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1. Clinical nutrition in surgical oncology: Young AIOM-AIRO-SICO multidisciplinary national survey on behalf of NutriOnc research group

Author: Luigi Marano, Federica Marmorino, Isacco Desideri, Ludovico Carbone, Alessandro Rizzo, Viola Salvestrini, Franco Roviello, Saverio Cinieri, Vittorio Donato, Raffaele De Luca, NutriOnc Research Group, Silvia Sofia, Marco Milone, Benedetto Ielpo, Maria Teresa Mita, Silvia Ministrini, Mario Giuffrida, Roberta Tutino, Caterina Baldi, Giampaolo Perri, Anna Stella Lippolis, Chiara Marafante, Giusy Giannandrea, Marco Vito Marino, Letizia Laface, Salomone Di Saverio, Luca Aldrighetti, Nicola de’Angelis, Nick Salimian, Marco Caricato, Gianluca Pellino, Sara Vertaldi, Federica Cipriani, Gabriella Teresa Capolupo, Antonio Costanzo, Letizia Santandrea, Gaetano Gallo, Andrea Belli, Laura Mastrangelo, Fausto Rosa, Nicolò Pecorelli, Graziella Marino, Alessio Giordano, Nicola Cillara, Maria Lemma, Francesco Pata, Federico Cammillini, Gianmario Edoardo Poto, Giulia Grassi, Donato Francesco Altomare, Arcangelo Picciariello, Lorenzo Petagna, Luca Ippolito, Elio Treppiedi, Daniele Delogu, Abdallah Moukachar, Stefano Granieri, Giuseppe Cuticone, Osvaldo Carpineto Samorani, Daniela Rega, Leonardo Solaini, Stefano de Pascale, Francesca Ascari, Michele Manigrasso, Simona Badalucco, Salvatore Paiella, Sara Coppola, Roberta Iadarola, Giovanna Di Meo, Isacco Montroni, Fabio Vistoli, Valentina Ferraro, Edoardo Saladino, Federico Fazio, Roberta Rota, Francesco Orlando, Simone Famularo, Cinzia Bizzoca, Giorgio Dalmonte, Marco Inama, Luigi Verre, Leandro Siragusa, Casoni Pattacini Gianmaria, Michele Benedetti, Nicolò Tamini, Cristian Conti, Giorgio Ammerata, Serena Mantova, Vito Leonardo Pinto, Arianna Corvasce, Giorgio Micheletti, Teresa Perra, Marco Pellicciaro, Marco Materazzo, Michele Zuolo, Emanuele Doria, Antonio Brillantino, Luca Del Prete, Andrea Muratore, Claudio Luciani, Giulia Turri, Fabio Casciani, Giuliani Giuseppe, Graziana Barile, Oldrà Gaia, Valeria Restaino, Simona Deidda, Michele Ammendola, Andrea Fares Bucci, Patrizia Marsanic, Dario Cassetti, Luca Resca, Daniele Fusario, Eleonora Andreucci, Anna Michelotti, Brunella Amoruso, Isabella Franco, Laura Noto, Andrea Spallanzani, Raimondo Calogero Scalia, Teresa Del Giudice, Valeria Merz, Gianmarco Motta, Alessandro Parisi, Mikol Modesti, Antonella Argentiero, Debora Basile, Gianmarco Vannini, Carlotta Ottanelli, Salvatore Corallo, Eufemia Stefania Lutrino, Daniele Rossini, Federica Morano, Luigia Stefania Stucci, Costanza Winchler, Martina Catalano, Andrea Marini, Giuseppe Brisinda, Enrico Sammarco, Martina Carullo, Giandomenico Roviello, Mirko Barone, Maria Grazia Rodriquenz, Giuseppe Tirino, Alessia Amoruso, Anna Russo, Veronica Conca, Laura Orgiano, Sveva Macrini, Giulia Nazzicone, Maria Bensi, Martina Montesano, Emanuela Dell’Aquila, Andrea Sbrana, Beatrice Borelli, Lorenzo Fornaro, Lucrezia Raimondi, Valeria Zurlo, Mattia Garutti, Elena Ongaro, Arianna Pellegrino, Andrea lanese, Laura Bernardini, Alessandra Boccaccino, Patrizia Farina, Federica Buzzacchino, Angelica Petrillo, Ada Taravella, Vittorio Studiale, Paolo Ciracì, Giovanna Lovino, Dora Di Cosmo, Sabrina Montrone, Fabiana Gregucci, Luca Dominici, Alba Fiorentino, Filippo Carannante, Giambattista Siepe, Giampaolo Montesi, Manuele Roghi, Michele Aquilano, Andrea Romei, Ilaria Bonaparte, Roberta Grassi, Emma D’Ippolito, Giulio Frosini, Giuseppina De Marco, Gennaro Giovine, Chiara Mattioli, Ilaria Morelli, Victoria Lorenzetti, Matteo Mariotti, Carolina Orsatti, Vincenzo Troncone, Lorenzo Livi, Antonio Angrisani, Marco Banini, Teresa Di Pietro, Giuseppe Carlo Iorio, Iacopo Cavallo, Cecilia Cerbai, Valerio Nardone, Francesca De Felice, Consuelo Rosa, Giulia Stocchi, Sara Lucidi, Michele Ganovelli, Damiano Dei, Chiara Cascone, Anna Peru, Luisa Caprara, Lucia Angelini, Luca Visani, Giulio Francolini, Beatrice Bettazzi, Francesco Belia, Virginia Boccardi, Simone Serafini, Vincenzo Bottino, Luca Ferrario, Giuseppe Frazzetta, Felice Pirozzi, Gennaro Martines, Francesco Antonio Ciarleglio, Daniele Indiani, Giuliano Barugola, Luca Mazza, and Chiara Guarini
Subjects: clinical nutrition, cancer, malnutrition, nutritional assessment, survey, Nutrition. Foods and food supply, TX341-641
Abstract: Malnutrition is a common condition in cancer patients which is usually associated with functional limitations, as well as increased morbidity and mortality. Based on the support of the young sections of Italian Association of Medical Oncology (AIOM), Italian Association of Radiotherapy and Clinical Oncology (AIRO) and Italian Society of Surgical Oncology (SICO) merged into the NutriOnc Research Group, we performed a multidisciplinary national survey with the aim to define the awareness of nutritional issues among healthcare professionals delivering anticancer care. The questionnaire was organized in four sections, as follows: Knowledge and practices regarding Nutritional Management of cancer patients; Timing of screening and assessment of Nutritional Status; Nutritional Treatment and prescription criteria; Immunonutrition and educational topics. The modules focused on esophagogastric, hepato-bilio-pancreatic and colorectal malignancies. Overall, 215 physicians completed the survey. As regards the management of Nutritional Status of cancer patients, many responders adopted the ERAS program (49.3%), while a consistent number of professionals did not follow a specific validated nutritional care protocol (41.8%), mainly due to lack of educational courses (14.5%) and financial support (15.3%). Nearly all the included institutions had a multidisciplinary team (92%) to finalize the treatment decision-making. Cancer patients routinely underwent nutritional screening according to 57.2% of interviewed physicians. The timing of nutritional assessment was at diagnosis (37.8%), before surgery (25.9%), after surgery (16.7%), before radiochemotherapy (13.5%) and after radiochemotherapy (7%). Most of the responders reported that nutritional status was assessed throughout the duration of cancer treatments (55.6%). An important gap between current delivery and need of nutritional assessment persists. The development of specific and defined care protocols and the adherence to these tools may be the key to improving nutritional support management in clinical practice.
Published: 2023
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2. Surgical stress and metabolic response after totally laparoscopic right colectomy

Author: Marco Milone, Antonella Desiderio, Nunzio Velotti, Michele Manigrasso, Sara Vertaldi, Umberto Bracale, Michele D’Ambra, Giuseppe Servillo, Giuseppe De Simone, Fatima Domenica Elisa De Palma, Giuseppe Perruolo, Gregory Alexander Raciti, Claudia Miele, Francesco Beguinot, and Giovanni Domenico De Palma
Subjects: Medicine, Science
Abstract: Abstract No clear consensus on the need to perform an intracorporeal anastomosis (IA) after laparoscopic right colectomy is currently available. One of the potential benefits of intracorporeal anastomosis may be a reduction in surgical stress. Herein, we evaluated the surgical stress response and the metabolic response in patients who underwent right colonic resection for colon cancer. Fifty-nine patients who underwent laparoscopic resection for right colon cancer were randomized to receive an intracorporeal or an extracorporeal anastomosis (EA). Data including demographics (age, sex, BMI and ASA score), pathological (AJCC tumour stage and tumour localization) and surgical results were recorded. Moreover, to determine the levels of the inflammatory response, mediators, such as C-reactive protein (CRP), tumour necrosis factor (TNF), interleukin 1β (IL-1β), IL-6, IL-10, and IL-13, were evaluated. Similarly, cortisol and insulin levels were evaluated as hormonal responses to surgical stress. We found that the proinflammatory mediator IL-6, CRP, TNF and IL-1β levels, were significantly reduced in IA compared to EA. Concurrently, an improved profile of the anti-inflammatory cytokines IL-10 and IL-13 was observed in the IA group. Relative to the hormone response to surgical stress, cortisol was increased in patients who underwent EA, while insulin was reduced in the EA group. Based on these results, surgical stress and metabolic response to IA justify advocating the adoption of a totally laparoscopic approach when performing a right colectomy for cancer. This trial is registered on ClinicalTrials.gov (ID: NCT03422588).
Published: 2021
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3. The Role of Indocyanine Near-Infrared Fluorescence in Colorectal Surgery

Author: Francesco Maione, Michele Manigrasso, Alessia Chini, Sara Vertaldi, Pietro Anoldo, Anna D’Amore, Alessandra Marello, Carmen Sorrentino, Grazia Cantore, Rosa Maione, Nicola Gennarelli, Salvatore D’Angelo, Nicola D’Alesio, Giuseppe De Simone, Giuseppe Servillo, Marco Milone, and Giovanni Domenico De Palma
Subjects: indocyanine green, colorectal cancer, perfusion, minimally invasive surgery, nearinfrared fluorescence, Surgery, RD1-811
Abstract: PurposesThe aim of this study was to evaluate the importance of Indocyanine Green in control of anastomosis perfusion and on anastomotic leakage rates during laparoscopic and robotic colorectal procedures.MethodsA retrospective review of patients who underwent elective minimally invasive surgery for colorectal cancer from 1 January 2018 to 31 December 2020 was performed. All patients underwent Near-Infrared Fluorescence-Indocyanine Green system in two moments: before performing the anastomosis and after completing the anastomotic procedure. Primary outcomes were the rate of intraoperative change in the surgical resection due to an inadequate vascularization and the rate of postoperative anastomotic leakage. Secondary outcomes were the postoperative complications, both medical and surgical (intra-abdominal bleeding, anastomotic leakage).ResultsOur analysis included 93 patients. Visible fluorescence was detected in 100% of the cases. In 7 patients (7.5%), the planned site of resection was changed due to inadequate perfusion. The mean extension of the surgical resection in these 7 patients was 2.2 ± 0.62. Anastomotic leakage occurred in 2 patients (2.1%). Other complications included 8 postoperative bleedings (8.6%) and 1 pulmonary thromboembolism.ConclusionsThe intraoperative use of Near-Infrared Fluorescence-Indocyanine Green in colorectal surgery is safe, feasible, and associated with a substantial reduction in postoperative anastomotic leakage rate.
Published: 2022
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4. Robotic Surgery and Functional Esophageal Disorders: A Systematic Review and Meta-Analysis

Author: Sara Vertaldi, Anna D’Amore, Michele Manigrasso, Pietro Anoldo, Alessia Chini, Francesco Maione, Marcella Pesce, Giovanni Sarnelli, Giovanni Domenico De Palma, and Marco Milone
Subjects: robotic fundoplication, laparoscopic fundoplication, reflux, hiatal hernia, functional outcomes, Medicine
Abstract: The functional disease of the esophago-gastric junction (EGJ) is one of the most common health problems. It often happens that patients suffering from GERD need surgical management. The laparoscopic fundoplication has been considered the gold standard surgical treatment for functional diseases of the EGJ. The aim of our meta-analysis is to investigate functional outcomes after robotic fundoplication compared with conventional laparoscopic fundoplication. A prospective search of online databases was performed by two independent reviewers using the search string “robotic and laparoscopic fundoplication”, including all the articles from 1996 to December 2021. The risk of bias within each study was assessed with the Cochrane ROBINS-I and RoB 2.0 tools. Statistical analysis was performed using Review Manager version 5.4. In addition, sixteen studies were included in the final analysis, involving only four RCTs. The primary endpoints were functional outcomes after laparoscopic (LF) and robotic fundoplication (RF). No significant differences between the two groups were found in 30-day readmission rates (p = 0.73), persistence of symptomatology at follow-up (p = 0.60), recurrence (p = 0.36), and reoperation (p = 0.81). The laparoscopic fundoplication represents the gold standard treatment for the functional disease of the EGJ. According to our results, the robotic approach seems to be safe and feasible as well. Further randomized controlled studies are required to better evaluate the advantages of robotic fundoplication.
Published: 2023
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5. Histopathological Examination and Endoscopic Sinusectomy: Is It Possible?

Author: Sara Vertaldi, Pietro Anoldo, Grazia Cantore, Alessia Chini, Anna D'Amore, Maria D'Armiento, Nicola Gennarelli, Francesco Maione, Michele Manigrasso, Alessandra Marello, Pietro Schettino, Carmen Sorrentino, Loredana M. Sosa Fernandez, Giovanni D. De Palma, and Marco Milone
Subjects: pilonidal disease, EPSiT, malignant degeneration, VAAPS, histopathological examination (HPE), Surgery, RD1-811
Abstract: IntroductionAlthough carcinomatous degeneration is a rare occurrence, some authors support the need for a histopathological examination after pilonidal cyst excision. Today, minimally invasive techniques are widely spread for the treatment of pilonidal sinus disease but opposed to standard procedures, these techniques could not allow to perform a histopathological examination because of the absence of a specimen. The aim of this two-institutions study is to evaluate whether histopathological examination of the pilonidal sinus excision material can be successfully performed after an endoscopic ablation of the cyst.Materials and MethodsWe identified all consecutive patients from January 2021 to September 2021 with diagnosis of pilonidal sinus disease who underwent Video Assisted Ablation of Pilonidal Sinus (VAAPS) followed by histopathological examination.ResultsA total of 45 patients were included in the study. All patients were Caucasians and aged below 50 years. Nine of them underwent surgery due to recurrence of PSD. No evidence of malignancy was detected in the histopathological examination of the pilonidal sinus sampling material.DiscussionWe were able to send pilonidal sinus sampling material for a histopathological examination in all patients who underwent minimally invasive technique for the treatment of pilonidal sinus disease. No evidence of malignancy was found in any of the 45 samples. Our findings prove that minimally invasive ablation of pilonidal sinus does not preclude histopathological examination of the cysts.
Published: 2022
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6. Endoscopic Treatment of Pilonidal Sinus Disease: State of Art and Review of the Literature

Author: Michele Manigrasso, Pietro Anoldo, Grazia Cantore, Alessia Chini, Anna D'Amore, Nicola Gennarelli, Francesco Maione, Alessandra Marello, Pietro Schettino, Carmen Sorrentino, Sara Vertaldi, Loredana Maria Sosa Fernandez, Giovanni Domenico De Palma, and Marco Milone
Subjects: pilonidal, endoscopic, VAAPS, EPSiT, PEPSiT, state of art, Surgery, RD1-811
Abstract: Background: Pilonidal sinus disease (PSD) is a chronic troublesome pathology of the natal cleft of the sacrococcygeal region, with an estimated incidence of 26 cases in every 100,000 inhabitants. The aim of this review is to give a snapshot of the current literature on the endoscopic approach to PSD.Methods: A search on endoscopic treatment of pilonidal disease was performed according to PRISMA guidelines, adopting the following search terms: (pilonidal OR sacrococcygeal) and (endoscopic OR VAAPS OR EPSiT OR minimally invasive OR video-assisted OR video assisted).Results: Thirty-four articles were included in the final analysis, among which 23 were on adults and 11 were on pediatric population. The endoscopic approach is associated with painless postoperative pain, good aesthetic results, short time off work, and high patient satisfaction.Despite these advantages in short-term outcomes, results on recurrence rate in a long-term follow up are needed to definitively confirm the importance of this technique.Conclusions: The endoscopic approach is associated with significant postoperative advantages over other standard surgical approaches, and it should be included in the surgical portfolio for the treatment of PSD. According to the Italian guidelines, this technique could be considered as the gold standard for limited PSD. However, the favorable short-term-outcomes and lack of reliable data on long-term follow-up must be a stimulus to perform further high-quality studies to give definitive conclusions on this technique.
Published: 2022
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7. Incidence and risk factors of portomesenteric venous thrombosis after colorectal surgery for cancer in the elderly population

