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Article: The carotid sheath route: An option to approach retrocarotid prespinal tumors with paravertebral extension.

Gagliardi, Filippo / Giordano, Leone / Medone, Marzia / Snider, Silvia / Roncelli, Francesca / Pompeo, Edoardo / Mortini, Pietro

Journal of craniovertebral junction & spine

2023 Volume 14, Issue 1, Page(s) 11–15

Abstract: Background: The elective route to approach paravertebral lesions growing into the anterolateral lodge of the neck is widely recognized as the prespinal route with its two major variants. Recently, attention has been focused on the possibility of opening ...

Abstract	Background: The elective route to approach paravertebral lesions growing into the anterolateral lodge of the neck is widely recognized as the prespinal route with its two major variants. Recently, attention has been focused on the possibility of opening the inter-carotid-jugular window in case of reparative surgery for traumatic brachial plexus injury. Aims: For the first time, the authors validate the clinical application of the carotid sheath route in the surgical treatment of paravertebral lesions expanding into the anterolateral lodge of the neck. Methods: A microanatomic study was conducted to collect anthropometric measurements. The technique was illustrated in a clinical setting. Results: The opening of the inter-carotid-jugular surgical window allows additional access to the prevertebral and periforaminal space. It optimizes the operability on the prevertebral compartment, compared to the retro-sternocleidomastoid (SCM) approach, and on the periforaminal compartment, compared to the standard pre-SCM approach. The surgical control of the vertebral artery is comparable to that obtained with the retro-SCM approach, while the control of the esophagotracheal complex and the retroesophageal space is comparable to the pre-SCM approach. The risk profile on the inferior thyroid vessels, recurrent nerve, and sympathetic chain is superimposable to the pre-SCM approach. Conclusions: The carotid sheath route is a safe and effective option to approach prespinal lesions with retrocarotid monolateral paravertebral extension.
Language	English
Publishing date	2023-03-13
Publishing country	India
Document type	Journal Article
ZDB-ID	2573344-8
ISSN	0976-9285 ; 0974-8237
ISSN (online)	0976-9285
ISSN	0974-8237
DOI	10.4103/jcvjs.jcvjs_148_22
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Article ; Online: Surgical Anatomy of the Retrosigmoid Approach With Transtentorial Extension: Protecting the 4th Cranial Nerve.

Nizzola, Mariagrazia / Pompeo, Edoardo / Torregrossa, Fabio / Leonel, Luciano César P C / Mortini, Pietro / Link, Michael J / Peris-Celda, Maria

Operative neurosurgery (Hagerstown, Md.)

2024

Abstract: Background and objectives: The retrosigmoid approach with transtentorial extension (RTA) allows us to address posterior cranial fossa pathologies that extend through the tentorium into the supratentorial space. Incision of the tentorium cerebelli is ... ...

Abstract	Background and objectives: The retrosigmoid approach with transtentorial extension (RTA) allows us to address posterior cranial fossa pathologies that extend through the tentorium into the supratentorial space. Incision of the tentorium cerebelli is challenging, especially for the risk of injury of the cranial nerve (CN) IV. We describe a tentorial incision technique and relevant anatomic landmarks. Methods: The RTA was performed stepwise on 5 formalin-fixed (10 sides), latex-injected cadaver heads. The porus trigeminus's midpoint, the lateral border of the suprameatal tubercle (SMT)'s base, and cerebellopontine fissure were assessed as anatomic landmarks for the CN IV tentorial entry point, and relative measurements were collected. A clinical case was presented. Results: The tentorial opening was described in 4 different incisions. The first is curved and starts in the posterior aspect of the tentorium. It has 2 limbs: a medial one directed toward the tentorium's free edge and a lateral one that extends toward the superior petrosal sinus (SPS). The second incision turns inferiorly, medially, and parallel to the SPS down to the SMT. At that level, the second incision turns perpendicular toward the tentorium's free edge and ends 1 cm from it. The third incision proceeds posteriorly, parallel to the free edge. At the cerebellopontine fissure, the incision can turn toward and cut the tentorium-free edge (fourth incision). On average, the CN IV tentorial entry point was 12.7 mm anterior to the SMT base's lateral border and 20.2 mm anterior to the cerebellopontine fissure. It was located approximately in the same coronal plane as the porus trigeminus's midpoint, on average 1.9 mm anterior. Conclusion: The SMT and the cerebellopontine fissure are consistently located posterior to the CN IV tentorial entry point. They can be used as surgical landmarks for RTA, reducing the risk of injury to the CN IV.
Language	English
Publishing date	2024-03-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	2767575-0
ISSN	2332-4260 ; 2332-4252
ISSN (online)	2332-4260
ISSN	2332-4252
DOI	10.1227/ons.0000000000001136
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Article: Posttraumatic extraskeletal chondroma of the posterior neck: A systematic literature review on a rare finding and report of a case.

