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Morales-Conde S, Navarro-Morales L, Moreno-Suero F, Balla A, Licardie E. Fluorescence and tracers in surgery: the coming future. Cir Esp 2024; 102 Suppl 1:S45-S60. [PMID: 38851317 DOI: 10.1016/j.cireng.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 05/23/2024] [Indexed: 06/10/2024]
Abstract
The revolution that we are seeing in the world of surgery will determine the way we understand surgical approaches in coming years. Since the implementation of minimally invasive surgery, innovations have constantly been developed to allow the laparoscopic approach to go further and be applied to more and more procedures. In recent years, we have been in the middle of another revolutionary era, with robotic surgery, the application of artificial intelligence and image-guided surgery. The latter includes 3D reconstructions for surgical planning, virtual reality, holograms or tracer-guided surgery, where ICG-guided fluorescence has provided a different perspective on surgery. ICG has been used to identify anatomical structures, assess tissue perfusion, and identify tumors or tumor lymphatic drainage. But the most important thing is that this technology has come hand in hand with the potential to develop other types of tracers that will facilitate the identification of tumor cells and ureters, as well as different light beams to identify anatomical structures. These will lead to other types of systems to assess tissue perfusion without the use of tracers, such as hyperspectral imaging. Combined with the upcoming introduction of ICG quantification, these developments represent a real revolution in the surgical world. With the imminent implementation of these technological advances, a review of their clinical application in general surgery is timely, and this review serves that aim.
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Affiliation(s)
- Salvador Morales-Conde
- Servicio de Cirugía General y Digestiva, Hospital Universitario Virgen Macarena, Facultad de Medicina, Universidad de Sevilla, Sevilla, Spain; Servicio de Cirugía General y Digestiva, Hospital Quironsalud Sagrado Corazón, Sevilla, Spain.
| | - Laura Navarro-Morales
- Servicio de Cirugía General y Digestiva, Hospital Quironsalud Sagrado Corazón, Sevilla, Spain.
| | - Francisco Moreno-Suero
- Servicio de Cirugía General y Digestiva, Hospital Quironsalud Sagrado Corazón, Sevilla, Spain.
| | - Andrea Balla
- Servicio de Cirugía General y Digestiva, Hospital Universitario Virgen Macarena, Facultad de Medicina, Universidad de Sevilla, Sevilla, Spain; Servicio de Cirugía General y Digestiva, Hospital Quironsalud Sagrado Corazón, Sevilla, Spain.
| | - Eugenio Licardie
- Servicio de Cirugía General y Digestiva, Hospital Universitario Virgen Macarena, Facultad de Medicina, Universidad de Sevilla, Sevilla, Spain; Servicio de Cirugía General y Digestiva, Hospital Quironsalud Sagrado Corazón, Sevilla, Spain.
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Peltrini R, Podda M, Castiglioni S, Di Nuzzo MM, D'Ambra M, Lionetti R, Sodo M, Luglio G, Mucilli F, Di Saverio S, Bracale U, Corcione F. Intraoperative use of indocyanine green fluorescence imaging in rectal cancer surgery: The state of the art. World J Gastroenterol 2021; 27:6374-6386. [PMID: 34720528 PMCID: PMC8517789 DOI: 10.3748/wjg.v27.i38.6374] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 07/01/2021] [Accepted: 08/18/2021] [Indexed: 02/06/2023] Open
Abstract
Indocyanine green (ICG) fluorescence imaging is widely used in abdominal surgery. The implementation of minimally invasive rectal surgery using new methods like robotics or a transanal approach required improvement of optical systems. In that setting, ICG fluorescence optimizes intraoperative vision of anatomical structures by improving blood and lymphatic flow. The purpose of this review was to summarize all potential applications of this upcoming technology in rectal cancer surgery. Each type of use has been separately addressed and the evidence was investigated. During rectal resection, ICG fluorescence angiography is mainly used to evaluate the perfusion of the colonic stump in order to reduce the risk of anastomotic leaks. In addition, ICG fluorescence imaging allows easy visualization of organs such as the ureter or urethra to protect them from injury. This intraoperative technology is a valuable tool for conducting lymph node dissection along the iliac lymphatic chain or to better identifying the rectal dissection planes when a transanal approach is performed. This is an overview of the applications of ICG fluorescence imaging in current surgical practice and a synthesis of the results obtained from the literature. Although further studies are need to investigate the real clinical benefits, these findings may enhance use of ICG fluorescence in current clinical practice and stimulate future research on new applications.
