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Taje R, Peer M, Gallina FT, Ambrogi V, Sharbel A, Melis E, Elia S, Idit M, Facciolo F, Patirelis A, Sorge R, Pompeo E. Ergonomic Assessment of Robotic versus Thoracoscopic Thymectomy. J Clin Med 2024; 13:1841. [PMID: 38610606 PMCID: PMC11012820 DOI: 10.3390/jcm13071841] [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: 01/02/2024] [Revised: 03/13/2024] [Accepted: 03/20/2024] [Indexed: 04/14/2024] Open
Abstract
Introduction: Robotic and thoracoscopic surgery are being increasingly adopted as minimally invasive alternatives to open sternotomy for complete thymectomy. The superior maneuverability range and three-dimensional magnified vision are potential ergonomical advantages of robotic surgery. To compare the ergonomic characteristics of robotic versus thoracoscopic thymectomy, a previously developed scoring system based on impartial findings was employed. The relationship between ergonomic scores and perioperative endpoints was also analyzed. Methods: Perioperative data of patients undergoing robotic or thoracoscopic complete thymectomy between January 2014 and December 2022 at three institutions were retrospectively retrieved. Surgical procedures were divided into four standardized surgical steps: lower-horns, upper-horns, thymic veins and peri-thymic fat dissection. Three ergonomic domains including maneuverability, exposure and instrumentation were scored as excellent(score-3), satisfactory(score-2) and unsatisfactory(score-1) by three independent reviewers. Propensity score matching (2:1) was performed, including anterior mediastinal tumors only. The primary endpoint was the total maneuverability score. Secondary endpoints included the other ergonomic domain scores, intraoperative adverse events, conversion to sternotomy, operative time, post-operative complications and residual disease. Results: A total of 68 robotic and 34 thoracoscopic thymectomies were included after propensity score matching. The robotic group had a higher total maneuverability score (p = 0.039), particularly in the peri-thymic fat dissection (p = 0.003) and peri-thymic fat exposure score (p = 0.027). Moreover, the robotic group had lower intraoperative adverse events (p = 0.02). No differences were found in residual disease. Conclusions: Robotic thymectomy has shown better ergonomic maneuverability compared to thoracoscopy, leading to fewer intraoperative adverse events and comparable early oncological results.
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Affiliation(s)
- Riccardo Taje
- Department of Thoracic Surgery, University of Rome “Tor Vergata”, 00133 Rome, Italy; (R.T.); (V.A.); (A.P.)
- Doctoral School of Microbiology, Immunology, Infectious Diseases and Transplants, MIMIT, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Michael Peer
- Department of Thoracic Surgery, Ichilov Medical Center, Tel Aviv 6423906, Israel; (M.P.); (A.S.)
| | - Filippo Tommaso Gallina
- Department of Thoracic Surgery, IRCCS National Cancer Institute Regina Elena, 00144 Rome, Italy; (F.T.G.); (E.M.); (F.F.)
| | - Vincenzo Ambrogi
- Department of Thoracic Surgery, University of Rome “Tor Vergata”, 00133 Rome, Italy; (R.T.); (V.A.); (A.P.)
| | - Azzam Sharbel
- Department of Thoracic Surgery, Ichilov Medical Center, Tel Aviv 6423906, Israel; (M.P.); (A.S.)
| | - Enrico Melis
- Department of Thoracic Surgery, IRCCS National Cancer Institute Regina Elena, 00144 Rome, Italy; (F.T.G.); (E.M.); (F.F.)
| | - Stefano Elia
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy;
| | - Matot Idit
- Department of Anaesthesia and Intensive Care, Ichilov Medical Center, Tel Aviv 6423906, Israel;
| | - Francesco Facciolo
- Department of Thoracic Surgery, IRCCS National Cancer Institute Regina Elena, 00144 Rome, Italy; (F.T.G.); (E.M.); (F.F.)
| | - Alexandro Patirelis
- Department of Thoracic Surgery, University of Rome “Tor Vergata”, 00133 Rome, Italy; (R.T.); (V.A.); (A.P.)
| | - Roberto Sorge
- Department of Biostatistics, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | - Eugenio Pompeo
- Department of Thoracic Surgery, University of Rome “Tor Vergata”, 00133 Rome, Italy; (R.T.); (V.A.); (A.P.)