Pompeo, Edoardo / Gagliardi, Filippo / Medone, Marzia / Roncelli, Francesca / De Domenico, Pierfrancesco / Snider, Silvia / Terreni, Mariarosa / Mortini, Pietro

Journal of craniovertebral junction & spine

2023 Volume 14, Issue 3, Page(s) 306–310

Abstract: Extraskeletal chondromas (EC) are uncommon, benign cartilaginous tumours. Most common locations are upper and lower extremities. Location in the neck is extremely rare and reported only within the anterior compartment. Data are limited to just four case ... ...

Abstract	Extraskeletal chondromas (EC) are uncommon, benign cartilaginous tumours. Most common locations are upper and lower extremities. Location in the neck is extremely rare and reported only within the anterior compartment. Data are limited to just four case reports in the paediatric population. The first case of EC in neck's posterior compartment is described herein. EC present peculiar features on imaging. Aetiology is unclear; however, trauma has been suggested as possible causative mechanism. Treatment of choice is surgical excision; recurrence is not uncommon, but additional removal seems to be resolutive. All cases in literature were asymptomatic, except for one presenting respiratory stridor. The present patient suffered from neck functional limitation and upper limb hypoesthesia. Symptoms improved after surgery in both cases. Imaging follow-up at 6 months in the present case showed no sign of recurrence. ECs are rare, benign lesions. However, they may be preoperatively misinterpreted as more malignant counterparts (both radiologically or histologically), so accurate diagnostic work-up and planning of the surgical procedure are essential.
Language	English
Publishing date	2023-09-18
Publishing country	India
Document type	Case Reports
ZDB-ID	2573344-8
ISSN	0976-9285 ; 0974-8237
ISSN (online)	0976-9285
ISSN	0974-8237
DOI	10.4103/jcvjs.jcvjs_65_23
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Article: Anterior selective scalenectomy for periforaminal exposure in the ventral supraclavicular approach.

Gagliardi, Filippo / Medone, Marzia / Giordano, Leone / Snider, Silvia / Piloni, Martina / Pompeo, Edoardo / Roncelli, Francesca / Ruffino, Luca / Mortini, Pietro

Journal of craniovertebral junction & spine

2023 Volume 14, Issue 2, Page(s) 144–148

Abstract: Aims and objectives: Route of choice to access cervical paravertebral lesions with foraminal involvement is the anterolateral corridor with its variants. Main limitation of these techniques is represented by the limited surgical access to periforaminal ... ...

