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Perri D, Rocco B, Sighinolfi MC, Bove P, Pastore AL, Volpe A, Minervini A, Antonelli A, Zaramella S, Galfano A, Cacciamani GE, Celia A, Dalpiaz O, Crivellaro S, Greco F, Pini G, Porreca A, Pacchetti A, Calcagnile T, Berti L, Buizza C, Mazzoleni F, Bozzini G. Open versus Robot-Assisted Radical Cystectomy for the Treatment of pT4a Bladder Cancer: Comparison of Perioperative Outcomes. Cancers (Basel) 2024; 16:1329. [PMID: 38611006 PMCID: PMC11011112 DOI: 10.3390/cancers16071329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 03/17/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
We compared the perioperative outcomes of open (ORC) vs. robot-assisted (RARC) radical cystectomy in the treatment of pT4a MIBC. In total, 212 patients underwent ORC (102 patients, Group A) vs. RARC (110 patients, Group B) for pT4a bladder cancer. Patients were prospectively followed and retrospectively reviewed. We assessed operative time, estimated blood loss (EBL), intraoperative and postoperative complications, length of stay, transfusion rate, and oncological outcomes. Preoperative features were comparable. The mean operative time was 232.8 vs. 189.2 min (p = 0.04), and mean EBL was 832.8 vs. 523.7 mL in Group A vs. B (p = 0.04). An intraoperative transfusion was performed in 32 (31.4%) vs. 11 (10.0%) cases during ORC vs. RARC (p = 0.03). The intraoperative complications rate was comparable. The mean length of stay was shorter after RARC (12.6 vs. 7.2 days, p = 0.02). Postoperative transfusions were performed in 36 (35.3%) vs. 13 (11.8%) cases (p = 0.03), and postoperative complications occurred in 37 (36.3%) vs. 29 (26.4%) patients in Groups A vs. B (p = 0.05). The positive surgical margin (PSM) rate was lower after RARC. No differences were recorded according to the oncological outcomes. ORC and RARC are feasible treatments for the management of pT4a bladder tumors. Minimally invasive surgery provides shorter operative time, bleeding, transfusion rate, postoperative complications, length of stay, and PSM rate.
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Affiliation(s)
- Davide Perri
- Department of Urology, ASST Lariana, 22100 Como, Italy (G.B.)
| | - Bernardo Rocco
- Department of Urology, ASST Santi Paolo e Carlo, 20142 Milan, Italy
| | | | - Pierluigi Bove
- Department of Urology, Ospedale San Carlo di Nancy, 00165 Rome, Italy
| | | | - Alessandro Volpe
- Department of Urology, Ospedale Maggiore della Carità, 28100 Novara, Italy
| | - Andrea Minervini
- Department of Urology, Azienda Ospedaliero Universitaria Careggi, 50134 Florence, Italy
| | | | | | - Antonio Galfano
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | | | - Antonio Celia
- Department of Urology, Ospedale San Bassiano, 36061 Bassano del Grappa, Italy
| | - Orietta Dalpiaz
- Department of Urology, Medical University of Graz, 8010 Graz, Austria
| | - Simone Crivellaro
- Department of Urology, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Francesco Greco
- Department of Urology, Humanitas Gavazzeni, 24125 Bergamo, Italy
| | | | - Angelo Porreca
- Department of Urology, Policlinico Abano Terme, Abano Terme, 35031 Padova, Italy
| | | | | | - Lorenzo Berti
- Department of Urology, Ospedale di Busto Arsizio, 21052 Busto Arsizio, Italy
| | - Carlo Buizza
- Department of Urology, Ospedale di Busto Arsizio, 21052 Busto Arsizio, Italy
| | | | - Giorgio Bozzini
- Department of Urology, ASST Lariana, 22100 Como, Italy (G.B.)
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Sighinolfi MC, De Maria M, Meneghetti I, Felline M, Ceretti AP, Mosillo L, Catalano C, Morandi A, Calcagnile T, Panio E, Sangalli M, Turri F, Terzoni S, Assumma S, Sarchi L, Afonina M, Marconi A, Bianchi PP, Micali S, Rocco B, Gaia G. Correction: The use of Versius CMR for pelvic surgery: a multicentric analysis of surgical setup and early outcomes. World J Urol 2024; 42:86. [PMID: 38372831 PMCID: PMC10876755 DOI: 10.1007/s00345-024-04850-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024] Open
Affiliation(s)
| | | | | | - Mauro Felline
- Unit of Gynecology, ASST Santi Paolo and Carlo, Milan, Italy
| | | | | | | | | | | | - Enrico Panio
- Unit of Urology, ASST Santi Paolo and Carlo, Milan, Italy
| | | | - Filippo Turri
- Unit of Urology, ASST Santi Paolo and Carlo, Milan, Italy
| | | | - Simone Assumma
- Unit of Urology, ASST Santi Paolo and Carlo, Milan, Italy
| | - Luca Sarchi
- Unit of Urology, ASST Santi Paolo and Carlo, Milan, Italy
| | | | | | | | - Salvatore Micali
- Unit of Urology, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Bernardo Rocco
- Unit of Urology, ASST Santi Paolo and Carlo, Milan, Italy
| | - Giorgia Gaia
- Unit of Gynecology, ASST Santi Paolo and Carlo, Milan, Italy
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Sighinolfi MC, Rocco B, Terzoni S, Morandi A, Afonina M, Assumma S, Calcagnile T, Turri F, Sangalli M, Panio E, Sarchi L, Grasso A, Dell'orto P, Pozzi E, Ramondo A, Santangelo E, Petix M, Gaia G. New robotic systems: first head-to-head comparison between Hugo RAS and Versius CMR in the pre-clinical setting. Minerva Urol Nephrol 2024; 76:1-4. [PMID: 38426418 DOI: 10.23736/s2724-6051.23.05568-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Affiliation(s)
- Maria C Sighinolfi
- Urology Unit, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy -
| | - Bernardo Rocco
- Urology Unit, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy
| | - Stefano Terzoni
- Urology Unit, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy
| | - Alessandro Morandi
- Gynecology Unit, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy
| | - Margarita Afonina
- Gynecology Unit, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy
| | - Simone Assumma
- Urology Unit, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy
| | - Tommaso Calcagnile
- Urology Unit, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy
| | - Filippo Turri
- Urology Unit, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy
| | - Mattia Sangalli
- Urology Unit, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy
| | - Enrico Panio
- Urology Unit, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy
| | - Luca Sarchi
- Urology Unit, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy
| | - Angelica Grasso
- Urology Unit, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy
| | - Paolo Dell'orto
- Urology Unit, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy
| | - Efrem Pozzi
- Urology Unit, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy
| | - Augusto Ramondo
- Urology Unit, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy
| | | | - Michele Petix
- Urology Unit, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy
| | - Giorgia Gaia
- Gynecology Unit, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy
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Sighinolfi MC, De Maria M, Meneghetti I, Felline M, Ceretti AP, Mosillo L, Catalano C, Morandi A, Calcagnile T, Panio E, Sangalli M, Turri F, Terzoni S, Assumma S, Sarchi L, Afonina M, Marconi A, Bianchi PP, Micali S, Rocco B, Gaia G. The use of Versius CMR for pelvic surgery: a multicentric analysis of surgical setup and early outcomes. World J Urol 2024; 42:31. [PMID: 38217724 PMCID: PMC10787883 DOI: 10.1007/s00345-023-04730-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/16/2023] [Indexed: 01/15/2024] Open
Abstract
INTRODUCTION Versius CMR is a novel robotic system characterized by an open surgical console and independent bedside units. The system has potentials of flexibility and versatility, and has been used in urological, gynecological, and general surgical procedure. The aim is to depict a comprehensive analysis of the Versius system for pelvic surgery. METHODS This is a study involving two Institutions, ASST Santi Paolo and Carlo, Milan, and Apuane Hospital, Massa, Italy. All interventions performed in the pelvic area with the Versius were included. Data about indications, intra-, and post-operative course were prospectively collected and analyzed. RESULTS A total of 171 interventions were performed with the Versius. Forty-two of them involved pelvic procedures. Twenty-two had an oncological indication (localized prostate cancer), the remaining had a non-oncological or functional purpose. The mostly performed pelvic procedure was radical prostatectomy (22) followed by annexectomy (9). No intra-operative complication nor conversion to other approaches occurred. A Clavien II complication and one Clavien IIIb were reported. Malfunctioning/alarms requiring a power cycle of the system occurred in 2 different cases. An adjustment in trocar placement according to patients' height was required in 2 patients undergoing prostatectomy, in which the trocar was moved caudally. In two cases, a pelvic prolapse was repaired concomitant with other gynecological procedures. CONCLUSIONS Pelvic surgery with the Versius is feasible without major complications; either dissection and reconstructive steps could be accomplished, provided a proper OR setup and trocar placement are pursued. Versius can be easily adopted by surgeons of different disciplines and backgrounds; a further multi-specialty implementation is presumed and long-term oncological and functional outcomes are awaited.
