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Article: Robotic Intraoperative Tracheobronchial Repair during Minimally Invasive 3-Stage Esophagectomy.

Marano, Alessandra / Palagi, Silvia / Pellegrino, Luca / Borghi, Felice

Journal of chest surgery

2020 Volume 54, Issue 2, Page(s) 154–157

Abstract: Tracheobronchial injury (TBI) is an uncommon but potentially fatal event. Iatrogenic lesions during bronchoscopy, endotracheal intubation, or thoracic surgery are considered the most common causes of TBI. When TBI is detected during surgery, concomitant ... ...

Abstract	Tracheobronchial injury (TBI) is an uncommon but potentially fatal event. Iatrogenic lesions during bronchoscopy, endotracheal intubation, or thoracic surgery are considered the most common causes of TBI. When TBI is detected during surgery, concomitant surgical treatment is recommended. Herein we present a case of successful robotic primary repair of iatrogenic tracheal and left bronchial branch tears during a robot-assisted hybrid 3-stage esophagectomy after neoadjuvant chemoradiotherapy. A robotic approach can facilitate the repair of this injury while reducing both the potential risk of conversion to open surgery and the associated increased risk of postoperative respiratory complications.
Language	English
Publishing date	2020-10-28
Document type	Case Reports
ISSN	2765-1606
ISSN	2765-1606
DOI	10.5090/jcs.20.055
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Article: Post-pregnancy recurrent biliary colic with intraoperative diagnosis of limy bile syndrome.

Migliore, Marco / Giraudo, Giorgio / Gianotti, Laura / Testa, Valentina / Borghi, Felice

International journal of surgery case reports

2021 Volume 83, Page(s) 105976

Abstract: Introduction: Limy bile syndrome (LBS) is an unusual condition in which gallbladder and/or bile ducts are filled with paste-like radiopaque material with a high calcium carbonate content. It can be rarely associated with PTH disorder and hypercalcemia.!# ...

Abstract	Introduction: Limy bile syndrome (LBS) is an unusual condition in which gallbladder and/or bile ducts are filled with paste-like radiopaque material with a high calcium carbonate content. It can be rarely associated with PTH disorder and hypercalcemia. Presentation of case: A 35-year-old woman presented with epigastric and right hypochondrium pain since a few hours. Similar attacks occurred in the past months soon after a pregnancy with vaginal delivery. Laboratory findings were not significant. The abdominal ultrasound highlighted a micro-lithiasis of gallbladder without complications. Considering the recurrent biliary attacks, laparoscopic cholecystectomy was performed with intraoperative diagnosis of LBS. A subsequent endocrinological screening highlighted a normocalcemic hyperparathyroidism associated with Vitamin D deficiency, likely related to the recent pregnancy and not to LBS. Discussion: LBS is a rare condition with not clear etiology, frequently associated with cholelithiasis, of which it shares clinical presentation and potential complications. Diagnosis of LBS is based on abdominal X-ray/computed tomography scan, or it could be an intraoperative finding. The gold standard treatment is represented by laparoscopic cholecystectomy. The pregnancy with its related cholestatic phenotype could facilitate the LBS manifestation. An endocrinological screening should be performed to rule out a concomitant calcium metabolism disorder. Conclusion: Knowledge of this rare condition could help general surgeons handle it properly.
Language	English
Publishing date	2021-05-13
Publishing country	Netherlands
Document type	Journal Article
ISSN	2210-2612
ISSN	2210-2612
DOI	10.1016/j.ijscr.2021.105976
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Article ; Online: Robot-assisted esophagectomy with robot-sewn intrathoracic anastomosis (Ivor Lewis): surgical technique and early results.

Marano, Alessandra / Salomone, Sara / Pellegrino, Luca / Geretto, Paolo / Robella, Manuela / Borghi, Felice

Updates in surgery

2022 Volume 75, Issue 4, Page(s) 941–952

Abstract: Esophagectomy is the selected treatment for nonmetastatic esophageal and esophagogastric junction cancer, although high perioperative morbidity and mortality incur. Robot-assisted minimally invasive esophagectomy (RAMIE) effectively reduces ... ...

