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Cirocchi R, Matteucci M, Randolph J, Duro F, Properzi L, Avenia S, Amato B, Iandoli R, Tebala G, Boselli C, Covarelli P, Sapienza P. Anatomical variants of the intercostobrachial nerve and its preservation during surgery, a systematic review and meta-analysis. World J Surg Oncol 2024; 22:92. [PMID: 38605346 PMCID: PMC11007944 DOI: 10.1186/s12957-024-03374-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/28/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND The anatomic variants of the intercostobrachial nerve (ICBN) represent a potential risk of injuries during surgical procedure such as axillary lymph node dissection and sentinel lymph node biopsy in breast cancer and melanoma patients. The aim of this systematic review and meta-analysis was to investigate the different origins and branching patterns of the intercostobrachial nerve also providing an analysis of the prevalence, through the analysis of the literature available up to September 2023. MATERIALS AND METHODS The protocol for this study was registered on PROSPERO (ID: CRD42023447932), an international prospective database for reviews. The PRISMA guideline was respected throughout the meta-analysis. A systematic literature search was performed using PubMed, Scopus and Web of Science. A search was performed in grey literature through google. RESULTS We included a total of 23 articles (1,883 patients). The prevalence of the ICBN in the axillae was 98.94%. No significant differences in prevalence were observed during the analysis of geographic subgroups or by study type (cadaveric dissections and in intraoperative dissections). Only five studies of the 23 studies reported prevalence of less than 100%. Overall, the PPE was 99.2% with 95% Cis of 98.5% and 99.7%. As expected from the near constant variance estimates, the heterogeneity was low, I2 = 44.3% (95% CI 8.9%-65.9%), Q = 39.48, p = .012. When disaggregated by evaluation type, the difference in PPEs between evaluation types was negligible. For cadaveric dissection, the PPE was 99.7% (95% CI 99.1%-100.0%) compared to 99.0% (95% CI 98.1%-99.7%). CONCLUSIONS The prevalence of ICBN variants was very high. The dissection of the ICBN during axillary lymph-node harvesting, increases the risk of sensory disturbance. The preservation of the ICBN does not modify the oncological radicality in axillary dissection for patients with cutaneous metastatic melanoma or breast cancer. Therefore, we recommend to operate on these patients in high volume center to reduce post-procedural pain and paresthesia associated with a lack of ICBN variants recognition.
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Affiliation(s)
- Roberto Cirocchi
- Department of Medicine and Surgery, University of Perugia, Perugia, 06132, Italy.
| | - Matteo Matteucci
- Department of Medicine and Surgery, University of Milan, Milan, 20122, Italy
| | - Justus Randolph
- Georgia Baptist College of Nursing, Mercer University, Atlanta, GA, 30341, USA
| | - Francesca Duro
- Department of Medicine and Surgery, University of Perugia, Perugia, 06132, Italy
| | - Luca Properzi
- Department of Medicine and Surgery, University of Perugia, Perugia, 06132, Italy
| | - Stefano Avenia
- Department of Medicine and Surgery, University of Perugia, Perugia, 06132, Italy
| | - Bruno Amato
- Department of Public Health, University of Naples "Federico II", Naples, 80131, Italy
| | - Ruggiero Iandoli
- Department of General Surgery, P.O Frangipane Ariano Irpino, Avellino, 83031, Italy
| | - Giovanni Tebala
- Department of Digestive and Emergency Surgery, AOSP of Terni, Terni, 05100, Italy
| | - Carlo Boselli
- Department of Medicine and Surgery, University of Perugia, Perugia, 06132, Italy
| | - Piero Covarelli
- Department of Medicine and Surgery, University of Perugia, Perugia, 06132, Italy
| | - Paolo Sapienza
- Department of Surgery, "Sapienza" University of Rome, Roma, 00161, Italy
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Cirocchi R, Cianci MC, Amato L, Properzi L, Buononato M, Di Rienzo VM, Tebala GD, Avenia S, Iandoli R, Santoro A, Vettoretto N, Coletta R, Morabito A. Correction: Laparoscopic appendectomy with single port vs conventional access: systematic review and meta-analysis of randomized clinical trials. Surg Endosc 2024; 38:2305. [PMID: 38379007 PMCID: PMC10978648 DOI: 10.1007/s00464-024-10750-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Affiliation(s)
- Roberto Cirocchi
- Department of Medicine and Surgery, S. Maria Hospital, University of Perugia, Terni, Italy.
