68 research outputs found
Laparoscopic right colectomy: Road to safety surgery
No full textLaparoscopic right hemicolectomy indicates a surgical technique for the removal of right-sided colon cancer; it nowadays represents an effective treatment for this disease, but it remains a demanding procedure, burdened by the risk of serious complications, especially in laparoscopic surgery. Indeed, a standard technique for the execution of this intervention does not exist. The purpose of this study is to suggest a standardization of the procedure advising some tips and tricks which could benefit its learning and its performance, helping operators to minimize the risk of major complications. After creation of pneumoperitoneum and port placement, the procedure is structured in consecutive steps: surgical field exposure, vascular dissection, coloparietal detachment, ileal and colic sectioning, anastomosis. During the intervention, the surgical plans and all the structures involved are identified and safeguarded. The entire demolition phase occurs in an anti-clockwise direction. An intracorporeal anastomosis is performed and enterotomies are closed using a two-layer, running barbed suture. During all phases, the assistant grabs and moves bowels in order to improve the field exposure and facilitate the operator's maneuvers
Case report of an uncommon case of drain-site hernia after colorectal surgery
No full texttrocar site herniation is a rare but potentially serious complication of laparoscopic surgery. Data about drain site hernia after laparoscopic surgery is scarce and anecdotal
Long-term follow-up for pilonidal sinus surgery: A review of literature with metanalysis
No full textDual docking technique for robotic repair of simultaneous inguinal and umbilical hernia: A preliminary single center experience
No full textBackground: This study aimed to assess clinical results in terms of intraoperative outcomes, recovery and recurrence of our robotic technique for the treatment of patients affected by simultaneous inguinal and umbilical hernia, providing technical details to facilitate multiquadrant surgery in robotic hernia repair. Methods: Data from patients affected by simultaneous primary inguinal and umbilical hernia who underwent robotic repair with our dual docking technique was retrospectively analysed. Results: Fifteen patients were included. No intraoperative complications occurred. All patients achieved complete mobilisation within 7 h. The mean length of hospital stay was 21.6 h, with five patients discharged on the same day of surgery. There was no major complication and no recurrence within the median follow-up period of 673 days. Conclusions: This surgical technique shows optimal postoperative outcomes, such as early mobilisation and short length of stay. Our study provides an aid to surgeons performing multiquadrant robotic surgery for the treatment of abdominal hernias
A giant inguinal hernia in a patient with Ehlers-Danlos syndrome
No full textBACKGROUND: 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. AIM: Inour study, we present a case of inguinal hernia in a EDS patient successfully treated with a robotic transabdominal preperitoneal procedure (TAPP procedure). MATERIAL AND METHODS: 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. RESULTS: 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. DISCUSSION: 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. CONCLUSION: 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. KEY WORDS: Ehlers-Danlos syndrome, Inguinal hernia, TAPP
Case report of a conservative management of cervical esophageal perforation with acrylic glue injection
No full textVentral Hernia Repair: A Journey from Laparoscopic to Robotic Surgery: Is Cost Efficiency Guaranteed?
