti, J, Anestiadou, E, Angelos, P, Annicchiarico, A, Antonelli, A, Aparicio-Sanchez, D, Ardito, A, Argenio, G, Arvieux, C, Askevold, I, Atanasov, B, Augustin, G, Awad, S, Bacchiocchi, G, Bagnoli, C, Bahouth, H, Baili, E, Bains, L, Baiocchi, G, Bala, M, Balague, C, Balalis, D, Baldini, E, Baraket, O, Baral, S, Barone, M, Barranquero, A, Barreras, J, Bass, G, Bayhan, Z, Bellanova, G, Ben-Ishay, O, Bert, F, Bianchi, V, Biancuzzi, H, Bidoli, C, Radulescu, R, Bignell, M, Biloslavo, A, Bini, R, Bissacco, D, Boati, P, Boddaert, G, Bogdanic, B, Bombardini, C, Bonavina, L, Bonomo, L, Bottari, A, Bouliaris, K, Brachini, G, Brillantino, A, Brisinda, G, Bulanauca, M, Buonomo, L, Burcharth, J, Buscemi, S, Calabretto, F, Calini, G, Calu, V, Campanile, F, Dall'Orto, R, Campos-Serra, A, Campostrini, S, Capoglu, R, Carvas, J, Cascella, M, Pattacini, G, Celentano, V, Centonze, D, Ceresoli, M, Chatzipetris, D, Chessa, A, Chiarello, M, Chirica, M, Chooklin, S, Chouliaras, C, Chowdhury, S, Cianci, P, Cillara, N, Cimbanassi, S, Cioffi, S, Colak, E, Ruiz, E, Conti, L, Coppola, A, De Sa, T, Costa, S, Cozza, V, Curro', G, Dabekaussen, K, D'Acapito, F, Damaskos, D, D'Ambrosio, G, Das, K, Davies, R, De Beaux, A, Fernandez, S, De Luca, A, De Stefano, F, Degrate, L, Demetrashvili, Z, Demetriades, A, Detanac, D, Dezi, A, Di Buono, G, Di Carlo, I, Di Lascio, P, Di Martino, M, Di Saverio, S, Diaconescu, B, Diaz, J, Dibra, R, Dimitrov, E, Dinuzzi, V, Dios-Barbeito, S, Diyani, J, Dogjani, A, Domanin, M, D'Oria, M, Munoz-Cruzado, V, East, B, Ekelund, M, Ekwen, G, Elbaih, A, Elhadi, M, Enninghorst, N, Ernisova, M, Escalera-Antezana, J, Esposito, S, Esposito, G, Estaire, M, Fare, C, Farre, R, Favi, F, Ferrario, L, Vajana, A, Filisetti, C, Fleres, F, Fonseca, V, Forero-Torres, A, Forfori, F, Fortuna, L, Fradelos, E, Fraga, G, Fransvea, P, Frassini, S, Frazzetta, G, Pizzocaro, E, Frountzas, M, Gachabayov, M, Galeiras, R, Vazquez, A, Gargarella, S, Garzali, I, Ghannam, W, Ghazi, F, Gillman, L, Gioco, R, Giordano, A, Giordano, L, Giove, C, Giraudo, G, Giuffrida, M, Capponi, M, Gois, E, Gomes, C, Gomes, F, Gonsaga, R, Gonullu, E, Goosen, J, Goranovic, T, Gracia-Roman, R, Graziano, G, Griffiths, E, Guagni, T, Hadzhiev, D, Haidar, M, Hamid, H, Hardcastle, T, Hayati, F, Healey, A, Hecker, A, Hecker, M, Garcia, E, Hodonou, A, Huaman, E, Huerta, M, Ibrahim, A, Ibrahim, B, Ietto, G, Inama, M, Ioannidis, O, Isik, A, Ismail, N, Ismail, A, Jailani, R, Jang, J, Kalfountzos, C, Kalipershad, S, Kaouras, E, Kaplan, L, Kara, Y, Karamagioli, E, Karamarkovia, A, Katsaros, I, Kavalakat, A, Kechagias, A, Kenig, J, Kessel, B, Khan, J, Khokha, V, Kim, J, Kirkpatrick, A, Klappenbach, R, Kluger, Y, Kobe, Y, Lymperis, E, Kok, K, Kong, V, Korkolis, D, Koukoulis, G, Kovacevic, B, Kruger, V, Kryvoruchko, I, Kurihara, H, Kuriyama, A, Landaluce-Olavarria, A, Lapolla, P, Leppaniemi, A, Licari, L, Lisi, G, Litvin, A, Lizarazu, A, Bayo, H, Lohsiriwat, V, Moreira, C, Lostoridis, E, Luna, A, Luppi, D, Machain, V, Maegele, M, Maggiore, D, Magnone, S, Maier, R, Major, P, Manangi, M, Manetti, A, Mantoglu, B, Marafante, C, Mariani, F, Marinis, A, Mariot, E, Martines, G, Perez, A, Martino, C, Mascagni, P, Massalou, D, Massaro, M, Matias-Garcia, B, Mazzarella, G, Mazzarolo, G, Melo, R, Mendoza-Moreno, F, Meric, S, Meyer, J, Miceli, L, Michalopoulos, N, Milana, F, Mingoli, A, 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Uccelli, M, Uchikov, P, Ugarte-Sierra, B, Ukkonen, M, Vailas, M, Vassiliu, P, Vazquez, R, Velmahos, G, Verde, J, Veroux, M, Vigano, J, Vilallonga, R, Visconti, D, Vittori, A, Waledziak, M, Wannatoop, T, Widmer, L, Wilson, M, Woltz, S, Wong, T, Xenaki, S, Yu, B, Yule, S, Zachariah, S, Zacharis, G, Zaghi, C, Zakaria, A, Zambrano, D, Zampitis, N, Zampogna, B, Zanghi, S, Zantedeschi, M, Zapsalis, K, Zattoni, F, and Zese, M

Subjects
Settore SECS-P/10 - Organizzazione Aziendale, Settore MED/18 - Chirurgia Generale, Artificial intelligence, Settore SECS-P/07 - Economia Aziendale, Decision aid, Emergency Medicine, Decision aids, Surgery, [SDV.IB]Life Sciences [q-bio]/Bioengineering, Trauma and emergency surgery, Clinical decision-making, Survey
Abstract

Background Artificial intelligence (AI) is gaining traction in medicine and surgery. AI-based applications can offer tools to examine high-volume data to inform predictive analytics that supports complex decision-making processes. Time-sensitive trauma and emergency contexts are often challenging. The study aims to investigate trauma and emergency surgeons’ knowledge and perception of using AI-based tools in clinical decision-making processes. Methods An online survey grounded on literature regarding AI-enabled surgical decision-making aids was created by a multidisciplinary committee and endorsed by the World Society of Emergency Surgery (WSES). The survey was advertised to 917 WSES members through the society’s website and Twitter profile. Results 650 surgeons from 71 countries in five continents participated in the survey. Results depict the presence of technology enthusiasts and skeptics and surgeons' preference toward more classical decision-making aids like clinical guidelines, traditional training, and the support of their multidisciplinary colleagues. A lack of knowledge about several AI-related aspects emerges and is associated with mistrust. Discussion The trauma and emergency surgical community is divided into those who firmly believe in the potential of AI and those who do not understand or trust AI-enabled surgical decision-making aids. Academic societies and surgical training programs should promote a foundational, working knowledge of clinical AI.

