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Article ; Online: Intraoperative cholangiography during laparoscopic cholecystectomy. Should we follow the recommendations of the current guidelines?

Erdas, Enrico / Canu, Gian Luigi / Medas, Fabio

Journal of hepato-biliary-pancreatic sciences

2020 Volume 27, Issue 11, Page(s) e17–e18

MeSH term(s)	Cholangiography ; Cholecystectomy, Laparoscopic/adverse effects ; Gallstones/surgery ; Humans ; Intraoperative Care ; Intraoperative Complications
Language	English
Publishing date	2020-11-06
Publishing country	Japan
Document type	Letter
ZDB-ID	2536236-7
ISSN	1868-6982 ; 1868-6974
ISSN (online)	1868-6982
ISSN	1868-6974
DOI	10.1002/jhbp.832
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Article ; Online: Effective Surgical Management of a Large Serous Ovarian Cyst in a Morbidly Obese Middle-Aged Woman: A Case Study and Literature Review.

Peiretti, Michele / Mais, Valerio / D'Ancona, Gianmarco / Fais, Maria Luisa / Erdas, Enrico / Figus, Andrea / Angioni, Stefano

The American journal of case reports

2023 Volume 24, Page(s) e939697

Abstract: BACKGROUND In contemporary gynecological practice, encountering giant ovarian tumors is a rarity. While most are benign and of the mucinous subtype, the borderline variant only accounts for approximately 10% of these cases. This paper addresses the ... ...

Abstract	BACKGROUND In contemporary gynecological practice, encountering giant ovarian tumors is a rarity. While most are benign and of the mucinous subtype, the borderline variant only accounts for approximately 10% of these cases. This paper addresses the paucity of information about this specific subtype, emphasizing critical elements of managing borderline tumors that can pose life-threatening complications. Additionally, a review of other documented cases of the borderline variant in the literature is also included to foster a deeper understanding of this uncommon condition. CASE REPORT We present the multidisciplinary management of a 52-year-old symptomatic woman with a giant serous borderline ovarian tumor. Preoperative assessment showed a multiloculated pelvic-abdominal cyst responsible for compression of the bowel and retroperitoneal organs, and dyspnea. All tumor markers were negative. Together with anesthesiologists and interventional cardiologists, we decided to perform a controlled drainage of the cyst of the tumor, to prevent hemodynamic instability. Subsequent total extrafascial hysterectomy, contralateral salpingo-oophorectomy, and abdominal wall reconstruction, followed by admission to the intensive care unit, were also conducted by the multidisciplinary team. During the postoperative period, the patient experienced a cardiopulmonary arrest and acute renal failure, which were managed by dialysis. After discharge, the patient underwent oncologic followup, and after 2 years, she was found to be completely recovered and disease free. CONCLUSIONS Intraoperative controlled drainage of Giant ovarian tumor fluid, planned by a multidisciplinary management team, constitutes a valid and safe alternative to the popular choice of "en bloc" tumor resection. This approach avoids rapid changes in body circulation, which are responsible for intraoperative and postoperative severe complications.
MeSH term(s)	Middle Aged ; Female ; Humans ; Obesity, Morbid/complications ; Renal Dialysis ; Cysts ; Ovarian Neoplasms/surgery ; Ovarian Neoplasms/pathology ; Ovarian Cysts
Language	English
Publishing date	2023-06-21
Publishing country	United States
Document type	Review ; Case Reports ; Journal Article
ZDB-ID	2517183-5
ISSN	1941-5923 ; 1941-5923
ISSN (online)	1941-5923
ISSN	1941-5923
DOI	10.12659/AJCR.939697
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Article ; Online: What is the Real Incidence of Trocar Site Hernias?

Erdas, Enrico / Canu, Gian L / Cappellacci, Federico / Medas, Fabio / Calò, Pietro G

Surgical laparoscopy, endoscopy & percutaneous techniques

2021 Volume 31, Issue 2, Page(s) 135

MeSH term(s)	Hernia, Ventral/epidemiology ; Hernia, Ventral/etiology ; Hernia, Ventral/surgery ; Humans ; Incidence ; Laparoscopy/adverse effects ; Surgical Instruments/adverse effects
Language	English
Publishing date	2021-03-17
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.0000000000000934
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Article ; Online: The role of Rapid Intraoperative Parathyroid Hormone (ioPTH) assay in determining outcome of parathyroidectomy in primary hyperparathyroidism: A systematic review and meta-analysis.

