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Article ; Online: Coping with Covid-19 in Portugal

Violante, Teresa

From Constitutional Normality to the State of Emergency

2020

Keywords	article ; Recht und Gesellschaft ; ddc:342 ; covid19
Language	English
Publishing date	2020-04-12
Publishing country	de
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Robotic modified Sugarbaker technique for parastomal hernia repair: a standardized approach.

Ferrari, Davide / Violante, Tommaso / Gomaa, Ibrahim A / Cima, Robert R

Updates in surgery

2024

Abstract: Parastomal hernia (PSH) is a prevalent long-term morbidity associated with stoma construction, and the optimal operative management remains uncertain. This study addresses the need for a standardized approach to symptomatic PSH repair, focusing on the ... ...

Abstract	Parastomal hernia (PSH) is a prevalent long-term morbidity associated with stoma construction, and the optimal operative management remains uncertain. This study addresses the need for a standardized approach to symptomatic PSH repair, focusing on the robotic-assisted modified Sugarbaker technique with composite permanent mesh. The study, conducted in a high-volume colon and rectal surgery referral practice, outlines a systematic approach to patient selection, surgical procedures, and postoperative care. Preoperative evaluations include detailed medical and surgical histories, impact assessments of PSH, and oncological history reviews. The surgical technique involves the Da Vinci Xi™ robotic platform for adhesiolysis, hernia content reduction, stoma revision if needed, narrowing of the enlarged stoma trephine, lateralization of the stoma limb of bowel, and securing the mesh to the abdominal wall. Outcomes are reported for 102 patients undergoing robotic parastomal hernia repair from January 2021 to July 2023. Conversion to open surgery occurred in only one case (0.9%). Postoperative complications affected 39.2% of patients, with ileus being the most frequent (24.5%). Recurrence was observed in 5.8% of cases during an average follow-up of 10 months. In conclusion, parastomal hernia, a common complication post-stoma creation, demands surgical intervention. The robotic-assisted modified Sugarbaker repair technique, as outlined in this paper, offers promising results in terms of feasibility and outcomes.
Language	English
Publishing date	2024-04-04
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/s13304-024-01813-7
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Article ; Online: Access to Health Care by Migrants with Precarious Status During a Health Crisis: Some Insights from Portugal.

Raposo, Vera Lúcia / Violante, Teresa

Human rights review

2021 Volume 22, Issue 4, Page(s) 459–482

Abstract: In March 2020, the Portuguese Government issued a remarkable regulation by which irregular migrants who had previously started the regularization procedure were temporarily regularized and thus allowed full access to all social benefits, including ... ...

Abstract	In March 2020, the Portuguese Government issued a remarkable regulation by which irregular migrants who had previously started the regularization procedure were temporarily regularized and thus allowed full access to all social benefits, including healthcare. The Portuguese constitutional and legal framework is particularly generous regarding the right to healthcare to irregular migrants. Nevertheless, until now, several practical barriers prevented full access to healthcare services provided by the national health service, even in situations in which it was legally granted. This decision is not only remarkable in light of the fulfilling of migrants' rights to health, as imposed by international commitments assumed by, but also in view of the fight against COVID-19. The decision is grounded both on human rights and in public health reasons. The paper is divided in two main parts. In the first one, it analyzes national State obligations with regard to healthcare provision to migrants in irregular situation. In the second part, it analyzes the Portuguese solution, using this case study to discuss the possible mechanisms to comply with such obligations.
Language	English
Publishing date	2021-05-07
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2020969-1
ISSN	1874-6306 ; 1524-8879
ISSN (online)	1874-6306
ISSN	1524-8879
DOI	10.1007/s12142-021-00621-5
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Article ; Online: Robotic resection of presacral tumors.

Ferrari, D / Violante, T / Addison, P / Perry, W R G / Merchea, A / Kelley, S R / Mathis, K L / Dozois, E J / Larson, D W

Techniques in coloproctology

2024 Volume 28, Issue 1, Page(s) 49

Abstract: Background: Presacral tumors are a rare entity typically treated with an open surgical approach. A limited number of minimally invasive resections have been described. The aim of the study is to evaluate the safety and efficacy of roboticresection of ... ...