Published
2023

41. Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Author

Global Health Research Unit on Global Surgery, National Institute for Health and Care Research, Adisa, Adewale, Bahrami-Hessari, Michael, Bhangu, Aneel, George, Christina, Ghosh, Dhruv, Glasbey, James, Haque, Parvez, Ingabire, J C Allen, Kamarajah, Sivesh Kathir, Kudrna, Laura, Ledda, Virginia, Li, Elizabeth, Lillywhite, Robert, Mittal, Rohin, Nepogodiev, Dmitri, Ntirenganya, Faustin, Picciochi, Maria, Simões, Joana Filipa Ferreira, Booth, L, Elliot, R, Kennerton, A S, Pettigrove, K L, Pinney, L, Richard, H, Tottman, R, Wheatstone, P, Wolfenden, John W D, Smith, A, Sayed, A Emad, Goswami, Aakansha Giri, Malik, Aamer, Mclean, Aaron Lawson, Hassan, Abbas, Nazimi, Abd Jabar, Aladna, Abdallah, Abdelgawad, Abdalrahman, Saed, Abdel, Abdelmageed, Abdelfatah, Ghannam, Abdelilah, Mahmoud, Abdelrahman, Alvi, Abdul, Ismail, Abdulaziz, Adesunkanmi, Abdulhafiz, Ebrahim, Abdulla, Al-Mallah, Abdullah, Alqallaf, Abdullah, Durrani, Abdullah, Gabr, Abdullah, Kirfi, Abdullahi Musa, Altaf, Abdulmalik, Almutairi, Abdulmjeed, Sabbagh, Abdulrahman J, Ajiya, Abdulrazak, Haddud, Abdurrahman, Alnsour, Abed Alfattah Mahmoud, Singh, Abhinav, Mittal, Abhishek, Semple, Abigail, Adeniran, Abiodun, Negussie, Abraham, Oladimeji, Abraham, Muhammad, Abubakar Bala, Yassin, Abubaker, Gungor, Abuzer, Tarsitano, Achille, Soibiharry, Adaiah, Dyas, Adam, Frankel, Adam, Peckham-Cooper, Adam, Truss, Adam, Issaka, Adamu, Ads, Adel Mohamed, Aderogba, Adeleke Akeem, Adeyeye, Ademola, Ademuyiwa, Adesoji, Sleem, Adham, Papa, Adrian, Cordova, Adriana, Appiah-Kubi, Adu, Meead, Adullah, Nacion, Aeris Jane D, Michael, Afieharo, Forneris, Agustin Albani, Duro, Agustin, Gonzalez, Agustin Rodriguez, Altouny, Ahmad, Ghazal, Ahmad, Khalifa, Ahmad, Ozair, Ahmad, Quzli, Ahmad, Haddad, Ahmad, Othman, Ahmad Faidzal, Yahaya, Ahmad Shuib, Elsherbiny, Ahmed, Nazer, Ahmed, Tarek, Ahmed, Abu-Zaid, Ahmed, Al-Nusairi, Ahmed, Azab, Ahmed, Elagili, Ahmed, Elkazaz, Ahmed, Kedwany, Ahmed, Nuhu, Ahmed Mohammed, Sakr, Ahmed, Shehta, Ahmed, Shirazi, Ahmed, Mohamed, Ahmed Mohamed Ibrahim, Sherif, Ahmed Elshawadfy, Awad, Ahmed K, Abbas, Ahmed M, Abdelrahman, Ahmed Saber, Ammar, Ahmed Siddique, Azzam, Ahmed Y, Ciftci, Ahmet Burak, Dural, Ahmet Cem, Sanli, Ahmet Necati, Rahy-Martín, Aida Cristina, Tantri, Aida Rosita, Khan, Aimal, Al-Touny, Aiman, Tariq, Aiman, Gmati, Aimen, Costas-Chavarri, Ainhoa, Auerkari, Aino, Landaluce-Olavarria, Aitor, Puri, Ajay, Radhakrishnan, Ajay, Ubom, Akaninyene Eseme, Pradhan, Akhilesh, Turna, Akif, Adepiti, Akinfolarin, Kuriyama, Akira, Kassam, Al-Faraaz, Hassouneh, Ala, El-Hussuna, Alaa, Habeebullah, Alaa, Ads, Alaa Mohamed, Mousli, Alaa, Biloslavo, Alan, Hoang, Alan, Kirk, Alan, Santini, Alasdair, Melero, Alba Vazquez, Calvache, Albaro José Nieto, Baduell, Albert, Chan, Albert, Abrate, Alberto, Balduzzi, Alberto, Sánchez, Alberto Cabañero, Navarrete-Peón, Alberto, Porcu, Alberto, Brolese, Alberto, Barranquero, Alberto G, Saibene, Alberto Maria, Adam, Albushra Altayeb, Vagge, Aldo, Maquilón, Alejandra Jara, Leon-Andrino, Alejandro, Sekulić, Aleksandar, Trifunovski, Aleksandar, Mako, Aleksandro, Bedada, Alemayehu Ginbo, Broglia, Alessandro, Coppola, Alessandro, Giani, Alessandro, Grandi, Alessandro, Iacomino, Alessandro, Moro, Alessandro, D’amico, Alessia, Malagnino, Alessia, Tang, Alethea, Doyle, Alex, Alfieri, Alex, Haynes, Alex, Wilkins, Alex, Baldwin, Alexander, Heriot, Alexander, Laird, Alexander, Lazarides, Alexander, O'connor, Alexander, Trulson, Alexander, Rokohl, Alexander Christopher, Caziuc, Alexandra, Triantafyllou, Alexandra, Anesi, Alexandre, Nikova, Alexandrina, Andrianakis, Alexandros, Charalabopoulos, Alexandros, Tsolakidis, Alexandros, Chirca, Alexandru, Arnaud, Alexis P, Narvaez-Rojas, Alexis Rafael, Kavalakat, Alfie, Spina, Alfio, Recordare, Alfonso, Annicchiarico, Alfredo, Conti, Alfredo, Mohammed, Alhassan Datti, Kocataş, Ali, Almhimid, Ali, Arnaout, Ali, Fahmy, Ali, Mangi, Ali, Modabber, Ali, Ulas, Ali Bilal, Mohamedahmed, Ali Yasen Y, Frontali, Alice, Moynihan, Alice, Yunus, Alif, Ahmad, Aline, Kent, Alistair J, Khamees, Almu'atasim, Ugwu, Aloy Okechukwu, Turan, Alparslan, Mohammed, Alsnosy Abdullah Khalefa, Navarro-Barrios, Alvaro, Yebes, Alvaro, De Sousa, Álvaro Francisco Lopes, Moreno, Amabelle, Sethi, Aman, Dawson, Amanda Caroline, Othman, Amani Alsayd Abdulsalam, Kaur, Amanjot, Wolde, Amanuel, Antonelli, Amedeo, Scifo, Amedeo, Alhamad, Ameen, Davis, Amelia, Alderazi, Amer, Harky, Amer, Mohammed-Durosinlorun, Amina, Seguya, Amina, Okhakhu, Amina, Chamakhi, Amine, Sebai, Amine, Souadka, Amine, Asla, Amir, Agrawal, Amit, Persad, Amit, Gupta, Amit, Elgazar, Amr, Kulkarni, Amruta, Coates, Amy, Bellés, Ana Ciscar, Hadzibegovic, Ana Danic, Jotic, Ana, Kowark, Ana, Martins, Ana, Pineda, Ana Mejía, Peral, Ana, Gollarte, Ana Sánchez, Senent-Boza, Ana, Camarena, Ana Isabel Avellaneda, Castaño-Leon, Ana M, Bravo, Ana Maria Minaya, Moro, Ana María Gimeno, Musina, Ana-Maria, Tapia-Herrero, Ana-María, Kothari, Anai, Gupta, 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Prashanth, Salunke, Pravin, Shah, Pritik A, Punjabi, Prof Prakash P, Christodoulou, Prokopi, Hamdan, Qusai, Tawalbeh, Ra'fat, Gadelkareem, Rabea, Awad, Rabih, Callcut, Rachael, Clegg, Rachael, Choron, Rachel, Payne, Rachel, Gefen, Rachel, Costea, Radu, Drasovean, Radu, Mirica, Radu Mihail, Ravindra, Raevin, Fajardo, Rafael Torre, Nunes, Rafael Leite, Aspide, Raffaele, Lombardi, Raffaele, Vidya, Raghavan, Elboraei, Rahma, Saaid, Rahmah, Ghodke, Rahul, Gupta, Rahul, Sharma, Rahul Deo, Lunevicius, Raimunda, Kalayarasan, Raja, Mohan, Rajashekar, Singh, Rajdeep, Sivaprakasam, Rajesh, Seenivasagam, Rajkumar Kottayasamy, Rajendram, Rajkumar, Radulescu, Raluca Bievel, Goicea, Raluca, Seshadri, Ramakrishnan Ayloor, Sarı, Ramazan, Nataraja, Ramesh, Aslam, Ramisha, Abdelemam, Rania, Shrestha, Rashmit, Bharathan, Rasiah, Pellini, Raul, Guevara, Raul, Agarwal, Ravi, Vissapragada, Ravi, Alharmi, Rawan Arahman, Sayyed, Raza, Browning, Rebecca, Critchley, Rebecca, Mallick, Rebecca, Alarabi, Rehab, Beron, Reinaldo Isaac, Függer, Reinhold, Othman, Rema, Saad, Rema, Amores, Remedios Revilla, Colombari, Renan Carlo, Radivojević, Renata Curic, Patrone, Renato, Novysedlák, René, Huatuco, René Manuel Palacio, Baertschiger, Reto, Liang, Rhea, Luckwell, Rhy, Escrevente, Ricardo, Rezende, Ricardo Fernande, Cruz, Ricardo Pedrini, Lenzi, Riccardo, Rosati, Riccardo, Donovan, Richard, Egan, Richard, Morris, Richard, Page, Richard, Seglenieks, Richard, Unsworth, Richard, Wilkin, Richard, Skipworth, Richard Je, Davies, Richard Justin, Bezirci, Rifat, Talwar, Rishi, Azami, Rizwan, Bohmer, Rob, Crichton, Robert, Fruscio, Robert, Hooker, Robert, Jach, Robert, Parker, Robert, Pillerstorff, Robert, Sinnerton, Robert, Stabler, Robert, O'connell, Robert Michael, Ragozzino, Roberta, Tutino, Roberta, Angelico, Roberta, Cammarata, Roberto, Colasanti, Roberto, Macchiavello, Roberto, Peltrini, Roberto, Pirrello, Roberto, Vaschetti, Roberto, Pires, Robinson Esteve, Papalia, Rocco, Arrangoiz, Rodrigo, Hompes, Roel, Salah, Rokeya, Pinto, Romina, Flumignan, Ronald, Callan, Rory, Cuthbert, Rory, Dennis, Rory, Scaramuzzo, Rosa, Macías, Rosa Montero, Sánchez, Rosa, Ogu, Rosemary, Ramely, Rosnelifaizur, Sgarzani, Rossella, Ramli, Roszalina, Hillier, Roxane, Thumbadoo, Ruben, Ooi, Rucira, Abdus-Salam, Rukiyat, Masri, Ruqaya, Hodgson, Russell, Mathew, Ryan, Wade, Ryckie, D'archi, Sabatino, Khan, Sabina, Ngaserin, Sabrina, Kale, Sachin, Hassan, Sadiq, Merghani, Safa, Benamar, Safia, Muhammad, Sagir, Badran, Saif, Elsahli, Saifaleslam, Heta, Saimir, Hammouche, Salah, Baeesa, Saleh, Paiella, Salvatore, Eldeen, Samaher Taj Eldeen Hassan Taj, Arkani, Samara, Mittal, Samarth, Hirji, Sameer, Tebha, Sameer, Emile, Sameh, Dbouk, Samer, Bandyopadhyay, Samik Kumar, Muhammad, Saminu, Olori, Samson, Asirifi, Samuel Amoako, Hailu, Samuel, Ling, Samuel, Newman, Samuel, Ross, Samuel, Wanjara, Samuel, Kumar, Sandip, Seneviratne, Sanjeewa, Tamburello, Sara, Suarez, Sara Busto, Ingallinella, Sara, Irshaidat, 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Subjects
general surgery, acute care surgery, Settore MED/18 - CHIRURGIA GENERALE, climate change, trauma, Settore MED/40 - Ginecologia E Ostetricia, environmental impact, surgery, Settore MED/31 - Otorinolaringoiatria, None, Medicine and Health Sciences, Surgery, operating theatre, environment
Abstract

