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  1. Article: Feasibility of Roux-en-Y Gastric Bypass with the novel robotic platform HUGO™ RAS.

    Raffaelli, Marco / Voloudakis, Nikolaos / Pennestrì, Francesco / Gallucci, Pierpaolo / Modesti, Cristina / Salvi, Giulia / Greco, Francesco / Ciccoritti, Luigi

    Frontiers in surgery

    2023  Volume 10, Page(s) 1181790

    Abstract: Introduction: Robotic assisted surgery is a rapidly developing field of minimally invasive bariatric surgery in the last 20 years. Its wide diffusion has led to the development and standardization of robotic assisted approaches for bariatric operations. ...

    Abstract Introduction: Robotic assisted surgery is a rapidly developing field of minimally invasive bariatric surgery in the last 20 years. Its wide diffusion has led to the development and standardization of robotic assisted approaches for bariatric operations. In this study, we present the first four Roux-en-Y Gastric Bypass (RYGB) operations performed with the new Hugo™ RAS system (Medtronic, Minneapolis, MN, USA).
    Methods: In January and February 2023, 4 consecutive patients scheduled for minimal invasive Roux-en-Y-Bypass were selected and underwent the procedure robotic-assisted with the new platform. No exclusion criteria were applied.
    Results: Four patients, two females and two males, underwent RYGB with a median BMI of 40 Kg/m
    Conclusions: Based on our initial experience, RYGB with the Hugo™ RAS system is feasible. This study provides the configurations necessary to perform RYGB with the Hugo™ RAS system as well as general information and insights from our preliminary experience.
    Language English
    Publishing date 2023-06-05
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2773823-1
    ISSN 2296-875X
    ISSN 2296-875X
    DOI 10.3389/fsurg.2023.1181790
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  2. Article ; Online: Robotic-assisted Roux-en-Y gastric bypass with the novel platform Hugo

    Raffaelli, Marco / Greco, Francesco / Pennestrì, Francesco / Gallucci, Pierpaolo / Ciccoritti, Luigi / Salvi, Giulia / Procopio, Priscilla Francesca / Voloudakis, Nikolaos

    Updates in surgery

    2023  Volume 76, Issue 1, Page(s) 179–185

    Abstract: Robotic assisted surgery is a rapidly developing field in bariatric surgery. Its wide diffusion has led to the development and standardisation of robotic assisted approaches for various bariatric operations. However, further application has been limited ... ...

    Abstract Robotic assisted surgery is a rapidly developing field in bariatric surgery. Its wide diffusion has led to the development and standardisation of robotic assisted approaches for various bariatric operations. However, further application has been limited thus far due to issues of cost-effectiveness and accessibility. The introduction of new robotic platforms may help overcome those obstacles. In this study, we present the first fifteen cases of Roux-en-Y Gastric Bypass (RYGB) operations performed with the new Hugo™ RAS system (Medtronic, Minneapolis, MN, USA). From January to March 2023, consecutive patients scheduled for minimal invasive Roux-en-Y-Bypass were randomly selected and underwent the procedure robotic-assisted with the new platform. No exclusion criteria were applied. Seven female and eight male patients with a median BMI of 42 (range: 36-50) and obesity-related comorbidities in eight cases underwent RYGB. The median docking time was 7 min (range: 6-8.5) and the median console time was 100 min (range: 70-150). Procedures were performed without intraoperative complications and no conversion to laparoscopy or open surgery was noted. Operative times were indicative of a steep learning curve. No early post-operative complications were observed. Based on our initial experience, RYGB with the Hugo™ RAS system is promising and may be integrated in established robotic programmes without requiring a long adaptation period.
    MeSH term(s) Adult ; Female ; Humans ; Male ; Middle Aged ; Gastric Bypass/methods ; Laparoscopy/methods ; Obesity, Morbid/surgery ; Robotic Surgical Procedures/methods ; Treatment Outcome
    Language English
    Publishing date 2023-10-20
    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/s13304-023-01657-7
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  3. Article: Obesity Surgery Mortality Risk Score as a Predictor for Intensive Care Unit Admission in Patients Undergoing Laparoscopic Bariatric Surgery.

