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  1. Article ; Online: Disentangling seemingly contradictory results of the first two randomised controlled trials comparing open and robotic pancreatoduodenectomy.

    Boggi, Ugo / Napoli, Niccolò / Kauffmann, Emanuele F

    The Lancet regional health. Europe

    2024  Volume 40, Page(s) 100900

    Language English
    Publishing date 2024-04-06
    Publishing country England
    Document type Journal Article
    ISSN 2666-7762
    ISSN (online) 2666-7762
    DOI 10.1016/j.lanepe.2024.100900
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  2. Article ; Online: Robotic pancreas-preserving total duodenectomy: first-world experience.

    Napoli, Niccolò / Kauffmann, Emanuele F / Ginesini, Michael / Boggi, Ugo

    Updates in surgery

    2023  Volume 75, Issue 6, Page(s) 1735–1740

    Abstract: Pancreas sparing total duodenectomy (PSTD) is an exceedingly rare procedure that is performed mostly for benign disease, widely involving the duodenum, that cannot be treated otherwise. PSTD requires meticulous dissection as well as reconstruction of ... ...

    Abstract Pancreas sparing total duodenectomy (PSTD) is an exceedingly rare procedure that is performed mostly for benign disease, widely involving the duodenum, that cannot be treated otherwise. PSTD requires meticulous dissection as well as reconstruction of both biliary and pancreatic drainage. Despite these technical aspects appear to be ideal for robotic assistance, robotic PSTD has not been described yet.Robotic PSTD was successfully performed in two patients. In both patients biliary and pancreatic drainage were reconstructed on the second jejunal loop, which was pulled in the duodenal bed. In the first patient, gastro-jejunostomy was performed on the blind end of the neo-duodenum (Billorth I type gastric reconstruction). In the second patient, gastro-jejunostomy was achieved in an antecolic position, 40 cm downstream the neo-ampulla in the second patient (Billorth II type gastric reconstruction). In both patients, indication to PSTD was duodenal polyps not amenable to endoscopic removal. The first patient suffered from prolonged delayed gastric emptying, but she is currently doing well 5 years and beyond after the procedure. The second patient complained of mild delayed gastric emptying that resolved spontaneously. He is now doing well 5 months after surgery.We have shown the feasibility of robotic PSTD in what we believe to be a world premiere. Further experience is required to refine the procedure and improve outcomes.
    MeSH term(s) Male ; Female ; Humans ; Gastroparesis ; Robotic Surgical Procedures ; Pancreas/surgery ; Duodenum/surgery ; Digestive System Surgical Procedures/methods
    Language English
    Publishing date 2023-06-05
    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/s13304-023-01555-y
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  3. Article ; Online: Division of the neck of the pancreas in minimally invasive surgery without a preemptive retropancreatic tunnel.

    Kauffmann, Emanuele F / Napoli, Niccolò / Ginesini, Michael / Boggi, Ugo

    Updates in surgery

    2023  Volume 75, Issue 3, Page(s) 769–773

    MeSH term(s) Humans ; Pancreas/surgery ; Pancreatectomy ; Minimally Invasive Surgical Procedures ; Pancreatic Neoplasms/surgery ; Laparoscopy ; Robotic Surgical Procedures
    Language English
    Publishing date 2023-02-23
    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/s13304-023-01459-x
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  4. Article ; Online: Ca 125 is an independent prognostic marker in resected pancreatic cancer of the head of the pancreas.

    Napoli, Niccolò / Kauffmann, Emanuele F / Ginesini, Michael / Lami, Lucrezia / Lombardo, Carlo / Vistoli, Fabio / Campani, Daniela / Boggi, Ugo

    Updates in surgery

    2023  Volume 75, Issue 6, Page(s) 1481–1496

    Abstract: The prognostic value of carbohydrate antigen 125 (Ca 125) is emerging also in pancreatic cancer (PDAC). In this study, we aim to define the prognostic value of Ca 125 in resected PDAC of the head of the pancreas. This is a single-center, retrospective ... ...

