Laparoscopic right hemicolectomy: a SICE (Società Italiana di Chirurgia Endoscopica e Nuove tecnologie) network prospective study on the approach to right colon lymphadenectomy in Italy: is there a standard?—CoDIG 2 (ColonDx Italian Group)

Background: Colon cancer is a disease with a worldwide spread. Surgery is the best option for the treatment of advanced colon cancer, but some aspects are still debated, such as the extent of lymphadenectomy. In Japanese guidelines, the gold standard was D3 dissection to remove the central lymph nodes (203, 213, and 223), but in 2009, Hoenberger et al. introduced the concept of complete mesocolic excision, in which surgical dissection follows the embryological planes to remove the mesentery entirely to prevent leakage of cancer cells and collect more lymph nodes. Our study describes how lymphadenectomy is currently performed in major Italian centers with an unclear indication on the type of lymphadenectomy that should be performed during right hemicolectomy (RH). Methods: CoDIG 2 is an observational multicenter national study that involves 76 Italian general surgery wards highly specialized in colorectal surgery. Each center was asked not to modify their usual surgical and clinical practices. The aim of the study was to assess the preference of Italian surgeons on the type of lymphadenectomy to perform during RH and the rise of any new trends or modifications in habits compared to the findings of the CoDIG 1 study conducted 4 years ago. Results: A total of 788 patients were enrolled. The most commonly used surgical technique was laparoscopic (82.1%) with intracorporeal (73.4%), side-to-side (98.7%), or isoperistaltic (96.0%) anastomosis. The lymph nodes at the origin of the vessels were harvested in an inferior number of cases (203, 213, and 223: 42.4%, 31.1%, and 20.3%, respectively). A comparison between CoDIG 1 and CoDIG 2 showed a stable trend in surgical techniques and complications, with an increase in the robotic approach (7.7% vs. 12.3%). Conclusions: This analysis shows how lymphadenectomy is performed in Italy to achieve oncological outcomes in RH, although the technique to achieve a higher lymph node count has not yet been standardized. Trial registration (ClinicalTrials.gov) ID: NCT05943951

Evaluation of patients’ perception of safety in an italian hospital using the pmos-30 questionnaire

Background: In our study, an Italian version of the PMOS-30 questionnaire was used to evaluate its feasibility and to improve health care quality in an Italian hospital. Methods: A cross-sectional study was conducted with 435 inpatients at a hospital in the Campania Region of Southern Italy using the PMOS-30 questionnaire and two other questions to assess patient feedback about the overall perception of safety. Results: The item “I was always treated with dignity and respect” showed the greatest percentage of agreement (agree/strongly agree = 89.2%; mean = 4.24). The least agreement was associated with the four “Staff Roles and Responsibilities” items (agree/strongly agree ranged from 31.5 to 40.0%; weighted mean = 2.84). All other 25 items had over 55.0% agree-ment, with 19 items over 70%. Moreover, 94.5% of the patients considered the safety of the ward sufficient/good/very good, and 92.8% did not notice situations that could cause harm to patients. Conclusion: Patient perception of safety was found to be satisfactory. The results were presented to the hospital decision makers for suggesting appropriate interventions. Our experience showed that the use of the PMOS-30 questionnaire may improve safety and health care quality in hospital settings through patient feedback

Robot-assisted laparoscopic gastrectomy for gastric cancer.

Phase. evidence in the shape of a series of randomized controlled trials and meta-analyses has shown that laparoscopic gastrectomy is safe and gives better short-term results with respect to the traditional open technique for early-stage gastric cancer. In fact, in the East laparoscopic gastrectomy has become routine for early-stage gastric cancer. In contrast, the treatment of advanced gastric cancer through a minimally invasive way is still a debated issue, mostly due to worries about its oncological efficacy and the difficulty of carrying out an extended lymphadenectomy and intestinal reconstruction after total gastrectomy laparoscopically. Over the last ten years the introduction of robotic surgery has implied overcoming some intrinsic drawbacks found to be present in the conventional laparoscopic procedure. Robot-assisted gastrectomy with D2 lymphadenectomy has been shown to be safe and feasible for the treatment of gastric cancer patients. But unfortunately, most available studies investigating the robotic gastrectomy for gastric cancer compared to laparoscopic and open technique are so far retrospective and there have not been phase III trials. In the present review we looked at scientific evidence available today regarding the new high-tech surgical robotic approach, and we attempted to bring to light the real advantages of robot-assisted gastrectomy compared to the traditional laparoscopic and open technique for the treatment of gastric cancer

MONITORAGGIO MICROCLIMATICO CONTINUO DELLE SALE OPERATORIE

L’installazione all’interno delle sale operatorie di centraline per la misura continua dei parametri di temperatura, umidità e delta pressorio può diventare uno strumento efficace di valutazione della tenuta microclimatica delle sale operatori

Beta(2)-adrenergic receptor gene delivery to the endothelium corrects impaired adrenergic vasorelaxation in hypertension.

Impaired beta-adrenergic receptor (AR)-mediated vasorelaxation in hypertension plays a role in increased peripheral vascular resistance and blood pressure. Because the beta(2)AR is the most abundant vascular AR subtype, we sought to enhance betaAR vasorelaxation by overexpressing beta(2)ARs via adenoviral-mediated gene transfer (ADbeta(2)AR) to the vascular endothelium of the carotid artery.In normotensive Wistar-Kyoto (WKY) and spontaneously hypertensive (SHR) rats, we exposed the right common carotid artery to ADbeta(2)AR in situ for 15 minutes by injection into the lumen while the blood flow was interrupted. Control carotids received an empty vector (ADempty). Three days later, transgene expression and selective endothelial localization were confirmed in infected vessels. Vasoregulation after beta(2)AR overexpression (2-fold) was studied in isolated organ baths. ADbeta(2)AR carotid responses to alpha(1)AR and alpha(2)AR agonists were not affected, whereas responses to epinephrine were altered and betaAR-mediated vasorelaxation was enhanced after beta(2)AR overexpression. As expected, betaAR-mediated vasodilatation in control carotids of SHR rats was significantly less than in similar control WKY carotid arteries. ADbeta(2)AR treatment enhanced betaAR vasorelaxation in SHR to levels similar to those seen in ADbeta(2)AR WKY carotids.Our results demonstrate a critical role for the endothelium in betaAR-mediated vasorelaxation and suggest that impaired betaAR signaling may account for dysfunctional betaAR vasorelaxation in hypertension rather than impaired endothelium-dependent nitric oxide metabolism