    Aceto, Paola / De Cicco, Roberto / Calabrese, Claudia / Marusco, Irene / Del Tedesco, Filippo / Luca, Ersilia / Modesti, Cristina / Sacco, Teresa / Sollazzi, Liliana / Ciccoritti, Luigi / Greco, Francesco / Giustacchini, Piero / Pennestrì, Francesco / Gallucci, Pierpaolo / Raffaelli, Marco

    Journal of clinical medicine

    2024  Volume 13, Issue 8

    Abstract: Background: ...

    Abstract Background:
    Language English
    Publishing date 2024-04-12
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2662592-1
    ISSN 2077-0383
    ISSN 2077-0383
    DOI 10.3390/jcm13082252
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  4. Article ; Online: Single Institution Experience in the Management of Locally Advanced (pT4) Differentiated Thyroid Carcinomas.

    Sessa, Luca / De Crea, Carmela / Voloudakis, Nikolaos / Pennestri', Francesco / Revelli, Luca / Gallucci, Pierpaolo / Perotti, Germano / Tagliaferri, Luca / Rossi, Ernesto / Rossi, Esther Diana / Pontecorvi, Alfredo / Bellantone, Rocco / Raffaelli, Marco

    Annals of surgical oncology

    2024  

    Abstract: Background: Locally infiltrating (T4) differentiated thyroid carcinomas (DTC) represent a challenge. Surgical strategy and adjuvant therapy should be planned balancing morbidity and oncologic outcome. A series of patients with T4 DTC who underwent ... ...

    Abstract Background: Locally infiltrating (T4) differentiated thyroid carcinomas (DTC) represent a challenge. Surgical strategy and adjuvant therapy should be planned balancing morbidity and oncologic outcome. A series of patients with T4 DTC who underwent multidisciplinary evaluation and treatment is reported. The main study endpoints were the oncologic outcome, complication rates, and risk factors for tumor recurrence.
    Patients and methods: All DTC cases operated between 2009 and 2021 were reviewed and T4 DTC cases were identified. En bloc resection of inferior laryngeal nerve (ILN), tracheal, and/or internal jugular vein (IJV) was performed in cases of massive infiltration. In cases of pharyngoesophageal junction (PEJ) invasion, the shaving technique was always applied.
    Results: Among 4775 DTC cases, 60 were T4. ILN infiltration was documented in 45 cases (en bloc resection in 9), tracheal infiltration in 14 (tracheal resection in 2), PEJ invasion in 11 (R0 resection in 7 cases and < 1 cm residual tissue in 4 cases), IJV resection in 6, and laryngeal in 2. In total, 11 postoperative ILN palsy, 23 transient hypoparathyroidisms, and 2 hematomas requiring reoperation were registered. Final histology showed 7 pN0, 22 pN1a, and 31 pN1b tumors. Aggressive variants were observed in 47 patients. All but 1 patient underwent radioiodine treatment, 12 underwent adjuvant external beam radiation therapy (EBRT), and 2 underwent chemotherapy. At a median follow-up of 58 months, no tumor-related death was registered, and seven patients required reoperation for recurrence. Tracheal invasion was the only significant factor negatively impacting recurrence (p = 0.045).
    Conclusions: A multidisciplinary approach is essential for the management of T4 DTC. Individualized and balanced surgical strategy and adjuvant treatments, in particular EBRT, ensure control of locally advanced disease with acceptable morbidity.
    Language English
    Publishing date 2024-05-03
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1200469-8
    ISSN 1534-4681 ; 1068-9265
    ISSN (online) 1534-4681
    ISSN 1068-9265
    DOI 10.1245/s10434-024-15356-z
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  5. Article ; Online: Robot-assisted vs laparoscopic bariatric procedures in super-obese patients: clinical and economic outcomes.