Medas, Fabio / Cappellacci, Federico / Canu, Gian Luigi / Noordzij, Jacob Pieter / Erdas, Enrico / Calò, Pietro Giorgio

International journal of surgery (London, England)

2021 Volume 92, Page(s) 106042

Abstract: Background: Primary hyperparathyroidism (PHPT) is a common endocrine disorder. In the last few decades, the introduction of Rapid Intraoperative Parathyroid Hormone (ioPTH) monitoring has allowed to ensurance of the excision of all hyperfunctioning ... ...

Abstract	Background: Primary hyperparathyroidism (PHPT) is a common endocrine disorder. In the last few decades, the introduction of Rapid Intraoperative Parathyroid Hormone (ioPTH) monitoring has allowed to ensurance of the excision of all hyperfunctioning parathyroid tissues, reducing the risks of persistent and recurrent PHPT. However, the use of ioPTH is still debated among endocrine surgeons. Material and methods: The objective of this systematic review and meta-analysis was to assess if ioPTH monitoring is able to reduce the incidence of persistent or recurrent PHPT. A systematic literature search was performed using PubMed, Scopus, ISI-Web of Science and Cochrane Library Database. Prospective and retrospective studies addressing the efficacy of ioPTH monitoring were included in the systematic review and meta-analysis. The random-effects model was assumed to account for different sources of variation among studies. The overall effect size was computed through the inverse variance method. Heterogeneity across studies, possible outlier studies, and publication bias were evaluated. Results: A total of 28 studies with 13,323 patients were included in the quantitative analysis. The incidence of operative failure was 3.2% in the case group and 5.8% in the control group. After excluding three outlier studies, the quantitative analysis revealed that ioPTH reduced significantly the incidence of postoperative persistent or recurrent PHPT. (Risk Difference = -0.02; CI = -0.03, -0.01; p < 0.001). There was no evidence of heterogeneity among the studies (Q = 19.92, p = 0.70; I Conclusion: ioPTH monitoring is effective in reducing the incidence of persistent and recurrent PHPT. Its routine use should be suggested in the next guidelines regarding management of PHPT.
MeSH term(s)	Humans ; Hyperparathyroidism, Primary/prevention & control ; Hyperparathyroidism, Primary/surgery ; Intraoperative Period ; Parathyroid Hormone/blood ; Parathyroidectomy ; Secondary Prevention ; Treatment Outcome
Chemical Substances	Parathyroid Hormone
Language	English
Publishing date	2021-07-30
Publishing country	England
Document type	Journal Article ; Meta-Analysis ; Review ; Systematic Review
ZDB-ID	2212038-5
ISSN	1743-9159 ; 1743-9191
ISSN (online)	1743-9159
ISSN	1743-9191
DOI	10.1016/j.ijsu.2021.106042
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Article: The Use of Harmonic Focus and Thunderbeat Open Fine Jaw in Thyroid Surgery: Experience of a High-Volume Center.

Canu, Gian Luigi / Medas, Fabio / Cappellacci, Federico / Casti, Francesco / Bura, Raffaela / Erdas, Enrico / Calò, Pietro Giorgio

Journal of clinical medicine

2022 Volume 11, Issue 11

Abstract: Background: In thyroid surgery, achieving accurate haemostasis is fundamental in order to avoid the occurrence of complications. Energy-based devices are currently extensively utilized in this field of surgery. This study aims to compare Harmonic Focus ... ...

