Background and aimIn presence of malignant dysphagia, in patients unfit for surgery, the placemen... more Background and aimIn presence of malignant dysphagia, in patients unfit for surgery, the placement of a self‐expandable metal stent (SEMS) represents a safe and effective palliative treatment. Esophageal stents (ES) present an over‐the‐wire mechanism where the stent is deployed under X‐ray control. Recently a through‐the‐scope (TTS) ES was launched. The aim of our retrospective study is to assess the technical and clinical success of the new TTS‐ES.Materials and methodsPatients with malignant dysphagia caused by esophageal cancer or ab‐extrinsic compression, who underwent TTS esophageal stent in six Italian endoscopic referral centers, were retrospectively reviewed.ResultsA total of 40 patients were enrolled. TTS stent placement was successful in 39/40 patients (97.5%). 31 patients had an Ogilvie score of 4, nine an Ogilvie 3. After 2 weeks from stent placement 29 reported Ogilvie score of 0, eight a score of 1. None of the patients developed retrosternal pain requiring drugs. No pa...
Endoscopic Follow-up of Digestive Anastomosis, 2014
After esophagectomy, the surgical defect is reconstructed to form an esophageal conduit to mainta... more After esophagectomy, the surgical defect is reconstructed to form an esophageal conduit to maintain the continuity of digestive tract. The reconstruction requires the transposition of stomach (gastric pull-up), intestinal graft, or musculocutaneous graft to replace the esophagus. Despite continuous refinements over decades, this technique is still associated with high risk of graft-related complications such as necrosis, leakage, fistula, strictures, or impaction. Local recurrence of primary esophageal cancer and development of metachronous cancers in the remnant esophagus are constant risks for neoplastic patients undergoing esophagectomy. Failure to detect these complications during follow-up may lead to severe or even fatal outcomes. Therefore, a rigorous postoperative surveillance is always justified. Being a safe tool with versatile diagnostic and therapeutic utilities, endoscopy deserves a central role in the physician’s armamentarium in the postoperative management of esophageal reconstruction.
International Journal of Advanced Robotic Systems, 2015
In this paper a simple but effective measuring system for endoluminal procedures is presented. Th... more In this paper a simple but effective measuring system for endoluminal procedures is presented. The device allows measuring forces during the endoluminal manipulation of tissues with a standard surgical instrument for laparoscopic procedures. The force measurement is performed by recording both the forces applied directly by the surgeon at the instrument handle and the reaction forces on the access port. The measuring system was used to measure the forces necessary for appropriate surgical manipulation of tissues during transanal endoscopic microsurgery (TEM). Ex-vivo and in-vivo measurements were performed, reported and discussed. The obtained data can be used for developing and appropriately dimensioning novel dedicated instrumentation for TEM procedures.
Most patients with hemorrhoidal disease may be treated conservatively Along the years several sur... more Most patients with hemorrhoidal disease may be treated conservatively Along the years several surgical options have been proposed. including closed open and semiclosed hemorrhoidectomy (HC), radiofrequency HC (LigaSure), piles' suture or Farag operation, manual and stapled haemorrhoidopexy (PPH) with or without excision of anal tags, doppler hemorrhoidal artery ligation with or without recto-anal mucopexy ano-mucosal flap circumferential HC or Whitehead-Rand procedure. Randomized prospective trials and metanalyses have been carried out with the aim of finding the gold standard operation. When carried out for advanced disease, HC appears to be more effective than PPH, which achieves good results in third degree, but carries high reintervention rate in fourth degree piles. Almost all trials comparing open and closed HC show similar outcomes. None of the costly innovations appears to be superior when compared with conventional procedures in terms of cure of the disease in the long ...
The advent of endoscopic techniques changed surgery in many regards. This paper intends to descri... more The advent of endoscopic techniques changed surgery in many regards. This paper intends to describe an overview about technologies to facilitate endoscopic surgery. The systems described have been developed for the use in general surgery, but an easy application also in other fields of endoscopic surgery seems realistic. The introduction of system technology and robotic technology enables today to design a highly ergonomic solo-surgery platform. This consists of a system of devices for endoscopic surgery (HF, light source, etc...) with which the surgeon interacts directly, positioning systems for optic and instruments that the surgeon drives as the likes without assistance, and a chair to increase the comfort of the surgeon during surgery. The system of endoscopic devices named OREST (Dornier, München) designed already in 1992 opened the way to a number of systems available today that allow to the surgeon a direct control of the instrumentation. A considerable step ahead in endoscop...