Abstract	Esophagectomy is the selected treatment for nonmetastatic esophageal and esophagogastric junction cancer, although high perioperative morbidity and mortality incur. Robot-assisted minimally invasive esophagectomy (RAMIE) effectively reduces cardiopulmonary complications compared to open esophagectomy and offers a technical advantage, especially for lymph node dissection and intrathoracic anastomosis. This article aims at describing our initial experience of Ivor Lewis RAMIE, focusing on the technique's main steps and robotic-sewn esophagogastrostomy. Prospectively collected data from all consecutive patients who underwent Ivor Lewis RAMIE for cancer was reviewed. Reconstruction was performed with a gastric conduit pull-up and a robotic-sewn intrathoracic anastomosis. Intraoperative and postoperative complications were recorded as prescribed by the Esophagectomy Complications Consensus Group (ECCG). Thirty patients underwent Ivor Lewis RAMIE with complete mediastinal lymph node dissection and robot-sewn anastomosis. No intraoperative complications nor conversion occurred. Pulmonary complications totaled 26.7%. Anastomotic leakage (ECCG, type III) and conduit necrosis (ECCG, type III) both occurred in one patient (3.3%). Chylothorax appeared in 2 patients (6.7%) (ECCG, Type IIA). Anastomotic stricture, successfully treated with endoscopic dilatations, occurred in 8 cases (26.7%). Median overall postoperative stay was 11 days (range, 6-51 days). 30 day and 90 day mortality was 0%. R0 resection was performed in 96.7% of patients with a median number of 47 retrieved lymph nodes. RAMIE with robot-sewn intrathoracic anastomosis appears to be feasible, safe and effective, with favorable perioperative results. Nevertheless, further high-quality studies are needed to define the best anastomotic technique for Ivor Lewis RAMIE.
MeSH term(s)	Humans ; Esophagectomy/methods ; Robotics ; Robotic Surgical Procedures/methods ; Esophageal Neoplasms/pathology ; Retrospective Studies ; Anastomosis, Surgical/methods ; Postoperative Complications/epidemiology ; Postoperative Complications/surgery ; Treatment Outcome
Language	English
Publishing date	2022-12-12
Publishing country	Italy
Document type	Journal Article
ZDB-ID	2572692-4
ISSN	2038-3312 ; 2038-131X
ISSN (online)	2038-3312
ISSN	2038-131X
DOI	10.1007/s13304-022-01439-7
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Article ; Online: Three-row versus two-row circular staplers for left-sided colorectal anastomosis: a propensity score-matched analysis of the iCral 2 and 3 prospective cohorts.

Catarci, Marco / Guadagni, Stefano / Masedu, Francesco / Ruffo, Giacomo / Viola, Massimo G / Borghi, Felice / Baldazzi, Gianandrea / Scatizzi, Marco

International journal of surgery (London, England)

2023 Volume 109, Issue 8, Page(s) 2312–2323

Abstract: Background: Since most anastomoses after left-sided colorectal resections are performed with a circular stapler, any technological change in stapling devices may influence the incidence of anastomotic adverse events. The aim of the present study was to ... ...

Abstract	Background: Since most anastomoses after left-sided colorectal resections are performed with a circular stapler, any technological change in stapling devices may influence the incidence of anastomotic adverse events. The aim of the present study was to analyze the effect of a three-row circular stapler on anastomotic leakage and related morbidity after left-sided colorectal resections. Materials and methods: A circular stapled anastomosis was performed in 4255 (50.9%) out of 8359 patients enrolled in two prospective multicenter studies in Italy, and, after exclusion criteria to reduce heterogeneity, 2799 (65.8%) cases were retrospectively analyzed through a 1:1 propensity score-matching model including 20 covariates relative to patient characteristics, to surgery and to perioperative management. Two well-balanced groups of 425 patients each were obtained: group (A) - true population of interest, anastomosis performed with a three-row circular stapler; group (B) - control population, anastomosis performed with a two-row circular stapler. The target of inferences was the average treatment effect in the treated (ATT). The primary endpoints were overall and major anastomotic leakage and overall anastomotic bleeding; the secondary endpoints were overall and major morbidity and mortality rates. The results of multiple logistic regression analyses for the outcomes, including the 20 covariates selected for matching, were presented as odds ratios (OR) and 95% confidence intervals (95% CI). Results: Group A versus group B showed a significantly lower risk of overall anastomotic leakage (2.1 vs. 6.1%; OR 0.33; 95% CI 0.15-0.73; P =0.006), major anastomotic leakage (2.1 vs. 5.2%; OR 0.39; 95% CI 0.17-0.87; P =0.022), and major morbidity (3.5 vs. 6.6% events; OR 0.47; 95% CI 0.24-0.91; P =0.026). Conclusion: The use of three-row circular staplers independently reduced the risk of anastomotic leakage and related morbidity after left-sided colorectal resection. Twenty-five patients were required to avoid one leakage.
MeSH term(s)	Humans ; Anastomotic Leak/etiology ; Anastomotic Leak/prevention & control ; Anastomotic Leak/surgery ; Retrospective Studies ; Prospective Studies ; Propensity Score ; Anastomosis, Surgical/methods ; Surgical Stapling/adverse effects ; Surgical Stapling/methods ; Colorectal Neoplasms/surgery ; Colorectal Neoplasms/complications
Language	English
Publishing date	2023-08-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	2212038-5
ISSN	1743-9159 ; 1743-9191
ISSN (online)	1743-9159
ISSN	1743-9191
DOI	10.1097/JS9.0000000000000480
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Article: Oral Antibiotics Alone versus Oral Antibiotics Combined with Mechanical Bowel Preparation for Elective Colorectal Surgery: A Propensity Score-Matching Re-Analysis of the iCral 2 and 3 Prospective Cohorts.

