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3. Ergonomics in the operating room and surgical training: a survey on the Italian scenario

Author

Stefano Restaino, Marco D’Indinosante, Federica Perelli, Martina Arcieri, Vittorio Cherchi, Marco Petrillo, Anna Franca Cavaliere, Stefano Cianci, Giulia Pellecchia, Roberto Luca Meniconi, Alessandro Coppola, Vito Chiantera, Giovanni Scambia, Lorenza Driul, Giuseppe Vizzielli, SPIGC Working Group, Berton Federico, Conti Luigi, Formisano Giampaolo, Guaitoli Eleonora, Iossa Angelo, Maruccia Michele, Mazzari Andrea, Oragano Luigi, Pasculli Alessandro, Ratti Francesca, Serenari Matteo, Settembrini Alberto, Sirignano Pasqualino, Soriero Domenico, Vallicelli Carlo, Cianci (Sicilia) Stefano, Iaco (Puglia) Giulia De, Falcone (Campania) Francesca, Giaccari (Triveneto) Sara, Giovenzana (Lombardia) Marco, Pasqui (Toscana) Edoardo, Petrillo (Sardegna) Marco, Portigliotti (Piemonte) Luca, Sena (Calabria) Giuseppe, Sparavigna (Liguria) Marco, Bettini Giordana, Fanello Gianfranco, Mendogni Paolo, Monteleone Lorenzo, Pertile Nicoletta Pia Ardò Davide, Tomaiuolo Pasquina, Negrello Sara, Di Bartolomeo Mattia, Patini Romeo, Vito Marcuzzo Alberto, Campione Alberto, Comacchio Giovanni, Murana Giacomo, Antonio Martino, Manitto Mattia, Galzerano Giuseppe, Di Marco Carlo, Velluti Francesco, Berardi Gianmauro, Romboli Andrea, Weindelmejer Jacopo, Tamburrino Domenico, Calarco Alessandro, Losco Luigi, Nacchiero Eleonora, Elia Rossella, Torto Federico Lo, Vicenti Giovanni, Pappalardo Vincenzo, Pisani Dafne, Palmisano Graziano, Brascia Debora, Troisi Luigi, Renzi Federica, Melandro Fabio, Pecere Silvia, Gazia Carlo, Di Franco Gregorio, Romano Gaetano, Bolletta Alberto, Botteri Emanuele, Di Meo Giovanna, Ronsini Carlo, Chiappetta Sonia, Sgaramella Ilaria, Pennestri Francesco, Girardi Antonella, Mariniello Donatella, Marcasciano Marco, Telegrafo Michele, Fragomeni Simona, Paoli Francesca De, Bogani Giorgio, Gueli Alletti Salvatore, Pedone Anchora Luigi, Della Corte Luigi, Piovano Elisa, Borghese Martina, Taliento Cristina, Raimondo Diego, Raffone Antonio, Casarin Jvan, Perrone Emanuele, Stabile Guglielmo, and Capozzi Vito

Subjects
surgery, ergonomic, gyne and obstetrics, operatory room, survey, Public aspects of medicine, RA1-1270
Abstract

IntroductionSurgical-related injuries are frequent, in fact the reported percentage of musculoskeletal disorders in surgeons is between 47% and 87%. These conditions are caused by long periods of standing, incorrect postures, repeated movements, little rest between operations, the lack of integrated operator rooms, the correct number and arrangement of monitors and the use of non-ergonomic instruments. This survey aims to assess the Italian overview both highlighting how prevalent surgical-related injury is in our surgeons and whether there is an operating room ergonomics education program in Italian surgical specialty schools.MethodsAn anonymous questionnaire was designed through SurveyMonkey© web application. This survey was composed of 3 different sections concerning the general characteristics of the participants, their surgical background and any training performed, and any injuries or ailments related to the surgical activity. The survey was carried out in the period 1th of December 2022 and the 6th of February 2023.ResultsAt the close of our survey, 300 responses were collected. Among the participants, the two most represented specialties were Gynecology and Obstetrics (42.3%) and General Surgery (39.7%) and surgeons were mainly employed in the Northern regions of Italy (54.8%). Analyzing the participants’ background, 61.7% of the respondents had laparoscopic training during their training and only 53.1% had a pelvic trainer during their residency. In accordance with 98.7% of the respondents, during surgery we have the feeling of being in an uncomfortable position that causes discomfort or muscle pain, and regarding the frequency of these discomforts, the majority of our study population experiences these problems monthly (46.2%), while in 29.6% it is experienced weekly, 12.1% annually and finally 12.1% daily. The surgical approach that is most correlated with these disorders is laparoscopy (62.7%) while the one that causes the least discomfort is robotic surgery (1.4%). These discomforts cause 43.9% of our population to take a break or do short exercises to reduce pain during surgery, and the body areas most affected are the back (61.6%), neck (40.6%) and shoulders (37.8%).ConclusionDespite this, our survey allows us to highlight some now-known gaps present in the surgical training program of our schools and the lack of protection toward our surgeons during their long career.