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Affiliation(s)
| | | | | | - Mauro Felline
- Unit of Gynecology, ASST Santi Paolo and Carlo, Milan, Italy
| | | | | | | | | | | | - Enrico Panio
- Unit of Urology, ASST Santi Paolo and Carlo, Milan, Italy
| | | | - Filippo Turri
- Unit of Urology, ASST Santi Paolo and Carlo, Milan, Italy
| | | | - Simone Assumma
- Unit of Urology, ASST Santi Paolo and Carlo, Milan, Italy
| | - Luca Sarchi
- Unit of Urology, ASST Santi Paolo and Carlo, Milan, Italy
| | | | | | | | - Salvatore Micali
- Unit of Urology, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Bernardo Rocco
- Unit of Urology, ASST Santi Paolo and Carlo, Milan, Italy
| | - Giorgia Gaia
- Unit of Gynecology, ASST Santi Paolo and Carlo, Milan, Italy
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Sighinolfi MC, Sarchi L, Gaia G, Formisano G, Turri F, Sangalli M, Calcagnile T, Assumma S, Panio E, Darisi R, Afonina M, Grasso A, Dell'Orto P, Piacentini I, Salay A, Barabino M, Pisani A, Terzoni S, Marconi A, Bianchi PP, Rocco B. Multimodular robotic systems (Hugo RAS and Versius CMR) for pelvic surgery: tasks and perspectives from the bed-side assistant. J Robot Surg 2023; 17:3039-3043. [PMID: 37775674 DOI: 10.1007/s11701-023-01718-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 09/03/2023] [Indexed: 10/01/2023]
Abstract
The Hugo RAS and Versius are new robotic systems with a multimodular configuration, requiring a dedicated positioning of units, arms and trocars. While promising flexibility and multiquadrant opportunities-with an enhanced range of motion-the presence of multiple units around the patient should be effectively managed by the assistant and requires a new background of tasks. The article represents a practical guide while providing an overview on assistants' perspectives.
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Affiliation(s)
- Maria Chiara Sighinolfi
- Unit of Urology, Department of Health Science, University of Milan, ASST Santi Paolo and Carlo, Via A. Di Rudini 8, Milan, Italy.
| | - Luca Sarchi
- Unit of Urology, Department of Health Science, University of Milan, ASST Santi Paolo and Carlo, Via A. Di Rudini 8, Milan, Italy
| | - Giorgia Gaia
- Unit of Gynecology, University of Milan, ASST Santi Paolo and Carlo, Milan, Italy
| | - Giampaolo Formisano
- Unit of General Surgery, Department of Health Science, University of Milan, ASST Santi Paolo and Carlo, Milan, Italy
| | - Filippo Turri
- Unit of Urology, Department of Health Science, University of Milan, ASST Santi Paolo and Carlo, Via A. Di Rudini 8, Milan, Italy
| | - Mattia Sangalli
- Unit of Urology, Department of Health Science, University of Milan, ASST Santi Paolo and Carlo, Via A. Di Rudini 8, Milan, Italy
| | - Tommaso Calcagnile
- Unit of Urology, Department of Health Science, University of Milan, ASST Santi Paolo and Carlo, Via A. Di Rudini 8, Milan, Italy
| | - Simone Assumma
- Unit of Urology, Department of Health Science, University of Milan, ASST Santi Paolo and Carlo, Via A. Di Rudini 8, Milan, Italy
| | - Enrico Panio
- Unit of Urology, Department of Health Science, University of Milan, ASST Santi Paolo and Carlo, Via A. Di Rudini 8, Milan, Italy
| | - Ruggero Darisi
- Unit of Urology, Department of Health Science, University of Milan, ASST Santi Paolo and Carlo, Via A. Di Rudini 8, Milan, Italy
| | - Margarita Afonina
- Unit of Gynecology, University of Milan, ASST Santi Paolo and Carlo, Milan, Italy
| | - Angelica Grasso
- Unit of Urology, Department of Health Science, University of Milan, ASST Santi Paolo and Carlo, Via A. Di Rudini 8, Milan, Italy
| | - Paolo Dell'Orto
- Unit of Urology, Department of Health Science, University of Milan, ASST Santi Paolo and Carlo, Via A. Di Rudini 8, Milan, Italy
| | - Igor Piacentini
- Unit of Urology, Department of Health Science, University of Milan, ASST Santi Paolo and Carlo, Via A. Di Rudini 8, Milan, Italy
| | - Adelona Salay
- Unit of General Surgery, Department of Health Science, University of Milan, ASST Santi Paolo and Carlo, Milan, Italy
| | - Matteo Barabino
- Unit of General Surgery, Department of Health Science, University of Milan, ASST Santi Paolo and Carlo, Milan, Italy
| | - Andrea Pisani
- Unit of General Surgery, Department of Health Science, University of Milan, ASST Santi Paolo and Carlo, Milan, Italy
| | - Stefano Terzoni
- Unit of Urology, Department of Health Science, University of Milan, ASST Santi Paolo and Carlo, Via A. Di Rudini 8, Milan, Italy
| | - Annamaria Marconi
- Unit of Gynecology, University of Milan, ASST Santi Paolo and Carlo, Milan, Italy
| | - Paolo Pietro Bianchi
- Unit of General Surgery, Department of Health Science, University of Milan, ASST Santi Paolo and Carlo, Milan, Italy
| | - Bernardo Rocco
- Unit of Urology, Department of Health Science, University of Milan, ASST Santi Paolo and Carlo, Via A. Di Rudini 8, Milan, Italy
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Rocco B, Sighinolfi MC, Sarchi L, Assumma S, Turri F, Sangalli M, Gaia G, Grasso A, Dell'Orto P, Calcagnile T, Piacentini I, Coelho RF, Terzoni S, Panio E, Moscovas MC, Patel V. First case of robot-assisted radical cystectomy and intracorporeal neobladder reconstruction with the Hugo RAS system: step-by-step surgical setup and technique. J Robot Surg 2023; 17:2247-2251. [PMID: 37294418 DOI: 10.1007/s11701-023-01629-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 05/21/2023] [Indexed: 06/10/2023]
Abstract
Robotic assisted radical cystectomy (RARC) is a standard option for the treatment of bladder cancer. Currently, novel platforms are entering the market and the Hugo RAS (Medtronic, Minneapolis, MN, USA) is a new system consisting of an open console with 3D-HD screen and a multi-modular fashion. Even if several series are already available for radical prostatectomy, to now a full description of RARC performed with Hugo RAS is still lacking. We report the first case of RARC with intracorporeal neobladder performed with the Hugo RAS-and another case of RARC with ureterostomy. Both patients were affected by MIBC. Case 1 was a 61-year-old patient without comorbidities (CCI 4), in which a Bordeaux ileal neobladder was scheduled after previous NAC. The second was the case of a 70-year-old one with CCI 7 and BMI 35; in this case, a ureterostomy was planned. Details of the robotic system: one 11 mm endoscope port was placed on the midline 2 cm above the umbilicus. Another two 8 mm robotic ports were symmetrically placed under vision on a transversal line-located 1 cm below the umbilicus. A third robotic port was positioned on the left side in a W configuration. All ports were located at least 9 cm between each other. Finally, two assistant ports were positioned in the right abdominal site. All arm-carts were parked 45-60 cm from the operative bed, before the docking process begins. Three arm-carts were parked on the left side, the assistant and the scrub nurse worked on the right side, while the energy tower stayed at the foot of the bed, according to the previous description of Hugo RAS robotic radical prostatectomy. The endoscope arm-cart is docked first, then the adjacent left carts are docked; finally, the surgeon's right-hand cart is docked from the right side of the bed. The docking angles and tilt we applied were: endoscope: 175°; minus 45°; surgeon left hand 140°; minus 30°; surgeon right hand 225°; minus 30°; fourth arm 125°; plus 15°. The instruments we used were those fitting our conventional four-instrument setup for RARC: monopolar shears, Maryland forceps, needle driver and Cadiere as the fourth arm. The procedures were completed without technical errors or technological failures-requiring a change in surgical strategy. Docking time was approximately 35 min; console time up to urethral dissection was 150 and 140 min in Case 1 and 2. The time for pelvic nodal dissection was approximately 37 min for both. The multi-modularity fashion of the Hugo RAS allowed an easy management of the bowel in Case 1; the absence of robotic staplers required the use of the laparoscopic ones, managed by an adjunctive assistant with room within the cart. In conclusion, RARC with the Hugo RAS is a feasible procedure able to reproduce all surgical steps without critical errors or complications requiring a change in surgical planning. Urinary diversion with intracorporeal reconstruction is feasible as well, with adequate preliminary outcomes.