    Marincola, Giuseppe / Procopio, Priscilla Francesca / Pennestrì, Francesco / Gallucci, Pierpaolo / Voloudakis, Nikolaos / Ciccoritti, Luigi / Greco, Francesco / Salvi, Giulia / Prioli, Francesca / De Crea, Carmela / Raffaelli, Marco

    Journal of robotic surgery

    2024  Volume 18, Issue 1, Page(s) 34

    Abstract: The increased operative time and costs represent the main limitations of robotic technology application to bariatric surgery. Robotic platforms may help the surgeon to overcome the technical difficulties in super-obese (SO, BMI ≥ 50 kg/ ... ...

    Abstract The increased operative time and costs represent the main limitations of robotic technology application to bariatric surgery. Robotic platforms may help the surgeon to overcome the technical difficulties in super-obese (SO, BMI ≥ 50 kg/m
    MeSH term(s) Humans ; Retrospective Studies ; Robotics ; Robotic Surgical Procedures/methods ; Bariatrics ; Obesity ; Laparoscopy ; Gastric Bypass
    Language English
    Publishing date 2024-01-17
    Publishing country England
    Document type Journal Article
    ZDB-ID 2268283-1
    ISSN 1863-2491 ; 1863-2483
    ISSN (online) 1863-2491
    ISSN 1863-2483
    DOI 10.1007/s11701-023-01748-y
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  6. Article: Controversial Role of Robot in Primary and Revisional Bariatric Surgery Procedures: Review of the Literature and Personal Experience.

    Fantola, Giovanni / Moroni, Enrico / Runfola, Matteo / Lai, Emanuele / Pintus, Stefano / Gallucci, Pierpaolo / Pennestrì, Francesco / Raffaelli, Marco

    Frontiers in surgery

    2022  Volume 9, Page(s) 916652

    Abstract: Laparoscopy is the surgical standard of care for bariatric procedures; however, during the last two decades, the robotic approach has gained increasing interest. It is currently considered a safe and effective alternative to laparoscopy. This literature ... ...

    Abstract Laparoscopy is the surgical standard of care for bariatric procedures; however, during the last two decades, the robotic approach has gained increasing interest. It is currently considered a safe and effective alternative to laparoscopy. This literature review investigates the role of the robotic approach for primary and revisional bariatric procedures, with the particular aim of comparing this technique with the standard-of-care laparoscopic approach. The feasibility of robotic dissection and suturing could have potential advantages: robotics may prevent the risk of leak and bleeding and other surgical complications, determining potential benefits in terms of operative time, length of hospital stay, and learning curve. Considering primary procedures, the literature reveals no advantages in robotic versus the laparoscopic approach for adjustable gastric banding and sleeve gastrectomy. Robotic Roux-en-Y gastric bypass is associated with a longer operative time and a shorter hospital length of stay than laparoscopy. The robotic approach in revisional surgery has been proven to be safe and effective. Despite the longer operative time, the robotic platform could achieve a lower bleeding rate compared with laparoscopy. The surgeon's selection criteria related to referrals to the robotic approach of difficult-perceived cases could represent a bias. In conclusion, robotic surgery can be considered a safe and effective approach in both primary and revisional bariatric surgery, despite the lack of evidence to support its routine use in primary bariatric surgery. However, in revisional bariatric surgery and in surgical complex procedures, the robotic approach could have potential benefits in terms of surgical complications and learning curves.
    Language English
    Publishing date 2022-05-31
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 2773823-1
    ISSN 2296-875X
    ISSN 2296-875X
    DOI 10.3389/fsurg.2022.916652
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  7. Article ; Online: Robot-assisted vs laparoscopic lateral transabdominal adrenalectomy: a propensity score matching analysis.

    De Crea, Carmela / Pennestrì, Francesco / Voloudakis, Nikolaos / Sessa, Luca / Procopio, Priscilla Francesca / Gallucci, Pierpaolo / Bellantone, Rocco / Raffaelli, Marco

    Surgical endoscopy

    2022  Volume 36, Issue 11, Page(s) 8619–8629

    Abstract: Background: Laparoscopic adrenalectomy (LA) is the gold standard treatment for adrenal lesions. Robot-assisted adrenalectomy (RAA) is a safe approach, associated with higher costs in absence of clear-cut benefits. Several series reported some advantages ...