Author: Michele Manigrasso, Marco Milone, Nunzio Velotti, Sara Vertaldi, Pietro Schettino, Mario Musella, Giovanni Aprea, Nicola Gennarelli, Francesco Maione, Giovanni Sarnelli, Pietro Venetucci, Giovanni Domenico De Palma, and Francesco Milone
Subjects: Portomesenteric, Venous thrombosis, Colorectal, Surgery, RD1-811, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract: Abstract Background Although it is known that portomesenteric venous thrombosis (PMVT) is associated with total colectomy and proctocolectomy in young patients with inflammatory bowel disease, little is known about incidence and risk factors of PMVT among the elderly population undergoing colorectal surgery for cancer. Methods Data of elderly patients (> 70 years) undergoing surgery for colorectal cancer were retrospectively registered. The occurrence of PMVT was correlated with the patients’ characteristics and operative variables. Data collected included age, sex, obesity, ASA score, tumor degree, type of surgical resection, surgical approach (laparoscopic or open), and duration of surgery (from skin incision to the application of dressings). Results A total of 137 patients > 70 years who underwent surgery for colorectal cancer and developed an acute intraabdominal process with suggestive symptoms, needing a CT scan, were included. Three of these patients (2.1%) had portomesenteric venous thrombosis during the study period, which was proved with CT scan. There were no significant patients’ characteristics or operative variables between patients with or without the occurrence of PMVT after surgery. Of interest, only operative time was significantly higher in patients with PMVT after surgery (256 ± 40 vs 140 ± 41, p
Published: 2019
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8. Long-Term Functional Results of a Modified Caudal-to-Cranial Approach in Laparoscopic Segmental Left Colectomy for Diverticular Disease

Author: Michele Manigrasso, Marcella Pesce, Marco Milone, Pietro Anoldo, Anna D’Amore, Giovanni Galasso, Nicola Gennarelli, Francesco Maione, Sara Vertaldi, Giovanni Sarnelli, and Giovanni Domenico De Palma
Subjects: Diseases of the digestive system. Gastroenterology, RC799-869
Abstract: A modified caudal-to-cranial approach to perform laparoscopic left colectomy for benign diseases has been recently designed to facilitate the low-tie mesenteric dissection. A chart review has been performed including all consecutive patients with uncomplicated diverticulitis who have been treated by segmental left colectomy with a caudal-to-cranial approach. A total of 34 patients were included in the study. 21 patients were male, mean age was 54.1±11.3, and mean BMI was 26±5.5. Patients with ASA Score I were 7, with ASA II were 9, and with ASA Score III were 5. Incontinence Score (IS) resulted in an average of 5±2,2 grade of incontinence and the CS score showed an average of 10±3,2 grade of constipation. Health status, evaluated by Short Form-36 questionnaire, was demonstrated in these patients’ great physical function, role, general health, and social function. The anorectal manometry performed 6 months after surgery showed a normal value in terms of the anal resting pressure (47±13 mmHg) and an increased volume to stimulate desire to defecate (197±25 ml). The length of the anal sphincter was normal compared to the reference value (37±5.4 mm). Although further studies are required to obtain definitive conclusions, our results are encouraging to propose low-tie segmental colectomy as the standard procedure for the treatment of uncomplicated diverticulitis, and our modified surgical approach could be considered useful to facilitate the surgical approach.
Published: 2021
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9. The Role of Robotic Visceral Surgery in Patients with Adhesions: A Systematic Review and Meta-Analysis

Author: Marco Milone, Michele Manigrasso, Pietro Anoldo, Anna D’Amore, Ugo Elmore, Mariano Cesare Giglio, Gianluca Rompianesi, Sara Vertaldi, Roberto Ivan Troisi, Nader K. Francis, and Giovanni Domenico De Palma
Subjects: conversion, abdominal adhesions, laparoscopic surgery, robotic surgery, Medicine
Abstract: Abdominal adhesions are a risk factor for conversion to open surgery. An advantage of robotic surgery is the lower rate of unplanned conversions. A systematic review was conducted using the terms “laparoscopic” and “robotic”. Inclusion criteria were: comparative studies evaluating patients undergoing laparoscopic and robotic surgery; reporting data on conversion to open surgery for each group due to adhesions and studies including at least five patients in each group. The main outcomes were the conversion rates due to adhesions and surgeons’ expertise (novice vs. expert). The meta-analysis included 70 studies from different surgical specialities with 14,329 procedures (6472 robotic and 7857 laparoscopic). The robotic approach was associated with a reduced risk of conversion (OR 1.53, 95% CI 1.12–2.10, p = 0.007). The analysis of the procedures performed by “expert surgeons” showed a statistically significant difference in favour of robotic surgery (OR 1.48, 95% CI 1.03–2.12, p = 0.03). A reduced conversion rate due to adhesions with the robotic approach was observed in patients undergoing colorectal cancer surgery (OR 2.62, 95% CI 1.20–5.72, p = 0.02). The robotic approach could be a valid option in patients with abdominal adhesions, especially in the subgroup of those undergoing colorectal cancer resection performed by expert surgeons.
Published: 2022
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10. Robotic Esophagectomy. A Systematic Review with Meta-Analysis of Clinical Outcomes

Author: Michele Manigrasso, Sara Vertaldi, Alessandra Marello, Stavros Athanasios Antoniou, Nader Kamal Francis, Giovanni Domenico De Palma, and Marco Milone
Subjects: robotic, esophagectomy, esophageal cancer, laparoscopic, open surgery, Medicine
Abstract: Background: Robot-Assisted Minimally Invasive Esophagectomy is demonstrated to be related with a facilitation in thoracoscopic procedure. To give an update on the state of art of robotic esophagectomy for cancr a systematic review with meta-analysis has been performed. Methods: a search of the studies comparing robotic and laparoscopic or open esophagectomy was performed trough the medical libraries, with the search string “robotic and (oesophagus OR esophagus OR esophagectomy OR oesophagectomy)”. Outcomes were: postoperative complications rate (anastomotic leakage, bleeding, wound infection, pneumonia, recurrent laryngeal nerves paralysis, chylotorax, mortality), intraoperative outcomes (mean blood loss, operative time and conversion), oncologic outcomes (harvested nodes, R0 resection, recurrence) and recovery outcomes (length of hospital stay). Results: Robotic approach is superior to open surgery in terms of blood loss p = 0.001, wound infection rate, p = 0.002, pneumonia rate, p = 0.030 and mean number of harvested nodes, p < 0.0001 and R0 resection rate, p = 0.043. Similarly, robotic approach is superior to conventional laparoscopy in terms of mean number of harvested nodes, p = 0.001 pneumonia rate, p = 0.003. Conclusions: robotic surgery could be considered superior to both open surgery and conventional laparoscopy. These encouraging results should promote the diffusion of the robotic surgery, with the creation of randomized trials to overcome selection bias.
Published: 2021
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11. Robotic Colorectal Cancer Surgery. How to Reach Expertise? A Single Surgeon-Experience

Author: Michele Manigrasso, Sara Vertaldi, Pietro Anoldo, Anna D’Amore, Alessandra Marello, Carmen Sorrentino, Alessia Chini, Salvatore Aprea, Salvatore D’Angelo, Nicola D’Alesio, Mario Musella, Antonio Vitiello, Giovanni Domenico De Palma, and Marco Milone
Subjects: robotic, colorectal, colorectal cancer, laparoscopic, learning curve, Medicine
Abstract: The complexity associated with laparoscopic colorectal surgery requires several skills to overcome the technical difficulties related to this procedure. To overcome the technical challenges of laparoscopic surgery, a robotic approach has been introduced. Our study reports the surgical outcomes obtained by the transition from laparoscopic to robotic approach in colorectal cancer surgery to establish in which type of approach the proficiency is easier to reach. Data about the first consecutive 15 laparoscopic and the first 15 consecutive robotic cases are extracted, adopting as a comparator of proficiency the last 15 laparoscopic colorectal resections for cancer. The variables studied are operative time, number of harvested nodes, conversion rate, postoperative complications, recovery outcomes. Our analysis includes 15 patients per group. Our results show that operative time is significantly longer in the first 15 laparoscopic cases (p = 0.001). A significantly lower number of harvested nodes was retrieved in the first 15 laparoscopic cases (p = 0.003). Clavien Dindo I complication rate was higher in the first laparoscopic group, but without a significant difference among the three groups (p = 0.09). Our results show that the surgeon needed no apparent learning curve to reach their laparoscopic standards. However, further multicentric prospective studies are needed to confirm this conclusion.
Published: 2021
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12. Barbed suture in gastro-intestinal surgery: A review with a meta-analysis

Author: Giovanni Domenico De Palma, Antonio Vitiello, Michele Manigrasso, Katia Di Lauro, Marco Milone, Francesco Milone, Sara Vertaldi, Nunzio Velotti, Mario Musella, Pietro Anoldo, Velotti, N., Manigrasso, M., Di Lauro, K., Vertaldi, S., Anoldo, P., Vitiello, A., Milone, F., Musella, M., De Palma, G. D., and Milone, M.
Subjects: medicine.medical_specialty, Gastric Bypass, Anastomosis, Intracorporeal anastomosi, 03 medical and health sciences, Laparoscopic, Postoperative Complications, 0302 clinical medicine, Suture (anatomy), Colorectal surgery, medicine, Humans, Bariatric surgery, Sutures, Intracorporeal anastomosis, business.industry, Suture Techniques, medicine.disease, Surgery, Stenosis, Barbed suture, 030220 oncology & carcinogenesis, Meta-analysis, Laparoscopy, 030211 gastroenterology & hepatology, business, Gastro intestinal
Abstract: Background The laparoscopic approach is a very popular technique for many gastrointestinal operations and barbed sutures may improve the difficulties of intracorporeal anastomosis by eliminating the need for knot tying. The aim of this systematic review with a meta-analysis is to explore literature to establish the security profile of barbed suture compared with conventional laparoscopic sutures. Materials and methods A systematic search was performed in all electronic databases (PubMed, Web of Science, Scopus, EMBASE) and 12 studies were included in the analysis, involving 27,133 patients, whereof 3372 cases (patients undergone barbed suture usage) and 23,761 controls (patients undergone conventional suture usage). We found 3 studies discussing differences between barbed and conventional sutures in colorectal surgery and 8 studies presenting results in bariatric surgery, both in Roux-en-y gastric bypass and Mini Gastric/One Anastomosis Gastric Bypass. Results We found comparable rate of leaks, bleedings and stenosis. The meta-regression analysis demonstrated that, both in case of bariatric and colorectal surgery, the demographic characteristic of patients and the oncological features of neoplasms did not impact of these findings. As expected, operative time is significantly shorter when barbed suture is used. Conclusion Our analysis on current literature define an acceptable security profile for barbed suture with effective results particularly in terms of shorter operative time.
Published: 2022

13. Clinical nutrition in surgical oncology: Young AIOM-AIRO-SICO multidisciplinary national survey on behalf of NutriOnc research group

Author: Marano, Luigi, Marmorino, Federica, Desideri, Isacco, Carbone, Ludovico, Rizzo, Alessandro, Salvestrini, Viola, Roviello, Franco, Cinieri, Saverio, Donato, Vittorio, De Luca, Raffaele, Silvia, Sofia, Marco, Milone, Benedetto, Ielpo, Maria Teresa Mita, Silvia, Ministrini, Mario, Giuffrida, Roberta, Tutino, Caterina, Baldi, Giampaolo, Perri, Anna Stella Lippolis, Chiara, Marafante, Giusy, Giannandrea, Marco Vito Marino, Letizia, Laface, Salomone Di Saverio, Luca, Aldrighetti, Nicola, De'Angelis, Nick, Salimian, Marco, Caricato, Gianluca, Pellino, Sara, Vertaldi, Federica, Cipriani, Gabriella Teresa Capolupo, Antonio, Costanzo, Letizia, Santandrea, Gallo, Gaetano, Andrea, Belli, Laura, Mastrangelo, Fausto, Rosa, Nicolò, Pecorelli, Graziella, Marino, Alessio, Giordano, Nicola, Cillara, Maria, Lemma, Francesco, Pata, Federico, Cammillini, Gianmario Edoardo Poto, Giulia, Grassi, Donato Francesco Altomare, Arcangelo, Picciariello, Lorenzo, Petagna, Luca, Ippolito, Elio, Treppiedi, Daniele, Delogu, Abdallah, Moukachar, Stefano, Granieri, Giuseppe, Cuticone, Osvaldo Carpineto Samorani, Daniela, Rega, Leonardo, Solaini, Stefano de Pascale, Francesca, Ascari, Michele, Manigrasso, Simona, Badalucco, Salvatore, Paiella, Sara, Coppola, Roberta, Iadarola, Giovanna Di Meo, Isacco, Montroni, Fabio, Vistoli, Valentina, Ferraro, Edoardo, Saladino, Federico, Fazio, Roberta, Rota, Francesco, Orlando, Simone, Famularo, Cinzia, Bizzoca, Giorgio, Dalmonte, Marco, Inama, Luigi, Verre, Leandro, Siragusa, Casoni Pattacini Gianmaria, Michele, Benedetti, Nicolò, Tamini, Cristian, Conti, Giorgio, Ammerata, Serena, Mantova, Vito Leonardo Pinto, Arianna, Corvasce, Giorgio, Micheletti, Teresa, Perra, Marco, Pellicciaro, Marco, Materazzo, Michele, Zuolo, Emanuele, Doria, Antonio, Brillantino, Luca Del Prete, Andrea, Muratore, Claudio, Luciani, Giulia, Turri, Fabio, Casciani, Giuliani, Giuseppe, Graziana, Barile, Oldrà, Gaia, Valeria, Restaino, Simona, Deidda, Michele, Ammendola, Andrea Fares Bucci, Patrizia, Marsanic, Dario, Cassetti, Luca, Resca, Daniele, Fusario, Eleonora, Andreucci, Anna, Michelotti, Brunella, Amoruso, Isabella, Franco, Laura, Noto, Andrea, Spallanzani, Raimondo Calogero Scalia, Teresa Del Giudice, Valeria, Merz, Gianmarco, Motta, Alessandro, Parisi, Mikol, Modesti, Antonella, Argentiero, Debora, Basile, Gianmarco, Vannini, Carlotta, Ottanelli, Salvatore, Corallo, Eufemia Stefania Lutrino, Daniele, Rossini, Federica, Morano, Luigia Stefania Stucci, Costanza, Winchler, Martina, Catalano, Andrea, Marini, Giuseppe, Brisinda, Enrico, Sammarco, Martina, Carullo, Giandomenico, Roviello, Mirko, Barone, Maria Grazia Rodriquenz, Giuseppe, Tirino, Alessia, Amoruso, Anna, Russo, Veronica, Conca, Laura, Orgiano, Sveva, Macrini, Giulia, Nazzicone, Maria, Bensi, Martina, Montesano, Emanuela, Dell'Aquila, Andrea, Sbrana, Beatrice, Borelli, Lorenzo, Fornaro, Lucrezia, Raimondi, Valeria, Zurlo, Mattia, Garutti, Elena, Ongaro, Arianna, Pellegrino, Andrea, Lanese, Laura, Bernardini, Alessandra, Boccaccino, Patrizia, Farina, Federica, Buzzacchino, Angelica, Petrillo, Ada, Taravella, Vittorio, Studiale, Paolo, Ciracì, Giovanna, Lovino, Dora Di Cosmo, Sabrina, Montrone, Fabiana, Gregucci, Luca, Dominici, Alba, Fiorentino, Filippo, Carannante, Giambattista, Siepe, Giampaolo, Montesi, Manuele, Roghi, Michele, Aquilano, Andrea, Romei, Ilaria, Bonaparte, Roberta, Grassi, Emma, D'Ippolito, Giulio, Frosini, Giuseppina De Marco, Gennaro, Giovine, Chiara, Mattioli, Ilaria, Morelli, Victoria, Lorenzetti, Matteo, Mariotti, Carolina, Orsatti, Vincenzo, Troncone, Lorenzo, Livi, Antonio, Angrisani, Marco, Banini, Teresa Di Pietro, Giuseppe Carlo Iorio, Iacopo, Cavallo, Cecilia, Cerbai, Valerio, Nardone, Francesca De Felice, Consuelo, Rosa, Giulia, Stocchi, Sara, Lucidi, Michele, Ganovelli, Damiano, Dei, Chiara, Cascone, Anna, Peru, Luisa, Caprara, Lucia, Angelini, Luca, Visani, Giulio, Francolini, Beatrice, Bettazzi, Francesco, Belia, Virginia, Boccardi, Simone, Serafini, Vincenzo, Bottino, Luca, Ferrario, Giuseppe, Frazzetta, Felice, Pirozzi, Gennaro, Martines, Francesco Antonio Ciarleglio, Daniele, Indiani, Giuliano, Barugola, Luca, Mazza, and Chiara, Guarini
Subjects: nutritional assessment, clinical nutrition, cancer, malnutrition, survey
Published: 2023