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Affiliation(s)
- Bernardo Rocco
- Urology Unit, ASST Santi Paolo and Carlo, Via Rudini 8, Milan, Italy
| | | | - Luca Sarchi
- Urology Unit, ASST Santi Paolo and Carlo, Via Rudini 8, Milan, Italy
| | - Simone Assumma
- Urology Unit, ASST Santi Paolo and Carlo, Via Rudini 8, Milan, Italy
| | - Filippo Turri
- Urology Unit, ASST Santi Paolo and Carlo, Via Rudini 8, Milan, Italy
| | - Mattia Sangalli
- Urology Unit, ASST Santi Paolo and Carlo, Via Rudini 8, Milan, Italy
| | - Giorgia Gaia
- Gynecology Unit, ASST Santi Paolo and Carlo, Milan, Italy
| | - Angelica Grasso
- Urology Unit, ASST Santi Paolo and Carlo, Via Rudini 8, Milan, Italy
| | - Paolo Dell'Orto
- Urology Unit, ASST Santi Paolo and Carlo, Via Rudini 8, Milan, Italy
| | | | - Igor Piacentini
- Urology Unit, ASST Santi Paolo and Carlo, Via Rudini 8, Milan, Italy
| | | | - Stefano Terzoni
- Urology Unit, ASST Santi Paolo and Carlo, Via Rudini 8, Milan, Italy
| | - Enrico Panio
- Urology Unit, ASST Santi Paolo and Carlo, Via Rudini 8, Milan, Italy
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Sighinolfi MC, Menezes AD, Patel V, Moschovas M, Assumma S, Calcagnile T, Panio E, Sangalli M, Turri F, Sarchi L, Micali S, Varca V, Annino F, Leonardo C, Bozzini G, Cacciamani G, Gregori A, Morini E, Terzoni S, Eissa A, Rocco B. Three-Dimensional Customized Imaging Reconstruction for Urological Surgery: Diffusion and Role in Real-Life Practice from an International Survey. J Pers Med 2023; 13:1435. [PMID: 37888045 PMCID: PMC10607910 DOI: 10.3390/jpm13101435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/28/2023] Open
Abstract
Despite the arising interest in three-dimensional (3D) reconstruction models from 2D imaging, their diffusion and perception among urologists have been scarcely explored. The aim of the study is to report the results of an international survey investigating the use of such tools among urologists of different backgrounds and origins. Beyond demographics, the survey explored the degree to which 3D models are perceived to improve surgical outcomes, the procedures mostly making use of them, the settings in which those tools are mostly applied, the surgical steps benefiting from 3D reconstructions and future perspectives of improvement. One hundred responders fully completed the survey. All levels of expertise were allowed; more than half (53%) were first surgeons, and 59% had already completed their training. Their main application was partial nephrectomy (85%), followed by radical nephrectomy and radical prostatectomy. Three-dimensional models are mostly used for preoperative planning (75%), intraoperative consultation and tailoring. More than half recognized that 3D models may highly improve surgical outcomes. Despite their recognized usefulness, 77% of responders use 3D models in less than 25% of their major operations due to costs or the extra time taken to perform the reconstruction. Technical improvements and a higher availability of the 3D models will further increase their role in surgical and clinical daily practice.
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Affiliation(s)
| | | | - Vipul Patel
- Global Robotic Institute, AdventHealth, Orlando, FL 34747, USA
| | | | - Simone Assumma
- Urologic Unit, ASST Santi Paolo e Carlo, La Statale University, 20122 Milan, Italy
| | - Tommaso Calcagnile
- Urologic Unit, ASST Santi Paolo e Carlo, La Statale University, 20122 Milan, Italy
| | - Enrico Panio
- Urologic Unit, ASST Santi Paolo e Carlo, La Statale University, 20122 Milan, Italy
| | - Mattia Sangalli
- Urologic Unit, ASST Santi Paolo e Carlo, La Statale University, 20122 Milan, Italy
| | - Filippo Turri
- Urologic Unit, ASST Santi Paolo e Carlo, La Statale University, 20122 Milan, Italy
| | - Luca Sarchi
- Urologic Unit, ASST Santi Paolo e Carlo, La Statale University, 20122 Milan, Italy
| | - Salvatore Micali
- Urologic Unit, Azienda Ospedaliera Universitaria di Modena, 41124 Modena, Italy
| | - Virginia Varca
- Urologic Unit, ASST Rhodense—Presidio di Garbagnate Milanese, 20024 Milan, Italy
| | | | | | | | - Giovanni Cacciamani
- USC Institute of Urology, University of Southern California, Los Angeles, CA 90089, USA
| | - Andrea Gregori
- Urologic Unit, Fatebenefratelli-Sacco Hospital, 20157 Milan, Italy
| | | | - Stefano Terzoni
- Urologic Unit, ASST Santi Paolo e Carlo, La Statale University, 20122 Milan, Italy
| | - Ahmed Eissa
- Urologic Department, Faculty of Medicine, Tanta University, Tanta 31527, Egypt
| | - Bernardo Rocco
- Urologic Unit, ASST Santi Paolo e Carlo, La Statale University, 20122 Milan, Italy
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Sarchi L, Sighinolfi MC, Assumma S, Calcagnile T, Grasso A, Sangalli M, Turri F, dell'Orto P, Rocco B. Re: Carlo A. Bravi, Marco Paciotti, Eleonora Balestrazzi, et al. Outcomes of Robot-assisted Radical Prostatectomy with the Hugo RAS Surgical System: Initial Experience at a High-volume Robotic Center. Eur Urol Focus. In press. https://doi.org/10.1016/j.euf.2023.01.008. Eur Urol Focus 2023; 9:844-845. [PMID: 36906482 DOI: 10.1016/j.euf.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 02/11/2023] [Indexed: 03/11/2023]
Affiliation(s)
- Luca Sarchi
- Urology Unit, ASST Santi Paolo e Carlo, La Statale University, Milan, Italy.
| | | | - Simone Assumma
- Urology Unit, ASST Santi Paolo e Carlo, La Statale University, Milan, Italy
| | - Tommaso Calcagnile
- Urology Unit, ASST Santi Paolo e Carlo, La Statale University, Milan, Italy
| | - Angelica Grasso
- Urology Unit, ASST Santi Paolo e Carlo, La Statale University, Milan, Italy
| | - Mattia Sangalli
- Urology Unit, ASST Santi Paolo e Carlo, La Statale University, Milan, Italy
| | - Filippo Turri
- Urology Unit, ASST Santi Paolo e Carlo, La Statale University, Milan, Italy
| | - Paolo dell'Orto
- Urology Unit, ASST Santi Paolo e Carlo, La Statale University, Milan, Italy
| | - Bernardo Rocco
- Urology Unit, ASST Santi Paolo e Carlo, La Statale University, Milan, Italy
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9
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Sighinolfi MC, Terzoni S, Scanferla E, Bianchi PP, Formisano G, Piccolo G, Barabino M, Pisani A, Salaj A, Gaia G, Marconi AM, Turri F, Sangalli M, Centanni S, Stocco M, Chiumello D, Assumma S, Sarchi L, Calcagnile T, Panio E, Grasso A, Dell'Orto P, Mariani NM, Verrusio C, Baisi A, Bozzini G, Rocco B. Prior Robotic Console Expertise May Improve Basic Skills at the New Hugo RAS Simulator: Results from a Cohort Trial and Implications for Skill Transference Across Platforms. EUR UROL SUPPL 2023; 53:83-89. [PMID: 37441345 PMCID: PMC10334229 DOI: 10.1016/j.euros.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2023] [Indexed: 07/15/2023] Open
Abstract
Background Robot-assisted surgery ensures minimal invasiveness; since the expiry of the Da Vinci patent, new robotic systems have entered the market. Recently, the Hugo RAS received CE approval for several surgical procedures. However, more is needed to know about skill acquisition at the new simulator. Objective This study aims to analyse the factors impacting basic surgical skills at the Hugo RAS simulator. Design setting and participants We present a cross-sectional study involving 71 participants of different backgrounds invited to a hands-on session with the Hugo RAS simulator voluntarily. All of them had no prior expertise with the system. Participants were recruited among medical/nurse students, residents, and laparoscopic and robotic surgeons. Intervention All participants underwent a hands-on "pick and place" exercise at the Hugo RAS simulator; the metrics of a second-round pick and place exercise were recorded. Outcome measurements and statistical analysis Metrics were analysed with regard to the following variables: demographics, videogame use, and prior surgical experience (no surgical expertise, experience with laparoscopy, and experience with robotic console). Results and limitations All participants completed the test. Of them, 77.5% were naïve to surgery, 8.5% had prior laparoscopic expertise, and 14.1% had prior robotic console experience. The time to complete the pick and place exercise was significantly lower (p < 0.001) among prior robotic surgeons (38 s, interquartile range [IQR] 34-45) compared with both naïve participants (61 s, IQR 53-71) and laparoscopists (93 s, IQR 53-162). The overall score of the exercise decreased with age (p = 0.046); however, the overall scores were significantly and steadily higher among surgeons experienced in robotic consoles across all age groups (p = 0.006). Neither gender (p = 0.7) nor videogame use (p = 0.9) correlated significantly with the metrics. Conclusions This is the first study analysing factors impacting basic skill acquisition at a new robotic simulator. Experience with robotic consoles may represent a major factor, raising the hypothesis of the transferability of basic robotic skills across different robotic systems. Further studies are required to explore this issue. Patient summary In the present study, we analysed which characteristics may affect the basic surgical skills at a novel robotic platform.