Published
2024
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13. Similar outcome of tricuspid valve repair and replacement for isolated tricuspid infective endocarditis

Author

Di Mauro, Michele, Bonalumi, Giorgia, Giambuzzi, Ilaria, Dato, Guglielmo Mario Actis, Centofanti, Paolo, Corte, Alessandro Della, Ratta, Ester Della, Cugola, Diego, Merlo, Maurizio, Santini, Francesco, Salsano, Antonio, Rinaldi, Mauro, Mancuso, Samuel, Cappabianca, Giangiuseppe, Beghi, Cesare, De Vincentiis, Carlo, Biondi, Andrea, Livi, Ugolino, Sponga, Sandro, Pacini, Davide, Murana, Giacomo, Scrofani, Roberto, Antona, Carlo, Cagnoni, Giovanni, Nicolini, Francesco, Benassi, Filippo, De Bonis, Michele, Pozzoli, Alberto, Pano, Marco, Nicolardi, Salvatore, Falcetta, Giosuè, Colli, Andrea, Musumeci, Francesco, Gherli, Riccardo, Vizzardi, Enrico, Salvador, Loris, Picichè, Marco, Paparella, Domenico, Margari, Vito, Troise, Giovanni, Villa, Emmanuel, Dossena, Yudit, Lucarelli, Carla, Onorati, Francesco, Faggian, Giuseppe, Mariscalco, Giovanni, Maselli, Daniele, Barili, Fabio, Parolari, Alessandro, and Lorusso, Roberto

Published
2022
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27. Frozen elephant trunk technique using hybrid grafts: 15-year outcomes from a single-centre experience.

Author

Murana, Giacomo, Gliozzi, Gregorio, Marco, Luca Di, Campanini, Francesco, Snaidero, Silvia, Nocera, Chiara, Rucci, Paola, Barberio, Giuseppe, Leone, Alessandro, Lovato, Luigi, and Pacini, Davide

Subjects
*ENDOVASCULAR aneurysm repair, *ELEPHANTS, *LOG-rank test
Abstract

Open in new tab Download slide OBJECTIVES The purpose of the study is to compare the short- and long-term outcomes of the frozen elephant trunk (FET) technique based on 2 different hybrid grafts implanted from January 2007 to July 2022. METHODS The study includes patients who underwent an elective or emergency FET procedure. Short-term, long-term mortality and freedom from thoracic endovascular aortic repair (TEVAR) were the primary end points. Analyses were carried out separately for the periods 2007–2012 and 2013–2022 RESULTS Of the 367 enrolled, 49.3% received E-Vita Open implantation and 50.7% received Thoraflex Hybrid implants. Overall mean age was 61 years [standard deviation (SD) = 11] and 80.7% were male. The average annual volume of FET procedures was 22.7 cases/year. Compared to E-Vita Open, patients implanted with Thoraflex Hybrid grafts were more likely to receive distal anastomosis in zone 2 (68.3% vs 11.6%, P  < 0.001) with a shorter stent portion, mean = 103mm (SD = 11.3) vs mean = 149 mm (SD = 12.7; P  < 0.001) and they underwent a reduced visceral ischaemia time, mean = 42.5 (SD = 14.2) vs mean= 61.0 (SD = 20.2) min, P  < 0.001. In the period 2013–2022, overall survival at 1, 2 and 5 years was 74.8%, 72.5% and 63.2% for Thoraflex and 73.2%, 70.7% and 64.1% for E-Vita, without significant differences between groups (log-rank test = 0.01, P  = 0.907). Overall freedom from TEVAR at 1, 2 and 5 years was 66.7%, 57.6% and 39.3% for Thoraflex and 79%, 69.7% and 66% for E-Vita, with significant differences between groups (log-rank test = 5.28, P  = 0.029). In a competing risk analysis adjusted for chronic/residual aortic syndromes and stent diameter, the Thoraflex group was more likely to receive TEVAR during follow-up (subdistribution hazard ratio SHR = 2.12, 95% confidence interval 1.06–4.22). CONCLUSIONS The FET technique addresses acute and chronic arch disease with acceptable morbidity and mortality. Downstream endovascular reinterventions are very common during follow-up. [ABSTRACT FROM AUTHOR]