Endoscopic surgery has acquired undisputed importance in the field of both general and specialise... more Endoscopic surgery has acquired undisputed importance in the field of both general and specialised surgery. The introduction of robotic technology in surgery has recently led to the development of new positioning systems for endoscopic surgery. These allow direct control of the endoscopic procedures by the surgeon, whose vision currently depends on the assistant in charge of positioning the optic camera in compliance with his wishes. We experimented different positioning systems for optics and rigid endoscopic instruments for laparoscopy, some of which were our own design. Over 400 cholecystectomies were carried out by six different surgeons on phantoms containing animal organs. The experimental systems were AESOP (Computer Motion, USA), with both foot-pedal and voice control, ENDOASSIST (Armstrong Healthcare Co. UK), controlled by a device worn by the surgeon, FIPS Endoarm (Karlsruhe Research Centre, Germany), controlled by a joystick and voice, and the passive TISKA Endoarm system...
Reducing the number of ports used to perform laparoscopic cholecystectomy (LC) is indicated as me... more Reducing the number of ports used to perform laparoscopic cholecystectomy (LC) is indicated as means of further minimising postoperative pain, allowing a rapid return to activity and work, and obtaining patient satisfaction and better cosmetic results. It is still debatable whether the three-port technique is comparably safe. Since 2001, 374 consecutive patients underwent laparoscopic cholecystectomy in elective and emergency surgery. Three ports were routinely positioned and the need for a fourth cannula was evaluated during the surgical procedure. Of the 374 consecutive cholecystectomies performed, 204 were completed with three ports and 161 needed a fourth port to be completed, while 9 required conversion to laparotomy. Patients who were operated on with just three ports were significantly younger and mostly female. Complications of procedures completed with three ports were negligible and those of procedures completed with four ports were in line with the recent literature. Our ...
Fondements et buts de l'etude : La chirurgie d'urgence en presence d'une occlusion in... more Fondements et buts de l'etude : La chirurgie d'urgence en presence d'une occlusion intestinale aigue est grevee d'un taux significativement plus eleve de complications moderees et serieuses pouvant aller jusqu'a la mort du patient. Les trois differentes options qui s'offrent au chirurgien sont l'operation d'Hartmann, la colectomie subtotale et la resection anastomose immediate apres lavage sur table ; ces trois possibilites presentent un certain nombre d'inconvenients. L'usage en clinique de stents metalliques autos expansibles represente une alternative valable dans le traitement de l'occlusion aigue du colon par cancer. Materiel et methodes : Les patients avec une obstruction par cancer du colon gauche qui remplissent les criteres de l'etude sont assignes de facon randomisee dans l'un des deux groupes de traitement ainsi definis : A/mise en place en urgence d'un stent metallique auto expansible suivi par une resection elective de la tumeur par voie ouverte ou coelioscopique. B/chirurgie d'urgence qu'il s'agisse de la procedure d'Hartmann par resection suivie de la colostomie, resection anastomose immediate apres vidange "Wash-out" sur table, ou colectomie subtotale. Le critere principal d'evaluation est l'incidence des complications dans les deux groupes. Les criteres secondaires sont le pourcentage de reussite de la mise en place des stents en urgence, le pourcentage de complications rapportees a la mise en place des stents, les differences de duree du sejour hospitalier, duree et qualite de vie, differences de couts, resultats oncologiques. Resultats : Dans les etudes prospectives analysees dans differents centres, l'indice des complications, postoperatoires chez les patients qui furent soumis a la chirurgie colique d'urgence est environ 35%, alors que la morbidite pour la mise en place d'un stent suivie d'une chirurgie elective dans 2° temps est d'environ 15% (5% pour le stent et 10% pour la chirurgie). Si la difference se confirmait, le nombre des patients necessaires pour rendre la difference statistiquement significative dans l'etude est de 72 patients dans chaque groupe. Conclusion : Cette etude clinique randomisee a pour but d'evaluer si la mise en place d'un stent dans l'intention de passerelle pour la chirurgie "bridge-to-surgery", suivie par une chirurgie elective est superieure a un traitement chirurgical d'urgence chez les patients en occlusion aigue par un cancer colique. Les resultats esperes consistent en une reduction des complications postoperatoires et du sejour hospitalier chez les patients soumis a la mise en place d'un stent et ceci sans aggravation de l'evolution de la maladie neoplasique.
