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1.
Dig Dis Sci ; 68(3): 913-921, 2023 03.
Artículo en Inglés | MEDLINE | ID: mdl-35796855

RESUMEN

INTRODUCTION: Growing evidence supports the role of the intestinal microbiome in the development of different intestinal and extraintestinal diseases. Diverticular disease (DD) is one of the most common disorders in western countries. In the last years, different articles have suggested a possible role of the intestinal microbiome in DD pathogenesis and in the development of acute diverticulitis (AD). This systematic review aimed to clarify the current knowledge on the role of the intestinal microbiome in colonic diverticulitis in different stages according to the 2009 PRISMA guidelines. MATERIALS AND METHODS: Two independent reviewers searched the literature in a systematic manner through online databases, including Medline, Scopus, Embase, Cochrane Oral Health Group Specialized Register, ProQuest Dissertations and Theses Database, and Google Scholar. Patients with any stage of disease were included. The Newcastle-Ottawa scale for case-control and cohort studies was used for the quality assessment of the selected articles. RESULTS: Overall, nine studies were included in the review. Only one article was focused on patients with AD, while all other articles only considered patients with DD without acute inflammation signs. Enterobacteriaceae seems to be the microbiota most associated with the disease, followed by Bifidobacteria. CONCLUSIONS: All the included studies showed great heterogeneity in population characteristics and sampling methods. Therefore, given the high prevalence of colonic diverticulitis in the general population, further studies are needed to clarify the role of the intestinal microbiome, paving the way to new target therapies with important social implications.


Asunto(s)
Enfermedades Diverticulares , Diverticulitis del Colon , Diverticulitis , Microbioma Gastrointestinal , Humanos , Enfermedades Diverticulares/etiología , Diverticulitis/epidemiología , Intestinos
2.
Int J Med Robot ; 18(4): e2391, 2022 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-35277927

RESUMEN

BACKGROUND: Ilio-inguinal lymphadenectomy for stage III melanoma and skin cancers still represents the best therapeutic option for a subset of patients, although the incidence of post-operative complications is dramatically high. Only a paucity of papers on robotic approach have been published, reporting experiences on isolated pelvic or inguinal lymphadenectomy, and no series on combined dissections have been described yet. We present the preliminary results achieved with combined robotic approach, with special emphasis on lymph nodal mapping, dissection technique and postoperative complications linked with the lymphatic system. METHODS: Between September 2019 and September 2021, 10 patients were submitted to robotic inguinal and iliac-obturator lymphadenectomy. RESULTS: Post-operative course was characterised by early mobilisation and minimal post-operative pain. Only one lymphoedema occurred and lymph nodal harvesting was more than satisfactory. CONCLUSIONS: Robotic surgery provides meticulous lymph nodal dissections, with promising functional and oncologic outcomes. Further series are advocated to confirm these preliminary results.


Asunto(s)
Melanoma , Procedimientos Quirúrgicos Robotizados , Neoplasias Cutáneas , Humanos , Escisión del Ganglio Linfático/métodos , Metástasis Linfática , Melanoma/etiología , Melanoma/cirugía , Complicaciones Posoperatorias/etiología , Procedimientos Quirúrgicos Robotizados/métodos , Neoplasias Cutáneas/etiología , Neoplasias Cutáneas/cirugía
3.
ANZ J Surg ; 91(9): E554-E560, 2021 09.
Artículo en Inglés | MEDLINE | ID: mdl-34180567

RESUMEN

BACKGROUND: Laparoscopic cholecystectomy is one of the most performed surgeries worldwide but its learning curve is still unclear. METHODS: A systematic review was conducted according to the 2009 Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Two independent reviewers searched the literature in a systematic manner through online databases, including Medline, Scopus, Embase, and Google Scholar. Human studies investigating the learning curve of laparoscopic cholecystectomy were included. The Newcastle-Ottawa scale for cohort studies and the GRADE scale were used for the quality assessment of the selected articles. RESULTS: Nine cohort studies published between 1991 and 2020 were included. All studies showed a great heterogeneity among the considered variables. Seven articles (77.7%) assessed intraoperative variables only, without considering patient's characteristics, operator's experience, and grade of gallbladder inflammation. Only five articles (55%) provided a precise cut-off value to see proficiency in the learning curve, ranging from 13 to 200 laparoscopic cholecystectomies. CONCLUSIONS: The lack of clear guidelines when evaluating the learning curve in surgery, probably contributed to the divergent data and heterogeneous results among the studies. The development of guidelines for the investigation and reporting of a surgical learning curve would be helpful to obtain more objective and reliable data especially for common operation such as laparoscopic cholecystectomy.