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Affiliation(s)
- Maria Chiara Sighinolfi
- Unit of Urology, Department of Health Science, La Statale University of Milan, Milan, Italy
- ASST Santi Paolo and Carlo, Milan, Italy
| | - Stefano Terzoni
- San Paolo Bachelor School of Nursing, ASST Santi Paolo e Carlo, Milan, Italy
| | - Elena Scanferla
- Unit of Urology, Department of Health Science, La Statale University of Milan, Milan, Italy
- ASST Santi Paolo and Carlo, Milan, Italy
| | | | | | - Gaetano Piccolo
- Unit of General Surgery, ASST Santi Paolo and Carlo, Milan, Italy
| | - Matteo Barabino
- Unit of General Surgery, ASST Santi Paolo and Carlo, Milan, Italy
| | - Andrea Pisani
- Unit of General Surgery, ASST Santi Paolo and Carlo, Milan, Italy
| | - Adelona Salaj
- Unit of General Surgery, ASST Santi Paolo and Carlo, Milan, Italy
| | - Giorgia Gaia
- Unit of Gynecology, ASST Santi Paolo and Carlo, Milan, Italy
| | | | - Filippo Turri
- Unit of Urology, Department of Health Science, La Statale University of Milan, Milan, Italy
- ASST Santi Paolo and Carlo, Milan, Italy
| | - Mattia Sangalli
- Unit of Urology, Department of Health Science, La Statale University of Milan, Milan, Italy
- ASST Santi Paolo and Carlo, Milan, Italy
| | - Stefano Centanni
- ASST Santi Paolo and Carlo, Milan, Italy
- Department of Health Sciences, La Statale University of Milan, Milan, Italy
| | - Matteo Stocco
- ASST Santi Paolo and Carlo, Milan, Italy
- Department of Health Sciences, La Statale University of Milan, Milan, Italy
| | - Davide Chiumello
- Unit of Anesthesiology, ASST Santi Paolo and Carlo, Milan, Italy
| | - Simone Assumma
- Unit of Urology, Department of Health Science, La Statale University of Milan, Milan, Italy
- ASST Santi Paolo and Carlo, Milan, Italy
| | - Luca Sarchi
- Unit of Urology, Department of Health Science, La Statale University of Milan, Milan, Italy
- ASST Santi Paolo and Carlo, Milan, Italy
| | - Tommaso Calcagnile
- Unit of Urology, Department of Health Science, La Statale University of Milan, Milan, Italy
- ASST Santi Paolo and Carlo, Milan, Italy
| | - Enrico Panio
- Unit of Urology, Department of Health Science, La Statale University of Milan, Milan, Italy
- ASST Santi Paolo and Carlo, Milan, Italy
| | - Angelica Grasso
- Unit of Urology, Department of Health Science, La Statale University of Milan, Milan, Italy
- ASST Santi Paolo and Carlo, Milan, Italy
| | - Paolo Dell'Orto
- Unit of Urology, Department of Health Science, La Statale University of Milan, Milan, Italy
- ASST Santi Paolo and Carlo, Milan, Italy
| | | | | | - Alessandro Baisi
- Unit of Thoracic Surgery, ASST Santi Paolo and Carlo, Milan, Italy
| | | | - Bernardo Rocco
- Unit of Urology, Department of Health Science, La Statale University of Milan, Milan, Italy
- ASST Santi Paolo and Carlo, Milan, Italy
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10
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Sighinolfi MC, Gaia G, Afonina M, Assumma S, Calcagnile T, Garelli G, Sangalli M, Guarnerio PP, Felline M, Eissa A, Sarchi L, Terzoni S, Micali S, Marconi A, Rocco B. Level 1 Evidence for Robotic Surgery for Urological and Gynecological Pelvic Cancers: Where do We Currently Stand? CLIN EXP OBSTET GYN 2023. [DOI: 10.31083/j.ceog5002044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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11
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Sighinolfi MC, Terzoni S, Scanferla E, Bianchi PP, Formisano G, Gaia G, Marconi AM, Chiumello D, Patel V, Moschovas MC, Turri F, Dell'Orto P, Maruccia S, Grasso A, Sangalli M, Centanni S, Stocco M, Assumma S, Sarchi L, Calcagnile T, Panio E, Bozzini G, Rocco B. Impact of hands-on practice with HugoRAS and Versius System simulators on the attractiveness of robotic surgery among medical and nurse undergraduate students. J Robot Surg 2023:10.1007/s11701-023-01543-9. [PMID: 36780055 DOI: 10.1007/s11701-023-01543-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 02/04/2023] [Indexed: 02/14/2023]
Abstract
The scenario of robotic surgery is rapidly evolving with the introduction of new robotic systems. A structured learning program in robotic surgery during academic education is often lacking, especially for undergraduates; as a result, many students may be unaware of indications to robotic surgery and technological progress. The aim of the study is to evaluate the knowledge and interest toward robotic surgery of medical and nurse students, and to analyze how the attractiveness may change after a hand-on training course with new simulators of Hugo RAS and Versius System. We performed a cross-sectional study involving medical and nurse students recruited on a voluntary basis at ASST Santi Paolo and Carlo, Milan; participants were invited to join a hands-on practice simulation with the Hugo RAS and/or Versius Trainer Simulator. Before the hand-on exercise, students were asked to fulfill an online anonymous questionnaire addressing knowledge and interest toward robotic surgery. After a 2-h hands-on exercises at the Hugo RAS and/or at the Versius Trainer simulator (preceded by a brief lecture on robotic surgery and new systems), participants were asked to complete a second-round questionnaire to evaluate changes in attractiveness toward robotic surgery. Data were recorded in a database; after a descriptive analysis of the variables, median values were compared with the Mann-Whitney U test, frequencies with the Fisher's exact test and in the case of paired observations (before and after the simulation), the Mc Nemar test was used. Forty-one undergraduates agreed to participate. Twenty-three nursing students and 18 medical students were recruited. Some of them had a basic knowledge in robotic surgery and were able to figure out some surgical indications, given the presence of a robotic program already settled up at the institution. Before the hands-on course, 44.0% nurse students and 36.6% of medical students were interested in surgical disciplines and robotic surgery. After the simulation, all students (100%) reported a high level of interest in robotic surgery and some of them required for a dedicated internship (p < 0.001). The students provided also feedback on the perceived ease-of-use of the robotic simulators (on a scale 0-10); overall, the median score was 8, IQR [7-8], with no differences between nursing and medical students (p = 0.482). In conclusion, the study demonstrates a great interest toward robotic surgery as a part of medical and nurse education. A hands-on simulation further improved the interest of undergraduates from both backgrounds. The technological progress with the availability of new surgical systems will be the future challenge of training programs and should be considered at all levels of education.
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Affiliation(s)
- Maria Chiara Sighinolfi
- From the Unit of Urology, Department of Health Science-La Statale University of Milan, ASST Santi Paolo and Carlo, Via Rudini 8, Milan, Italy.
| | - Stefano Terzoni
- From the Unit of Urology, Department of Health Science-La Statale University of Milan, ASST Santi Paolo and Carlo, Via Rudini 8, Milan, Italy
| | - Elena Scanferla
- From the Unit of Urology, Department of Health Science-La Statale University of Milan, ASST Santi Paolo and Carlo, Via Rudini 8, Milan, Italy
| | | | | | - Giorgia Gaia
- Unit of Gynecology, ASST Santi Paolo and Carlo, Milan, Italy
| | | | - Davide Chiumello
- Unit of Anesthesiology, ASST Santi Paolo and Carlo, Milan, Italy
| | - Vipul Patel
- Adventhealth, University of Central Florida, Orlando, FL, USA
| | | | - Filippo Turri
- From the Unit of Urology, Department of Health Science-La Statale University of Milan, ASST Santi Paolo and Carlo, Via Rudini 8, Milan, Italy
| | - Paolo Dell'Orto
- From the Unit of Urology, Department of Health Science-La Statale University of Milan, ASST Santi Paolo and Carlo, Via Rudini 8, Milan, Italy
| | - Serena Maruccia
- From the Unit of Urology, Department of Health Science-La Statale University of Milan, ASST Santi Paolo and Carlo, Via Rudini 8, Milan, Italy
| | - Angelica Grasso
- From the Unit of Urology, Department of Health Science-La Statale University of Milan, ASST Santi Paolo and Carlo, Via Rudini 8, Milan, Italy
| | - Mattia Sangalli
- From the Unit of Urology, Department of Health Science-La Statale University of Milan, ASST Santi Paolo and Carlo, Via Rudini 8, Milan, Italy
| | - Stefano Centanni
- Department of Health Science-La Statale University of Milan, ASST Santi Paolo and Carlo, Milan, Italy
| | - Matteo Stocco
- Department of Health Science-La Statale University of Milan, ASST Santi Paolo and Carlo, Milan, Italy
| | - Simone Assumma
- From the Unit of Urology, Department of Health Science-La Statale University of Milan, ASST Santi Paolo and Carlo, Via Rudini 8, Milan, Italy
| | - Luca Sarchi
- From the Unit of Urology, Department of Health Science-La Statale University of Milan, ASST Santi Paolo and Carlo, Via Rudini 8, Milan, Italy
| | - Tommaso Calcagnile
- From the Unit of Urology, Department of Health Science-La Statale University of Milan, ASST Santi Paolo and Carlo, Via Rudini 8, Milan, Italy
| | - Enrico Panio
- From the Unit of Urology, Department of Health Science-La Statale University of Milan, ASST Santi Paolo and Carlo, Via Rudini 8, Milan, Italy
| | | | - Bernardo Rocco
- From the Unit of Urology, Department of Health Science-La Statale University of Milan, ASST Santi Paolo and Carlo, Via Rudini 8, Milan, Italy
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Sighinolfi M, Scanferla E, Terzoni S, Calcagnile T, Assumma S, Stroppa D, Guglielmo O, Santoro V, Gaia G, Margarita A, Formisano G, Salaj A, Pisani Ceretti A, Barabino M, Bianchi P, Bozzini G, Micali S, Piacentini I, Maggioni M, Grasso A, Sarchi L, Del Nero A, Dell’Orto P, Rocco B. The introduction of novel robotic platforms and simulator tasks: Results of a multivariate analysis of factors impacting basic skills acquisition at the HugoTM RAS simulator. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00370-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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13
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Rocco B, Gaia G, Assumma S, Calcagnile T, Sangalli M, Terzoni S, Eissa A, Bozzini G, De Concilio B, Celia A, Micali S, Sighinolfi MC. Corrigendum to "Rectal Perforation During Pelvic Surgery" [Eur Urol Open Sci 44 (2022) 54-59]. EUR UROL SUPPL 2023; 49:10. [PMID: 36874597 PMCID: PMC9974975 DOI: 10.1016/j.euros.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
[This corrects the article DOI: 10.1016/j.euros.2022.04.006.].