14. Re-thoracoscopy for the management of gastric conduit dehiscence after minimally invasive McKeown esophagectomy

Author: Pietro Anoldo, Sara Vertaldi, Michele Manigrasso, Anna D'Amore, Giovanni Domenico De Palma, Marco Milone, Anoldo, Pietro, Vertaldi, Sara, Manigrasso, Michele, D'Amore, Anna, De Palma, Giovanni Domenico, and Milone, Marco
Subjects: Emergency thoracoscopy, Case report, Surgery, Gastric conduit dehiscence, Minimally invasive esophagectomy
Abstract: Introduction and importance: Gastric conduit dehiscence after esophagectomy represents a severe complication associated with high mortality. Surgical management is achieved through thoracotomy, but often ends up in conduit sacrifice and diversion. Case presentation: A 59-years-old man underwent minimally invasive McKeown esophagectomy for esophageal adenocarcinoma. After a worsening of the postoperative course and evidence at the CT scan and endoscopy of highly suspect gastric conduit failure, the patient underwent an exploratory thoracoscopy, which revealed a partial dehiscence of the gastric conduit treated with resection of the dehiscent gastric wall by a linear stapler on the guide of a 36-french orogastric tube. Patient had a regular postoperative course without any complications and was discharged on the 6th postoperative day. Clinical discussion: The management of conduit necrosis is extremely challenging. There are several interventional options and it is difficult to decide the most appropriate treatment for each individual patient. In our case we decided to perform a reintervention with a thoracoscopic approach, resecting the dehiscent area of the gastric conduit. Conclusions: Minimally invasive surgery is a valid option for the management of post-operative complications, including those in emergency setting. Re-suturing a partial dehiscence of gastric conduit may be feasible if tissue conditions allow.
Published: 2023

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

Author: Balla, Andrea, Sartori, Alberto, Botteri, Emanuele, Podda, Mauro, Ortenzi, Monica, Silecchia, Gianfranco, Guerrieri, Mario, Agresta, Ferdinando, Antonino, Agrusa, Daniele, Aguzzi, Mariantonietta, Alagia, Laura, Alberici, Marco Ettore Allaix, Luisa, Ambrosio, Alfonso, Amendola, Michele, Ammendola, Pietro Maria Amodio, Gabriele, Anania, Jacopo, Andreuccetti, Alfredo, Annichiarico, Pietro, Anoldo, Alessandro, Anselmo, Giovanni, Aprea, Giacomo, Arcuri, Alberto, Arezzo, Giulia, Armatura, Giulia, Bagaglini, Francesco, Bagolini, Beatrice, Bailetti, Gianluca, Baiocchi, Edoardo, Baldini, Elisa, Bannone, Mirko, Barone, Gianluca, Baronio, Raffaele, Basile, Bellucci, Marco, Andrea Benedetti Cacciaguerra, Ilaria, Benzoni, Francesco, Bianco, Giuseppe, Boccia, Cristina, Bombardini, Luigi, Boni, Dario, Bono, Luca Domenico Bonomo, Giulia, Bonventre, Andrea, Bottari, Claudio, Botti, Giacomo, Brentegani, Mattia, Buonomo, Umberto, Bracale, Cosimo, Callari, Luca, Calligaris, Pietro Giorgio Calò, Angelo, Cangiano, Lorenzo, Capezzuoli, Gabriella Teresa Capolupo, Marianna, Capuano, Filippo, Carannante, Eugenia, Cardamone, Teresa, Carfora, Chiara, Caricato, Pietro, Carnevali, Francesco Maria Carrano, Lorenzo, Casali, Gianmaria Casoni Pataccini, Gianluca, Cassese, Simone, Castiglioni, Flavia, Cavicchi, Ceccarelli, Graziano, Giovanni, Cestaro, Pasquale, Cianci, Claudio, Cimmino, Marco, Clementi, Coletta, Diego, Riccardo, Conventi, Corallino, Diletta, Maurizio, Costantini, Lorenzo, Crepaz, Diego, Cuccurullo, Curci, FABIO PIO, Giuseppe, Currò, Giorgio, Dalmonte, Giovanni, D'Alterio, Michele, D'Ambra, D'Ambrosio, Giancarlo, Anna, D'Amore, Michele De Capua, Simona, Deidda, Daniele, Delogu, Maurizio De Luca, Nicolò De Manzini, DE STEFANI, Elena, Giuseppe Di Buono, Marcello Di Martino, DI TOMASO, Anna, Ugo, Elmore, CORDOVA HERENCIA, INGRID ELVA, Giovanni, Emiliani, Sofia, Esposito, Fazio, Federico, Federico, Festa, Marcello, Filotico, Fiocca, Fausto, Irene, Fiume, Francesco, Fleres, Giulia, Fontana, Tommaso, Fontana, Edoardo, Forcignanò, Giampaolo, Formisano, Laura, Fortuna, Uberto Fumagalli Romario, Andrea, Galderisi, Raffaele, Galleano, Carlo, Gazia, Alessio, Giordano, Giorgio, Giraudo, Maria Carmela Giuffrida, Simona, Giura, Anna, Guida, Antonio Maria Iannello, Marco, Inama, Sara, Ingallinella, Iossa, Angelo, Livio, Iudici, Laracca, GIOVANNI GUGLIELMO, LARGHI LAUREIRO, Zoe, Saverio, Latteri, Luca, Leonardi, Pasquale, Lepiane, Edelweiss, Licitra, Paolo, Locurto, Sarah Lo Faso, Nicola, Luciani, Luzza, Luigi, Magaletti, Sara, Michele, Manigrasso, Alessandra, Marano, Francesco, Marchetti, Alessandra, Marello, Nicolò, Mariani, Jacopo Nicolò Marin, Gennaro, Martines, Laura, Mastrangelo, Antonio, Matarangolo, Marco, Materazzo, Mazzarella, Gennaro, Giorgio, Mazzarolo, Maria Paola Menna, Meoli, Francesca, Marco, Milone, Elisabetta, Moggia, Davide, Moioli, Sarah, Molfino, Vitantonio, Mongelli, Roberto, Montalti, Giulia, Montori, Luca, Morelli, Gianluigi, Moretto, Muttillo, EDOARDO MARIA, Irnerio, Muttillo, Francesca, Notte, Alessandro, M Paganini, Gianluca, Pagano, Palmieri, Livia, Giuseppe, Palomba, Valentina, Palumbo, Panetta, Cristina, Giulia, Paradiso, Beniamino, Pascotto, Passannanti, Daniele, Renato, Patrone, Francesca, Pecchini, Francesca, Pego, Fabio, Pelle, Perrotta, Nicola, Wanda, Petz, Biagio, Picardi, Picchetto, Andrea, Chiara, Piceni, Pietricola, Giulia, Enrico, Pinotti, Felice, Pirozzi, Paolo, Pizzini, Poillucci, Gaetano, Ilaria, Puccica, Lorenzo, Ramaci, Rapanotti, Eleonora, Daniela, Rega, Angelica, Reggiani, Giorgio, Romano, Gregorio, Romeo, Luigi, Romeo, Gianluca, Rompianesi, Stefano, Rossi, Edoardo, Saladino, Roberto, Santambrogio, Federica, Saraceno, Giuliano, Sarro, Diego, Sasia, Grazia, Savino, Rosa, Scaramuzzo, Antonio, Sciuto, Michela, Scollica, Giovanni, Scudo, Ardit, Seitaj, Carlo, Serra, Francesco, Serra, Pierpaolo, Sileri, Leandro, Siragusa, Carmen, Sorrentino, Giuseppe, Surfaro, Ernesto, Tartaglia, Beatrice, Torre, Andrea, Tufo, Matteo, Uccelli, Alessandro, Ussia, Vaccari, Samuele, Marina, Valente, Sara, Vertaldi, Alessandro, Vitali, Luca, Zaccherini, Luigi, Zorcolo, Noemi, Zorzetti, Balla, A., Sartori, A., Botteri, E., Podda, M., Ortenzi, M., Silecchia, G., Guerrieri, M., Agresta, F., Agrusa, A., Aguzzi, D., Alagia, M., Alberici, L., Allaix, M. E., Ambrosio, L., Amendola, A., Ammendola, M., Amodio, P. M., Anania, G., Andreuccetti, J., Annichiarico, A., Anoldo, P., Anselmo, A., Aprea, G., Arcuri, G., Arezzo, A., Armatura, G., Bagaglini, G., Bagolini, F., Bailetti, B., Baiocchi, G., Baldini, E., Bannone, E., Barone, M., Baronio, G., Basile, R., Bellucci, M., Cacciaguerra, A. B., Benzoni, I., Bianco, F., Boccia, G., Bombardini, C., Boni, L., Bono, D., Bonomo, L. D., Bonventre, G., Bottari, A., Botti, C., Brentegani, G., Buonomo, M., Bracale, U., Callari, C., Calligaris, L., Calo, P. G., Cangiano, A., Capezzuoli, L., Capolupo, G. T., Capuano, M., Carannante, F., Cardamone, E., Carfora, T., Caricato, C., Carnevali, P., Carrano, F. M., Casali, L., Pataccini, G. C., Cassese, G., Castiglioni, S., Cavicchi, F., Ceccarelli, G., Cestaro, G., Cianci, P., Cimmino, C., Clementi, M., Coletta, D., Conventi, R., Corallino, D., Costantini, M., Crepaz, L., Cuccurullo, D., Curci, F. P., Curro, G., Dalmonte, G., D'Alterio, G., D'Ambra, M., D'Ambrosio, G., D'Amore, A., De Capua, M., Deidda, S., Delogu, D., De Luca, M., De Manzini, N., De Stefani, E., Di Buono, G., Di Martino, M., Di Tomaso, A., Elmore, U., Herencia, I. E. C., Emiliani, G., Esposito, S., Fazio, F., Festa, F., Filotico, M., Fiocca, F., Fiume, I., Fleres, F., Fontana, G., Fontana, T., Forcignano, E., Formisano, G., Fortuna, L., Romario, U. F., Galderisi, A., Galleano, R., Gazia, C., Giordano, A., Giraudo, G., Giuffrida, M. C., Giura, S., Guida, A., Iannello, A. M., Inama, M., Ingallinella, S., Iossa, A., Iudici, L., Laracca, G. G., Laureiro, Z. L., Latteri, S., Leonardi, L., Lepiane, P., Licitra, E., Locurto, P., Faso, S. L., Luciani, N., Luzza, L., Magaletti, S., Manigrasso, M., Marano, A., Marchetti, F., Marello, A., Mariani, N., Marin, J. N., Martines, G., Mastrangelo, L., Matarangolo, A., Materazzo, M., Mazzarella, G., Mazzarolo, G., Menna, M. P., Meoli, F., Milone, M., Moggia, E., Moioli, D., Molfino, S., Mongelli, V., Montalti, R., Montori, G., Morelli, L., Moretto, G., Muttillo, E. M., Muttillo, I., Notte, F., Paganini, A. M., Pagano, G., Palmieri, L., Palomba, G., Palumbo, V., Panetta, C., Paradiso, G., Pascotto, B., Passannanti, D., Patrone, R., Pecchini, F., Pego, F., Pelle, F., Perrotta, N., Petz, W., Picardi, B., Picchetto, A., Piceni, C., Pietricola, G., Pinotti, E., Pirozzi, F., Pizzini, P., Poillucci, G., Puccica, I., Ramaci, L., Rapanotti, E., Rega, D., Reggiani, A., Romano, G., Romeo, G., Romeo, L., Rompianesi, G., Rossi, S., Saladino, E., Santambrogio, R., Saraceno, F., Sarro, G., Sasia, D., Savino, G., Scaramuzzo, R., Sciuto, A., Scollica, M., Scudo, G., Seitaj, A., Serra, C., Serra, F., Sileri, P., Siragusa, L., Sorrentino, C., Surfaro, G., Tartaglia, E., Torre, B., Tufo, A., Uccelli, M., Ussia, A., Vaccari, S., Valente, M., Vertaldi, S., Vitali, A., Zaccherini, L., Zorcolo, L., Zorzetti, N., Balla, Andrea, Sartori, Alberto, Botteri, Emanuele, Podda, Mauro, Ortenzi, Monica, Silecchia, Gianfranco, Guerrieri, Mario, Agresta, Ferdinando, de Manzini, Nicolo, and ARMIS (Augmented Reality in Minimally Invasive Surgery) Collaborative, Group
Subjects: Virtual reality (VR), minimally invasive surgery (MIS), Augmented reality (AR), Minimally invasive surgery (MIS), Mixed reality (MR), Survey, Training, training, augmented reality (AR), mixed reality (MR), survey, virtual reality (VR), Settore MED/18 - Chirurgia Generale, Surgery
Abstract: Minimally invasive surgery (MIS) is a widespread approach in general surgery. Computer guiding software, such as the augmented reality (AR), the virtual reality (VR) and mixed reality (MR), has been proposed to help surgeons during MIS. This study aims to report these technologies' current knowledge and diffusion during surgical training in Italy. A web-based survey was developed under the aegis of the Italian Society of Endoscopic Surgery (SICE). Two hundred and seventeen medical doctors' answers were analyzed. Participants were surgeons (138, 63.6%) and residents in surgery (79, 36.4%). The mean knowledge of the role of the VR, AR and MR in surgery was 4.9 ± 2.4 (range 1-10). Most of the participants (122, 56.2%) did not have experience with any proposed technologies. However, although the lack of experience in this field, the answers about the functioning of the technologies were correct in most cases. Most of the participants answered that VR, AR and MR should be used more frequently for the teaching and training and during the clinical activity (170, 80.3%) and that such technologies would make a significant contribution, especially in training (183, 84.3%) and didactic (156, 71.9%). Finally, the main limitations to the diffusion of these technologies were the insufficient knowledge (182, 83.9%) and costs (175, 80.6%). Based on the present study, in Italy, the knowledge and dissemination of these technologies are still limited. Further studies are required to establish the usefulness of AR, VR and MR in surgical training.
Published: 2023

16. Enterotomy Closure after Minimally Invasive Distal Gastrectomy with Intracorporeal Anastomosis: A Multicentric Study

Author: Marco Milone, Sara Vertaldi, Marie Sophie Alfano, Antonino Agrusa, Gabriele Anania, Gian Luca Baiocchi, Pietro Paolo Bianchi, Alberto Biondi, Umberto Bracale, Salvatore Buscemi, Matteo Chiozza, Francesco Corcione, Domenico D’Ugo, Maurizio Degiuli, Giuseppe De Simone, Ugo Elmore, Federica Galli, Giuseppe Giuliani, Pietro Maida, Francesco Maione, Michele Manigrasso, Giampaolo Marte, Stefano Olmi, Stefano Rausei, Rossella Reddavid, Riccardo Rosati, Matteo Uccelli, Giovanni Domenico De Palma, Elisa Cassinotti, Luigi Boni, Milone, Marco, Vertaldi, Sara, Alfano, Marie Sophie, Agrusa, Antonino, Anania, Gabriele, Baiocchi, Gian Luca, Bianchi, Pietro Paolo, Biondi, Alberto, Bracale, Umberto, Buscemi, Salvatore, Chiozza, Matteo, Corcione, Francesco, D'Ugo, Domenico, Degiuli, Maurizio, De Simone, Giuseppe, Elmore, Ugo, Galli, Federica, Giuliani, Giuseppe, Maida, Pietro, Maione, Francesco, Manigrasso, Michele, Marte, Giampaolo, Olmi, Stefano, Rausei, Stefano, Reddavid, Rossella, Rosati, Riccardo, Uccelli, Matteo, De Palma, Giovanni Domenico, Cassinotti, Elisa, and Boni, Luigi
Subjects: Gastroenterology, Surgery
Abstract: Introduction: Despite progressive improvements in technical skills and instruments that have facilitated surgeons performing intracorporeal gastro-jejunal and jejuno-jejunal anastomoses, one of the big challenging tasks is handsewn knot tying. We analysed the better way to fashion a handsewn intracorporeal enterotomy closure after a stapled anastomosis. Methods: All 579 consecutive patients from January 2009 to December 2019 who underwent minimally invasive partial gastrectomy for gastric cancer were retrospectively analysed. Different ways to fashion intracorporeal anastomoses were investigated: robotic versus laparoscopic approach; laparoscopic high definition versus three-dimensional versus 4K technology; single-layer versus double-layer enterotomies. Double-layer enterotomies were analysed layer by layer, comparing running versus interrupted suture; the presence versus absence of deep corner suture; and type of suture thread. Results: Significantly lower rates of bleeding (p = 0.011) and leakage (p = 0.048) from gastro-jejunal anastomosis were recorded in the double-layer group. Barbed suture thread was significantly associated with reduced intraluminal bleeding and leakage rates both in the first (p = 0.042 and p = 0.010) and second layer (p = 0.002 and p = 0.029). Conclusions: Double-layer sutures using barbed suture thread both in first and second layer to fashion enterotomy closure result in lower intraluminal bleeding and anastomotic leak rates.
Published: 2022

