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1. Augmented reality (AR) in minimally invasive surgery (MIS) training: where are we now in Italy? The Italian Society of Endoscopic Surgery (SICE) ARMIS survey

Author

Balla, Andrea, Sartori, Alberto, Botteri, Emanuele, Podda, Mauro, Ortenzi, Monica, Silecchia, Gianfranco, Guerrieri, Mario, Agresta, Ferdinando, Antonino, Agrusa, Daniele, Aguzzi, Mariantonietta, Alagia, Laura, Alberici, Marco Ettore Allaix, Luisa, Ambrosio, Alfonso, Amendola, Michele, Ammendola, Pietro Maria Amodio, Gabriele, Anania, Jacopo, Andreuccetti, Alfredo, Annichiarico, Pietro, Anoldo, Alessandro, Anselmo, Giovanni, Aprea, Giacomo, Arcuri, Alberto, Arezzo, Giulia, Armatura, Giulia, Bagaglini, Francesco, Bagolini, Beatrice, Bailetti, Gianluca, Baiocchi, Edoardo, Baldini, Elisa, Bannone, Mirko, Barone, Gianluca, Baronio, Raffaele, Basile, Bellucci, Marco, Andrea Benedetti Cacciaguerra, Ilaria, Benzoni, Francesco, Bianco, Giuseppe, Boccia, Cristina, Bombardini, Luigi, Boni, Dario, Bono, Luca Domenico Bonomo, Giulia, Bonventre, Andrea, Bottari, Claudio, Botti, Giacomo, Brentegani, Mattia, Buonomo, Umberto, Bracale, Cosimo, Callari, Luca, Calligaris, Pietro Giorgio Calò, Angelo, Cangiano, Lorenzo, Capezzuoli, Gabriella Teresa Capolupo, Marianna, Capuano, Filippo, Carannante, Eugenia, Cardamone, Teresa, Carfora, Chiara, Caricato, Pietro, Carnevali, Francesco Maria Carrano, Lorenzo, Casali, Gianmaria Casoni Pataccini, Gianluca, Cassese, Simone, Castiglioni, Flavia, Cavicchi, Ceccarelli, Graziano, Giovanni, Cestaro, Pasquale, Cianci, Claudio, Cimmino, Marco, Clementi, Coletta, Diego, Riccardo, Conventi, Corallino, Diletta, Maurizio, Costantini, Lorenzo, Crepaz, Diego, Cuccurullo, Curci, FABIO PIO, Giuseppe, Currò, Giorgio, Dalmonte, Giovanni, D'Alterio, Michele, D'Ambra, D'Ambrosio, Giancarlo, Anna, D'Amore, Michele De Capua, Simona, Deidda, Daniele, Delogu, Maurizio De Luca, Nicolò De Manzini, DE STEFANI, Elena, Giuseppe Di Buono, Marcello Di Martino, DI TOMASO, Anna, Ugo, Elmore, CORDOVA HERENCIA, INGRID ELVA, Giovanni, Emiliani, Sofia, Esposito, Fazio, Federico, Federico, Festa, Marcello, Filotico, Fiocca, Fausto, Irene, Fiume, Francesco, Fleres, Giulia, Fontana, Tommaso, Fontana, Edoardo, Forcignanò, Giampaolo, Formisano, Laura, Fortuna, Uberto Fumagalli Romario, Andrea, Galderisi, Raffaele, Galleano, Carlo, Gazia, Alessio, Giordano, Giorgio, Giraudo, Maria Carmela Giuffrida, Simona, Giura, Anna, Guida, Antonio Maria Iannello, Marco, Inama, Sara, Ingallinella, Iossa, Angelo, Livio, Iudici, Laracca, GIOVANNI