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  1. Article ; Online: Robotic assisted treatment of flank hernias: case series.

    Di Giuseppe, Matteo / Mongelli, Francesco / Marcantonio, Maria / La Regina, Davide / Pini, Ramon

    BMC surgery

    2020  Volume 20, Issue 1, Page(s) 184

    Abstract: Background: Flank hernias are uncommon, surgical treatment is challenging and the minimally-invasive approach not always feasible. The aim of this study was to report the safety and feasibility of the robotic-assisted repair.: Methods: The study was ... ...

    Abstract Background: Flank hernias are uncommon, surgical treatment is challenging and the minimally-invasive approach not always feasible. The aim of this study was to report the safety and feasibility of the robotic-assisted repair.
    Methods: The study was approved by the local ethic committee (2019-01132 CE3495). A retrospective search on a prospectively collected dataset including demographic and clinical records on robotic surgery at our institution was performed to identify patients treated for a flank hernia. Patients were followed-up 6 months.
    Results: From January 2018 to December 2019, out of 190 patients who underwent robotic-assisted hernia surgery, seven with incisional flank hernia were included. Median age was 69.0 years (IQR 63.2-78.0), BMI was 27.3 kg/m
    Conclusions: Robotics in abdominal wall hernia surgery remains a matter of debate, despite a growing interest from the surgical community. In our reported experience with flank hernias, we found the robotic-assisted approach to be safe and feasible for the treatment of this uncommon clinical entity.
    MeSH term(s) Abdominal Wall/surgery ; Aged ; Feasibility Studies ; Female ; Hernia, Ventral/etiology ; Hernia, Ventral/surgery ; Herniorrhaphy/instrumentation ; Herniorrhaphy/methods ; Humans ; Laparoscopy/adverse effects ; Laparoscopy/instrumentation ; Laparotomy/adverse effects ; Male ; Middle Aged ; Recurrence ; Retrospective Studies ; Robotic Surgical Procedures/methods ; Surgical Mesh ; Treatment Outcome
    Keywords covid19
    Language English
    Publishing date 2020-08-12
    Publishing country England
    Document type Journal Article
    ZDB-ID 2050442-1
    ISSN 1471-2482 ; 1471-2482
    ISSN (online) 1471-2482
    ISSN 1471-2482
    DOI 10.1186/s12893-020-00843-3
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  2. Article ; Online: Learning curve of robotic-assisted transabdominal preperitoneal repair (rTAPP) for inguinal hernias.

    Proietti, Francesco / La Regina, Davide / Pini, Ramon / Di Giuseppe, Matteo / Cianfarani, Agnese / Mongelli, Francesco

    Surgical endoscopy

    2020  Volume 35, Issue 12, Page(s) 6643–6649

    Abstract: Background: Learning curves describe the rate of performance improvements according to the surgeon's caseload, followed by a plateau where limited additional improvements are observed. The aim of this study was to evaluate the learning curve for robotic- ...

    Abstract Background: Learning curves describe the rate of performance improvements according to the surgeon's caseload, followed by a plateau where limited additional improvements are observed. The aim of this study was to evaluate the learning curve for robotic-assisted transabdominal preperitoneal repair (rTAPP) for inguinal hernias in surgeons already experienced in laparoscopic TAPP.
    Methods: The study was approved by local ethic committee. Male patients undergoing rTAPP for inguinal hernia from October 2017 to December 2019 at the Bellinzona Regional Hospital were selected from a prospective database. Demographic and clinical data, including operative time, conversion to laparoscopic or open surgery, intra- and postoperative complications were collected and analyzed.
    Results: Over the study period, 170 rTAPP were performed by three surgeons in 132 patients, and mean age was 60.1 ± 13.7 years. The cumulative summation (CUSUM) test showed a significant operative time reduction after the 43
    Conclusion: Our study shows that the rTAPP, performed by experienced laparoscopists, has a learning curve which requires 43 inguinal hernia repairs to achieve 90% proficiency and to significantly reduce the operative time.
    MeSH term(s) Aged ; Hernia, Inguinal/surgery ; Herniorrhaphy ; Humans ; Laparoscopy ; Learning Curve ; Male ; Middle Aged ; Robotic Surgical Procedures ; Surgical Mesh ; Treatment Outcome
    Language English
    Publishing date 2020-11-30
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 639039-0
    ISSN 1432-2218 ; 0930-2794
    ISSN (online) 1432-2218
    ISSN 0930-2794
    DOI 10.1007/s00464-020-08165-4
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  3. Article: Ultrasound-Guided Pudendal Nerve Block in Patients Undergoing Open Hemorrhoidectomy: A Post-Hoc Cost-Effectiveness Analysis from a Double-Blind Randomized Controlled Trial.

