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Article ; Online: Indocyanine green (ICG)-guided robotic resection for liver adenoma: combined technologies for precision surgery.

Ingallinella, Sara / Aldrighetti, Luca / Marino, Rebecca / Ratti, Francesca

2024

Abstract: HCA resection is crucial to prevent bleeding and malignant transformation. The aim of this study was to enhance the precision of tumor resection in hepatocellular adenoma (HCA) through the combination of intraoperative ultrasound (IOUS) and indocyanine ... ...

Abstract	HCA resection is crucial to prevent bleeding and malignant transformation. The aim of this study was to enhance the precision of tumor resection in hepatocellular adenoma (HCA) through the combination of intraoperative ultrasound (IOUS) and indocyanine green (ICG) fluorescence imaging. ICG was intravenously injected 24 h before surgery, enabling positive staining of HCA nodules. IOUS guided the parenchymal transection performed using the RoboLap approach. IOUS combined with ICG effectively demarcated lesions, allowing precision surgery while sparing healthy liver tissue. Intraoperative frozen examination further validated the potential of ICG to identify previously undetected lesions. The study showed promising advantages of ICG in HCA resections, potentially reducing the risk of recurrence and malignant transformation. The combined robotic and laparoscopic approach improved the feasibility of parenchymal-sparing surgery, offering a cautious assessment of HCA lesions.
Language	English
Publishing date	2024-04-19
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/s13304-024-01840-4
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Article ; Online: Robo-Lap Approach Optimizes Intraoperative Outcomes in Robotic Left and Right Hepatectomy.

Ratti, Francesca / Marino, Rebecca / Ingallinella, Sara / Clocchiatti, Lucrezia / Corallino, Diletta / Catena, Marco / Aldrighetti, Luca

JSLS : Journal of the Society of Laparoendoscopic Surgeons

2023 Volume 27, Issue 3

Abstract: Background: The aim of the present study is to evaluate the possible advantages of the Robo-Lap (parenchymal transection by laparoscopic ultrasonic dissector and robotic bipolar forceps and scissors) compared with pure robotic technique (parenchymal ... ...

Abstract	Background: The aim of the present study is to evaluate the possible advantages of the Robo-Lap (parenchymal transection by laparoscopic ultrasonic dissector and robotic bipolar forceps and scissors) compared with pure robotic technique (parenchymal transection by use of robotic bipolar forceps and scissors) in major anatomical liver resections with specific focus on intraoperative outcomes. Methods: Major liver resections performed by robotic approach between February 1, 2021 and March 31, 2023 were stratified into two groups according to the approach used to address the phase of liver transection; Pure Robotic Group (n = 21) versus Robo-Lap Group (n = 48). The two groups were compared in terms of intra- and postoperative outcomes and in terms of rate of achievement of intraoperative textbook outcomes. Results: Conversion rate was similar between the two groups while incidence of adverse intraoperative events (according to Satava classification) was higher in the Pure Robotic compared with the Robo-Lap group (85.7% vs 39.6%, p < 0.001). Time to perform parenchymal transection was significantly shorter in the Robo-Lap group (180 min) compared with the Pure Robotic Group (240 min), p = 0.003. Intraoperative textbook outcomes were achieved in a lower proportion of patients in the Pure Robotic compared with the Robo-Lap group. Conclusion: Outcomes of the present study suggest a favorable role of the Robo-Lap approach in robotic major resections as it allows an improvement of the intraoperative results, a greater probability of an uneventful conduction of the procedure, and therefore, better management of the operating room time.
MeSH term(s)	Humans ; Hepatectomy/methods ; Robotic Surgical Procedures/methods ; Treatment Outcome ; Liver ; Robotics ; Liver Neoplasms/surgery ; Laparoscopy/methods
Language	English
Publishing date	2023-08-17
Publishing country	United States
Document type	Journal Article
ZDB-ID	2011211-7
ISSN	1938-3797 ; 1086-8089
ISSN (online)	1938-3797
ISSN	1086-8089
DOI	10.4293/JSLS.2023.00025
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Article ; Online: Robotic Approach for Lymphadenectomy in Biliary Tumors: The Missing Ring Between the Benefits of Laparoscopic and Reproducibility of Open Approach?

Ratti, Francesca / Cipriani, Federica / Ingallinella, Sara / Tudisco, Antonella / Catena, Marco / Aldrighetti, Luca

Annals of surgery

2022 Volume 278, Issue 4, Page(s) e780–e788

Abstract: Objective: This study aimed to evaluate the oncological adequacy of lymphadenectomy (LND) for biliary tumors and surgical outcomes of resections performed using robotic, laparoscopic, and open approaches and to compare the techniques within a weighted ... ...

