Publications by authors named "Luca Arru"

19 Publications

  • Page 1 of 1

Indocyanine green fluorescence-guided intraoperative detection of peritoneal carcinomatosis: systematic review.

BMC Surg 2020 Jul 17;20(1):158. Epub 2020 Jul 17.

Department of Surgery, General and Upper G.I. Surgery Division, University of Verona, Verona, Italy.

Background: To review the available clinical data about the value of Indocyanine Green (ICG) fluorescence imaging for intraoperative detection of peritoneal carcinomatosis.

Methods: We conducted a systematic review, according to the PRISMA guidelines, for clinical series investigating the possible role of ICG fluorescence imaging in detecting peritoneal carcinomatosis during surgical treatment of abdominal malignancies. With the aim to analyze actual application in the daily clinical practice, papers including trials with fluorophores other than ICG, in vitro and animals series were excluded. Data on patients and cancer features, timing, dose and modality of ICG administration, sensitivity, specificity and accuracy of fluorescence diagnosis of peritoneal nodules were extracted and analyzed.

Results: Out of 192 screened papers, we finally retrieved 7 series reporting ICG-guided detection of peritoneal carcinomatosis. Two papers reported the same cases, thus only 6 series were analyzed, for a total of 71 patients and 353 peritoneal nodules. The investigated tumors were colorectal carcinomas in 28 cases, hepatocellular carcinoma in 16 cases, ovarian cancer in 26 cases and endometrial cancer in 1 case. In all but 4 cases, the clinical setting was an elective intervention in patients known as having peritoneal carcinomatosis. No series reported a laparoscopic procedure. Technical data of ICG management were consistent across the studies. Overall, 353 lesions were harvested and singularly evaluated. Sensitivity varied from 72.4 to 100%, specificity from 54.2 to 100%. Two series reported that planned intervention changed in 25 and 29% of patients, respectively.

Conclusion: Indocyanine Green based fluorescence of peritoneal carcinomatosis is a promising intraoperative tool for detection and characterization of peritoneal nodules in patients with colorectal, hepatocellular, ovarian carcinomas. Further prospective studies are needed to fix its actual diagnostic value on these and other abdominal malignancies with frequent spread to peritoneum.
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http://dx.doi.org/10.1186/s12893-020-00821-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7367360PMC
July 2020

Fluorescence-guided lymphadenectomy in gastric cancer: a prospective western series.

Updates Surg 2020 Sep 30;72(3):761-772. Epub 2020 Jun 30.

Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy.

Background: Indocyanine green (ICG) has been recently introduced in clinical practice as a fluorescent tracer. Lymphadenectomy is particularly challenging in gastric cancer surgery, owing to the complex anatomical drainage.

Aim: The primary outcomes of this study were the feasibility and usefulness of ICG-guided lymphadenectomy in gastric cancer surgery, considering both the success rate and improved understanding of the surgical anatomy of nodal basins. The secondary outcome was the diagnostic ability of ICG to predict the presence of nodal metastases.

Patients And Methods: We conducted a single-center prospective trial comprising 13 patients with gastric cancer. ICG was injected the afternoon prior to surgery or intraoperatively via the submucosal or subserosal route. Standard lymphadenectomy was performed in all patients, according to patient age and tumor stage, as usual, but after standard lymphadenectomy the residual ICG + nodes were harvested and analyzed. Each nodal station and each dissected node was recorded and classified as ICG + or ICG- (both in vivo and back table evaluation was utilized for classification). After pathological analysis, each nodal station and each dissected node was recorded as metastatic or nonmetastatic (E&E staining).

Results: The feasibility rate was 84.6% (11/13). The mean number of dissected lymph nodes per patient was 37.9. Focusing on the 11 patients in whom ICG-guided nodal navigation was successfully performed, 81 lymph node stations were removed, for a total of 417 lymph nodes. Sixty-six stations (81.48%), comprising a total of 336 lymph nodes, exhibited fluorescence. No IC- node was metastatic; all 54 metastatic nodes were ICG + . A total of 282 ICG + nodes were nonmetastatic. In two cases, some nodes outside D2 areas were harvested, being ICG + (1 case of metastatic node).