Abstract	Background: Presacral tumors are a rare entity typically treated with an open surgical approach. A limited number of minimally invasive resections have been described. The aim of the study is to evaluate the safety and efficacy of roboticresection of presacral tumors. Methods: This is a retrospective single system analysis, conducted at a quaternary referral academic healthcare system, and included all patients who underwent a robotic excision of a presacral tumor between 2015 and 2023. Outcomes of interest were operative time, estimated blood loss, complications, length of stay, margin status, and recurrence rates. Results: Sixteen patients (11 females and 5 males) were included. The median age of the cohort was 51 years (range 25-69 years). The median operative time was 197 min (range 98-802 min). The median estimated blood loss was 40 ml, ranging from 0 to 1800 ml, with one patient experiencing conversion to open surgery after uncontrolled hemorrhage. Urinary retention was the only postoperative complication that occurred in three patients (19%) and was solved within 30 days in all cases. The median length of stay was one day (range 1-6 days). The median follow-up was 6.7 months (range 1-110 months). All tumors were excised with appropriate margins, but one benign and one malignant tumor recurred (12.5%). Ten tumors were classified as congenital (one was malignant), two were mesenchymal (both malignant), and five were miscellaneous (one malignant). Conclusions: Robotic resection of select presacral pathology is feasible and safe. Further studies must be conducted to determine complication rates, outcomes, and long-term safety profiles.
MeSH term(s)	Humans ; Middle Aged ; Female ; Male ; Robotic Surgical Procedures/methods ; Adult ; Aged ; Retrospective Studies ; Operative Time ; Treatment Outcome ; Length of Stay/statistics & numerical data ; Margins of Excision ; Blood Loss, Surgical/statistics & numerical data ; Postoperative Complications/etiology ; Postoperative Complications/epidemiology ; Neoplasm Recurrence, Local/surgery ; Neoplasm Recurrence, Local/epidemiology ; Pelvic Neoplasms/surgery
Language	English
Publishing date	2024-04-23
Publishing country	Italy
Document type	Journal Article ; Evaluation Study
ZDB-ID	2083309-X
ISSN	1128-045X ; 1123-6337
ISSN (online)	1128-045X
ISSN	1123-6337
DOI	10.1007/s10151-024-02922-6
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Article: Surgical masks vs respirators for the protection against coronavirus infection: state of the art.

Violante, Tommaso / Violante, Francesco Saverio

La Medicina del lavoro

2020 Volume 111, Issue 5, Page(s) 365–371

Abstract: Background: During the Covid-19 outbreak, a recurrent subject in scientific literature has been brought back into discussion: whether surgical masks provide a sufficient protection against airborne SARS-CoV-2 infections.: Objectives: The objective of ...

Abstract	Background: During the Covid-19 outbreak, a recurrent subject in scientific literature has been brought back into discussion: whether surgical masks provide a sufficient protection against airborne SARS-CoV-2 infections. Objectives: The objective of this review is to summarize the available studies which have compared the respective effectiveness of surgical masks and filtering facepiece respirators for the prevention of infections caused by viruses that are transmitted by the respiratory tract. Methods: The relevant scientific literature was identified by querying the PubMed database with a combination of search strings. The narrower search string "(surgical mask ) AND (respirator OR respirators)" included all the relevant articles retrieved using broader search strategies. Of all the relevant articles found, seven systematic reviews were selected and examined. Results:* The currently available scientific evidence seems to suggest that surgical masks and N95 respirators/FFP2 confer an equivalent degree of protection against airborne viral infections. Discussion: Since surgical masks are less expensive than N95 respirators but seem to be as effective in protecting against airborne infection and they are also more comfortable for the user, requiring less respiratory work, they should be the standard protective device for health care workers and especially for workers who carry out non-medical jobs. Filtering facepiece respirators, whose extended use is less comfortable for the wearer, may be preferred for procedures which require greater protection for a shorter time.
MeSH term(s)	Betacoronavirus ; COVID-19 ; Coronavirus Infections/prevention & control ; Humans ; Masks ; Occupational Exposure/prevention & control ; Pandemics/prevention & control ; Pneumonia, Viral/prevention & control ; Respiratory Protective Devices ; SARS-CoV-2
Keywords	covid19
Language	English
Publishing date	2020-10-31
Publishing country	Italy
Document type	Comparative Study ; Journal Article ; Review
ZDB-ID	123678-7
ISSN	0025-7818
ISSN	0025-7818
DOI	10.23749/mdl.v111i5.9692
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Article ; Online: Unveiling the Hidden Consequences: The Initial Impact of COVID-19 on Colorectal Cancer Operation.

Ferrari, Davide / Violante, Tommaso / Day, Courtney N / McKenna, Nicholas P / Mathis, Kellie L / Dozois, Eric J / Larson, David W

Journal of the American College of Surgeons

2024

Abstract: Background: The COVID-19 pandemic has severely affected healthcare systems globally, resulting in significant delays and challenges in various medical treatments, particularly in cancer care. This study aims to investigate the repercussions of the ... ...