Asunto(s)
Colecistectomía Laparoscópica , Humanos , Curva de Aprendizaje
4.
Surg Oncol ; 37: 101524, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-33556883

RESUMEN

BACKGROUND AND OBJECTIVES: Colorectal cancer is still one of the leading causes of cancer-related deaths worldwide and specific tools to improve disease assessment and treatment response are advocated. The aim of this study was to analyze miRNAs expression in metastatic and non-metastatic colorectal cancer, in order to identify reliable biomarkers suitable for prognosis, treatment and patient's monitoring. MATERIAL AND METHODS: Among 25 patients (mean age 71 ± 12 years; Female/Male: 12/13) submitted to laparoscopic colorectal resection between August 2017 and February 2019, miRNAs were extracted from fresh frozen tissues of solid tumors. Gene expression's analysis arising from microarray technology was performed. RESULTS: Pathological evaluation identified 15 metastatic patients (8 presenting with stage III and 7 with stage IV cancers) and 10 non-metastatic patients (4 presenting with stage I and 6 stage II cancers). Bioinformatic analysis of solid biopsies revealed 16 miRNAs (11 upregulated and 5 downregulated) differently expressed between metastatic and non-metastatic groups, with three miRNAs (miR-7515, miR-7109-5p and miR-6831-5p) never linked to colorectal cancer before. CONCLUSIONS: Our study showed an association between miRNAs and metastatic colorectal cancer, suggesting their potential role as biomarkers for tumor management, if confirmed by further studies.


Asunto(s)
Biomarcadores de Tumor/genética , Neoplasias Colorrectales/genética , MicroARNs/genética , Metástasis de la Neoplasia/genética , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores de Tumor/análisis , Neoplasias Colorrectales/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Metástasis de la Neoplasia/patología , Proyectos Piloto , Estudios Prospectivos
5.
Surg Technol Int ; 36: 23-28, 2020 May 28.
Artículo en Inglés | MEDLINE | ID: mdl-32359170

RESUMEN

BACKGROUND: Despite being widely adopted, the laparoscopic approach to radical and partial nephrectomy is still burdened by high rates of hemorrhagic complications, which require blood transfusions and conversion to open surgery with increased morbidity. While pre-operative renal artery embolization (PRAE) can prevent intraoperative blood loss and vascular injuries, its prophylactic use is still a matter of debate. This study evaluated the safety and efficacy of PRAE in overcoming the main pitfalls of laparoscopy, which are related to the absence of tactile feedback. METHODS: Data from 48 patients who underwent laparoscopic nephrectomy for cancer (34 laparoscopic radical nephrectomy (LRN) and 14 "off-clamp" laparoscopic partial nephrectomy (LPN) after selective and superselective PRAE, respectively) were retrospectively evaluated. RESULTS: The overall median blood loss was 50 ml and only 2 patients (4%) required one unit of blood products. While conversion to open surgery was not required in the LPN group, one case in the LRN group was converted to open surgery due to intraoperative incoercible bleeding from an unrecognized, and thus not embolized, aberrant inferior polar artery. Post-embolization syndrome occurred in 7 patients (15%), resulting in mild flank pain and nausea. No patients in the LPN group experienced new onset of acute renal failure. CONCLUSION: Our experience supports pre-operative renal embolization as a safe, minimally invasive procedure that is effective for reducing perioperative bleeding in the laparoscopic setting.


Asunto(s)
Neoplasias Renales , Laparoscopía , Humanos , Neoplasias Renales/cirugía , Nefrectomía , Arteria Renal , Estudios Retrospectivos , Resultado del Tratamiento
6.
Surg Technol Int ; 34: 129-133, 2019 May 15.
Artículo en Inglés | MEDLINE | ID: mdl-31037715