    Mongelli, Francesco / Lucchelli, Massimo / La Regina, Davide / Christoforidis, Dimitri / Saporito, Andrea / Vannelli, Alberto / Di Giuseppe, Matteo

    ClinicoEconomics and outcomes research : CEOR

    2021  Volume 13, Page(s) 299–306

    Abstract: Background: Pudendal nerve block (PNB) has been demonstrated to reduce postoperative pain and re-admission rates after open hemorrhoidectomy and may reduce costs but, to date, no study has reported data on this aspect. The aim of our study was to ... ...

    Abstract Background: Pudendal nerve block (PNB) has been demonstrated to reduce postoperative pain and re-admission rates after open hemorrhoidectomy and may reduce costs but, to date, no study has reported data on this aspect. The aim of our study was to perform a cost analysis on PNB use in in- and outpatients undergoing open hemorrhoidectomy.
    Methods: From January 2018 to December 2019, patients undergoing open hemorrhoidectomy were included and randomized to undergo spinal anesthesia either with or without the PNB. Clinical data, direct and indirect costs for in- and outpatients, operating time and operating theatre occupancy were recorded. A cost-effectiveness analysis based on the diagnosis-related groups (DRG) and TARMED reimbursement systems was performed.
    Results: Patients who underwent PNB in addition to spinal anesthesia had significantly less pain and a shorter length of hospital stay after open hemorrhoidectomy. The cost analysis included all 49 patients, 23 of whom, in addition to spinal anesthesia, received a PNB. There were no significant differences in operating theatre occupancy (p=0.662), mean operative time (p=0.610) or time required for anesthesia (p=0.124). Direct costs were comparable (482±386 vs 613±543 EUR, p=0.108), while indirect costs were significantly lower in the PNB group (2606±816 vs 2769±1506 EUR, p=0.005). We estimated an incremental cost-effectiveness ratio (ICER) of -243 ± 881 EUR/pain unit on the VAS.
    Conclusion: Despite limitations, the ultrasound-guided PNB seems to reduce costs in patient undergoing open hemorrhoidectomy under spinal anesthesia. It was shown to be clinically beneficial and cost-effective, and therefore recommendable in patients undergoing open hemorrhoidectomy.
    Language English
    Publishing date 2021-04-28
    Publishing country New Zealand
    Document type Case Reports ; Clinical Trial
    ZDB-ID 2520698-9
    ISSN 1178-6981
    ISSN 1178-6981
    DOI 10.2147/CEOR.S306138
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  4. Article ; Online: Liver Blood Tests in the Management of Suspected Choledocholithiasis.

    Mongelli, Francesco / Di Giuseppe, Matteo / Porcellini, Iride / Proietti, Francesco / Cristaudi, Alessandra / Pini, Ramon / La Regina, Davide

    Laboratory medicine

    2021  Volume 52, Issue 6, Page(s) 597–602

    Abstract: Objective: The likelihood of common bile duct (CBD) stones considers liver blood tests (LBTs) if they are markedly altered only. The aim of our study was to find a reliable tool based on LBTs to predict the presence of CBD stones.: Methods: We ... ...