17. A national survey on the current status of minimally invasive gastric practice on behalf of GIRCG

Author: Marco Milone, Anna D’Amore, Sergio Alfieri, Maria Raffaella Ambrosio, Jacopo Andreuccetti, Luca Ansaloni, Adelmo Antonucci, Marco Arganini, Gianluca Baiocchi, Mirko Barone, Lapo Bencini, Maria Bencivenga, Luigi Boccia, Luigi Boni, Marco Braga, Fabio Cianchi, Chiara Cipollari, Alessandro Contine, Christian Cotsoglou, Simone D’Imporzano, Giovanni De Manzoni, Stefano De Pascale, Nicola De Ruvo, Maurizio Degiuli, Annibale Donini, Ugo Elmore, Giorgio Ercolani, Giovanni Ferrari, Romario Uberto Fumagalli, Gianluca Garulli, Roberta Gelmini, Luigina Graziosi, Monica Gualtierotti, Alfredo Guglielmi, Marco Inama, Federica Maffeis, Francesco Maione, Michele Manigrasso, Federico Marchesi, Daniele Marrelli, Andrea Massobrio, Gianluigi Moretto, Aballah Moukachar, Giuseppe Navarra, Giuseppe Nigri, Stefano Olmi, Raffaele Palaia, Davide Papis, Paolo Parise, Corrado Pedrazzani, Roberto Petri, Giusto Pignata, Michele Pisano, Stefano Rausei, Rossella Reddavid, Giuseppe Rocco, Fausto Rosa, Riccardo Rosati, Luca Rossit, Matteo Rottoli, Franco Roviello, Stefano Santi, Stefano Scabini, Stefano Scaringi, Leonardo Solaini, Fabio Staderini, Lucio Taglietti, Beatrice Torre, Paolo Ubiali, Matteo Uccelli, Fabio Uggeri, Sara Vertaldi, Jacopo Viganò, Giovanni Domenico De Palma, Simone Giacopuzzi, Milone, Marco, D'Amore, Anna, Alfieri, Sergio, Ambrosio, Maria Raffaella, Andreuccetti, Jacopo, Ansaloni, Luca, Antonucci, Adelmo, Arganini, Marco, Baiocchi, Gianluca, Barone, Mirko, Bencini, Lapo, Bencivenga, Maria, Boccia, Luigi, Boni, Luigi, Braga, Marco, Cianchi, Fabio, Cipollari, Chiara, Contine, Alessandro, Cotsoglou, Christian, D'Imporzano, Simone, De Manzoni, Giovanni, De Pascale, Stefano, De Ruvo, Nicola, Degiuli, Maurizio, Donini, Annibale, Elmore, Ugo, Ercolani, Giorgio, Ferrari, Giovanni, Fumagalli, Romario Uberto, Garulli, Gianluca, Gelmini, Roberta, Graziosi, Luigina, Gualtierotti, Monica, Guglielmi, Alfredo, Inama, Marco, Maffeis, Federica, Maione, Francesco, Manigrasso, Michele, Marchesi, Federico, Marrelli, Daniele, Massobrio, Andrea, Moretto, Gianluigi, Moukachar, Aballah, Navarra, Giuseppe, Nigri, Giuseppe, Olmi, Stefano, Palaia, Raffaele, Papis, Davide, Parise, Paolo, Pedrazzani, Corrado, Petri, Roberto, Pignata, Giusto, Pisano, Michele, Rausei, Stefano, Reddavid, Rossella, Rocco, Giuseppe, Rosa, Fausto, Rosati, Riccardo, Rossit, Luca, Rottoli, Matteo, Roviello, Franco, Santi, Stefano, Scabini, Stefano, Scaringi, Stefano, Solaini, Leonardo, Staderini, Fabio, Taglietti, Lucio, Torre, Beatrice, Ubiali, Paolo, Uccelli, Matteo, Uggeri, Fabio, Vertaldi, Sara, Viganò, Jacopo, De Palma, Giovanni Domenico, Giacopuzzi, Simone, Milone, M, D'Amore, A, Alfieri, S, Ambrosio, M, Andreuccetti, J, Ansaloni, L, Antonucci, A, Arganini, M, Baiocchi, G, Barone, M, Bencini, L, Bencivenga, M, Boccia, L, Boni, L, Braga, M, Cianchi, F, Cipollari, C, Contine, A, Cotsoglou, C, D'Imporzano, S, De Manzoni, G, De Pascale, S, De Ruvo, N, Degiuli, M, Donini, A, Elmore, U, Ercolani, G, Ferrari, G, Fumagalli, R, Garulli, G, Gelmini, R, Graziosi, L, Gualtierotti, M, Guglielmi, A, Inama, M, Maffeis, F, Maione, F, Manigrasso, M, Marchesi, F, Marrelli, D, Massobrio, A, Moretto, G, Moukachar, A, Navarra, G, Nigri, G, Olmi, S, Palaia, R, Papis, D, Parise, P, Pedrazzani, C, Petri, R, Pignata, G, Pisano, M, Rausei, S, Reddavid, R, Rocco, G, Rosa, F, Rosati, R, Rossit, L, Rottoli, M, Roviello, F, Santi, S, Scabini, S, Scaringi, S, Solaini, L, Staderini, F, Taglietti, L, Torre, B, Ubiali, P, Uccelli, M, Uggeri, F, Vertaldi, S, Viganò, J, De Palma, G, and Giacopuzzi, S
Subjects: GIRCG, Gastric cancer, Minimally invasive surgery, Upper GI surgery, Settore MED/18 - CHIRURGIA GENERALE, Surgery
Abstract: Italian Research Group for Gastric Cancer (GIRCG), during the 2013 annual Consensus Conference to gastric cancer, stated that laparoscopic or robotic approach should be limited only to early gastric cancer (EGC) and no further guidelines were currently available. However, accumulated evidences, mainly from eastern experiences, have supported the application of minimally invasive surgery also for locally advanced gastric cancer (AGC). The aim of our study is to give a snapshot of current surgical propensity of expert Italian upper gastrointestinal surgeons in performing minimally invasive techniques for the treatment of gastric cancer in order to answer to the question if clinical practice overcome the recommendation. Experts in the field among the Italian Research Group for Gastric Cancer (GIRCG) were invited to join a web 30-item survey through a formal e-mail from January 1st, 2020, to June 31st, 2020. Responses were collected from 46 participants out of 100 upper gastrointestinal surgeons. Percentage of surgeons choosing a minimally invasive approach to treat early and advanced gastric cancer was similar. Additionally analyzing data from the centers involved, we obtained that the percentage of minimally invasive total and partial gastrectomies in advanced cases augmented with the increase of surgical procedures performed per year (p = 0.02 and p = 0.04 respectively). It is reasonable to assume that there is a widening of indications given by the current national guideline into clinical practice. Propensity of expert Italian upper gastrointestinal surgeons was to perform minimally invasive surgery not only for early but also for advanced gastric cancer. Of interest volume activity correlated with the propensity of surgeons to select a minimally invasive approach.
Published: 2022

18. Evolving trends in the management of acute appendicitis during COVID-19 waves. The ACIE appy II study (vol 46, pg 2021, 2022)

Author: Pata, Francesco, Di Martino, Marcello, Podda, Mauro, Di Saverio, Salomone, Ielpo, Benedetto, Pellino, ACIE Appy Study Collaborative Abba Julio, Gianluca., Abdullah, Alshamrani, Abdullah, Alturkistani, Abdulrahman, Alghamdi, Abdulrahman, Almalki, Adam, Orengia, Adnan, Kuvvetli, Adolfo, Pisanu, Adrian, Smith, Adriana Michelle Treviño Figueroa, Aeris Jane Nacion, Ahmad, Alhazmi, Ahmad, Bouhuwaish, Ahmad, Khalid, Ahmed, Alsufyani, Ainhoa Valle Rubio, Akshay, Bavikatte, Kumar, Akshay, Al-Radjid, Jamiri, Alberto de San Ildefonso Pereira, Alberto, Porcu, Alberto, Sartori, Aldo, Rocca, Aleksandar, Sretenovic, Anselmo, Alessandro, Alessandro De Luca, Alexandros, Charalabopoulos, Alexios, Tzivanakis, Alfonso, Bandin, Alfonso, Nájar, Alice, Frontali, Alsulaimani, Faisal, Amaia Martínez Roldan, Amal, Hamid, Ana, André, Ana, Minaya-Bravo, Andre, Das, Andrea, Bondurri, Andrea, Costanzi, Lucchi, Andrea, Andrei, Mihailescu, Police, Andrea, Andres Mendoza Zuchini, Angela, Romano, Iossa, Angelo, Antonella, Chessa, Antonella, Tromba, Antonio, Castaldi, Antonio, Brillantino, Antonio, Ferronetti, Giuliani, Antonio, Antonio Ramos-De la Medina, Antonio, Tarasconi, Arcangelo, Picciariello, Argyrios, Ioannidis, Ari, Leppäniemi, Arshad, Rashid, Ashrarur Rahman Mitul, Asif, Mehraj, Asim, Laharwal, Atif, Iqbal, Athanasios, Liarakos, Athanasios, Marinis, Beatriz de Andrés-Asenjo, Belén, Matías-García, DE SIMONE, Belinda, Ben, Creavin, Ben, Stubbs, Brian, Goh, Branislav, Jovanovic, Bruno, Sensi, Carlo, Gazia, Carlos, Cerdán, Carlos Javier Gómez Díaz, Carlos Petrola Chacón, Carlos, Yánez, Carmelo Lo Faro, Caroline, Reinke, Casandra, Dominguez, Charudutt, Paranjape, Charlotte, Thomas, Chia Chi Fung, DE LUCIA, Chiara, Chiu Hiu Fung Jennifer, Christian, Ovalle-Chao, Claudio, Guerci, Cleo, Kenington, Corina, Gica, Cristina, Folliero, Cristopher, Varela, Daniel, Popowich, Daniele, Delogu, Daniele, Zigiotto, Danilo, Vinci, Dario, D'Antonio, David Alessio Merlini, David, Merlini, David, Moro-Valdezate, Deborah, Keller, Diana Cristiana Nicolaescu, Diego, Sasia, Edgar, Rodas, Dimitrios, Linardoutsos, Domenico, Russello, Pedro Alfonso Nájar-Castañeda, Habil Gregor Stavrou, Edoardo, Rosso, Edoardo, Saladino, Edoardo, Ricciardi, Eduardo, Smith-Singares, Efstratia, Baili, Eleftheria, Douka, Guaitoli, Eleonora, Elisa, Francone, Elisa Maria Vaterlini, Elisa Sefora Pierobon, Emilio, Morales, Emilio Peña Ros, Enrico, Benzoni, Enrico, Erdas, Enrico, Pinotti, Enrique, Colás-Ruiz, Ernesto, Laterza, Esteban, Foianini, Eugenia, Cardamone, Eugenio, Licardie, Fabio, Marino, Fahad, Alsofyani, Fahad, Qahtani, Farhan, Khan, Fatlum, Maraska, Fatmir, Saliu, Fausto, Madrid, Fausto, Rosa, Federico, Luvisetto, Felipe, Alconchel, Felipe, Pareja-Ciuro, Fernanda, Neves, Ferdinando, Agresta, Fernando, Cordera, Fernando, Pardo, Fernando, Mendoza-Moreno, Fernando, Munoz-Flores, Francesca Maria Silvestri, Francesca Paola Tropeano, Francesca, Pecchini, Francesca, Serio, Francesco, Colombo, Francesco Di Marzo, Francesco, Ferrara, Francesco, Lancellotti, Francesco, Litta, Francesco, Martini, Francesco, Roscio, Francisco, Blanco-Antona, Francisco Javier Quezada Barcenas, Francisco, Schlottmann, Gabriel, Herrera-Almario, Gabrielle van Ramshorst, Gallo, Gaetano, Gaetano, Luglio, Georgios, Kampouroglou, Georgios, Papadopoulos, Gerardo, Arredondo, Giacomo, Calini, Giampaolo, Formisano, Galiffa, Giampaolo, Gian Marco Palini, Gianluca, Colucci, Gianluca, Pagano, Gianluca, Vanni, Gianmaria Casoni Pattacini, Gianpiero, Gravante, Giorgio, Lisi, Giovanni, Bellanova, Giovanni De Nobili, Giovanni Sammy Necchi, Sinibaldi, Giovanni, Giulia, Bacchiocchi, Giulia, Bagaglini, Maggi, Giulia, Giuliano, Izzo, Giulio, Argenio, Giuseppe, Brisinda, Giuseppe, Esposito, Giuseppe, Frazzetta, Giuseppe Massimiliano De Luca, Nigri, Giuseppe, Giuseppe, Sica, MARTIN DE MERCADO, Gonzalo, Gustavo Armand Ugon, Gustavo, Martinez-Mier, Gustavo Miguel Machain Vega, Gustavo, Nari, Herald, Nikaj, Ignacio, Neri, Igor Alberdi San Roman, Iliya, Fidoshev, Iñaki, Martínez, Ionut, Negoi, Irene, Ortega, Irune Vicente Rodríguez, Isabel, Cornejo, Ismael, Mora-Guzmán, Issam, Al-Najami, Ivan, Romic, Izaskun, Balciscueta, James, Olivier, Jan, Lammel-Lindemann, Jana, Dziakova, Javier, Salinas, Jelena Pejanovic Jovanovic, Jeryl Anne Silvia Reyes, Joanne, Salas, Jose Antonio Diaz-Elizondo, Jose Gustavo Parreira, Juan, Bellido, Juan, Salamea, Juan Carlos Martín Del Olmo, Juliana María Ordoñez, Sofi, Junaid, Justin, Davies, Kapil, Sahnan, Kebebe, Bekele, Kelvin, Voon, Leandro, Siragusa, Lorenzo, Petagna, Ferrario, Luca, Luca, Giordano, Luca, Nespoli, Luca, Pio, Lucia, Moletta, Luciano, Curella, Lucio, Taglietti, Luigi, Bonavina, Luigi, Conti, Luis Eduardo Pérez-Sánchez, Luis Felipe Cabrera Vargas, Luis, Sánchez-Guillén, Luis, Tallon-Aguilar, Mansoor, Khan, Marcello Giuseppe Spampinato, Marcelo, Viola, Marcelo Viola Malet, Angrisani, Marco, Marco, Calussi, Marco, Catarci, Marco, Giordano, Marco, Materazzo, Marco, Milone, Marco, Pellicciaro, Marco Vito Marino, María Daniela Moreno Villamizar, Lolli, MARIA GIULIA, Bellini, MARIA IRENE, Maria, Lemma, Maria Michela Chiarello, Mario, Montes-Manrique, Mario, Rodriguez-Lopez, Mario, Serradilla-Martín, Mark, Peter, Marta, Paniagua-García-Señoráns, Martin, Rutegård, Martin, Salö, Massimiliano, Silveri, Massimiliano, Veroux, Matteo, Nardi, Matteo, Rottoli, Matti, Tolonen, Mauricio Pedraza Ciro, Mauricio, Zuluaga, Maurizio, Iacobone, Mauro, Montuori, Mazin, Ali, Melody García Domínguez, Menna Maria Paola, Micaela, Piccoli, Michela, Campanelli, Michele De Rosa, Manigrasso, Michele, Maruccia, Michele, Michele, Torre, Michele, Zuolo, Miguel, Pera, Mihiri, Weerasekera, Mikel, Prieto, Min Myat Thway, Mohamed, Shaat, Mohammad, Azfar, Mostafa, Shalaby, Muhammad Asif Raza, Muhammad Umar Younis, Muhammed, Elhadi, Mujahid, Ali, Musab, Althomali, Nadiah Al Amri, Nagendra, Dudi-Venkata, Nahar, Alselaim, Neil, Smart, Nelson, Trelles, Nicolò, Falco, Petrucciani, Niccolo', Nicola, Antonacci, Nicola, Cillara, Nicolae, Gica, Nicolò, Pecorelli, Nicolò, Tamini, Nikolaos, Machairas, Nura, Feituri, Nuria Ortega Torrecilla, Octavio Avila Mercado, Ohood, Alaamer, Oktay, Irkorucu, Omar, Alsherif, Oreste Claudio Buonomo, Orestes, Valles-Guerra, Orestis, Ioannidis, Oscar Isaac Hernández Palmas, Oscar Sanz Guadarrama, Osman, Bozbiyik, Pablo, Rodrigues, Pamela, Milito, Paolo, Panaccio, Panagiotis, Dorovinis, Paola, Prieto, Paolo, Baroffio, Patrizia, Marsanic, Pawel, Ajawin, Peng Soon Koh, Pietro, Anoldo, Piotr, Major, Qasem, Alharthi, Rashid, Lui, Riccardo, Caruso, Richard, Brady, Rishi, Rattan, Rishi, Singhal, Roberta, Angelico, Roberta Maria Isernia, Roberta, Tutino, Roberto, Peltrini, Rodrigo, Tejos, Roosevelt, Fajardo, Rossella, Elia, Salvador, Morales-Conde, Sami, Benli, Sara, Fuentes, Sara Gortázar de Las Casas, Sara Ortiz de Guzmán Aragón, Sara, Vertaldi, Selmy, Awad, Sergio, Gentilli, Sergio Alberto Weckmann Lujan, Serkan, Tayar, Shabab, Althobaiti, DI GIOVANNI, Silvia, Soliman, Ghedan, Sonia, Pérez-Bertólez, Sonja, Chiappetta, Spiros, Delis, Stefano, Scaringi, Süleyman, Çetinkünar, Stylianos, Kykalos, Syed Muhammad Ali, Sylvia, Krivan, Tak Lit Derek Fung, Tarik, Delko, Tatiana Nicolás López, Tercio De Campos, Teresa Calderón Duque, Teresa, Perra, Theodore, Liakakos, Theodoros, Daskalakis, Tijmen, Koëter, Tiku, Zalla, Tomás Elosua González, Tommaso, Campagnaro, Toure Alpha Oumar, Ugo, Grossi, Valentina, Sosa, Valentina, Testa, Valentina, Tomajer, Valeria, Andriola, Valeria, Tonini, Valerio, Celentano, Voglino, Valerio, Venkateswara Rao Katta, Víctor Hugo García Orozco, Victor, Turrado-Rodriguez, Victor, Visag-Castillo, Victoria, Graham, Viktor, Rachkov, Vincenzo, Papagni, Vincenzo, Vigorita, Virginia Jiménez Carneros, Bellato, Vittoria, Wolf, Bechstein, Yuksel, Altinel, and Zutoia, Balciscueta
Subjects: appendicitis, COVID19
Published: 2022

