Biomedical subjects

Emilio Morpurgo

Publications and source records attributed to Emilio Morpurgo.

8 recordsLinked to original sources

PubMed2004

A simple technique for identification and preservation of the hypogastric nerves during rectal surgery.

HYPOTHESIS: Rectal resection is associated with a risk of sexual dysfunction even when performed for benign disease, with the most frequent type resulting in retrograde ejaculation due to injury to the hypogastric nerves. DESIGN: A simple technique to identify and protect these nerves during rectal mobilization. SETTING: Exposure of the hypogastric plexus during rectal resection. CONCLUSION: Careful identification of the hypogastric nerves during rectal mobilization using the described technique may reduce injury to these nerves and related sexual dysfunction.

Digestive System Surgical Procedures↗

PubMed2004

Robotic and laparoscopic surgery for treatment of colorectal diseases.

PURPOSE: In the last ten years, several robotic systems have been developed to overcome the loss of the three-dimensional view and dexterity characteristic of laparoscopic surgery. The aim of this study was to compare the traditional laparoscopic approach and robotic techniques in the treatment of colorectal diseases. METHODS: The study compares a consecutive series of patients treated surgically for colorectal disease from June 2001 to May 2003 with the da Vinci robotic system (Intuitive Surgical) and a matched number of patients who underwent conventional laparoscopy during the same time interval. The factors analyzed were the time required to prepare the patient and the room, total time of surgery, length of specimens, number of lymph nodes retrieved, blood loss, complications, and postoperative results. RESULTS: The study included 106 patients (53 in each group). No differences were observed in total time of surgery (laparoscopic group, 222 +/- 77 minutes vs. robotic group, 240 +/- 61 minutes), specimen length (laparoscopic group, 29 +/- 11 cm vs. robotic group, 27 +/- 13 cm), or number of lymph nodes retrieved (laparoscopic group, 16 +/- 9 vs. robotic group, 17 +/- 10). It took significantly longer to prepare the operating room and patient in the robotic group (24 +/- 12 minutes) than in the laparoscopic group (18 +/- 7 minutes). There were three conversions to laparotomy in the laparoscopic group; in the robotic group, two cases were converted to laparoscopy and three to hand-assisted laparoscopy. No significant differences were observed between the two groups in terms of recovery of bowel function and postoperative hospital stay. CONCLUSIONS: Robot-assisted surgery proved to be as safe and effective as laparoscopic techniques in the treatment of colorectal diseases. Because of its dexterity and three-dimensional view, the da Vinci system was particularly useful in specific stages of the procedure, e.g., takedown of the splenic flexure, dissection of a narrow pelvis, identification of nervous plexus, and handsewn anastomosis. The cost-effectiveness of the procedure still needs to be evaluated.

Aged↗

PubMed2004

The da Vinci robot in right adrenalectomy: considerations on technique.

The da Vinci Robotic System (Intuitive Surgical, Mountain View, CA) became available at the General Surgery Department of Camposampiero Hospital in May 2001. From May 2001 to October 2002, 139 robotic operations were performed, one of which was a right adrenalectomy for a right adrenal mass. The progressive growth of the mass was the indication for surgical excision. Surgical adrenalectomy was successfully completed with da Vinci Robotic System using 5 ports (3 for the robotic system, 2 as service trocars). The wrist-like movements of the instrument's tip easily enabled the detachment of the right hepatic lobe from the gland and vessel isolation, while the 3-dimensional vision facilitated dissection of the veins from the vena cava.

Adrenal Gland Neoplasms↗

PubMed2003

Characterization and clinical behavior of Crohn's disease initially presenting predominantly as colitis.

PURPOSE: We studied patients with Crohn's disease affecting the colon to characterize disease behavior and to determine whether such patients might be candidates for sphincter-sparing surgery. METHODS: Ninety-two consecutive patients with Crohn's colitis were studied prospectively. Mean follow-up after diagnosis was 82 (range, 6-291) months. Parameters that were evaluated included previous surgery for Crohn's disease, granulomatous vs. nongranulomatous disease, extent of colonic involvement, and presence or absence of extracolonic disease. The clinical course of the disease and postoperative outcome were evaluated. The outcome of Crohn's colitis patients who underwent ileal pouch-anal anastomosis for presumed ulcerative colitis was also evaluated. RESULTS: There were 39 patients with granulomatous colitis and 53 patients without granulomas. There was no statistical difference in the age of diagnosis or presence of small-bowel (23 vs. 27 percent), ileocolic (34 vs. 30 percent), or perineal (36 vs. 22 percent) disease in these patients. At initial presentation, 88 percent of patients with pancolitis had colitis alone without other sites of intestinal disease compared with only 37 percent of patients with segmental colitis (P < 0.001). Kaplan-Meier analysis showed that patients with granulomas and patients with segmental colitis at presentation have a significantly higher recurrence when compared with patients without granulomas and patients with pancolitis (P < 0.03). Thirteen patients without granulomatous disease and eight with granuloma underwent ileal pouch-anal anastomosis. Seven patients (3 with granuloma, 4 without granuloma) had a recurrence of Crohn's disease in the ileal pouch; 2 required pouch removal and permanent diversion for fistulizing disease in the ileal pouch and 5 were successfully treated conservatively without surgery. CONCLUSION: The presence of granulomas and segmental involvement of the colon in patients with Crohn's colitis may reflect a more virulent clinical course. Ileal pouch-anal anastomosis may be considered as an option in select patients with Crohn's colitis without small-bowel or perianal disease. Based on our data, patients with nongranulomatous pancolitis may be better candidates for sphincter-sparing surgery.