GUGLIELMO, LARGHI LAUREIRO, Zoe, Saverio, Latteri, Luca, Leonardi, Pasquale, Lepiane, Edelweiss, Licitra, Paolo, Locurto, Sarah Lo Faso, Nicola, Luciani, Luzza, Luigi, Magaletti, Sara, Michele, Manigrasso, Alessandra, Marano, Francesco, Marchetti, Alessandra, Marello, Nicolò, Mariani, Jacopo Nicolò Marin, Gennaro, Martines, Laura, Mastrangelo, Antonio, Matarangolo, Marco, Materazzo, Mazzarella, Gennaro, Giorgio, Mazzarolo, Maria Paola Menna, Meoli, Francesca, Marco, Milone, Elisabetta, Moggia, Davide, Moioli, Sarah, Molfino, Vitantonio, Mongelli, Roberto, Montalti, Giulia, Montori, Luca, Morelli, Gianluigi, Moretto, Muttillo, EDOARDO MARIA, Irnerio, Muttillo, Francesca, Notte, Alessandro, M Paganini, Gianluca, Pagano, Palmieri, Livia, Giuseppe, Palomba, Valentina, Palumbo, Panetta, Cristina, Giulia, Paradiso, Beniamino, Pascotto, Passannanti, Daniele, Renato, Patrone, Francesca, Pecchini, Francesca, Pego, Fabio, Pelle, Perrotta, Nicola, Wanda, Petz, Biagio, Picardi, Picchetto, Andrea, Chiara, Piceni, Pietricola, Giulia, Enrico, Pinotti, Felice, Pirozzi, Paolo, Pizzini, Poillucci, Gaetano, Ilaria, Puccica, Lorenzo, Ramaci, Rapanotti, Eleonora, Daniela, Rega, Angelica, Reggiani, Giorgio, Romano, Gregorio, Romeo, Luigi, Romeo, Gianluca, Rompianesi, Stefano, Rossi, Edoardo, Saladino, Roberto, Santambrogio, Federica, Saraceno, Giuliano, Sarro, Diego, Sasia, Grazia, Savino, Rosa, Scaramuzzo, Antonio, Sciuto, Michela, Scollica, Giovanni, Scudo, Ardit, Seitaj, Carlo, Serra, Francesco, Serra, Pierpaolo, Sileri, Leandro, Siragusa, Carmen, Sorrentino, Giuseppe, Surfaro, Ernesto, Tartaglia, Beatrice, Torre, Andrea, Tufo, Matteo, Uccelli, Alessandro, Ussia, Vaccari, Samuele, Marina, Valente, Sara, Vertaldi, Alessandro, Vitali, Luca, Zaccherini, Luigi, Zorcolo, Noemi, Zorzetti, Balla, A., Sartori, A., Botteri, E., Podda, M., Ortenzi, M., Silecchia, G., Guerrieri, M., Agresta, F., Agrusa, A., Aguzzi, D., Alagia, M., Alberici, L., Allaix, M. E., Ambrosio, L., Amendola, A., Ammendola, M., Amodio, P. M., Anania, G., Andreuccetti, J., Annichiarico, A., Anoldo, P., Anselmo, A., Aprea, G., Arcuri, G., Arezzo, A., Armatura, G., Bagaglini, G., Bagolini, F., Bailetti, B., Baiocchi, G., Baldini, E., Bannone, E., Barone, M., Baronio, G., Basile, R., Bellucci, M., Cacciaguerra, A. B., Benzoni, I., Bianco, F., Boccia, G., Bombardini, C., Boni, L., Bono, D., Bonomo, L. D., Bonventre, G., Bottari, A., Botti, C., Brentegani, G., Buonomo, M., Bracale, U., Callari, C., Calligaris, L., Calo, P. G., Cangiano, A., Capezzuoli, L., Capolupo, G. T., Capuano, M., Carannante, F., Cardamone, E., Carfora, T., Caricato, C., Carnevali, P., Carrano, F. M., Casali, L., Pataccini, G. C., Cassese, G., Castiglioni, S., Cavicchi, F., Ceccarelli, G., Cestaro, G., Cianci, P., Cimmino, C., Clementi, M., Coletta, D., Conventi, R., Corallino, D., Costantini, M., Crepaz, L., Cuccurullo, D., Curci, F. P., Curro, G., Dalmonte, G., D'Alterio, G., D'Ambra, M., D'Ambrosio, G., D'Amore, A., De Capua, M., Deidda, S., Delogu, D., De Luca, M., De Manzini, N., De Stefani, E., Di Buono, G., Di Martino, M., Di Tomaso, A., Elmore, U., Herencia, I. E. C., Emiliani, G., Esposito, S., Fazio, F., Festa, F., Filotico, M., Fiocca, F., Fiume, I., Fleres, F., Fontana, G., Fontana, T., Forcignano, E., Formisano, G., Fortuna, L., Romario, U. F., Galderisi, A., Galleano, R., Gazia, C., Giordano, A., Giraudo, G., Giuffrida, M. C., Giura, S., Guida, A., Iannello, A. M., Inama, M., Ingallinella, S., Iossa, A., Iudici, L., Laracca, G. G., Laureiro, Z. L., Latteri, S., Leonardi, L., Lepiane, P., Licitra, E., Locurto, P., Faso, S. L., Luciani, N., Luzza, L., Magaletti, S., Manigrasso, M., Marano, A., Marchetti, F., Marello, A., Mariani, N., Marin, J. N., Martines, G., Mastrangelo, L., Matarangolo, A., Materazzo, M., Mazzarella, G., Mazzarolo, G., Menna, M. P., Meoli, F., Milone, M., Moggia, E., Moioli, D., Molfino, S., Mongelli, V., Montalti, R., Montori, G., Morelli, L., Moretto, G., Muttillo, E. M., Muttillo, I., Notte, F., Paganini, A. M., Pagano, G., Palmieri, L., Palomba, G., Palumbo, V., Panetta, C., Paradiso, G., Pascotto, B., Passannanti, D., Patrone, R., Pecchini, F., Pego, F., Pelle, F., Perrotta, N., Petz, W., Picardi, B., Picchetto, A., Piceni, C., Pietricola, G., Pinotti, E., Pirozzi, F., Pizzini, P., Poillucci, G., Puccica, I., Ramaci, L., Rapanotti, E., Rega, D., Reggiani, A., Romano, G., Romeo, G., Romeo, L., Rompianesi, G., Rossi, S., Saladino, E., Santambrogio, R., Saraceno, F., Sarro, G., Sasia, D., Savino, G., Scaramuzzo, R., Sciuto, A., Scollica, M., Scudo, G., Seitaj, A., Serra, C., Serra, F., Sileri, P., Siragusa, L., Sorrentino, C., Surfaro, G., Tartaglia, E., Torre, B., Tufo, A., Uccelli, M., Ussia, A., Vaccari, S., Valente, M., Vertaldi, S., Vitali, A., Zaccherini, L., Zorcolo, L., Zorzetti, N., Balla, Andrea, Sartori, Alberto, Botteri, Emanuele, Podda, Mauro, Ortenzi, Monica, Silecchia, Gianfranco, Guerrieri, Mario, Agresta, Ferdinando, de Manzini, Nicolo, and ARMIS (Augmented Reality in Minimally Invasive Surgery) Collaborative, Group