Abstract	Background: In thyroid surgery, achieving accurate haemostasis is fundamental in order to avoid the occurrence of complications. Energy-based devices are currently extensively utilized in this field of surgery. This study aims to compare Harmonic Focus and Thunderbeat Open Fine Jaw with regard to surgical outcomes and complications. Methods: Patients submitted to total thyroidectomy in our center, between January 2017 and June 2020, were retrospectively analysed. Based on the energy-based device utilized, two groups were identified: Group A (Harmonic Focus) and Group B (Thunderbeat Open Fine Jaw). Results: A total of 527 patients were included: 409 in Group A and 118 in Group B. About surgical outcomes, the mean operative time was significantly shorter in Group B than in Group A (p < 0.001), while as regards complications, the occurrence of transient recurrent laryngeal nerve injury was significantly greater in Group B than in Group A (p = 0.019). Conclusions. Both Harmonic Focus and Thunderbeat Open Fine Jaw have proven to be effective devices. Operative times were significantly shorter in thyroidectomies performed with Thunderbeat Open Fine Jaw; however, the occurrence of transient recurrent laryngeal nerve injury was significantly greater in patients operated on with this device.
Language	English
Publishing date	2022-05-29
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm11113062
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Article ; Online: Intact parathyroid hormone value on the first postoperative day following total thyroidectomy as a predictor of permanent hypoparathyroidism: a retrospective analysis on 426 consecutive patients.

Canu, Gian Luigi / Medas, Fabio / Cappellacci, Federico / Soddu, Cristina / Romano, Giorgio / Erdas, Enrico / Calò, Pietro Giorgio

Endokrynologia Polska

2022 Volume 73, Issue 1, Page(s) 48–55

Abstract: Introduction: Hypoparathyroidism represents a common complication following total thyroidectomy. To date, there is still no reliable and immediate postoperative parameter to establish which patients with postsurgical hypoparathyroidism will develop ... ...

Abstract	Introduction: Hypoparathyroidism represents a common complication following total thyroidectomy. To date, there is still no reliable and immediate postoperative parameter to establish which patients with postsurgical hypoparathyroidism will develop permanent hypoparathyroidism. The main purpose of the present study was to assess whether the intact parathyroid hormone (iPTH) value on the first postoperative day is a good predictor of permanent hypoparathyroidism. Material and methods: Patients undergoing thyroidectomy in our unit between March 2018 and January 2020 were analysed. According to the iPTH value on the first postoperative day and on the basis of the detection threshold of the iPTH test used, patients were divided into two groups: Group A (iPTH ≥ 4.6 pg/mL) and Group B (iPTH < 4.6 pg/mL, undetectable). Results: In total 426 patients were included: 364 in Group A and 62 in Group B. Permanent hypoparathyroidism occurred in 3 (0.82%) patients from Group A and in 26 (41.94%) from Group B (p < 0.001). When iPTH levels were < 4.6 pg/mL on the first postoperative day the sensitivity for the prediction of permanent hypoparathyroidism was 89.66%, the specificity was 90.93%, the positive predictive value (PPV) was 41.94%, the negative predicitive value (NPV) was 99.18% and the accuracy was 90.85%. Conclusions: An iPTH value < 4.6 pg/mL on the first postoperative day following total thyroidectomy has proven to be a good parameter for early identification of patients at high risk for permanent hypoparathyroidism. Moreover, we want to underline that in our experience no patient with an iPTH level > 6.5 pg/mL developed this complication.
MeSH term(s)	Calcium ; Humans ; Hypocalcemia/etiology ; Hypoparathyroidism/diagnosis ; Hypoparathyroidism/etiology ; Parathyroid Hormone ; Postoperative Complications/diagnosis ; Postoperative Complications/etiology ; Retrospective Studies ; Thyroidectomy/adverse effects
Chemical Substances	Parathyroid Hormone ; Calcium (SY7Q814VUP)
Language	English
Publishing date	2022-02-14
Publishing country	Poland
Document type	Journal Article
ZDB-ID	419270-9
ISSN	2299-8306 ; 0423-104X
ISSN (online)	2299-8306
ISSN	0423-104X
DOI	10.5603/EP.a2022.0005
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Article ; Online: A mini-invasive approach is feasible in patients with primary hyperparathyroidism and discordant or negative localisation studies.

Canu, Gian Luigi / Cappellacci, Federico / Noordzij, Jacob Pieter / Piras, Stefano / Erdas, Enrico / Calò, Pietro Giorgio / Medas, Fabio

Updates in surgery

2022 Volume 74, Issue 2, Page(s) 747–755

Abstract: Preoperative localisation of pathological glands in patients with primary hyperparathyroidism (PHP) is the mainstay for mini-invasive parathyroidectomy. Nevertheless, a not negligible number of patients presents discordant or negative neck ultrasound (US) ...