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Affiliation(s)
- Bernardo Rocco
- Department of Urology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Giorgia Gaia
- Department of Gynecology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Simone Assumma
- Department of Urology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Tommaso Calcagnile
- Department of Urology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Mattia Sangalli
- Department of Urology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Stefano Terzoni
- SIG Group on Continence Care, European Association of Urology Nurses, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Ahmed Eissa
- Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | | | - Antonio Celia
- San Bassiano Hospital, Bassano Del Grappa, Vicenza, Italy
| | - Salvatore Micali
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
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14
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Sighinolfi MC, Assumma S, Cassani A, Sarchi L, Calcagnile T, Terzoni S, Sandri M, Micali S, Noel J, Moschovas MC, Seetharam B, Bozzini G, Patel V, Rocco B. Pre-operative prediction of extracapsular extension of prostate cancer: first external validation of the PRECE model on an independent dataset. Int Urol Nephrol 2023; 55:93-97. [PMID: 36181585 DOI: 10.1007/s11255-022-03365-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 08/11/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION The PRECE is a model predicting the risk of extracapsular extension (ECE) of prostate cancer: it has been developed on more than 6000 patients who underwent robotic radical prostatectomy (RARP) at the Global Robotic Institute, FL, USA. Up to now, it is the single tool predicting either the side and the amount of ECE. The model has a free user-friendly interface and is made up from simple and available covariates, namely age, PSA, cT, GS and percent of positive core, the latter topographically distributed within the prostate gland. Despite the successful performance at internal validation, the model is still lacking an external validation (EV). The aim of the paper is to externally validate the PRECE model on an Italian cohort of patients elected to RARP. METHODS 269 prostatic lobes from 141 patients represented the validation dataset. The EV was performed with the receiver operating characteristics (ROC) curves and calibration, to address the ability of PRECE to discriminate between patients with or without ECE. RESULTS Overall, an ECE was found in 91 out of the 269 prostatic lobes (34%). Twenty-five patients out of pT3 had a bilateral ECE. The ROC curve showed an AUC of 0.80 (95% CI 0.74-0.85). Sensitivity and specificity were 77% and 69%, respectively. The model showed an acceptable calibration with tendency towards overestimation. CONCLUSIONS From the current EV, the PRECE displays a good predictive performance to discriminate between cases with and without ECE; despite preliminary, outcomes may support the generalizability of the model in dataset other than the development one.
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Affiliation(s)
| | - Simone Assumma
- ASST Santi Paolo e Carlo, Milan, Italy.,Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | | | - Luca Sarchi
- Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Tommaso Calcagnile
- ASST Santi Paolo e Carlo, Milan, Italy.,Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | | | - Marco Sandri
- Data Methods and Systems Statistical Laboratory, University of Brescia, Brescia, Italy
| | | | | | | | | | | | | | - Bernardo Rocco
- ASST Santi Paolo e Carlo, Milan, Italy.,University of Milan, Milan, Italy
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15
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Calcagnile T, Sighinolfi MC, Rocco B, Assumma S, Di Bari S, Panio E, Pescuma A, Ticonosco M, Tosi G, Oltolina P, Resca S, Kaleci S, Galli R, Curti P, Schips L, Ditonno P, Villa L, Ferretti S, Bergamaschi F, Bozzini G, Eissa A, Zoeir A, Sherbiny AE, Frattini A, Prati A, Fedelini P, Okhunov Z, Tubaro A, Landman J, Bianchi G, Puliatti S, Micali S. Asymptomatic bacteriuria in candidates for active treatment of renal stones: results from an international multicentric study on more than 2600 patients. Urolithiasis 2022; 51:16. [PMID: 36512096 DOI: 10.1007/s00240-022-01385-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/17/2022] [Indexed: 12/15/2022]
Abstract
The occurrence of asymptomatic bacteriuria concomitant to urolithiasis is an issue for patients undergoing renal stone treatment. Disposing of a preoperative urine culture is essential to reduce the risk of septic events. The endpoint of the study is to report which characteristics of candidates for renal stone treatment are frequently associated with positive urine culture. 2605 patients were retrospectively enrolled from 14 centers; inclusion criteria were age > 18 and presence of a single renal stone 1-2 cm in size. The variables collected included age, gender, previous renal surgery, comorbidities, skin-to-stone distance, stone size, location, density, presence of hydronephrosis. After a descriptive analysis, the association between continuous and categorical variables and the presence of positive urine culture was assessed using a logistic regression model. Overall, 240/2605 patients (9%) had preoperative bacteriuria. Positive urine culture was more frequent in females, patients with previous renal interventions, chronic kidney disease, congenital anomalies, larger stones, increased density. Multivariate analysis demonstrated that previous renal interventions (OR 2.6; 95% CI 1.9-3.4; p < 0.001), renal-related comorbidities (OR 1.31; 95% CI 1.19-1.4; p < 0.001), higher stone size (OR 1.06; 95% CI 1.02-1.1; p = 0.01) and density (OR 1.00; 95% CI 1.0-1.00; p = 0.02) were associated with bacteriuria; male gender and lower caliceal location were inversely related to it. Beyond expected risk factors, such as female gender, other parameters are seemingly favoring the presence of positive urine culture. The awareness of variables associated with bacteriuria allows to assess which individuals are at increased risk of presenting bacteriuria and reduce the rate of septic complications.
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Affiliation(s)
- T Calcagnile
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy.
- Department of Urology, ASST Santi Paolo e Carlo-University of Milan, Milan, Italy.
| | - M C Sighinolfi
- Department of Urology, ASST Santi Paolo e Carlo-University of Milan, Milan, Italy
| | - B Rocco
- Department of Urology, ASST Santi Paolo e Carlo-University of Milan, Milan, Italy
| | - S Assumma
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
- Department of Urology, ASST Santi Paolo e Carlo-University of Milan, Milan, Italy
| | - S Di Bari
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - E Panio
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
- Department of Urology, ASST Santi Paolo e Carlo-University of Milan, Milan, Italy
| | - A Pescuma
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - M Ticonosco
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - G Tosi
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - P Oltolina
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - S Resca
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - S Kaleci
- Clinical and Experimental Medicine (CEM), Department of Surgical, Medical, Dental and Morphological Sciences With Interest in Transplant, Oncology and Regenerative Medicine, University of Modena & Reggio Emilia, Modena, Italy
| | - R Galli
- Department of Urology, Policlinico San Pietro, Ponte San Pietro, Italy
| | - P Curti
- Ospedale "Mater Salutis"-AULSS 9 Scaligera, Verona, Italy
| | - L Schips
- Department of Urology, Ospedale SS. Annunziata, Chieti, Italy
| | - P Ditonno
- Department of Urology, University of Bari, Bari, Italy
| | - L Villa
- Department of Urology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - S Ferretti
- Department of Urology, Ospedale Maggiore, Parma, Italy
| | - F Bergamaschi
- Department of Urology, Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | - G Bozzini
- Department of Urology, Ospedale Sant'Anna, Como, Italy
| | - A Eissa
- Department of Urology, Tanta University, Tanta, Egypt
| | - A Zoeir
- Department of Urology, Tanta University, Tanta, Egypt
| | - A El Sherbiny
- Department of Urology, Tanta University, Tanta, Egypt
| | - A Frattini
- Department of Urology, Ospedale Civile di Guastalla, Guastalla, Italy
| | - A Prati
- Department of Urology, Ospedale di Vaio, Fidenza, Italy
| | - P Fedelini
- Department of Urology, AORN Antonio Cardarelli, Naples, Italy
| | - Z Okhunov
- Department of Urology, University of California, Irvine, CA, USA
| | - A Tubaro
- Department of Urology, Ospedale Sant'Andrea, la Sapienza" University, Rome, Italy
| | - J Landman
- Department of Urology, University of California, Irvine, CA, USA
| | - G Bianchi
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - S Puliatti
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - S Micali
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
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16
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Rocco B, Eissa A, Gaia G, Assumma S, Sarchi L, Bozzini G, Micali S, Calcagnile T, Sighinolfi MC. Pelvic lymph node dissection in prostate and bladder cancers. Minerva Urol Nephrol 2022; 74:680-694. [PMID: 36197698 DOI: 10.23736/s2724-6051.22.04904-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Prostate cancer and bladder cancer accounts for approximately 13.5% and 3% of all male cancers and all newly diagnosed cancers (regardless sex), respectively. Thus, these cancers represent a major health and economic burden globally. The knowledge of lymph node status is an integral part of the management of any solid tumor. In the urological field, pelvic lymph node dissection (PLND) is of paramount importance in the diagnosis, management, and prognosis of prostate and bladder cancers. However, PLND may be associated with several comorbidities. In this narrative review, the most recent updates concerning the patterns and incidence of lymph node metastasis, the role of different imaging studies and nomograms in determining patients' eligibility for PLND, and the anatomical templates of PLND in urologic patients with bladder or prostate cancer will be discussed.