Background: Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods: This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low-middle-income countries. Results: In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of 'single-use' consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low-middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion: This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high- and low-middle-income countries.

Published
2023

42. Time for a paradigm shift in shared decision-making in trauma and emergency surgery? Results from an international survey

Author

Cobianchi, Lorenzo, Dal Mas, Francesca, Agnoletti, Vanni, Ansaloni, Luca, Biffl, Walter, Butturini, Giovanni, Campostrini, Stefano, Catena, Fausto, Denicolai, Stefano, Fugazzola, Paola, Martellucci, Jacopo, Massaro, Maurizio, Previtali, Pietro, Ruta, Federico, Venturi, Alessandro, Woltz, Sarah, Kaafarani, Haytham M., Loftus, Tyler J., Aapoäÿlu, Recayi, Abbott, Kenneth Lyle, Abdelmalik, Abubaker, Abebe, Nebyou Seyoum, Abu-Zidan, Fikri, Adam, Yousif Abdallah Yousif, Adamou, Harissou, Adamovich, Dmitry Mikhailovich, Agresta, Ferdinando, Agrusa, Antonino, Akin, Emrah, Alessiani, Mario, Alexandrino, Henrique, Bidoli, Chiara, Ali, Syed Muhammad, Mihai, Vasilescu Alin, Almeida, Pedro Miguel, Al-Shehari, Mohammed Mohammed, Altomare, Michele, Amico, Francesco, Ammendola, Michele, Andreuccetti, Jacopo, Anestiadou, Elissavet, Annicchiarico, Alfredo, Antonelli, Amedeo, Aparicio-Sanchez, Daniel, Ardito, Antonella, Argenio, Giulio, Arvieux, Catherine Claude, Arvieux, Catherine, Askevold, Ingolf Harald, Atanasov, Boyko Tchavdarov, Augustin, Goran, Awad, Selmy Sabry, Bacchiocchi, Giulia, Bagnoli, Carlo, Bahouth, Hany, Baili, Efstratia, Bains, Lovenish, Baiocchi, Gian Luca, Bala, Miklosh, Balaguà©, Carmen, Balalis, Dimitrios, Baldini, Edoardo, Baraket, Oussama, Baral, Suman, Barone, Mirko, Gonzãlez Barranquero, Alberto, Barreras, Jorge Arturo, Bass, Gary Alan, Bayhan, Zulfu, Bellanova, Giovanni, Ben-Ishay, Offir, Bert, Fabrizio, Bianchi, Valentina, Biancuzzi, Helena, Radulescu, Raluca Bievel, Bignell, Mark Brian, Biloslavo, Alan, Bini, Roberto, Bissacco, Daniele, Boati, Paoll, Boddaert, Guillaume, Bogdanic, Branko, Bombardini, Cristina, Bonavina, Luigi, Bonomo, Luca, Bottari, Andrea, Bouliaris, Konstantinos, Brachini, Gioia, Brillantino, Antonio, Brisinda, Giuseppe, Bulanauca, Maloni Mamada, Buonomo, Luis Antonio, Burcharth, Jakob, Buscemi, Salvatore, Calabretto, Francesca, Calini, Giacomo, Calu, Valentin, Campanile, Fabio Cesare, Campo Dall’Orto, Riccardo, Campos-Serra, Andrea, Carvas, Joao Miguel, Cascella, Marco, Pattacini, Gianmaria Casoni, Celentano, Valerio, Centonze, Danilo Corrado, Ceresoli, Marco, Chatzipetris, Dimitrios, Chessa, Antonella, Chiarello, Maria Michela, Chirica, Mircea, Chooklin, Serge, Chouliaras, Christos, Chowdhury, Sharfuddin, Cianci, Pasquale, Cillara, Nicola, Cimbanassi, Stefania, Cioffi, Stefano Piero Bernardo, Colãis-Ruiz, Enrique, Colak, Elif, Conti, Luigi, Coppola, Alessandro, de Sa, Tiago Correia, Costa, Silvia Dantas, Cozza, Valerio, Curro’, Giuseppe, Dabekaussen, Kirsten Felicia Ann-Sophie Aimee, D’Acapito, Fabrizio, Damaskos, Dimitrios, D’Ambrosio, Giancarlo, Das, Koray, Davies, Richard Justin, de Beaux, Andrew Charles, De Lebrusant Fernandez, Sara Patricia, De Luca, Alessandro, De Simone, Belinda, De Stefano, Francesca, Degrate, Luca, Demetrashvili, Zaza, Demetriades, Andreas Kyriacou, Detanac, Dzemail Smail, Dezi, Agnese, Di Buono, Giuseppe, Carlo, Isidoro-D. I., Di Lascio, Pierpaolo, Di Martino, Marcello, Di Saverio, Salomone, Diaconescu, Bogdan, Diaz, Jose J., Dibra, Rigers, Dimitrov, Evgeni Nikolaev, Dinuzzi, Vincenza Paola, Dios-Barbeito, Sandra, Diyani, Jehangir Farman Ali, Dogjani, Agron, Domanin, Maurizio, D’Oria, Mario, Munoz-Cruzado, Virginia Duran, East, Barbora, Ekelund, Mikael, Ekwen, Gerald Takem, Elbaih, Adel Hamed, Elhadi, Muhammed, Enninghorst, Natalie, Ernisova, Mairam, Escalera-Antezana, Juan Pablo, Esposito, Sofia, Esposito, Giuseppe, Estaire-Gãmez, Mercedes, Farã, Camilla Nikita, Farre, Roser, Favi, Francesco, Ferrario, Luca, Ferrario di Tor Vajana, Antonjacopo, Filisetti, Claudia, Fleres, Francesco, Fonseca, Vinicius Cordeiro, Forero-Torres, Alexander, Forfori, Francesco, Fortuna, Laura, Fradelos, Evangelos, Fraga, Gustavo P., Fransvea, Pietro, Frassini, Simone, Frazzetta, Giuseppe, Frigerio, Isabella, Frountzas, Maximos, Gachabayov, Mahir, Galeiras, Rita, Garcãa, Belen Matãas, Garcia Vazquez, Alain, Gargarella, Simone, Garzali, Ibrahim Umar, Ghannam, Wagih Mommtaz, Ghazi, Faiz Najmuddin, Gillman, Lawrence Marshall, Gioco, Rossella, Giordano, Alessio, Giordano, Luca, Giove, Carlo, Giraudo, Giorgio, Giuffrida, Mario, Capponi, Michela Giulii, Gois, Emanuel, Gomes, Carlos Augusto, Gomes, Felipe Couto, Gonsaga, Ricardo Alessandro Teixeira, Gonullu, Emre, Goosen, Jacques, Goranovic, Tatjana, Gracia-Roman, Raquel, Graziano, Giorgio Maria Paolo, Griffiths, Ewen Alexander, Guagni, Tommaso, Hadzhiev, Dimitar Bozhidarov, Haidar, Muad Gamil, Hamid, Hytham K. S., Hardcastle, Timothy Craig, Hayati, Firdaus, Healey, Andrew James, Hecker, Andreas, Hecker, Matthias, Garcia, Edgar Fernando Hernandez, Hodonou, Adrien Montcho, Huaman, Eduardo cancio, Huerta, Martin, Ibrahim, Aini Fahriza, Ibrahim, Basil Mohamed Salabeldin, Ietto, Giuseppe, Inama, Marco, Ioannidis, Orestis, Isik, Arda, Ismail, Nizar, Ismail, Azzain Mahadi Hamid, Jailani, RUHI Fadzlyana, Jang, Ji Young, Kalfountzos, Christos, Kalipershad, Sujala Niatarika Rajsain, Kaouras, Emmanouil, Kaplan, Lewis Jay, Kara, Yasin, Karamagioli, Evika, Karamarkovia, Aleksandar, Katsaros, Ioannis, Kavalakat, Alfie J., Kechagias, Aristotelis, Kenig, Jakub, Kessel, Boris Juli, Khan, Jim S., Khokha, Vladimir, Kim, Jae Il, Kirkpatrick, Andrew Wallace, Klappenbach, Roberto, Kobe, Yoshiro, Lymperis, Efstratios Kofopoulos, Kok, Kenneth Yuh Yen, Kong, Victor, Korkolis, Dimitris P., Koukoulis, Georgios, Kovacevic, Bojan, Kruger, Vitor