19. Endoscopic approach to complex or recurrent pilonidal sinus: A retrospective analysis

Author: Francesco Maione, Anna D'Amore, Marco Milone, Sara Vertaldi, Pietro Anoldo, Alessia Chini, Carmen Sorrentino, Alessandra Marello, Grazia Cantore, Rosa Maione, Salvatore D'Angelo, Nicola D'Alesio, Giuseppe De Simone, Giuseppe Servillo, Giovanni Domenico De Palma, Michele Manigrasso, Maione, Francesco, D'Amore, Anna, Milone, Marco, Vertaldi, Sara, Anoldo, Pietro, Chini, Alessia, Sorrentino, Carmen, Marello, Alessandra, Cantore, Grazia, Maione, Rosa, D'Angelo, Salvatore, D'Alesio, Nicola, De Simone, Giuseppe, Servillo, Giuseppe, De Palma, Giovanni Domenico, and Manigrasso, Michele
Subjects: endoscopic, recurrence, pilonidal, Surgery, sinus, Dermatology, complex
Abstract: Pilonidal Sinus is a benign, chronic disease that affects the hair follicles of the natal cleft of the sacrococcygeal area. Its ideal treatment is controversial, especially in complex or recurrent cases. The aim of this study is to evaluate the use of minimally invasive endoscopic approach in this setting. We enrolled patients affected by complex or recurrent sacrococcygeal pilonidal sinus from January 2015 through December 2020 who underwent Video-Assisted Ablation of Pilonidal Sinus. All patients enrolled were re-evaluated once a year with a standard physical examination. The patients included were 38. Recurrence rate at 1-, 3- and 5-years follow-ups were 28.9%, 22.2% and 38.1% respectively. Of interest, the mean (SD) distance from the most lateral orifice to the midline was higher in group of patients with recurrence and the multivariate analysis demonstrated that it was the limiting factor, which influences the recurrence rate. In complex or recurrent pilonidal sinus disease with pits off the midline the endoscopic approach should not be the first choice. This makes us think that these cases should have their own classification to be identified and guide surgeons in choosing the appropriate approach.
Published: 2022

20. Correction: ERas and COLorectal endoscopic surgery: an Italian society for endoscopic surgery and new technologies (SICE) national report

Author: Milone, Marco, Elmore, Ugo, Manigrasso, Michele, Ortenzi, Monica, Botteri, Emanuele, Arezzo, Alberto, Silecchia, Gianfranco, Guerrieri, Mario, De Palma, Giovanni Domenico, Agresta, Ferdinando, Francesco, Pizza, Dario, D'Antonio, Francesco, Amalfitano, Francesco, Selvaggi, Sciaudone, Guido, Lucio, Selvaggi, Daniela, Prando, Fabio, Cavallo, Giovanni, Lezoche, Diego, Cuccurullo, Ernesto, Tartaglia, Carlo, Sagnelli, Andrea, Coratti, Angela, Tribuzi, Michele Di Marino, Gabriele, Anania, Cristina, Bombardini, Mauro Pietro Zago, Fulvio, Tagliabue, Morena, Burati, Salomone Di Saverio, Samuele, Colombo, Sara El Adla, Maurizio De Luca, Monica, Zese, Dario, Parini, Paolo, Prosperi, Giovanni, Alemanno, Jacopo, Martellucci, Stefano, Olmi, Alberto, Oldani, Matteo, Uccelli, Dario, Bono, Donatella, Scaglione, Roberto, Saracco, Mauro, Podda, Adolfo, Pisanu, Valentina, Murzi, Antonino, Agrusa, Salvatore, Buscemi, Irnerio Angelo Muttillo, Biagio, Picardi, Edoardo Maria Muttillo, Leonardo, Solaini, Davide, Cavaliere, Giorgio, Ercolani, Francesco, Corcione, Roberto, Peltrini, Umberto, Bracale, Andrea, Lucchi, Laura, Vittori, Michele, Grassia, Alberto, Porcu, Teresa, Perra, Claudio, Feo, Pierluigi, Angelini, Domenico, Izzo, Luigi, Ricciardelli, Mario, Trompetto, Gaetano, Gallo, Alberto Realis Luc, Andrea, Muratore, Marcello, Calabrò, Bruno, Cuzzola, Andrea, Barberis, Federico, Costanzo, Giulio, Angelini, Graziano, Ceccarelli, Fabio, Rondelli, Michele De Rosa, Elisa, Cassinotti, Luigi, Boni, Ludovica, Baldari, Paolo Pietro Bianchi, Giampaolo, Formisano, Giuseppe, Giuliani, Andrea Alessandro Pisani Ceretti, Nicolò Maria Mariani, Marco, Giovenzana, Roberto, Farfaglia, Paolo, Marcianò, Valeria, Arizzi, Micaela, Piccoli, Francesca, Pecchini, Gianmaria Casoni Pattacini, Nereo, Vettoretto, Claudio, Guarnieri, Letizia, Laface, Emmanuele, Abate, Massimiliano, Casati, Carlo, Feo, Nicolò, Fabri, Antonio, Pesce, Piero, Maida, Giampaolo, Marte, Roberta, Abete, Lorenzo, Casali, Alessandro, Marchignoli, Matteo, Dall'Aglio, Stefano, Scabini, Davide, Pertile, Alessandra, Aprile, Jacopo, Andreuccetti, Alberto Di Leo, Lorenzo, Crepaz, Francesco, Maione, Sara, Vertaldi, Alessia, Chini, Riccardo, Rosati, Francesco, Puccetti, Giulia, Maggi, Andrea, Cossu, Alberto, Sartori, Giacomo, Piatto, Nicola, Perrotta, Marta, Celiento, Marco, Scorzelli, Vincenzo, Pilone, Salvatore, Tramontano, Pietro, Calabrese, Raffaele, Sechi, Nicola, Cillara, Giaime, Putzu, Michele Guido Podda, Mauro, Montuori, Enrico, Pinotti, Giuseppe, Sica, Marzia, Franceschilli, Bruno, Sensi, Maurizio, Degiuli, Rossella, Reddavid, Lucia, Puca, Marco, Farsi, Alessio, Minuzzo, Elena, Gia, Gian Luca Baiocchi, Valerio, Ranieri, Andrea, Celotti, Francesco, Bianco, Sebastiano, Grassia, and Alessandra, Novi
Subjects: Surgery, Settore MED/18
Published: 2022

21. ERas and COLorectal endoscopic surgery: an Italian society for endoscopic surgery and new technologies (SICE) national report

Author: Marco, Milone, Ugo, Elmore, Michele, Manigrasso, Monica, Ortenzi, Emanuele, Botteri, Alberto, Arezzo, Silecchia, Gianfranco, Mario, Guerrieri, Giovanni Domenico De Palma, Ferdinando, Agresta, Francesco, Pizza, Dario, D???antonio, Francesco, Amalfitano, Francesco, Selvaggi, Guido, Sciaudone, Lucio, Selvaggi, Daniela, Prando, Fabio, Cavallo, Giovanni, Lezoche, Diego, Cuccurullo, Ernesto, Tartaglia, Carlo, Sagnelli, Andrea, Coratti, Angela, Tribuzi, Michele Di Marino, Gabriele, Anania, Cristina, Bombardini, Mauro Pietro Zago, Fulvio, Tagliabue, Morena, Burati, Salomone Di Saverio, Samuele, Colombo, Sara El Adla, Maurizio De Luca, Monica, Zese, Dario, Parini, Paolo, Prosperi, Giovanni, Alemanno, Jacopo, Martellucci, Stefano, Olmi, Alberto, Oldani, Matteo, Uccelli, Dario, Bono, Donatella, Scaglione, Roberto, Saracco, Mauro, Podda, Adolfo, Pisanu, Valentina, Murzi, Antonino, Agrusa, Salvatore, Buscemi, Irnerio Angelo Muttillo, Biagio, Picardi, Leonardo, Solaini, Davide, Cavaliere, Giorgio, Ercolani, Francesco, Corcione, Roberto, Peltrini, Umberto, Bracale, Andrea, Lucchi, Laura, Vittori, Michele, Grassia, Alberto, Porcu, Teresa, Perra, Claudio, Feo, Pierluigi, Angelini, Domenico, Izzo, Luigi, Ricciardelli, Mario, Trompetto, Gallo, Gaetano, Alberto Realis Luc, Andrea, Muratore, Marcello, Calabr??, Bruno, Cuzzola, Andrea, Barberis, Federico, Costanzo, Giulio, Angelini, Graziano, Ceccarelli, Fabio, Rondelli, Michele De Rosa, Elisa, Cassinotti, Luigi, Boni, Ludovica, Baldari, Paolo Pietro Bianchi, Giampaolo, Formisano, Giuseppe, Giuliani, Andrea Alessandro Pisani Ceretti, Nicol?? Maria Mariani, Marco, Giovenzana, Roberto, Farfaglia, Paolo, Marcian??, Valeria, Arizzi, Micaela, Piccoli, Francesca, Pecchini, Gianmaria Casoni Pattacini, Nereo, Vettoretto, Claudio, Guarnieri, Letizia, Laface, Emmanuele, Abate, Massimiliano, Casati, Carlo, Feo, Nicol??, Fabri, Antonio, Pesce, Piero, Maida, Giampaolo, Marte, Roberta, Abete, Lorenzo, Casali, Alessandro, Marchignoli, Matteo, Dall???aglio, Stefano, Scabini, Davide, Pertile, Alessandra, Aprile, Jacopo, Andreuccetti, Alberto Di Leo, Lorenzo, Crepaz, Francesco, Maione, Sara, Vertaldi, Alessia, Chini, Riccardo, Rosati, Francesco, Puccetti, Giulia, Maggi, Andrea, Cossu, Alberto, Sartori, Giacomo, Piatto, Nicola, Perrotta, Marta, Celiento, Marco, Scorzelli, Vincenzo, Pilone, Salvatore, Tramontano, Pietro, Calabrese, Raffaele, Sechi, Nicola, Cillara, Giaime, Putzu, Michele Guido Podda, Mauro, Montuori, Enrico, Pinotti, Giuseppe, Sica, Marzia, Franceschilli, Bruno, Sensi, Maurizio, Degiuli, Rossella, Reddavid, Lucia, Puca, Marco, Farsi, Alessio, Minuzzo, Elena, Gia, Gian Luca Baiocchi, Valerio, Ranieri, Andrea, Celotti, Francesco, Bianco, Sebastiano, Grassia, Alessandra, Novi, Muttillo, EDOARDO MARIA, Milone, Marco, Elmore, Ugo, Manigrasso, Michele, Ortenzi, Monica, Botteri, Emanuele, Arezzo, Alberto, Silecchia, Gianfranco, Guerrieri, Mario, De Palma, Giovanni Domenico, Agresta, Ferdinando, and Rosati, Riccardo
Subjects: colorectal, ERAS, enhanced recovery, minimally invasive, Length of Stay, Postoperative Complications, Enhanced Recovery, Humans, Surgery, Laparoscopy, Prospective Studies, Minimally invasive, Colorectal Neoplasms, Colorectal Surgery, Colorectal
Abstract: Background Several reports demonstrated a strong association between the level of adherence to the protocol and improved clinical outcomes after surgery. However, it is difficult to obtain full adherence to the protocol into clinical practice and has still not been identified the threshold beyond which improved functional results can be reached. Methods The ERCOLE (ERas and COLorectal Endoscopic surgery) study was as a cohort, prospective, multi-centre national study evaluating the association between adherence to ERAS items and clinical outcomes after minimally invasive colorectal surgery. The primary endpoint was to associate the percentage of ERAS adherence to functional recovery after minimally invasive colorectal cancer surgery. The secondary endpoints of the study was to validate safety of the ERAS programme evaluating complications’ occurrence according to Clavien-Dindo classification and to evaluate the compliance of the Italian surgeons to each ERAS item. Results 1138 patients were included. Adherence to the ERAS protocol was full only in 101 patients (8.9%), > 75% of the ERAS items in 736 (64.7%) and > 50% in 1127 (99%). Adherence to > 75% was associated with a better functional recovery with 90.2 ± 98.8 vs 95.9 ± 33.4 h (p = 0.003). At difference, full adherence to the ERAS components 91.7 ± 22.1 vs 92.2 ± 31.6 h (p = 0.8) was not associated with better recovery. Conclusions Our results were encouraging to affirm that adherence to the ERAS program up to 75% could be considered satisfactory to get the goal. Our study could be considered a call to simplify the ERAS protocol facilitating its penetrance into clinical practice.
Published: 2022

22. Robotic repair of iatrogenic left diaphragmatic hernia. A case report

Author: Giovanni Domenico De Palma, Giuseppe Servillo, Michele Manigrasso, Marco Milone, Salvatore D’Angelo, Sara Vertaldi, Vertaldi, S., Manigrasso, M., D'Angelo, S., Servillo, G., De Palma, G. D., and Milone, M.
Subjects: Surgical repair, medicine.medical_specialty, Diaphragmatic hernia, business.industry, Robotic repair, Diaphragmatic breathing, medicine.disease, Surgery, 03 medical and health sciences, Dissection, surgical procedures, operative, 0302 clinical medicine, Iatrogenic, Minimally invasive surgery, Cardiothoracic surgery, Parasternal line, 030220 oncology & carcinogenesis, Case report, Medicine, 030211 gastroenterology & hepatology, Hernia, Complication, business
Abstract: Highlights • Iatrogenic diaphragmatic hernia is a rare complication occurring after abdominal or thoracic surgery and it is associated with a high rate of misdiagnosis. • Patients with large diaphragmatic defects can be critically symptomatic immediately after surgery. • CT scan is the best imaging modality to diagnose diaphragmatic hernias. • Patients with chronic symptomatic hernia should undergo surgical repair of defect. • Robotic technology allows to perform an accurate dissection near important anatomic structures and it allows to suture in a confined space, which is technically challenging to approach with laparoscopic instruments., Introduction Iatrogenic diaphragmatic hernia after laparoscopic left adrenalectomy has been rarely reported in adults. Surgery is the preferred treatment because of the risks of incarceration, strangulation and pulmonary complications. Presentation of case An elderly woman with parasternal diaphragmatic hernia has been successfully treated by robotic repair with mesh placement. The short-term follow-up showed that there was no recurrence or any symptoms after the intervention. Discussion Iatrogenic diaphragmatic hernia is a rare complication occurring after abdominal or thoracic surgery. The diagnosis could be challenging because of the presence of chronic symptoms. Computed tomography can be considered the gold standard technique to assess the correct diagnosis of diaphragmatic hernias in the majority of cases. Patients with chronic symptomatic hernia should undergo surgical repair of defect. Robotic technology because of its enhanced precision and the endowrist movement of the robotic arms, facilitates the dissection near the esophago-gastric junction and the other important adjacent structures. Conclusion Robotic technology seems to be a valid approach for the repair of diaphragmatic defects, even if this remains a high cost-related procedure.
Published: 2020

