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Article ; Online: Training simulator efficacy in developing thoracic and general surgical skills in a residency programme: a pilot study.

Grossi, Sarah / Cattoni, Maria / Filipponi, Luca / Marzorati, Alessandro / Rotolo, Nicola / Carcano, Giulio / Imperatori, Andrea

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery

2024 Volume 65, Issue 2

Abstract: Objectives: Virtual training simulators have been introduced in several surgical disciplines to improve residents' abilities. Through the use of the LapSim® virtual training simulator (Surgical Science, Göteborg, Sweden), this study aims to plan an ... ...

Abstract	Objectives: Virtual training simulators have been introduced in several surgical disciplines to improve residents' abilities. Through the use of the LapSim® virtual training simulator (Surgical Science, Göteborg, Sweden), this study aims to plan an effective learning path in minimally invasive thoracic and general surgery. Methods: All thoracic and general surgery trainees in their 1st and 2nd year of residency at the University of Insubria were enrolled and randomized into 2 groups: residents undergoing an intensive twice-a-week virtual training programme (group A: n = 8) and those undergoing a once-weekly non-intensive virtual training programme (group B: n = 9). The virtual training programme was divided into 4 modules, each of 12 weeks. In the 1st module, trainees repeated grasping, cutting, clip application, lifting and grasping, and fine dissection exercises during each training session. Seal-and-cut exercise was performed as the initial and final test. Data on surgical manoeuvres (time and on mistakes) were collected; intra- and inter-group comparisons were planned. Results: No significant differences were observed between groups A and B at the 1st session, confirming that the 2 groups had similar skills at the beginning. After 12 weeks, both groups showed improvements, but comparing data between initial and final test, only Group A registered a significant reduction in total time (P-value = 0.0015), left (P-value = 0.0017) and right (P-value = 0.0186) instrument path lengths, and in left (P-value = 0.0010) and right (P-value = 0.0073) instrument angular path lengths, demonstrating that group A acquired greater precision in surgical manoeuvres. Conclusions: Virtual simulator training programme performed at least twice a week was effective for implementing basic surgical skills required for the trainee's professional growth. Additional virtual training modules focused on more complex exercises are planned to confirm these preliminary results.
MeSH term(s)	Humans ; Internship and Residency ; Pilot Projects ; Laparoscopy ; Computer Simulation ; Education, Medical, Graduate/methods ; Clinical Competence ; User-Computer Interface
Language	English
Publishing date	2024-02-07
Publishing country	Germany
Document type	Journal Article
ZDB-ID	639293-3
ISSN	1873-734X ; 1010-7940 ; 1567-4258
ISSN (online)	1873-734X
ISSN	1010-7940 ; 1567-4258
DOI	10.1093/ejcts/ezae044
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Article ; Online: Tumors after kidney transplantation: a population study.

Ietto, Giuseppe / Gritti, Mattia / Pettinato, Giuseppe / Carcano, Giulio / Gasperina, Daniela Dalla

World journal of surgical oncology

2023 Volume 21, Issue 1, Page(s) 18

Abstract: One of the main causes of post-transplant-associated morbidity and mortality is cancer. The aims of the project were to study the neoplastic risk within the kidney transplant population and identify the determinants of this risk. A cohort of 462 renal ... ...

Abstract	One of the main causes of post-transplant-associated morbidity and mortality is cancer. The aims of the project were to study the neoplastic risk within the kidney transplant population and identify the determinants of this risk. A cohort of 462 renal transplant patients from 2010 to 2020 was considered. The expected incidence rates of post-transplant cancer development in the referenced population, the standardized incidence ratios (SIR) taking the Italian population as a comparison, and the absolute risk and the attributable fraction were extrapolated from these cohorts of patients. Kidney transplant recipients had an overall cancer risk of approximately three times that of the local population (SIR 2.8). A significantly increased number of cases were observed for Kaposi's sarcoma (KS) (SIR 195) and hematological cancers (SIR 6.8). In the first 3 years post-transplant, the risk to develop either KS or hematological cancers was four times higher than in the following years; in all cases of KS, the diagnosis was within 2 years from the transplant. Post-transplant immunosuppression represents the cause of 99% of cases of KS and 85% of cases of lymphomas, while only 39% is represented by solid tumors. Data related to the incidence, the percentages attributable to post-transplant immunosuppression, and the time of onset of neoplasms, particularly for KS and hematological tumors could help improve the management for the follow-up in these patients.
MeSH term(s)	Humans ; Kidney Transplantation/adverse effects ; Neoplasms/epidemiology ; Sarcoma, Kaposi/complications ; Sarcoma, Kaposi/epidemiology ; Incidence ; Hematologic Neoplasms ; Risk Factors
Language	English
Publishing date	2023-01-23
Publishing country	England
Document type	Journal Article
ZDB-ID	2118383-1
ISSN	1477-7819 ; 1477-7819
ISSN (online)	1477-7819
ISSN	1477-7819
DOI	10.1186/s12957-023-02892-3
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Article: Laparoscopy in Emergency: Why Not? Advantages of Laparoscopy in Major Emergency: A Review.