Abstract	Objective: This study aimed to evaluate the oncological adequacy of lymphadenectomy (LND) for biliary tumors and surgical outcomes of resections performed using robotic, laparoscopic, and open approaches and to compare the techniques within a weighted propensity score analysis. Background: The need to perform formal LND is considered a limit for the applicability of minimally invasive liver surgery. Methods: Overall, 25 robotic resections with LND (2021-2022) from a single-center constituted the study group (Rob group), matched by inverse probability treatment weighting with 97 laparoscopic (Lap group) and 113 open (Open group) procedures to address the primary endpoint. A "per-period" analysis was performed comparing the characteristics and outcomes of the Rob group with the first 25 consecutive laparoscopic liver resections with associated LND (LapInit group). Results: Minimally invasive techniques performed equally well regarding the number of harvested nodes, blood transfusions, functional recovery, length of stay, and major morbidity and provided a short-term benefit to patients when compared with the open technique. A better performance of the robotic approach over laparoscopic approach (and both approaches over the open technique) was recorded for patients achieving LND with retrieval of >6 nodes. The open approach reduced both the operative time and time for LND, and robotic surgery performed better than laparoscopic surgery. Conclusions: Minimally invasive techniques are excellent tools for the management of LND in patients with biliary tumors, showing feasibility, and oncological adequacy. Robotics could contribute to the large-scale diffusion of these procedures with a high profile of complexity.
MeSH term(s)	Humans ; Reproducibility of Results ; Retrospective Studies ; Laparoscopy/methods ; Robotic Surgical Procedures/methods ; Biliary Tract Neoplasms ; Lymph Node Excision ; Treatment Outcome
Language	English
Publishing date	2022-11-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	340-2
ISSN	1528-1140 ; 0003-4932
ISSN (online)	1528-1140
ISSN	0003-4932
DOI	10.1097/SLA.0000000000005748
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Article ; Online: Navigator nurse implementation within a fast track program of liver resections: How to improve the healthcare service and perioperative results.

Fermi, Francesca / Ratti, Francesca / Stepanyan, Perthshanush / Corallino, Diletta / Ingallinella, Sara / Reineke, Raffaella / Beretta, Luigi / Aldrighetti, Luca

World journal of surgery

2023 Volume 48, Issue 1, Page(s) 193–202

Abstract: Background: The introduction into the clinical practice of the navigator nurse (NaNu) to address the task of counseling and short term follow-up help the effective implementation of the fast track protocol. The aim of the present study was to ... ...

Abstract	Background: The introduction into the clinical practice of the navigator nurse (NaNu) to address the task of counseling and short term follow-up help the effective implementation of the fast track protocol. The aim of the present study was to investigate the impact of the standardization of the NaNu's role in patients undergoing liver surgery. Methods: Patients undergoing elective liver surgery for all diagnosis and approach, from 2015, received counseling and postoperative follow-up by NaNu and constituted the study group (n = 890). This group was compared with the control group (n = 712) including patients treated in the era before the implementation of the NaNu role (2011-2014). Outcome was evaluated in terms of discrepancy between functional recovery and discharge, number of ER accesses, number of readmissions. Results: Preoperative characteristics of patients and disease, as well as type of resection and postoperative outcomes were similar between the two groups. The proportion of laparoscopic cases was higher in the study group (51.2% vs. 32% in the control). Time for discharge, interval between functional recovery and discharge, number of ER accesses and number of readmissions were reduced in the study group. Benign diagnosis, absence of complications, laparoscopic approach and presence of NaNu were independent predictors of shorter length of stay. The positive effect of NaNu's activation was recorded in patients with complications and undergoing open surgery. Conclusion: The implementation of NaNu's role has allowed to us optimize the level of healthcare service offered to patients. The wider benefit was offered in the setting of complex patients.
MeSH term(s)	Humans ; Hepatectomy ; Liver ; Body Fluids ; Elective Surgical Procedures ; Delivery of Health Care
Language	English
Publishing date	2023-12-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	224043-9
ISSN	1432-2323 ; 0364-2313
ISSN (online)	1432-2323
ISSN	0364-2313
DOI	10.1002/wjs.12026
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Article: Evaluation of the economic impact of the robotic approach in major and postero-superior segment liver resections: a multicenter retrospective analysis.

