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Raj R, Lotwala V, Anajwala P. Minimally invasive supraomohyoid neck dissection by total endoscopic technique for oral squamous carcinoma. Surg Endosc 2015; 30:2315-20. [PMID: 26715016 DOI: 10.1007/s00464-015-4427-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 07/07/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVE To study the feasibility of a total endoscopic technique for selective neck dissection in oral cancers and to compare the technique with conventional open technique with a long cervical scar. METHODS We included patients with early intraorally resectable squamous carcinomas and excluded patients whose primary lesion required reconstruction with microvascular flaps. We compared the following intraoperative parameters: cumulative length of the incision(s), duration of surgery, estimated blood loss, and intraoperative complications. The postoperative parameters included hospital stay, shoulder function, duration of analgesic use, and early postoperative complications. We used Shoulder Pain And Disability Index scores to assess shoulder function and assessed the oncologic outcome histopathologically by the number of nodes dissected. RESULTS The mean operative time for minimally invasive supraomohyoid neck dissection (MISOND) was 53.7 ± 29.8 min, which was significantly longer than 39.4 ± 5.0 min for the open technique. The estimated blood loss in the MISOND group was significantly lower compared with the open technique (p < 0.001), and there were no major intraoperative complications in either group. Postoperative recovery assessed by hospital stay and time to resume routine work was slightly shorter in the MISOND group but not statistically significant. There were no reported early postoperative complications such as haemorrhage, wound dehiscence, or chyle leakage in either group. The mean Shoulder Pain And Disability Index score assessed 2 weeks postoperatively for the MISOND group was 14.35 ± 0.71 %, which was significantly better than 44.14 ± 1.18 % for the open technique (p < 0.001). The number of nodes dissected showed no significant difference between groups. CONCLUSIONS MISOND is a feasible and safe procedure with immediate oncologic outcomes comparable with those of conventional open SOND and provides better cosmetic and functional outcomes.
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Affiliation(s)
- Ravindrasinh Raj
- Department of Surgical Oncology, Bharat Cancer Hospital and Research Institute, Saroli, Kadodara Road, Surat, 395010, Gujarat, India.
| | - Vikram Lotwala
- Department of Minimal Access Surgery, Bharat Cancer Hospital and Research Institute, Surat, India
| | - Piyush Anajwala
- Department of Minimal Access Surgery, Bharat Cancer Hospital and Research Institute, Surat, India
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Chowbey PK, Soni V, Khullar R, Sharma A, Baijal M. Endoscopic neck surgery. J Minim Access Surg 2011; 3:3-7. [PMID: 20668611 PMCID: PMC2910378 DOI: 10.4103/0972-9941.30679] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2006] [Accepted: 11/30/2006] [Indexed: 11/04/2022] Open
Abstract
Endoscopic surgery in the neck was attempted in 1996 for performing parathyroidectomy. A similar surgical technique was used for performing thyroidectomy the following year. Most commonly reported endoscopic neck surgery studies in literature have been on thyroid and parathyroid glands. The approaches are divided into two types i.e., the total endoscopic approach using CO(2) insufflation and the video-assisted approach without CO(2) insufflation. The latter approach has been reported more often. The surgical access (port placements) may vary-the common sites are the neck, anterior chest wall, axilla, and periareolar region. The limiting factors are the size of the gland and malignancy. Few reports are available on endoscopic resection for early thyroid malignancy and cervical lymph node dissection. Endoscopic neck surgery has primarily evolved due to its cosmetic benefits and it has proved to be safe and feasible in suitable patients with thyroid and parathyroid pathologies. Application of this technique for approaching other cervical organs such as the submandibular gland and carotid artery are still in the early experimental phase.