    Abstract Background: Laparoscopic adrenalectomy (LA) is the gold standard treatment for adrenal lesions. Robot-assisted adrenalectomy (RAA) is a safe approach, associated with higher costs in absence of clear-cut benefits. Several series reported some advantages of RAA over LA in challenging cases, but definitive conclusions are lacking. We evaluated the cost effectiveness and outcomes of robotic (R-LTA) and laparoscopic (L-LTA) approach for lateral transabdominal adrenalectomy in a high-volume center.
    Methods: Among 356 minimally invasive adrenalectomies (January 2012-August 2021), 286 were performed with a lateral transabdominal approach: 191 L-LTA and 95 R-LTA. The R-LTA and L-LTA patients were matched for lesion side and size, hormone secretion, and BMI with propensity score matching (PSM) analysis. Postoperative complications, operative time (OT), postoperative stay (POS), and costs were compared.
    Results: PSM analysis identified 184 patients, 92 in R-LTA and 92 in L-LTA group. The two groups were well matched. The median lesion size was 4 cm in both groups (p = 0.533). Hormonal hypersecretion was detected in 55 and 54 patients of R-LTA and L-LTA group, respectively (p = 1). Median OT was significantly longer in R-LTA group (90.0 vs 65.0 min) (p < 0.001). No conversion was registered. Median POS was similar (4.0 vs 3.0 days in the R-LTA and L-LTA) (p = 0.467). No difference in postoperative complications was found (p = 1). The cost margin analysis showed a positive income for both procedures (3137 vs 3968 € for R-LTA and L-LTA). In the multiple logistic regression analysis, independent risk factors for postoperative complications were hypercortisolism (OR = 3.926, p = 0.049) and OT > 75 min (OR = 8.177, p = 0.048).
    Conclusions: The postoperative outcomes of R-LTA and L-TLA were similar in our experience. Despite the higher cost, RAA appears to be cost effective and economically sustainable in a high-volume center (60 adrenalectomies/year), especially if performed in challenging cases, including patients with large (> 6 cm) and/or functioning tumors.
    MeSH term(s) Humans ; Adrenalectomy/adverse effects ; Adrenalectomy/methods ; Propensity Score ; Robotics ; Laparoscopy/methods ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Postoperative Complications/surgery ; Adrenal Gland Neoplasms/surgery ; Adrenal Gland Neoplasms/pathology ; Retrospective Studies ; Treatment Outcome
    Language English
    Publishing date 2022-10-03
    Publishing country Germany
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 639039-0
    ISSN 1432-2218 ; 0930-2794
    ISSN (online) 1432-2218
    ISSN 0930-2794
    DOI 10.1007/s00464-022-09663-3
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  8. Article ; Online: The new robotic platform Hugo™ RAS for lateral transabdominal adrenalectomy: a first world report of a series of five cases.

    Raffaelli, Marco / Gallucci, Pierpaolo / Voloudakis, Nikolaos / Pennestrì, Francesco / De Cicco, Roberto / Arcuri, Giovanni / De Crea, Carmela / Bellantone, Rocco

    Updates in surgery

    2022  

    Abstract: Robotic assisted surgery is the most rapidly developing field of minimally invasive surgery. Its wide diffusion has led to the development and standardization of robotic-assisted approaches also for adrenalectomy. In this study, we present the first five ...