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Affiliation(s)
- Bernardo Rocco
- Department of Urology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Ahmed Eissa
- Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt -
| | - Giorgia Gaia
- Department of Obstetrics and Gynecology, ASST Santi Paolo e Carlo, Milan, Italy
| | - Simone Assumma
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Luca Sarchi
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Salvatore Micali
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Tommaso Calcagnile
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Maria C Sighinolfi
- Department of Urology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
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17
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Rocco B, Assumma S, Calcagnile T, Sangalli M, Turri F, Micali S, Gaia G, Bozzini G, Sighinolfi MC. Reproducibility of a modified posterior reconstruction during robotic intracorporeal neobladder reconfiguration. Int Braz J Urol 2022; 49:136-142. [PMID: 36512461 PMCID: PMC9881819 DOI: 10.1590/s1677-5538.ibju.2022.0417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/07/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Robotic intracorporeal neobladder reconstruction is a complex procedure in which the approximation of the reservoir to the urethral stump can be a demanding step. The aim of the study is to evaluate the reproducibility of a modified posterior reconstruction (PR) during the reconfiguration of intracorporeal neobladder after robot assisted radical cystectomy (RARC). MATERIALS AND METHODS From July 2021 to July 2022, 35 RARC were performed, and 17 patients underwent intracorporeal neobladder reconstruction. A PR was planned in males (14). Intra- and peri-operative data were collected. SURGICAL TECHNIQUE RARC and node dissection are performed. Afterwards, 40-cm ileal segment is isolated; the portion with the more adequate mesenteric length is brought down to the pelvis. A modified PR is performed with a double-armed barbed suture: a first layer connects the Denonvillier's fascia to the rhabdosphincter in a running fashion; the second layer is created with the other arm and approximates the posterior side of the ileal segment towards the urethral stump. In the anterior caudal part of the ileum, a 1.5-cm incision is made to realize the neobladder neck; the neovesical-urethral anastomosis is performed with a second bidirectional suture. RESULTS Anastomotic and PR time were 14 (range 7-20) and 5 minutes (4-8), respectively. A single Clavien IIIa complication was recorded in a patient who underwent NAC and had a C. albicans superinfection in the post-operative course. All patients were discharged with complete or acceptable bladder voiding. Twelve patients with follow-up >90-days reported a satisfying daytime continence. CONCLUSIONS PR represents a simple technical refinement that improves neobladder-urethral anastomosis by favoring ileal approximation to the urethral stump and decreasing anastomotic tension.
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Affiliation(s)
- Bernardo Rocco
- ASST Santi Paolo e CarloDepartment of UrologyMilanoItalyDepartment of Urology, ASST Santi Paolo e Carlo, Milano, Italy
| | - Simone Assumma
- ASST Santi Paolo e CarloDepartment of UrologyMilanoItalyDepartment of Urology, ASST Santi Paolo e Carlo, Milano, Italy
| | - Tommaso Calcagnile
- ASST Santi Paolo e CarloDepartment of UrologyMilanoItalyDepartment of Urology, ASST Santi Paolo e Carlo, Milano, Italy
| | - Mattia Sangalli
- ASST Santi Paolo e CarloDepartment of UrologyMilanoItalyDepartment of Urology, ASST Santi Paolo e Carlo, Milano, Italy
| | - Filippo Turri
- ASST Santi Paolo e CarloDepartment of UrologyMilanoItalyDepartment of Urology, ASST Santi Paolo e Carlo, Milano, Italy
| | - Salvatore Micali
- University of Modena and Reggio EmiliaDepartment of UrologyItalyDepartment of Urology, University of Modena and Reggio Emilia, Italy
| | - Giorgia Gaia
- ASST Santi Paolo e CarloDepartment of Gynecology and ObstetricsMilanoItalyDepartment of Gynecology and Obstetrics, ASST Santi Paolo e Carlo, Milano, Italy
| | | | - Maria Chiara Sighinolfi
- ASST Santi Paolo e CarloDepartment of UrologyMilanoItalyDepartment of Urology, ASST Santi Paolo e Carlo, Milano, Italy,Correspondence address: Maria Chiara Sighinolfi MD, PhD, Department of Urology, ASST Santi Paolo e Carlo, Milano, Italy. Telephone: +39 059 541298 E-mail.
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Farinha R, Sarchi L, Paciotti M, Bravi CA, Mottaran A, Piro A, Nocera L, Calcagnile T, Assumma S, Sighinolfi MC, Yadav S, Terzoni S, Puliatti S, Koukourikis P, Groote RD, Faustino F, Naeyer GD, Gaia G, Rocco B, Mottrie A. New Robotic Platforms for Gynecology. Are We Achieving One of the Golden Goals? CLIN EXP OBSTET GYN 2022. [DOI: 10.31083/j.ceog4911246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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19
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Calcagnile T, Sighinolfi M, Puliatti S, Kaleci S, Ticonosco M, Benedetti M, Assumma S, Di Bari S, Ragusa A, Piro A, Ciarlariello S, Fidanza F, Di Pietro C, Rocco B, Micali S. External validation of a nomogram for outcome prediction in management of medium-sized (1–2 CM) kidney stones. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01042-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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20
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Sighinolfi MC, Eissa A, Bellorofonte C, Mofferdin A, Eldeeb M, Assumma S, Panio E, Calcagnile T, Stroppa D, Bozzini G, Gaia G, Terzoni S, Sangalli M, Micali S, Rocco B. Low-intensity Extracorporeal Shockwave Therapy for the Management of Postprostatectomy Erectile Dysfunction: A Systematic Review of the Literature. EUR UROL SUPPL 2022; 43:45-53. [PMID: 35928730 PMCID: PMC9344341 DOI: 10.1016/j.euros.2022.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2022] [Indexed: 11/22/2022] Open
Abstract
Context Erectile dysfunction (ED) following radical prostatectomy is a concern for patients and their partners. Low-intensity extracorporeal shockwave therapy (LI-ESWT) can potentially enhance tissue repair and regeneration. The aim of the current study was to systematically review the literature to assess the role of LI-ESWT in the management of patients with postprostatectomy ED. Evidence acquisition Two authors independently performed a systematic search of the PubMed and Web of Science databases to identify all relevant articles. Non-English reports, case reports, reviews, letters, and editorials were excluded. Risk of bias was assessed according to the GRADE guidelines. Evidence synthesis Nine articles met the inclusion criteria and were included in the qualitative analysis. All the studies included were published between 2015 and 2022 and the majority of them compared phosphodiesterase type 5 inhibitors (PDE5Is) alone versus a combination of LI-ESWT and PDE5Is. Only three studies were randomized controlled trials (RCTs). In general, there is no standardized protocol for LI-ESWT for postprostatectomy ED. In comparisons of LI-ESWT + PDE5Is versus PDE5Is alone, some authors found a statistically significant improvement in erectile function with LI-ESWT + PDE5Is. The starting time for LI-ESWT differed among the studies, ranging from 3 d to 6 mo after surgery. The main limitations of the review are the scarcity of studies, small sample sizes, high risk of bias, and high heterogeneity among studies. Conclusions There is currently limited evidence on the use of LI-ESWT either alone or in combination with PDE5Is in penile rehabilitation protocols after prostatectomy. However, small clinical trials with short follow-up show that LI-ESWT could potentially play a role in the management of postprostatectomy ED in the future. Further RCTs with larger sample sizes are needed. Patient summary Despite limited reports in the literature, low-intensity shockwave therapy after removal of the prostate is a promising noninvasive treatment for dealing with erectile dysfunction after surgery.
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Affiliation(s)
| | - Ahmed Eissa
- Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
- Corresponding author. Department of Urology, Tanta University Hospitals, Al-Giesh Street, El-Gharbia 31527, Tanta, Egypt. Tel. +2 11 10304666.
| | | | | | - Mosaab Eldeeb
- Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Simone Assumma
- Urology Department, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
- Urology Department, University of Modena & Reggio Emilia, Modena, Italy
| | - Enrico Panio
- Urology Department, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
- Urology Department, University of Modena & Reggio Emilia, Modena, Italy
| | - Tommaso Calcagnile
- Urology Department, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
- Urology Department, University of Modena & Reggio Emilia, Modena, Italy
| | - Daniele Stroppa
- Urology Department, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | | | - Giorgia Gaia
- Gynecology Department, ASST Santi Paolo e Carlo, Milan, Italy
| | - Stefano Terzoni
- Urology Department, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Mattia Sangalli
- Urology Department, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Salvatore Micali
- Urology Department, University of Modena & Reggio Emilia, Modena, Italy
| | - Bernardo Rocco
- Urology Department, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
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21
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Calcagnile T, Sighinolfi M, Rocco B, Oltolina P, Di Bari S, Kaleci S, Galli R, Curti P, Schips L, Ditonno P, Villa L, Ferretti S, Bergamaschi F, Bozzini G, Zoeir A, El Sherbiny A, Frattini A, Fedelini P, Okhunov Z, Tubaro A, Landman J, Puliatti S, Bianchi G, Micali S. Asymptomatic bacteriuria in candidates for active treatment of renal stones: Results from an international multicentric study on more than 2600 patients. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00347-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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22
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Sarchi L, Eissa A, Puliatti S, Amato M, Assumma S, Calcagnile T, Ticonosco M, Iseppi A, Toso S, Sighinolfi MC, Bianchi G, Micali S, Rocco B. Psychological distress among patients awaiting histopathologic results after prostate biopsy: An unaddressed concern. Urologia 2021; 89:382-387. [PMID: 34612746 DOI: 10.1177/03915603211049889] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Prostate cancer is the most commonly diagnosed neoplasm in men. From the introduction of PSA testing, an increasing number of men undergoes prostate biopsy (PBX). While the physical side effects of PBx have been well investigated, its psychological impact has been under-evaluated. AIM The aim of our study is to investigate the presence of psychological distress (anxiety and depression) in patients waiting for histopathological results after prostate biopsy (PBx). METHODS From February to April 2019, 51 consecutive patients undergoing prostate biopsies at our institution were included. Age, PSA, DRE, familiarity for prostate cancer, number of previous biopsies, type of anesthesia, number of cores were recorded. All patients filled the Hospital Anxiety and Depression Scale (HADS), a psychometric Likert-scale questionnaire, before receiving the histopathological results of their PBx. RESULTS The prevalence of psychological distress among patients awaiting histopathologic results is 41% (21/51 patients), with anxiety being the main component of their distress. On multivariate analysis, PSA, family history, and repeat biopsy were significantly associated with anxiety and depression. CONCLUSION Patients undergoing PBx experience a burden of psychological distress waiting for histopathologic results, especially anxiety. Appropriate counseling should be offered to patients at high risk of developing psychological distress after PBx. Future goals would include technological improvements to shorten the time between biopsy and definitive results.