    Abstract The prognostic value of carbohydrate antigen 125 (Ca 125) is emerging also in pancreatic cancer (PDAC). In this study, we aim to define the prognostic value of Ca 125 in resected PDAC of the head of the pancreas. This is a single-center, retrospective study. Data from patients with a pre-operative assay of Ca 125 who underwent a pancreatic resection for PDAC between 2010 and 2018 were analyzed. As per National Comprehensive Cancer Guidelines, tumors were classified in resectable (R-PDAC), borderline resectable (BR-PDAC), and locally advanced (LA-PDAC). The Kaplan-Meier method was used to evaluate the overall survival. Cox proportional hazard regression was used to evaluate the role of pre-operative Ca 125 in predicting survival (while adjusting for confounders). The maximally selected log-rank statistic was used to identify a Ca 125 cut-off defining two groups with different survival probability. Inclusion criteria were met by 207 patients (R-PDAC: 80, BR-PDAC: 91, and LA-PDAC: 36). Ca 125 predicted overall survival before and after adjusting for confounding factors in all categories of anatomic resectability (R-PDAC: HR = 4.3; p = 0.0249) (BR-PDAC: HR = 7.82; p = 0.0024) (LA-PDAC: HR = 11.4; p = 0.0043). In BR-PDAC and LA-PDAC (n = 127), the division in two groups (high vs. low Ca 125) correlated with T stage (p = 0.0317), N stage (p = 0.0083), mean LN ratio (p = 0.0292), and tumor grading (p = 0.0143). This study confirmed the prognostic value of Ca125 in resected pancreatic cancer and, therefore, the importance of biologic over anatomic resectability. Ca 125 should be routinely assayed in surgical candidates with PDAC.
    MeSH term(s) Humans ; Prognosis ; Carcinoma, Pancreatic Ductal/surgery ; Retrospective Studies ; Pancreatic Neoplasms ; Pancreas/surgery ; Head and Neck Neoplasms ; Pancreatic Neoplasms
    Language English
    Publishing date 2023-08-03
    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/s13304-023-01587-4
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  5. Article ; Online: Safety and safety protocols for living donor nephrectomy in Italy.

    Napoli, Niccolò / Kauffmann, Emanuele F / Ginesini, Michael / Gianfaldoni, Cesare / Fiaschetti, Pamela / Lombardi, Ilaria / Cardillo, Massimo / Vistoli, Fabio / Boggi, Ugo

    Updates in surgery

    2023  Volume 76, Issue 1, Page(s) 209–218

    Abstract: Living donor kidney transplantation (LDKTx) is recommended by all scientific societies. Living donor nephrectomy (LDN) is probably one of the safest surgical procedures, but it carries some risk for healthy donors. The aim of this study is to provide a ... ...

    Abstract Living donor kidney transplantation (LDKTx) is recommended by all scientific societies. Living donor nephrectomy (LDN) is probably one of the safest surgical procedures, but it carries some risk for healthy donors. The aim of this study is to provide a snapshot of LDKTx activities in Italy and ask about safety measures implemented in LDN. Data on LDKTx were extracted from the national database. Safety measures were examined through a specific survey. Between 2001 and 2022 40,663 kidney transplants (31.4 per million population-pmp) were performed, including 4731 LDKTx (3.7 pmp). There was no postoperative death of the donor. After a median follow-up of 52.2 months [IQR:17.9-99.5], the 10-year donor survival rate was 93.38% (CI:97.52-98.94). There was evidence of renal disease in 65 donors (1.8%), including 42 (1.1%) with stage III end-stage renal disease. Twenty-nine out of 35 transplant centers (TC) involved in LDKTx responded to the survey (82.9%). Six TCs (21.4%) had a total experience of 20 or fewer LDN. Minimally invasive LDN was the first choice at 24 TC (82.8%). At 10 TC (37.0%) only one surgeon performed LDN. Nineteen TCs (65.5%) had a surgical safety checklist for LDN and 14 had a postoperative surveillance protocol. The renal artery was occluded in 3 TCs (10.3%) mainly by non-transfixion methods (including clips). Redundancy of key safety systems in the operating room was available in 22 of 29 centers (75.8%). In summary, LDKTx should be further implemented in Italy. Donor safety should be improved through the implementation of a national procedural protocol.
    MeSH term(s) Humans ; Living Donors ; Nephrectomy/adverse effects ; Nephrectomy/methods ; Kidney ; Kidney Transplantation ; Laparoscopy/methods ; Italy
    Language English
    Publishing date 2023-11-08
    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/s13304-023-01678-2
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  6. Article ; Online: State of the art of robotic pancreatoduodenectomy.