Abstract	Background: The COVID-19 pandemic has severely affected healthcare systems globally, resulting in significant delays and challenges in various medical treatments, particularly in cancer care. This study aims to investigate the repercussions of the pandemic on surgical interventions for colorectal cancer in the United States, using data from the National Cancer Database (NCDB). Methods: We conducted a retrospective analysis of the NCDB, encompassing adult patients who underwent surgical procedures for colon and rectal cancer in 2019 (pre-COVID) and 2020 (COVID). We examined various demographic and clinical variables, including patient characteristics, tumor staging, surgical approaches, and socioeconomic factors. Results: The analysis included 105,517 patients, revealing a 17.3% reduction in surgical cases during the initial year of the pandemic. Patients who underwent surgery in 2020 displayed more advanced clinical and pathological tumor stages compared to those treated in 2019. After diagnosis, no delay was reported in the treatment. Patients operated during the pandemic, African American patients, uninsured and Medicaid beneficiaries had worse stage colon and rectal cancer, and individuals with lower incomes bore the burden of advanced colon cancer. Conclusions: The impact of the COVID-19 pandemic on colorectal cancer surgery transcends a mere decline in case numbers, resulting in a higher prevalence of patients with advanced disease. This study underscores the exacerbated disparities in cancer care, particularly affecting vulnerable populations. The COVID-19 pandemic has left a significant and enduring imprint on colorectal cancer surgery, intensifying the challenges faced by patients and healthcare systems. Comprehensive studies are imperative to comprehend the long-term consequences of delayed screenings, diagnoses, and treatments, as healthcare planning for the future must consider the unintended repercussions of pandemic-related disruptions.
Language	English
Publishing date	2024-03-25
Publishing country	United States
Document type	Journal Article
ZDB-ID	1181115-8
ISSN	1879-1190 ; 1072-7515
ISSN (online)	1879-1190
ISSN	1072-7515
DOI	10.1097/XCS.0000000000001042
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Article ; Online: Same-Day Ileostomy Closure Discharge Reduces Costs without Compromising Outcomes: An Economic Analysis.

Ferrari, Davide / Violante, Tommaso / Moriarty, James P / Borah, Bijan J / Merchea, Amit / Stocchi, Luca / Larson, David W

Annals of surgery

2024

Abstract: Objective: This study aims to assess the costs of a Same-Day Discharge Enhanced Recovery Pathway (SDD) for diverting loop ileostomy closure compared to a standard institutional enhanced recovery protocol (ERP).: Summary background data: Every year, ... ...

Abstract	Objective: This study aims to assess the costs of a Same-Day Discharge Enhanced Recovery Pathway (SDD) for diverting loop ileostomy closure compared to a standard institutional enhanced recovery protocol (ERP). Summary background data: Every year, 50,155 patients in the United States undergo temporary stoma reversal. While ambulatory stoma closure has shown promise, widespread adoption remains slow. This study builds on previous research, focusing on the costs of a novel SDD protocol introduced in 2020. Methods: A retrospective case-control study was conducted at Mayo Clinic, Rochester, Minnesota, and Mayo Clinic, Jacksonville, Florida, comparing patients undergoing same-day discharge diverting loop ileostomy closure (SDD) from August 2020 to February 2023 to those in a matched cohort receiving standard inpatient ERP. Patients were matched based on age, sex, ASA score, surgery period, and hospital. Primary outcomes included direct hospitalization and additional costs in the 30 days post-discharge. Results: The SDD group (n=118) demonstrated a significant reduction in median index episode hospitalization and 30-day post-operative costs compared to the inpatient group (n=236), with savings of $4,827 per patient. Complication rates were similar, and so were readmission and reoperation rates. Conclusions: Implementation of the SDD for diverting loop ileostomy closure is associated with substantial cost savings without compromising patient outcomes. The study advocates for a shift towards same-day discharge protocols, offering economic benefits and potential improvements in healthcare resource utilization.
Language	English
Publishing date	2024-03-28
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.0000000000006285
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Article ; Online: The death of laparoscopy.

Ferrari, Davide / Violante, Tommaso / Novelli, Marco / Starlinger, Patrick P / Smoot, Rory L / Reisenauer, Janani S / Larson, David W

Surgical endoscopy

2024

Abstract: Background: The introduction of laparoscopy in 1989 revolutionized surgical practices, reducing post-operative complications, and enhancing outcomes. Despite its benefits, limitations in laparoscopic tools have led to continued use of open surgery. ... ...