Ietto, Giuseppe / Amico, Francesco / Pettinato, Giuseppe / Iori, Valentina / Carcano, Giulio

Life (Basel, Switzerland)

2021 Volume 11, Issue 9

Abstract: A laparoscopic approach is suggested with the highest grade of recommendation for acute cholecystitis, perforated gastroduodenal ulcers, acute appendicitis, gynaecological disorders, and non-specific abdominal pain (NSAP). To date, the main qualities of ... ...

Abstract	A laparoscopic approach is suggested with the highest grade of recommendation for acute cholecystitis, perforated gastroduodenal ulcers, acute appendicitis, gynaecological disorders, and non-specific abdominal pain (NSAP). To date, the main qualities of laparoscopy for these acute surgical scenarios are clearly stated: quicker surgery, faster recovery and shorter hospital stay. For the remaining surgical emergencies, as well as for abdominal trauma, the role of laparoscopy is still a matter of debate. Patients might benefit from a laparoscopic approach only if performed by experienced teams and surgeons which guarantee a high standard of care. More precisely, laparoscopy can limit damage to the tissue and could be effective for the reduction of the overall amount of cell debris, which is a result of the intensity with which the immune system reacts to the injury and the following symptomatology. In fact, these fragments act as damage-associated molecular patterns (DAMPs). DAMPs, as well as pathogen associated molecular patterns (PAMPs), are recognised by both surface and intracellular receptors of the immune cells and activate the cascade which, in critically ill surgical patients, is responsible for a deranged response. This may result in the development of progressive and multiple organ dysfunctions, manifesting with acute respiratory distress syndrome (ARDS), coagulopathy, liver dysfunction and renal failure. In conclusion, none of the emergency surgical scenarios preclude laparoscopy, provided that the surgical tactic could ensure sufficient cleaning of the abdomen in addition to resolving the initial tissue damage caused by the "trauma".
Language	English
Publishing date	2021-09-03
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2662250-6
ISSN	2075-1729
ISSN	2075-1729
DOI	10.3390/life11090917
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Article ; Online: Dual-layer spectral CT fusion imaging for lung biopsies: more accurate targets, diagnostic samplings, and biomarker information?

Curti, Marco / Fontana, Federico / Piacentino, Filippo / Ossola, Christian / Coppola, Andrea / Carcano, Giulio / Venturini, Massimo

European radiology experimental

2022 Volume 6, Issue 1, Page(s) 34

Abstract: The increasingly widespread use of computed tomography (CT) has increased the number of detected lung lesions, which are then subjected to needle biopsy to obtain histopathological diagnosis. Obtaining high-quality biopsy specimens is fundamental for ... ...

Abstract	The increasingly widespread use of computed tomography (CT) has increased the number of detected lung lesions, which are then subjected to needle biopsy to obtain histopathological diagnosis. Obtaining high-quality biopsy specimens is fundamental for diagnosis and biomolecular characterisation that guide therapy decision-making. In order to obtain samples with high diagnostic potential, fusion imaging techniques, such as fusion between positron emission tomography and CT, have been introduced to target the biopsy where there more viable neoplastic cells can be sampled. Nowadays, dual-layer spectral CT represents a novel technology enabling an increased tissue characterisation. In particular, Z-effective images, i.e., colour-coded images based on the effective atomic number of tissue components, provide a higher level of discrimination than usual imaged based on x-ray attenuation in Hounsfield units and offer the potential of a better tissue characterisation. Our hypothesis is based on the future use of data provided by spectral CT, in particular by Z-effective images, as a guide for appropriate biopsy sampling for histopathological and biomolecular characterisation in the era of patient tailored-therapy.
MeSH term(s)	Biomarkers ; Biopsy ; Humans ; Lung/diagnostic imaging ; Lung/pathology ; Positron-Emission Tomography/methods ; Tomography, X-Ray Computed/methods
Chemical Substances	Biomarkers
Language	English
Publishing date	2022-08-15
Publishing country	England
Document type	Journal Article
ISSN	2509-9280
ISSN (online)	2509-9280
DOI	10.1186/s41747-022-00290-0
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Article: Meckel's Diverticulum Causing Ileal Volvulus and Peritonitis after a Recent Appendectomy: A Case Report and Literature Review-We Should Likely Resect an Incidental MD.

