1,721,254 research outputs found
The role of three-dimensional imaging reconstruction in complex mininvasive liver resections
No full textBackground: Parenchyma-saving liver surgery, calculation of the future liver remnant (FLR) and surgical technique improve minimally invasive liver surgery (MILS). 3D rendering (3DR) allows surgical planning, ameliorating intraoperative lesions identification and their relationship with vasculo-biliary structures. Methods: Between November 2019 and July 2021, 246 liver resections were carried out. Patients eligible for a preoperative 3DR (lesion multifocality or large dimensions; proximity, encasement, or invasion of critical vasculo-biliary structures; patients with increased surgical risk; planning of parenchyma-sparing resections; and substantial vasculo-biliary variations) underwent a 0.5 or 1 mm-thick tri-phasic abdominal CT scan at our Centre. Preoperative 3DR was performed in 82 (33.3%) cases, which were compared to 106 non-3DR patients through a propensity score matching (PSM) analysis for age, gender, ASA score, BMI, indication, neoadjuvant chemotherapy, previous abdominal surgery, previous hepatectomies, type of surgery, postero-superior segments, number and total size of the lesions (≥ 5 cm). Results: Amongst all 82 3DR, 28 patients (37.0%) underwent preoperative changes of the original surgical plan: 14 concerned surgical access, anatomic variations, middle hepatic vein management, and preservation/resection of liver portions; 9 patients were excluded from surgical treatment (due to disease extension, FLR insufficiency, and/or patients with high surgical risk), and 5 received a new surgical indication. 3DR patients underwent a laparoscopic (54.8%), open (34.2%), or robotic approach (11%). Nodules ≥ 5 cm were more common in 3DR group (69.4% vs. 38.7%, p = 0.003) but no differences in the number of repeat hepatectomy (p = 0.109), type of resection (p = 0.162), number of PS resections (p = 0.118), and number of nodules (p = 0.131) was found. After PSM analysis, we identified 32 cases in each group. The conversion rate (12.5% vs. 18.7%, p = 0.731) and blood loss (450 cc vs. 425 cc, p = 0.568) were similar. Blood transfusion (31.3% vs. 43.8%, p = 0.439), R1 vascular (12.5% vs. 31.3%, p = 0.129), incidence of Clavien-Dindo complications ≥ 3 (3.1% vs. 12.5%, p = 0.355), and length of stay (4.5 vs. 5 days, p = 0.545) resulted slightly improved in the 3DR group, although statistically not significant. Operative time (450 min vs. 425 min, p = 0.013) was significantly increased in 3DR group. Conclusions: 3DR in MILS has the potential to improve perioperative parameters, refine surgical strategy and allow a safe intraoperative change in surgical strategy leading to a more conservative approach while removing more liver lesions
Comment on "development and Validation of a Nomogram to Preoperatively Estimate Post-hepatectomy Liver Dysfunction Risk and Long-term Survival in Patients with Hepatocellular Carcinoma": A "minimally Invasive" Step Forward
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Reply to: “Nomogram to predict surgical hepatocellular carcinoma with Child-Pugh B: Feasibility and overlooked predictors”
No full textRobotic liver resection of caudate lobe with 3-D rendering and intraoperative ICG-fluorescence for giant hemangioma
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Organizational Features in the Management of Infrastructure Safety
Full text linkThe topic dealing with the infrastructure safety is one of the most relevant arguments in the governance of a geographical area where many structural systems have been built over time. Indeed, many structural systems often present safety or functionality critical issues and specific interventions are required to prevent undesirable social consequences. In this context, the stakeholders, i.e., public or private actors and institutions, are strongly involved in both the economic and administrative procedures. This contribution preliminarily provides some enhancements to improve the management of the infrastructures safety. Specifically, analyzing an Italian case study, the study proposes to adopt the remote sensing through satellite-based sensor technologies for an analysis at territorial scale. In this way, the territorial point of view on the critical issues affecting the infrastructures leads to involve the stakeholders to attain a wider degree of organization in the governance and management processes
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