Catarci, Marco / Guadagni, Stefano / Masedu, Francesco / Sartelli, Massimo / Montemurro, Leonardo Antonio / Baiocchi, Gian Luca / Tebala, Giovanni Domenico / Borghi, Felice / Marini, Pierluigi / Scatizzi, Marco / The Italian ColoRectal Anastomotic Leakage iCral Study Group

Antibiotics (Basel, Switzerland)

2024 Volume 13, Issue 3

Abstract: The evidence regarding the role of oral antibiotics alone (oA) or combined with mechanical bowel preparation (MoABP) for elective colorectal surgery remains controversial. A prospective database of 8359 colorectal resections gathered over a 32-month ... ...

Abstract	The evidence regarding the role of oral antibiotics alone (oA) or combined with mechanical bowel preparation (MoABP) for elective colorectal surgery remains controversial. A prospective database of 8359 colorectal resections gathered over a 32-month period from 78 Italian surgical units (the iCral 2 and 3 studies), reporting patient-, disease-, and procedure-related variables together with 60-day adverse events, was re-analyzed to identify a subgroup of 1013 cases (12.1%) that received either oA or MoABP. This dataset was analyzed using a 1:1 propensity score-matching model including 20 covariates. Two well-balanced groups of 243 patients each were obtained: group A (oA) and group B (MoABP). The primary endpoints were anastomotic leakage (AL) and surgical site infection (SSI) rates. Group A vs. group B showed a significantly higher AL risk [14 (5.8%) vs. 6 (2.5%) events; OR: 3.77; 95%CI: 1.22-11.67;
Language	English
Publishing date	2024-03-03
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2681345-2
ISSN	2079-6382
ISSN	2079-6382
DOI	10.3390/antibiotics13030235
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Article ; Online: Bowel preparation for elective colorectal resection: multi-treatment machine learning analysis on 6241 cases from a prospective Italian cohort.

Catarci, Marco / Guadagni, Stefano / Masedu, Francesco / Ruffo, Giacomo / Viola, Massimo Giuseppe / Borghi, Felice / Garulli, Gianluca / Pirozzi, Felice / Delrio, Paolo / De Luca, Raffaele / Baldazzi, Gianandrea / Scatizzi, Marco

International journal of colorectal disease

2024 Volume 39, Issue 1, Page(s) 53

Abstract: Background: Current evidence concerning bowel preparation before elective colorectal surgery is still controversial. This study aimed to compare the incidence of anastomotic leakage (AL), surgical site infections (SSIs), and overall morbidity (any ... ...

Abstract	Background: Current evidence concerning bowel preparation before elective colorectal surgery is still controversial. This study aimed to compare the incidence of anastomotic leakage (AL), surgical site infections (SSIs), and overall morbidity (any adverse event, OM) after elective colorectal surgery using four different types of bowel preparation. Methods: A prospective database gathered among 78 Italian surgical centers in two prospective studies, including 6241 patients who underwent elective colorectal resection with anastomosis for malignant or benign disease, was re-analyzed through a multi-treatment machine-learning model considering no bowel preparation (NBP; No. = 3742; 60.0%) as the reference treatment arm, compared to oral antibiotics alone (oA; No. = 406; 6.5%), mechanical bowel preparation alone (MBP; No. = 1486; 23.8%), or in combination with oAB (MoABP; No. = 607; 9.7%). Twenty covariates related to biometric data, surgical procedures, perioperative management, and hospital/center data potentially affecting outcomes were included and balanced into the model. The primary endpoints were AL, SSIs, and OM. All the results were reported as odds ratio (OR) with 95% confidence intervals (95% CI). Results: Compared to NBP, MBP showed significantly higher AL risk (OR 1.82; 95% CI 1.23-2.71; p = .003) and OM risk (OR 1.38; 95% CI 1.10-1.72; p = .005), no significant differences for all the endpoints were recorded in the oA group, whereas MoABP showed a significantly reduced SSI risk (OR 0.45; 95% CI 0.25-0.79; p = .008). Conclusions: MoABP significantly reduced the SSI risk after elective colorectal surgery, therefore representing a valid alternative to NBP.
MeSH term(s)	Humans ; Prospective Studies ; Anastomosis, Surgical ; Anastomotic Leak/etiology ; Machine Learning ; Colorectal Neoplasms/surgery ; Italy/epidemiology
Language	English
Publishing date	2024-04-16
Publishing country	Germany
Document type	Journal Article
ZDB-ID	84975-3
ISSN	1432-1262 ; 0179-1958
ISSN (online)	1432-1262
ISSN	0179-1958
DOI	10.1007/s00384-024-04627-6
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Article ; Online: Feasibility of enhanced recovery after surgery program in colorectal surgery during COVID-19 pandemic in Italy: should we change something?

