SURRENECTOMIA LAPAROSCOPICA VERSUS SURRENECTOMIA ROBOTICA: STUDIO PROSPETTICO RANDOMIZZATO

Dopo l'introduzione del Robot nella chirurgia addominale, anche la surrenectomia laparoscopica è divenuta intervento routinario con approccio Robot-assistito. In letteratura sono descritte casistiche in numero variabile che riportano vantaggi e svantaggi dell'utilizzo del Robot nella surrenectomia. La maggior parte dei lavori riporta aumento dei tempi operatori e dei costi nella surrenectomia robotica. Attualmente non sono stati dimostrati vantaggi con questa tecnica, rispetto a quella laparoscopica tradizionale, se non in termini di minore perdita ematica intraoperatoria e miglior outcome nei pazienti con lesioni surrenaliche maggiori di 5 cm diam. Scopo di questa tesi è stato quello di confrontare due gruppi di pazienti sottoposti a surrenectomia laparoscopica tradizionale e Surrenectomia Robotica. Lo studio è stato condotto in modo prospettico, selezionando in maniera randomizzata pazienti con caratteristiche simili per età, sesso, dimensioni della lesione surrenalica. Il tempo operatorio medio della surrenectomia robotica è risultato più lungo di quello della surrenectomia laparoscopica tradizionale. La degenza media dei pazienti operati con robot è risultata più breve. Non ci sono state differenze in termini di complicanze tra i due gruppi. In conclusione il nostro studio dimostra, su un numero limitato di casi, che la surrenctomia robotica non apporta sostanziali vantaggi in termini di outcome rispetto a quella tradizionale, mentre è evidente il maggiore costo dovuto al più lungo tempo operatorio e il costo di utilizzo del Robot. I nostri dati confermano quindi quelli già pubblicati in letteratura

Minimally invasive video-assisted thyroidectomy for benign thyroid disease: an evidence-based review

Abstract: Background A decade after nearly all surgical disciplines developed minimally invasive techniques, the first report of a single case of minimally invasive thyroidectomy was published. Minimally invasive video-assisted thyroidectomy (MIVAT) is now considered the most widely practiced and most easily reproducible minimally invasive procedure for thyroidectomy. The aim of this review was to analyze the treatment of benign thyroid diseases by MIVAT. Methods A systematic evidence-based literature review focusing on three questions was carried out. Additional data were obtained on the basis of our personal experience. (1) Are minimally invasive procedures indicated in the treatment of thyroid diseases? (2) Is MIVAT a safe technique and what are the demonstrated advantages? (3) Since different thyroid diseases may be treated by MIVAT, is it of any value in the treatment of benign thyroid diseases? Results MIVAT can be considered an appropriate treatment of some thyroid diseases; it represents a safe procedure with the same incidence of complications as traditional surgery, and also has advantages in terms of both cosmetic result and postoperative distress. Conclusions In spite of an increasing trend toward performing more extensive procedures other than thyroidectomy alone during videoscopic procedures, the current literature seems to reaffirm that the main and safest indication for MIVAT is benign disease

Minimally Invasive Video-Assisted Thyroidectomy for Benign Thyroid Disease: An Evidence-Based Review

Background: A decade after nearly all surgical disciplines developed minimally invasive techniques, the first report of a single case of minimally invasive thyroidectomy was published. Minimally invasive video-assisted thyroidectomy (MIVAT) is now considered the most widely practiced and most easily reproducible minimally invasive procedure for thyroidectomy. The aim of this review was to analyze the treatment of benign thyroid diseases by MIVAT. Methods: A systematic evidence-based literature review focusing on three questions was carried out. Additional data were obtained on the basis of our personal experience. (1) Are minimally invasive procedures indicated in the treatment of thyroid diseases? (2) Is MIVAT a safe technique and what are the demonstrated advantages? (3) Since different thyroid diseases may be treated by MIVAT, is it of any value in the treatment of benign thyroid diseases? Results: MIVAT can be considered an appropriate treatment of some thyroid diseases; it represents a safe procedure with the same incidence of complications as traditional surgery, and also has advantages in terms of both cosmetic result and postoperative distress. Conclusions: In spite of an increasing trend toward performing more extensive procedures other than thyroidectomy alone during videoscopic procedures, the current literature seems to reaffirm that the main and safest indication for MIVAT is benign disease

No metagenomic evidence of tumorigenic viruses in cancers from a selected cohort of immunosuppressed subjects.

The possible existence of yet undiscovered human tumorigenic viruses is still under scrutiny. The development of large-scale sequencing technologies, coupled with bioinformatics techniques for the characterization of metagenomic sequences, have provided an invaluable tool for the detection of unknown, infectious, tumorigenic agents, as demonstrated by several recent studies. However, discoveries of novel viruses possibly associated with tumorigenesis are scarce at best. Here, we apply a rigorous bioinformatics workflow to investigate in depth tumor metagenomes from a small but carefully selected cohort of immunosuppressed patients. While a variegated bacterial microbiome was associated with each tumor, no evidence of the presence of putative oncoviruses was found. These results are consistent with the major findings of several recent papers and suggest that new human tumorigenic viruses are not common even in immunosuppressed populations