Adolescent↗

PubMed2002

Fournier's gangrene.

Fournier's gangrene can still be a life-threatening condition with a high mortality rate. Diagnosis and treatment should be prompt and adequate. Radiological studies may help to define the extent of the disease preoperatively in cases in which this is unclear. Surgery with extensive debridement of all necrotic tissue is the mainstay of treatment.

Fournier Gangrene↗

PubMedDate not supplied

Clinical characteristics of familial adenomatous polyposis and management of duodenal adenomas.

The aim of this study was to evaluate the clinical characteristics of patients with familial adenomatous polyposis (FAP) undergoing surgical treatment over a 10-year period and specifically to evaluate the incidence and clinical outcome of patients treated for duodenal adenomas. Patients with FAP who underwent surgical treatment for colonic polyposis at the University of Louisville from January 1992 to July 2002 were investigated. Surgical treatment included colectomy and ileal J-pouch-anal anastomosis (IPAA) or completion proctectomy with or without IPAA in those who had previously undergone subtotal colectomy elsewhere. All patients underwent screening gastroduodenoscopy at 3-year intervals beginning at the time of diagnosis or referral. Postoperative morbidity, mortality, and functional outcome were evaluated, as well as the occurrence of extracolonic manifestations and results of treatment for duodenal adenomas when required. Fifty-four patients were included in the study (mean age 28 +/- 2 years). Twenty-seven of them (50%) underwent colectomy and IPAA as the initial operation. Twenty-seven patients had previously undergone subtotal colectomy. Eight of these 27 patients had cancer in the rectum, of which three were T4 and one was T2N1 cancer. Twenty-two patients underwent a completion proctectomy and three required abdominoperineal resection. Twenty of the 54 patients developed duodenal adenomas. The mean age of diagnosis of duodenal disease was not significantly different from that of patients who were still free of duodenal polyps (40 +/- 11 vs. 34 +/- 12 years). Seven of these 20 patients underwent local excision of duodenal polyps (either endocopically or transduodenally); four of these patients developed recurrent disease. Six patients underwent pancreaticoduodenectomy for duodenal adenomas with severe dyplasia. These patients experienced an increased number of bowel movements, from five per day (range 4 to 8) to 10 per day (range 6 to 15). One patient required pouch excision and end ileostomy to control diarrhea. Our data demonstrate the following: (1) patients with FAP who have undergone prior subtotal colectomy and ileorectal anastomosis have a high risk of developing advanced cancer in the rectal stump; (2) duodenal adenomas are common in patients with FAP and may occur at an early age; (3) screening duodenoscopy should be initiated at the time of diagnosis of FAP; (4) local excision of duodenal adenomas is associated with a high risk of local recurrence; and (5) even though pancreaticoduodenectomy is the treatment of choice for advanced duodenal adenomas, this procedure may adversely affect pouch function in some patients.

Abdominal Neoplasms↗

PubMedDate not supplied

[Videolaparoscopic surgery in the treatment of colorectal disease: our experience with 200 patients].

In this article we examine our experience over the last 4 years, from 1998 to 2001, in the surgical treatment of colorectal disease using the laparoscopic approach. We treated 200 patients, 54 of whom presented benign disease and 146 malignancies. The operations were performed by a team of surgeons and nurses experienced in advanced laparoscopy. Over this period, the duration of the surgical intervention was gradually reduced by 17%. The conversion rate from laparoscopy to open procedures was also reduced (mean rate 11%). Canalization and the resumption of walking and nutrition were reasonably fast. Postoperative complications occurred in 22% of cases The number of fistulas and anastomotic dehiscences was high (10/200 = 5%), due both to evaluation errors and the choice of surgical material. At present, on applying the criteria of traditional open surgery, this figure is also coming down. Bleeding complications (12/200 = 6%) can also be ascribed to the learning curve (2 bleeds in the trocar site and 2 haematomas in the Pfannenstiel laparotomy site) and are therefore likely to be reduced. Bleeding during the surgical procedures, however, was very low, with a mean value of 69.6 ml. Laparoscopic surgery for colorectal disease is well standardized and we believe there should be no doubts as to its use in benign disease. Its use in oncological surgery, though theoretically correct, needs to be confirmed by the trials currently in progress. The results we have obtained in our experience, after completion of the learning curve, agree with the figures reported in the literature.

Adult↗

PubMedDate not supplied

[Robotic surgery: considerations after 250 procedures].

The aim of this study was to investigate the results of the first 250 procedures performed on 216 patients with the da Vinci Robotic Surgical System (34/216 patients were submitted to double procedure). The purpose of the da Vinci surgical system is to exactly translate the surgeon's hand movements to the robotic arms that manipulate the laparoscopic instruments, thus facilitating minimally invasive surgery. The da Vinci system has been available in our department since 2001. The first 50 procedures were simple cases (cholecystectomies and transperitoneal hernia repairs) and were performed during the learning curve of the surgical team. The last 200 procedures were more complex cases. Time of preparation of the robot gradually decreased with growing experience. The total conversion rate (to standard laparoscopy and to open surgery) was 4.8% (12/250); conversion to laparotomy was 2.8% (7/250). Morbidity was 8.8% (19/216), and reoperation was needed in 6 patients. Mortality was 1.8% (4/216). We conclude that robotic surgery has now moved beyond the learning phase with the device and may be routinely used in selected, more complex cases, such as colorectal surgery and surgery of the gastro-oesophageal junction. The device can also be used in pancreatic and gastric surgery.

Adult↗