    Napoli, Niccolò / Kauffmann, Emanuele F / Vistoli, Fabio / Amorese, Gabriella / Boggi, Ugo

    Updates in surgery

    2021  Volume 73, Issue 3, Page(s) 873–880

    Abstract: Current evidence shows that robotic pancreatoduodenectomy (RPD) is feasible with a safety profile equivalent to either open pancreatoduodenectomy (OPD) or laparoscopic pancreatoduodenectomy (LPD). However, major intraoperative bleeding can occur and ... ...

    Abstract Current evidence shows that robotic pancreatoduodenectomy (RPD) is feasible with a safety profile equivalent to either open pancreatoduodenectomy (OPD) or laparoscopic pancreatoduodenectomy (LPD). However, major intraoperative bleeding can occur and emergency conversion to OPD may be required. RPD reduces the risk of emergency conversion when compared to LPD. The learning curve of RPD ranges from 20 to 40 procedures, but proficiency is reached only after 250 operations. Once proficiency is achieved, the results of RPD may be superior to those of OPD. As for now, RPD is at least equivalent to OPD and LPD with respect to incidence and severity of POPF, incidence and severity of post-operative complications, and post-operative mortality. A minimal annual number of 20 procedures per center is recommended. In pancreatic cancer (versus OPD), RPD is associated with similar rates of R0 resections, but higher number of examined lymph nodes, lower blood loss, and lower need of blood transfusions. Multivariable analysis shows that RPD could improve patient survival. Data from selected centers show that vein resection and reconstruction is feasible during RPD, but at the price of high conversion rates and frequent use of small tangential resections. The true Achilles heel of RPD is higher operative costs that limit wider implementation of the procedure and accumulation of a large experience at most single centers. In conclusion, when proficiency is achieved, RPD may be superior to OPD with respect to CR-POPF and oncologic outcomes. Achievement of proficiency requires commitment, dedication, and truly high volumes.
    MeSH term(s) Humans ; Learning Curve ; Pancreatic Neoplasms/surgery ; Pancreaticoduodenectomy ; Postoperative Complications/epidemiology ; Postoperative Complications/prevention & control ; Retrospective Studies ; Robotic Surgical Procedures
    Language English
    Publishing date 2021-05-20
    Publishing country Italy
    Document type Journal Article ; Review
    ZDB-ID 2572692-4
    ISSN 2038-3312 ; 2038-131X
    ISSN (online) 2038-3312
    ISSN 2038-131X
    DOI 10.1007/s13304-021-01058-8
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  7. Article: Robot-assisted radical antegrade modular pancreatosplenectomy including resection and reconstruction of the spleno-mesenteric junction

    Napoli, Niccolò / Kauffmann, Emanuele F / Menonna, Francesca / Iacopi, Sara / Cacace, Concetta / Boggi, Ugo

    Journal of visualized experiments. 2020 Jan. 03, , no. 155

    2020  

    Abstract: This article shows the technique of robot-assisted radical antegrade modular pancreatosplenectomy, including resection and reconstruction of the spleno-mesenteric junction, for cancer of the body-tail of the pancreas. The patient is placed supine with ... ...