Conclusions: Fluorescence lymphography-guided lymphadenectomy is a promising new technique that combines a high feasibility rate with considerable ease of use. Regarding its diagnostic value, the key finding from this prospective series is that no metastatic nodes were found outside fluorescent lymph node stations. Further studies are needed to investigate whether this technique can help surgeons performing standard lymphadenectomy and selecting cases for D2 + lymphadenectomy.
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http://dx.doi.org/10.1007/s13304-020-00836-0DOI Listing
September 2020

Minimally Invasive Adrenalectomy: Technical Aspects of the Laparoscopic and the Robotic Approach.

Chirurgia (Bucur) 2020 Jan-Feb;115(1):80-88

Adrenalectomy is nowadays a procedure routinely performed by minimally invasive surgery. In this article we aim to describe in depth our technique for laparoscopic and robotic left and right adrenalectomies, by using four cases and discussing the advantages and disadvantages of each technique.
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http://dx.doi.org/10.21614/chirurgia.115.1.80DOI Listing
March 2020

Comment on "The Limit for Artificial Intelligence's Potentiality in Surgery Doesn't Have to Be the Surgeon".

Ann Surg 2019 06;269(6):e75-e77

Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, IL Department of General Surgery, Centre Hospitalier de Luxembourg, Luxembourg Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy.

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http://dx.doi.org/10.1097/SLA.0000000000002950DOI Listing
June 2019

Rare anatomic variation of the hepatic arterial blood supply: case report and literature review.

Surg Radiol Anat 2019 Mar 13;41(3):343-345. Epub 2018 Dec 13.

Department of General and Minimally Invasive Surgery, Centre Hospitalier de Luxembourg, 4, rue Ernest Barblé, 1210, Luxembourg City, Luxembourg.

Purpose: Our aim is to present a rare case of anatomic variation of the arterial blood supply to the liver because preoperative knowledge of hepatic vascular variations is mandatory in hepatic surgery and liver transplantation.

Methods: We present a case of unusual arterial blood supply to the liver, a right hepatic artery coming from the splenic artery, associated to a classical common hepatic artery and a left hepatic artery from the left gastric artery. Preoperative diagnosis was made using CT-scan and 3D reconstruction.

Results: The right hepatic artery was found behind the portal vein and its diameter showed its importance in the vascularisation of the liver. To our knowledge this type of variation has only twice been described before. The accuracy of the 3D reconstruction allowed us to adopt the best surgical strategy to avoid lesions of the two accessory arteries which proved important sources of blood supply.

Conclusions: Precise preoperative evaluation of liver blood supply has great importance on surgical, transplantation strategy and outcome and rare anatomic variations have to be known to avoid lesions of potentially important arteries. New techniques of 3D reconstruction can ease the preoperative recognition of such difficult anatomic variations.
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http://dx.doi.org/10.1007/s00276-018-2163-5DOI Listing
March 2019

Short-term results of near-total (95%) laparoscopic gastrectomy.

Cir Esp (Engl Ed) 2018 Dec 20;96(10):634-639. Epub 2018 Jul 20.

Department of Visceral and Mini-Invasive Surgery CHL, Luxembourg, Luxemburgo.

Introduction: Total gastrectomy is a surgery with significant perioperative morbidity and mortality, being considered the treatment of choice in proximal gastric cancer. First described in 1980, our group reported and standardized totally laparoscopic 95% gastrectomy in 2014. This technique aims to reduce the complications of total gastrectomy while maintaining oncological radicality. We present the initial results from a cohort of consecutive cases after performing the technique for 4 years at 2 hospital centers.

Methods: A prospective observational study was carried out in 67 patients with laparoscopic 95% gastrectomy between 2014 and 2017. The main objective has been to detect complications (Clavien Dindo> IIIa), focusing on anastomotic leaks as the most important. The secondary objective was to assess the quality of oncological surgery.

Results: Sixty-seven consecutive patients were included, in whom 95% totally laparoscopic gastrectomy was performed. There was no case of anastomotic leak. Two patients (2.98%) had one or more Clavien Dindo complications equal to or greater than IIIa. The total hospital stay was 6 (3-13) days. R0 radical resection was performed in all patients.

