86 research outputs found
The Mesentery in Robot-Assisted Total Mesorectal Excision
No full textIn recent decades, surgery for rectal cancer has evolved from an operation normally performed under poor vision with a lot of blood loss, relatively high morbidity, and mortality to a safer operation. Currently, minimally invasive rectal procedures are performed with limited blood loss, reduced morbidity, and minimal mortality. The main cause is better knowledge of anatomy and adhering to the principle of operating along embryological planes. Surgery has become surgery of compartments, more so than that of organs. So, rectal cancer surgery has evolved to mesorectal cancer surgery as propagated by Heald and others. The focus on the mesentery of the rectum has led to renewed attention to the anatomy of the fascia surrounding the rectum. Better magnification during laparoscopy and improved optimal three-dimensional (3D) vision during robot-assisted surgery have contributed to the refinement of total mesorectal excision (TME). In this chapter, we describe how to perform a robot-assisted TME with particular attention to the mesentery. Specific points of focus and problem solving are discussed
Implementation of totally robotic right hemicolectomy: lessons learned from a prospective cohort
No full textRobotics facilitates the realization of intra-corporeal anastomosis during right hemicolectomy and allows extracting the operative specimen through a C-section, offering potential benefits in terms of post-operative recovery and incidence of incisional hernia. Therefore, we progressively implemented robotic right hemicolectomy (robRHC) in our centre, and would like to report our initial experience with the technique. Consecutive patients who underwent robRHC within a single centre were prospectively included. Variables related to patients' demographics, surgical procedures, post-operative recovery and pathological outcomes were collected. Sixty patients underwent robRHC in our centre. Indications for robRHC were colon cancer in 58 patients (96.7%) and polyps not amenable to endoscopic resection in 2 patients (3.3%). Fifty-eight patients underwent robRHC with D2 lymphadenectomy and central vessel ligation (96.7%), and two patients (3.3%) had robRHC associated with another procedure. All patients had intra-corporeal anastomosis. The mean ± operative time was of 200.4 ± 114.9 min. Two conversions (3.3%) to open surgery were performed. The mean ± SD length of stay was of 5.4 ± 3.8 days. Seven patients (11.7%) experienced a post-operative complication with a Clavien-Dindo score ≥ 2. Two patients (3.5%) had an anastomotic leak. The mean ± SD number of harvested lymph nodes was of 22.4 ± 7.6. All patients had negative pathological margins (R0 resection). To conclude, robotic RHC is a safe procedure, which can be implemented with satisfying peri- and post-operative outcomes. The potential benefits of the technique remain to be demonstrated by randomized controlled trials
Comment on : Intracorporeal Versus Extracorporeal Anastomosis in Robotic Right Colectomy : A Multicenter, Triple-Blind, Randomized Clinical Trial
No full textComment on : Dohrn N, Yikilmaz H, Laursen M, Khesrawi F, Clausen FB, Sørensen F, Jakobsen HL, Brisling S, Lykke J, Eriksen JR, Klein MF, Gögenur I. Intracorporeal Versus Extracorporeal Anastomosis in Robotic Right Colectomy: A Multicenter, Triple-blind, Randomized Clinical Trial. Ann Surg. 2022 Nov 1;276(5):e294-e301. doi: 10.1097/SLA.0000000000005254
Tras los «pasos perdidos» de la memoria del homo lector: Viaggio a Salamanca de Raffaele Nigro: un viaje a la humanidad
No full text[ES] Homo viator y homo loquens son experiencias antropológicas originarias. Se viaja para narrar y se narra para viajar. Se asedia la palabra, se la atesora, para luego diseminarla. El viaje que Raffaele Nigro, autor y protagonista de la novela Viaggio a Salamanca, realiza es un viaje a la semilla de lo literario, al omphalos de las letras que es la Universidad de Salamanca para inscribir este signo y escribir su propio periplo en la escritura y en la definición de su entidad como homo lector.
A partir de tres núcleos interpretativos: viaje a la ciudad-biblioteca, viaje a la palabra y viaje a la humanidad, en el presente trabajo se intenta analizar cómo, a través de complejas formulaciones intertextuales que tienen como hipotexto al homónimo cuento borgeano, Unamuno y a las tradiciones que le son más caras, Nigro construye la magnífica instancia de un Congreso mundial de las Letras como excusa para entramar, en compleja mise en abyme, realidad y ficción, «precursores» y lecturas, autores, personajes y lectores, en una apuesta de fe a las posibilidades que la literatura y sus imaginerías, todavía es capaz de brindar.[EN] Homo viator and homo loquens are original anthropological experiences. One travels to narrate and one narrates to travel. One besieges the word, one treasures it up, to disseminate it later. The Travel that Raffaele Nigro -the author and protagonist of the novel Viaggio a Salamanca— makes, is a travel to the seed of the literary, to the omphalos of the Letters which is the Universidad de Salamanca so as to inscribe this sign and to write his own periplus in the writing and in the definition of his entity as an homo lector.