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Affiliation(s)
- Roberto Peltrini
- Department of Public Health, University of Naples Federico II, Napoli 80131, Italy
| | - Mauro Podda
- Department of Emergency Surgery, Cagliari University Hospital "Duilio Casula", Azienda Ospedaliero-Universitaria di Cagliari, Cagliari 09100, Italy
| | - Simone Castiglioni
- Department of Medical, Oral and Biotechnological Sciences, University G. D’Annunzio Chieti-Pescara, Pescara 65100, Italy
| | | | - Michele D'Ambra
- Department of Public Health, University of Naples Federico II, Napoli 80131, Italy
| | - Ruggero Lionetti
- Department of Public Health, University of Naples Federico II, Napoli 80131, Italy
| | - Maurizio Sodo
- Department of Public Health, University of Naples Federico II, Napoli 80131, Italy
| | - Gaetano Luglio
- Department of Public Health, University of Naples Federico II, Napoli 80131, Italy
| | - Felice Mucilli
- Department of Medical, Oral and Biotechnological Sciences, University G. D’Annunzio Chieti-Pescara, Pescara 65100, Italy
| | - Salomone Di Saverio
- Department of General Surgery, University of Insubria, ASST Sette Laghi, Varese 21100, Italy
| | - Umberto Bracale
- Department of Public Health, University of Naples Federico II, Napoli 80131, Italy
| | - Francesco Corcione
- Department of Public Health, University of Naples Federico II, Napoli 80131, Italy
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Corcione F, Bracale U. Management of intraoperative and postoperative complications during laparoscopic colorectal procedures. Minerva Surg 2021; 76:291-293. [PMID: 34549915 DOI: 10.23736/s2724-5691.21.08910-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Affiliation(s)
| | - Umberto Bracale
- Department of Public Health, Federico II University, Naples, Italy -
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Nastasia Ş, Simionescu AA, Tuech JJ, Roman H. Recommendations for a Combined Laparoscopic and Transanal Approach in Treating Deep Endometriosis of the Lower Rectum-The Rouen Technique. J Pers Med 2021; 11:jpm11050408. [PMID: 34068385 PMCID: PMC8153645 DOI: 10.3390/jpm11050408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/04/2021] [Accepted: 05/10/2021] [Indexed: 11/16/2022] Open
Abstract
The complete excision of low rectovaginal deep endometriosis is a demanding surgery associated with an increased risk of intra- and postoperative complications, which can impact the quality of life. Given the choices of optimal surgery procedures available, we would like to emphasize that a minimally invasive approach with plasma medicine and a transanal disc excision could significantly improve surgery for deep endometriosis, avoiding the lateral thermal damage of vascular and parasympathetic fibers of roots S2–S5 in the pelvic plexus. The management of low rectal deep endometriosis is distinct from other gastrointestinal-tract endometriosis nodules. Suggestions and explanations are presented for this minimal approach. These contribute to individualized medical care for deep endometriosis. In brief, a laparoscopic transanal disc excision (LTADE; Rouen technique) was performed through a laparoscopic deep rectal dissection, combined with plasma energy shaving, and followed by a transanal disc excision of the low and mid-rectal deep endometriotic nodules, with the use of a semi-circular stapler. LTADE is indicated as the first-line surgical treatment for low and mid-rectal deep endometriotic nodule excisions, because it can preserve rectal length and innervation. This technique requires a multidisciplinary team with surgical colorectal training.
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Affiliation(s)
- Şerban Nastasia
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania;
| | - Anca Angela Simionescu
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, Carol Davila University of Medicine and Pharmacy, 11–13 Ion Mihalache Blv, District 1, 011171 Bucharest, Romania
- Correspondence: or ; Tel.: +40-318-89-30
| | - Jean Jacques Tuech
- Digestive Tract Research Group EA3234/IFRMP23, Department of Digestive Surgery, Rouen University Hospital, 76031 Rouen, France;
| | - Horace Roman
- Centre d’endométriose, Clinique Tivoli-Ducos, 91 rue Rivière, 33000 Bordeaux, France;
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Bracale U, Silvestri V, Pontecorvi E, Russo I, Triassi M, Cassinotti E, Merola G, Montuori P, Boni L, Corcione F. Smoke Evacuation During Laparoscopic Surgery: A Problem Beyond the COVID-19 Period. A Quantitative Analysis of CO 2 Environmental Dispersion Using Different Devices. Surg Innov 2021; 29:154-159. [PMID: 33961529 PMCID: PMC9016373 DOI: 10.1177/15533506211014857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. The COVID-19 pandemic leads to several debates
regarding the possible risk for healthcare professionals during surgery. SAGES
and EAES raised the issue of the transmission of infection through the surgical
smoke during laparoscopy. They recommended the use of smoke evacuation devices
(SEDs) with CO2 filtering systems. The aim of the present study is to
compare the efficacy of different SEDs evaluating the CO2
environmental dispersion in the operating theater. Methods. We
prospectively evaluated the data of 4 group of patients on which we used
different SEDs or standard trocars: AIRSEAL system (S1 group), a homemade device
(S2 group), an AIRSEAL system + homemade device (S3 group), and with standard
trocars and without SED (S4 group). Quantitative analysis of CO2 environmental
dispersion was carried out associated to the following data in order to evaluate
the pneumoperitoneum variations: a preset insufflation pressure, real
intraoperative pneumoperitoneum pressure, operative time, total volume of
insufflated CO2, and flow rate index. Results. 16
patients were prospectively enrolled. The [CO2] mean value was
711 ppm, 641 ppm, 593 ppm, and 761 ppm in S1, S2, S3, and S4 groups,
respectively. The comparison between data of all groups showed statistically
significant differences in the measured ambient CO2 concentration.
Conclusion. All tested SEDs seem to be useful to reduce the
CO2 environmental dispersion respect to the use of standard
trocars. The association of AIRSEAL system and a homemade
device seems to be the best solution combining an adequate smoke evacuation and
a stable pneumoperitoneum during laparoscopic surgery.