Background and aimIn presence of malignant dysphagia, in patients unfit for surgery, the placemen... more Background and aimIn presence of malignant dysphagia, in patients unfit for surgery, the placement of a self‐expandable metal stent (SEMS) represents a safe and effective palliative treatment. Esophageal stents (ES) present an over‐the‐wire mechanism where the stent is deployed under X‐ray control. Recently a through‐the‐scope (TTS) ES was launched. The aim of our retrospective study is to assess the technical and clinical success of the new TTS‐ES.Materials and methodsPatients with malignant dysphagia caused by esophageal cancer or ab‐extrinsic compression, who underwent TTS esophageal stent in six Italian endoscopic referral centers, were retrospectively reviewed.ResultsA total of 40 patients were enrolled. TTS stent placement was successful in 39/40 patients (97.5%). 31 patients had an Ogilvie score of 4, nine an Ogilvie 3. After 2 weeks from stent placement 29 reported Ogilvie score of 0, eight a score of 1. None of the patients developed retrosternal pain requiring drugs. No pa...
Endoscopic Follow-up of Digestive Anastomosis, 2014
After esophagectomy, the surgical defect is reconstructed to form an esophageal conduit to mainta... more After esophagectomy, the surgical defect is reconstructed to form an esophageal conduit to maintain the continuity of digestive tract. The reconstruction requires the transposition of stomach (gastric pull-up), intestinal graft, or musculocutaneous graft to replace the esophagus. Despite continuous refinements over decades, this technique is still associated with high risk of graft-related complications such as necrosis, leakage, fistula, strictures, or impaction. Local recurrence of primary esophageal cancer and development of metachronous cancers in the remnant esophagus are constant risks for neoplastic patients undergoing esophagectomy. Failure to detect these complications during follow-up may lead to severe or even fatal outcomes. Therefore, a rigorous postoperative surveillance is always justified. Being a safe tool with versatile diagnostic and therapeutic utilities, endoscopy deserves a central role in the physician’s armamentarium in the postoperative management of esophageal reconstruction.
International Journal of Advanced Robotic Systems, 2015
In this paper a simple but effective measuring system for endoluminal procedures is presented. Th... more In this paper a simple but effective measuring system for endoluminal procedures is presented. The device allows measuring forces during the endoluminal manipulation of tissues with a standard surgical instrument for laparoscopic procedures. The force measurement is performed by recording both the forces applied directly by the surgeon at the instrument handle and the reaction forces on the access port. The measuring system was used to measure the forces necessary for appropriate surgical manipulation of tissues during transanal endoscopic microsurgery (TEM). Ex-vivo and in-vivo measurements were performed, reported and discussed. The obtained data can be used for developing and appropriately dimensioning novel dedicated instrumentation for TEM procedures.
Most patients with hemorrhoidal disease may be treated conservatively Along the years several sur... more Most patients with hemorrhoidal disease may be treated conservatively Along the years several surgical options have been proposed. including closed open and semiclosed hemorrhoidectomy (HC), radiofrequency HC (LigaSure), piles' suture or Farag operation, manual and stapled haemorrhoidopexy (PPH) with or without excision of anal tags, doppler hemorrhoidal artery ligation with or without recto-anal mucopexy ano-mucosal flap circumferential HC or Whitehead-Rand procedure. Randomized prospective trials and metanalyses have been carried out with the aim of finding the gold standard operation. When carried out for advanced disease, HC appears to be more effective than PPH, which achieves good results in third degree, but carries high reintervention rate in fourth degree piles. Almost all trials comparing open and closed HC show similar outcomes. None of the costly innovations appears to be superior when compared with conventional procedures in terms of cure of the disease in the long ...
The advent of endoscopic techniques changed surgery in many regards. This paper intends to descri... more The advent of endoscopic techniques changed surgery in many regards. This paper intends to describe an overview about technologies to facilitate endoscopic surgery. The systems described have been developed for the use in general surgery, but an easy application also in other fields of endoscopic surgery seems realistic. The introduction of system technology and robotic technology enables today to design a highly ergonomic solo-surgery platform. This consists of a system of devices for endoscopic surgery (HF, light source, etc...) with which the surgeon interacts directly, positioning systems for optic and instruments that the surgeon drives as the likes without assistance, and a chair to increase the comfort of the surgeon during surgery. The system of endoscopic devices named OREST (Dornier, München) designed already in 1992 opened the way to a number of systems available today that allow to the surgeon a direct control of the instrumentation. A considerable step ahead in endoscop...