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Affiliation(s)
- Luca Sarchi
- Urology Department, University of Modena & Reggio Emilia, Modena, Italy
| | - Ahmed Eissa
- Urology Department, University of Modena & Reggio Emilia, Modena, Italy.,Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Stefano Puliatti
- Urology Department, University of Modena & Reggio Emilia, Modena, Italy.,ORSI Academy, Gent, Belgium.,Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
| | - Marco Amato
- Urology Department, University of Modena & Reggio Emilia, Modena, Italy.,ORSI Academy, Gent, Belgium.,Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
| | - Simone Assumma
- Urology Department, University of Modena & Reggio Emilia, Modena, Italy
| | | | - Marco Ticonosco
- Urology Department, University of Modena & Reggio Emilia, Modena, Italy
| | - Andrea Iseppi
- Urology Department, University of Modena & Reggio Emilia, Modena, Italy
| | - Stefano Toso
- Urology Department, University of Modena & Reggio Emilia, Modena, Italy
| | | | - Giampaolo Bianchi
- Urology Department, University of Modena & Reggio Emilia, Modena, Italy
| | - Salvatore Micali
- Urology Department, University of Modena & Reggio Emilia, Modena, Italy
| | - Bernardo Rocco
- Urology Department, University of Modena & Reggio Emilia, Modena, Italy
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23
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Sighinolfi M, Battaglia M, Bellardita L, Castiglioni S, Dal Moro F, De Giorgi U, De Monte A, Di Maio M, Gaboardi F, Gontero P, Jereczek B, Leonardi R, Lombardi E, Madonia M, Mangiagalli A, Marenghi C, Marrocco W, Masini C, Miano R, Polloni G, Prezioso D, Ruffini L, Sabbatini R, Schips L, Selli C, Valdagni R, Varca V, Veneziano P, Calcagnile T, Rocco B. Prostate cancer awareness among Italian adult males: a national web-based survey. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00789-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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24
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Bonfante G, Ciarlariello S, Sarchi L, Calcagnile T, Assumma S, Filippi B, Pescuma A, Rassweiler J, Gozen A, Silay S, Puliatti S, Eissa A, Bozzini G, Sighinolfi M, Bianchi G, Rocco B, Micali S. Investigating the spread of en bloc resection for bladder cancer in daily practice among IEA and ESUT members. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00701-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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25
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Micali S, Calcagnile T, Sighinolfi M, Iseppi A, Morini E, Benedetti M, Oltolina P, Ragusa A, Kaleci S, Bevilacqua L, Puliatti S, De Nunzio C, Arada R, Chiancone F, Campobasso D, Eissa A, Bonfante G, Simonetti E, Cotugno M, Galli R, Curti P, Schips L, Ditonno P, Villa L, Ferretti S, Bergamaschi F, Bozzini G, Zoeir A, El Sherbiny A, Frattini A, Fedelini P, Okhunov Z, Tubaro A, Landman J, Bianchi G, Rocco B. Urinary tract infections in candidates to active treatment of renal stone: results from an international multicentric study on more than 2600 patients. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00867-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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26
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Sighinolfi MC, Zoeir A, Eissa A, Sarchi L, Assumma S, Calcagnile T, Filippi B, Moschovas M, Bhat S, Puliatti S, Micali S, Bozzini G, Patel V, Rocco B. Review of nomograms to counsel patients after oncologic surgery: a support for telemedicine to stratify the risk of relapse and customize the follow-up scheduling. Minerva Urol Nephrol 2021; 73:402-404. [PMID: 33769010 DOI: 10.23736/s2724-6051.21.04012-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Maria C Sighinolfi
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy -
| | - Ahmed Zoeir
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy.,Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ahmed Eissa
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy.,Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Luca Sarchi
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Simone Assumma
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Tommaso Calcagnile
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Beatrice Filippi
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | - Stefano Puliatti
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Salvatore Micali
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Vipul Patel
- Global Robotic Institute, Celebration, FL, USA
| | - Bernardo Rocco
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
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27
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Calcagnile T, Sighinolfi MC, Sarchi L, Assumma S, Filippi B, Bonfante G, Cassani A, Spandri V, Turri F, Puliatti S, Bozzini G, Moschovas M, Bianchi G, Micali S, Rocco B. COVID-19 and slowdown of residents' activity: Feedback from a novel e-learning event and overview of the literature. Urologia 2021; 88:332-336. [PMID: 33749385 DOI: 10.1177/03915603211001253] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the impact of an e-learning online event, created for supporting resident's training during the slowdown of surgical and clinical activities caused by COVID-19 pandemic. An overview of PubMed literature depicting the state of the art of urology residency in the COVID-19 era was performed as well, to contextualize the issue. METHODS An online learning event for residents was set up at the beginning of the pandemic; the faculty consisted of experts in urology who provided on-line lectures and videos on surgical anatomy, procedures, updates in guidelines, technology, training. The audience was composed of 30-500 attendees from Italy, USA, India and Belgium. A questionnaire to analyze relevance, satisfaction and popularity of the lessons was mailed to 30 local residents. RESULTS AND LIMITATIONS Almost all residents defined the web environment suitable to achieve the learning outcomes; the method, the number and the competence of the faculty were appropriate/excellent. Most of the younger residents (81.8%) stated their surgical knowledge would improve after the course; 72.7% declared they would take advantage into routine inpatients clinical activity. Nineteen more expert residents agreed that the course would improve their surgical knowledge and enhance their practical skills; almost all stated that the initiative would change their outpatients and inpatients practice. Overall, 44 articles available in PubMed have addressed the concern of urological learning and training during the pandemic from different standpoints; four of them considered residents' general perception towards web-based learning programs. CONCLUSIONS The paper confirms residents' satisfaction with e-learning methods and, to our knowledge, is the first one focusing on a specific event promptly settled up at the beginning of the outbreak. Web-based educational experience developed during the pandemic may represent the very basis for the implementation of prospective on-site training and overall scientific update of future urologists.
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Affiliation(s)
- Tommaso Calcagnile
- Department of Urology, University of Modena & Reggio Emilia, Modena, Italy
| | | | - Luca Sarchi
- Department of Urology, University of Modena & Reggio Emilia, Modena, Italy
| | - Simone Assumma
- Department of Urology, University of Modena & Reggio Emilia, Modena, Italy
| | - Beatrice Filippi
- Department of Urology, University of Modena & Reggio Emilia, Modena, Italy
| | - Giulia Bonfante
- Department of Urology, University of Modena & Reggio Emilia, Modena, Italy
| | - Alessandra Cassani
- Department of Urology, University of Modena & Reggio Emilia, Modena, Italy
| | - Valentina Spandri
- Department of Urology, University of Modena & Reggio Emilia, Modena, Italy
| | - Filippo Turri
- Department of Urology, University of Modena & Reggio Emilia, Modena, Italy
| | - Stefano Puliatti
- Department of Urology, University of Modena & Reggio Emilia, Modena, Italy
| | - Giorgio Bozzini
- Department of Urology, ASST Valle Olona Busto Arsizio, Varese, Italy
| | - Marcio Moschovas
- Department of Urology, Advent Health Global Robotics Institute, Celebration, FL, USA
| | - Giampaolo Bianchi
- Department of Urology, University of Modena & Reggio Emilia, Modena, Italy
| | - Salvatore Micali
- Department of Urology, University of Modena & Reggio Emilia, Modena, Italy
| | - Bernardo Rocco
- Department of Urology, University of Modena & Reggio Emilia, Modena, Italy
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Ticonosco M, Assumma S, Iseppi A, Benedetti M, Sarchi L, Ferrari R, Calcagnile T, Rocco B, Sighinolfi MC, Alriyalat S, Reggiani Bonetti L, Migaldi M, Micali S. Expression of aquaporins 3 in low grade risk of recurrence primary bladder cancer. Urologia 2021; 88:190-193. [PMID: 33612088 DOI: 10.1177/0391560321993588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Bladder cancer (BC) is one of the most frequent malignancy of the urinary tract. Recent studies demonstrated the role of aquaporins urothelial tumor cells (AQPs) as potential prognostic factor for tumor progression and invasion. In this study we investigated the AQP3 expression levels inside primary superficial (pTa) low grade bladder cancer, correlating with pathological parameters and clinical outcomes. MATERIALS AND METHODS We retrospectively analyzed tumor samples of 66 patients with diagnosis of superficial urothelial (pTa) bladder cancer between 1997 and 2007. All patients underwent transurethral bladder resection (TURB) and immediate single instillation of mitomycin C. All tumors samples were blindly reviewed by two expert anatomopathologists and only pTa low grade urothelial bladder cancer were included. Cancer recurrence was defined as the detection of bladder lesions during follow-up cystoscopy. AQP3-immunoreactive areas detected at immunohistochemical analysis were classified as AQP3 positive. RESULTS Of these 60.6% of patients was detected as negative for AQP3 expression. Forty-two patients develop cancer recurrence during follow-up with a mean progression free survival of 16.44 months. The absence of reaction for AQP3 was observed 56% (9/16) tumor grading G1 and 62% (31/50) tumor grading G2. No correlation was observed with sexual gender, grading of tumor differentiation, and recurrence of cancer disease. Kaplan-Meier curves of disease-free survival (DFS) showed a significant separation (p = 0.028) between patients AQP3-positive and AQP3-negative. It was observed a mean DFS of 23.83 and 14.43 months respectively in absence and presence of AQP3 expression. CONCLUSION AQP3 expression is related to disease-free interval (DFI) and the absence of AQP3 expression correlates with a late relapse. The expression of AQP3 does not provide a reproducible quantitative aspect. AQP3 are not suitable to forecast tumor cell behavior but they perform a role as regulator for tumor cell homeostasis and for additional therapeutic developments.
