Biomedical subjects

Alessandro Jelmoni

Publications and source records attributed to Alessandro Jelmoni.

3 recordsLinked to original sources

PubMed2005

Telerobotic-assisted laparoscopic cholecystectomy: our experience on 29 patients.

BACKGROUND/PURPOSE: The role of computer-assisted surgery (CAS) is still debated and not clearly defined. METHODS: The authors report their initial experience with CAS, comparing 29 patients submitted to cholecystectomy, using a Zeus remote-controlled robot and an Aesop remote voice-activated endoscope robot, with 29 patients submitted to standard laparoscopic cholecystectomy (LC). The surgical field and the arms of the robot were under the direct and real-time control of the surgeon, who stayed at the workstation and maneuvered the Zeus, using joysticks. The workstation was in the same room as the patient. RESULTS: Twenty-nine patients underwent telerobotic-assisted cholecystectomy (TLAC); 1 procedure was converted to standard LC and 1 to open cholecystectomy. The conversions were due to choledocholithiasis and cholecystitis. During TLAC, the mean operating time and transition time (from the induction of anesthesia to incision of the skin) were, respectively, 75 min (range, 60-170 min) and 45 min (range, 25-60 min). We did not observe any complications related to TLAC. The limitations of TLAC were the lack of tactile feedback, the increase in surgical time, and the expensive cost of the procedure to reach the same result as that of LC. CONCLUSIONS: After this initial experience, we believe that TLAC could be considered only for training in CAS, but that it is without advantages in terms of its higher cost compared with LC.

Adolescent↗

PubMed2004

Usefulness of both operative cholangiography and conversion to decrease major bile duct injuries during laparoscopic cholecystectomy.

BACKGROUND/PURPOSE: We evaluated the role of operative cholangiography and of conversion to decrease major bile duct injuries. METHODS: We report 1074 patients who underwent laparoscopic cholecystectomy, out of a total of 1195 patients who underwent laparoscopy, over an 8-year period. The planned laparoscopic operative procedure in all the patients was the standard four-port technique with the operator on the left side of the patient. Operative cholangiography was performed with Olsen's pliers. RESULTS: We performed 993 (83%) operative cholangiographies; 121 (10.1%) patients were converted from laparoscopic to open cholecystectomy. Despite a prolonged time of dissection, 54 (4.5%) patients were converted because of unclear anatomy of Calot's triangle. One hundred and ninety patients suffered acute cholecystitis and, of those, 52 (27.3% of 190 patients) were converted. Fifteen patients showed intraoperative biliary duct stones and they were converted. Seven (0.58%) bile duct injuries (one stricture and six fistulas) are reported. CONCLUSIONS: The low number of major bile duct injuries reported in our study showed the value of operative cholangiography during laparoscopic cholecystectomy. Moreover, another important factor found to reduce major bile duct injuries was conversion when, despite accurate dissection, the anatomy of Calot's triangle remained unclear.

Adolescent↗

PubMedDate not supplied

Selection criteria for non-surgical treatment of liver injury in adult polytraumatized patients.

Conservative treatment of hepatic trauma is currently implemented in 80-90% of cases with a success rate of 92.5% and is mainly based on the haemodynamic status of the patients. We conducted a retrospective study of 71 patients with hepatic trauma from January 1993 to April 2001 and reviewed our experience with surgical and conservative treatment, also considering associated extrahepatic lesions. Fifty-three (74.6%) patients with liver trauma underwent celiotomy and 18 (25.3%) were treated conservatively. Haemodynamic instability was the most common indication for surgery (34 patients). Eighteen (52.9%) patients required an extrahepatic surgical procedure. Nineteen (35.8%) patients were haemodynamically stable and the indications for surgery in these cases were penetrating trauma in 6, large haemoperitoneum in 12, and diaphragmatic rupture in 1. The overall mortality in the operated group was 15%, but the liver-related mortality rate was 7.5%. The success rate for conservative management was 88.8%, with mortality 0% and morbidity 11%. The patients managed conservatively had grades of injury (I-III) similar to the haemodynamically stable operated patients (94.4% vs 94.7%), whereas the haemoperitoneum was larger in the operated group (63.1% vs 11.1%). Non-operative management is the preferred treatment option in haemodynamically stable patients with limited haemoperitoneum, regardless of the grade of the hepatic lesion, and without severe intra-abdominal injuries.

Adolescent↗