Zanchetta, Matteo / Inversini, Davide / Pappalardo, Vincenzo / Grappolini, Niccolo / Morabito, Marika / Gianazza, Simone / Carcano, Giulio / Ietto, Giuseppe

Life (Basel, Switzerland)

2023 Volume 13, Issue 10

Abstract: Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract with a 1-3% prevalence in the general population. The surgical management of symptomatic MD is well described in the literature, but there is still no ... ...

Abstract	Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract with a 1-3% prevalence in the general population. The surgical management of symptomatic MD is well described in the literature, but there is still no consensus on the indication for prophylactic resection of incidental asymptomatic MD. To address this issue, we extensively reviewed the current literature and report our experience with laparoscopic management of an unusual case of MD causing ileal volvulus and acute peritonitis two weeks after a laparoscopic appendectomy for acute gangrenous appendicitis performed in another hospital. A 50-year-old man presented to the emergency department with acute and severe abdominal pain, vomiting, and constipation. He had undergone a laparoscopic appendectomy for acute appendicitis two weeks before in another hospital. The patient was apyretic, distressed, and seeking an antalgic position. The abdomen was mildly distended and tender, and the Blumberg sign was mildly positive in the central quadrants. The clinical picture deteriorated with fever, peritonismus, and leukocytosis. A CT scan showed an ileo-ileal adhesion near the ileocolic junction and dilatation of the upstream loops with the air-fluid levels. Through an urgent laparoscopy, a necrotic mass, the MD, was wedge-resected, and the surrounding ileal volvulus derotated. The postoperative course was uneventful. There is no definitive consensus on the appropriate management of incidental asymptomatic MD, although several studies have attempted to identify guiding criteria. Features of the MD, the patient's risk factors, clinical presentation, and surgical approach need to be considered to establish definitive guidelines for the management of incidental asymptomatic MD. In the absence of definitive guidelines, personal expertise and judgement are the main resources for the surgeon approaching an incidental asymptomatic MD.
Language	English
Publishing date	2023-09-30
Publishing country	Switzerland
Document type	Case Reports
ZDB-ID	2662250-6
ISSN	2075-1729
ISSN	2075-1729
DOI	10.3390/life13101996
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Article: Laparoscopic vs Open Treatment for Gastric and Non-Gastric Gastrointestinal Stromal Tumors: a Two-Center Experience.

Pappalardo, Vincenzo / Lianos, Georgios D / Morabito, Marika / Gianazza, Simone / Cassinotti, Elisa / Frattini, Francesco / Pino, Antonella / Rausei, Stefano / Carcano, Giulio

Surgical technology international

2023 Volume 42

Abstract: We retrospectively reviewed the medical records of 109 patients who underwent curative laparoscopic or open resection for different types of gastrointestinal stromal tumors (GIST). Only primary GIST patients who did not receive preoperative chemotherapy ... ...