Subjects
Virtual reality (VR), minimally invasive surgery (MIS), Augmented reality (AR), Minimally invasive surgery (MIS), Mixed reality (MR), Survey, Training, training, augmented reality (AR), mixed reality (MR), survey, virtual reality (VR), Settore MED/18 - Chirurgia Generale, Surgery
Abstract

Minimally invasive surgery (MIS) is a widespread approach in general surgery. Computer guiding software, such as the augmented reality (AR), the virtual reality (VR) and mixed reality (MR), has been proposed to help surgeons during MIS. This study aims to report these technologies' current knowledge and diffusion during surgical training in Italy. A web-based survey was developed under the aegis of the Italian Society of Endoscopic Surgery (SICE). Two hundred and seventeen medical doctors' answers were analyzed. Participants were surgeons (138, 63.6%) and residents in surgery (79, 36.4%). The mean knowledge of the role of the VR, AR and MR in surgery was 4.9 ± 2.4 (range 1-10). Most of the participants (122, 56.2%) did not have experience with any proposed technologies. However, although the lack of experience in this field, the answers about the functioning of the technologies were correct in most cases. Most of the participants answered that VR, AR and MR should be used more frequently for the teaching and training and during the clinical activity (170, 80.3%) and that such technologies would make a significant contribution, especially in training (183, 84.3%) and didactic (156, 71.9%). Finally, the main limitations to the diffusion of these technologies were the insufficient knowledge (182, 83.9%) and costs (175, 80.6%). Based on the present study, in Italy, the knowledge and dissemination of these technologies are still limited. Further studies are required to establish the usefulness of AR, VR and MR in surgical training.

Published
2023

2. Negative pressure wound therapy for prevention of surgical site infection in patients at high risk after clean-contaminated major pancreatic resections: A single-center, phase 3, randomized clinical trial

Author

Claudio Bassi, Massimiliano Tuveri, Livio Iudici, Matteo De Pastena, Antonio Pea, Roberto Salvia, Cecilia Bortolato, Luca Landoni, Gessica Manzini, Giuseppe Malleo, Deborah Bonamini, and Stefano Andrianello

Subjects
Male, medicine.medical_specialty, wound therapy, Visual analogue scale, medicine.medical_treatment, Population, 030230 surgery, Single Center, law.invention, Pancreaticoduodenectomy, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Negative-pressure wound therapy, surgical sites infection, wound therapy, medicine, Humans, Surgical Wound Infection, education, Neoadjuvant therapy, Aged, surgical sites infection, Aged, 80 and over, education.field_of_study, business.industry, Middle Aged, Surgery, 030220 oncology & carcinogenesis, Relative risk, Female, business, Body mass index, Negative-Pressure Wound Therapy
Abstract

Background Surgical site infections are an important burden of pancreatic surgery, prolonging hospitalization and delaying adjuvant treatment. The aim of this study was to compare negative pressure wound therapy with standard sterile dressing in terms of the prevention of non–organ-space surgical site infection (superficial and deep surgical site infection) in the high-risk setting. Methods The trial was conducted at the University of Verona Hospital Trust, Verona, Italy, from July 25, 2018, through October 10, 2019, among adults undergoing surgery for periampullary neoplasms. Only patients at high-risk for surgical site infection based on body mass index, diabetes, steroids, neoadjuvant therapy, American Society of Anesthesiologists score, Charlson comorbidity index, duration of surgery, and blood loss were included and randomized. Results A total of 351 patients were screened, 100 met the inclusion criteria and were 1:1 allocated in the 2 arms. The difference in terms of non–organ-space surgical site infection comparing negative pressure wound therapy with standard sterile dressing was not significant (10.9 vs 12.2%, risk ratio [RR] 1.144, confidence interval [CI] 95% 0.324–4.040, P = 1.000). Hematomas (4.3 vs 2%, RR 1.565, CI 95% 0.312–7.848, P = .609) and organ-space infections (46.7 vs 43.8%, RR 1.059, CI 95% 0.711–1.576, P = .836) were similar. Negative pressure wound therapy prevented the development of seromas (0 vs 12.2%, RR 0.483, CI 95% 0.390–0.599, P = .027). The aesthetic result assessed on postoperative day 7 was better in the negative pressure wound therapy group (visual analogue scale, 8 vs 7, P = .029; Stony Brook Scar Evaluation Scale, 3.2 vs 2.5, P = .009), but it was no more evident on postoperative day 30 after a total number of 23 dropouts. Conclusion Compared with standard sterile dressing, negative pressure wound therapy is not associated with an improved rate of non–organ-space surgical site infection after surgery for periampullary neoplasms in patients at high risk for surgical site infection. Additional studies will help identify the population that could benefit most from this intervention.