Borghi, Felice / Pellegrino, Luca / Pruiti, Vincenzo / Donati, Danilo / Giraudo, Giorgio

Updates in surgery

2020 Volume 72, Issue 2, Page(s) 319–320

MeSH term(s)	Betacoronavirus ; COVID-19 ; Coronavirus Infections/epidemiology ; Enhanced Recovery After Surgery ; Humans ; Intestinal Diseases/surgery ; Italy ; Pandemics ; Pneumonia, Viral/epidemiology ; SARS-CoV-2
Keywords	covid19
Language	English
Publishing date	2020-06-13
Publishing country	Italy
Document type	Letter
ZDB-ID	2572692-4
ISSN	2038-3312 ; 2038-131X
ISSN (online)	2038-3312
ISSN	2038-131X
DOI	10.1007/s13304-020-00827-1
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Article ; Online: Implementation of an enhanced recovery after surgery protocol for colorectal cancer in a regional hospital network supported by audit and feedback: a stepped wedge, cluster randomised trial.

Pagano, Eva / Pellegrino, Luca / Robella, Manuela / Castiglione, Anna / Brunetti, Francesco / Giacometti, Lisa / Rolfo, Monica / Rizzo, Alessio / Palmisano, Sarah / Meineri, Maurizio / Bachini, Ilaria / Morino, Mario / Allaix, Marco Ettore / Mellano, Alfredo / Massucco, Paolo / Bellomo, Paola / Polastri, Roberto / Ciccone, Giovannino / Borghi, Felice

BMJ quality & safety

2024

Abstract: Background: Enhanced recovery after surgery (ERAS) protocols are known to potentially improve the management and outcomes of patients undergoing colorectal surgery, with limited evidence of their implementation in hospital networks and in a large ... ...

Abstract	Background: Enhanced recovery after surgery (ERAS) protocols are known to potentially improve the management and outcomes of patients undergoing colorectal surgery, with limited evidence of their implementation in hospital networks and in a large population. We aimed to assess the impact of the implementation of an ERAS protocol in colorectal cancer surgery in the entire region of Piemonte, Italy, supported by an audit and feedback (A&F) intervention. Methods: A large, stepped wedge, cluster randomised trial enrolled patients scheduled for elective surgery at 29 general surgery units (clusters). At baseline (first 3 months), standard care was continued in all units. Thereafter, four groups of clusters began to adopt the ERAS protocol successively. By the end of the study, each cluster had a period in which standard care was maintained (control) and a period in which the protocol was applied (experimental). ERAS implementation was supported by initial training and A&F initiatives. The primary endpoint was length of stay (LOS) without outliers (>94th percentile), and the secondary endpoints were outliers for LOS, postoperative medical and surgical complications, quality of recovery and compliance with ERAS items. Results: Of 2626 randomised patients, 2397 were included in the LOS analysis (1060 in the control period and 1337 in the experimental period). The mean LOS without outliers was 8.5 days during the control period (SD 3.9) and 7.5 (SD 3.5) during the experimental one. The adjusted difference between the two periods was a reduction of -0.58 days (95% CI -1.07, -0.09; p=0.021). The compliance with ERAS items increased from 52.4% to 67.3% (estimated absolute difference +13%; 95% CI 11.4%, 14.7%). No difference in the occurrence of complications was evidenced (OR 1.22; 95% CI 0.89, 1.68). Conclusion: Implementation of the ERAS protocol for colorectal cancer, supported by A&F approach, led to a substantial improvement in compliance and a reduction in LOS, without meaningful effects on complications.
Language	English
Publishing date	2024-02-29
Publishing country	England
Document type	Journal Article
ZDB-ID	2592909-4
ISSN	2044-5423 ; 2044-5415
ISSN (online)	2044-5423
ISSN	2044-5415
DOI	10.1136/bmjqs-2023-016594
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Article: Robotic approach to large tailgut cyst with malignant transformation: A case report.