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Affiliation(s)
- P K Chowbey
- Department of Minimal Access and Bariatric Surgery Centre, Sir Ganga Ram Hospital, New Delhi, India
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El-Labban GM. Minimally invasive video-assisted thyroidectomy versus conventional thyroidectomy: A single-blinded, randomized controlled clinical trial. J Minim Access Surg 2011; 5:97-102. [PMID: 20407568 PMCID: PMC2843132 DOI: 10.4103/0972-9941.59307] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Accepted: 11/07/2009] [Indexed: 11/04/2022] Open
Abstract
UNLABELLED We aimed to test the hypothesis that Minimally Invasive Video-assisted Thyroidectomy (MIVAT) affords comparable safety and efficacy as to the open conventional surgery, when dealing with patients with unilateral thyroid nodules or follicular lesions, in terms of cosmetic results, intraoperative and postoperative complications, postoperative pain and hospital stay. MATERIALS AND METHODS This was a single-blinded randomised controlled trial comparing the MIVAT with conventional thyroidectomy. The primary endpoints of the study were measurement of postoperative pain after 24 and 48 hours from operation and self-rated patient satisfaction with cosmetic outcome three months postoperatively. The secondary outcome measures were operative time, incidence of temporary and permanent recurrent laryngeal nerve injury, postoperative haematoma formation, length of incision, and duration of hospital stay. RESULTS Operative time was significantly less with open thyroidectomy than with MIVAT, while MIVAT was associated with less pain 24 hours postoperatively. Blood loss did not reach significance between procedures. Comparisons between the two procedures with regard to pain scores after 24 and 48 hours, respectively, depicted statistically significant differences in favour of the MIVAT after 24 hours. MIVAT was associated with less scarring and more satisfactory cosmetic results. There were statistically no significant differences between both procedures for the presence of transient recurrent laryngeal nerve palsy and hypoparathyroidism. CONCLUSIONS MIVAT is a safe procedure that produces outcomes, in view of short-term adverse events, similar to those of open thyroidectomy, and is superior in terms of immediate postoperative pain and cosmetic results.
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Affiliation(s)
- Gouda M El-Labban
- Department of Surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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Papaspyrou G, Ferlito A, Silver CE, Werner JA, Genden E, Sesterhenn AM. Extracervical approaches to endoscopic thyroid surgery. Surg Endosc 2010; 25:995-1003. [PMID: 20844894 DOI: 10.1007/s00464-010-1341-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Accepted: 08/17/2010] [Indexed: 01/28/2023]
Abstract
There is increasing demand for surgical procedures which avoid visible scars while maintaining optimal functional and ideal cosmetic results, without compromising the safety or effectiveness of the procedure. Endoscopic techniques have been adapted to abdominal and pelvic surgery and increasingly employed over the past three decades. Although hampered by the absence of a natural cavity, endoscopic techniques have been adapted to surgery in the neck for the past 15 years, particularly for the thyroid gland. While earlier attempts at endoscopic thyroid surgery were performed through incisions in or near the midline of the neck, recent techniques have been developed to place the incisions and endoscopic ports extracervically, or at least away from the midline region of the neck, rendering the cosmetic result more acceptable. Most of these approaches are through the axilla, breast, chest wall or a combination of approaches. Visualization of the thyroid and rate of complications with these approaches are equal to those attained with older endoscopic approaches. Careful patient selection is important for endoscopic surgery. Complications unique to the endoscopic approach are mostly related to insufflation of cervical tissues with pressurized CO(2).