Abstract	Aims and objectives: Route of choice to access cervical paravertebral lesions with foraminal involvement is the anterolateral corridor with its variants. Main limitation of these techniques is represented by the limited surgical access to periforaminal area due to the bulk generated by the anterior scalene muscle (ASM). Over the years, alternative techniques for ASM surgical management have been developed, which are still today a matter of debate. Most popular include ASM scalene complete section (SCS) and ASM medial detachment (SMD). Authors describe an innovative, minimally invasive muscle section technique, the anterior selective scalenectomy (ASS), which reduces the risk of iatrogenic morbidity and optimizes exposure of periforaminal area in anterolateral cervical routes. Materials and methods: A laboratory investigation was conducted. Technique was applied in a surgical setting, and an illustrative case was reported. Results: ASS is a quick and easy technique to perform. It allows optimization of surgical visibility and control on the periforaminal area in the cervical anterolateral corridor. It respects muscle anatomy and vascularization, favoring functional recovery and management of peri-operative pain; it reduces the risk of morbidity on phrenic nerve and pleura. Considering the minimally invasive nature of the technique, it allows for a slightly more limited exposure compared to traditional techniques while ensuring optimal surgical maneuverability on the target area. Conclusions: ASS represents an effective and safe alternative to traditional ASM section techniques for the exposure of periforaminal area in anterolateral cervical routes. It is indicated in case of lesions with paravertebral development and minimal intraforaminal component in the C3-C6 segment.
Language	English
Publishing date	2023-06-13
Publishing country	India
Document type	Journal Article
ZDB-ID	2573344-8
ISSN	0976-9285 ; 0974-8237
ISSN (online)	0976-9285
ISSN	0974-8237
DOI	10.4103/jcvjs.jcvjs_153_22
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Article ; Online: Efficacy of radiotherapy and stereotactic radiosurgery as adjuvant or salvage treatment in atypical and anaplastic (WHO grade II and III) meningiomas: a systematic review and meta-analysis.

Gagliardi, Filippo / De Domenico, Pierfrancesco / Snider, Silvia / Pompeo, Edoardo / Roncelli, Francesca / Barzaghi, Lina Raffaella / Acerno, Stefania / Mortini, Pietro

Neurosurgical review

2023 Volume 46, Issue 1, Page(s) 71

Abstract: The role of radiotherapy (RT) and stereotactic radiosurgery (SRS) as adjuvant or salvage treatment in high-grade meningiomas (HGM) is still debated. Despite advances in modern neuro-oncology, HGM (WHO grade II and III) remains refractory to multimodal ... ...