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Affiliation(s)
- Umberto Bracale
- Department of General Surgery and Surgical Specialty, General and Mini-Invasive Surgical Unit, University Federico II of Naples, Naples, Italy
| | - Vania Silvestri
- Department of General Surgery and Surgical Specialty, General and Mini-Invasive Surgical Unit, University Federico II of Naples, Naples, Italy
| | - Emanuele Pontecorvi
- Department of General Surgery and Surgical Specialty, General and Mini-Invasive Surgical Unit, University Federico II of Naples, Naples, Italy
| | - Immacolata Russo
- Department of Public Health, 478484University Federico II of Naples, Naples, Italy
| | - Maria Triassi
- Department of Public Health, 478484University Federico II of Naples, Naples, Italy
| | - Elisa Cassinotti
- Department of Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, 9304University of Milan, Milan, Italy
| | - Giovanni Merola
- Department of General Surgery and Surgical Specialty, General and Mini-Invasive Surgical Unit, University Federico II of Naples, Naples, Italy
| | - Paolo Montuori
- Department of Public Health, 478484University Federico II of Naples, Naples, Italy
| | - Luigi Boni
- Department of Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, 9304University of Milan, Milan, Italy
| | - Francesco Corcione
- Department of General Surgery and Surgical Specialty, General and Mini-Invasive Surgical Unit, University Federico II of Naples, Naples, Italy
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Bracale U, Peltrini R, DI Nuzzo MM, Altieri G, Silvestri V, Dolce P, D'Ambra M, Lionetti R, Corcione F. Risk of anastomotic bleeding after left colectomy with preservation of inferior mesenteric artery for diverticular disease: preliminary results. Minerva Surg 2021; 76:310-315. [PMID: 33433072 DOI: 10.23736/s2724-5691.20.08645-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The inferior mesenteric artery (IMA) preservation in elective laparoscopic left colectomy for diverticular disease may reduce the risk of anastomotic leakage. However, an increased risk of bleeding is assumed. The aim of this study was to investigate the risk of colorectal anastomosis bleeding when IMA is resected or preserved during left colectomy. METHODS A retrospective study of a prospectively collected database was performed. All patients who underwent elective left colectomy, from December 2018 to September 2020 were included. Patients' data and clinical information were collected and analyzed. Patients were categorized in two groups: IMA resected (IMA-R) and IMA preserving (IMA-P) left colectomy. Perioperative outcomes between the two groups were compared. RESULTS Sixty-three consecutive patients who underwent left colectomy over a period of three years were enrolled: 42 in IMA-R group and 22 in the IMA-P group. There were no significant differences in demographic and intraoperative characteristics between the two groups, except for patients' age and primary disease. Six patients (9.37%) developed anastomotic bleeding during recovery, more frequently in the IMA-P than IMA-R group, although the difference is not statistically significative (13.6% and 7.3%; P=0.406). All bleedings were self-limited and only one needed red blood cells transfusion. Using the bioabsorbable staple line reinforcement (BSLR) has proved to be advantageous in preventing anastomotic bleeding in the IMA-P group. CONCLUSIONS IMA preserving left colectomy seems to be associated with a higher risk of mostly self-limited anastomotic bleeding during recovery. BSLR seems to be effective in this group of patients.
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Affiliation(s)
- Umberto Bracale
- Department of Public Health, Federico II University, Naples, Italy -
| | - Roberto Peltrini
- Department of Public Health, Federico II University, Naples, Italy
| | - Maria M DI Nuzzo
- Department of Public Health, Federico II University, Naples, Italy
| | - Gaia Altieri
- Department of Medical and Surgical Sciences, Sacred Heart Catholic University, Rome, Italy
| | - Vania Silvestri
- Department of Public Health, Federico II University, Naples, Italy
| | - Pasquale Dolce
- Department of Public Health, Federico II University, Naples, Italy
| | - Michele D'Ambra
- Department of Public Health, Federico II University, Naples, Italy
| | - Ruggero Lionetti
- Department of Public Health, Federico II University, Naples, Italy
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Bracale U, Pontecorvi E, Silvestri V, Cuccurullo D, D'Ambra M, Lionetti R, Coppola A, Carannante F, Pirozzi F, Peltrini R, Sciuto A, Corcione F. Laparoscopic segmental resection for tumours of the Angle of Treitz: a challenging but feasible surgical option. Results from a retrospective case-series analysis. Updates Surg 2020; 73:179-186. [PMID: 33146889 PMCID: PMC7889543 DOI: 10.1007/s13304-020-00910-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 10/24/2020] [Indexed: 12/22/2022]
Abstract
Tumours of the small intestine are rare and account for about 5% of gastrointestinal tract neoplasms. The angle of Treitz (AT) could be defined as the intestinal loop comprised between the third duodenal portion and the first 10 cm of jejunum. A gold standard surgical treatment for AT neoplasm has not yet been well defined. This paper is focused on a very rare disease and at the best of our knowledge this is the largest case series in the literature about the Laparoscopic Segmental Resection (LSR) of AT tumours. Using a prospectively collected database, all data of consecutive patients, from January 2007 to May 2019, who underwent LSR for AT tumours at two different institutions were analysed. Patients’ demographics, intra and post-operative data, 30-day mortality and overall survival were collected. A total of 16 patients were retrieved from our database. The mean operative time was 206,5 ± 79 min. Conversion to open surgery was needed in two cases due to tumor size and, respectively, invasion of the transverse colon which required a multivisceral resection. The mean distal and proximal resection margins were 7.4 ± 2.2 and 3.9 ± 1.2 cm. The median number of harvested nodes was 9 ± 3. Pathological diagnosis was GIST in 11 cases, adenocarcinoma in 4 and sarcoma in 1 case. In conclusion, in experienced hands, LSR appears to be a safe and effective treatment option for tumours of the AT. Prospective studies are needed to confirm these findings.