Favali, Kryvoruchko, Igor A., Kurihara, Hayato, Kuriyama, Akira, Landaluce-Olavarria, Aitor, Lapolla, Pierfrancesco, Licari, Leo, Lisi, Giorgio, Litvin, Andrey, Lizarazu, Aintzane, Bayo, Heura Llaquet, Lohsiriwat, Varut, Moreira, Claudia Cristina Lopes, Lostoridis, Eftychios, Luna, Agustãn Tovar, Luppi, Davide, Gustavo Miguel Machain, V., Maegele, Marc, Maggiore, Daniele, Magnone, Stefano, Maier, Ronald V., Major, Piotr, Manangi, Mallikarjuna, Manetti, Andrea, Mantoglu, Baris, Marafante, Chiara, Mariani, Federico, Marinis, Athanasios, Mariot, EvandroAntonio Sbalcheiro, Marseglia, Giuseppe Roberto, Martãnez-Pãrez, Aleix, Martines, Gennaro, Perez, Aleix Martinez, Martino, Costanza, Mascagni, Pietro, Massalou, Damien, Matãas-Garcãa, Belãn, Mazzarella, Gennaro, Mazzarolo, Giorgio, Melo, Renato Bessa, Mendoza-Moreno, Fernando, Meric, Serhat, Meyer, Jeremy, Miceli, Luca, Michalopoulos, Nikolaos V., Milana, Flavio, Mingoli, Andrea, Mishra, Tushar S., Mohamed, Muyed, Mohamed, Musab Isam Eldin Abbas, Mohamedahmed, Ali Yasen, Mohammed, Mohammed Jibreel Suliman, Mohan, Rajashekar, Moore, Ernest E., Morales-Garcia, Dieter, Muhrbeck, Mãns, Mulita, Francesk, Mustafa, Sami Mohamed Siddig, Muttillo, Edoardo Maria, Naimzada, Mukhammad David, Navsaria, Pradeep H., Negoi, Ionut, Nespoli, Luca, Nguyen, Christine, Nidaw, Melkamu Kibret, Nigri, Giuseppe, Nikolopoulos, Ioannis, O’Connor, Donal Brendan, Ogundipe, Habeeb Damilola, Oliveri, Cristina, Olmi, Stefano, Ong, Ernest Cun Wang, Orecchia, Luca, Osipov, Aleksei V., Othman, Muhammad Faeid, Pace, Marco, Pacilli, Mario, Pagani, Leonardo, Palomba, Giuseppe, Pantalone, Desire’, Panyko, Arpad, Paolillo, Ciro, Papa, Mario Virgilio, Papaconstantinou, Dimitrios, Papadoliopoulou, Maria, Papadopoulos, Aristeidis, Papis, Davide, Pararas, Nikolaos, Parreira, Jose Gustavo, Parry, Neil Geordie, Pata, Francesco, Patel, Tapan, Paterson-Brown, Simon, Pavone, Giovanna, Pecchini, Francesca, Pellino, Gianluca, Pelloni, Maria, Peloso, Andrea, del Pozo, Eduardo Perea, Pereira, Rita Goncalves, Pereira, Bruno Monteiro, Perez, Aintzane Lizarazu, Perra, Teresa, Perrone, Gennaro, Pesce, Antonio, Petagna, Lorenzo, Petracca, Giovanni, Phupong, Vorapong, Picardi, Biagio, Picciariello, Arcangelo, Piccoli, Micaela, Piccolo, Daniele, Picetti, Edoardo, Pikoulis Pikoulis, Emmanouil, Pintar, Tadeja, Pirozzolo, Giovanni, Piscioneri, Francesco, Podda, Mauro, Porcu, Alberto, Privitera, Francesca, Punzo, Clelia, Quaresima, Silvia, Quiodettis, Martha Alexa, Qvist, Niels, Rahim, Razrim, de Almeida, Filipe Ramalho, Ramely, Rosnelifaizur Bin, Rasa, Huseyin Kemal, Reichert, Martin, Reinisch-Liese, Alexander, Renne, Angela, Riccetti, Camilla, Rodriguez-Luna, Maria Rita, Roizblatt, Daniel, Romanzi, Andrea, Romeo, Luigi, Roscio, Francesco Pietro Maria, Rosnelifaizur, Ramely Bin, Rossi, Stefano, Rubiano, Andres M., Ruiz-Úcar, Elena, Sakakushev, Boris Evgeniev, Salamea, Juan Carlos, Sall, Ibrahima, Samarakoon, Lasitha Bhagya, Sammartano, Fabrizio, Arteaga, Alejandro Sanchez, Sanchez-Cordero, Sergi, Santoanastaso, Domenico Pietro Maria, Sasia, Diego, Sato, Norio, Savchuk, Artem, Sawyer, Robert Grant, Scaioli, Giacomo, Schizas, Dimitrios, Sebastiani, Simone, Seeliger, Barbara, Lohse, Helmut Alfredo Segovia, Seretis, Charalampos, Sermonesi, Giacomo, Serradilla-Martin, Mario, Shelat, Vishal G., Shlyapnikov, Sergei, Sidiropoulos, Theodoros, Simoes, Romeo Lages, Siragusa, Leandro, Siribumrungwong, Boonying, Slavchev, Mihail, Solaini, Leonardo, Soldini, Gabriele, Sopuev, Andrey, Soreide, Kjetil, Sovatzidis, Apostolos, Stahel, Philip Frank, Strickland, Matt, Sultan, Mohamed Arif Hameed, Sydorchuk, Ruslan, Sydorchuk, Larysa, Syed, Syed Muhammad Ali Muhammad, Syed, Ali Muhammad, Tallon-Aguilar, Luis, Tamburini, Andrea Marco, Tamini, Nicolò, Tan, Edward C. T. H., Tan, Jih Huei, Tarasconi, Antonio, Tartaglia, Nicola, Tartaglia, Giuseppe, Tartaglia, Dario, Taylor, John Vincent, Tebala, Giovanni Domenico, Teuben, Michel, Theodorou, Alexis, Tolonen, Matti, Tomasicchio, Giovanni, Toro, Adriana, Torre, Beatrice, Triantafyllou, Tania, Trigiante Trigiante, Giuseppe, Tripepi, Marzia, Trostchansky, Julio, Tsekouras, Konstantinos, Turrado-Rodriguez, Victor, Tutino, Roberta, Uccelli, Matteo, Uchikov, Petar Angelov, Ugarte-Sierra, Bakarne, Ukkonen, Mika Tapani, Vailas, Michail, Vassiliu, Panteleimon G., Vazquez, Alain Garcia, Vazquez, Rita Galeiras, Verde, Juan Ezequiel, Verde, Juan Manuel, Veroux, Massimiliano, Viganò, Jacopo, Vilallonga, Ramon, Visconti, Diego, Vittori, Alessandro, Waledziak, Maciej, Wannatoop, Tongporn, Widmer, Lukas Werner, Wilson, Michael Samuel James, Wong, Ting Hway, Xenaki, Sofia, Byungchul, Yu, Yule, Steven, Zachariah, Sanoop Koshy, Zacharis, Georgios, Zaghi, Claudia, Zakaria, Andee Dzulkarnaen, Zambrano, Diego A., Zampitis, Nikolaos, Zampogna, Biagio, Zanghã, Simone, Zapsalis, Konstantinos, Zattoni, Fabio, Zese, Monica, Farre, Silvia Pãrez, Pegoraro, Veronica, Zantedeschi, Maristella, Reitano, Elisa, Pizzocaro, Erica, Cobianchi, L, Dal Mas, F, Agnoletti, V, Ansaloni, L, Biffl, W, Butturini, G, Campostrini, S, Catena, F, Denicolai, S, Fugazzola, P, Martellucci, J, Massaro, M, Previtali, P, Ruta, F, Venturi, A, Woltz, S, Kaafarani, H, Loftus, T, Aapoaylu, R, Abbott, K, Abdelmalik, A, Abebe, N, Abu-Zidan, F, Adam, Y, Adamou, H, Adamovich, D, Agresta, F, Agrusa, A, Akin, E, Alessiani, M, Alexandrino, H, Bidoli, C, Ali, S, Mihai, V, Almeida, P, Al-Shehari, M, Altomare, M, Amico, F, Ammendola, M, Andreuccetti, J, Anestiadou, E, Annicchiarico, A, Antonelli, A, Aparicio-Sanchez, D, Ardito, A, Argenio, G, Arvieux, C, Askevold, I, Atanasov, B, Augustin, G, Awad, S, Bacchiocchi, G, Bagnoli, C, Bahouth, H, Baili, E, Bains, L, Baiocchi, G, Bala, M, Balaguacopyright, C, Balalis, D, Baldini, E, Baraket, O, Baral, S, Barone, M, Gonzalez