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Affiliation(s)
- Giorgos Papaspyrou
- Department of Otolaryngology, Head and Neck Surgery, Philipp University, Marburg, Germany
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Ruggieri M, Zullino A, Straniero A, Maiuolo A, Fumarola A, Vietri F, D’Armiento M. Is minimally invasive surgery appropriate for small differentiated thyroid carcinomas? Surg Today 2010; 40:418-22. [DOI: 10.1007/s00595-009-4108-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Accepted: 07/09/2009] [Indexed: 10/19/2022]
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Fan Y, Guo B, Guo S, Kang J, Wu B, Zhang P, Zheng Q. Minimally invasive video-assisted thyroidectomy: experience of 300 cases. Surg Endosc 2010; 24:2393-400. [DOI: 10.1007/s00464-010-0960-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2009] [Accepted: 01/26/2010] [Indexed: 11/30/2022]
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Dhiman SV, Inabnet WB. Minimally invasive surgery for thyroid diseases and thyroid cancer. J Surg Oncol 2008; 97:665-8. [DOI: 10.1002/jso.21019] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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New Technologies in Surgery: Diagnosis and Treatment of Complications of Mivat (Minimally Invasive Video-Assisted Thyroidectomy). POLISH JOURNAL OF SURGERY 2008. [DOI: 10.2478/v10035-008-0063-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ruggieri M, Straniero A, Genderini M, D'Armiento M, Fumarola A, Trimboli P, Gargiulo P. The eligibility of MIVA approach in thyroid surgery. Langenbecks Arch Surg 2007; 392:413-6. [PMID: 17342549 DOI: 10.1007/s00423-007-0155-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2006] [Accepted: 01/16/2007] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Thyroid size, by preoperative ultrasound evaluation, is a very important criterion of minimally invasive video-assisted thyroidectomy (MIVAT) exclusion because the working space provided by the technique is limited. The aim of this work is to verify the suitability of MIVAT and its applicability in clinical practice in patients with a thyroid volume up to 50 ml. METHODS From January 2003 to February 2006, 33 patients were selected for MIVAT. A completely gas-less procedure was carried out through a central skin incision performed "high" between the cricoid and jugular notch. RESULTS The skin incision performed was from 20 to 35 mm (mean 24.88 mm +/- 2.74) for different thyroid sizes. We obtained in all cases excellent results about patients cure rate and comfort, few cases of postoperative pain, and attractive cosmetic results. CONCLUSION In this study, we demonstrated that the MIVAT, for thyroids up to 50 ml in volume, is feasible and safe. This procedure allows more patients, who would have been excluded before, to take advantage of this minimally invasive approach with good cosmetic results, highly regarded by young female patients, and reduced paresthetic consequences.
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Affiliation(s)
- Massimo Ruggieri
- Department of Surgery Francesco Durante, University of Rome La Sapienza, Viale del Policlinico, 00161 Rome, Italy.
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Ruggieri M, Straniero A, Genderini M, D'Armiento M, Fumarola A, Trimboli P, Gargiulo P. The size criteria in minimally invasive video-assisted thyroidectomy. BMC Surg 2007; 7:2. [PMID: 17254332 PMCID: PMC1796854 DOI: 10.1186/1471-2482-7-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2006] [Accepted: 01/25/2007] [Indexed: 11/30/2022] Open
Abstract
Background Thyroid size is a very important criteria of MIVAT exclusion because the working space provided by the technique is limited. The aim of this work has been to verify the suitability of MIVAT and its applicability in clinical practice, not only in patients with a thyroid volume up to 25 ml but also in patients with a thyroid volume included from 25 to 50 ml. Methods From January 2003 to February 2006, 33 patients have been selected for MIVAT. A completely gasless procedure was carried out through a central 20 to 35 mm skin incision performed "high" between the cricoid and jugular notch. Results The patients were separated in 2 groups. The first group (less than 25 ml) included 23 patients, the second group (from 25 to 50 ml) included 10 patients. The skin incision performed was from 20 to 25 mm (mean 23.61 mm ± 1.83) long in the first group and from 25 to 35 mm (mean 27.8 mm ± 2.20) long in the second one; this difference is significant (t test p < 0.001). Conclusion Our study suggest that the MIVAT using for thyroids bigger than 25 ml and up to 50 ml in volume is feasible and safe. This way allows more patients, excluded before, to take the advantages of minimally invasive approach.