Abstract	Preoperative localisation of pathological glands in patients with primary hyperparathyroidism (PHP) is the mainstay for mini-invasive parathyroidectomy. Nevertheless, a not negligible number of patients presents discordant or negative neck ultrasound (US) and
MeSH term(s)	Humans ; Hyperparathyroidism, Primary/diagnostic imaging ; Hyperparathyroidism, Primary/surgery ; Minimally Invasive Surgical Procedures/methods ; Parathyroidectomy/methods ; Radiopharmaceuticals ; Retrospective Studies ; Technetium Tc 99m Sestamibi ; Ultrasonography
Chemical Substances	Radiopharmaceuticals ; Technetium Tc 99m Sestamibi (971Z4W1S09)
Language	English
Publishing date	2022-01-06
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/s13304-021-01213-1
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Article ; Online: External hernia of the supravesical fossa: Rare or simply misidentified?

Amato, G / Romano, G / Erdas, E / Medas, F / Gordini, L / Podda, F / Calò, P

International journal of surgery (London, England)

2017 Volume 41, Page(s) 119–126

Abstract: Background: External hernias of the supravesical fossa are considered rare, perhaps wrongly. Highlighting clinical and anatomical features could be useful for correct, preoperative diagnosis, thus avoiding the risk of complications such as incarceration. ...

Abstract	Background: External hernias of the supravesical fossa are considered rare, perhaps wrongly. Highlighting clinical and anatomical features could be useful for correct, preoperative diagnosis, thus avoiding the risk of complications such as incarceration. The study aims to demonstrate that the incidence of external protrusions of the supravesical fossa is higher that supposed. Probably, being mistaken for direct hernias, these hernia types are misidentified and not included in current classifications. This issue deserves attention due to the elevated risk of incarceration related to its distinctive structure. Material and methods: 249 consecutive open anterior inguinal hernia procedures were analyzed. Hernias were categorized according to the Nyhus classification. A subgroup of direct hernias involved true hernias of the supravesical fossa. Multiple ipsilateral, as well as combined hernias having a multi-component structure, were also considered. Results: 13 true hernias of the supravesical fossa and 19 multiple ipsilateral or combined hernias composed of direct and/or indirect hernia, together with one hernia of the supravesical fossa were identified. 4 true hernias of the supravesical fossa presented signs of incarceration. In three other combined protrusions, the herniated component of the supravesical fossa also showed incarceration of the visceral content. Conclusions: Hernias of the supravesical fossa would appear to be more frequent than imagined. These protrusions show a diverticular shape and the base is often tightened by the stiffer medial umbilical fold. This explains the apparently higher tendency to incarceration that distinguishes this hernia type. Preoperative signs of inguinal pain and irreducibility are pathognomonic for correct diagnosis. In these cases, surgical treatment in the short term is recommended.
Language	English
Publishing date	2017-05
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2212038-5
ISSN	1743-9159 ; 1743-9191
ISSN (online)	1743-9159
ISSN	1743-9191
DOI	10.1016/j.ijsu.2017.03.075
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Article ; Online: Does antithrombotic prophylaxis worsen early outcomes of total thyroidectomy? - a retrospective cohort study.

Erdas, E / Medas, F / Sanna, S / Gordini, L / Pisano, G / Canu, G L / Calò, P G

BMC surgery

2019 Volume 18, Issue Suppl 1, Page(s) 82

Abstract: Background: Currently, there is no strong evidence on the effectiveness and safety of pharmacological antithrombotic prophylaxis in thyroid surgery. The aim of this study was to establish whether the prophylactic use of low-molecular-weight heparin ( ... ...