    Abstract Objective: The likelihood of common bile duct (CBD) stones considers liver blood tests (LBTs) if they are markedly altered only. The aim of our study was to find a reliable tool based on LBTs to predict the presence of CBD stones.
    Methods: We retrospectively considered all patients who underwent magnetic resonance cholangiopancreatography (MRCP) because of suspected CBD stones from January 2014 to June 2019. Demographic, clinical data, and LBT values were collected and analyzed.
    Results: We selected 191 patients, 64 (33.5%) with positive MRCP and 127 (66.5%) with negative MRCP. The analysis showed that our compound LBT-based score had 83.6%, 90.7%, and 90.6% sensitivity, specificity, and negative predictive values, respectively, in determining MRCP results.
    Conclusion: We designed a weighted score with high diagnostic power in determining MRCP results that could help in differentiating between candidates for primary cholecystectomy and patients who benefit from preoperative MRCP.
    MeSH term(s) Cholangiopancreatography, Magnetic Resonance ; Choledocholithiasis/diagnostic imaging ; Gallstones ; Hematologic Tests ; Humans ; Liver ; Retrospective Studies ; Sensitivity and Specificity
    Language English
    Publishing date 2021-03-18
    Publishing country England
    Document type Journal Article
    ZDB-ID 391758-7
    ISSN 1943-7730 ; 0007-5027
    ISSN (online) 1943-7730
    ISSN 0007-5027
    DOI 10.1093/labmed/lmab042
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  5. Article ; Online: Robot-assisted Treatment of Epigastric Hernias With a Suprapubic Approach.

    Pini, Ramon / Di Giuseppe, Matteo / Toti, Johannes M A / Mongelli, Francesco / Marcantonio, Maria / Spampatti, Sebastiano / La Regina, Davide

    Surgical laparoscopy, endoscopy & percutaneous techniques

    2021  Volume 31, Issue 5, Page(s) 584–587

    Abstract: Background: Robot-assisted ventral hernia repair has shown itself to be feasible and safe in abdominal wall surgery. Presently, the ports are placed laterally to meet the distance from the fascial defect. The aim of our study is to report our experience ...

    Abstract Background: Robot-assisted ventral hernia repair has shown itself to be feasible and safe in abdominal wall surgery. Presently, the ports are placed laterally to meet the distance from the fascial defect. The aim of our study is to report our experience of epigastric hernia treatment with trocar insertion in the suprapubic region.
    Materials and methods: On a prospectively collected dataset on robot-assisted surgery, patients treated for epigastric hernias with suprapubic approach were identified. Demographic and clinical data were collected and analyzed.
    Results: Twelve patients were selected. Median age was 58.5 years [interquartile range (IQR): 47.8 to 67.3 y]; 4 patients were male (33.3%) and the median body mass index was 23.9 kg/m2 (IQR: 22.3 to 26.2 kg/m2). All patients were referred to surgery because of pain. The median measure of the hernia defect was 30 mm (IQR: 13.75 to 31.0 mm); median larger mesh diameter was 13.5 cm (IQR: 9.5 to 15.0 cm); and median operative time was 136.5 minutes (IQR: 120.0 to 186.5 min). No intraoperative complication or conversion to open surgery occurred. Postoperatively, 2 patients presented a seroma and median length of hospital stay was 2.0 days (IQR: 1.75 to 3 d). No case of hernia recurrence was recorded at a mean follow-up of 11.2 months (range: 4 to 29 mo).
    Conclusions: In the robot-assisted treatment of hernias of the epigastric region, a suprapubic port placement can be considered instead of a lateral one to have a better field overview, especially in subxiphoid hernias. Further studies are needed to assess the benefits and limitations of such technique.
    MeSH term(s) Hernia, Ventral/surgery ; Herniorrhaphy ; Humans ; Laparoscopy ; Male ; Middle Aged ; Robotics ; Surgical Mesh
    Language English
    Publishing date 2021-04-23
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1475108-2
    ISSN 1534-4908 ; 1530-4515 ; 1051-7200
    ISSN (online) 1534-4908
    ISSN 1530-4515 ; 1051-7200
    DOI 10.1097/SLE.0000000000000941
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    Zs.A 3200: Show issues Location:
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  6. Article ; Online: Pudendal Nerve Block in Hemorrhoid Surgery: A Systematic Review and Meta-analysis.