Conclusions: 95% gastrectomy allows selected patients to meet the oncological standards of resection in proximal gastric cancer in a reproducible and safe manner, reducing perioperative risks such as anastomotic leakage. It is a non-comparative observational prospective study, so more studies are needed to assess the standardization of the technique.
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http://dx.doi.org/10.1016/j.ciresp.2018.06.009DOI Listing
December 2018

Distant nodal metastasis: is it always an unresectable disease?

Transl Gastroenterol Hepatol 2017 5;2. Epub 2017 Jan 5.

Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy.

This article aims at analyzing the published literature concerning the treatment of patients with gastric cancer and distant nodal metastases, actually considered metastatic disease. A systematic search was undertaken using Medline, Embase, Cochrane and Web-of-Science libraries. No specific restriction on year of publication was used; preference was given to English papers. Both clinical series and literature reviews were selected. Only 11 papers address the issue of surgery for nodal basins outside the D2 dissection area. From these papers, in selected cases extended surgery may prove useful in prolonging survival, when a comprehensive therapeutic pathway including chemotherapy is scheduled. In conclusion, in presence of nodal metastases outside the loco-regional nodes, surgery may be considered for metastatic nodes in stations 13 and 16, in selected cases.
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http://dx.doi.org/10.21037/tgh.2016.12.01DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5313284PMC
January 2017

Fast-Track in Bariatric and Metabolic Surgery: Feasibility and Cost Analysis Through a Matched-Cohort Study in a Single Centre.

Obes Surg 2016 08;26(8):1970-7

Centre Hospitalier de Luxembourg, 4 Rue Barblé, L-1210, Luxembourg City, Grand Duchy of Luxembourg.

Background: Due to the rise in severe obesity in Western countries and the increase in bariatric surgery, enhanced recovery (ER) pathways should be developed and promoted.

Methods: A monocentric prospective series of 103 bariatric surgery patients managed with the ER pathway (group ER) was compared with a retrospective and immediately previous series of 103 patients managed with standard care (group CS). The aim of the present study was to assess and compare the differences in terms of mean postoperative length of stay (LOS), costs for surgery and recovery, and the differences in terms of complications, readmission, and reoperation rate in the short term between the ER and CS groups.

Results: The mean LOS was 4.18 days in group CS and 1.79 days in group ER (p < 0.0001). The mean operative time (OT) per patient was 190.20 min in the group CS and 133.54 min in the group ER, resulting in an average cost of 7272.57€ per patient in group CS and 5424.09€ per patient in group ER. The average recovery cost was 1809.94€ for the group CS series and 775.07 for the group ER one. Overall complications (Clavien-Dindo up to II) occurred in 6 patients (5.8 %) in group CS and in 2 patients (1.9 %) in group ER (p = 0.149) and specific complications (Clavien-Dindo IIIb) occurred for 9 patients (8.7 %) in Group CS and for 14 patients (13.5 %) in group ER (p = 0.268) after hospital discharge within 1-month of follow-up. Twelve patients (11.5 %) in group CS and 13 (12.5 %) in group ER were readmitted after discharge (p = 0.831) within 1-month of follow-up; 8 patients (7.7 %) in group CS versus 9 patients (8.8 %) in group ER needed to be reoperated (p = 0.800) within 1-month follow-up.

Conclusions: Enhanced recovery pathway reduces significantly LOS in bariatric surgical patients and shortens the mean OT of the procedure, with no significant differences in terms of surgical outcomes. Furthermore, recovery charges were lower and operative time was shorter allowing for procedural cost reduction.
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http://dx.doi.org/10.1007/s11695-016-2255-4DOI Listing
August 2016

Pure laparoscopic pancreatoduodenectomy with initial approach to the superior mesenteric artery.

Wideochir Inne Tech Maloinwazyjne 2015 Sep 11;10(3):450-7. Epub 2015 Sep 11.

Centre Hospitalier de Luxembourg, Service de Chirurgie Générale et Mini-invasive, Luxembourg City, Luxembourg GD.

Introduction: The "artery-first approach" (AFA) to the superior mesenteric artery allows an early assessment of resectability of pancreatic tumours and could improve the benefits of laparoscopy, reducing invasiveness, especially for unresectable tumours.

Aim: To describe our technique of pure laparoscopic pancreatoduodenectomy (PLPD) with the AFA, and to report the surgical outcomes of this procedure in a small series of 12 patients through a retrospective analysis of a prospectively collected database.