Barranquero, A, Barreras, J, Bass, G, Bayhan, Z, Bellanova, G, Ben-Ishay, O, Bert, F, Bianchi, V, Biancuzzi, H, Radulescu, R, Bignell, M, Biloslavo, A, Bini, R, Bissacco, D, Boati, P, Boddaert, G, Bogdanic, B, Bombardini, C, Bonavina, L, Bonomo, L, Bottari, A, Bouliaris, K, Brachini, G, Brillantino, A, Brisinda, G, Bulanauca, M, Buonomo, L, Burcharth, J, Buscemi, S, Calabretto, F, Calini, G, Calu, V, Campanile, F, Campo Dall'Orto, R, Campos-Serra, A, Carvas, J, Cascella, M, Pattacini, G, Celentano, V, Centonze, D, Ceresoli, M, Chatzipetris, D, Chessa, A, Chiarello, M, Chirica, M, Chooklin, S, Chouliaras, C, Chowdhury, S, Cianci, P, Cillara, N, Cimbanassi, S, Cioffi, S, Colais-Ruiz, E, Colak, E, Conti, L, Coppola, A, de Sa, T, Costa, S, Cozza, V, Curro', G, Dabekaussen, K, D'Acapito, F, Damaskos, D, D'Ambrosio, G, Das, K, Davies, R, de Beaux, A, De Lebrusant Fernandez, S, De Luca, A, De Simone, B, De Stefano, F, Degrate, L, Demetrashvili, Z, Demetriades, A, Detanac, D, Dezi, A, Di Buono, G, Carlo, I, Di Lascio, P, Di Martino, M, Di Saverio, S, Diaconescu, B, Diaz, J, Dibra, R, Dimitrov, E, Dinuzzi, V, Dios-Barbeito, S, Diyani, J, Dogjani, A, Domanin, M, D'Oria, M, Munoz-Cruzado, V, East, B, Ekelund, M, Ekwen, G, Elbaih, A, Elhadi, M, Enninghorst, N, Ernisova, M, Escalera-Antezana, J, Esposito, S, Esposito, G, Estaire-Gamez, M, Fara, C, Farre, R, Favi, F, Ferrario, L, Ferrario di Tor Vajana, A, Filisetti, C, Fleres, F, Fonseca, V, Forero-Torres, A, Forfori, F, Fortuna, L, Fradelos, E, Fraga, G, Fransvea, P, Frassini, S, Frazzetta, G, Frigerio, I, Frountzas, M, Gachabayov, M, Galeiras, R, Garcaa, B, Garcia Vazquez, A, Gargarella, S, Garzali, I, Ghannam, W, Ghazi, F, Gillman, L, Gioco, R, Giordano, A, Giordano, L, Giove, C, Giraudo, G, Giuffrida, M, Capponi, M, Gois, E, Gomes, C, Gomes, F, Gonsaga, R, Gonullu, E, Goosen, J, Goranovic, T, Gracia-Roman, R, Graziano, G, Griffiths, E, Guagni, T, Hadzhiev, D, Haidar, M, Hamid, H, Hardcastle, T, Hayati, F, Healey, A, Hecker, A, Hecker, M, Garcia, E, Hodonou, A, Huaman, E, Huerta, M, Ibrahim, A, Ibrahim, B, Ietto, G, Inama, M, Ioannidis, O, Isik, A, Ismail, N, Ismail, A, Jailani, R, Jang, J, Kalfountzos, C, Kalipershad, S, Kaouras, E, Kaplan, L, Kara, Y, Karamagioli, E, Karamarkovia, A, Katsaros, I, Kavalakat, A, Kechagias, A, Kenig, J, Kessel, B, Khan, J, Khokha, V, Kim, J, Kirkpatrick, A, Klappenbach, R, Kobe, Y, Lymperis, E, Kok, K, Kong, V, Korkolis, D, Koukoulis, G, Kovacevic, B, Kruger, V, Kryvoruchko, I, Kurihara, H, Kuriyama, A, Landaluce-Olavarria, A, Lapolla, P, Licari, L, Lisi, G, Litvin, A, Lizarazu, A, Bayo, H, Lohsiriwat, V, Moreira, C, Lostoridis, E, Luna, A, Luppi, D, V, G, Maegele, M, Maggiore, D, Magnone, S, Maier, R, Major, P, Manangi, M, Manetti, A, Mantoglu, B, Marafante, C, Mariani, F, Marinis, A, Mariot, E, Marseglia, G, Martanez-Parez, A, Martines, G, Perez, A, Martino, C, Mascagni, P, Massalou, D, Mataas-Garcaa, B, Mazzarella, G, Mazzarolo, G, Melo, R, Mendoza-Moreno, F, Meric, S, Meyer, J, Miceli, L, Michalopoulos, N, Milana, F, Mingoli, A, Mishra, T, Mohamed, M, Mohamedahmed, A, Mohammed, M, Mohan, R, Moore, E, Morales-Garcia, D, Muhrbeck, M, Mulita, F, Mustafa, S, Muttillo, E, Naimzada, M, Navsaria, P, Negoi, I, Nespoli, L, Nguyen, C, Nidaw, M, Nigri, G, Nikolopoulos, I, O'Connor, D, Ogundipe, H, Oliveri, C, Olmi, S, Ong, E, Orecchia, L, Osipov, A, Othman, M, Pace, M, Pacilli, M, Pagani, L, Palomba, G, Pantalone, D, Panyko, A, Paolillo, C, Papa, M, Papaconstantinou, D, Papadoliopoulou, M, Papadopoulos, A, Papis, D, Pararas, N, Parreira, J, Parry, N, Pata, F, Patel, T, Paterson-Brown, S, Pavone, G, Pecchini, F, Pellino, G, Pelloni, M, Peloso, A, del Pozo, E, Pereira, R, Pereira, B, Perra, T, Perrone, G, Pesce, A, Petagna, L, Petracca, G, Phupong, V, Picardi, B, Picciariello, A, Piccoli, M, Piccolo, D, Picetti, E, Pikoulis Pikoulis, E, Pintar, T, Pirozzolo, G, Piscioneri, F, Podda, M, Porcu, A, Privitera, F, Punzo, C, Quaresima, S, Quiodettis, M, Qvist, N, Rahim, R, de Almeida, F, Ramely, R, Rasa, H, Reichert, M, Reinisch-Liese, A, Renne, A, Riccetti, C, Rodriguez-Luna, M, Roizblatt, D, Romanzi, A, Romeo, L, Roscio, F, Rosnelifaizur, R, Rossi, S, Rubiano, A, Ruiz-Ascar, E, Sakakushev, B, Salamea, J, Sall, I, Samarakoon, L, Sammartano, F, Arteaga, A, Sanchez-Cordero, S, Santoanastaso, D, Sasia, D, Sato, N, Savchuk, A, Sawyer, R, Scaioli, G, Schizas, D, Sebastiani, S, Seeliger, B, Lohse, H, Seretis, C, Sermonesi, G, Serradilla-Martin, M, Shelat, V, Shlyapnikov, S, Sidiropoulos, T, Simoes, R, Siragusa, L, Siribumrungwong, B, Slavchev, M, Solaini, L, Soldini, G, Sopuev, A, Soreide, K, Sovatzidis, A, Stahel, P, Strickland, M, Sultan, M, Sydorchuk, R, Sydorchuk, L, Syed, S, Syed, A, Tallon-Aguilar, L, Tamburini, A, Tamini, N, Tan, E, Tan, J, Tarasconi, A, Tartaglia, N, Tartaglia, G, Tartaglia, D, Taylor, J, Tebala, G, Teuben, M, Theodorou, A, Tolonen, M, Tomasicchio, G, Toro, A, Torre, B, Triantafyllou, T, Trigiante Trigiante, G, Tripepi, M, Trostchansky, J, Tsekouras, K, Turrado-Rodriguez, V, Tutino, R, Uccelli, M, Uchikov, P, Ugarte-Sierra, B, Ukkonen, M, Vailas, M, Vassiliu, P, Vazquez, A, Vazquez, R, Verde, J, Veroux, M, Vigano, J, Vilallonga, R, Visconti, D, Vittori, A, Waledziak, M, Wannatoop, T, Widmer, L, Wilson, M, Wong, T, Xenaki, S, Yu, B, Yule, S, Zachariah, S, Zacharis, G, Zaghi, C, Zakaria, A, Zambrano, D, Zampitis, N, Zampogna, B, Zangha, S, Zapsalis, K, Zattoni, F, Zese, M, Farre, S, Pegoraro, V, Zantedeschi, M, Reitano, E, Pizzocaro, E, Laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie (ICube), École Nationale du Génie de l'Eau et de l'Environnement de Strasbourg (ENGEES)-Université de Strasbourg (UNISTRA)-Institut National des Sciences Appliquées - Strasbourg (INSA Strasbourg), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de Recherche en Informatique et en Automatique (Inria)-Les Hôpitaux Universitaires de Strasbourg (HUS)-Centre National de la Recherche Scientifique (CNRS)-Matériaux et Nanosciences Grand-Est (MNGE), Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Réseau nanophotonique et optique, Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS), and The Team Dynamics Study Group