    Mongelli, Francesco / Treglia, Giorgio / La Regina, Davide / Di Giuseppe, Matteo / Galafassi, Jacopo / Majno-Hurst, Pietro E / Christoforidis, Dimitrios

    Diseases of the colon and rectum

    2021  Volume 64, Issue 5, Page(s) 617–631

    Abstract: Background: Postoperative pain represents an important issue in traditional hemorrhoidectomy. Optimal pain control is mandatory, especially in a surgical day care setting.: Objective: The aim of this study was to investigate the use of pudendal nerve ...

    Abstract Background: Postoperative pain represents an important issue in traditional hemorrhoidectomy. Optimal pain control is mandatory, especially in a surgical day care setting.
    Objective: The aim of this study was to investigate the use of pudendal nerve block in patients undergoing hemorrhoidectomy.
    Data sources: PubMed, Google Scholar, Cochrane Library, and Web of Science databases were searched up to December 2020.
    Study selection: Randomized trials evaluating the pudendal nerve block effect in patients undergoing hemorrhoidectomy were selected.
    Interventions: Hemorrhoidectomy under general or spinal anesthesia with or without pudendal nerve block was performed.
    Main outcome measures: Opioid consumption, pain on the visual analogue scale, length of hospital stay, and readmission rate were the main outcomes of interest and were plotted by using a random-effects model.
    Results: The literature search revealed 749 articles, of which 14 were deemed eligible. A total of 1214 patients were included, of whom 565 received the pudendal nerve block. After hemorrhoidectomy, patients in the pudendal nerve block group received opioids less frequently (relative risk, 0.364; 95% CI, 0.292-0.454, p < 0.001) and in a lower cumulative dose (standardized mean difference, -0.935; 95% CI, -1.280 to -0.591, p < 0.001). Moreover, these patients experienced less pain at 24 hours (standardized mean difference, -1.862; 95% CI, -2.495 to -1.228, p < 0.001), had a shorter length of hospital stay (standardized mean difference, -0.742; 95% CI, -1.145 to -0.338, p < 0.001), and had a lower readmission rate (relative risk, 0.239; 95% CI, 0.062-0.916, p = 0.037). Sensitivity analysis excluded the occurrence of publication bias on the primary end point, and the overall evidence quality was judged "high."
    Limitations: Occurrence of publication bias among some secondary end points and heterogeneity are the main limitations of this study.
    Conclusions: This systematic review and meta-analysis show significant advantages of pudendal nerve block use. A reduction in opioid consumption, postoperative pain, complications, and length of stay can be demonstrated. Despite the limitations, pudendal nerve block in patients undergoing hemorrhoidectomy should be considered.
    MeSH term(s) Analgesics, Opioid/therapeutic use ; Hemorrhoidectomy/methods ; Hemorrhoids/surgery ; Humans ; Length of Stay ; Nerve Block/methods ; Pain Measurement ; Pain, Postoperative/drug therapy ; Pain, Postoperative/prevention & control ; Patient Readmission ; Pudendal Nerve
    Chemical Substances Analgesics, Opioid
    Language English
    Publishing date 2021-02-15
    Publishing country United States
    Document type Journal Article ; Meta-Analysis ; Systematic Review
    ZDB-ID 212581-x
    ISSN 1530-0358 ; 0012-3706
    ISSN (online) 1530-0358
    ISSN 0012-3706
    DOI 10.1097/DCR.0000000000001985
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  7. Article ; Online: Late onset of pneumothorax after bronchoscopic lung volume reduction due to migration of a nitinol coil.

    Mongelli, Francesco / Cafarotti, Stefano / Di Giuseppe, Matteo / Patella, Miriam

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

    2017  Volume 53, Issue 4, Page(s) 884–885

    Abstract: The use of Endobronchial coils are a relatively new brochoscopic technique for lung volume reduction. They appear to be safe and effective in improving quality of life, reducing morbidity and mortality related to the primary disease, while avoiding the ... ...