Material And Methods: Twelve selected patients underwent elective full laparoscopic pancreatoduodenectomy with the AFA. The technical aspects of the procedure are described in detail and the included images facilitate the understanding of the procedure.

Results: The mean operative time was 300 min (range: 250-540 min). No intraoperative complications were observed. No conversion to laparotomy was necessary. The mean postoperative hospital stay was 18 days (range: 8-42). Mortality was null. There were 3 major complications at the 3rd post-operative month follow-up: 2 patients reporting a grade A pancreatic fistula and one biliary fistula.

Conclusions: Our work shows that pure laparoscopic pancreatoduodenectomy (PLPD) with the AFA is feasible, in selected patients. The AFA could improve on the advantages of laparoscopy in the identification of unresectable patients, and it also allows early control of vascular structures.
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http://dx.doi.org/10.5114/wiitm.2015.54040DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4653251PMC
September 2015

Totally laparoscopic 95% gastrectomy for cancer: technical considerations.

Langenbecks Arch Surg 2015 Apr 22;400(3):387-93. Epub 2015 Feb 22.

Service de Chirurgie Générale et Mininvasive, Centre Hospitalier de Luxembourg, U26 4 rue Barblé, 1210, Luxembourg, Luxembourg,

Introduction: Total gastrectomy is the standard treatment for tumours arising in the proximal stomach and for diffuse cancer according to the Lauren classification. Laparoscopic approach is progressively accepted and provides encouraging results. In order to reduce complications associated to the esophago-jejunal anastomosis, the concept of the 95 % open gastrectomy was developed in Japan, in the early 1980s. This procedure provides the spearing of a small remnant gastric stump of 2 cm and allows performing a gastro-jejunal anastomosis. Unlike the 7/8 gastrectomy, the 95 % gastrectomy allows the complete resection of the gastric fundus and an optimized pericardial lymph node dissection (group 1 and 2). We herein describe, step-by-step, our technique of full laparoscopic 95 % gastrectomy (G95 %), with D2 lymphadenectomy, including complete lymphadenectomy of the cardial nodes.

Discussion: When it is possible to respect the oncologic criteria regarding proximal resection margin, 95 % gastrectomy would offer best short-term results, such as lower anastomotic leak rate and a better quality of life, limiting the effect of disruption of the eso-gastric junction.

Conclusion: In selected patients, laparoscopic G95 % is feasible and safe; it could be performed without any additional technical difficulties. Controlled clinical trials are necessary to confirm the encouraging results of the cases series, recently reported in literature.
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http://dx.doi.org/10.1007/s00423-015-1283-1DOI Listing
April 2015

Advanced sealing and dissecting devices in laparoscopic adrenal surgery.

JSLS 2013 Oct-Dec;17(4):622-6

Surgical Clinic, Department of Medical and Experimental Sciences, University of Brescia, Brescia, Italy.

Objectives: This study sought to analyze the impact of advanced sealing/dissecting devices on operative and postoperative outcomes in laparoscopic adrenalectomy.

Method: Patients were divided into three groups according to the devices used during their procedures [electrothermal bipolar vessel system (EBVS), ultrasound shears (US), and monopolar electrocautery (ME)]. A comparison of the perioperative outcomes was performed.

Results: Conversion rates and intraoperative and postoperative complication rates did not differ among the three groups. Major blood loss that required transfusion was registered in only two cases, all of which were performed with ME. Procedures with EBVS were shorter than those with US or ME. For left adrenalectomies only, operative times were similar for US and EBVS. The use of EBVS was found to be an independent predictor of decreased operative time.

Conclusion: The use of advanced sealing devices was associated with reduced operative time, with particular benefits in left adrenalectomy. EBVS and US may provide better hemostasis than ME.
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http://dx.doi.org/10.4293/108680813X13693422520350DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3866068PMC
September 2014

Percutaneous and reduced-port Roux-en-Y gastric bypass: technical aspects.

J Am Coll Surg 2013 Aug;217(2):e1-8

Department of General and Mini-Invasive Surgery, Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg.

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http://dx.doi.org/10.1016/j.jamcollsurg.2013.04.019DOI Listing
August 2013

Laparoscopic gastrointestinal anastomoses using knotless barbed sutures are safe and reproducible: a single-center experience with 201 patients.