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Ceccarelli M, D'Onofrio M, Ambrogi V, Russo M. A numerical analysis of ventilation motion after chest surgery with a RESPIRholter device. Respir Med Case Rep 2024; 49:102005. [PMID: 38576859 PMCID: PMC10992684 DOI: 10.1016/j.rmcr.2024.102005] [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] [Received: 08/02/2023] [Revised: 12/09/2023] [Accepted: 03/06/2024] [Indexed: 04/06/2024] Open
Abstract
This case report presents a numerical evaluation of respiration in terms of biomechanical parameters of chest motion. This experimental evaluation is performed with RESPIRholter, a wearable device specifically developed to monitor the movement in the ribcage through the motion of the sixth rib whose characteristic motion is considered as representative of the motion of the thorax. Here we present test results acquired with a RESPIRholter device in a 6-h acquisition. These results characterize respiration biomechanics for diagnostic purposes in a chest surgery patient, highlighting the diagnostic utility of RESPIRholter in the identification of post-operation respiratory problem.
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Affiliation(s)
- Marco Ceccarelli
- Department of Industrial Engineering, University of Rome Tor Vergata, Via del Politecnico 1, 00133, Rome, Italy
| | - Manuel D'Onofrio
- Department of Surgical Sciences, University of Rome Tor Vergata, 00133, Rome, Italy
| | - Vincenzo Ambrogi
- Department of Surgical Sciences, University of Rome Tor Vergata, 00133, Rome, Italy
| | - Matteo Russo
- Department of Industrial Engineering, University of Rome Tor Vergata, Via del Politecnico 1, 00133, Rome, Italy
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Coco D, Leanza S, Bastone SA, Viola MG, Ambrogi V. Image-guided techniques for localization of pulmonary nodules during video-assisted thoracoscopic surgery lobectomy. Kardiochir Torakochirurgia Pol 2023; 20:251-254. [PMID: 38283561 PMCID: PMC10809814 DOI: 10.5114/kitp.2023.134162] [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] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 06/06/2023] [Indexed: 01/30/2024]
Abstract
In the modern era when screening and early surveillance of pulmonary nodules are increasing in importance, the management of the pulmonary nodule represents a different challenge to thoracic surgeons. The difficulty lies in the merging of sound surgical and oncological principles with more minimally invasive and appropriate lung-sparing surgery. The success rates of video-assisted thoracoscopic surgery (VATS) resection for smaller as well as subsolid nodules have increased as a result of radiologists' preoperative localization tools. Fast tracking in thoracic surgery is promoted by proper postoperative care for patients having lobectomies in combination with the VATS technique. Image-guided surgery refers to the application of a real-time correlation of the surgical field to preoperative imaging data collection that reflects the precise placement of a chosen surgical instrument in the adjacent anatomic structures. Among the cross-sectional digital imaging techniques the most widely utilized imaging modalities for image-guided therapy are computed tomography and magnetic resonance imaging. Additionally, surgical navigation devices, tracking tools, integration software, ultrasound, and angiography are used to support these procedures. For people who are thinking about implementing or optimizing a nodule localization program in view of workflow patterns, surgeon preferences, and institutional resources in a certain facility, this review provides in-depth, unbiased evaluation and offers useful information.