Abstract	The role of radiotherapy (RT) and stereotactic radiosurgery (SRS) as adjuvant or salvage treatment in high-grade meningiomas (HGM) is still debated. Despite advances in modern neuro-oncology, HGM (WHO grade II and III) remains refractory to multimodal therapies. Published reports present aggregated data and are extremely varied in population size, exclusion criteria, selection bias, and inclusion of mixed histologic grades, making it extremely difficult to draw conclusions when taken individually. This current work aims to gather the existing evidence on RT and SRS as adjuvants following surgery or salvage treatment at recurrence after multimodality therapy failure and to conduct a systematic comparison between these two modalities. An extensive systematic literature review and meta-analysis were performed. A total of 42 papers were eligible for final analysis (RT n = 27; SRS n = 15) after searching MEDLINE via PubMed, Web-of-science, Cochrane Wiley, and Embase databases. Adjuvant regimens were addressed in 37 papers (RT n = 26; SRS n = 11); salvage regimens were described in 5 articles (RT n = 1; SRS n = 4). The primary outcomes of the study were the overall recurrence rate and mortality. Other actuarial rates (local and distant control, OS, PFS, and complications) were retrieved and analyzed as secondary outcomes. A total of 2853 patients harboring 3077 HGM were included. The majority were grade II (87%) with a mean pre-radiation volume of 8.7 cc. Adjuvant regimen: 2742 patients (76.4% RT; 23.6% SRS) with an overall grade II/III rate of 6.6/1. Lesions treated adjSRS were more frequently grade III (17 vs 12%, p < 0.001), and received subtotal resection (57 vs 27%, p = 0.001) compared to the RT cohort. AdjSRS cohort had a significantly shorter mean follow-up than adjRT (36.7 vs 50.3 months, p = 0.01). The overall recurrence rate was 38% in adjRT vs 25% in adjSRS (p = 0.01), while mortality did not differ between the groups (20% vs 23%, respectively; p = 0.80). The median time to recurrence was 1.5 times longer in the RT group (p = 0.30). Five-year local control was 55% in adjRT and 26% in adjSRS (p = 0.01), while 5-year OS was 73% and 78% (p = 0.62), and 5-year PFS was 62% and 40% in adjRT and adjSRS (p = 0.008). No difference in the incidence of complications (24% vs 14%, p = 0.53). Salvage regimen: 110 patients (37.3% RT; 62.7% SRS) with a grade II/III rate of 8.6/1. The recurrence rate was 46% in salRT vs 24% in salSRS (p = 0.39), time to recurrence was 1.8 times longer in the salRT group (35 vs 18.5 months, p = 0.74). Mortality was slightly yet not significantly higher in salRT (34% vs 12%, p = 0.54). Data on local and distant control were only available for salSRS. The 5-year OS was 49% and 83% (p = 0.90), and the 5-year PFS was 39% and 50% in salRT and salSRS (p = 0.66), respectively. High-grade meningiomas (WHO grade II and III) receiving adjuvant RT showed a higher overall recurrence rate than meningiomas receiving adjuvant SRS. The adjRT cohort, however, achieved higher 5-year LC and PFS rates, thus suggesting a potentially longer time to recurrence compared to adjSRS patients, who, meanwhile, experienced a significantly shorter follow-up. This result must also consider the higher number of grade III lesions and the smaller extent of resection achieved in the adjSRS group. Overall mortality did not differ between the two groups. No differences in outcome measures were observed in salvage regimens.
MeSH term(s)	Humans ; Meningioma/radiotherapy ; Meningioma/surgery ; Meningioma/pathology ; Radiosurgery ; Treatment Outcome ; Salvage Therapy ; Retrospective Studies ; Meningeal Neoplasms/radiotherapy ; Meningeal Neoplasms/surgery ; Meningeal Neoplasms/pathology ; World Health Organization ; Neoplasm Recurrence, Local/radiotherapy ; Neoplasm Recurrence, Local/surgery ; Neoplasm Recurrence, Local/pathology ; Follow-Up Studies
Language	English
Publishing date	2023-03-17
Publishing country	Germany
Document type	Meta-Analysis ; Systematic Review ; Journal Article ; Review
ZDB-ID	6907-3
ISSN	1437-2320 ; 0344-5607
ISSN (online)	1437-2320
ISSN	0344-5607
DOI	10.1007/s10143-023-01969-7
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Article ; Online: Single Versus Fractionated Gamma Knife Radiosurgery for Nonfunctioning Pituitary Adenomas Close to the Optic Pathway: A Multicenter Propensity Score Matched Study.

Albano, Luigi / Losa, Marco / Barzaghi, Lina Raffaella / Barrile, Elena / Bindal, Shray K / Wei, Zhishuo / Pompeo, Edoardo / Villanacci, Federico / Del Vecchio, Antonella / Flickinger, John C / Niranjan, Ajay / Mortini, Pietro / Lunsford, L Dade

Neurosurgery

2024

Abstract: Background and objectives: Gamma Knife radiosurgery (GKRS), typically administered in a single session (S-GKRS), is an effective treatment for nonfunctioning pituitary adenoma (NFPA). For lesions close to the optic pathway, the use of hypofractionated ... ...