Surg Endosc 2013 Oct 14;27(10):3841-5. Epub 2013 May 14.

Department of Digestive Surgery, University Hospital of Luxembourg, Luxembourg, Luxembourg,

Background: Intestinal anastomosis is a complex procedure during laparoscopy, mainly due to the difficulties knotting the sutures. Unidirectional barbed sutures have been proposed to simplify wall and mesentery closure, but the results for intestinal anastomosis are not clear. This study aimed to establish the feasibility and the safety of laparoscopic intestinal anastomosis using barbed suture.

Methods: Between June 2011 and May 2012, 15-cm-long unidirectional absorbable barbed sutures (V-Loc; Covidien, Mansfield, MA, USA) were used for all laparoscopic intestinal anastomoses: one suture for closure of intestinal openings after mechanical anastomoses and two sutures for hand-sewn anastomoses.

Results: Over a 1-year period, 201 consecutive patients required 220 laparoscopic anastomoses for gastrojejunostomy (n = 177; 172 during Roux-en-Y gastric bypass and 5 after gastrectomy), ileocolostomy (n = 15), colocolostomy (n = 1), esophagojejunostomy (n = 5), and jejunojejunostomy (n = 22; 4 after small bowel resection and 18 during gastric bypass or gastrectomy). Senior and training surgeons performed 209 closures of intestinal openings and 11 hand-sewn anastomoses. There was no conversion to usual sutures. One fistula occurred in an esophagojejunostomy and was managed conservatively. One self-limited anastomotic bleeding occurred, and no anastomotic stenosis occurred during 6 months of follow-up evaluation.

Conclusions: The use of knotless barbed suture for laparoscopic intestinal anastomosis is safe and reproducible.
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http://dx.doi.org/10.1007/s00464-013-2992-6DOI Listing
October 2013

Factors influencing outcomes in laparoscopic adrenal surgery.

Langenbecks Arch Surg 2013 Jun 30;398(5):735-43. Epub 2013 Apr 30.

Surgical Clinic, Department of Experimental and Clinical Sciences, University of Brescia, Brescia, Italy.

Purpose: This study aims to recognize factors affecting operative and postoperative outcomes in patients undergoing unilateral laparoscopic adrenalectomy performed by using the transabdominal approach.

Methods: From a prospectively collected adrenal database, we performed a retrospective analysis of all patients undergoing unilateral adrenalectomy from July 2002 to December 2011. The outcome measures considered were the following: conversion rate, intra- and postoperative complications, duration of surgery, length of hospital stay, and return-to-work time. Demographic data, American Society of Anesthesiologists score, characteristics of adrenal tumor, and operative and postoperative variables were analyzed to assess their influence on the outcome variables.

Results: A total of 163 laparoscopic adrenalectomies were included. Intraoperative complications, conversion to laparotomy, and postoperative complications were observed in 6.7, 6.1, and 1.8 % of cases, respectively. Conversion to open surgery, intraoperative complications, metastasis, and pheochromocytoma were found to be predictive factors for operative time of >140 min. An operative duration of >140 min was associated with intraoperative complications. Tumor size, intraoperative complications, and adrenalectomy for metastasis significantly increased conversion rate. Hospital stay was extended by operative time of >140 min, conversion to laparotomy, and postoperative complications.

Conclusion: Our study highlights that simple clinical variables, long procedures, and operative complications have a negative impact on procedural outcomes. Based on this, it may be possible to predict cases requiring collaboration with experienced surgeons in order to minimize perioperative morbidity.
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http://dx.doi.org/10.1007/s00423-013-1082-5DOI Listing
June 2013

[Three-port laparoscopic sleeve gastrectomy: feasibility and short outcomes in 25 consecutives super-obese patients].

Cir Esp 2013 May 8;91(5):294-300. Epub 2013 Mar 8.

Department of Surgery, U.M.A.D.E. and U.P.O, Universitary Hospital Center of Luxembourg Luxembourg, Luxembourg.

Introduction: The aim of this paper is to propose our technique, namely three-port laparoscopic sleeve gastrectomy (TPLSG), to define the feasibility and expose the short-outcomes, as an alternative between the standard laparoscopic approach and the single incision (SILSG) for such patients.