Published
2024
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37. Surgical and endovascular treatment of late postcoarctation repair aortic aneurysms: Results from an international multicenter study

Author

Melissano, Germano, primary, Canaud, Ludovic, additional, Pacini, Davide, additional, Bilman, Victor, additional, Erben, Young, additional, Oo, Aung Ye, additional, Riambau, Vicente, additional, Pedro, Luís Mendes, additional, Oderich, Gustavo S., additional, Estrera, Anthony L., additional, Velayudhan, Bashi, additional, Tsilimparis, Nikolaos, additional, Black, James H., additional, Verzini, Fabio, additional, Azizzadeh, Ali, additional, Czerny, Martin, additional, Pochettino, Alberto, additional, Nobre, Ângelo Lucas, additional, de la Cruz, Kim I., additional, Sanvito, Francesca, additional, Rinaldi, Enrico, additional, Loschi, Diletta, additional, Lovato, Luigi, additional, Murana, Giacomo, additional, Pham, Si, additional, Cangut, Busra, additional, Lopez-Marco, Ana, additional, Vigliotti, Rossella Chiara, additional, Garrido, Pedro, additional, Guerra, Nuno, additional, Fernandes, Ruy, additional, Sandhu, Harleen K., additional, Lima, Guilherme Baumgardt Barbosa, additional, Idhrees, Mohammed, additional, Benfor, Bright, additional, Gibello, Lorenzo, additional, Berger, Tim, additional, and Chiesa, Roberto, additional

Published
2022
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38. BioGlue® is not associated with polypropylene suture breakage after aortic surgery

Author

Pacini, Davide, Murana, Giacomo, Hollinworth, David, Northrup, William F., Arnold, Stacy G., Di Bartolomeo, Roberto, Pacini D., Murana G., Hollinworth D., Northrup W.F., Arnold S.G., and Di Bartolomeo R.

Subjects
cardiovascular surgery, in vitro testing, suture breakage, Surgery, ®, aortic anastomosi, BioGlue, polypropylene suture
Abstract

ObjectiveWe have encountered broken or damaged polypropylene sutures (Prolene®) at the anastomotic sites during aortic reoperations. Because a surgical sealant, bovine serum albumin-glutaraldehyde (BioGlue®), was used in previous aortic surgery in some of these cases, we undertook this in vitro study to evaluate whether the use of BioGlue® was associated with breakage of polypropylene sutures at the aortic anastomosis.Materials and methodsThe broken polypropylene sutures, anastomotic sites and aortic tissue at the location of suture breakage were visually inspected and evaluated intraoperatively. Six human cadaveric aortic samples were incised circumferentially and anastomosed proximally to a valved conduit with running 4–0 polypropylene sutures (Prolene®). In the test group (n = 3), BioGlue® was applied directly to the Prolene® sutures at the anastomotic sites, while in the control group (n = 3) the anastomoses were not sealed with any surgical adhesive. The six samples were immersed in Dulbecco's phosphate buffered saline solution and mounted on a M-6 Six Position Heart Valve Durability Testing System and tested up to 120 million cycles for a 2-year period. During and upon completion of the testing, the integrity of Prolene® sutures, the anastomosis and aortic tissues was regularly assessed by visual inspection.ResultsIntraoperative findings included a stretched and thin aortic wall (some with thrombus), a small cleft between the aortic tissue and the Dacron vascular graft. An excessive amount of BioGlue® was often found around the anastomosis, with cracking material, but no signs of mechanical damage were observed in these cases. Upon visual inspection during and after in vitro testing, there was no apparent damage to the polypropylene sutures on the interior or exterior of the aortic anastomoses in any of the samples. No difference was observed in the physical integrity of the polypropylene sutures at anastomotic lines, the anastomoses and aortic tissues between the test and control samples.ConclusionsThe results of this study suggest that the use of BioGlue® was not associated with breakage of the polypropylene sutures at the anastomotic sites after aortic dissection repair.

Published
2022

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