Abstract	Background and objectives: Gamma Knife radiosurgery (GKRS), typically administered in a single session (S-GKRS), is an effective treatment for nonfunctioning pituitary adenoma (NFPA). For lesions close to the optic pathway, the use of hypofractionated radiosurgery is growing. This study seeks to compare the results of S-GKRS vs fractionated-GKRS (F-GKRS) for NFPAs adjacent to the optic pathway. Methods: Two cohorts of patients with residual or recurrent NFPAs in contact to the optic pathway were retrospectively included in this study: (1) a group of patients who underwent a 3-day course of F-GKRS in Europe and (2) a group of patients treated with S-GKRS in the United States. A propensity score matching (ratio 1:1) was carried out to obtain and compare 2 homogeneous groups of patients with NFPA. Results: A total of 84 patients were included for analysis (42 in the S-GKRS cohort and 42 in the F-GKRS group). The 2 cohorts did not differ for age, sex, number of previous surgical procedure, tumor volume, and follow-up. The mean follow-up was 60.2 ± 37.0 months and 62.4 ± 37.4 months for F-GKRS and S-GKRS cohort, respectively (P = .38). The overall tumor control at last follow-up was achieved in 95.2% and 92.9% of patients in F-GKRS and S-GKRS, respectively (P = .64). The 1-year, 3-year, 5-year, and 7-year progression-free survival rate after F-GKRS was 100%, 97.1%, 97.1%, and 91%, respectively. In the S-GKRS sample, progression-free survival rates were 100%, 100%, 92.5%, and 92.5% at 1, 3, 5, and 7 years after treatment, respectively. Two patients (4.7%) from the F-GKRS cohort and 2 (4.7%) from the S-GKRS cohort sustained visual worsening after radiosurgery (P = 1.0). Conclusion: In the management of NFPAs adjacent to the optic pathway both F-GKRS and S-GKRS had comparable outcomes and risks at 7 years. Future prospective studies including larger cohorts with longer follow-up are needed to confirm our results.
Language	English
Publishing date	2024-02-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	135446-2
ISSN	1524-4040 ; 0148-396X
ISSN (online)	1524-4040
ISSN	0148-396X
DOI	10.1227/neu.0000000000002886
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Zs.MO 539: Show issues

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Article ; Online: Gamma Knife radiosurgery for cluster-tic syndrome unresponsive to medical treatment: illustrative case.

Barzaghi, Lina R / Pompeo, Edoardo / Albano, Luigi / Del Vecchio, Antonella / Mortini, Pietro

Journal of neurosurgery. Case lessons

2021 Volume 2, Issue 4, Page(s) CASE2191

Abstract: Background: Cluster-tic syndrome is a disorder characterized by the coexistence of symptoms related to both cluster headache and trigeminal neuralgia. Etiopathogenesis is not yet well defined. Medical treatment, including drugs for both cluster headache ...

Abstract	Background: Cluster-tic syndrome is a disorder characterized by the coexistence of symptoms related to both cluster headache and trigeminal neuralgia. Etiopathogenesis is not yet well defined. Medical treatment, including drugs for both cluster headache and trigeminal neuralgia, is the first therapeutic choice, whereas more invasive treatments are indicated in the case of pharmacological therapy failure or in the presence of drug side effects. To date, no randomized and/or large cohort trials describing Gamma Knife radiosurgery (GKRS) for cluster-tic syndrome are available, probably due to the syndrome's rarity. Observations: The authors describe the case of a 76-year-old woman with refractory cluster-tic syndrome who underwent GKRS with double target (the retrogasserian portion of the trigeminal nerve and the sphenopalatine ganglion). The Numerical Rating Scale (NRS) of pain and the Barrow Neurological Institute (BNI) pain intensity score before treatment were 7 (up to 10 during paroxysmal pain attacks) and V, respectively. At last follow-up, 24 months after GKRS, the patient had discontinued her pain medications and NRS and BNI pain scores were 1 and I, respectively. No trigeminal sensory disorders were reported. Lessons: The present case shows that GKRS, in selected cases, could be an effective treatment in patients with refractory cluster-tic syndrome.
Language	English
Publishing date	2021-07-26
Publishing country	United States
Document type	Case Reports
ISSN	2694-1902
ISSN (online)	2694-1902
DOI	10.3171/CASE2191
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Article ; Online: Comparative Analysis on Surgical Operability and Degree of Exposure of Microsurgical Approaches to Intraforaminal Lumbar Disk Herniations.