RESUMEN

INTRODUCTION: Needlescopic cholecystectomy (NC) was introduced in the late 1990s. It uses a reduced trocar caliber in an otherwise standard four-port laparoscopic cholecystectomy (LC) and seeks to achieve "scarless" surgery without compromising patient safety. MATERIALS AND METHODS: Between May 2016 and November 2017, 29 patients underwent elective NC at the Department of General Surgery of Sant'Andrea Hospital (La Spezia, Italy). Inclusion criteria were female sex, age between 18 and 45 years, good performance status (ASA 1-2) and BMI lower than 25. Twenty-one patients underwent a standard 4-port technique: 12mm port in the supraumbilical area, 5mm port in the subxiphoid position, 3mm port in the mid-epigastric area and another 3 mm port in the right mid-clavicular position. In 8 patients, 3mm ports were replaced by 2mm angiocath. A Critical View of Safety (CVS) was achieved in all procedures. Intra-operative cholangiography (IOC) via the cystic duct before any transection of the structures was routinely performed in selected cases, such as those with an unclear biliary anatomy or risk factors for main-duct stones. In our institution, laparoscopic transcystic common bile duct (CBD) exploration is routinely performed in CBD lithiasis. RESULTS: The mean operative time was 66.79 min (range 25-120 min). IOC was performed in 12 patients (41.4%) with suspected choledocolythiasis. There was no conversion to conventional laparoscopic cholecystectomy or open cholecystectomy. The mean hospital stay was 1.48 days (1-7 days). A Clavien-Dindo IIIB complication occurred in one patient on the third postoperative day. The mean VAS pain score was 3 (0-7). Closure of the skin with primary intention was achieved in all patients. Mean return to work was 6.76 days (3-15 days) and the mean return to previous physical activity was 12.17 days (4-30 days). All of the patients completed the Scar Satisfaction Questionnaire: 26 (89.7% ) and 3 patients (10.3%) were very satisfied and satisfied, respectively. CONCLUSION: Any effort to reduce invasiveness and improve cosmesis must not jeopardize safety. Our case series demonstrates that needlescopy can be safely associated with intraoperative cholangiography to recognize CBD stones. This technique offers the advantage of minor postoperative pain, better cosmesis results, early return to routine life activities and great satisfaction for the patient. Needlescopy is a valuable and safe alternative that is suitable for elective cholecystectomy in properly selected patients, such as young female patients.


Asunto(s)
Colecistectomía Laparoscópica/instrumentación , Colecistectomía Laparoscópica/métodos , Adolescente , Adulto , Colangiografía/métodos , Coledocolitiasis/cirugía , Técnicas Cosméticas/instrumentación , Femenino , Humanos , Cuidados Intraoperatorios , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/instrumentación , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Adulto Joven
7.
Surg Endosc ; 32(12): 4772-4779, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-29770883

RESUMEN

OBJECTIVE: In this study, we aim to assess the impact of tumor size on clinical and oncological outcomes in patients undergoing laparoscopic liver resection (LLR) for hepatocellular carcinoma (HCC). BACKGROUND: LLR has been shown to be feasible, safe, and oncologically efficient. However, it has been slow to develop in patients with HCC who often suffer from chronic liver disease which represents an additional challenge for the surgeon. The experience with large HCCs is even more limited. METHODS: Between 2003 and 2016, 172 patients from two high-volume liver surgery centers underwent LLR for HCC. Prospectively collected data were analyzed after stratification in 3 groups according to tumor major diameter (group 1: < 3 cm; group 2: between 3 and 5 cm; group 3: ≥ 5 cm). Perioperative and long-term outcomes were compared between the three groups and sub-analyses were carried out on the extent and location of the resections. RESULTS: Groups 1, 2, and 3 consisted of 82, 52, and 38 patients, respectively. Minor and major resections were performed in 98.8% and 1.2% in group 1, in 90.4% and 9.6% in group 2, and in 68.4% and 31.6% in group 3, respectively. Postero-superior "technically major" resections were performed in 15.8% patients in group 1, in 19.2% in group 2, and in 15.8% in group 3, respectively. Group 3 had higher conversion rates (p < 0.001), more frequent (p = 0.056) and more prolonged (p = 0,075) pedicle clamping and longer operative time (p < 0.001), higher blood losses (p = 0.025), and longer total hospital and intensive care unit stays. These differences ceased after removing the major resections from the study population, except for the postoperative length of stay. There were no differences in morbidity, mortality, completeness of resection rates, and long-term outcomes between the three groups. CONCLUSION: LLR for HCC appears to be safe and oncologically efficient when performed in high-volume HPB and laparoscopic centers. Tumor size does not appear to impact negatively on the outcomes except for postoperative hospital stay.