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Affiliation(s)
- Umberto Bracale
- Department of General and Oncological Minimally Invasive Surgery, University Federico II of Naples, Via Pansini 5 7th Building, Naples, Italy.
| | - Emanuele Pontecorvi
- Department of General and Oncological Minimally Invasive Surgery, University Federico II of Naples, Via Pansini 5 7th Building, Naples, Italy
| | - Vania Silvestri
- Department of General and Oncological Minimally Invasive Surgery, University Federico II of Naples, Via Pansini 5 7th Building, Naples, Italy
| | - Diego Cuccurullo
- Department of General Surgery, Azienda Ospedaliera Dei Colli, Monaldi Hospital, Naples, Italy
| | - Michele D'Ambra
- Department of General and Oncological Minimally Invasive Surgery, University Federico II of Naples, Via Pansini 5 7th Building, Naples, Italy
| | - Ruggero Lionetti
- Department of General and Oncological Minimally Invasive Surgery, University Federico II of Naples, Via Pansini 5 7th Building, Naples, Italy
| | - Andrea Coppola
- Department of General and Oncological Minimally Invasive Surgery, University Federico II of Naples, Via Pansini 5 7th Building, Naples, Italy
| | - Filippo Carannante
- Department of Geriatric Surgery, Università Campus Bio-Medico, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - Felice Pirozzi
- Department of General Surgery, Santa Maria delle Grazie Hospital, Pozzuoli, Italy
| | - Roberto Peltrini
- Department of General and Oncological Minimally Invasive Surgery, University Federico II of Naples, Via Pansini 5 7th Building, Naples, Italy
| | - Antonio Sciuto
- Department of General Surgery, Santa Maria delle Grazie Hospital, Pozzuoli, Italy
| | - Francesco Corcione
- Department of General and Oncological Minimally Invasive Surgery, University Federico II of Naples, Via Pansini 5 7th Building, Naples, Italy
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Corcione F, Silvestri V, Merola G, Dambra M, Lionetti R, Pirozzi N, Peltrini R, Pontecorvi E, Bracale U. Use of the ORBEYE TM Exoscope in General Surgery: The Advent of Video-Assisted Open Surgery. Surg Innov 2020; 28:79-84. [PMID: 33054634 DOI: 10.1177/1553350620965344] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background. Microsurgery has quickly become the "gold standard" approach for vascular surgical steps during neurosurgery. However, despite its advantages, the microscope has not been widely adopted in general surgery. A new 3D-surgical exoscope, the ORBEYETM, has been developed and introduced to some surgical specialties. Herein, we present our preliminary experience with the ORBEYETM exoscope as applied to a number of general surgical procedures. Method. Throughout February 2020, 7 patients had undergone varying surgical procedures at our institute utilizing the ORBEYETM in some of specific procedural steps where the surgeons felt that the surgery would benefit from more enhanced magnification. Upon completion, all the surgeons who had taken part in the procedure were asked if they had experienced any nausea, dizziness, or eyestrain during its use. Results. The ORBEYETM was employed in a number of surgical steps for the following procedures: throughout an inguinal hernia repair, during a duodeno-cephalo-pancreatectomy, for a subtotal gastrectomy, during para-aortic mass dissection, and during Ivor Lewis procedure. None of the surgeons involved in the procedures reported experiencing any nausea, dizziness nor eyestrain, nor any other physical discomforts. Conclusion. To the best of our knowledge, ours is the very first report on the employment of the ORBEYE exoscope during general surgery. Our experience assures us that this highly ergonomic technology with its high-resolution 4K 3D optical system allows the surgeon to perform safe and precise surgery in several dedicated steps in which adequate magnification is required with no adverse effects to the surgeon or the surgical procedure itself.
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Affiliation(s)
- Francesco Corcione
- Department of General Surgery and Surgical Specialties, General and Mininvasive Oncological Surgical Unit, School of Medicine, 9307University Federico II of Naples, Italy
| | - Vania Silvestri
- Department of General Surgery and Surgical Specialties, General and Mininvasive Oncological Surgical Unit, School of Medicine, 9307University Federico II of Naples, Italy
| | - Giovanni Merola
- Department of General Surgery and Surgical Specialties, General and Mininvasive Oncological Surgical Unit, School of Medicine, 9307University Federico II of Naples, Italy
| | - Michele Dambra
- Department of General Surgery and Surgical Specialties, General and Mininvasive Oncological Surgical Unit, School of Medicine, 9307University Federico II of Naples, Italy
| | - Ruggero Lionetti
- Department of General Surgery and Surgical Specialties, General and Mininvasive Oncological Surgical Unit, School of Medicine, 9307University Federico II of Naples, Italy
| | - Nello Pirozzi
- Department of General Surgery and Surgical Specialties, General and Mininvasive Oncological Surgical Unit, School of Medicine, 9307University Federico II of Naples, Italy
| | - Roberto Peltrini
- Department of General Surgery and Surgical Specialties, General and Mininvasive Oncological Surgical Unit, School of Medicine, 9307University Federico II of Naples, Italy
| | - Emanuele Pontecorvi
- Department of General Surgery and Surgical Specialties, General and Mininvasive Oncological Surgical Unit, School of Medicine, 9307University Federico II of Naples, Italy
| | - Umberto Bracale
- Department of General Surgery and Surgical Specialties, General and Mininvasive Oncological Surgical Unit, School of Medicine, 9307University Federico II of Naples, Italy
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Selvaggio M, Fontanelli GA, Marrazzo VR, Bracale U, Irace A, Breglio G, Villani L, Siciliano B, Ficuciello F. The MUSHA underactuated hand for robot-aided minimally invasive surgery. Int J Med Robot 2018; 15:e1981. [PMID: 30588772 DOI: 10.1002/rcs.1981] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 12/13/2018] [Accepted: 12/13/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Keyhole surgery is characterized by loss of dexterity of surgeon's movements because of the limited workspace, nonintuitive motor skills of the surgical systems, and loss of tactile sensation that may lead to tissue damage and bad execution of the tasks. METHODS In this paper, a three-fingered underactuated miniature tool for robot-aided laparoscopic surgery is presented. The design is conceived to realize a closed-hand configuration allowing the insertion of the tool into the abdominal cavity through the trocar in one step and to reach different grasping as well as pushing/holding configurations once in the cavity. RESULTS Aiming to replicate human hand dexterity and versatility, different solutions for the kinematic structure of the hand are analyzed using quality indices to evaluate the manipulability and stability of the grasp. Furthermore, a first prototype of fingertip force sensor based on fiber Bragg grating (FBG) technology has been realized and tested. The design choices of the prototype are described and discussed with the aid of experiments. CONCLUSIONS The whole concept and the need for such anthropomorphic tool are discussed with surgeons to highlight constraints and potentials in surgical tasks. The feedback by expert surgeons is used to provide specifications and improvements to the kinematics and mechanical design. The investigations of different designs allow identifying the optimal solution to improve grasping and manipulation capabilities. The tests on FBG sensors led to the conclusion that this technology guarantees good performance and can be a good solution for applications in surgical robotics.