Published
2020

3. Prognostic Value of Perineural Invasion in Resected Gastric Cancer Patients According to Lauren Histotype

Author

Giulio Di Mare, Lorenzo Giacinto De Franco, Franco Roviello, Daniele Marrelli, Livio Iudici, Mario Marini, Carla Vindigni, Costantino Voglino, and Francesco Ferrara

Subjects
Male, Cancer Research, medicine.medical_specialty, Pathology, Lymphovascular invasion, medicine.medical_treatment, Perineural invasion, Kaplan-Meier Estimate, Adenocarcinoma, Prognostic factors, Gastroenterology, Disease-Free Survival, Extended lymphadenectomy, Pathology and Forensic Medicine, Gastric cancer, Lauren histotype, Aged, Cohort Studies, Female, Humans, Middle Aged, Neoplasm Invasiveness, Neoplasm Staging, Peripheral Nerves, Prognosis, Proportional Hazards Models, Retrospective Studies, Stomach Neoplasms, 2734, Oncology, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Medicine, Survival analysis, Univariate analysis, Proportional hazards model, business.industry, Hazard ratio, Cancer, General Medicine, medicine.disease, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Lymphadenectomy, business
Abstract

The purpose of this study is to investigate perineural invasion (PNI) as a prognostic factor in gastric cancer patients. 455 patients submitted to extended (D2 or more) lymphadenectomy (median number of 39 retrieved lymph nodes, range: 15-140) between 1995 and 2012 were retrospectively studied. Patients were categorized in two groups according to the PNI status, and PNI positivity was assessed in presence of cancer cells in the perinerium or the neural fascicles using hematoxylin and eosin staining. Median follow-up for surviving patients was 80.3 months. Survival analysis was performed by univariate and multivariate analysis, using a Cox proportional hazards model. 162 patients (33.9%) had positive PNI; this was strongly associated with advanced stages of disease, residual tumor, lymphovascular invasion, Lauren diffuse-mixed histotype and tumor size. Five-year cancer-related survival was 65,7% and 20,6% in PNI negative vs. positive groups, respectively (p

Published
2017
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4. Lymphadenectomy: state of the art

Author

Lorenzo Giacinto De Franco, Karol Polom, Livio Iudici, Daniele Marrelli, and Franco Roviello

Subjects
medicine.medical_specialty, medicine.medical_treatment, D2 lymphadenectomy, D2 plus lymphadenectomy, Gastric cancer (GC), Long-term survival, Morbidity, Mortality, Postoperative complications, Gastroenterology, Hepatology, Review Article, 030230 surgery, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, medicine, business.industry, Standard treatment, General surgery, Cancer, medicine.disease, Surgery, D2 dissection, Survival benefit, 030220 oncology & carcinogenesis, Observational study, Lymphadenectomy, business
Abstract

The extent of lymphadenectomy in gastric cancer (GC) surgery has been for long time a matter of debate. Randomized trials performed in the West reported worse results of D2 dissection, in terms of postoperative complications and long-term survival benefit, than Eastern series and observational studies from specialized Western centers. However, long-term re-evaluation of such trials and in depth-analysis of other experiences demonstrated the potential benefit of D2 in reducing the probability of cancer-related death and the safety of this procedure when avoiding unnecessary spleno-pancreatectomy and in centers with ad adequate surgical volume. Nowadays, the D2 is considered the standard treatment in most guidelines all over the world. More limited procedures (D1, D1 plus) may be adequate in selected cases, and more extended dissections (D2 plus) could be indicated in advanced forms with high risk of metastases to distant nodes, but in specialized centers or in the setting of clinical studies. The integration with neoadjuvant therapies and multimodality approach could offer a chance of cure in groups of patients with poor results when approached with standard treatment.

Published
2017

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