Subjects
Settore SECS-P/10 - Organizzazione Aziendale, Settore MED/18 - Chirurgia Generale, Settore SECS-P/07 - Economia Aziendale, Emergency Medicine, Clinical decision-making, Patient-centric care, Shared decision-making, Survey, Trauma and emergency surgery, Surgery, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

Background Shared decision-making (SDM) between clinicians and patients is one of the pillars of the modern patient-centric philosophy of care. This study aims to explore SDM in the discipline of trauma and emergency surgery, investigating its interpretation as well as the barriers and facilitators for its implementation among surgeons. Methods Grounding on the literature on the topics of the understanding, barriers, and facilitators of SDM in trauma and emergency surgery, a survey was created by a multidisciplinary committee and endorsed by the World Society of Emergency Surgery (WSES). The survey was sent to all 917 WSES members, advertised through the society’s website, and shared on the society’s Twitter profile. Results A total of 650 trauma and emergency surgeons from 71 countries in five continents participated in the initiative. Less than half of the surgeons understood SDM, and 30% still saw the value in exclusively engaging multidisciplinary provider teams without involving the patient. Several barriers to effectively partnering with the patient in the decision-making process were identified, such as the lack of time and the need to concentrate on making medical teams work smoothly. Discussion Our investigation underlines how only a minority of trauma and emergency surgeons understand SDM, and perhaps, the value of SDM is not fully accepted in trauma and emergency situations. The inclusion of SDM practices in clinical guidelines may represent the most feasible and advocated solutions.

Published
2023

43. Development and validation of a preoperative 'difficulty score' for laparoscopic transabdominal adrenalectomy: a multicenter retrospective study

Author

Alessandro M. Paganini, Andrea Balla, Carlo Ingaldi, Guido A. M. Tiberio, Giovanni Casole, Silvia Quaresima, Riccardo Casadei, Claudio Ricci, Zeno Ballarini, Marie Sophie Alfano, Guido Di Dalmazi, Laura Alberici, Giovanni Lezoche, Francesco Minni, Monica Ortenzi, Saverio Selva, Pietro Ursi, Mario Guerrieri, Alberici L., Paganini A.M., Ricci C., Balla A., Ballarini Z., Ortenzi M., Casole G., Quaresima S., Di Dalmazi G., Ursi P., Alfano M.S., Selva S., Casadei R., Ingaldi C., Lezoche G., Guerrieri M., Minni F., and Tiberio G.A.M.

Subjects
medicine.medical_specialty, medicine.medical_treatment, Operative Time, Population, Adrenal Gland Neoplasms, Laparoscopic adrenalectomy, Difficulty score, Logistic regression, Cohort Studies, Postoperative Complications, Internal medicine, laparoscopic adrenalectomy, postoperative complications, Humans, Medicine, education, Retrospective Studies, education.field_of_study, business.industry, Adrenalectomy, Area under the curve, Retrospective cohort study, Odds ratio, Cohort, Laparoscopy, Surgery, business, Abdominal surgery
Abstract

Background A difficulty score for laparoscopic adrenalectomy (LA) is lacking in the literature. A retrospective cohort study was designed to develop a preoperative “difficulty score” for LA. Methods A multicenter study was conducted involving four Italian tertiary centers for adrenal disease. The population was randomly divided into two subsets: training group and validation one. A multicenter study was undertaken, including 964 patients. Patient, adrenal lesion, surgeon’s characteristics, and the type of procedure were studied as potential predictors of target events. The operative time (pOT), conversion rate (cLA), or both were used as indicators of the difficulty in three multivariate models. All models were developed in a training cohort (70% of the sample) and validated using 30% of patients. For all models, the ability to predict complicated postoperative course was reported describing the area under the curve (AUCs). Logistic regression, reporting odds ratio (OR) with p-value, was used. Results In model A, gender (OR 2.04, p = 0.001), BMI (OR 1.07, p = 0.002), previous surgery (OR 1.29, p = 0.048), site (OR 21.8, p p = 0.002), cumulative sum of procedures (OR 0.99, p p p = 0.015) increased the pOT. In model B, ASA (OR 2.86, p = 0.001), lesion size (OR 1.20, p = 0.005), and extended resection (OR 8.85, p = 0.007) increased the cLA risk. Model C had similar results to model A. All scores obtained predicted the target events in validation cohort (OR 1.99, p p = 0.007; OR 1.70, p Conclusion A difficulty score based on both pOT and cLA (Model C) was developed using 70% of the sample. The score was validated using a second cohort. Finally, the score was tested, and its results are able to predict a complicated postoperative course.

Published
2021

44. Fluorescence-based bowel anastomosis perfusion evaluation: results from the IHU-IRCAD-EAES EURO-FIGS registry

Author

Jan Grosek, Laurents P. S. Stassen, Andrea Balla, Davide Cosola, Catalin Copaescu, Silvia Quaresima, Maurizio Castagnola, Giuseppe Navarra, Paolo De Paolis, Gonzalo P Martin-Martin, Andrea Picchetto, Ivano Dal Dosso, J. Kosir, Marcello Calabrò, Harmony Impellizzeri, Roland Chautems, Carlo Castoro, Mahdi Al-Taher, Gian Luca Baiocchi, Giancarlo D'Ambrosio, G. Moretto, Giovanni Maria Garbarino, Giorgio Bianchi, Giuseppe Spinoglio, Alessandro Franchello, Robert Juvan, Salvador Morales Conde, Carlos Marques Ferreira, Emilio Bertani, Marco Filauro, Nunzio Rosso, Antonio Pesce, Gabriele Anania, Andrea Spota, Lorenzo Casali, Ramon Vilallonga, Marc Olivier Sauvain, Christian Franzini, Orestis Ioannidis, Michele Diana, Eleftherios Gialamas, Alend Saadi, Eric Felli, Gaetano La Greca, Jacques Marescaux, Paola De Nardi, José F. Noguera, Alessio Rollo, Pietro Riva, Nicolò de Manzini, Marta Silvestri, Caterina Santi, Luciano Tartamella, Gregor Norčič, Alessandro Patané, Thomas Carus, Alessandro M. Paganini, Luigi Boni, Surgery, MUMC+: MA Heelkunde (9), MUMC+: MA AIOS Heelkunde (9), RS: NUTRIM - R2 - Liver and digestive health, RS: SHE - R1 - Research (OvO), Spota, A., Al-Taher, M., Felli, E., Morales Conde, S., Dal Dosso, I., Moretto, G., Spinoglio, G., Baiocchi, G., Vilallonga, R., Impellizzeri, H., Martin-Martin, G. P., Casali, L., Franzini, C., Silvestri, M., de Manzini, N., Castagnola, M., Filauro, M., Cosola, D., Copaescu, C., Garbarino, G. M., Pesce, A., Calabro, M., de Nardi, P., Anania, G., Carus, T., Boni, L., Patane, A., Santi, C., Saadi, A., Rollo, A., Chautems, R., Noguera, J., Grosek, J., D'Ambrosio, G., Ferreira, C. M., Norcic, G., Navarra, G., Riva, P., Quaresima, S., Paganini, A., Rosso, N., De Paolis, P., Balla, A., Sauvain, M. O., Gialamas, E., Bianchi, G., La Greca, G., Castoro, C., Picchetto, A., Franchello, A., Tartamella, L., Juvan, R., Ioannidis, O., Kosir, J. A., Bertani, E., Stassen, L., Marescaux, J., and Diana, M.