Gagliardi, Filippo / Pompeo, Edoardo / Snider, Silvia / Roncelli, Francesca / Medone, Marzia / De Domenico, Pierfrancesco / Piloni, Martina / Mortini, Pietro

Journal of neurological surgery. Part A, Central European neurosurgery

2022 Volume 85, Issue 3, Page(s) 307–315

Abstract: Background: Intraforaminal lumbar disk herniations (IFDHs) represent a heterogeneous and relatively uncommon disease; their treatment is technically demanding due to the anatomical relationships with nerve roots and vertebral joints. Over time, several ...

Abstract	Background: Intraforaminal lumbar disk herniations (IFDHs) represent a heterogeneous and relatively uncommon disease; their treatment is technically demanding due to the anatomical relationships with nerve roots and vertebral joints. Over time, several approaches have been developed without reaching a consensus about the best treatment strategy. Materials and methods: Authors comparatively analyze surgical operability and exposure in terms of quantitative variables between the different microsurgical approaches to IFDHs, defining the impact of each approach on surgical maneuverability and exposure on specific targets.A comparative microanatomical laboratory investigation was conducted. The operability score (OS) was applied for quantitative analysis of surgical operability. Results: Transarticular and combined translaminar-trans-pars-interarticularis approaches result in providing the best surgical exposure and maneuverability on all targets with surgical controls on both nerve roots, at the expense of a higher risk of iatrogenic instability. Trans-pars-interarticularis approach reaches comparable levels of operability, even limited to the pure foraminal area (lateral compartment); similar findings were recorded for partial facetectomy on the medial compartment. The contralateral interlaminar approach provides good visualization of the foramen without consensual favorable maneuverability, which should be considered the main drawback. Conclusions: Approach selection has to consider disease location, the possible migration of disk fragments, the degree of nerve root involvement, and risk of iatrogenic instability. According to the findings, authors propose an operative algorithm to tailor the surgical strategy, based both on the precise definition of anatomic boundaries of exposure of each approach and on surgical maneuverability on specific targets.
MeSH term(s)	Humans ; Intervertebral Disc Displacement/surgery ; Lumbar Vertebrae/surgery ; Iatrogenic Disease
Language	English
Publishing date	2022-12-08
Publishing country	Germany
Document type	Journal Article
ZDB-ID	2651663-9
ISSN	2193-6323 ; 2193-6315
ISSN (online)	2193-6323
ISSN	2193-6315
DOI	10.1055/a-1994-8142
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Article ; Online: History of Evolution of Posterolateral Approaches to the Thoracic Spine: From Cure of Pott's Disease to Epidural Tumor Resection.

Gagliardi, Filippo / Pompeo, Edoardo / De Domenico, Pierfrancesco / Snider, Silvia / Roncelli, Francesca / Acerno, Stefania / Mortini, Pietro

Journal of neurological surgery. Part A, Central European neurosurgery

2022 Volume 84, Issue 2, Page(s) 198–205

Abstract: Since the end of the nineteenth century, the wide dissemination of Pott's disease has ignited debates about which should be the ideal route to perform ventrolateral decompression of the dorsal spine in case of paraplegia due to spinal cord compression in ...