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Affiliation(s)
- Mario Selvaggio
- Department of Information Technology and Electrical Engineering, University of Naples Federico II, Naples, Italy
| | - Giuseppe Andrea Fontanelli
- Department of Information Technology and Electrical Engineering, University of Naples Federico II, Naples, Italy
| | - Vincenzo Romano Marrazzo
- Department of Information Technology and Electrical Engineering, University of Naples Federico II, Naples, Italy
| | - Umberto Bracale
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Andrea Irace
- Department of Information Technology and Electrical Engineering, University of Naples Federico II, Naples, Italy
| | - Giovanni Breglio
- Department of Information Technology and Electrical Engineering, University of Naples Federico II, Naples, Italy
| | - Luigi Villani
- Department of Information Technology and Electrical Engineering, University of Naples Federico II, Naples, Italy
| | - Bruno Siciliano
- Department of Information Technology and Electrical Engineering, University of Naples Federico II, Naples, Italy
| | - Fanny Ficuciello
- Department of Information Technology and Electrical Engineering, University of Naples Federico II, Naples, Italy
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10
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Bracale U, Andreuccetti J, Sodo M, Merola G, Pignata G. Lack of advantages of slit mesh placement during laparoscopic transabdominal preperitoneal inguinal hernia repair (TAPP): a single centre, case matched study. BMC Surg 2018; 18:75. [PMID: 30236096 PMCID: PMC6148989 DOI: 10.1186/s12893-018-0409-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 09/12/2018] [Indexed: 11/25/2022] Open
Abstract
Background During laparoscopic trans-abdominal pre-peritoneal hernia repair (TAPP) the positioning of the mesh around the spermatic cord could provide an additional anchoring point and ensure better defect closure, thereby preventing mesh movement and recurrence. The primary aim of our retrospective study was to determine if, during a TAPP procedure, an advantageous difference for mesh placement exists between the slit and the non-slit techniques in terms of recurrence rate. Secondary aims were intra and post-operative complications and the time required to return to normal activity. Methods From January 2010 to December 2015, data from patients who had undergone TAPPs at our Institution were prospectively collected. We performed a retrospective case control matched study of two homogenous (BMI, Age, type of hernia) groups of 100 patients who underwent respectively TAPP with no slit mesh placement (Group NS) and slit mesh placement (Group S). Statistical analysis was carried out using a SPSS 20. To compare continuous variables, an independent sample T-test was performed. A Chi-square test was employed for categorical data. Results No differences were found between the slit and non-slit groups in terms of biometric features and intra and post-operative outcomes were found to be similar in both groups as well. In particular, at mean follow-up of 57.34 ± 10.56 months for Group NS and 55.66 ± 8.61 months for Group S months only one recurrence per group was found. Conclusion Our study failed to prove a superiority of the slit mesh technique over the no-slit mesh technique during TAPP. However, in light of its not being a randomized study, a subsequent, well-designed RCT would be desirable in order to better determine if the Slit mesh technique could prove to be advantageous enough to justify its routine use during the TAPP procedure.
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Affiliation(s)
- Umberto Bracale
- Department of Surgical Specialities and nephrology, University Federico II Naples, Via Pansini 5, 80131, Naples, Italy.
| | - Jacopo Andreuccetti
- Department of General and Mini-invasive Surgery, San Camillo Hospital of Trento, Via Giovanelli 19, 38121, Trento, Italy
| | - Maurizio Sodo
- Department of General and Mini-invasive Surgery, San Camillo Hospital of Trento, Via Giovanelli 19, 38121, Trento, Italy
| | - Giovanni Merola
- Department of General and Mini-invasive Surgery, San Camillo Hospital of Trento, Via Giovanelli 19, 38121, Trento, Italy.,Department of Surgical Specialities and nephrology, University Federico II Naples, Via Pansini 5, 80131, Naples, Italy
| | - Giusto Pignata
- Department of General and Mini-invasive Surgery, San Camillo Hospital of Trento, Via Giovanelli 19, 38121, Trento, Italy
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Balla A, Quaresima S, Subiela JD, Shalaby M, Petrella G, Sileri P. Outcomes after rectosigmoid resection for endometriosis: a systematic literature review. Int J Colorectal Dis 2018; 33:835-847. [PMID: 29744578 DOI: 10.1007/s00384-018-3082-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE "Endometriosis" is defined such as the presence of endometrial glands and stroma outside the uterine cavity. This ectopic condition may develop as deeply infiltrating endometriosis (DIE) when a solid mass is located deeper than 5 mm underneath the peritoneum including the intestinal wall. The ideal surgical treatment is still under search, and treatment may range from simple shaving to rectal resection. The aim of the present systematic review is to report and analyze the postoperative outcomes after rectosigmoid resection for endometriosis. METHODS We performed a systematic review according to Meta-analysis of Observational Studies in Epidemiology guidelines. The search was carried out in the PubMed database, using the keywords: "rectal resection" AND "endometriosis" and "rectosigmoid resection" AND "endometriosis." The search revealed 380 papers of which 78 were fully analyzed. RESULTS Thirty-eight articles published between 1998 and 2017 were included. Three thousand seventy-nine patients (mean age 34.28 ± 2.46) were included. Laparoscopic approach was the most employed (90.3%) followed by the open one (7.9%) and the robotic one (1.7%). Overall operative time was 238.47 ± 66.82. Conversion rate was 2.7%. In more than 80% of cases, associated procedures were performed. Intraoperative complications were observed in 1% of cases. The overall postoperative complications rate was 18.5% (571 patients), and the most frequent complication was recto-vaginal fistula (74 patients, 2.4%). Postoperative mortality rate was 0.03% and mean hospital stay was 8.88 ± 3.71 days. CONCLUSIONS Despite the large and extremely various number of associated procedures, rectosigmoid resection is a feasible and safe technique to treat endometriosis.