Subjects
medicine.medical_specialty, Registry, RESECTION, INDOCYANINE GREEN, Subgroup analysis, Anastomotic Leak, Near-infrared fluorescence imaging, Anastomosis, Anastomotic leakage (AL) is one of the dreaded complications following surgery in the digestive tract. Nearinfrared fluorescence (NIRF) imaging is a means to intraoperatively visualize anastomotic perfusion, NO, 03 medical and health sciences, COLORECTAL-SURGERY, ESOPHAGECTOMY, 0302 clinical medicine, LEAKAGE, Statistical significance, Internal medicine, medicine, Humans, Image-guided surgery, Registries, Anastomotic leakage (AL) is one of the dreaded complications following surgery in the digestive tract. Nearinfrared fluorescence (NIRF) imaging is a means to intraoperatively visualize anastomotic perfusion, facilitating fluorescence image-guided surgery (FIGS) with the purpose to reduce the incidence of AL. The aim of this study was to analyze the current practices and results of NIRF imaging of the anastomosis in digestive tract surgery through the EURO-FIGS registry, COMPLICATIONS, CONSEQUENCES, business.industry, Incidence (epidemiology), Anastomosis, Surgical, Hepatology, CANCER, facilitating fluorescence image-guided surgery (FIGS) with the purpose to reduce the incidence of AL. The aim of this study was to analyze the current practices and results of NIRF imaging of the anastomosis in digestive tract surgery through the EURO-FIGS registry, Perfusion, Surgery, Computer-Assisted, 030220 oncology & carcinogenesis, RISK-FACTORS, fluorescence-guided surgery, image-guided surgery, near-infrared fluorescence imaging, registry, Fluorescence-guided surgery, 030211 gastroenterology & hepatology, Surgery, Radiology, ENHANCED REALITY, business, Abdominal surgery
Abstract

Background: Anastomotic leakage (AL) is one of the dreaded complications following surgery in the digestive tract. Near-infrared fluorescence (NIRF) imaging is a means to intraoperatively visualize anastomotic perfusion, facilitating fluorescence image-guided surgery (FIGS) with the purpose to reduce the incidence of AL. The aim of this study was to analyze the current practices and results of NIRF imaging of the anastomosis in digestive tract surgery through the EURO-FIGS registry. Methods: Analysis of data prospectively collected by the registry members provided patient and procedural data along with the ICG dose, timing, and consequences of NIRF imaging. Among the included upper-GI, colorectal, and bariatric surgeries, subgroup analysis was performed to identify risk factors associated with complications. Results: A total of 1240 patients were included in the study. The included patients, 74.8% of whom were operated on for cancer, originated from 8 European countries and 30 hospitals. A total of 54 surgeons performed the procedures. In 83.8% of cases, a pre-anastomotic ICG dose was administered, and in 60.1% of cases, a post-anastomotic ICG dose was administered. A significant difference (p < 0.001) was found in the ICG dose given in the four pathology groups registered (range: 0.013–0.89mg/kg) and a significant (p < 0.001) negative correlation was found between the ICG dose and BMI. In 27.3% of the procedures, the choice of the anastomotic level was guided by means of NIRF imaging which means that in these cases NIRF imaging changed the level of anastomosis which was first decided based on visual findings in conventional white light imaging. In 98.7% of the procedures, the use of ICG partly or strongly provided a sense of confidence about the anastomosis. A total of 133 complications occurred, without any statistical significance in the incidence of complications in the anastomoses, whether they were ICG-guided or not. Conclusion: The EURO-FIGS registry provides an insight into the current clinical practice across Europe with respect to NIRF imaging of anastomotic perfusion during digestive tract surgery.

Published
2021

45. Outcomes after rectosigmoid resection for endometriosis. A systematic literature review

Author

Silvia Quaresima, Mostafa Shalaby, Andrea Balla, Giuseppe Petrella, José Daniel Subiela, Pierpaolo Sileri, Balla, A, Quaresima, S, Subiela, Jd, Shalaby, M, Petrella, G, and Sileri, P

Subjects
medicine.medical_specialty, Fistula, Endometriosis, Deeply infiltrating endometriosis (DIE), 03 medical and health sciences, 0302 clinical medicine, Robotic Surgical Procedures, Internal medicine, Epidemiology, Rectal resection, medicine, Humans, Rectosigmoid resection, 030219 obstetrics & reproductive medicine, business.industry, Proctocolectomy, Restorative, Gastroenterology, Postoperative outcomes, Hepatology, medicine.disease, Surgery, Rectal Diseases, Treatment Outcome, medicine.anatomical_structure, Systematic review, 030220 oncology & carcinogenesis, Female, Laparoscopy, Uterine cavity, Complication, business
Abstract

"Endometriosis" is defined such as the presence of endometrial glands and stroma outside the uterine cavity. This ectopic condition may develop as deeply infiltrating endometriosis (DIE) when a solid mass is located deeper than 5 mm underneath the peritoneum including the intestinal wall. The ideal surgical treatment is still under search, and treatment may range from simple shaving to rectal resection. The aim of the present systematic review is to report and analyze the postoperative outcomes after rectosigmoid resection for endometriosis. We performed a systematic review according to Meta-analysis of Observational Studies in Epidemiology guidelines. The search was carried out in the PubMed database, using the keywords: "rectal resection" AND "endometriosis" and "rectosigmoid resection" AND "endometriosis." The search revealed 380 papers of which 78 were fully analyzed. Thirty-eight articles published between 1998 and 2017 were included. Three thousand seventy-nine patients (mean age 34.28 +/- 2.46) were included. Laparoscopic approach was the most employed (90.3%) followed by the open one (7.9%) and the robotic one (1.7%). Overall operative time was 238.47 +/- 66.82. Conversion rate was 2.7%. In more than 80% of cases, associated procedures were performed. Intraoperative complications were observed in 1% of cases. The overall postoperative complications rate was 18.5% (571 patients), and the most frequent complication was recto-vaginal fistula (74 patients, 2.4%). Postoperative mortality rate was 0.03% and mean hospital stay was 8.88 +/- 3.71 days. Despite the large and extremely various number of associated procedures, rectosigmoid resection is a feasible and safe technique to treat endometriosis.

Published
2018

46. Muzi's Tension Free Primary Closure of Pilonidal Sinus Disease: Updates on Long-Term Results on 514 Patients

Author

Agnese Cianfarani, Silvia Quaresima, Marco Gallinella Muzi, Pierpaolo Sileri, Giuseppe Petrella, Marco Colella, Oreste Claudio Buonomo, Claudia Mosconi, Pietro Mascagni, Andrea Balla, Muzi, Mg, Mascagni, P, Buonomo, O, Cianfarani, A, Mosconi, C, Colella, M, Balla, A, Petrella, G, Quaresima, S, and Sileri, P

Subjects
Adult, Male, medicine.medical_specialty, Time Factors, recurrence, Adolescent, Visual analogue scale, Operative Time, gastroenterology, long-term results, surgical technique, surgery, Young Adult, 03 medical and health sciences, Pilonidal Sinus, 0302 clinical medicine, Patient satisfaction, Surveys and Questionnaires, Sinus disease, medicine, pilonidal sinus disease (PSD), Humans, Effective treatment, Pain Measurement, Retrospective Studies, Vas score, Pain, Postoperative, tension free primary closure, Wound Closure Techniques, business.industry, Postoperative complication, Long term results, Middle Aged, Surgery, Settore MED/18 - Chirurgia Generale, Patient Satisfaction, 030220 oncology & carcinogenesis, Anesthesia, Operative time, Female, 030211 gastroenterology & hepatology, business, Follow-Up Studies
Abstract

The aim of this study is to evaluate the long-term results of Muzi's tension free primary closure technique for pilonidal sinus disease (PSD), in terms of patients' discomfort and recurrence rate. This study is a retrospective analysis of prospectively collected data. Five hundred fourteen patients were treated. Postoperative pain (assessed by a visual analog scale, VAS), complications, time needed to return to full-day activities, and recurrence rate were recorded. At 12, 22, and 54 months postoperative, patients' satisfaction was evaluated by a questionnaire scoring from 0 (not satisfied) to 12 (greatly satisfied). The median operative time was 30 min. The overall postoperative complication rate was 2.52%. Median VAS score was 1. The mean of resumption to normal activity was 8.1 days. At median follow-up of 49 months, recurrence rate was 0.4% (two patients). At 12 months' follow-up, the mean satisfaction score was 10.3 +/- 1.7. At 22 and 54 months' follow-up, the score was confirmed. Muzi's tension free primary closure technique has proved to be an effective treatment, showing in the long-term follow-up low recurrence rate and high degree of patient satisfaction. Therefore, we strongly recommend this technique for the treatment of PSD.