Endoscopic surgery has acquired undisputed importance in the field of both general and specialise... more Endoscopic surgery has acquired undisputed importance in the field of both general and specialised surgery. The introduction of robotic technology in surgery has recently led to the development of new positioning systems for endoscopic surgery. These allow direct control of the endoscopic procedures by the surgeon, whose vision currently depends on the assistant in charge of positioning the optic camera in compliance with his wishes. We experimented different positioning systems for optics and rigid endoscopic instruments for laparoscopy, some of which were our own design. Over 400 cholecystectomies were carried out by six different surgeons on phantoms containing animal organs. The experimental systems were AESOP (Computer Motion, USA), with both foot-pedal and voice control, ENDOASSIST (Armstrong Healthcare Co. UK), controlled by a device worn by the surgeon, FIPS Endoarm (Karlsruhe Research Centre, Germany), controlled by a joystick and voice, and the passive TISKA Endoarm system...
Reducing the number of ports used to perform laparoscopic cholecystectomy (LC) is indicated as me... more Reducing the number of ports used to perform laparoscopic cholecystectomy (LC) is indicated as means of further minimising postoperative pain, allowing a rapid return to activity and work, and obtaining patient satisfaction and better cosmetic results. It is still debatable whether the three-port technique is comparably safe. Since 2001, 374 consecutive patients underwent laparoscopic cholecystectomy in elective and emergency surgery. Three ports were routinely positioned and the need for a fourth cannula was evaluated during the surgical procedure. Of the 374 consecutive cholecystectomies performed, 204 were completed with three ports and 161 needed a fourth port to be completed, while 9 required conversion to laparotomy. Patients who were operated on with just three ports were significantly younger and mostly female. Complications of procedures completed with three ports were negligible and those of procedures completed with four ports were in line with the recent literature. Our ...
Fondements et buts de l'etude : La chirurgie d'urgence en presence d'une occlusion in... more Fondements et buts de l'etude : La chirurgie d'urgence en presence d'une occlusion intestinale aigue est grevee d'un taux significativement plus eleve de complications moderees et serieuses pouvant aller jusqu'a la mort du patient. Les trois differentes options qui s'offrent au chirurgien sont l'operation d'Hartmann, la colectomie subtotale et la resection anastomose immediate apres lavage sur table ; ces trois possibilites presentent un certain nombre d'inconvenients. L'usage en clinique de stents metalliques autos expansibles represente une alternative valable dans le traitement de l'occlusion aigue du colon par cancer. Materiel et methodes : Les patients avec une obstruction par cancer du colon gauche qui remplissent les criteres de l'etude sont assignes de facon randomisee dans l'un des deux groupes de traitement ainsi definis : A/mise en place en urgence d'un stent metallique auto expansible suivi par une resection elective de la tumeur par voie ouverte ou coelioscopique. B/chirurgie d'urgence qu'il s'agisse de la procedure d'Hartmann par resection suivie de la colostomie, resection anastomose immediate apres vidange "Wash-out" sur table, ou colectomie subtotale. Le critere principal d'evaluation est l'incidence des complications dans les deux groupes. Les criteres secondaires sont le pourcentage de reussite de la mise en place des stents en urgence, le pourcentage de complications rapportees a la mise en place des stents, les differences de duree du sejour hospitalier, duree et qualite de vie, differences de couts, resultats oncologiques. Resultats : Dans les etudes prospectives analysees dans differents centres, l'indice des complications, postoperatoires chez les patients qui furent soumis a la chirurgie colique d'urgence est environ 35%, alors que la morbidite pour la mise en place d'un stent suivie d'une chirurgie elective dans 2° temps est d'environ 15% (5% pour le stent et 10% pour la chirurgie). Si la difference se confirmait, le nombre des patients necessaires pour rendre la difference statistiquement significative dans l'etude est de 72 patients dans chaque groupe. Conclusion : Cette etude clinique randomisee a pour but d'evaluer si la mise en place d'un stent dans l'intention de passerelle pour la chirurgie "bridge-to-surgery", suivie par une chirurgie elective est superieure a un traitement chirurgical d'urgence chez les patients en occlusion aigue par un cancer colique. Les resultats esperes consistent en une reduction des complications postoperatoires et du sejour hospitalier chez les patients soumis a la mise en place d'un stent et ceci sans aggravation de l'evolution de la maladie neoplasique.
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