Abstract	We retrospectively reviewed the medical records of 109 patients who underwent curative laparoscopic or open resection for different types of gastrointestinal stromal tumors (GIST). Only primary GIST patients who did not receive preoperative chemotherapy or oral imatinib treatment were included in the analysis. We divided the patients into 2 groups according to the surgical approach:a laparoscopic group (LAP) and a laparotomic group (OPEN). Our aim was to confirm the feasibility and safety of laparoscopic surgery for GISTs that differed in size and location, and to assess its long-term oncologic outcome in terms of overall survival (OS) and disease-free survival (DFS). Furthermore, we performed a surgical short-term outcome analysis. The two groups did not differ with respect to age at operation, gender, BMI or comorbidities. Even the NIH and AFIP risk classifications were not significantly different between the two groups. Furthermore, in our analysis, there was no significant difference in mean tumor size or location between the two groups. Wedge resection was the most frequently performed procedure. The conversion rate was 7.8%. The operative time was 194.75 (60- 350) min for the open group and 181.70 (57-480) min for the laparoscopic group. Our data clearly indicated that the long-term oncologic outcome and DFS of laparoscopic resection were not inferior to those of traditional open operations and laparoscopic resection was still feasible in cases with large tumors: the median size of the tumor was 4.5 cm (3-25) and the tumor was larger than 4.5 cm in 47.7% of the cases in the LAP group. With regard to short-term outcomes, our study demonstrated that the LAP group had fewer complications, faster gastrointestinal recovery, reduced use of analgesic drugs and shorter postoperative hospital stay (each p<0.05). In conclusion, our experience confirms that GISTs are very uncommon cancers for which the prognosis is closely related to size, localization and class of risk. In light of our clinical data, laparoscopic resection for gastric and non-gastric GISTs is a safe, feasible and oncologically correct procedure. The most important advantage of this technique is that it ensures a better postoperative outcome compared with open surgery, without worsening the prognosis.
Language	English
Publishing date	2023-06-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	1225512-9
ISSN	1090-3941
ISSN	1090-3941
DOI	10.52198/23.STI.42.GS1699
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Article ; Online: Pocket-sized, wireless-Bluetooth ultrasound system to perform diagnostic and low-complexity interventional procedures in bedridden patients during the COVID-19 pandemic: from intensive care unit to domiciliary service?

Ossola, Christian / Piacentino, Filippo / Fontana, Federico / Curti, Marco / Zorzetto, Giada / Coppola, Andrea / Carcano, Giulio / Venturini, Massimo

European radiology experimental

2022 Volume 6, Issue 1, Page(s) 20

Abstract: The use of a pocked-sized, wireless-Bluetooth ultrasound portable system with display images presented on a tablet facilitated the work of our radiologists during the first wave of coronavirus disease 2019 (COVID-19) to perform diagnostic and ... ...

Abstract	The use of a pocked-sized, wireless-Bluetooth ultrasound portable system with display images presented on a tablet facilitated the work of our radiologists during the first wave of coronavirus disease 2019 (COVID-19) to perform diagnostic and interventional procedures in bedridden patients. The device is equipped with a battery-powered probe without cables that transmits images to a tablet (or a cell phone) through a dedicated App. We hypothesise in future to extend diagnostic and low-complexity interventional procedures from hospitalised patients to at-home patients who are not able to mobilise out of bed or are difficult to transport. This domiciliary service might also reduce the overhead of hospital accesses.
MeSH term(s)	Bedridden Persons ; COVID-19 ; Humans ; Intensive Care Units ; Pandemics ; Ultrasonography/methods
Language	English
Publishing date	2022-05-10
Publishing country	England
Document type	Journal Article
ISSN	2509-9280
ISSN (online)	2509-9280
DOI	10.1186/s41747-022-00273-1
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Article: Transcatheter Aortic Valve Implantation (TAVI) Planning with Dual-Layer Spectral CT Using Virtual Monoenergetic Image (VMI) Reconstructions and 20 mL of Contrast Media.

Fontana, Federico / Piacentino, Filippo / Gnesutta, Aroa / Macchi, Edoardo / Coppola, Andrea / Saccomanno, Angiola / Gatta, Tonia / Recaldini, Chiara / Minenna, Manuela / Tamborini, Claudio / Dossi, Filippo / Ascenti, Velio / Barbera, Simone / Cicero, Giuseppe / Carcano, Giulio / Ascenti, Giorgio / Castiglioni, Battistina / Venturini, Massimo

Journal of clinical medicine

2024 Volume 13, Issue 2

Abstract: Transcatheter aortic valve implantation (TAVI) is a less invasive alternative to surgical implantation and its implementation is progressively increasing worldwide. We routinely perform pre-procedural aortic angiography CT to assess aortic dimensions and ...

Abstract	Transcatheter aortic valve implantation (TAVI) is a less invasive alternative to surgical implantation and its implementation is progressively increasing worldwide. We routinely perform pre-procedural aortic angiography CT to assess aortic dimensions and vascular anatomy. This study aims to evaluate the image quality of CTA for TAVI planning using dual-layer spectral CT, with virtual monoenergetic image reconstructions at 40 keV. Thirty-one patients underwent a CTA protocol with the injection of 20 mL of contrast media. Image quality was assessed by measuring the mean density in Hounsfield Units (HU), the signal-to-noise ratio, and the contrast-to-noise ratio in VMI reconstructions. Additionally, a blinded subjective analysis was conducted by two observers. The results showed significant enhancement at all sampled vascular levels with a gradual decrease in HU from proximal to distal regions. Favourable subjective ratings were given for all parameters, with greater variability in the evaluation of iliac axes. A significant negative correlation (
Language	English
Publishing date	2024-01-17
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm13020524
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Article ; Online: Pre-graduation medical training including virtual reality during COVID-19 pandemic: a report on students' perception.