Published
2018

47. Transanal Inspection and Management of Low Colorectal Anastomosis Performed With a New Technique: the TICRANT Study

Author

Ucchino Giampiero, Giannandrea Baldazzi, Pierpaolo Sileri, Paolo Delrio, Giovanni Maria Romano, Luana Franceschilli, Adele Noviello, Mostafa Shalaby, Giulia Missori, Sebastian Smolarek, Pasquale Ascenzi, Francesco Crafa, Jacques Megevand, Silvia Quaresima, Diletta Cassini, Crafa, F, Smolarek, S, Missori, G, Shalaby, M, Quaresima, S, Noviello, A, Cassini, D, Ascenzi, P, Franceschilli, L, Delrio, P, Baldazzi, G, Giampiero, U, Megevand, J, Romano, Gm, and Sileri, P

Subjects
Male, medicine.medical_specialty, Colorectal cancer, Anal Canal, Anastomotic Leak, 030230 surgery, Anastomosis, 03 medical and health sciences, 0302 clinical medicine, Surgical Stapling, Medicine, Humans, Prospective Studies, Aged, Aged, 80 and over, business.industry, Rectal Neoplasms, Anastomosis, Surgical, Colorectal anastomosis, Middle Aged, medicine.disease, Total mesorectal excision, anastomotic leak, anterior resection, double stapling technique, rectal cancer, total mesorectal excision, aged, aged, 80 and over, anal canal, female, humans, male, middle aged, prospective studies, rectal neoplasms, anastomosis surgical, surgical stapling, Surgery, Anastomotic leakage, Rectal cancer surgery, 030211 gastroenterology & hepatology, Female, business
Abstract

Background: Anastomotic leakage is one of the most serious complications after rectal cancer surgery. Method: A prospective multicenter interventional study to assess a newly described technique of creating the colorectal and coloanal anastomosis. The primary outcome was to access the safety and efficacy of this technique in the reduction of anastomotic leak. Result: Fifty-three patients with rectal cancer who underwent low or ultra-low anterior resection were included in the study. There were 35 males and 18 females, with a median age of 68 years (range = 49-89 years). The median tumor distance from the anal verge was 8 cm (range = 4-12 cm), and the median body mass index was 24 kg/m2 (range = 20-35 kg/m2). Thirty patients underwent open, 16 laparoscopic, and 7 robotic surgeries. Multiple firing (2-charges) was required in 30 patients to obtain a complete rectal division. Forty-five patients had colorectal anastomosis, and 8 patients had coloanal anastomosis. The protective ileostomy was created in 40 patients at the time of initial surgery. There was no mortality in the first 30 days postoperatively, and only 10 (19%) patients developed complications. There were 3 anastomotic leakages (6%); 2 of them were subclinical with ileostomy created at initial operation and both were treated conservatively with transanal drainage and intravenous antibiotics. One patient required reoperation and ileostomy. The median length of hospital stay was 10 days (range = 4-20 days). Conclusion: Our technique is a safe and efficient method of creation of colorectal anastomosis. It is also a universal method that can be used in open, laparoscopic, and robotic surgeries.

Published
2017

48. Radiofrequency-Based Identification Medical Device. An Evaluable Solution for Surgical Sponge Retrieval?

Author

Silvia Quaresima, Pierpaolo Sileri, Luca Armisi, Alessandra Lazzaro, Ilaria Piccolo, Carlo Maria Medaglia, L Iezzi, A. Corona, Nicola Rosato, Achille L. Gaspari, Sergio Sbrenni, Nicola Di Lorenzo, Lazzaro, A, Corona, A, Iezzi, L, Quaresima, S, Armisi, L, Piccolo, I, Medaglia, Cm, Sbrenni, S, Sileri, P, Rosato, N, Gaspari, Al, and Di Lorenzo, N

Subjects
medicine.medical_specialty, Medical device, image-guided surgery, Gossypiboma, phantoms, 030230 surgery, surgery, 03 medical and health sciences, 0302 clinical medicine, equipment design, biomedical engineering, medicine, computer simulation, foreign bodies, In patient, humans, Foreign Bodies, Phantoms, Imaging, business.industry, software, radio frequency identification device, Surgical Sponges, simulation, imaging, swine, animals, internet, phantoms, imaging, surgery, computer-assisted, surgical sponges, medicine.disease, Settore MED/18, Surgery, Settore MED/18 - Chirurgia Generale, Image-guided surgery, Surgery, Computer-Assisted, 030220 oncology & carcinogenesis, computer-assisted, business
Abstract

Background. A retained surgical item in patients (gossypiboma) is a persisting problem, despite consistent improvements and existing guidelines in counting instruments and sponges. Previous experiences with radiofrequency identification technology (RFID) tracking sponges show that it could represent an innovation, in order to reduce the criticism and increase the effectiveness during surgical procedures. We present an automated system that allows reduction of errors and improves safety in the operating room. Methods. The system consists of 3 antennas, surgical sponges containing RFID tags, and dedicated software applications, with Wi-Fi real-time communication between devices. The first antenna provides the initial count of gauzes; the second a real-time counting during surgery, including the sponges thrown into the kick-bucket; and the third can be used in the event of uneven sponge count. The software allows management at all stages of the process. Results. In vitro and in vivo tests were performed: the system provided excellent results in detecting sponges in patients’ body. Hundred percent retained sponges were detected correctly, even when they were overlapped. No false positive or false negative was recorded. The counting procedure turned out to be more streamlined and efficient and it could save time in a standard procedure. Conclusions. The RFID system for sponge tracking was shown to be experimentally a reliable and feasible method to track sponges with a full detection accuracy in the operating room. The results indicate the system to be safe and effective with acceptable cost-effective parameters.

Published
2017

50. Transanal Minimally Invasive Surgery for Rectal Lesions

Author

Pierpaolo Sileri, Andrea Balla, Luana Franceschilli, Iafrate C, La Torre M, Mostafa Shalaby, Di Lorenzo N, Silvia Quaresima, Quaresima, S, Balla, A, Franceschilli, L, La Torre, M, Iafrate, C, Shalaby, M, Di Lorenzo, N, and Sileri, P

Subjects
Adenoma, Adult, Male, medicine.medical_specialty, Gastrointestinal Stromal Tumors, medicine.medical_treatment, Transanal minimally invasive Surgery (TAMIS), Carcinoid Tumor, Transanal Endoscopic Surgery, 03 medical and health sciences, 0302 clinical medicine, Colorectal surgery, Scientific Papers, medicine, Humans, Prospective Studies, Natural orifice transluminal endoscopic surgery (NOTES), Single-site laparoscopic surgery (SILS), Surgical oncology, Aged, Aged, 80 and over, Female, Follow-Up Studies, Laparoscopy, Middle Aged, Rectal Neoplasms, Treatment Outcome, Surgery, Prospective cohort study, GiST, medicine.diagnostic_test, business.industry, General surgery, Microsurgery, medicine.disease, Settore MED/18, Natural orifice transluminal endoscopic surgery (NOTES) Single-site laparoscopic surgery (SILS), 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, medicine.symptom, business, Subcutaneous emphysema
Abstract

Background and objectives Transanal minimally invasive surgery (TAMIS) has emerged as an alternative to transanal endoscopic microsurgery (TEM). The authors report their experience with TAMIS for the treatment of mid and high rectal tumors. Methods From November 2011 through May 2016, 31 patients (21 females, 68%), with a median age of 65 years who underwent single-port TAMIS were prospectively enrolled. Mean distance from the anal verge of the rectal tumors was 9.5 cm. Seventeen patients presented with T1 cancer, 10 with large adenoma, 2 with gastrointestinal stromal tumor (GIST) and 2 with carcinoid tumor. Data concerning demographics, operative procedure and pathologic results were analyzed. Results TAMIS was successfully completed in all cases. In 4 (13%) TAMIS was converted to standard Park's transanal technique. Median postoperative stay was 3 days. The overall complication rate was 9.6%, including 1 urinary tract infection, 1 subcutaneous emphysema, and 1 hemorrhoidal thrombosis. TAMIS allowed an R0 resection in 96.8% of cases (30/31 cases) and a single case of local recurrence after a large adenoma resection was encountered. Conclusion TAMIS is a safe technique, with a short learning curve for laparoscopic surgeons already proficient in single-port procedures, and provides effective oncological outcomes compared to other techniques.

Published
2016

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