Ingallinella, Sara / Ardito, Francesco / Ratti, Francesca / Marino, Rebecca / Catena, Marco / De Rose, Agostino Maria / Razionale, Francesco / Rumi, Filippo / Cicchetti, Americo / Giuliante, Felice / Aldrighetti, Luca

Hepatobiliary surgery and nutrition

2024 Volume 13, Issue 2, Page(s) 241–257

Abstract: Background: Economic impact of robotic liver surgery (RLS) is still a debated issue due to the heterogeneity of liver resections considered and the lack of a rigorous methodology. Therefore, the aim of this study is to perform a time-driven activity- ... ...

Abstract	Background: Economic impact of robotic liver surgery (RLS) is still a debated issue due to the heterogeneity of liver resections considered and the lack of a rigorous methodology. Therefore, the aim of this study is to perform a time-driven activity-based costing (TD-ABC) comparing the costs of RLS, laparoscopic liver surgery (LLS) and open liver surgery (OLS) in the context of complex liver resections and to compare short term perioperative outcomes. Methods: The institutional databases of two Italian high volume hepatobiliary centres were retrospectively reviewed from February 2021 to April 2022. Patients submitted to major hepatectomies or postero-superior liver resections were selected and divided into three groups according to the approach scheduled (RLS, LLS and OLS) and compared. Major contributors of perioperative expenses were calculated using the TD-ABC model and accurately quantifying each unit resource consumed per patient and the time spent performing each activity. A primary intention-to-treat analysis (ITT-A) including conversions in the RLS and LLS groups was performed. Results: Forty-seven RLS, 101 LLS and 124 OLS were collected. LLS and RLS showed reduced blood loss, morbidity, mortality and hospital stay compared with open. A trend towards reduced conversion rate in RLS compared to LLS was registered. Total costs associated with RLS were estimated at €10,637 Conclusions: RLS offers economic advantages over OLS, as initial higher costs are offset by better perioperative outcomes. The evolving robotic marketplace is expected to drive down RLS costs, promoting widespread adoption in minimally invasive procedures. Despite its higher costs than LLS, RLS's ability to enhance minimally invasive feasibility makes it a preferred choice for complex cases, reducing the need for conversions.
Language	English
Publishing date	2024-03-26
Publishing country	China (Republic : 1949- )
Document type	Journal Article
ZDB-ID	2812398-0
ISSN	2304-389X ; 2304-3881
ISSN (online)	2304-389X
ISSN	2304-3881
DOI	10.21037/hbsn-23-407
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Article ; Online: Pathophysiology of Crohn's disease inflammation and recurrence.

Petagna, L / Antonelli, A / Ganini, C / Bellato, V / Campanelli, M / Divizia, A / Efrati, C / Franceschilli, M / Guida, A M / Ingallinella, S / Montagnese, F / Sensi, B / Siragusa, L / Sica, G S

Biology direct

2020 Volume 15, Issue 1, Page(s) 23

Abstract: Chron's Disease is a chronic inflammatory intestinal disease, first described at the beginning of the last century. The disease is characterized by the alternation of periods of flares and remissions influenced by a complex pathogenesis in which ... ...

Abstract	Chron's Disease is a chronic inflammatory intestinal disease, first described at the beginning of the last century. The disease is characterized by the alternation of periods of flares and remissions influenced by a complex pathogenesis in which inflammation plays a key role. Crohn's disease evolution is mediated by a complex alteration of the inflammatory response which is characterized by alterations of the innate immunity of the intestinal mucosa barrier together with a remodeling of the extracellular matrix through the expression of metalloproteins and increased adhesion molecules expression, such as MAcCAM-1. This reshaped microenvironment enhances leucocytes migration in the sites of inflammation, promoting a T
MeSH term(s)	Crohn Disease/etiology ; Crohn Disease/immunology ; Crohn Disease/surgery ; Humans ; Immunity, Innate ; Inflammation/etiology ; Inflammation/immunology ; Recurrence
Keywords	covid19
Language	English
Publishing date	2020-11-07
Publishing country	England
Document type	Journal Article ; Review
ISSN	1745-6150
ISSN (online)	1745-6150
DOI	10.1186/s13062-020-00280-5
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Article: The Role of Active Inflammation and Surgical Therapy in Crohn's Disease Recurrence.

Ingallinella, S / Campanelli, M / Antonelli, A / Arcudi, C / Bellato, V / Divizia, A / Franceschilli, M / Petagna, L / Sensi, B / Sibio, S / Siragusa, L / Sica, G S

Gastroenterology research and practice

2020 Volume 2020, Page(s) 2845407

Abstract: An altered balance between effector and regulatory factors is supposed to sustain the tissue-damaging immune response in inflammatory bowel disease (IBD). Several studies demonstrate that severe active inflammation is a strong predictor for surgical ... ...