Asunto(s)
Carcinoma Hepatocelular , Hepatectomía , Laparoscopía , Neoplasias Hepáticas , Anciano , Carcinoma Hepatocelular/patología , Carcinoma Hepatocelular/cirugía , Femenino , Hepatectomía/efectos adversos , Hepatectomía/métodos , Humanos , Italia , Laparoscopía/efectos adversos , Laparoscopía/métodos , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/cirugía , Efectos Adversos a Largo Plazo , Masculino , Persona de Mediana Edad , Evaluación de Procesos y Resultados en Atención de Salud , Estudios Retrospectivos , Carga Tumoral , Reino Unido
9.
Surg Endosc ; 31(3): 1354-1360, 2017 03.
Artículo en Inglés | MEDLINE | ID: mdl-27444829

RESUMEN

BACKGROUND: For the treatment of both primary and metastatic liver tumors, laparoscopic parenchyma-sparing surgery is advocated to reduce postoperative liver failure and facilitate reoperation in the case of recurrence. However, atypical and wedge resections are associated with a higher amount of intraoperative bleeding than are anatomical resections, and such bleeding is known to affect short- and long-term outcomes. Beyond the established role of radiofrequency and microwave ablation in the setting of inoperable liver tumors, the application of thermoablative energy along the plane of the liver surface to be transected results in a zone of coagulative necrosis, possibly minimizing bleeding of the cut liver surface during parenchymal transection. METHODS: From January 2013 to March 2016, a total of 20 selected patients underwent laparoscopic ultrasound-guided liver resection with thermoablative precoagulation of the transection line. RESULTS: During a period of 38 months, 50 laparoscopic thermoablative procedures were performed. Colorectal liver metastases were the most frequent diagnosis. Seventy-two percent of the nodules were removed using parenchymal transection with radiofrequency-precoagulation, while microwave-precoagulation was performed for 20 % of the resected nodules. The remaining 8 % of the nodules were treated by thermoablation alone. The hepatic pedicle was intermittently clamped in six patients. The mean blood loss was 290 mL, and four patients required perioperative transfusions. CONCLUSIONS: Precoagulation-assisted parenchyma-sparing laparoscopic liver surgery can get minimal blood loss during parenchymal transection and lower the need for perioperative transfusions, providing a nonquantifiable margin of oncological safety on the remaining liver. Additional results from larger series are advocated to confirm these preliminary data.


Asunto(s)
Electrocoagulación , Hepatectomía/métodos , Laparoscopía , Neoplasias Hepáticas/irrigación sanguínea , Neoplasias Hepáticas/cirugía , Anciano , Anciano de 80 o más Años , Pérdida de Sangre Quirúrgica/prevención & control , Femenino , Humanos , Neoplasias Hepáticas/diagnóstico por imagen , Masculino , Microondas/uso terapéutico , Persona de Mediana Edad , Ultrasonografía Intervencional
10.
World J Surg ; 40(11): 2790-2795, 2016 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-27334448

RESUMEN

BACKGROUND: In sigmoid cancer, both inferior mesenteric artery high or low ligations are accepted for curative purposes. Since inferior mesenteric artery ligation could compromise blood flow to the anastomosis, potentially increasing anastomotic leakage onset, real oncological benefits and possible disadvantages related to vascular transection level are still on debate. We introduce totally laparoscopic inferior mesenteric artery peeling technique to release from the concept of lymph nodal harvesting linked to arterial transection level. METHODS: Over a period of 24 months, 31 patients presenting with sigmoid cancer were submitted to laparoscopic sigmoidectomy associated with inferior mesenteric artery peeling. Data on intraoperative and postoperative outcomes have been prospectively collected. RESULTS: Mean operative time was 180 min (range 110-330 min); mean intraoperative blood loss was 60 ml (range 30-150 ml), and mean postoperative hospitalization was 6.2 days (range 4-11 days). Mean number of lymph node harvested was 16.7 (range 12-28). CONCLUSIONS: Given a proper selection of patients, laparoscopic sigmoidectomy comprehensive of sub-adventitial IMA skeletonization from its aortic origin could provide good oncological outcomes and recanalization rate. Further data are advocated to confirm these preliminary results.


Asunto(s)
Laparoscopía , Arteria Mesentérica Inferior/cirugía , Neoplasias del Colon Sigmoide/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Pérdida de Sangre Quirúrgica , Femenino , Humanos , Escisión del Ganglio Linfático , Masculino , Persona de Mediana Edad , Tempo Operativo , Proyectos Piloto , Estudios Prospectivos
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