23. The Role of Robotic Visceral Surgery in Patients with Adhesions: A Systematic Review and Meta-Analysis

Author: Marco Milone, Michele Manigrasso, Pietro Anoldo, Anna D’Amore, Ugo Elmore, Mariano Cesare Giglio, Gianluca Rompianesi, Sara Vertaldi, Roberto Ivan Troisi, Nader K. Francis, Giovanni Domenico De Palma, Milone, Marco, Manigrasso, Michele, Anoldo, Pietro, D'Amore, Anna, Elmore, Ugo, Giglio, Mariano Cesare, Rompianesi, Gianluca, Vertaldi, Sara, Troisi, Roberto Ivan, Francis, Nader K, and De Palma, Giovanni Domenico
Subjects: robotic surgery, Medicine (miscellaneous), abdominal adhesion, conversion, laparoscopic surgery
Abstract: Abdominal adhesions are a risk factor for conversion to open surgery. An advantage of robotic surgery is the lower rate of unplanned conversions. A systematic review was conducted using the terms “laparoscopic” and “robotic”. Inclusion criteria were: comparative studies evaluating patients undergoing laparoscopic and robotic surgery; reporting data on conversion to open surgery for each group due to adhesions and studies including at least five patients in each group. The main outcomes were the conversion rates due to adhesions and surgeons’ expertise (novice vs. expert). The meta-analysis included 70 studies from different surgical specialities with 14,329 procedures (6472 robotic and 7857 laparoscopic). The robotic approach was associated with a reduced risk of conversion (OR 1.53, 95% CI 1.12–2.10, p = 0.007). The analysis of the procedures performed by “expert surgeons” showed a statistically significant difference in favour of robotic surgery (OR 1.48, 95% CI 1.03–2.12, p = 0.03). A reduced conversion rate due to adhesions with the robotic approach was observed in patients undergoing colorectal cancer surgery (OR 2.62, 95% CI 1.20–5.72, p = 0.02). The robotic approach could be a valid option in patients with abdominal adhesions, especially in the subgroup of those undergoing colorectal cancer resection performed by expert surgeons.
Published: 2021

24. Histopathological Examination and Endoscopic Sinusectomy: Is It Possible?

Author: Sara Vertaldi, Pietro Anoldo, Grazia Cantore, Alessia Chini, Anna D'Amore, Maria D'Armiento, Nicola Gennarelli, Francesco Maione, Michele Manigrasso, Alessandra Marello, Pietro Schettino, Carmen Sorrentino, Loredana M. Sosa Fernandez, Giovanni D. De Palma, Marco Milone, Vertaldi, Sara, Anoldo, Pietro, Cantore, Grazia, Chini, Alessia, D'Amore, Anna, D'Armiento, Maria, Gennarelli, Nicola, Maione, Francesco, Manigrasso, Michele, Marello, Alessandra, Schettino, Pietro, Sorrentino, Carmen, Sosa Fernandez, Loredana M, De Palma, Giovanni D, and Milone, Marco
Subjects: malignant degeneration, VAAPS, histopathological examination (HPE), Surgery, EPSiT, pilonidal disease
Abstract: IntroductionAlthough carcinomatous degeneration is a rare occurrence, some authors support the need for a histopathological examination after pilonidal cyst excision. Today, minimally invasive techniques are widely spread for the treatment of pilonidal sinus disease but opposed to standard procedures, these techniques could not allow to perform a histopathological examination because of the absence of a specimen. The aim of this two-institutions study is to evaluate whether histopathological examination of the pilonidal sinus excision material can be successfully performed after an endoscopic ablation of the cyst.Materials and MethodsWe identified all consecutive patients from January 2021 to September 2021 with diagnosis of pilonidal sinus disease who underwent Video Assisted Ablation of Pilonidal Sinus (VAAPS) followed by histopathological examination.ResultsA total of 45 patients were included in the study. All patients were Caucasians and aged below 50 years. Nine of them underwent surgery due to recurrence of PSD. No evidence of malignancy was detected in the histopathological examination of the pilonidal sinus sampling material.DiscussionWe were able to send pilonidal sinus sampling material for a histopathological examination in all patients who underwent minimally invasive technique for the treatment of pilonidal sinus disease. No evidence of malignancy was found in any of the 45 samples. Our findings prove that minimally invasive ablation of pilonidal sinus does not preclude histopathological examination of the cysts.
Published: 2021

25. Preoperative Localization in Colonic Surgery (PLoCoS Study): a multicentric experience on behalf of the Italian Society of Colorectal Surgery (SICCR)

Author: Michele Manigrasso 1, Marco Milone 2, Mario Musella 3, Pietro Venetucci 3, Francesco Maione 2, Ugo Elmore 4, Gaetano Gallo 5, Roberto Perinotti 6, Giovanni Domenico De Palma, Giovanni Sarnelli, Nicola Gennarelli, Sara Vertaldi, Giuseppe Sammarco, Giuseppina Vescio, Vincenzo Tiesi, Francesco Pata, Donato Francesco Altomare, Arcangelo Picciariello, Vincenzo Papagni, Leonardo Vincenti, Massimiliano Mistrangelo, Edoardo Forcignanò, Antonio Salzano, Andrea Bondurri, Anna Maffioli, Francesco Colombo, Andrea Lauretta, Giuseppe Sica, Michela Campanelli, Marco Stella, Paolo Boati, Francesco Ferrara, Francesco Selvaggi, Gianluca Pellino, Francesco Maria Romano, Lucio Selvaggi, Yves Panis, Alice Frontali, Giovanni Spiezio, Antonino Spinelli, Francesca Di Candido, Annalisa Maroli, Claudio Coco, Gianluca Rizzo, Elisabetta Moggia, Gaetano Luglio, Gianluca Pagano, Francesca Paola Tropeano, Roberto Peltrini, Federico Marchesi, Gabriele Luciano Petracca, Giorgio Dalmonte, Marina Valente, Antonio Giuliani, Harmony Impellizzeri, Enrico Marrano, Gianluigi Moretto, Cristina Folliero, Antonio Langone, Giuseppe Caristo, Giorgio Maria Paolo Graziano, Angelo Amico, Antonio Di Cataldo, Pietro Maida, Ester Marra, Roberta Abete, Antonio Castaldi, Alessio Palumbo, Fabrizio Foroni, Carmine Antropoli, Paola De Nardi, Roberto Quattromani, Riccardo Rosati, Manigrasso, Michele, 2, Marco Milone, Musella, Mario, 3, Pietro Venetucci, 2, Francesco Maione, 4, Ugo Elmore, 5, Gaetano Gallo, 6, Roberto Perinotti, Domenico De Palma, Giovanni, Sarnelli, Giovanni, Gennarelli, Nicola, Vertaldi, Sara, Sammarco, Giuseppe, Vescio, Giuseppina, Tiesi, Vincenzo, Pata, Francesco, Francesco Altomare, Donato, Picciariello, Arcangelo, Papagni, Vincenzo, Vincenti, Leonardo, Mistrangelo, Massimiliano, Forcignanò, Edoardo, Salzano, Antonio, Bondurri, Andrea, Maffioli, Anna, Colombo, Francesco, Lauretta, Andrea, Sica, Giuseppe, Campanelli, Michela, Stella, Marco, Boati, Paolo, Ferrara, Francesco, Selvaggi, Francesco, Pellino, Gianluca, Maria Romano, Francesco, Selvaggi, Lucio, Panis, Yve, Frontali, Alice, Spiezio, Giovanni, Spinelli, Antonino, Di Candido, Francesca, Maroli, Annalisa, Coco, Claudio, Rizzo, Gianluca, Moggia, Elisabetta, Luglio, Gaetano, Pagano, Gianluca, Paola Tropeano, Francesca, Peltrini, Roberto, Marchesi, Federico, Luciano Petracca, Gabriele, Dalmonte, Giorgio, Valente, Marina, Giuliani, Antonio, Impellizzeri, Harmony, Marrano, Enrico, Moretto, Gianluigi, Folliero, Cristina, Langone, Antonio, Caristo, Giuseppe, Maria Paolo Graziano, Giorgio, Amico, Angelo, Di Cataldo, Antonio, Maida, Pietro, Marra, Ester, Abete, Roberta, Castaldi, Antonio, Palumbo, Alessio, Foroni, Fabrizio, Antropoli, Carmine, De Nardi, Paola, Quattromani, Roberto, Rosati, Riccardo, Milone, Marco, Venetucci, Pietro, Maione, Francesco, Elmore, Ugo, Gallo, Gaetano, Perinotti, Roberto, and De Palma, Giovanni Domenico
Subjects: CT scan, medicine.medical_specialty, Adenoma, Colorectal cancer, Colonoscopy, colorectal, colonoscopy, localization, colon cancer, surgery, Descending colon, Lesion, Medicine, Humans, Prospective Studies, Stage (cooking), Colorectal, medicine.diagnostic_test, business.industry, medicine.disease, Colorectal surgery, Colon cancer, Settore MED/18, Surgery, medicine.anatomical_structure, Localization, Colonic Neoplasms, Adenocarcinoma, Radiology, medicine.symptom, business, Colorectal Neoplasms, Colorectal Surgery
Abstract: The aim of this prospective multicentric study was to compare the accurate colonic lesion localization ratio between CT and colonoscopy in comparison with surgery. All consecutive patients from 1st January to 31st December 2019 with a histologically confirmed diagnosis of dysplastic adenoma or adenocarcinoma with planned elective, curative colonic resection who underwent both colonoscopy and CT scans were included. Each patient underwent conventional colonoscopy and CT to stage the tumour, and the localization results of each procedure were registered. CT and colonoscopic localization were compared with surgical localization, adopted as the reference. Our analysis included 745 patients from 23 centres. After comparing the accuracy of colonoscopy and CT (for visible lesions) in localizing colonic lesions, no significant differences were found between the two preoperative tools (510/661 vs 499/661 correctly localized lesions, p = 0.518). Furthermore, after analysing only the patients who underwent complete colonoscopy and had a visible lesion on CT, no significant difference was observed between conventional colonoscopy and CT (331/427 vs 340/427, p = 0.505). Considering the intraoperative localization results as a reference, a comparison between colonoscopy and CT showed that colonoscopy significantly failed to correctly locate the lesions localized in the descending colon (17/32 vs 26/32, p = 0.031). We did not identify an advantage in using CT to localize colonic tumours. In this setting, colonoscopy should be considered the reference to properly localize lesions; however, to better identify lesions in the descending colon, CT could be considered a valuable tool to improve the accuracy of lesion localization.
Published: 2021

26. Relaparoscopy in the management of post-operative complications after minimally invasive gastrectomy for gastric cancer

Author: Ugo Elmore, Marco Milone, Paolo Parise, Nunzio Velotti, Andrea Cossu, Francesco Puccetti, Lavinia Barbieri, Sara Vertaldi, Francesco Milone, Giovanni Domenico De Palma, Riccardo Rosati, Elmore, Ugo, Milone, Marco, Parise, Paolo, Velotti, Nunzio, Cossu, Andrea, Puccetti, Francesco, Barbieri, Lavinia, Vertaldi, Sara, Milone, Francesco, De Palma, Giovanni Domenico, and Rosati, Riccardo
Subjects: Minimally invasive surgery, Surgery, Relaparoscopy, Gastric cancer
Abstract: Laparoscopy has already been validated for treatment of early gastric cancer. Despite that, no data have been published about the possibility of a minimally invasive approach to surgical complications after primary laparoscopic surgery. In this multicentre study, we describe our experience in the management of complications following laparoscopic gastrectomy for gastric cancer. A chart review has been performed over data from 781 patients who underwent elective gastrectomy for gastric cancer between January 1996 and July 2020 in two high referral department of gastric surgery. A fully descriptive analysis was performed, considering all the demographic characteristics of patients, the type of primary procedure and the type of complication which required reoperation. Moreover, a logistic regression was designed to investigate if either the patients or the primary surgery characteristics could affect conversion rate during relaparoscopy. Fifty-one patients underwent reintervention after elective laparoscopic gastric surgery. Among patients who received a laparoscopic reintervention, 11 patients (34.3%) required a conversion to open surgery. Recovery outcomes were significantly better in patients who completed the reoperation through laparoscopy. Relaparoscopy is safe and effective for management of complications following laparoscopic gastric surgery and represent a useful tool both for re-exploration and treatment, in expert and skilled hands.
Published: 2021

27. Robotic Esophagectomy. A Systematic Review with Meta-Analysis of Clinical Outcomes

Author: Nader K. Francis, Sara Vertaldi, Alessandra Marello, Giovanni Domenico De Palma, Stavros A. Antoniou, Michele Manigrasso, Marco Milone, Manigrasso, M., Vertaldi, S., Marello, A., Antoniou, S. A., Francis, N. K., De Palma, G. D., and Milone, M.
Subjects: robotic, medicine.medical_specialty, medicine.medical_treatment, Medicine (miscellaneous), laparoscopic, law.invention, open surgery, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Thoracoscopy, Medicine, Robotic surgery, esophageal cancer, Esophagus, medicine.diagnostic_test, business.industry, Esophageal cancer, medicine.disease, Surgery, Pneumonia, medicine.anatomical_structure, Esophagectomy, 030220 oncology & carcinogenesis, Meta-analysis, esophagectomy, 030211 gastroenterology & hepatology, Systematic Review, business
Abstract: Background: Robot-Assisted Minimally Invasive Esophagectomy is demonstrated to be related with a facilitation in thoracoscopic procedure. To give an update on the state of art of robotic esophagectomy for cancr a systematic review with meta-analysis has been performed. Methods: a search of the studies comparing robotic and laparoscopic or open esophagectomy was performed trough the medical libraries, with the search string “robotic and (oesophagus OR esophagus OR esophagectomy OR oesophagectomy)”. Outcomes were: postoperative complications rate (anastomotic leakage, bleeding, wound infection, pneumonia, recurrent laryngeal nerves paralysis, chylotorax, mortality), intraoperative outcomes (mean blood loss, operative time and conversion), oncologic outcomes (harvested nodes, R0 resection, recurrence) and recovery outcomes (length of hospital stay). Results: Robotic approach is superior to open surgery in terms of blood loss p = 0.001, wound infection rate, p = 0.002, pneumonia rate, p = 0.030 and mean number of harvested nodes, p < 0.0001 and R0 resection rate, p = 0.043. Similarly, robotic approach is superior to conventional laparoscopy in terms of mean number of harvested nodes, p = 0.001 pneumonia rate, p = 0.003. Conclusions: robotic surgery could be considered superior to both open surgery and conventional laparoscopy. These encouraging results should promote the diffusion of the robotic surgery, with the creation of randomized trials to overcome selection bias.
Published: 2021