| | - Maria Chiara Cianci
- Department of Neonatal and Paediatric Surgery, Meyer Children's Hospital, IRCCS, University of Florence, Florence, Italy
| | - Lavinia Amato
- General and Emergency Surgery, S. Maria della Stella Hospital, Orvieto, Italy
| | - Luca Properzi
- Department of Medicine and Surgery, S. Maria Hospital, Perugia, Italy
| | - Massimo Buononato
- General and Emergency Surgery, S. Maria della Stella Hospital, Orvieto, Italy
| | | | | | - Stefano Avenia
- Department of Medicine and Surgery, S. Maria Hospital, University of Perugia, Terni, Italy
| | - Ruggero Iandoli
- General Surgery P.O. Frangipane Ariano Irpino Asl AV, Ariano Irpino, Italy
| | | | | | - Riccardo Coletta
- Department of Neonatal and Paediatric Surgery, Meyer Children's Hospital, IRCCS, University of Florence, Florence, Italy
| | - Antonino Morabito
- Department of Neonatal and Paediatric Surgery, Meyer Children's Hospital, IRCCS, University of Florence, Florence, Italy
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Cirocchi R, Cianci MC, Amato L, Properzi L, Buononato M, Di Rienzo VM, Tebala GD, Avenia S, Iandoli R, Santoro A, Vettoretto N, Coletta R, Morabito A. Laparoscopic appendectomy with single port vs conventional access: systematic review and meta-analysis of randomized clinical trials. Surg Endosc 2024; 38:1667-1684. [PMID: 38332174 PMCID: PMC10978699 DOI: 10.1007/s00464-023-10659-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 12/22/2023] [Indexed: 02/10/2024]
Abstract
BACKGROUND Conventional three-access laparoscopic appendectomy (CLA) is currently the gold standard treatment, however, Single-Port Laparoscopic Appendectomy (SILA) has been proposed as an alternative. The aim of this systematic review/meta-analysis was to evaluate safety and efficacy of SILA compared with conventional approach. METHODS Per PRISMA guidelines, we systematically reviewed randomised controlled trials (RCTs) comparing CLA vs SILA for acute appendicitis. The randomised Mantel-Haenszel method was used for the meta-analysis. Statistical data analysis was performed with the Review Manager software and the risk of bias was assessed with the Cochrane "Risk of Bias" assessment tool. RESULTS Twenty-one studies (RCTs) were selected (2646 patients). The operative time was significantly longer in the SILA group (MD = 7,32), confirmed in both paediatric (MD = 9,80), (Q = 1,47) and adult subgroups (MD = 5,92), (Q = 55,85). Overall postoperative morbidity was higher in patients who underwent SILA, but the result was not statistically significant. In SILA group were assessed shorter hospital stays, fewer wound infections and higher conversion rate, but the results were not statistically significant. Meta-analysis was not performed about cosmetics of skin scars and postoperative pain because different scales were used in each study. CONCLUSIONS This analysis show that SILA, although associated with fewer postoperative wound infection, has a significantly longer operative time. Furthermore, the risk of postoperative general complications is still present. Further studies will be required to analyse outcomes related to postoperative pain and the cosmetics of the surgical scar.
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Affiliation(s)
- Roberto Cirocchi
- Department of Medicine and Surgery, S. Maria Hospital, University of Perugia, Terni, Italy.