Material And Methods: We conducted a prospective study of 25 patients: 12 male and 13 female, reporting a mean BMI of 53 kg/m² (range: 50-72) and a mean age of 38 years (range: 29-55). To evaluate the feasibility of our technique we have always respecting 3 pre-operatives conditions: BMI ≥ 50 kg/m². Preoperative abdominal US or CT to measure the liver and determine the hepato-splenic characteristics. "Intent to treat by 3 ports" (2 of 5 mm and one 12 mm in diameter). The short outcomes follow-up include: operative time, conversion, transfusions, fistula, reinterventions and parietal herniation at one and three months after surgery.

Results: Hepatomegaly was present in 19 (76%) patients, and it's greater on the left hepatic lobe in 9 (36%) patients. The mean operation time was 72 min (range: 50-110). No per-operative complications were observed. Conversion to four ports procedure was necessary in one patient. The mean hospital stay was 3 days (range: 2-5). No mortality and 30th POD morbidity rate was reported. No patient developed an incisional hernia to date.

Conclusion: The TPLSG reduces the ports in number and in size and subsequently the parietal trauma, it also an instrumental triangulation, making surgery safe and reproducible.
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http://dx.doi.org/10.1016/j.ciresp.2012.10.003DOI Listing
May 2013

Laparoscopic sigmoidectomy in moderate and severe diverticulitis: analysis of short-term outcomes in a continuous series of 121 patients.

Surg Endosc 2013 May 23;27(5):1766-71. Epub 2013 Feb 23.

Department of General and Mini-Invasive Surgery, Centre Hospitalier de Luxembourg, 4, rue Ernest Barblé, 1210 Luxembourg, Luxembourg.

Background: The role of laparoscopic surgery has been shown to be safe, feasible, and equivalent to open surgery for moderate diverticulitis, but its role in severe disease is still being elucidated. The aim of this study was to compare short-term outcomes in patients who underwent laparoscopic sigmoidectomy for moderate and severe diverticulitis.

Methods: All patients who had elective laparoscopic sigmoidectomy for diverticulitis between April 2003 and September 2011 at the University Hospital of Luxembourg were selected from a retrospective database. The patients were divided in two groups: moderate acute diverticulitis (MAD) included patients with an episode of left-lower-quadrant pain, elevated inflammatory markers, and radiologic evidence of diverticulitis, and severe acute diverticulitis (SAD) included patients with diverticula associated with abscess, phlegmon, perforation, fistula, obstruction, bleeding, or stricture.

Results: A total of 121 patients (81 MAD and 40 SAD) underwent elective laparoscopic sigmoidectomy with primary anastomosis. There were no significant differences between the two groups with respect to demographic characteristics, except for sex ratio. In this series the overall morbidity rate at 30 postoperative days (POD) was 12.4 %, with no significant differences between MAD and SAD (16.0 vs. 5 %, respectively; P = 0.083). No significant differences were found with respect to mean length of hospital stay (6.7 vs. 7.7 days; P = 0.399) as well. The overall conversion rate to open surgery was 2.5 % (3 patients), with no difference between the two groups. Conversion to laparotomy was associated with an increased morbidity rate (11.0 % for full laparoscopy vs. 66.6 % for conversion; P = 0.040) and a longer length of stay (6.8 vs. 16.7 days; P = 0.008). There were no deaths within 30 POD.

Conclusions: Elective laparoscopic sigmoidectomy is safe and feasible for patients with moderate and severe acute diverticulitis and the outcomes are equivalent.
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http://dx.doi.org/10.1007/s00464-012-2676-7DOI Listing
May 2013

Prospective randomized comparison of open versus laparoscopic management of splenic artery aneurysms: a 10-year study.

Surg Endosc 2012 Jun 30. Epub 2012 Jun 30.