28. Robotic versus laparoscopic approach to treat symptomatic achalasia: systematic review with meta-analysis

Author: Giovanni Sarnelli, Nicola Gennarelli, Francesco Maione, Giovanni Aprea, Sara Vertaldi, Nunzio Velotti, B De Conno, Marco Milone, G. De Simone, G.D. De Palma, M Pesce, Michele Manigrasso, Milone, M, Manigrasso, M, Vertaldi, S, Velotti, N, Aprea, G, Maione, F, Gennarelli, N, De Simone, G, De Conno, B, Pesce, M, Sarnelli, G, and De Palma, G D
Subjects: Male, robotic, Laparoscopic surgery, medicine.medical_specialty, medicine.medical_treatment, Operative Time, Achalasia, laparoscopic, law.invention, 03 medical and health sciences, 0302 clinical medicine, Robotic Surgical Procedures, Randomized controlled trial, law, medicine, Humans, Laparoscopy, minimally invasive surgery, Heller myotomy, medicine.diagnostic_test, business.industry, Gastroenterology, General Medicine, Length of Stay, Middle Aged, medicine.disease, Conversion to Open Surgery, Confidence interval, Surgery, Esophageal Achalasia, achalasia, Treatment Outcome, 030220 oncology & carcinogenesis, Meta-analysis, Female, 030211 gastroenterology & hepatology, business, Abdominal surgery
Abstract: SUMMARY Minimally invasive Heller myotomy is considered the gold standard surgical approach for symptomatic achalasia because it is a safe and effective procedure. Over the last years, several studies comparing the laparoscopic and robotic approach for Heller myotomy have been published. Although the robotic approach appears to have some advantages over standard laparoscopy, data on this topic are still controversial and no definite conclusions have been drawn. This metanalysis has been designed to systematically evaluate and compare the effectiveness and safety of the robot-assisted Heller myotomy as compared to the standard laparoscopic approach. According to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, a systematic search on both laparoscopic and robotic Heller myotomy was performed in all the major electronic databases (PubMed, Web of Science, Scopus, EMBASE), using the following search string: (achalasia OR Dor) AND robotic. Six articles were included in the final analysis. A metaregression analysis was performed to assess the possible effects of demographic variables (age, gender, body mass indes (BMI)) and previous abdominal surgery or endoscopic intervention on the analyzed outcomes. No statistical difference was observed in operative times (mean difference (MD) = 20.79, P = 0.19, 95% confidence interval (CI) −10.05,51,62), estimated blood loss (MD = −17.10, P = 0.13, 95% CI −40.48,5.08), conversion rate to open surgery (risk difference (RD) = −0.01, P = 0.33, 95% CI −0.05,0.02), length of hospital stay (MD = −0.73, P = 0.15, 95% CI −1.71,0.25) and long-term recurrence (odds ratio (OR) = 0.59, P = 0.45, 95% CI 0.15,2.33). On the contrary, the robotic approach was found to be associated with a significantly significant lower rate of intraoperative esophageal perforations (OR = 0.13, P < 0.001, 95% CI 0.04, 0.45). Our results suggest that the robotic approach is safer than the laparoscopic Heller myotomy, encouraging the use of robot-assisted surgery. However, our analysis is limited because of the exiguous number of comparative studies and because most of the included studies were statistically underpowered, given the small sample size. Moreover, a high degree of heterogeneity was observed in most of published studies. Taking in consideration the additional costs of robot-assisted procedures, larger Randomized Controlled Trials (RCTs) are advocated to confirm the safety and effectiveness of the robotic approach, and its advantages over standard laparoscopic surgery. In conclusion, well-designed prospective trials and RCTs with homogeneous parameters are needed to draw definitive conclusions about the best surgical approach to pursue in treating symptomatic achalasia.
Published: 2019

29. A giant inguinal hernia in a patient with Ehlers-Danlos syndrome

Author: Gennaro, Quarto, Anna, D'Amore, Sara, Vertaldi, Pietro, Anoldo, Giacomo, Benassai, Giovanni Domenico, De Palma, Michele, Manigrasso, and Marco, Milone
Subjects: Male, Treatment Outcome, Robotic Surgical Procedures, Humans, Ehlers-Danlos Syndrome, Hernia, Inguinal, Laparoscopy, Middle Aged, Surgical Mesh, Herniorrhaphy
Abstract: Inguinal hernia formation is a common event in patients with Ehlers-Danlos syndrome. Minimally invasive surgical technique for inguinal hernia repair is the same used in patients without EDS but it is related to more intraoperative and postoperative complications.Inour study, we present a case of inguinal hernia in a EDS patient successfully treated with a robotic transabdominal preperitoneal procedure (TAPP procedure).We decided to perform a robotic TAPP with the DaVinci Xi® platform (Intuitive Surgical, Sunnyvale, USA) under general anaesthesia. A robotic docking was performed and three arms were positioned in the abdomen. Total operative timing was 45 mins.During the robotic procedure no intraoperative complications were recorded and no drains were applied. The postoperative period was uneventful and the patient was discharged in the first postoperative day.Inguinal hernia occurs more frequently in patients with EDS, mainly men. Many surgeons believe that EDS may have a negative effect on the clinical outcome of hernioplasty because of postoperative complication and recurrence rates. Our strategy has been robotic technology to facilitate the surgical approach.Robotic technology is feasible and associated with a shorted recovery and better cosmetic results. The endowrist movement of the robotic arms allows wide instrument articulation in a confined space, bypassing the limitis of laparoscopic instruments. In this way, it is possible to realize an accurate dissection of important elements, to reduce operative timing and intraoperative and postoperative complications.Ehlers-Danlos syndrome, Inguinal hernia, TAPP.
Published: 2021

30. Long-Term Functional Results of a Modified Caudal-to-Cranial Approach in Laparoscopic Segmental Left Colectomy for Diverticular Disease

Author: Marco Milone, Sara Vertaldi, Nicola Gennarelli, Marcella Pesce, Pietro Anoldo, Giovanni Galasso, Giovanni Sarnelli, Francesco Maione, Giovanni Domenico De Palma, A. D'Amore, Michele Manigrasso, Manigrasso, M., Pesce, M., Milone, M., Anoldo, P., D'Amore, A., Galasso, G., Gennarelli, N., Maione, F., Vertaldi, S., Sarnelli, G., and De Palma, G. D.
Subjects: medicine.medical_specialty, Constipation, Hepatology, Article Subject, business.industry, Anorectal manometry, Left colectomy, Gastroenterology, RC799-869, Diseases of the digestive system. Gastroenterology, Surgery, 03 medical and health sciences, Cranial approach, Dissection, 0302 clinical medicine, 030220 oncology & carcinogenesis, Chart review, medicine, Diverticular disease, Defecation, 030211 gastroenterology & hepatology, medicine.symptom, business, Research Article
Abstract: A modified caudal-to-cranial approach to perform laparoscopic left colectomy for benign diseases has been recently designed to facilitate the low-tie mesenteric dissection. A chart review has been performed including all consecutive patients with uncomplicated diverticulitis who have been treated by segmental left colectomy with a caudal-to-cranial approach. A total of 34 patients were included in the study. 21 patients were male, mean age was 54.1 ± 11.3 , and mean BMI was 26 ± 5.5 . Patients with ASA Score I were 7, with ASA II were 9, and with ASA Score III were 5. Incontinence Score (IS) resulted in an average of 5 ± 2 , 2 grade of incontinence and the CS score showed an average of 10 ± 3 , 2 grade of constipation. Health status, evaluated by Short Form-36 questionnaire, was demonstrated in these patients’ great physical function, role, general health, and social function. The anorectal manometry performed 6 months after surgery showed a normal value in terms of the anal resting pressure ( 47 ± 13 mmHg) and an increased volume to stimulate desire to defecate ( 197 ± 25 ml). The length of the anal sphincter was normal compared to the reference value ( 37 ± 5.4 mm). Although further studies are required to obtain definitive conclusions, our results are encouraging to propose low-tie segmental colectomy as the standard procedure for the treatment of uncomplicated diverticulitis, and our modified surgical approach could be considered useful to facilitate the surgical approach.
Published: 2021

31. Conversions related to adhesions in abdominal surgery. Robotic versus laparoscopic approach: A multicentre experience

Author: Nicola de’Angelis, Sara Vertaldi, Giuseppe De Simone, Francesco Brunetti, Nassiba Beghdadi, Giuseppe Servillo, Giovanni Domenico De Palma, Marco Milone, Michele Manigrasso, Milone, M., De'Angelis, N., Beghdadi, N., Brunetti, F., Manigrasso, M., De Simone, G., Servillo, G., Vertaldi, S., and De Palma, G. D.
Subjects: medicine.medical_specialty, Biophysics, Tissue Adhesions, Conversion to open surgery, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Robotic Surgical Procedures, robotic surgery, Clinical endpoint, medicine, Humans, Robotic surgery, previous abdominal surgery, conversion, Laparoscopy, medicine.diagnostic_test, business.industry, adhesiolysi, Conversion to Open Surgery, Computer Science Applications, Surgery, adhesion, Treatment Outcome, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Peritoneal adhesion, business, Abdominal surgery
Abstract: Background: An advantage of robotic surgery over laparoscopy is the lower rate of unplanned conversion. One of the implicated reasons for conversion is adhesions from previous abdominal surgeries (PASs). Methods: A comparative analysis of 98 patients with history of open PAS treated by laparoscopic or robotic surgery was performed. Primary endpoint was the rate of conversion to open surgery related to adhesiolysis. Secondary endpoints were short-term outcomes and complications. Results: Conversion rate specifically related to adhesiolysis was significantly lower in robotic group (13 for laparoscopic group vs. 2 for robotic group; p = 0.046). Conversions occurred during adhesiolysis were significantly related to severity of adhesions expressed by peritoneal adhesion index (PAI) score (p < 0.001), number of abdominal areas involved by adhesions (p < 0.001) and severity of PAI into the target area of surgical intervention (p = 0.021). Conclusions: Benefits of robotic surgery are more noticeable in performing procedures with increasing technical difficulties.
Published: 2021

32. Circular versus linear stapling oesophagojejunostomy after laparoscopic total gastrectomy. A systematic review and meta-analysis

Author: Giuseppe Servillo, Paolo Parise, Riccardo Rosati, Giovanni Domenico De Palma, Ugo Elmore, Giovanni Aprea, Sara Vertaldi, Michele Manigrasso, Marco Milone, Milone, M., Elmore, U., Manigrasso, M., Vertaldi, S., Aprea, G., Servillo, G., Parise, P., De Palma, G. D., Rosati, R., Milone, Marco, Elmore, Ugo, Manigrasso, Michele, Vertaldi, Sara, Aprea, Giovanni, Servillo, Giuseppe, Parise, Paolo, De Palma, Giovanni Domenico, and Rosati, Riccardo
Subjects: medicine.medical_specialty, medicine.medical_treatment, Subgroup analysis, Constriction, Pathologic, Anastomosis, Gastrectomy, Stomach Neoplasms, Tumor stage, Surgical Stapling, medicine, Humans, Laparoscopic total gastrectomy, Meta-analysi, Retrospective Studies, Oesophagojejunostomy, business.industry, Anastomosis, Surgical, General Medicine, medicine.disease, Surgery, Stenosis, Meta-analysis, Stapler, Laparoscopic gastrectomy, Laparoscopy, Complication, business, Gastric cancer
Abstract: Background To assess which anastomosis technique is the most appropriate after laparoscopic total gastrectomy, a systematic review with meta-analysis has been performed to evaluate safety and efficacy of the linear versus circular stapler performing the oesophagojejunostomy. Methods A systematic search was performed using the string: total AND gastrectomy AND (circular OR linear OR stapler). Extracted data were patients’ number, gender, age, BMI, ASA Score, tumor stage. Outcomes were leakages, stenoses and bleedings, number of overall anastomotic complications, mortality, operative time, time to first flatus and diet resumption and length of stay of each group. A meta-analysis among the included studies was performed. A subgroup analysis, including the studies in which the Authors considered a single technique to perform each type of anastomosis (LS and CS), was performed. Meta-regression analyses were performed to assess if one or more demographic and clinical variables significantly impacted on the obtained results. Results 12 articles were included in the final analysis. A significant difference was observed in terms of “overall anastomotic complications” in favour of linear stapling (RD = 0.06, p = 0.01). No significant differences were observed in terms of postoperative complications anastomosis-related, even if a trend towards advantages of linear stapling have been found (stenosis: RD = 0.04, p = 0.06; bleeding: RD = 0.02, p = 0.05). However, all the study was retrospective and there was high heterogeneity among the studies. Conclusion Linear stapler seems to be related with lesser number of complication if compared with circular stapler. However, further high-quality studies are needed to obtain definitive conclusions.
Published: 2021

33. Surgical stress and metabolic response after totally laparoscopic right colectomy

Author: Gregory Alexander Raciti, Giovanni Domenico De Palma, Giuseppe De Simone, Sara Vertaldi, Francesco Beguinot, Claudia Miele, Antonella Desiderio, Nunzio Velotti, Fatima Domenica Elisa De Palma, Umberto Bracale, Michele Manigrasso, Marco Milone, Giuseppe Servillo, Michele D'Ambra, Giuseppe Perruolo, Milone, M., Desiderio, A., Velotti, N., Manigrasso, M., Vertaldi, S., Bracale, U., D'Ambra, M., Servillo, G., De Simone, G., De Palma, F. D. E., Perruolo, G., Raciti, G. A., Miele, C., Beguinot, F., De Palma, G. D., 'Federico II' University of Naples Medical School, Institute of Experimental Endocrinology and Oncology (IEOS), Consiglio Nazionale delle Ricerche (CNR), Centre de Recherche des Cordeliers (CRC (UMR_S_1138 / U1138)), École pratique des hautes études (EPHE), and Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université de Paris (UP)
Subjects: Male, medicine.medical_specialty, Surgical stress, Colorectal cancer, medicine.medical_treatment, Science, Urology, [SDV.CAN]Life Sciences [q-bio]/Cancer, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, Anastomosis, [SDV.IMM.II]Life Sciences [q-bio]/Immunology/Innate immunity, Article, Extracorporeal, Proinflammatory cytokine, 03 medical and health sciences, 0302 clinical medicine, Medical research, Humans, Medicine, Colectomy, Aged, Inflammation, Multidisciplinary, Molecular medicine, Tumor Necrosis Factor-alpha, business.industry, Interleukins, Insulin, Anastomosis, Surgical, Cancer, [SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, medicine.disease, 3. Good health, C-Reactive Protein, Oncology, [SDV.IMM.IA]Life Sciences [q-bio]/Immunology/Adaptive immunology, 030220 oncology & carcinogenesis, Colonic Neoplasms, Right Colectomy, Female, Laparoscopy, 030211 gastroenterology & hepatology, business, Biomarkers
Abstract: No clear consensus on the need to perform an intracorporeal anastomosis (IA) after laparoscopic right colectomy is currently available. One of the potential benefits of intracorporeal anastomosis may be a reduction in surgical stress. Herein, we evaluated the surgical stress response and the metabolic response in patients who underwent right colonic resection for colon cancer. Fifty-nine patients who underwent laparoscopic resection for right colon cancer were randomized to receive an intracorporeal or an extracorporeal anastomosis (EA). Data including demographics (age, sex, BMI and ASA score), pathological (AJCC tumour stage and tumour localization) and surgical results were recorded. Moreover, to determine the levels of the inflammatory response, mediators, such as C-reactive protein (CRP), tumour necrosis factor (TNF), interleukin 1β (IL-1β), IL-6, IL-10, and IL-13, were evaluated. Similarly, cortisol and insulin levels were evaluated as hormonal responses to surgical stress. We found that the proinflammatory mediator IL-6, CRP, TNF and IL-1β levels, were significantly reduced in IA compared to EA. Concurrently, an improved profile of the anti-inflammatory cytokines IL-10 and IL-13 was observed in the IA group. Relative to the hormone response to surgical stress, cortisol was increased in patients who underwent EA, while insulin was reduced in the EA group. Based on these results, surgical stress and metabolic response to IA justify advocating the adoption of a totally laparoscopic approach when performing a right colectomy for cancer.This trial is registered on ClinicalTrials.gov (ID: NCT03422588).
Published: 2021

