Operative blood loss and use of blood products after full robotic and conventional low anterior resection with total mesorectal excision for treatment of rectal cancer

To date, no studies have investigated the estimated blood loss (EBL) after full robotic low anterior resection (R-LAR) in a case-matched model, comparing it with the conventional open approach (O-LAR). Forty-nine patients in the R-LAR and 105 in the O-LAR group were matched for age, gender, BMI (body mass index), ASA (American Society of Anesthesiology) class, tumor–node–metastasis (TNM) classification and UICC (Union for International Cancer Control) stage, distance of the lower edge of the tumor from the anal verge, presence of comorbidities, and preoperative hemoglobin (Hb). EBL was significantly higher in the O-LAR group (P < 0.001); twelve units of packed red blood cells were globally transfused in the O-LAR group, compared to one unit only in the R-LAR (P = 0.051). A significantly higher postoperative Hb drop (3.0 vs. 2.4 g/dL, P = 0.015) was registered in the O-LAR patients. The length of hospital stay was much lower for the R-LAR group (8.4 vs. 12.4 days, P < 0.001). The number of harvested lymph nodes (17.4 vs. 13.5, P = 0.006) and extent of distal margin (2.9 vs. 1.9 cm, P < 0.001) were significantly higher in the R-LAR group. Open surgery was confirmed as the sole variable significantly associated (P < 0.001) with blood loss (odds ratio = 4.41, 95% CI 2.06–9.43). It was a confirmed prognosticator of blood loss (P = 0.006) when a preoperative clinical predictive model was built, using multivariate analysis (odds ratio = 3.95, 95% CI 1.47–10.6). In conclusion, R-LAR produced less operative blood loss and less drop in postoperative hemoglobin when compared to O-LAR. Other clinically relevant outcomes were similar or superior to O-LAR

Emicolectomia destra completamente robotica: analisi dei risultati clinici e oncologici precoci

Clinical and oncological results of routine application of robotic right hemicolectomy has been evaluated. Data from 14 consecutive patients, affected by right colon cancer, were prospectively collected and evaluated. The Authors suggest that superior dexterity of robotic instruments and tridimensional magnified vision of the operative field allow a subjective better identification and a safer isolation of the anatomical structures, although no relevant advantage over standard laparoscopy was found in their preliminary experience

Valutazione iniziale dell’impiego del sistema Da Vinci nella surrenectomia robotica

Introduction: In last years we have witnessed a progressive expansion of robotic abdominal surgery. The aim of our preliminary study was to determine potential advantages and limitations in adrenalectomy procedure. Methods: We prospectively evaluated five consecutive cases of monolateral transperitoneal robotic adrenalectomy. All the procedures were performed with the Da Vinci S surgical system, with the patient in 45° lateral decubitus, opposite to the lesion site, and with a 20° antitrendelemburg. Two robotic trocars were inserted into the flank and into the iliac fossa omolaterally plus a third trocar positioned in the controlateral hypochondrium for the assistant surgeon at the operating table. Results: From May 2007 until March 2009 at the European Institute of Oncology has been performed five adrenalectomy procedures, with full robotic technique. Two patients were male and three female. Mean age was 62.4 ± 11.3 years. Three were left and two were right adrenalectomies. Histology was: two adrenocortical adenomas and three metastasis, one from melanoma, one from ovarian cancer and the last from lung cancer. Mean operative time was 178 ± 28 min. with no conversion to open technique. Mean post-operative hospital stay was 4.4 ± 1.6 days (range 2-6) and none had post-operative minor or major complications. Blood loss was negligible in all cases. Conclusions: Robotic adrenalectomy have subjective advantages as the better identification of the dissection planes, thanks to the magnified vision of the operative field and the easier and safer isolation of the delicate anatomical structures with this type of surgery. An objective superiority of this technique over the traditional ones should be demonstrated with further studies

Resezione anteriore del retto completamente robotica: tecnica e risultati oncologici preliminari

Introduzione: La tecnica di resezione anteriore del retto robotica con escissione completa del mesoretto non è ancora standardizzata. Molti autori, infatti, preferiscono adottare una tecnica ibrida che prevede l’utilizzo della laparoscopia convenzionale per la legatura dei vasi e per la mobilizzazione della flessura splenica. Presentiamo una tecnica che permette di eseguire quest’intervento in maniera completamente robotica e avvalendosi di un unico posizionamento del carrello robotico. Metodi: Tutti gli interventi sono stati eseguiti utilizzando un unico posizionamento del carrello robotico. Per tutte le procedure sono stati impiegati tre bracci robotici più un ulteriore trocar per l’assistente posto al tavolo operatorio. I dati ottenuti sono stati raccolti prospetticamente in un database dedicato e analizzati. Risultati: Da gennaio 2007 a marzo 2009 presso la Divisione di Chirurgia Addomino-Pelvica dell’Istituto Europeo di Oncologia di Milano sono state operati 47 pazienti affetti da cancro del retto con tecnica completamente robotica impiegando il robot Da Vinci S: 19 femmine e 28 maschi. L’età media è stata di 62.4 ± 10.3 anni (range 37-82). Procedure in dettaglio: 32 resezioni anteriori del retto, 7 resezioni intersfinteriche e 8 addomino-perineali. Il tempo operatorio medio è stato di 300 ± 69 min (range 156-487). Nessun paziente è stato convertito in chirurgia open. Il numero di linfonodi asportati è stato in media 17.6 ± 7.2 (range 5-39), la distanza dal margine di resezione distale è stata in media di 26,14 ± 13 mm e il margine circonferenziale è risultato negativo in tutti i casi. Conclusioni: La resezione anteriore del retto completamente robotica eseguita con questa tecnica è una procedura oncologicamente sicura ed efficace nel trattamento delle neoplasie del retto. Essa sfrutta i vantaggi della chirurgia robotica in ogni fase dell’intervento senza la necessità di utilizzare tecniche ibride

L'iscrizione come strumento di integrazione culturale nella società romana. In ricordo di Angela Donati. Atti del Colloquio Borghesi 2021, Bertinoro, 28-30 ottobre 2021

Il volume raccoglie i contributi scaturiti dagli interventi presentati in occasione del Colloquio Borghesi 2021 di epigrafia latina, svoltosi presso il Centro Residenziale Universitario di Bertinoro nelle giornate del 28-30 ottobre 2021, dedicato alla memoria di Angela Donati e incentrato sul tema dell'iscrizione come strumento di integrazione culturale in ambito romano

Firefly: The Case for a Holistic Understanding of the Global Structure and Dynamics of the Sun and the Heliosphere

This white paper is on the HMCS Firefly mission concept study. Firefly focuses on the global structure and dynamics of the Sun's interior, the generation of solar magnetic fields, the deciphering of the solar cycle, the conditions leading to the explosive activity, and the structure and dynamics of the corona as it drives the heliosphere