De Ponti, Roberto / Marazzato, Jacopo / Maresca, Andrea M / Rovera, Francesca / Carcano, Giulio / Ferrario, Marco M

BMC medical education

2020 Volume 20, Issue 1, Page(s) 332

Abstract: Background: The Coronavirus Disease 19 (COVID-19) pandemic brought significant disruption to in-hospital medical training. Virtual reality simulating the clinical environment has the potential to overcome this issue and can be particularly useful to ... ...

Abstract	Background: The Coronavirus Disease 19 (COVID-19) pandemic brought significant disruption to in-hospital medical training. Virtual reality simulating the clinical environment has the potential to overcome this issue and can be particularly useful to supplement the traditional in-hospital medical training during the COVID-19 pandemic, when hospital access is banned for medical students. The aim of this study was to assess medical students' perception on fully online training including simulated clinical scenarios during COVID-19 pandemic. Methods: From May to July 2020 when in-hospital training was not possible, 122 students attending the sixth year of the course of Medicine and Surgery underwent online training sessions including an online platform with simulated clinical scenarios (Body Interact™) of 21 patient-based cases. Each session focused on one case, lasted 2 h and was divided into three different parts: introduction, virtual patient-based training, and debriefing. In the same period, adjunctive online training with formal presentation and discussion of clinical cases was also given. At the completion of training, a survey was performed, and students filled in a 12-item anonymous questionnaire on a voluntary basis to rate the training quality. Results were reported as percentages or with numeric ratings from 1 to 4. Due to the study design, no sample size was calculated. Results: One hundred and fifteen students (94%) completed the questionnaire: 104 (90%) gave positive evaluation to virtual reality training and 107 (93%) appreciated the format in which online training was structured. The majority of participants considered the platform of virtual reality training realistic for the initial clinical assessment (77%), diagnostic activity (94%), and treatment options (81%). Furthermore, 97 (84%) considered the future use of this virtual reality training useful in addition to the apprenticeship at patient's bedside. Finally, 32 (28%) participants found the online access difficult due to technical issues. Conclusions: During the COVID-19 pandemic, online medical training including simulated clinical scenarios avoided training interruption and the majority of participant students gave a positive response on the perceived quality of this training modality. During this time frame, a non-negligible proportion of students experienced difficulties in online access to this virtual reality platform.
MeSH term(s)	Betacoronavirus ; COVID-19 ; Clinical Competence ; Coronavirus Infections/epidemiology ; Coronavirus Infections/prevention & control ; Coronavirus Infections/transmission ; Education, Distance/organization & administration ; Education, Medical, Undergraduate/organization & administration ; Humans ; Pandemics/prevention & control ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/prevention & control ; Pneumonia, Viral/transmission ; SARS-CoV-2 ; Simulation Training/organization & administration ; Surveys and Questionnaires ; Virtual Reality
Keywords	covid19
Language	English
Publishing date	2020-09-25
Publishing country	England
Document type	Journal Article
ZDB-ID	2044473-4
ISSN	1472-6920 ; 1472-6920
ISSN (online)	1472-6920
ISSN	1472-6920
DOI	10.1186/s12909-020-02245-8
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Article ; Online: Authors' Reply: Laparoscopy or laparotomy during COVID-19: The pendulum continues swinging as uncertainty remains on virus transmission and epidemiology.

Pata, Francesco / Khan, Mansoor / Iovino, Domenico / Gallo, Gaetano / Carcano, Giulio / Di Saverio, Salomone

The journal of trauma and acute care surgery

2020 Volume 89, Issue 5, Page(s) e153–e154

MeSH term(s)	Betacoronavirus ; COVID-19 ; Coronavirus Infections ; Humans ; Laparoscopy ; Laparotomy ; Pandemics ; Pneumonia, Viral ; SARS-CoV-2 ; Uncertainty
Keywords	covid19
Language	English
Publishing date	2020-07-13
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	2651070-4
ISSN	2163-0763 ; 2163-0755
ISSN (online)	2163-0763
ISSN	2163-0755
DOI	10.1097/TA.0000000000002885
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