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Affiliation(s)
- Massimo Ruggieri
- Department of Surgery "Francesco Durante", University of Rome "La Sapienza", Rome, Italy
| | - Andrea Straniero
- Department of Surgery "Francesco Durante", University of Rome "La Sapienza", Rome, Italy
| | - Mariapia Genderini
- Department of Experimental Medicine and Pathology, Chair of Endocrinology, University of Rome "La Sapienza", Rome, Italy
| | - Massimino D'Armiento
- Department of Experimental Medicine and Pathology, Chair of Endocrinology, University of Rome "La Sapienza", Rome, Italy
| | - Angela Fumarola
- Department of Experimental Medicine and Pathology, Chair of Endocrinology, University of Rome "La Sapienza", Rome, Italy
| | - Pierpaolo Trimboli
- Department of Experimental Medicine and Pathology, Chair of Endocrinology, University of Rome "La Sapienza", Rome, Italy
| | - Patrizia Gargiulo
- Department of Clinical Sciences, University of Rome "La Sapienza", Rome, Italy
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Miccoli P, Berti P, Frustaci GL, Ambrosini CE, Materazzi G. Video-assisted thyroidectomy: indications and results. Langenbecks Arch Surg 2006; 391:68-71. [PMID: 16572329 DOI: 10.1007/s00423-006-0027-7] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2005] [Accepted: 12/28/2005] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND AIMS Minimally invasive video-assisted thyroidectomy (MIVAT) was set up and introduced in our department in 1998. Its results, after an acceptable relapse, can now be evaluated, also speculating on new possible indications. PATIENTS AND METHODS The procedure is based on a unique incision in the central neck, 2 cm above the sternal notch, using small conventional retractors and needlescopic (2 mm) reusable instruments. Haemostasis is achieved by a harmonic scalpel. Patients, 833, underwent MIVAT since June 1998. There were 715 females and 118 males (ratio 4:1). Lobectomy was carried out in 323 (38.7%) patients, total thyroidectomy in 510 (61.2%) patients. RESULTS Mean operative time of lobectomy was 36.2 min (range: 20-120); for total thyroidectomy, 46.1 min (30-130). Conversion to standard cervicotomy was required in 16 cases (1.9%); Operative complications were represented by transient monolateral recurrent nerve palsy in eight cases (0.9%), definitive monolateral recurrent nerve palsy in seven cases (0.8%). Twenty patients exhibited a hypoparathyroidism, which corresponds to 3.9% of total thyroidectomies performed, but only two showed permanent hypoparathyroidism (0.3%). CONCLUSION MIVAT can be considered a safe operation offering significant cosmetic advantages with possible new promising indications such as prophylactic thyroidectomy in rearranged during transfection (RET) gene mutation carriers. It is still limited to a minority of patients, in particular, in endemic goitre countries.
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Affiliation(s)
- Paolo Miccoli
- Dipartimento di Chirurgia, Università di Pisa, Ospedale Santa Chiara, Via Roma, 67, 56126, Pisa, Italy.
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Abstract
CONTEXT AND OBJECTIVE Minimally invasive video-assisted gasless thyroidectomy (MIVAT) has mainly been described in Italy and has been demonstrated to be a safe procedure with additional advantages regarding cosmetic results and postoperative outcome. The aim of this work is to analyze our preliminary results from minimally invasive video-assisted thyroidectomy. DESIGN AND SETTING Retrospective study at the Head and Neck Surgery Service of Hospital Ana Costa, Santos. METHODS Twelve patients underwent hemithyroidectomy and another three underwent total thyroidectomy by means of minimally invasive video-assisted thyroidectomy between June and September 2004. Gender, age, goiter volume, major diameter of the dominant nodule, duration of surgery, pain complaints during the first postoperative day, length of hospital stay, cosmetic result and complications were retrospectively analyzed. RESULTS All the patients were women, with median age of 34. The median goiter volume was 16.5 ml, and the median major diameter of the nodule was 2.3 cm. Ten patients reported mild pain at the surgical site. The median scar size was 2.0 cm and all patients considered the cosmetic results excellent. The median duration of surgery was 55 minutes, all patients were discharged on the first postoperative day, and there were no complications. CONCLUSIONS The outcome from minimally invasive video-assisted thyroidectomy is good in terms of cosmetic results, analgesia and postoperative recovery. The scar is shorter than in the conventional procedure.
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Affiliation(s)
- Rogério Aparecido Dedivitis
- Head and Neck Surgery Service, Hospital Ana Costa, Metropolitan University of Santos, Rua Dr. Olinto Rodrigues Dantas 343, CEP 11050-220 Santos, São Paulo, Brazil.