Abstract	An altered balance between effector and regulatory factors is supposed to sustain the tissue-damaging immune response in inflammatory bowel disease (IBD). Several studies demonstrate that severe active inflammation is a strong predictor for surgical complications and recurrence. Indeed, bowel resection in Crohn's disease (CD) patients has a high surgical recurrence rate. In this review, we examined the IBD inflammatory pathways, the current surgical treatments, and the almost inevitable recurrence. The question that might arise is if the cure of intestinal CD is to be found in the surgical approach. A selective search of two databases (PubMed and the Cochrane Library) has been carried out without considering a specific time horizon as inclusion criteria. The scope of this literature review was investigating on the role of inflammation in the management of CD. The following key words have been used to develop the query string: (
Language	English
Publishing date	2020-12-28
Publishing country	Egypt
Document type	Journal Article ; Review
ZDB-ID	2435460-0
ISSN	1687-630X ; 1687-6121
ISSN (online)	1687-630X
ISSN	1687-6121
DOI	10.1155/2020/2845407
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Article ; Online: The Role of Inflammation in Crohn's Disease Recurrence after Surgical Treatment.

Sensi, B / Siragusa, L / Efrati, C / Petagna, L / Franceschilli, M / Bellato, V / Antonelli, A / Arcudi, C / Campanelli, M / Ingallinella, S / Guida, A M / Divizia, A

Journal of immunology research

2020 Volume 2020, Page(s) 8846982

Abstract: Introduction: Postoperative recurrence after surgery for Crohn's disease (CD) is virtually inevitable, and its mechanism is poorly known.: Aim: To review the numerous factors involved in CD postoperative recurrence (POR) pathogenesis, focusing on ... ...

Abstract	Introduction: Postoperative recurrence after surgery for Crohn's disease (CD) is virtually inevitable, and its mechanism is poorly known. Aim: To review the numerous factors involved in CD postoperative recurrence (POR) pathogenesis, focusing on single immune system components as well as the immune system as a whole and highlighting the clinical significance in terms of preventive strategies and future perspectives. Methods: A systematic literature search on CD POR, followed by a review of the main findings. Results: The immune system plays a pivotal role in CD POR, with many different factors involved. Memory T-lymphocytes retained in mesenteric lymph nodes seem to represent the main driving force. New pathophysiology-based preventive strategies in the medical and surgical fields may help reduce POR rates. In particular, surgical strategies have already been developed and are currently under investigation. Conclusions: POR is a complex phenomenon, whose driving mechanisms are gradually being unraveled. New preventive strategies addressing these mechanisms seem promising.
MeSH term(s)	Adaptive Immunity ; Animals ; Biomarkers ; Combined Modality Therapy ; Crohn Disease/etiology ; Crohn Disease/pathology ; Crohn Disease/surgery ; Disease Management ; Disease Susceptibility ; Gastrointestinal Microbiome ; Humans ; Immunity, Innate ; Inflammation/complications ; Postoperative Period ; Recurrence ; Risk Factors
Chemical Substances	Biomarkers
Language	English
Publishing date	2020-12-26
Publishing country	Egypt
Document type	Journal Article ; Meta-Analysis ; Review
ZDB-ID	2817541-4
ISSN	2314-7156 ; 2314-7156
ISSN (online)	2314-7156
ISSN	2314-7156
DOI	10.1155/2020/8846982
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Article ; Online: Breast Cancer and COVID-19: The Effect of Fear on Patients' Decision-making Process.

Vanni, Gianluca / Materazzo, Marco / Pellicciaro, Marco / Ingallinella, Sara / Rho, Maurizio / Santori, Francesca / Cotesta, Maria / Caspi, Jonathan / Makarova, Anna / Pistolese, Chiara Adriana / Buonomo, Oreste Claudio

In vivo (Athens, Greece)

2020 Volume 34, Issue 3 Suppl, Page(s) 1651–1659

Abstract: Background/aim: Coronavirus-19 (COVID-19) pandemic outbreak is currently having a huge impact on medical resource allocation. Breast Cancer (BC) patients are concerned both with BC treatment and COVID-19. This study aimed to estimate the impact of ... ...