Starting from three interpretative nuclei: a travel to Salamanca, a travel to the word, and a travel to humanity, this paper tries to analyze how, through complex intertextual formulations having as an hypotext the homonym borgean tale, Unamuno and the traditions that are more dear to him, Nigro builds the magnificient instance of a worlwide Congress of Letters as an excuse to frame, in a complex mise en abyme, reality and fiction, «forerunners» and readings, authors, characters and readers, thus putting his faith in the possibilities that literature and its imagineries are still capable of offering
Quando crolla un’istituzione. Il corpo ufficiali della monarchia borbonica attraverso e oltre il 1860
No full textThe essay deals with one of the most controversial moments of contemporary Italian history: the downfall of the Kingdom of the Two Sicilies in 1860, and the partial co-optation of its élites by the new Italian nation-state. The issue is addressed through the prism of the Neapolitan military institution. Overcoming the traditional representation of the Neapolitan officer corps, the author outlines the social, professional and ideological features of the men who fought Garibaldi during the crucial year 1860. The analysis of a huge prosopographic database allowed to retrace the choices and the strategies carried out by the Neapolitan officers during and after the collapse of their institution. In the end, the author proposes a fresh interpretation of the engagement of the Neapolitan officers in the subsequent Italian history
Quando crolla un’istituzione. Il corpo ufficiali della monarchia borbonica attraverso e oltre il 1860.
No full textThe essay deals with one of the most controversial moments of contemporary Italian history: the downfall of the Kingdom of the Two Sicilies in 1860, and the partial co-optation of its élites by the new Italian nation-state. The issue is addressed through the prism of the Neapolitan military institution. Overcoming the traditional representation of the Neapolitan officer corps, the author outlines the social, professional and ideological features of the men who fought Garibaldi during the crucial year 1860. The analysis of a huge prosopographic database allowed to retrace the choices and the strategies carried out by the Neapolitan officers during and after the collapse of their institution. In the end, the author proposes a fresh interpretation of the engagement of the Neapolitan officers in the subsequent Italian history
Migración, autoficción y autotraducción en Cruzando el río en bicicleta de Ana Cecilia Prenz Kopušar
No full textTres países, tres ciudades, tres culturas y tres lenguas se entraman en esta opera prima de Cecilia Prenz. Nacida en Belgrado, autoidentificada como argentina y residente en Trieste. La novela, escrita primero en español y publicada en 2015 en Argentina, ha sido reeditada en versión italiana (autotraducida por la autora) por una editorial independiente de Trieste. Los dos productos,leídos comparativamente, permiten indagar aspectos que involucran la experiencia de la migración (o exilio con algunas variantes interpretativas personales) de la autora y de su familia, de la autoficción y la autotraducción y al mismo tiempo, el particular proceso de concientización de la propia identidad, terminada de configurar a través del memorial creativo.
Migration, Autofiction and Self-Translation in Cruzando el río en bicicleta by Ana Cecilia Prenz KopušarThree countries, three cities, three cultures and three languages are intertwined in Cecilia Prenz’s first work. Born in Belgrado, self-identified as Argentinean and resident in Trieste. The novel, first written in Spanish and published in Argentina in 2015, has been reissued in an Italian version (self-translated by the writer) by an independent publisher from Trieste. The two products, comparatively read, allow to investigate aspects that involve the author and her family’s experience of migration (or exile with some personal interpretative variations), of autofiction and of self-translation and, at the same time, the unique process ofawareness of the own identity, configured completely through the creative memorial.
Migrazione, autofinzione e autotraduzione in Cruzando el río en bicicleta di Ana Cecilia Prenz KopušarTre paesi, tre città, tre culture e tre lingue s’intrecciano in questo esordio di Cecilia Prenz. Nata a Belgrado, auto-identificata come argentina, vive a Trieste. Il romanzo, scritto in spagnolo e pubblicato prima nel 2015 in Argentina, è stato ristampato in versione italiana (autotradotta) da parte di un editore indipendente di Trieste. I due volumi, letti comparativamente, permettono di indagare gli aspetti che coinvolgono l’esperienza della migrazione (o esilio con alcune varianti interpretative personali) dell’autrice e della sua famiglia, dell’autofinzione, dell’auto-traduzione e, allo stesso tempo, il particolare processo di consapevolezza della propria identità, la cui configurazione ultima avviene attraverso il memoriale creativo
A comprehensive step‐by‐step approach for total robotic right hemicolectomy with intracorporeal anastomosis: A Video Vignette
No full textPredictors for selective flexure mobilization during robotic anterior resection for rectal cancer: a prospective cohort analysis
No full textIntroduction: Splenic flexure mobilization (SFM) may be indicated during anterior resection to provide a tension-free anastomosis. However, to date, no score allows identifying patients who may benefit from SFM.
Methods: Patients who underwent robotic anterior resection for rectal cancer were identified from a prospective register. Demographic and cancer-related variables were extracted, and predictors of SFM were identified using regression models. Thereafter, 20 patients with SFM and 20 patients without SFM were randomly selected and their pre-operative CTscan were reviewed. The radiological index was defined as 1/(sigmoid length/pelvis depth). The optimal cut-off value for predicting SFM was identified using ROC curve analysis.
Results: Five hundred and twenty-four patients were included. SFM was performed in 121 patients (27.8%) and increased operative time by 21.8 min (95% CI: 11.3 to 32.4, p < 0.001). The incidence of postoperative complications did not differ between patient with or without SFM. Realization of an anastomosis was the main predictor for SFM (OR: 42.4, 95% CI: 5.8 to 308.5, p < 0.001). In patients with colorectal anastomosis, both sigmoid length (15 ± 5.1 cm versus 24.2 ± 80.9 cm, p < 0.001) and radiological index (1 ± 0.3 versus 0.6 ± 0.2, p < 0.001) differed between patients who had SFM and patients who did not. ROC curve analysis of the radiological index indicated an optimal cut-off value of 0.8 (sensitivity: 75%, specificity: 90%).
Conclusion: SFM was performed in 27.8% of patients who underwent robotic anterior resection, and increased operative time by 21.8 min. For optimal surgical planning, patients requiring SFM can be identified based on pre-operative CT using the index 1/(sigmoid length/pelvis depth) with a cut-off value set at 0.8.</p
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