General Surgery, Department of Medical and Surgical Sciences, University of Brescia, Brescia, Italy,

BACKGROUND: The literature does not support the choice between open and laparoscopic management of splenic artery aneurysms (SAA). METHODS: We designed a prospective, randomized comparison between open and laparoscopic surgery for SAA. Primary end points were types of surgical procedures performed and clinical outcomes. Analysis was developed on an intention-to-treat basis. RESULTS: Fourteen patients were allocated to laparotomy (group A) and 15 to laparoscopy (group B). Groups displayed similar patient- and aneurysm-related characteristics. The conversion rate to open surgery was 13.3 %. The type of surgical procedure performed on the splenic artery was similar in the two groups: aneurysmectomy with splenic artery ligature or direct anastomosis was performed in 51 % and 21 % of patients in group A and in 60 % and 20 % in group B, respectively. The splenectomy rate was similar (14 % vs. 20 %). Postoperative splenic infarction was observed in one case in each group. Laparoscopy was associated with shorter procedures (p = 0.0003) and lower morbidity (25 % vs. 64 %, p = 0.045). Major morbidity requiring interventional procedures and blood transfusion was observed only in group A. Laparoscopy was associated with quicker resumption of oral diet (p < 0.001), earlier drain removal (p = 0.046), and shorter hospital stay (p < 0.01). During a mean follow-up of 50 months, two patients in group A required hospital readmission. In group B, two patients developed a late thrombosis of arterial anastomoses. CONCLUSIONS: Our study demonstrates that laparoscopy permits multiple technical options, does not increase the splenectomy rate, and reduces postoperative complications. It confirms the supposed clinical benefits of laparoscopy when ablative procedures are required but laparoscopic anastomoses show poor long-term results.
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http://dx.doi.org/10.1007/s00464-012-2413-2DOI Listing
June 2012

Prospective randomized comparison of laparoscopic versus open adrenalectomy for sporadic pheochromocytoma.

Surg Endosc 2008 Jun 9;22(6):1435-9. Epub 2008 Apr 9.

Surgical Clinic, Department of Medical and Surgical Sciences, University of Brescia, 25100, Brescia, Italy.

Background: Laparoscopic adrenalectomy for pheochromocytoma remains subject of debate, owing to the systemic consequences of pneumoperitoneum in patients with catecholamine-secreting tumors.

Methods: A prospective randomized study was conducted (2000-2006), evaluating cardiovascular instability during open (n = 9, group A) or laparoscopic (n = 13, group B) adrenalectomy for pheochromocytoma. Haemodynamic parameters were recorded by invasive monitoring.

Results: Haemodynamic instability was observed in 3/9 (group A) and 6/13 patients (group B), with a mean of 1.8 and 2.2 hypertensive peaks per patient (p = n.s.). Blood loss (164 +/- 94 cc versus 48 +/- 36 cc, p < 0.05) and operative time (180 +/- 40 versus 158 +/- 45 min, p = n.s.) favored laparoscopic procedures. Postoperative morbidity and mortality were nil. Hospital stay was shorter in group B (p < 0.05). Long-term follow-up was always normal.

Conclusions: Laparoscopic approach for pheochromocytoma can be as safe as open surgery; intraoperative haemodynamic instability, although usually controlled with success, remains a source of concern.
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http://dx.doi.org/10.1007/s00464-008-9904-1DOI Listing
June 2008

Hemoperitoneum after percutaneous liver biopsy. Video-laparoscopic management.

Ann Ital Chir 2007 Jan-Feb;78(1):65-7

UO. di Chirurgia Generale e Vascolare, Azienda Ospedaliera "Mellino Mellini", P.O. Chiari, BS.

Background: Percutaneous liver biopsy is a safe procedure, with a low rate of major complications. Among these massive hemoperitoneum is the most life threatening, and its management sometimes leads to an emergency invasive surgical approach.

Case Report And Results: The following case highlights the possible role of laparoscopy in diagnosis and treatment of this condition. In this patient a significant intraperitoneal bleeding developed from a liver lesion 48 hours after needle-biopsy. Video-laparoscopic exploration evidenced a grade III laceration of the right lobe, successfully managed with coagulation and apposition of an absorbable haemostatic gauze. Peritoneal toilette and multiple drains completed the procedure. No surgical complications developed and the patient was discharged on 5th post-operative day.

Discussion: Minimally invasive surgery has been, in this case, an adequate alternative for the treatment of this bleeding complication of liver biopsy, offering advantages in terms of low morbidity, quick recovery and satisfying cosmetic results.

Conclusions: Laparoscopy is gaining a prominent role in penetrating liver trauma, whenever conservative or angiographic management fails, and should be considered as the first surgical attempt especially in patients with stable hemodynamics despite active intraperitoneal bleeding.
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July 2007
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