| | - Maria Chiara Cianci
- Department of Neonatal and Paediatric Surgery, Meyer Children's Hospital, IRCCS, University of Florence, Florence, Italy
| | - Lavinia Amato
- General and Emergency Surgery, S. Maria della Stella Hospital, Orvieto, Italy
| | - Luca Properzi
- Department of Medicine and Surgery, S. Maria Hospital, Perugia, Italy
| | - Massimo Buononato
- General and Emergency Surgery, S. Maria della Stella Hospital, Orvieto, Italy
| | | | | | - Stefano Avenia
- Department of Medicine and Surgery, S. Maria Hospital, University of Perugia, Terni, Italy
| | - Ruggero Iandoli
- General Surgery P.O. Frangipane Ariano Irpino Asl AV, Ariano Irpino, Italy
| | | | | | - Riccardo Coletta
- Department of Neonatal and Paediatric Surgery, Meyer Children's Hospital, IRCCS, University of Florence, Florence, Italy
| | - Antonino Morabito
- Department of Neonatal and Paediatric Surgery, Meyer Children's Hospital, IRCCS, University of Florence, Florence, Italy
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Bencivenga F, Principi E, Giangrisostomi E, Cucini R, Battistoni A, D'Amico F, Di Cicco A, Di Fonzo S, Filipponi A, Gessini A, Gunnella R, Marsi M, Properzi L, Saito M, Masciovecchio C. Reflectivity enhancement in titanium by ultrafast XUV irradiation. Sci Rep 2014; 4:4952. [PMID: 24824987 PMCID: PMC4019955 DOI: 10.1038/srep04952] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 04/16/2014] [Indexed: 11/25/2022] Open
Abstract
The study of highly photo-excited matter at solid state density is an emerging field of research, which is benefitting the development of free-electron-laser (FEL) technology. We report an extreme ultraviolet (XUV) reflectivity experiment from a titanium (Ti) sample irradiated with ultrafast seeded FEL pulses at variable incident photon fluence and frequency. Using a Drude formalism we relate the observed increase in reflectivity as a function of the excitation fluence to an increase in the plasma frequency, which allows us to estimate the free electron density in the excited sample. The extreme simplicity of the experimental setup makes the present approach potentially a valuable complementary tool to determine the average ionization state of the excited sample, information of primary relevance for understanding the physics of matter under extreme conditions.
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Affiliation(s)
- F Bencivenga
- Elettra-Sincrotrone Trieste S.C.p.A., S.S. 14 km 163, 5 in AREA Science Park, I-34149 Basovizza, Italy
| | - E Principi
- Elettra-Sincrotrone Trieste S.C.p.A., S.S. 14 km 163, 5 in AREA Science Park, I-34149 Basovizza, Italy
| | - E Giangrisostomi
- 1] Elettra-Sincrotrone Trieste S.C.p.A., S.S. 14 km 163, 5 in AREA Science Park, I-34149 Basovizza, Italy [2] Dipartimento di Fisica, Università degli Studi di Trieste, 34127 Trieste, Italy
| | - R Cucini
- Elettra-Sincrotrone Trieste S.C.p.A., S.S. 14 km 163, 5 in AREA Science Park, I-34149 Basovizza, Italy
| | - A Battistoni
- 1] Elettra-Sincrotrone Trieste S.C.p.A., S.S. 14 km 163, 5 in AREA Science Park, I-34149 Basovizza, Italy [2] Dipartimento di Fisica, Università degli Studi di Trieste, 34127 Trieste, Italy
| | - F D'Amico
- Elettra-Sincrotrone Trieste S.C.p.A., S.S. 14 km 163, 5 in AREA Science Park, I-34149 Basovizza, Italy
| | - A Di Cicco
- Physics Division, School of Science and Technology, Università di Camerino, I-62032 Camerino (MC), Italy
| | - S Di Fonzo
- Elettra-Sincrotrone Trieste S.C.p.A., S.S. 14 km 163, 5 in AREA Science Park, I-34149 Basovizza, Italy
| | - A Filipponi
- Dipartimento di Scienze Fisiche e Chimiche, Università degli Studi dell'Aquila, I-67100 L'Aquila, Italy
| | - A Gessini
- Elettra-Sincrotrone Trieste S.C.p.A., S.S. 14 km 163, 5 in AREA Science Park, I-34149 Basovizza, Italy
| | - R Gunnella
- Physics Division, School of Science and Technology, Università di Camerino, I-62032 Camerino (MC), Italy
| | - M Marsi
- Laboratoire de Physique des Solides, CNRS-UMR 8502, Université Paris-Sud, FR-91405 Orsay, France
| | - L Properzi
- Physics Division, School of Science and Technology, Università di Camerino, I-62032 Camerino (MC), Italy
| | - M Saito
- Elettra-Sincrotrone Trieste S.C.p.A., S.S. 14 km 163, 5 in AREA Science Park, I-34149 Basovizza, Italy
| | - C Masciovecchio
- Elettra-Sincrotrone Trieste S.C.p.A., S.S. 14 km 163, 5 in AREA Science Park, I-34149 Basovizza, Italy
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