Abstract	Background: Currently, there is no strong evidence on the effectiveness and safety of pharmacological antithrombotic prophylaxis in thyroid surgery. The aim of this study was to establish whether the prophylactic use of low-molecular-weight heparin (LMWH) could negatively affect the early outcomes of patients undergoing total thyroidectomy. Methods: Data from patients submitted to total thyroidectomy between February 2013 and October 2017 were retrospectively collected and analysed. Only patients with indication to antithrombotic prophylaxis according to current guidelines were included in the study. Eligible cases were divided into two groups, which corresponded to two distinct periods of our surgical practice: Group A, which included 178 consecutive patients who were submitted to antithrombotic prophylaxis with LMWH, and Group B, which included 348 consecutive patients who did not receive prophylaxis. Primary endpoints were the incidence of post-operative cervical haematomas (POCH) and thromboembolic events. Secondary endpoint was the length of postoperative hospital stay. Statistical analysis was performed by using Student's t test for continuous variables and Chi-square test for categorical variables. A P value of less than 0.05 was considered statistically significant. Results: The two groups of patients were comparable in terms of age, gender, thyroid disease, duration of surgery, and weight of the thyroid gland. Overall, no thromboembolic events were registered. The comparative analysis of the other outcome measures, showed no significant differences between the two groups (POCH: 2 cases (1.12%) in Group A vs 8 cases (2.30%) in Group B - p 0.349; Postoperative hospital stay: 2.90 ± 0.86 days in Group A vs 2.89 ± 0.99 days in Group B - p 0.908). Conclusions: Data from this study do not support or contraindicate the use of antithrombotic prophylaxis in thyroid surgery. However, since thyroidectomy is a closed-space procedure, and even modest bleeding may quickly result in airway compression and death by asphyxia, mechanical prophylaxis should be preferred to LMWH whenever possible. Trial registration: ISRCTN ISRCTN12029395. Registered 05/02/2018 retrospectively registered.
MeSH term(s)	Aged ; Cohort Studies ; Female ; Fibrinolytic Agents/administration & dosage ; Hemorrhage/epidemiology ; Heparin, Low-Molecular-Weight/administration & dosage ; Humans ; Length of Stay ; Male ; Middle Aged ; Retrospective Studies ; Thyroid Gland/surgery ; Thyroidectomy/methods
Chemical Substances	Fibrinolytic Agents ; Heparin, Low-Molecular-Weight
Language	English
Publishing date	2019-04-24
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/s12893-018-0407-2
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Article ; Online: Tentacle-shaped mesh for fixation-free repair of umbilical hernias.

Amato, G / Romano, G / Agrusa, A / Canu, G L / Gulotta, E / Erdas, E / Calò, P G

Hernia : the journal of hernias and abdominal wall surgery

2019 Volume 23, Issue 4, Page(s) 801–807

Abstract: Purpose: Mesh fixation and broad overlap represent an open issue in umbilical hernia repair. A proprietary-designed implant with tentacle straps at its boundary has been developed to ensure a suture-free repair and a broader coverage of the abdominal ... ...

Abstract	Purpose: Mesh fixation and broad overlap represent an open issue in umbilical hernia repair. A proprietary-designed implant with tentacle straps at its boundary has been developed to ensure a suture-free repair and a broader coverage of the abdominal wall. The study describes the results of umbilical hernia procedures carried out with the tentacle-shaped implant and the related surgical technique. Methods: A proprietary tentacle-shaped flat mesh having a central body with integrated radiating arms at its edge was used to repair large umbilical hernias in 62 patients. The implant was placed in preperitoneal sublay. The friction of the straps, crossing the abdominal wall thanks to a special needle passer, was intended to assure adequate grip to hold the implant in place assuring a fixation-free procedure and broad overlap of the hernia defect. Results: In a mean follow-up of 48 months (range 10-62 months), 4 seromas and 2 ischemia of the navel skin occurred. No infections, hematomas, chronic pain, mesh dislocation, or recurrence has been reported. Conclusions: The tentacle strap system of the prosthesis effectively ensured an easier implant placement avoiding the need for suturing the mesh. The arms of the implant ensured a proper orientation and stabilization of the mesh in association with a broad defect overlap. The specifically developed surgical procedure showed a quick postoperative recovery, a very low complication rate, and no recurrences even in the long term.
MeSH term(s)	Abdominal Wall/surgery ; Adult ; Aged ; Female ; Hernia, Umbilical/surgery ; Herniorrhaphy/methods ; Humans ; Male ; Middle Aged ; Prostheses and Implants ; Prosthesis Implantation/methods ; Recurrence ; Surgical Mesh ; Suture Techniques ; Umbilicus/surgery
Language	English
Publishing date	2019-04-12
Publishing country	France
Document type	Journal Article
ZDB-ID	1388125-5
ISSN	1248-9204 ; 1265-4906
ISSN (online)	1248-9204
ISSN	1265-4906
DOI	10.1007/s10029-019-01950-8
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