34. Endoscopic Approach to Recurrent Pilonidal Sinus: A Retrospective Analysis

Author: Giovanni Domenico De Palma, Michele Manigrasso, Loredana Maria Sosa Fernandez, Sara Vertaldi, Nicola Gennarelli, Nunzio Velotti, Francesco Maione, Marco Milone, Mario Musella, Vincenza Paola Dinuzzi, Manigrasso, M., Velotti, N., Sosa Fernandez, L. M., Vertaldi, S., Maione, F., Gennarelli, N., Dinuzzi, V. P., Musella, M., De Palma, G. D., and Milone, M.
Subjects: Ablation Techniques, Adult, Male, medicine.medical_specialty, 2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), medicine.medical_treatment, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), pilonidal, Video-Assisted Surgery, 03 medical and health sciences, Pilonidal Sinus, 0302 clinical medicine, recurrent, Recurrence, Retrospective analysis, Humans, Medicine, VAAPS, Sinus (anatomy), Retrospective Studies, Wound Healing, business.industry, endoscopic approach, Endoscopy, Ablation, Surgery, Treatment Outcome, medicine.anatomical_structure, 030220 oncology & carcinogenesis, Female, 030211 gastroenterology & hepatology, business, Follow-Up Studies
Abstract: Background: The aim of this study is to report short-and long-term results using video-assisted ablation of pilonidal sinus (PS) technique to treat recurrent PS. Methods: We included all consecutive patients with a recurrent PS disease operated on with endoscopic approach since 1st January 2014 to 31st December 2018. Analyzed outcomes were recurrence rate at 1, 3, and 5 years, time off work, time to sitting on toilet and to walk without pain, time to wound healing, rate of incomplete wound healing and postoperative infection, postoperative pain at 6 hours, 1 day, and 1 week, and patients' satisfaction after 1 month. Demographic and sinuses' data were recorded. To adjust for all the variables, multivariate analyses were performed with outcomes as dependent variables, and with patients' and sinuses' characteristics as independent variables. Results: Sixty-three patients were included in the analysis. Recurrence rate at 1-year follow-up was 4.7% (3 patients on 63), at 3-year follow-up was 11.7% (4 on 34), and at 5-year follow-up was 23.07% (3 on 13). A 3-and 5-year follow-up was completed by 34 and 13 patients, respectively. The mean time off work was 3.5 ± 1.5 days, time to sitting on toilet without pain was 1.5 ± 1.1 days, and time to walk without pain was 1.3 ± 0.9 days. The mean time to wound healing was 27.9 ± 10.3 days, with a rate of incomplete wound healing of 4.7%. Postoperative infection rate was 7.9%. The mean postoperative pain was 1 ± 0.9 at 6 hours after the procedure, 0.6 ± 0.6 at 1 day and 0.1 ± 0.3 at 1 week. Patients' satisfaction was good in 98.5% of patients. After the multivariate analysis, no parameters showed an influence on the postoperative outcomes. Conclusions: Our results encouraged to adopt an endoscopic approach even in case of recurrent PS
Published: 2021

35. Laparoscopic left colic artery preserving sigmoidectomy for diverticulitis in a patient with urinary tract malformation ‐ a video vignette

Author: Marco Milone, Salvatore D’Angelo, Michele Manigrasso, Sara Vertaldi, Alessandra Marello, Giovanni Domenico De Palma, Milone, M., Manigrasso, M., Marello, A., D'Angelo, S., Vertaldi, S., and De Palma, G. D.
Subjects: Left colic artery, medicine.medical_specialty, business.industry, Gastroenterology, Mesenteric Artery, Inferior, Diverticulitis, medicine.disease, Diverticulitis, Colonic, Surgery, Sigmoidectomy, Vignette, Colon, Sigmoid, medicine.artery, Humans, Medicine, Laparoscopy, Urinary Tract, business, URINARY TRACT MALFORMATION
Published: 2021

36. Early versus delayed endoscopic treatment of acute pilonidal abscess: a propensity score-matched analysis

Author: Marco Milone, Giovanni Domenico De Palma, Loredana Maria Sosa Fernandez, Michele Manigrasso, Nunzio Velotti, Francesco Maione, Pietro Schettino, Sara Vertaldi, Mario Musella, Nicola Gennarelli, Manigrasso, M., Velotti, N., Sosa Fernandez, L. M., Vertaldi, S., Maione, F., Gennarelli, N., Schettino, P., Musella, M., De Palma, G. D., and Milone, M.
Subjects: medicine.medical_specialty, Pilonidal abscess, medicine.medical_treatment, 030230 surgery, 03 medical and health sciences, 0302 clinical medicine, Pilonidal Sinus, Pilonidal, Recurrence, Internal medicine, Incision and drainage, medicine, Humans, Acute absce, Propensity Score, business.industry, Gastroenterology, Endoscopic treatment, Treatment options, Perioperative, Hepatology, Colorectal surgery, Abscess, Surgery, Treatment Outcome, Video-assisted ablation, 030220 oncology & carcinogenesis, Propensity score matching, Neoplasm Recurrence, Local, business
Abstract: Background: According to the Italian Society of Colorectal Surgery guidelines, the most effective approach to the pilonidal abscess is adequate surgical drainage, concerning incision and drainage of the pilonidal cavity. Few recent studies have demonstrated that endoscopic approach could be a valid treatment option even in the case of acute pilonidal abscess. The aim of our study is to assess if video-assisted ablation of pilonidal sinus (VAAPS) could be an alternative to treat an acute pilonidal abscess and to evaluate if an immediate endoscopic approach to the pilonidal abscess is preferable to a delayed procedure after incision and drainage. Methods: All consecutive patients with an acute pilonidal abscess since 1 January 2014 to 31 December 2018 were enrolled in our propensity score-matched analysis and divided into two groups: the early VAAPS group and the delayed VAAPS group. Primary outcomes were recurrence rate at 1-year, 3-year, and 5-year follow-up. Secondary outcomes were time off, time to wound healing, incomplete wound healing, perioperative infection, patients’ satisfaction 1 month after the complete wound healing, and their health status before surgery and 6 months after complete wound healing. Results: After the propensity score matching, 82 patients were included in the final analysis (41 in each group). No differences were found in terms of recurrence in the two groups. Early endoscopic approach was associated with a better patients’ satisfaction (8.17 ± 1.2 vs 6.06 ± 1.48, p = 0.001) and a better postoperative health status (86.27 ± 6.54 vs 77.32 ± 5.85, p = 0.001). Conclusions: Our results encouraged to perform an immediate endoscopic approach to an acute pilonidal abscess.
Published: 2020

37. Robotic rectal resection preserving the inferior mesenteric artery – a video vignette

Author: G.D. De Palma, M. Gandini, Marco Milone, Sara Vertaldi, Michele Manigrasso, S. Aprea, Milone, M., Manigrasso, M., Gandini, M., Aprea, S., Vertaldi, S., and De Palma, G. D.
Subjects: medicine.medical_specialty, Vignette, business.industry, medicine.artery, Gastroenterology, medicine, MEDLINE, Rectal resection, business, Inferior mesenteric artery, Surgery
Published: 2020

38. Video-assisted ablation of pilonidal sinus – a video vignette

Author: L. M. Sosa Fernandez, Marco Milone, Sara Vertaldi, Michele Manigrasso, G.D. De Palma, Giuseppe Servillo, G. De Simone, Milone, M., Sosa Fernandez, L. M., Vertaldi, S., De Simone, G., Servillo, G., Manigrasso, M., and De Palma, G. D.
Subjects: medicine.medical_specialty, business.industry, General surgery, medicine.medical_treatment, Gastroenterology, MEDLINE, Video-Assisted Surgery, Ablation, medicine.anatomical_structure, Pilonidal Sinus, Treatment Outcome, Vignette, medicine, Humans, Video assisted, Neoplasm Recurrence, Local, business, Sinus (anatomy)
Published: 2020

39. Long-term results of a randomized clinical trial comparing endoscopic versus conventional treatment of pilonidal sinus

Author: Giuseppe De Simone, Giovanni Domenico De Palma, Vera Cirillo, Francesco Maione, Nicola Gennarelli, Loredana Maria Sosa Fernandez, Sara Vertaldi, Nunzio Velotti, Michele Manigrasso, Marco Milone, Katia Di Lauro, Milone, M., Velotti, N., Manigrasso, M., Vertaldi, S., Di Lauro, K., De Simone, G., Cirillo, V., Maione, F., Gennarelli, N., Sosa Fernandez, L. M., and De Palma, G. D.
Subjects: Adult, Male, medicine.medical_specialty, Cost-Benefit Analysis, 030230 surgery, law.invention, Pilonidal Sinu, 03 medical and health sciences, 0302 clinical medicine, Pilonidal Sinus, Randomized controlled trial, law, Recurrence, Sinus disease, medicine, VAAPS, Humans, Minimally Invasive Surgical Procedures, Prospective Studies, Minimally invasive, Cost-Benefit Analysi, Prospective cohort study, Long-term follow-up, Minimally invasive procedures, medicine.diagnostic_test, business.industry, Conventional treatment, Endoscopy, General Medicine, Long term results, Minimally Invasive Surgical Procedure, Surgery, Prospective Studie, Endoscopic, 030220 oncology & carcinogenesis, Invasive surgery, Female, business, Human
Abstract: Background In the new era of minimally invasive surgery, recent studies encouraged the adoption of endoscopic approaches as the most effective way to treat (pilonidal sinus disease) PSD but little is known about long-term results of minimally invasive procedures. Materials and methods A total of 145 patients with chronic non recurrent pilonidal sinus were enrolled for this randomized controlled trial. The follow-up rate was 97% at 5 years for a total of 74 patients assigned to the minimally invasive treatment group and 67 patients assigned to the conventional Bascom cleft lift treatment group. We evaluated the following outcomes: long-term recurrence rate, patients’ satisfaction, cosmetic outcome and cost-effectiveness results. Results Long-term data confirm that the recurrence rate was similar in both groups and, in minimally invasive patients, there were a higher satisfaction and better cosmetic results. Costs analysis revealed improved outcome in favour of VAAPS with a much lower mean global cost. Conclusion Minimally invasive treatment has all the characteristics of an ideal approach to PSD with advantages including minimal patient inconveniences, high satisfaction and good aesthetics results. It was also more cost effective to carry out the treatment.
Published: 2019

40. Robotic Colorectal Cancer Surgery. How to Reach Expertise? A Single Surgeon-Experience

Author: Nicola D’Alesio, Michele Manigrasso, Alessandra Marello, Marco Milone, Sara Vertaldi, Salvatore Aprea, Pietro Anoldo, Giovanni Domenico De Palma, Antonio Vitiello, Alessia Chini, Carmen Sorrentino, Mario Musella, A. D'Amore, Salvatore D’Angelo, Manigrasso, M., Vertaldi, S., Anoldo, P., D'Amore, A., Marello, A., Sorrentino, C., Chini, A., Aprea, S., D'Angelo, S., D'Alesio, N., Musella, M., Vitiello, A., De Palma, G. D., and Milone, M.
Subjects: robotic, Laparoscopic surgery, medicine.medical_specialty, Colorectal cancer, medicine.medical_treatment, Medicine (miscellaneous), colorectal cancer, Article, laparoscopic, 03 medical and health sciences, 0302 clinical medicine, Colorectal cancer surgery, Medicine, Prospective cohort study, colorectal, business.industry, General surgery, Cancer, medicine.disease, Colorectal surgery, Single surgeon, learning curve, 030220 oncology & carcinogenesis, Operative time, 030211 gastroenterology & hepatology, business
Abstract: The complexity associated with laparoscopic colorectal surgery requires several skills to overcome the technical difficulties related to this procedure. To overcome the technical challenges of laparoscopic surgery, a robotic approach has been introduced. Our study reports the surgical outcomes obtained by the transition from laparoscopic to robotic approach in colorectal cancer surgery to establish in which type of approach the proficiency is easier to reach. Data about the first consecutive 15 laparoscopic and the first 15 consecutive robotic cases are extracted, adopting as a comparator of proficiency the last 15 laparoscopic colorectal resections for cancer. The variables studied are operative time, number of harvested nodes, conversion rate, postoperative complications, recovery outcomes. Our analysis includes 15 patients per group. Our results show that operative time is significantly longer in the first 15 laparoscopic cases (p = 0.001). A significantly lower number of harvested nodes was retrieved in the first 15 laparoscopic cases (p = 0.003). Clavien Dindo I complication rate was higher in the first laparoscopic group, but without a significant difference among the three groups (p = 0.09). Our results show that the surgeon needed no apparent learning curve to reach their laparoscopic standards. However, further multicentric prospective studies are needed to confirm this conclusion.
Published: 2021

41. Barbed suture and gastrointestinal surgery. A retrospective analysis

Author: Loredana Maria Sosa Fernandez, Federica Calculli, Nunzio Velotti, Enrico Araimo, Michele Manigrasso, Pietro Anoldo, Sara Vertaldi, Katia Di Lauro, Giovanni Aprea, Marco Milone, Ugo Elmore, Mario Musella, Giovanni Domenico De Palma, Francesco Milone, Manigrasso, M., Velotti, N., Calculli, F., Aprea, G., Di Lauro, K., Araimo, E., Elmore, U., Vertaldi, S., Anoldo, P., Musella, M., Milone, M., Maria Sosa Fernandez, L., Milone, F., and De Palma, G. D.
Subjects: Laparoscopic surgery, medicine.medical_specialty, medicine.medical_treatment, Anastomosis, Intracorporeal anastomosi, 03 medical and health sciences, 0302 clinical medicine, Minimally invasive surgery, medicine, Retrospective analysis, Laparoscopy, Abscess, intracorporeal anastomosis, medicine.diagnostic_test, Intracorporeal anastomosis, business.industry, General Medicine, medicine.disease, Surgery, Barbed suture, 030220 oncology & carcinogenesis, Medicine, 030211 gastroenterology & hepatology, business, Surgical endoscopy, Research Article
Abstract: Although minimally invasive surgery is recognized as the gold standard of many surgical procedures, laparoscopic suturing is still considered as the most difficult skill in laparoscopic surgery. The introduction of barbed sutures facilitates laparoscopic suturing because it is not necessary to tie a knot. The efficacy of this method has been evaluated in different types of surgery; however, less is known about general surgery. We retrospectively analysed data from 378 patients who had undergone bariatric or surgical treatment for colic or gastric malignancy requiring a closure of gastroentero, entero-entero or enterocolotomy from January 2014 to January 2019, admitted to the General Surgery Unit and Operative Unit of Surgical Endoscopy of the University Federico II (Naples, Italy). We registered 12 anastomotic leaks (3.1%), 16 anastomotic intraluminal bleedings (4.2%) and 7 extraluminal bleedings. Other complications included 23 cases of postoperative nausea and vomit (6%), 14 cases of postoperative ileus (3.7%) and 3 cases of intra-abdominal abscess (0.8%). Overall complications rate was 19.8% (75/378). No postoperative death was registered. Thus, by pooling together 378 patients, we can assess that barbed suture could be considered safe and effective for closure of holes used for the introduction of a branch of mechanical stapler to perform intracorporeal anastomosis.
Published: 2019

42. Robotic cholecystectomy for acute cholecystitis

Author: Umberto Bracale, G.D. De Palma, Gianluca Cassese, Marco Milone, Sara Vertaldi, Michele Manigrasso, Michele D'Ambra, Milone, M., Vertaldi, S., Bracale, U., D'Ambra, M., Cassese, G., Manigrasso, M., and De Palma, G. D.
Subjects: Male, medicine.medical_specialty, Nausea, medicine.medical_treatment, Cholecystitis, Acute, Operative Time, Blood Loss, Surgical, 03 medical and health sciences, 0302 clinical medicine, Robotic Surgical Procedures, Blood loss, medicine, Acute cholecystitis, Cholecystectomy, Robotic surgery, 030212 general & internal medicine, Leukocytosis, Aged, business.industry, General Medicine, Length of Stay, Middle Aged, medicine.disease, Surgery, 030220 oncology & carcinogenesis, Cholecystitis, Vomiting, Female, Postoperative Complication, medicine.symptom, business, Human
Abstract: Introduction Nowadays laparoscopic cholecystectomy is considered as criterion standard for surgical treatment of acute calculous cholecystitis. During the last few years, there has been growing interest about the robotic approach. Several authors have reported the superiority of robotic cholecystectomy, associated with a lower percentage of conversion especially in patients with intraoperative diagnosis of acute or gangrenous cholecystitis. We report 3 case reports of moderate acute cholecystitis successfully treated by robotic cholecystectomy. Patient concerns Three patients presented moderate acute calculous cholecystitis with leukocytosis, fever, nausea, vomiting, and pain. Diagnosis Three patients of our study population had clinical and laboratory suspicion of moderate acute calculous cholecystitis verified by abdominal ultrasound examination, which found out cholelitiasis in all 3 cases. Final diagnosis was confirmed by intraoperative findings and histopathological examination, with two empyematous cholecystitis and one perforated cholecystitis. Interventions All patients underwent robotic cholecystectomy with the da Vinci Robotic Surgical System. The entire procedure required a mean operation time of 128 minutes and the average blood loss was 60 mL, without any intraoperative complications. Outcomes In all 3 cases postoperative period was uneventfull. All the patients were discharged within 24 hours and no readmissions were reported during a 30 days' follow-up. Conclusions Robotic cholecystectomy for ACC is feasible and safe. Several studies have demonstrated that robotic approach reduces the risk of conversion to open surgery in case of acute or gangrenous cholecystitis. Our results are in line with current literature. In fact, we have successfully treated 2 patients with empyematous acute cholecystitis and 1 with gangrenous cholecystitis with a totally robotic approach, without any complications or need of conversion to open surgery. In conclusion, our results confirm that it is the time to include robotic surgery in the emergency setting.
Published: 2019

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