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Affiliation(s)
- Marco Ticonosco
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Simone Assumma
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Andrea Iseppi
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Mattia Benedetti
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Luca Sarchi
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Riccardo Ferrari
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Tommaso Calcagnile
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Bernardo Rocco
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | | | - Mario Migaldi
- Department of Pathology, University of Modena and Reggio Emilia, Modena, Italy
| | - Salvatore Micali
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
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29
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Micali S, Sighinolfi MC, Iseppi A, Morini E, Calcagnile T, Benedetti M, Ticonosco M, Kaleci S, Bevilacqua L, Puliatti S, De Nunzio C, Arada R, Chiancone F, Campobasso D, Eissa A, Bonfante G, Simonetti E, Cotugno M, Galli R, Curti P, Schips L, Ditonno P, Villa L, Ferretti S, Bergamaschi F, Bozzini G, Zoeir A, Sherbiny AE, Frattini A, Fedelini P, Okhunov Z, Tubaro A, Landman J, Bianchi G, Rocco B. Initial Experience and Evaluation of a Nomogram for Outcome Prediction in Management of Medium-sized (1-2 cm) Kidney Stones. Eur Urol Focus 2021; 8:276-282. [PMID: 33419709 DOI: 10.1016/j.euf.2020.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/18/2020] [Accepted: 12/18/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND The gold standard treatment for solitary medium-sized (1-2 cm) renal stones is not defined by recent guidelines, since management modalities including shockwave lithotripsy (SWL), retrograde intrarenal surgery (RIRS), and percutaneous nephrolithotomy (PNL) are recommended. Improved ability to predict patient outcomes would aid in patients' counseling and decision-making. OBJECTIVE To develop a nomogram predicting treatment failure, based on preoperative clinical variables, to be used in the preplanning setting. DESIGN, SETTING, AND PARTICIPANTS We recruited 2605 patients from 14 centers and carried out a multicenter retrospective analysis of 699 SWL, 1290 RIRS, and 616 PN L procedures performed as first-line treatment for 1-2-cm kidney stones. The variables evaluated included age, gender, previous renal surgery, body mass index, stone size, location, stone density, skin-to-stone distance, presence of urinary tract infections (UTIs), and hydronephrosis. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Multivariate logistic regression was fitted to predict treatment failure, defined as the presence of residual fragments >4 mm. A nomogram was developed based on the coefficients of the logit function. RESULTS AND LIMITATIONS A total of 2431 (93.3%) patients were stone free; 174 (6.7%) treatment failures were recorded and considered the event to be predicted. On univariate analysis, type of procedure, preoperative hydronephrosis, stone density, stone location, and laterality turned out to be statistically significant. Skin-to-stone distance, UTIs, and previous renal surgery were predictors of failure on multivariate analysis. Each variable was given a score based on statistical relevance. The main limitation of the current study is its retrospective nature. CONCLUSIONS This nomogram provides a prediction of treatment failure and need of reintervention for medium-sized kidney stones. External validation is needed to determine its reproducibility and validity. PATIENT SUMMARY We developed a preoperative model of treatment outcomes for 1-2-cm kidney stones. Its application may assist urologists to counsel patients with regard to stone management modality.
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Affiliation(s)
- Salvatore Micali
- Department of Urology, Azienda Ospedaliero-Universitaria, Urological Residency School Network, University of Modena & Reggio Emilia, Modena, Italy
| | - Maria Chiara Sighinolfi
- Department of Urology, Azienda Ospedaliero-Universitaria, Urological Residency School Network, University of Modena & Reggio Emilia, Modena, Italy.
| | - Andrea Iseppi
- Department of Urology, Azienda Ospedaliero-Universitaria, Urological Residency School Network, University of Modena & Reggio Emilia, Modena, Italy
| | - Elena Morini
- Department of Urology, Azienda Ospedaliero-Universitaria, Urological Residency School Network, University of Modena & Reggio Emilia, Modena, Italy
| | - Tommaso Calcagnile
- Department of Urology, Azienda Ospedaliero-Universitaria, Urological Residency School Network, University of Modena & Reggio Emilia, Modena, Italy
| | - Mattia Benedetti
- Department of Urology, Azienda Ospedaliero-Universitaria, Urological Residency School Network, University of Modena & Reggio Emilia, Modena, Italy
| | - Marco Ticonosco
- Department of Urology, Azienda Ospedaliero-Universitaria, Urological Residency School Network, University of Modena & Reggio Emilia, Modena, Italy
| | - Shaniko Kaleci
- Clinical and experimental medicine (CEM), Department of Surgical, Medical, Dental and Morphological Sciences with Interest in Transplant, Oncology and Regenerative Medicine, University of Modena & Reggio Emilia, Modena, Italy
| | - Luigi Bevilacqua
- Department of Urology, Azienda Ospedaliero-Universitaria, Urological Residency School Network, University of Modena & Reggio Emilia, Modena, Italy
| | - Stefano Puliatti
- Department of Urology, Azienda Ospedaliero-Universitaria, Urological Residency School Network, University of Modena & Reggio Emilia, Modena, Italy
| | - Cosimo De Nunzio
- Department of Urology, Ospedale Sant'Andrea, "La Sapienza" University, Rome, Italy
| | - Raphael Arada
- Department of Urology, University of California, Irvine, Orange, CA, USA
| | | | - Davide Campobasso
- Department of Urology, Ospedale Civile di Guastalla, Urological Residency School Network, University of Modena & Reggio Emilia, Guastalla, Italy
| | - Ahmed Eissa
- Department of Urology, Tanta University, Tanta, Egypt
| | - Giulia Bonfante
- Department of Urology, Azienda Ospedaliero-Universitaria, Urological Residency School Network, University of Modena & Reggio Emilia, Modena, Italy
| | - Elisa Simonetti
- Department of Urology, Ospedale Maggiore, Urological Residency School Network, University of Modena & Reggio Emilia, Parma, Italy
| | - Michele Cotugno
- Department of Urology, Ospedale di Vaio, Urological Residency School Network, University of Modena & Reggio Emilia, Fidenza, Italy
| | - Riccardo Galli
- Department of Urology, Policlinico San Pietro, Ponte San Pietro, Italy
| | - Pierpaolo Curti
- Department of Urology, Ospedale Mater Salutis, Legnago, Italy
| | - Luigi Schips
- Department of Urology, Ospedale SS. Annunziata, Chieti, Italy
| | | | - Luca Villa
- Department of Urology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Stefania Ferretti
- Department of Urology, Ospedale Maggiore, Urological Residency School Network, University of Modena & Reggio Emilia, Parma, Italy
| | - Franco Bergamaschi
- Department of Urology, Arcispedale S. Maria Nuova, Urological Residency School Network, University of Modena & Reggio Emilia, Reggio Emilia, Italy
| | - Giorgio Bozzini
- Department of Urology, ASST Valle Olona, Urological Residency School Network, University of Modena & Reggio Emilia, Busto Arsizio, Varese, Italy
| | - Ahmed Zoeir
- Department of Urology, Tanta University, Tanta, Egypt
| | | | - Antonio Frattini
- Department of Urology, Ospedale Civile di Guastalla, Urological Residency School Network, University of Modena & Reggio Emilia, Guastalla, Italy
| | - Paolo Fedelini
- Department of Urology, AORN Antonio Cardarelli, Naples, Italy
| | - Zhamshid Okhunov
- Department of Urology, University of California, Irvine, Orange, CA, USA
| | - Andrea Tubaro
- Department of Urology, Ospedale Sant'Andrea, "La Sapienza" University, Rome, Italy
| | - Jaime Landman
- Department of Urology, University of California, Irvine, Orange, CA, USA
| | - Giampaolo Bianchi
- Department of Urology, Azienda Ospedaliero-Universitaria, Urological Residency School Network, University of Modena & Reggio Emilia, Modena, Italy
| | - Bernardo Rocco
- Department of Urology, Azienda Ospedaliero-Universitaria, Urological Residency School Network, University of Modena & Reggio Emilia, Modena, Italy
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30
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Benedetti M, Sighinolfi M, Calcagnile T, Saraceni G, Mofferdin A, Ferrari N, Puliatti S, Amato M, Bozzini G, Ahmed Z, Ahmed E, Ahmed E, De Nunzio C, Nacchia A, Fedelini P, Chiancone F, Ferretti S, Curti P, Bianchi G, Rocco B, Micali S. ESWL in the 21th century: Results from a multi-institutional international study. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)35408-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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31
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Sighinolfi M, Sarchi L, Ticonosco M, Filippi B, Assumma S, Calcagnile T, Morini E, Bonfante G, Sandri M, Puliatti S, Amato M, Micali S, Bianchi G, Maiorana A, Bonetti L, Rocco B. The Prediction of extracapsular extension of prostate cancer: First external validation study of the PRECE model. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)35369-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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