274 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
Intraoperative predictors of in-hospital mortality after open repair of ruptured abdominal aortic aneurysms
No full textBackground: Several models and scores have been released to predict early mortality in patients undergoing surgery for a ruptured abdominal aortic aneurysm (rAAA). These scores included above all preoperative factors and they could be useful to deny surgical repair. The aim of the study was to evaluate intraoperative predictors of in-hospital mortality in patients undergoing open surgical repair (OSR) for a rAAA. Methods: Between January 2007 and December 2020, 265 patients were admitted at our tertiary referral hospital for a rAAA. Two-hundred-twenty-two patients underwent OSR. Intra-operative factors were analyzed by means of univariate analysis (step 1). Associations of procedure variables with in-hospital mortality rates were sought based on a multivariate Cox regression analysis (step 2). Results: Overall, in-hospital mortality rate was 28.8% (64 cases). Multivariate Cox regression analysis reported that operation time >240 minutes (P=0.032, OR 2.155, CI 95% 1.068-4.349), and hemoperitoneum (P<0.001, OR 3.582, CI 95% 1.749-7.335) were negative predictive factors for in-hospital mortality. Patency of at least one hypogastric artery (P=0.010; OR 0.128, CI 95% 0.271-0.609), and infrarenal clamping (P=0.001; OR 0.157, CI 95% 0.052-0.483) had a protective role in reducing in-hospital mortality rate. Conclusions: Operation time >240 minutes, and hemoperitoneum affected in-hospital mortality in patients undergoing OSR for rAAA. Patency of at least one hypogastric artery, and infrarenal clamping had a protective role. Further studies are needed to validate these outcomes. A validated predictive model could be useful to help the physicians in communication with patients' relatives. (Cite this article as: Troisi N, Bertagna G, Saratzis A, Guadagni S, Minichilli F, Adami D, et al. Intraopera-tive predictors of in-hospital mortality after open repair of ruptured abdominal aortic aneurysms. Int Angiol 2023;42:310-7. DOI: 10.23736/S0392-9590.23.04941-6
Considerations on "Impact of ABO-incompatibility on hepatocellular carcinoma recurrence after living donor liver transplantation"
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Da Vinci single site© surgical platform in clinical practice: A systematic review
No full textBackground: The Da Vinci single-site © surgical platform (DVSSP) is a set of single-site instruments and accessories specifically dedicated to robot-assisted single-site surgery. Methods: The PubMed database from inception to June 2015 was searched for English literature on the clinical use of DVSSP in general surgery, urology and gynecology. Results: Twenty-nine articles involving the clinical application of DVSSP were identified; 15 articles on general surgery (561 procedures), four articles on urology (48 procedures) and 10 articles on gynecology (212 procedures). All studies have proven the safety and feasibility of the use of DVSSP. The principal reported advantage is the restoration of intra-abdominal triangulation, while the main reported limitation is the lack of the endowrist. Conclusions: Da Vinci systems have proven to be valuable assets in single-site surgery, owing to the combination of robot use with the dedicated single-incision platform. However, case-control or prospective trials are warranted to draw more definitive conc lusions
High-Intensity Focused Ultrasonography and Radiofrequency Ablation of Renal Cell Carcinoma Arisen in Transplanted Kidneys: Single-Center Experience With Long-Term Follow-Up and Review of Literature
No full textThe purpose of this article is to retrospectively evaluate the long-term outcome of patients treated with percutaneous thermoablation for renal cell carcinomas that have arisen in kidney grafts. Between April 2008 and February 2011, we treated 3 patients with renal cell carcinoma on a transplanted kidney: 2 cases were treated with high-intensity focused ultrasonography and 1 patient with radio frequency ablation. Postprocedural ultrasonography did not reveal any complications, and contrast-enhanced ultrasonography showed an avascular area in the treated nodules. None of the patients had recurrent tumors during a long-term clinical and radiologic follow-up (81, 73, and 43 months, respectively)
Laparoscopia 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
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