Abstract	Background/aim: Coronavirus-19 (COVID-19) pandemic outbreak is currently having a huge impact on medical resource allocation. Breast Cancer (BC) patients are concerned both with BC treatment and COVID-19. This study aimed to estimate the impact of anxiety among patients, caused by the spreading of COVID-19. Patients and methods: Between the 16th of January and the 20th of March 2020, we retrospectively enrolled 160 patients. Eighty-two patients with a suspected breast lesion (SBL) were divided into two groups: PRE-COVID-19-SBL and POST-COVID-19-SBL. Seventy-eight BC patients were divided into PRE-COVID-19-BC and POST-COVID-19-BC. Patient characteristics including age, marital status, SBL/BC diameter, personal and family history of BC, clinical stage and molecular subtype were recorded. Procedure Refusal (PR) and Surgical Refusal (SR) were also recorded with their reason. Results: BC and SBL analysis showed no difference in pre-treatment characteristics (p>0.05). Both POST-COVID-19-SBL and POST-COVID-19-BC groups showed higher rates of PR and SR (p=0.0208, p=0.0065 respectively). Infection risk represented primary reason for refusal among POST-COVID-19 patients. Conclusion: COVID-19-related anxiety could affect patients' decision-making process.
MeSH term(s)	Aged ; Aged, 80 and over ; Anxiety/etiology ; Anxiety/psychology ; Attitude to Health ; Biopsy, Large-Core Needle/methods ; Biopsy, Large-Core Needle/psychology ; Breast Neoplasms/diagnostic imaging ; Breast Neoplasms/pathology ; Breast Neoplasms/psychology ; Breast Neoplasms/surgery ; COVID-19 ; Coronavirus Infections/psychology ; Decision Making ; Elective Surgical Procedures/psychology ; Fear/psychology ; Female ; Humans ; Italy ; Mammography ; Mastectomy/psychology ; Middle Aged ; Pandemics ; Pneumonia, Viral/psychology ; Retrospective Studies ; Socioeconomic Factors ; Treatment Refusal/psychology ; Ultrasonography, Mammary ; Vacuum
Keywords	covid19
Language	English
Publishing date	2020-05-29
Publishing country	Greece
Document type	Journal Article
ZDB-ID	807031-3
ISSN	1791-7549 ; 0258-851X
ISSN (online)	1791-7549
ISSN	0258-851X
DOI	10.21873/invivo.11957
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Article ; Online: The Effect of coronavirus (COVID-19) on breast cancer teamwork

Vanni, G. / Materazzo, M. / Santori, F. / Pellicciaro, M. / Costesta, M. / Orsaria, P. / Cattadori, F. / Pistolese, C. A. / Perretta, T. / Chiocchi, M. / Meucci, R. / Lamacchia, F. / Assogna, M. / Caspi, J. / Granai, A. V. / De Majo, A. / Chiaravalloti, A. / D'Angelillo, M. R. / Barbarino, R. /

Ingallinella, S. / Morando, L. / Dalli, S. / Portarena, I. / Altomare, V. / Tazzioli, G. / Buonomo, O. C.

A multicentric survey

2020

Abstract: Background/Aim: Despite the large amount of clinical data available of Coronavirus-19 (COVID-19), not many studies have been conducted about the psychological toll on Health Care Workers (HCWs). Patients and Methods: In this multicentric descriptive ... ...

Abstract	Background/Aim: Despite the large amount of clinical data available of Coronavirus-19 (COVID-19), not many studies have been conducted about the psychological toll on Health Care Workers (HCWs). Patients and Methods: In this multicentric descriptive study, surveys were distributed among 4 different Breast Cancer Centers (BCC). BCCs were distinguished according to COVID-19 tertiary care hospital (COVID/No-COVID) and district prevalence (DP) (High vs. Low). DASS-21 score, PSS score and demographic data (age, sex, work) were evaluated. Results: A total of 51 HCWs were analyzed in the study. Age, work and sex did not demonstrate statistically significant values. Statistically significant distribution was found between DASS-21-stress score and COVID/No-COVID (p=0.043). No difference was found in the remaining DASS-21 and PSS scores, dividing the HCWs according to COVID-19-hospital and DP. Conclusion: Working in a COVID-19-hospital represents a factor that negatively affects psychosocial wellbeing. However, DP seems not to affect the psychosocial well-being of BCC HCWs. During the outbreak, psychological support for low risk HCWs should be provided regardless DP.
Keywords	Anxiety ; Breast cancer ; COVID-19 ; DASS-21 ; Heath care workers ; Multicentric study ; PSS ; Psychological well- being ; SARS-SOV-2 ; Score ; Adult ; Coronavirus Infections ; Depression ; Female ; Humans ; Male ; Middle Aged ; Occupational Diseases ; Occupational Stress ; Pandemics ; Personnel ; Hospital ; Pneumonia ; Viral ; Prevalence ; Protective Devices ; Psychosocial Support Systems ; Rome ; Severity of Illness Index ; Tertiary Care Centers ; Uncertainty ; Workload ; Breast Neoplasms ; Cancer Care Facilities ; Patient Care Team ; covid19
Language	English
Publishing country	it
Document type	Article ; Online
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