    Abstract Robotic assisted surgery is the most rapidly developing field of minimally invasive surgery. Its wide diffusion has led to the development and standardization of robotic-assisted approaches also for adrenalectomy. In this study, we present the first five robotic-assisted lateral transabdominal adrenalectomies performed with the new Hugo RAS™ system (Medtronic, Minneapolis, MN, USA). After an official training course of the surgical team, five consecutive patients scheduled for unilateral adrenalectomy, underwent robotic-assisted operations in our institution. Patients that were candidates for partial adrenalectomy were excluded. A description of the operating theatre, robotic arms and docking setup is provided. Four female and one male patient underwent lateral transabdominal adrenalectomy, three for lesions on the left side and two on the right. Median lesion size was 3.9 cm (range: 30-90) and preoperative diagnosis was Cushing's syndrome in three patients, an adrenal cystic lesion and a pheochromocytoma. The median docking time was 5 min (range: 5-8) and the median console time was 55 min (range: 29-108). Procedures were performed without intraoperative complications and no conversions or additional ports were needed. System's function and docking were uneventful. Based on our initial experience, adrenalectomy with the Hugo™ system is feasible. This study provides technical notes for other centres that wish to perform robotic-assisted adrenalectomies with the Hugo™ RAS as well as general information and our preliminary insights on this new platform.
    Language English
    Publishing date 2022-11-04
    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/s13304-022-01410-6
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  9. Article ; Online: Robotic vs laparoscopic approach for single anastomosis duodenal-ileal bypass with sleeve gastrectomy: a propensity score matching analysis.

    Pennestrì, Francesco / Sessa, Luca / Prioli, Francesca / Gallucci, Pierpaolo / Ciccoritti, Luigi / Greco, Francesco / De Crea, Carmela / Raffaelli, Marco

    Updates in surgery

    2022  

    Abstract: Biliopancreatic diversion with duodenal switch and single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) are technically demanding hypo-absorptive bariatric procedures. They are often indicated in superobese patients (BMI ≥ 50 kg/ ... ...

    Abstract Biliopancreatic diversion with duodenal switch and single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) are technically demanding hypo-absorptive bariatric procedures. They are often indicated in superobese patients (BMI ≥ 50 kg/m
    Language English
    Publishing date 2022-09-25
    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/s13304-022-01381-8
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  10. Article ; Online: Single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S): experience from a high-bariatric volume center.

    Pennestrì, Francesco / Sessa, Luca / Prioli, Francesca / Salvi, Giulia / Gallucci, Pierpaolo / Ciccoritti, Luigi / Greco, Francesco / De Crea, Carmela / Raffaelli, Marco

    Langenbeck's archives of surgery

    2022  Volume 407, Issue 5, Page(s) 1851–1862

    Abstract: Purpose: Biliopancreatic diversion with duodenal switch and single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) are technically demanding hypo-absorptive bariatric procedures generally indicated in super-obese patients (BMI ≥ 50 kg/ ...

    Abstract Purpose: Biliopancreatic diversion with duodenal switch and single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) are technically demanding hypo-absorptive bariatric procedures generally indicated in super-obese patients (BMI ≥ 50 kg/m
    Methods: Among 2313 patients who underwent bariatric procedures at our institution, between July 2016 and August 2021, 121 (5.2%) consenting patients were scheduled for SADI-S as primary (SADIS) or revisional procedure after sleeve gastrectomy (SADI) (respectively 87 and 34 patients). Early and late post-operative complications, operative time, post-operative stay, and follow-up data were analyzed.
    Results: Overall, the median preoperative BMI was 52.3 (48.75-57.05) kg/m
    Conclusion: Our data, coherently with the literature, confirm that SADI-S is a safe, effective procedure with acceptable complications rate. Larger studies with longer follow-ups are necessary to draw definitive conclusions.
    MeSH term(s) Adult ; Anastomosis, Surgical/methods ; Bariatrics ; Duodenum/surgery ; Gastrectomy/methods ; Gastric Bypass/adverse effects ; Humans ; Middle Aged ; Obesity, Morbid/complications ; Obesity, Morbid/surgery ; Retrospective Studies ; Weight Loss
    Language English
    Publishing date 2022-03-29
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 1423681-3
    ISSN 1435-2451 ; 1435-2443
    ISSN (online) 1435-2451
    ISSN 1435-2443
    DOI 10.1007/s00423-022-02501-z
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