    Abstract This article shows the technique of robot-assisted radical antegrade modular pancreatosplenectomy, including resection and reconstruction of the spleno-mesenteric junction, for cancer of the body-tail of the pancreas. The patient is placed supine with the legs parted and a pneumoperitoneum is established and maintained at 10 mmHg. To use the surgical system, four 8 mm ports and one 12 mm port are required. The optic port is placed at the umbilicus. The other ports are placed, on either side, along the pararectal line and the anterior axillary line at the level of the umbilical line. The assistant port (12 mm) is placed along the right pararectal line. Dissection begins by detaching the gastrocolic ligament, thus opening the lesser sac, and by a wide mobilization of the splenic flexure of the colon. The superior mesenteric vein is identified along the inferior border of the pancreas. Lymph node number 8a is removed to permit clear visualization of the common hepatic artery. A tunnel is then created behind the neck of the pancreas. To permit safe resection and reconstruction of the spleno-mesenteric junction, further preemptive dissection is required before dividing the pancreatic neck to bring in clear view all relevant vascular pedicles. Next, the splenic artery is ligated and divided, and the pancreatic neck is divided, with selective ligature of the pancreatic duct. After vein resection and reconstruction, dissection proceeds to complete the clearance of peripancreatic arteries that are peeled off from all lympho-neural tissues. Both celiac ganglia are removed en-bloc with the specimen. The Gerota fascia covering the upper pole of the left kidney is also removed en-bloc with the specimen. Division of short gastric vessels and splenectomy complete the procedure. A drain is left near the pancreatic stump. The round ligament of the liver is mobilized to protect the vessels.
    Keywords colon ; fascia ; ganglia ; hepatic artery ; kidneys ; ligaments ; liver ; lymph nodes ; neoplasms ; pancreas ; patients ; resection ; umbilicus
    Language English
    Dates of publication 2020-0103
    Size p. e60370.
    Publishing place Journal of Visualized Experiments
    Document type Article
    ZDB-ID 2259946-0
    ISSN 1940-087X
    ISSN 1940-087X
    DOI 10.3791/60370
    Database NAL-Catalogue (AGRICOLA)

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  8. Article ; Online: Outcomes of double-layer continuous suture hepaticojejunostomy in pancreatoduodenectomy and total pancreatectomy.

    Napoli, Niccolò / Kauffmann, Emanuele F / Caputo, Rosilde / Ginesini, Michael / Asta, Fabio / Gianfaldoni, Cesare / Amorese, Gabriella / Vistoli, Fabio / Boggi, Ugo

    HPB : the official journal of the International Hepato Pancreato Biliary Association

    2022  Volume 24, Issue 10, Page(s) 1738–1747

    Abstract: Background: This study aims to describe the technique and the results of double-layer continuous suture hepaticojejunostomy (HJ) following pancreatoduodenectomy (PD) and total pancreatectomy (TP).: Methods: A prospectively maintained database was ... ...

    Abstract Background: This study aims to describe the technique and the results of double-layer continuous suture hepaticojejunostomy (HJ) following pancreatoduodenectomy (PD) and total pancreatectomy (TP).
    Methods: A prospectively maintained database was analyzed retrospectively to identify incidence and severity of biliary leaks (BL) (ISGLS definition), as well as of HJ stenosis (HJS), cholangitis, and need for redo-HJ (in patients with a follow-up ≥3 years) in a consecutive series of 800 procedures (PD = 603; TP = 197). Predictors of biliary complications were also identified.
    Results: BLs occurred in 5 patients (0.6%), including 2 (0.3%) combined pancreatic and biliary leaks. Rates of HJS, cholangitis, and need for redo-HJ were 6.1%, 5.4%, and 2.0%, respectively. Incidence of BL was 0.6% in open procedures (4/587) and 0.4% in robotic operations (1/213). Incidence of late biliary complications was also equivalent in open and robotic procedures. Occurrence of BL was predicted by ASA IV status and duodenal cancer, HJS by any associated vascular procedure and hepatic duct size < 8 mm, cholangitis by any associated vascular procedure and normal bilirubin/hepatic enzymes, and redo HJ by history of cholecystectomy and neuroendocrine tumor/cancer.
    Discussion: Double layer continuous suture HJ is associated with low BL rates, and an acceptable incidence of late complications.
    MeSH term(s) Humans ; Pancreatectomy/adverse effects ; Pancreatectomy/methods ; Pancreaticoduodenectomy/adverse effects ; Retrospective Studies ; Biliary Tract Diseases ; Cholangitis/etiology ; Sutures/adverse effects ; Bilirubin ; Postoperative Complications/etiology
    Chemical Substances Bilirubin (RFM9X3LJ49)
    Language English
    Publishing date 2022-05-17
    Publishing country England
    Document type Journal Article
    ZDB-ID 2131251-5
    ISSN 1477-2574 ; 1365-182X
    ISSN (online) 1477-2574
    ISSN 1365-182X
    DOI 10.1016/j.hpb.2022.05.005
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  9. Article ; Online: Pancreatectomy with resection and reconstruction of the superior mesenteric artery.