    Abstract The use of Endobronchial coils are a relatively new brochoscopic technique for lung volume reduction. They appear to be safe and effective in improving quality of life, reducing morbidity and mortality related to the primary disease, while avoiding the many risks of morbidity and mortality associated with surgery. Nevertheless, some complications, such as pneumothorax, are relatively common in the periprocedural period. We describe a case of pneumothorax that occurred several days after brochoscopic technique for lung volume reduction due to direct perforation of the visceral pleura by a coil. The patient presented with a large pneumothorax associated with significant air leak, requiring surgical intervention. Exploration of the chest cavity showed a pleural tear caused by a coil. To our knowledge, this is an adverse event that has never been described before, suggesting the possible migration of the coil from the original position.
    MeSH term(s) Alloys ; Bronchoscopy/adverse effects ; Female ; Foreign-Body Migration/complications ; Humans ; Middle Aged ; Pneumonectomy/adverse effects ; Pneumonectomy/instrumentation ; Pneumonectomy/methods ; Pneumothorax/etiology
    Chemical Substances Alloys ; nitinol (2EWL73IJ7F)
    Language English
    Publishing date 2017-12-13
    Publishing country Germany
    Document type Case Reports ; 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/ezx402
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  8. Article ; Online: Ultrasound-guided pudendal nerve block in patients undergoing open hemorrhoidectomy: a double-blind randomized controlled trial.

    Di Giuseppe, Matteo / Saporito, Andrea / La Regina, Davide / Tasciotti, Edoardo / Ghielmini, Enea / Vannelli, Alberto / Pini, Ramon / Mongelli, Francesco

    International journal of colorectal disease

    2020  Volume 35, Issue 9, Page(s) 1741–1747

    Abstract: Purpose: In this double-blind randomized trial, we aimed to compare the postoperative pain, complications, and length of hospital stay in patients undergoing open hemorrhoidectomy under spinal anesthesia with or without the pudendal nerve block.: ... ...

    Abstract Purpose: In this double-blind randomized trial, we aimed to compare the postoperative pain, complications, and length of hospital stay in patients undergoing open hemorrhoidectomy under spinal anesthesia with or without the pudendal nerve block.
    Methods: Patients undergoing Milligan-Morgan hemorrhoidectomy under spinal anesthesia were randomized to undergo a pudendal nerve block or no intervention. Postoperative pain on the visual analogue scale (VAS) at 6, 12, 24, and 48 h; opioid administration; and length of hospital stay were recorded and analyzed.
    Results: Over the study period, 49 patients were included and 23 randomized in the treatment arm. No differences in terms of age, gender, and preoperative risk factors were noted between groups. The pain on the VAS at 6, 12, 24, and 48 h was 2.8 vs. 4.6 (p = 0.046), 3.4 vs. 4.7 (p = 0.697), 1.4 vs. 3.1 (p = 0.016), and 1.0 vs. 2.1 (p = 0.288) in the treatment and control groups respectively. No differences in opioids use or complications were noted. Length of hospital stay was 1.2 vs. 1.8 days respectively (p = 0.046). No complications directly associated to the pudendal nerve block were observed. Multivariate analysis revealed that the pudendal nerve block was an independent factor reducing the postoperative pain.
    Conclusions: The ultrasound-guided pudendal nerve block in patients undergoing open hemorrhoidectomy under spinal anesthesia showed a statistically significant reduction in postoperative pain and length of hospital stay. The proposed technique appeared to be safe and feasible and may be recommendable in patients undergoing open hemorrhoidectomy.
    Trial registration: ClinicalTrials.gov Identifier: NCT04251884.
    MeSH term(s) Double-Blind Method ; Hemorrhoidectomy/adverse effects ; Hemorrhoids/surgery ; Humans ; Nerve Block ; Pain, Postoperative/drug therapy ; Pain, Postoperative/etiology ; Pudendal Nerve ; Ultrasonography, Interventional
    Language English
    Publishing date 2020-05-30
    Publishing country Germany
    Document type Journal Article ; Randomized Controlled Trial
    ZDB-ID 84975-3
    ISSN 1432-1262 ; 0179-1958
    ISSN (online) 1432-1262
    ISSN 0179-1958
    DOI 10.1007/s00384-020-03630-x
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  9. Article ; Online: Suture and Fixation of the Transversalis Fascia during Robotic-Assisted Transabdominal Preperitoneal Hernia Repair to Prevent Seroma Formation after Direct Inguinal Hernia Repair.