Abstract	Background: The introduction of laparoscopy in 1989 revolutionized surgical practices, reducing post-operative complications, and enhancing outcomes. Despite its benefits, limitations in laparoscopic tools have led to continued use of open surgery. Robotic-assisted surgery emerged to address these limitations, but its adoption trends and potential impact on open and laparoscopic surgery require analysis. Methods: A retrospective analysis used the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) databases from 2012 to 2021. The study encompassed various abdominal procedures, employing Vector Autoregressive (VAR) models to analyze the dynamic relationships between surgical techniques. The models predicted future trends in open, laparoscopic, and robotic surgery until Q2 of 2025. Results: The analysis included 360,171 patients across diverse procedures. In urology, robotic surgery dominated prostatectomies (83.1% in 2021) and nephrectomies (55.1% in 2021), while the open approach remained the predominant surgical technique for cystectomies (72.5% in 2021). In general surgery, robotic colectomies were forecasted to surpass laparoscopy, becoming the primary approach by 2024 (45.7% in 2025). Proctectomies also showed a shift towards robotic surgery, predicted to surpass laparoscopy and open surgery by 2025 (32.3%). Pancreatectomies witnessed a steady growth in robotic surgery, surpassing laparoscopy in 2021, with forecasts indicating further increase. While hepatectomies remained predominantly open (70.0% in 2025), esophagectomies saw a rise in robotic surgery, predicted to become the primary approach by 2025 (52.3%). Conclusions: The study suggests a transformative shift towards robotic-assisted surgery, poised to dominate various minimally invasive procedures. The forecasts indicate that robotic surgery may surpass laparoscopy and open surgery in colectomies, proctectomies, pancreatectomies, and esophagectomies by 2025. This anticipated change emphasizes the need for proactive adjustments in surgical training programs to align with evolving surgical practices. The findings have substantial implications for future healthcare practices, necessitating a balance between traditional laparoscopy and the burgeoning role of robotic-assisted surgery.
Language	English
Publishing date	2024-03-22
Publishing country	Germany
Document type	Journal Article
ZDB-ID	639039-0
ISSN	1432-2218 ; 0930-2794
ISSN (online)	1432-2218
ISSN	0930-2794
DOI	10.1007/s00464-024-10774-2
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Article ; Online: Robotic-assisted reoperative ileal pouch-anal anastomosis: robotic pouch excision and pouch revision.

Violante, Tommaso / Behm, Kevin T / Shawki, Sherief F / Ferrari, Davide / D'Angelo, Anne-Lise D / Kelley, Scott R / Nitin, Mishra / Larson, David W

Techniques in coloproctology

2024 Volume 28, Issue 1, Page(s) 43

Abstract: Background: Up to 20% of patients with ileal pouch will develop pouch failure, ultimately requiring surgical reintervention. As a result of the complexity of reoperative pouch surgery, minimally invasive approaches were rarely utilized. In this series, ... ...

Abstract	Background: Up to 20% of patients with ileal pouch will develop pouch failure, ultimately requiring surgical reintervention. As a result of the complexity of reoperative pouch surgery, minimally invasive approaches were rarely utilized. In this series, we present the outcomes of the patients who underwent robotic-assisted pouch revision or excision to assess its feasibility and short-term results. Methods: All the patients affected by inflammatory bowel diseases and familial adenomatous polyposis who underwent robotic reoperative surgery of an existing ileal pouch were included. Results: Twenty-two patients were included; 54.6% were female. The average age at reoperation was 51 ± 16 years, with a mean body mass index of 26.1 ± 5.6 kg/m Conclusion: Robotic reoperative pouch surgery in highly selected patients is technically feasible with acceptable outcomes.
MeSH term(s)	Humans ; Female ; Adult ; Middle Aged ; Aged ; Male ; Reoperation ; Robotic Surgical Procedures/adverse effects ; Postoperative Complications/etiology ; Postoperative Complications/surgery ; Proctocolectomy, Restorative/adverse effects ; Proctocolectomy, Restorative/methods ; Colitis, Ulcerative/surgery ; Colitis, Ulcerative/complications ; Colonic Pouches/adverse effects ; Anastomosis, Surgical/adverse effects ; Treatment Outcome ; Retrospective Studies
Language	English
Publishing date	2024-04-01
Publishing country	Italy
Document type	Journal Article
ZDB-ID	2083309-X
ISSN	1128-045X ; 1123-6337
ISSN (online)	1128-045X
ISSN	1123-6337
DOI	10.1007/s10151-024-02918-2
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Article ; Online: Robotic-assisted surgery conversion: the sooner, the better? Insights from a Single-Center Study.

Violante, Tommaso / Ferrari, Davide / Mathis, Kellie L / D'Angelo, Anne-Lise D / Dozois, Eric J / Merchea, Amit / Larson, David W

Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract

2024

Language	English
Publishing date	2024-04-05
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2012365-6
ISSN	1873-4626 ; 1934-3213 ; 1091-255X
ISSN (online)	1873-4626 ; 1934-3213
ISSN	1091-255X
DOI	10.1016/j.gassur.2024.04.003
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