    Boggi, Ugo / Napoli, Niccolò / Kauffmann, Emanuele F / Iacopi, Sara / Ginesini, Michael / Gianfaldoni, Cesare / Campani, Daniela / Amorese, Gabriella / Vistoli, Fabio

    The British journal of surgery

    2022  Volume 110, Issue 8, Page(s) 901–904

    MeSH term(s) Humans ; Pancreatectomy ; Mesenteric Artery, Superior/surgery ; Pancreatic Neoplasms/surgery ; Abdomen/surgery ; Portal Vein/surgery ; Hepatic Artery/surgery
    Language English
    Publishing date 2022-11-29
    Publishing country England
    Document type Journal Article
    ZDB-ID 2985-3
    ISSN 1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
    ISSN (online) 1365-2168
    ISSN 0263-1202 ; 0007-1323 ; 1355-7688
    DOI 10.1093/bjs/znac363
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  10. Article ; Online: Feasibility of "cold" triangle robotic pancreatoduodenectomy.

    Kauffmann, Emanuele F / Napoli, Niccolò / Ginesini, Michael / Gianfaldoni, Cesare / Asta, Fabio / Salamone, Alice / Amorese, Gabriella / Vistoli, Fabio / Boggi, Ugo

    Surgical endoscopy

    2022  Volume 36, Issue 12, Page(s) 9424–9434

    Abstract: Background: Triangle pancreatoduodenectomy adds to the conventional procedure the en bloc removal of the retroperitoneal lympho-neural tissue included in the triangular area bounded by the common hepatic artery (CHA), the superior mesenteric artery (SMA) ...

    Abstract Background: Triangle pancreatoduodenectomy adds to the conventional procedure the en bloc removal of the retroperitoneal lympho-neural tissue included in the triangular area bounded by the common hepatic artery (CHA), the superior mesenteric artery (SMA), and the superior mesenteric vein/portal vein. We herein aim to show the feasibility of "cold" triangle robotic pancreaticoduodenectomy (C-Tr-RPD) for pancreatic cancer (PDAC).
    Methods: Cold dissection corresponds to sharp arterial divestment performed using only the tips of robotic scissors. After division of the gastroduodenal artery, triangle dissection begins by lateral-to-medial divestment of the CHA and anterior-to-posterior clearance of the right side of the celiac trunk. Next, after a wide Kocher maneuver, the origin of the SMA, and the celiac trunk are identified. After mobilization of the first jejunal loop and attached mesentery, the SMA is identified at the level of the first jejunal vein and is divested along the right margin working in a distal-to-proximal direction. Vein resection and reconstruction can be performed as required. C-Tr-RPD was considered feasible if triangle dissection was successfully completed without conversion to open surgery or need to use energy devices. Postoperative complications and pathology results are presented in detail.
    Results: One hundred twenty-seven consecutive C-Tr-RPDs were successfully performed. There were three conversions to open surgery (2.3%), because of pneumoperitoneum intolerance (n = 2) and difficult digestive reconstruction. Thirty-four patients (26.7%) required associated vascular procedures. No pseudoaneurysm of the gastroduodenal artery was observed. Twenty-eight patients (22.0%) developed severe postoperative complications (≥ grade III). Overall 90-day mortality was 7.1%, declining to 2.3% after completion of the learning curve. The median number of examined lymph nodes was 42 (33-51). The rate of R1 resection (7 margins < 1 mm) was 44.1%.
    Conclusion: C-Tr-RPD is feasible, carries a risk of surgical complications commensurate to the magnitude of the procedure, and improves staging of PDAC.
    MeSH term(s) Humans ; Pancreaticoduodenectomy/methods ; Robotic Surgical Procedures/methods ; Feasibility Studies ; Pancreatic Neoplasms/surgery ; Margins of Excision ; Postoperative Complications/surgery ; Pancreatic Neoplasms
    Language English
    Publishing date 2022-07-26
    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/s00464-022-09411-7
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