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Ruggieri M, Straniero A, Mascaro A, Genderini M, D'Armiento M, Gargiulo P, Fumarola A, Trimboli P. The minimally invasive open video-assisted approach in surgical thyroid diseases. BMC Surg 2005; 5:9. [PMID: 15857503 PMCID: PMC1131909 DOI: 10.1186/1471-2482-5-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2004] [Accepted: 04/27/2005] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The targets of minimally invasive surgery (MIVA) could be summarised by: achievement of the same results as those obtained with traditional surgery, less trauma, better post-operative course, early discharge from hospital and improved cosmetic results. The minimally invasive techniques in thyroid surgery can be described as either endoscopic "pure" approach (completely closed approach with or without CO2 insufflation), or "open approach" with central neck mini-incision or "open video-assisted approach". Traditionally, open thyroidectomy requires a 6 to 8 cm, or bigger, transverse wound on the lower neck. The minimally invasive approach wound is much shorter (1.5 cm for small nodules, up to 2-3 cm for the largest ones, in respect of the exclusion criteria) upon the suprasternal notch. Patients also experience much less pain after MIVA surgery than after conventional thyroidectomy. This is due to less dissection and destruction of tissues. Pathologies treated are mainly nodular goiter; the only kind of thyroid cancer which may be approached with endoscopic surgery is a small differentiated carcinoma without lymph node involvement. The patients were considered eligible for MIVA hemithyroidectomy and thyroidectomy on the basis of some criteria, such as gland volume and the kind of disease. In our experience we have chosen the minimally invasive open video-assisted approach of Miccoli et al. (2002). The aim of this work was to verify the suitability of the technique and the applicability in clinical practice. METHODS A completely gasless procedure was carried out through a 15-30 mm central incision about 20 mm above the sternal notch. Dissection was mainly performed under endoscopic vision using conventional endoscopic instruments. The video aided group included 11 patients. All patients were women with a average age of 54. RESULTS We performed thyroidectomy in 8 cases and hemithyroidectomy in 3 cases. The operative average time has been 170 minutes. CONCLUSION Nowadays this minimally invasive surgery, in selected patients, clearly demonstrates excellent results regarding patient cure rate and comfort, with shorter hospital stay, reduced postoperative pain and most attractive cosmetic results.
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Affiliation(s)
- Massimo Ruggieri
- Department of Surgical Sciences and Applied Medical Technologies "Francesco Durante", University of Rome "La Sapienza", Rome, Italy
| | - Andrea Straniero
- Department of Surgical Sciences and Applied Medical Technologies "Francesco Durante", University of Rome "La Sapienza", Rome, Italy
| | - Alessandra Mascaro
- Department of Surgical Sciences and Applied Medical Technologies "Francesco Durante", University of Rome "La Sapienza", Rome, Italy
| | - Mariapia Genderini
- Department of Experimental Medicine and Pathology, Chair of Endocrinology, University of Rome "La Sapienza", Rome, Italy
| | - Massimino D'Armiento
- Department of Experimental Medicine and Pathology, Chair of Endocrinology, University of Rome "La Sapienza", Rome, Italy
| | - Patrizia Gargiulo
- Department of Medicine, University of Rome "La Sapienza", Rome, Italy
| | - Angela Fumarola
- Department of Experimental Medicine and Pathology, Chair of Endocrinology, University of Rome "La Sapienza", Rome, Italy
| | - Pierpaolo Trimboli
- Department of Experimental Medicine and Pathology, Chair of Endocrinology, University of Rome "La Sapienza", Rome, Italy
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Abstract
Minimally invasive, video-assisted thyroidectomy (MIVAT) was first used in Pisa in 1998. The technique is characterized by a unique central access and external retraction. There is controversy about the validity and limited indications of this and other minimally invasive thyroidectomy techniques, but MIVAT looks promising. The results of MIVAT, in 5 years experience, are similar to those of traditional thyroidectomy.
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Affiliation(s)
- Paolo Miccoli
- Department of Surgery, University of Pisa, Via Roma 67, 56100 Pisa, Italy
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