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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

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: 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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Zs.A 5207: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Effect of previous abdominal surgery on robotic-assisted rectal cancer surgery.

Ferrari, Davide / Violante, Tommaso / Bhatt, Himani / Gomaa, Ibrahim A / D'Angelo, Anne-Lise D / Mathis, Kellie L / Larson, David W

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

2024 Volume 28, Issue 4, Page(s) 513–518

Abstract: Background: The effect of previous abdominal surgery (PAS) in laparoscopic surgery is well known and significantly adds to longer hospital length of stay (LOS), postoperative ileus, and inadvertent enterotomies. However, little evidence exists in ... ...

Abstract	Background: The effect of previous abdominal surgery (PAS) in laparoscopic surgery is well known and significantly adds to longer hospital length of stay (LOS), postoperative ileus, and inadvertent enterotomies. However, little evidence exists in patients with PAS undergoing robotic-assisted (RA) rectal surgery. Methods: All patients undergoing RA surgery for rectal cancer were reviewed. Patients with PAS were divided into minor and major PAS groups, defined as surgery involving >1 quadrant. The primary outcome was the risk of conversion to open surgery. Results: A total of 750 patients were included, 531 in the no-PAS (NPAS) group, 31 in the major PAS group, and 188 in the minor PAS group. Patients in the major PAS group had significantly longer hospital LOS (P < .001) and lower adherence to enhanced recovery pathways (ERPs; P = .004). The conversion rates to open surgery were similar: 3.4% in the NPAS group, 5.9% in the minor PAS group, and 9.7% in the major PAS group (P = .113). Estimated blood loss (EBL; P = .961), operative times (OTs; P = .062), complication rates (P = .162), 30-day readmission (P = .691), and 30-day mortality (P = .494) were similar. Of note, 53 patients underwent lysis of adhesions (LOA). On multivariate analysis, EBL >500 mL and LOA significantly influenced conversion to open surgery. EBL >500 mL, age >65 years, conversion to open surgery, and prolonged OT were risk factors for prolonged LOS, whereas adherence to ERPs was a protector. Conclusion: PAS did not seem to affect the outcomes in RA rectal surgery. Given this finding, the robotic approach may ultimately provide patients with PAS with similar risk to patients without PAS.
MeSH term(s)	Humans ; Aged ; Robotic Surgical Procedures/adverse effects ; Laparoscopy/adverse effects ; Digestive System Surgical Procedures/adverse effects ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Postoperative Complications/surgery ; Rectal Neoplasms/surgery ; Treatment Outcome ; Retrospective Studies ; Length of Stay
Language	English
Publishing date	2024-01-23
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.2024.01.011
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Zs.A 5207: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
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Article: Surgical masks vs respirators for the protection against coronavirus infection: state of the art

Violante, Tommaso / Violante, Francesco Saverio

Med Lav

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 ...

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.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #895851
Database	COVID19

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Article ; Online: Presacral Neuroendocrine Neoplasms: A Multi-site Review of Surgical Outcomes.

Violante, Tommaso / Murphy, Brenda / Ferrari, Davide / Graham, Rondell P / Navin, Patrick / Merchea, Amit / Larson, David W / Dozois, Eric J / Halfdanarson, Thorvardur R / Perry, William R

Annals of surgical oncology

2024

Abstract: Introduction: Presacral neuroendocrine neoplasms (PNENs) are rare tumors, with limited data on management and outcomes.: Methods: A retrospective review of institutional medical records was conducted to identify all patients with PNENs between 2008 ... ...

Abstract	Introduction: Presacral neuroendocrine neoplasms (PNENs) are rare tumors, with limited data on management and outcomes. Methods: A retrospective review of institutional medical records was conducted to identify all patients with PNENs between 2008 and 2022. Data collection included demographics, symptoms, imaging, surgical approaches, pathology, complications, and long-term outcomes. Results: Twelve patients were identified; two-thirds were female, averaging 44.8 years of age, and, for the most part, presenting with back pain, constipation, and abdominal discomfort. Preoperative imaging included computed tomography scans and magnetic resonance images, with somatostatin receptor imaging and biopsies being common. Half of the patients had metastatic disease on presentation. Surgical approach varied, with anterior, posterior, and combined techniques used, often involving muscle transection and coccygectomy. Short-term complications affected one-quarter of patients. Pathologically, PNENs were mainly well-differentiated grade 2 tumors with positive synaptophysin and chromogranin A. Associated anomalies were common, with tail-gut cysts prevalent. Mean tumor diameter was 6.3 cm. Four patients received long-term adjuvant therapy. Disease progression necessitated additional interventions, including surgery and various chemotherapy regimens. Skeletal, liver, thyroid, lung, and pancreatic metastases occurred during follow-up, with no mortality reported. Kaplan-Meier analysis showed a 5-year local recurrence rate of 23.8%, disease progression rate of 14.3%, and de novo metastases rate of 30%. Conclusion: The study underscores the complex management of PNENs and emphasizes the need for multicenter research to better understand and manage these tumors. It provides valuable insights into surgical outcomes, recurrence rates, and overall survival, guiding future treatment strategies for PNEN patients.
Language	English
Publishing date	2024-04-28
Publishing country	United States
Document type	Journal Article
ZDB-ID	1200469-8
ISSN	1534-4681 ; 1068-9265
ISSN (online)	1534-4681
ISSN	1068-9265
DOI	10.1245/s10434-024-15328-3
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