    Pini, Ramon / Mongelli, Francesco / Proietti, Francesco / Cianfarani, Agnese / Garofalo, Fabio / Di Giuseppe, Matteo / La Regina, Davide

    Surgical innovation

    2020  Volume 28, Issue 3, Page(s) 284–289

    Abstract: Background. ...

    Abstract Background.
    MeSH term(s) Fascia ; Hernia, Inguinal/surgery ; Herniorrhaphy/adverse effects ; Humans ; Infant, Newborn ; Laparoscopy ; Male ; Robotic Surgical Procedures ; Seroma/epidemiology ; Seroma/etiology ; Seroma/prevention & control ; Surgical Mesh ; Sutures/adverse effects ; Treatment Outcome
    Language English
    Publishing date 2020-09-16
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2182571-3
    ISSN 1553-3514 ; 1553-3506
    ISSN (online) 1553-3514
    ISSN 1553-3506
    DOI 10.1177/1553350620960976
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  10. Article: Safety, feasibility and clinical outcome of minimally invasive inguinal hernia repair in patients with previous radical prostatectomy: A systematic review of the literature.

    La Regina, Davide / Gaffuri, Paolo / Ceppi, Marcello / Saporito, Andrea / Ferrari, Matteo / Di Giuseppe, Matteo / Mongelli, Francesco

    Journal of minimal access surgery

    2019  Volume 15, Issue 4, Page(s) 281–286

    Abstract: Background: Radical prostatectomy (RP) represents an important acquired risk factor for the development of primary inguinal hernias (IH) with an estimated incidence rates of 15.9% within the first 2 years after surgery. The prostatectomy-related ... ...

    Abstract Background: Radical prostatectomy (RP) represents an important acquired risk factor for the development of primary inguinal hernias (IH) with an estimated incidence rates of 15.9% within the first 2 years after surgery. The prostatectomy-related preperitoneal fibrotic reaction can make the laparoendoscopic repair of the IH technically difficult, even if safety and feasibility have not been extensively evaluated yet. We conducted a systematic review of the available literature.
    Methods: A comprehensive computer literature search of PubMed and MEDLINE databases was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Terms used to search were ('laparoscopic' OR 'laparoscopy') AND ('inguinal' OR 'groin' OR 'hernia') AND 'prostatectomy'.
    Results: The literature search from PubMed and MEDLINE databases revealed 156 articles. Five articles were considered eligible for the analysis, including 229 patients who underwent 277 hernia repairs. The pooled analysis indicates no statistically significant difference of post-operative complications (Risk Ratios [RR] 2.06; 95% confidence interval [CI] 0.85-4.97), conversion to open surgery (RR 3.91; 95% CI 0.85-18.04) and recurrence of hernia (RR 1.39; 95% CI 0.39-4.93) between the post-prostatectomy group and the control group. There was a statistically significant difference of minor intraoperative complications (RR 4.42; CI 1.05-18.64), due to an injury of the inferior epigastric vessels.
    Conclusions: Our systematic review suggests that, in experienced hands, safety, feasibility and clinical outcomes of minimally invasive repair of IH in patients previously treated with prostatectomy, are comparable to those patients without previous RP.
    Language English
    Publishing date 2019-02-22
    Publishing country India
    Document type Journal Article ; Review
    ZDB-ID 2186884-0
    ISSN 1998-3921 ; 0972-9941
    ISSN (online) 1998-3921
    ISSN 0972-9941
    DOI 10.4103/jmas.JMAS_218_18
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