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Affiliation(s)
- Andrea Balla
- Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza, University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
| | - Silvia Quaresima
- Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza, University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - José D Subiela
- Department of Urology, Fundació Puigvert, Carrer de Cartegena 340, Universidad Autónoma de Barcelona, 08025, Barcelona, Spain
| | - Mostafa Shalaby
- Department of General Surgery, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Giuseppe Petrella
- Department of General Surgery, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Pierpaolo Sileri
- Department of General Surgery, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
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Bracale U, Merola G, Sciuto A, Cavallaro G, Andreuccetti J, Pignata G. Achieving the Learning Curve in Laparoscopic Inguinal Hernia Repair by Tapp: A Quality Improvement Study. J INVEST SURG 2018; 32:738-745. [DOI: 10.1080/08941939.2018.1468944] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Umberto Bracale
- Department of Surgical Specialities and Nephrology, University Federico II Naples Italy
| | - Giovanni Merola
- Department of Surgical Specialities and Nephrology, University Federico II Naples Italy
- Department of General and Mininvasive Surgery, San Camillo Hospital, Trento Italy
| | - Antonio Sciuto
- Department of Abdominal Surgery, Casa Sollievo della Sofferenza Research Hospital, San Giovanni Rotondo, Italy
| | | | - Jacopo Andreuccetti
- Department of General and Mininvasive Surgery, San Camillo Hospital, Trento Italy
| | - Giusto Pignata
- Department of General and Mininvasive Surgery, San Camillo Hospital, Trento Italy
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13
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Bracale U, Merola G, Cabras F, Andreuccetti J, Corcione F, Pignata G. The Use of Barbed Suture for Intracorporeal Mechanical Anastomosis During a Totally Laparoscopic Right Colectomy: Is It Safe? A Retrospective Nonrandomized Comparative Multicenter Study. Surg Innov 2018; 25:267-273. [DOI: 10.1177/1553350618765871] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background. A totally laparoscopic right colectomy could be perceived as a more challenging procedure over a laparoscopic-assisted right colectomy owing to the difficulty of intracorporeal anastomosis and the closure of the enterotomy. The aim of this study is to evaluate the safety and efficacy of the barbed auto-locking absorbable suture for the closure of an anastomotic stapler-access enterotomy during a totally laparoscopic right colectomy. Methods. From January 2010 to April 2016, data from patients who had undergone a laparoscopic right colectomy in 2 different departments of 2 institutions (the Department of General and Minimally Invasive Surgery, San Camillo Hospital in Trento and the Department of Surgical Specialties and Nephrology, University Federico II in Naples) were retrospectively analyzed. We compared the data of patients in whom the stapler-access enterotomy was closed through a conventional absorbable suture (Group A), with the data of patients in whom a stapler-access enterotomy was closed through a V-Loc 180 suture (Group B). Biometric features and intraoperative and postoperative data were collected and analyzed. Results. The 2 groups (Group A: 40 patients; Group B: 40 patients) were comparable for biometric features and postoperative outcomes. The anastomosing time was lower in Group B. A statistically significant difference was noted in the mean operative time between Groups A and B (Group A = 134.92 ± 34.17; Group B = 120.92 ± 23.27, P = .035). Only one anastomotic leakage per group was recorded, each treated with an anastomosis redo. During the reoperations, we find in both groups an intact stapler-access enterotomy. Conclusion. On retrospective analysis, barbed suture appears to be safe and efficient for closure of the stapler-access enterotomy during totally laparoscopic right colectomy.