Abstract	Since the end of the nineteenth century, the wide dissemination of Pott's disease has ignited debates about which should be the ideal route to perform ventrolateral decompression of the dorsal spine in case of paraplegia due to spinal cord compression in tuberculosis spondylitis. It was immediately clear that the optimal approach should be the one minimizing the surgical manipulation on both neural and extraneural structures while optimizing the exposure and surgical maneuverability on the target area. The first attempt was reported by Victor Auguste Menard in 1894, who described, for the first time, a completely different route from traditional laminectomy, called costotransversectomy. The technique was conceived to drain tubercular paravertebral abscesses causing paraplegia without manipulating the spinal cord. Over the following decades, many other routes have been described all over the world, thus demonstrating the wide interest on the topic. Surgical development has been marked by the new technical achievements and by instrumental/technological advancements, until the advent of portal surgery and endoscopy-assisted techniques. In this article, the authors retraced the milestones of this history up to the present days, through a systematic review on the topic.
MeSH term(s)	Humans ; Tuberculosis, Spinal/complications ; Tuberculosis, Spinal/surgery ; Epidural Neoplasms/complications ; Spine ; Spinal Cord Compression/surgery ; Paraplegia/etiology
Language	English
Publishing date	2022-01-10
Publishing country	Germany
Document type	Systematic Review ; Journal Article
ZDB-ID	2651663-9
ISSN	2193-6323 ; 2193-6315
ISSN (online)	2193-6323
ISSN	2193-6315
DOI	10.1055/a-1734-2085
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Article ; Online: Intraoperative image-guidance during robotic surgery: is there clinical evidence of enhanced patient outcomes?

Tappero, Stefano / Fallara, Giuseppe / Chierigo, Francesco / Micalef, Andrea / Ambrosini, Francesca / Diaz, Raquel / Dorotei, Andrea / Pompeo, Edoardo / Limena, Alessia / Bravi, Carlo Andrea / Longoni, Mattia / Piccinelli, Mattia Luca / Barletta, Francesco / Albano, Luigi / Mazzone, Elio / Dell'Oglio, Paolo

European journal of nuclear medicine and molecular imaging

2024

Abstract: Background: To date, the benefit of image guidance during robot-assisted surgery (IGS) is an object of debate. The current study aims to address the quality of the contemporary body of literature concerning IGS in robotic surgery throughout different ... ...

Abstract	Background: To date, the benefit of image guidance during robot-assisted surgery (IGS) is an object of debate. The current study aims to address the quality of the contemporary body of literature concerning IGS in robotic surgery throughout different surgical specialties. Methods: A systematic review of all English-language articles on IGS, from January 2013 to March 2023, was conducted using PubMed, Cochrane library's Central, EMBASE, MEDLINE, and Scopus databases. Comparative studies that tested performance of IGS vs control were included for the quantitative synthesis, which addressed outcomes analyzed in at least three studies: operative time, length of stay, blood loss, surgical margins, complications, number of nodal retrievals, metastatic nodes, ischemia time, and renal function loss. Bias-corrected ratio of means (ROM) and bias-corrected odds ratio (OR) compared continuous and dichotomous variables, respectively. Subgroup analyses according to guidance type (i.e., 3D virtual reality vs ultrasound vs near-infrared fluoresce) were performed. Results: Twenty-nine studies, based on 11 surgical procedures of three specialties (general surgery, gynecology, urology), were included in the quantitative synthesis. IGS was associated with 12% reduction in length of stay (ROM 0.88; p = 0.03) and 13% reduction in blood loss (ROM 0.87; p = 0.03) but did not affect operative time (ROM 1.00; p = 0.9), or complications (OR 0.93; p = 0.4). IGS was associated with an estimated 44% increase in mean number of removed nodes (ROM 1.44; p < 0.001), and a significantly higher rate of metastatic nodal disease (OR 1.82; p < 0.001), as well as a significantly lower rate of positive surgical margins (OR 0.62; p < 0.001). In nephron sparing surgery, IGS significantly decreased renal function loss (ROM 0.37; p = 0.002). Conclusions: Robot-assisted surgery benefits from image guidance, especially in terms of pathologic outcomes, namely higher detection of metastatic nodes and lower surgical margins. Moreover, IGS enhances renal function preservation and lowers surgical blood loss.
Language	English
Publishing date	2024-04-12
Publishing country	Germany
Document type	Journal Article ; Review
ZDB-ID	8236-3
ISSN	1619-7089 ; 0340-6997 ; 1619-7070
ISSN (online)	1619-7089
ISSN	0340-6997 ; 1619-7070
DOI	10.1007/s00259-024-06706-w
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