1,721,110 research outputs found
Costs–benefits of robot-assisted colorectal surgery: a different perspective
No full textThe costs of robot-assisted surgery (RAS) still represent a critical issue. Kulaylat et al. reported a propensity-matched study to compare the outcomes of colorectal surgery between a robotic and a laparoscopic group, concluding that RAS was burdened by higher costs. However, authors did not mention what da Vinci system, Si or Xi, they used and this could be crucial, as recently data published by our group on rectal resections showed that the use of the da Vinci Xi and the surgeon’s increased experience could improve the results and significantly reduce the costs of RAS
Considerations on "Impact of ABO-incompatibility on hepatocellular carcinoma recurrence after living donor liver transplantation"
No full textLaparoscopia d'urgenza nel trattamento delle ulcere peptiche perforate. Dodici anni di esperienza.
No full textLa laparoscopia è una metodica sicura ed efficace nel trattamento dell'ulcera peptica perforat
HALS, EVAR and robot-assisted surgery as minimally invasive approaches for abdominal aneurysm treatment
No full textDear Editor, We read with great interest the article by Berchiolli et al. [1] entitled “Hand-assisted laparoscopic surgery versus endovascular repair in abdominal aortic aneurysm treatment”, recently published by Journal of Vascular Surgery. In last decade, we have seen a paradigm shift in aneurysm repair towards a minimally invasive approach, mainly related to the preeminence of endovascular aneurysm repair (EVAR). Actually, laparoscopy and robot-assisted surgery also have a role in this field. Many studies have also described the benefits of EVAR, considered one of the most important options, in the acute setting [2], with faster recovery and shorter hospitalization. However, the main drawback remains its long-term seal. In fact, despite the advent of a new model of vascular graft, more than 5% of EVAR patients require reintervention [3]. Another concern is the cumulative radiation and iodinated contrast exposure in patients undergoing EVAR. In this setting, laparoscopic surgery is an appealing alternative, because it represents a minimally invasive option with a potentially higher long-term success rate. One of the main criticisms of this approach is the learning curve, which can be particularly steep for vascular surgeons, who are not used to it. On the contrary, the hand-assisted laparoscopic surgery (HALS), thanks to the manual control of the sac during dissection and sutures, is associated with a higher level of safety and with a shorter learning curve, still maintaining the advantages of minimally invasive surgery [4]. HALS has been introduced for abdominal aortic aneurysm treatment in some centers [5], showing encouraging results and a lower risk of aneurysm-related reintervention if compared to EVAR. An important remark on this work [1] concerns costs. In fact, a preliminary cost analysis of the perioperative period has shown a lower cost of HALS compared to EVAR and this difference could be even greater if we consider the economic impact of a stricter follow-up, which is mandatory for patients underwent EVAR, and the possible costs related to the risk of reoperation, which is higher in the EVAR group. Another possible minimally invasive alternative for aneurysm repair is robot-assisted surgery (RAS). Indeed, the robotic assistance can be very useful in this field, overcoming the kinematics limitations of laparoscopy and resulting in a potential higher level of precision and control and in a shorter learning curve [6]. This is even more evident with the latest da Vinci Xi [7], which combines the functionality of a boom-mounted system with the flexibility of a mobile platform allowing the operating surgeon to quickly scan over a wider operative field. The scope can be placed on any of the 8-mm robotic trocar, improving versatility. RAS could have also a specific role in Type-II Endoleak, the most frequent complication after EVAR [8], allowing the operating surgeon the ligation of aortic collaterals responsible for endoleak inflow and outflow in an easier way with respect to laparoscopy and in a definitive manner with respect to endovascular embolization, which is the first-line treatment option, but still has high recurrence rates. The main issues about RAS remain those related to costs; however, recent articles have suggested an economic gain with increasing surgeon’s experience and with the use of da Vinci Xi [9, 10], and this could also finally open the way for RAS for these procedures. For these reasons, we believe that the diffusion of HALS and RAS between vascular surgeons should be encouraged. Since literature lacks prospective studies about their use in vascular surgery, it would be interesting to value on a larger scale the usefulness and the application of these two well-consolidated minimally invasive techniques also to the vascular field
Adenocarcinoma on j-pouch after proctocolectomy for ulcerative colitis - Case report and review of literature (International Journal of Colorectal Disease DOI: 10.1007/s00384-014-1864-4)
No full textPouch adenocarcinoma following restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) has been reported and reviewed. We present a case-report of poorly differentiated mucinous adenocarcinoma of the pouch following 13 years after IPAA for UC with entirely stapled anastomosis and the review of all the previous experiences in the published literature.
The ileo-anal pouch mucosa and the anorectal mucosa below the ileo-anal anastomosis are at potential risk of developing dysplasia and adenocarcinoma. The risk of neoplastic degeneration of the mucosa remaining after RPC is very low, but it is assumed that it increases in time. Since the incidence of ileal pouch cancer after IPAA for RCU is 4.2% at 20 years and 5.1% at 25 years. The interval between IPAA and the development of cancer was 13 years in our patient. In the 38 cases reported to date, the cancers developed on average 10 years after construction of the IPAA. The longest reported interval was 27 years, the shortest 10 months. These data suggest the need of an endoscopic follow up to prevent or, occasionally, diagnose as early as possible, ileal pouch adenocarcinoma, which can occur both early or after many years by a PCR for RCU. For this reason it would be necessary to refer operated patients for a regular follow-up, ideally for the rest of life, which consists of endoscopic surveillance with multiple biopsies of the small residual rectal stump if present and of the pouch
Augmented Reality to Improve Surgical Simulation. Lessons Learned Towards the Design of a Hybrid Laparoscopic Simulator for Cholecystectomy
Full text linkHybrid surgical simulators based on Augmented Reality (AR) solutions benefit from the advantages of both the box trainers and the Virtual Reality simulators. This paper reports on the results of a long development stage of a hybrid simulator for laparoscopic cholecystectomy that integrates real and the virtual components. We first outline the specifications of the AR simulator and then we explain the strategy adopted for implementing it based on a careful selection of its simulated anatomical components, and characterized by a real-time tracking of both a target anatomy and of the laparoscope. The former is tracked by means of an electromagnetic field generator, while the latter requires an additional camera for video tracking. The new system was evaluated in terms of AR visualization accuracy, realism and hardware robustness. Obtained results show that the accuracy of AR visualization is adequate for training purposes. The qualitative evaluation confirms the robustness and the realism of the simulator. The AR simulator satisfies all the initial specifications in terms of anatomical appearance, modularity, reusability, minimization of spare parts cost, and ability to record surgical errors and to track in real-time the Calot's triangle and the laparoscope. The proposed system could be an effective training tool for learning the task of identification and isolation of Calot's triangle in laparoscopic cholecystectomy. Moreover, the presented strategy could be applied to simulate other surgical procedures involving the task of identification and isolation of generic tubular structures, such as blood vessels, biliary tree and nerves, which are not directly visibl
Early cholecystectomy for non severe acute gallstone pancreatitis. Easier said than done
No full textLaparoscopic cholecystectomy (LC) carried out within 3 days after an attack of non severe acute gallstone pancreatitis (NSAGP) is recommended to reduce hospital stay and overall costs. Aim of the study was to evaluate factors that may delay a timely surgical management of NSAGP and the consequences of this deviation
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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