Marano, Alessandra / Giuffrida, Maria Carmela / Peluso, Chiara / Testa, Valentina / Bosio, Paolo / Borghi, Felice

International journal of surgery case reports

2020 Volume 77S, Page(s) S57–S60

Abstract: Introduction: Tailgut cysts (TGC) are rare congenital retrorectal lesions deriving from vestiges of the hindgut. The risk of malignant transformation is relatively high. Thus early diagnosis and a complete removal of the mass are of paramount importance. ...

Abstract	Introduction: Tailgut cysts (TGC) are rare congenital retrorectal lesions deriving from vestiges of the hindgut. The risk of malignant transformation is relatively high. Thus early diagnosis and a complete removal of the mass are of paramount importance. We present a case of successful robotic exeresis of a large TGC adenocarcinoma. Presentation of case: A healthy 35-year-old woman was found to have a retrorectal TGC with suspected malignant transformation. The patient underwent complete robotic resection of the mass and pathology confirmed a TGC adenocarcinoma. The patient's post-operative course was unremarkable. At 24 months, the patient has not experienced any recurrence nor complained functional disorders. Discussion: The current case highlights the importance of TGC as a differential diagnosis of presacral masses, underscoring that malignant transformation can occur and may result in mortality and morbidity if radical surgery is not performed. Diagnosing TGC adenocarcinoma can be challenging because of its relatively low incidence. Biopsy is not recommended while magnetic resonance imaging (MRI) is indispensable in the evaluation of this lesion as the presence of intracystic vegetations could indicate a malignant transformation. Surgery is the mainstay of treatment and minimally invasive techniques have the potential to minimize morbidity and enhance recovery. Amongst these, the robotic approach can make the dissection of large lesions easier, reducing their manipulation and preventing nerve injuries. Conclusion: Robot-assisted resection of a TGC adenocarcinoma is safe and feasible. This approach can be particularly useful in the pelvis providing acceptable functional and oncological outcomes.
Language	English
Publishing date	2020-09-24
Publishing country	Netherlands
Document type	Case Reports
ISSN	2210-2612
ISSN	2210-2612
DOI	10.1016/j.ijscr.2020.09.025
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Article: Surgical Approach to Primary Hyperparathyroidism in Patients with Concomitant Thyroid Diseases: A Retrospective Single Center Study.

Castellano, Elena / Benso, Paolo / Attanasio, Roberto / Boriano, Alberto / Lauro, Corrado / Borretta, Giorgio / Borghi, Felice

International journal of endocrinology

2020 Volume 2020, Page(s) 2182539

Abstract: Background: Primary hyperparathyroidism (PHPT) and thyroid diseases are a frequent concomitant occurrence, but the surgical approach to associated disease is still debated.: Methods: We retrospectively evaluated a series of PHPT patients focusing on ... ...

Abstract	Background: Primary hyperparathyroidism (PHPT) and thyroid diseases are a frequent concomitant occurrence, but the surgical approach to associated disease is still debated. Methods: We retrospectively evaluated a series of PHPT patients focusing on thyroid disease and surgery. Results: Among 238 PHPT patients undergoing parathyroidectomy (PTX) between 2002 and 2017, 128 were affected also by a benign thyroid disease, namely, goiter in 118 (76 multinodular (MNG) and 42 uninodular (UNG)), autoimmune thyroiditis in 10, and hyperthyroidism in 21. Surgical approach was unilateral neck exploration (UNE) in 59 patients and bilateral neck exploration (BNE) in 69. The PHPT cure rate was 94%. On comparing patients submitted to PTX only and PTX plus thyroidectomy (TX), in the latter MNG and hyperthyroidism were more frequent, and surgical time and length of stay were longer. No difference in surgical complications was found between patients undergoing UNE and BNE. Conclusion: PHPT patients with a concomitant thyroid disease underwent double surgery in almost two-thirds of the cases, mostly by BNE. The main factors driving the decision to perform concomitant PTX and TX were the presence of thyroid nodular disease with the nodule site ipsilateral to the presurgically localized parathyroid adenoma.
Language	English
Publishing date	2020-02-22
Publishing country	Egypt
Document type	Journal Article
ZDB-ID	2502951-4
ISSN	1687-8345 ; 1687-8337
ISSN (online)	1687-8345
ISSN	1687-8337
DOI	10.1155/2020/2182539
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