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Affiliation(s)
| | - Giovanni Merola
- University Federico II of Naples, Naples, Italy
- San Camillo Hospital, Trento, Italy
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Millochau JC, Stochino-Loi E, Darwish B, Abo C, Coget J, Chati R, Tuech JJ, Roman H. Multiple Nodule Removal by Disc Excision and Segmental Resection in Multifocal Colorectal Endometriosis. J Minim Invasive Gynecol 2018; 25:139-146. [DOI: 10.1016/j.jmig.2017.09.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 08/18/2017] [Accepted: 09/04/2017] [Indexed: 12/31/2022]
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Roman H, Darwish B, Bridoux V, Chati R, Kermiche S, Coget J, Huet E, Tuech JJ. Functional outcomes after disc excision in deep endometriosis of the rectum using transanal staplers: a series of 111 consecutive patients. Fertil Steril 2017; 107:977-986.e2. [DOI: 10.1016/j.fertnstert.2016.12.030] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 12/01/2016] [Accepted: 12/25/2016] [Indexed: 01/28/2023]
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Roman H, Moatassim-Drissa S, Marty N, Milles M, Vallée A, Desnyder E, Stochino Loi E, Abo C. Rectal shaving for deep endometriosis infiltrating the rectum: a 5-year continuous retrospective series. Fertil Steril 2016; 106:1438-1445.e2. [DOI: 10.1016/j.fertnstert.2016.07.1097] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 07/13/2016] [Accepted: 07/18/2016] [Indexed: 10/21/2022]
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17
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Bracale U, Melillo P, Lazzara F, Andreuccetti J, Stabilini C, Corcione F, Pignata G. Single-Access Laparoscopic Rectal Resection Versus the Multiport Technique. Surg Innov 2015; 22:46-53. [DOI: 10.1177/1553350614529668] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Background. Single-access laparoscopic surgery is not used routinely for the treatment of colorectal disease. The aim of this retrospective cohort study is to compare the results of single-access laparoscopic rectal resection (SALR) versus multiaccess laparoscopic rectal resection with a mean follow-up of 24 months. Methods. This retrospective cohort study enrolled 42 patients. Between January 2010 and June 2012, 21 SALRs were performed. These patients were compared with a group of 21 other patients who had undergone multiport laparoscopic rectal resection. This control group had the same exclusion criteria and patient demographics. Short-term outcomes were reassessed with a mean follow-up of 2 years. Statistical analysis included the Student t test and Fisher’s exact test. Finally, we performed a differential cost analysis between the 2 procedures. Results. Exclusion criteria, patient demographics, and indication for surgery were similar in both groups. The conversion rate was 0% in both groups. There were no intraoperative complications or deaths. Bowel recovery was similar in both groups. No interventions, readmissions, or deaths were recorded at 30 days’ follow-up. At a mean follow-up of 24 months, all the patients with a preoperative diagnosis of cancer are still alive and disease free. Considering the selected 3 items, the mean cost per patient for single-access laparoscopic surgery and multiple-access laparoscopic surgery were estimated as 7213 and 7495 Euros, respectively. Conclusion. We think that SALR could be performed in selected patients by surgeons with high multiport laparoscopic skills. It is compulsory by law to evaluate outcomes and cost-effectiveness by using randomized controlled trials.
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Affiliation(s)
- Umberto Bracale
- General and Mininvasive Surgical Unit, San Camillo Hospital, Trento, Italy
- Department of Surgical Specialities and Nephrology, University of Naples Federico II, Naples, Italy
| | - Paolo Melillo
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, Second University of Naples, Naples, Italy
| | - Fabrizio Lazzara
- General and Mininvasive Surgical Unit, San Camillo Hospital, Trento, Italy
| | | | - Cesare Stabilini
- General and Mininvasive Surgical Unit, San Camillo Hospital, Trento, Italy
| | - Francesco Corcione
- General, Laparoscopic and Robotic Surgical Unit, Monaldi Hospital, Naples, Italy
| | - Giusto Pignata
- General and Mininvasive Surgical Unit, San Camillo Hospital, Trento, Italy
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Akladios C, Messori P, Faller E, Puga M, Afors K, Leroy J, Wattiez A. Is ileostomy always necessary following rectal resection for deep infiltrating endometriosis? J Minim Invasive Gynecol 2014; 22:103-9. [PMID: 25109779 DOI: 10.1016/j.jmig.2014.08.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 07/31/2014] [Accepted: 08/01/2014] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To verify the hypothesis that in most patients bowel segmental resection to treat endometriosis can be safely performed without creation of a stoma and to discuss the limitations of this statement. DESIGN Retrospective study (Canadian Task Force classification III). SETTING Tertiary referral center. PATIENTS Forty-one women with sigmoid and rectal endometriotic lesions who underwent segmental resection. INTERVENTION Segmental resection procedures performed between 2004 and 2011. Patient demographic, operative, and postoperative data were compared. MEASUREMENTS AND MAIN RESULTS Sigmoid resection was performed in 6 patients (15%), and rectal anterior resection in 35 patients (high in 21 patients [51%], and low, i.e., <10 cm from the anal verge, in 14 [34%]). In 4 patients a temporary ileostomy was created. There was 1 anastomotic leak (2.4%), in a patient with an unprotected anastomosis, which was treated via laparoscopic surgery and creation of a temporary ileostomy. Other postoperative complications included hemoperitoneum, pelvic abscess, pelvic collection, and a ureteral vaginal fistula, in 1 patient each (all 2.4%). CONCLUSION A protective stoma may be averted in low anastomosis if it is >5 cm from the anal verge and there are no adverse intraoperative events.
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Affiliation(s)
- Cherif Akladios
- Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France; IRCAD, Strasbourg, France.
| | - Pietro Messori
- Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France; IRCAD, Strasbourg, France
| | - Emilie Faller
- Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France; IRCAD, Strasbourg, France
| | - Marco Puga
- Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France; IRCAD, Strasbourg, France
| | - Karolina Afors
- Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France; IRCAD, Strasbourg, France
| | - Joel Leroy
- Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France; IRCAD, Strasbourg, France
| | - Arnaud Wattiez
- Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France; IRCAD, Strasbourg, France
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Multidisciplinary laparoscopic treatment for bowel endometriosis. Best Pract Res Clin Gastroenterol 2014; 28:53-67. [PMID: 24485255 DOI: 10.1016/j.bpg.2013.11.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 10/02/2013] [Accepted: 11/23/2013] [Indexed: 01/31/2023]
Abstract
Endometriosis is a handicapping disease affecting young females in the reproductive period. It mainly occurs in the pelvis and affects the bowel in 3-37%. Endometriosis can cause menstrual and non-menstrual pelvic pain and infertility. Colorectal involvement results in alterations of bowel habit such as constipation, diarrhoea, tenesmus, and rarely rectal bleeding. A precise diagnosis about the presence, location and extent is necessary. Based on clinical examination, the diagnosis of bowel endometriosis can be made by transvaginal ultrasound, barium enema examination and magnetic resonance imaging. Multidisciplinary laparoscopic treatment has become the standard of care and depending on size of the lesion and site of involvement full-thickness disc excision or bowel resection is performed by an experienced colorectal surgeon. Anastomotic complications occur around 1%. Long-term outcome after bowel resection for severe endometriosis is good with a pregnancy rate of 50%.