No full textBackground/Objectives: Ventral hernia repair has evolved with the introduction of minimally invasive techniques like l-IPOM and rTA-RM. While robotic surgery offers advantages in precision and ergonomics, its higher costs pose questions regarding its cost-effectiveness compared to laparoscopic approaches. Methods: A retrospective analysis of patients with primary or incisional ventral hernias undergoing either l-IPOM or rTA-RM between February 2022 and October 2023 was conducted. Data on demographics, surgical outcomes, hospital costs, disposable supplies, and robotic system expenses were collected. A one-to-one propensity score matching (PSM) was used to ensure comparability between the groups. Results: After matching, 30 patients were included in each group. The rTA-RM group had longer operative times (93.2 vs. 74.4 min, p = 0.004) but shorter hospital stays (1 day vs. 2 days, p = 0.003) and lower postoperative pain scores (median VAS score 3 vs. 5, p = 0.004). Total costs were comparable between rTA-RM and l-IPOM (EUR 6862 vs. EUR 6575, p = 0.32), with robotic surgery incurring higher capital costs but lower disposable supply costs (EUR 1057 vs. EUR 2006, p < 0.01). Conclusions: Despite the higher per-case cost associated with robotic systems, overall costs for rTA-RM were similar to those for l-IPOM, suggesting that robotic surgery may be cost-competitive due to lower disposable supply expenses and shorter hospital stays. Further research is needed to assess long-term outcomes and broader economic impacts
Robotic Surgery and Functional Esophageal Disorders: A Systematic Review and Meta-Analysis
No full textThe 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
Correction to: Ostomy closure rate during COVID-19 pandemic: an Italian multicentre observational study (Updates in Surgery, (2022), 74, 3, (1017-1025), 10.1007/s13304-022-01274-w)
No full textWhile typesetting the article the Collaborators were not included in the proofs. The collaborators names are provided below: DOC Collaborative Group: Laura Agostinelli, Ferdinando Agresta, Gabriele Anania, Laura Antolino, Pietro Anoldo, Emanuele Botteri, Umberto Bracale, Fabio Carbone, Massimo Carlini, Francesco Maria Carrano, Giorgia Casadei, Diego Coletta, Francesco Crafa, Nicola de’Angelis, Paolo Delrio, Giovanni Domenico De Palma, Marcello Di Martino, Ugo Elmore, Lorenzo Gozzini, Michele Grieco, Giovanni Battista Levi Sandri, Edelweiss Licitra, Andrea Lucchi, Marco Massani, Riccardo Memeo, Marco Milone, Dario Oppici, Monica Ortenzi, Alberto Patriti, Francesca Pecchini, Roberto Peltrini, Micaela Piccoli, Adolfo Pisanu, Mauro Podda, Gilberto Poggioli, Maria Chiara Ranucci, Daniela Rega, Riccardo Rosati, Francesco Roscio, Matteo Rottoli, Roberto Santoro, Alberto Sartori, Antonino Spinelli, Serafino Vanella, Giovanni Vennarecci, Nereo Vettoretto. The original article has been corrected
Comparison between LigaSureTM and Harmonic® in Laparoscopic Sleeve Gastrectomy: A Single-Center Experience on 422 Patients
No full textBackground. New laparoscopic devices, such as electrothermal bipolar-activated devices (LigaSure™ (LS)) or ultrasonic systems (Harmonic® scalpel (HS)), have been applied recently to bariatric surgery allowing to reduce blood loss and surgical risks. The aim of this study was to retrospectively compare intraoperative performance of HS and LS, postoperative results, and clinical outcomes in a large cohort of patients undergoing LSG. Methods. Data from 422 morbidly obese patients undergoing LSG in our Bariatric Unit at the Advanced Biomedical Sciences Department of the “Federico II” University of Naples (Italy) between January 2009 and December 2017 were retrospectively analyzed. Subjects were divided into two groups (HS and LS), and operative time, intraoperative complications, and postoperative (within 30 days from surgery) complications were compared. Bleeding from the omentum or from the staple line, use of hemostatic clips, and absorbable hemostat were recorded as intraoperative complications; hemorrhages, abscess formation, gastric leaks, fever, and mortality were considered as postoperative complications. Results. Statistical analysis showed no difference in terms of baseline demographics between the two cohorts. Operative time (48 ± 9 vs 49 ± 6 min, p=0.646) and the rates of intraoperative and postoperative complications did not significantly differ between groups. Conclusion. Harmonic® and LigaSure™ are both useful tools in bariatric surgery, and these two advanced power devices are user-friendly and can facilitate surgeon work; from this point of view, the choice of the energy device should be based on the preference of the surgeon and on the hospital costs policy and availability
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