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Meuleman C, Tomassetti C, D'Hoore A, Buyens A, Van Cleynenbreugel B, Fieuws S, Penninckx F, Vergote I, D'Hooghe T. Clinical outcome after CO₂ laser laparoscopic radical excision of endometriosis with colorectal wall invasion combined with laparoscopic segmental bowel resection and reanastomosis. Hum Reprod 2011; 26:2336-43. [PMID: 21771772 DOI: 10.1093/humrep/der231] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Laparoscopic segmental bowel resection and reanastomosis for endometriosis with colorectal wall invasion can be associated with high complication rates. This study was performed to test the hypothesis that this high complication rate can be prevented and combined with a good clinical outcome, following a multidisciplinary surgical approach. METHODS A retrospective cohort study of all patients with deep endometriosis and colorectal invasion treated by CO₂ laser laparoscopic radical excision between September 2004 and September 2006 (n = 45) to document the clinical outcome: complications, recurrence and fertility (life table analysis), pain, quality of life (QOL) and sexual function. RESULTS No immediate major post-operative complications requiring surgical reintervention were recorded. Gynaecological pain (P < 0.0001), sexual function (P < 0.03) and QOL (P< 0.0001), improved significantly after a median follow-up period of 27 (range: 16-40) months. Although five patients (11%) had a surgical reintervention, histologically proven recurrent endometriosis was observed in only two (4%), with a cumulative endometriosis recurrence rate of 2.2 and 4.4% after 1 and 3 years, respectively. Thirteen of 28 patients who wanted to become pregnant conceived after surgery. One patient delivered twice. These 14 pregnancies were achieved spontaneously (n = 9) or after IVF (n = 5). The cumulative pregnancy rate was 47% after 3 years. CONCLUSION Pain, sexual function and QOL improved significantly and were associated with a good fertility rate and a low complication and recurrence rate after a CO₂ laser laparoscopic radical excision of endometriosis with colorectal wall invasion combined with laparoscopic segmental bowel resection and reanastomosis.
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Affiliation(s)
- C Meuleman
- Department of Obstetrics and Gynaecology, Leuven University Fertility Centre, University Hospital Leuven, Leuven, Belgium
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Namkung J, Kim SJ, Kim JH, Kim J, Hur SY. Rectal endometriosis with invasion into lymph nodes. J Obstet Gynaecol Res 2011; 37:1117-21. [DOI: 10.1111/j.1447-0756.2010.01467.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wolthuis AM, Meuleman C, Tomassetti C, D'Hooghe T, Fieuws S, Penninckx F, D'Hoore A. Laparoscopic sigmoid resection with transrectal specimen extraction: a novel technique for the treatment of bowel endometriosis. Hum Reprod 2011; 26:1348-55. [PMID: 21427115 DOI: 10.1093/humrep/der072] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Multidisciplinary laparoscopic treatment is the standard of care for radical treatment of deep infiltrating pelvic endometriosis. If bowel resection is necessary, a muscle-split or Pfannenstiel incision is also required. The avoidance of any laparotomy could decrease surgical stress response, give a faster return to normal bowel function, decrease post-operative pain and reduce wound complications and incisional hernias. We assessed post-operative outcome after a full laparoscopic sigmoid resection for bowel endometriosis. PATIENTS AND METHODS Twenty-one patients who underwent elective full laparoscopic sigmoid resection for bowel endometriosis from September 2009 to September 2010 were matched for age, American Society of Anesthesiologists class and BMI to 21 patients who underwent a conventional laparoscopic sigmoid resection. Groups were compared for peri-operative factors, complications, length of hospital stay, post-operative pain (Visual Analog Scale: VAS), analgesics consumption and inflammatory response (plasma C-reactive protein: CRP). RESULTS Median operating time was 15 min shorter with transrectal specimen extraction (P = 0.003). VAS-scores and use of analgesics were higher in the conventional laparoscopic group (P = 0.0005). Mean CRP-level tended to be higher in the transrectal specimen extraction group (38%, P = 0.054) but there was no difference in increase in CRP level between groups (P = 0.15). There were no anastomotic leaks or reinterventions in either group, and the median hospital stay was similar. At follow-up, no wound infections or incisional hernias were observed and no patients reported anal dysfunction. CONCLUSION Full laparoscopic sigmoid resection reduced operating times and decreased post-operative VAS-scores and analgesic requirements compared with the conventional laparoscopic sigmoid resection for bowel endometriosis.
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Affiliation(s)
- A M Wolthuis
- Department of Abdominal Surgery, University Hospital Leuven, Herestraat 49, 3000 Leuven, Belgium.
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Meuleman C, Tomassetti C, D'Hoore A, Van Cleynenbreugel B, Penninckx F, Vergote I, D'Hooghe T. Surgical treatment of deeply infiltrating endometriosis with colorectal involvement. Hum Reprod Update 2011; 17:311-26. [DOI: 10.1093/humupd/dmq057] [Citation(s) in RCA: 248] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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