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Affiliation(s)
- Danilo Coco
- Department of General Surgery, Giglio Hospital Foundation, Cefalù (PA), Italy
| | - Silvana Leanza
- Department of General Surgery, Giglio Hospital Foundation, Cefalù (PA), Italy
| | - Sebastiano Angelo Bastone
- Ph.D. Program in Applied Medical-Surgical Sciences, Department of Surgical Science, PTV Policlinico Tor Vergata University, Rome, Italy
| | | | - Vincenzo Ambrogi
- Ph.D. Program in Applied Medical-Surgical Sciences, Department of Surgical Science, PTV Policlinico Tor Vergata University, Rome, Italy
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Gallina FT, Marinelli D, Tajè R, Forcella D, Alessandrini G, Cecere FL, Fusco F, Visca P, Sperduti I, Ambrogi V, Cappuzzo F, Melis E, Facciolo F. Analysis of predictive factors of unforeseen nodal metastases in resected clinical stage I NSCLC. Front Oncol 2023; 13:1229939. [PMID: 38023117 PMCID: PMC10661928 DOI: 10.3389/fonc.2023.1229939] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 08/25/2023] [Indexed: 12/01/2023] Open
Abstract
Background Despite notable advances made in preoperative staging, unexpected nodal metastases after surgery are still significantly detected. In this study we aim to analyze the upstaging rate in patients with clinical stage I NSCLC without evidence of nodal disease in the preoperative staging who underwent lobectomy and radical lymphadenectomy. Methods Patients who underwent lobectomy and systematic lymphadenectomy for clinical stage I NSCLC were evaluated. Exclusion criteria included the neoadjuvant treatment, incomplete resection and no adherence to preoperative guidelines. Results A total of 297 patients were included in the study. 159 patients were female, and the median age was 68 (61 - 73). The variables that showed a significant correlation with the upstaging rate at the univariate analysis were the number of resected lymph nodes and micropapillar/solid adenocar-cinoma subtype. This result was confirmed in the multivariate analysis with a OR= 2.545 (95%CI 1.136-5.701; p=0.02) for the number of resected lymph nodes and a OR=2.717 (95%CI 1.256-5.875; p=0.01) for the high-grade pattern of adenocarcinoma. Conclusion Our results showed that in a homogeneous cohort of patients with clinical stage I NSCLC, the number of resected lymph nodes and the histological subtype of adenocarcinoma can significantly be associated with nodal metastasis.
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Affiliation(s)
| | - Daniele Marinelli
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Riccardo Tajè
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Daniele Forcella
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | | | - Francesca Fusco
- Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Paolo Visca
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Isabella Sperduti
- Biostatistics, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Vincenzo Ambrogi
- Department of Thoracic Surgery, Tor Vergata Policlinic, Rome, Italy
| | - Federico Cappuzzo
- Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Enrico Melis
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Francesco Facciolo
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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Tajè R, Gallina FT, Forcella D, Alessandrini G, Papale M, Sardellitti F, Pierconti F, Coccia C, Ambrogi V, Facciolo F, Melis E. Multimodal evaluation of locoregional anaesthesia efficacy on postoperative pain after robotic pulmonary lobectomy for NSCLC: a pilot study. J Robot Surg 2023; 17:1705-1713. [PMID: 36967424 DOI: 10.1007/s11701-023-01578-y] [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: 02/17/2023] [Accepted: 03/18/2023] [Indexed: 03/28/2023]
Abstract
The primary objectives of the study were to analyse the robotic approach and ultrasound-guided paravertebral block compared to thoracoscopic intercostal nerve block after robotic pulmonary lobectomy on postoperative pain and opioids use. The secondary objectives were to analyse and compare patients' necessity of additional antalgic drugs and patients' performance during respiratory therapy, following robotic surgery and in the two groups. Consecutively, 52 patients undergoing robotic pulmonary lobectomies were treated either with ropivacaine-based intercostal nerve block or paravertebral block from February 2022 to October 2022. When necessary, morphine was administered at day 1. Acetaminophen was administered as an additional antalgic drug on demand up to 3 g per day. Pain was measured 1 h after the end of the surgical procedure and daily through the pain numeric rating scale (NRS). Morphine administration rate and per day and total additional administrations of acetaminophen were recorded. Pain and opioids administration was measured 1 month after the procedure. Data were analysed in the overall population and in the intercostal nerve block group VS paravertebral block group. Overall, 34.6% of the patients required morphine administration and 51.7% of the patients required at least daily acetaminophen administration up to discharge. At 1 month postoperatively, four patients presented with chronic pain and one still was under opioid medication. At intergroup analysis, the paravertebral block group demonstrated lower NRS at fixed time points (p < 0.0001) and lower morphine consumption (45.7%VS11.8%; p = 0.02). Acetaminophen rescue administration at fixed time points was lower in the paravertebral block group (p < 0.0001) and mobility and dynamic pain resulted in better results (p = 0.03; p = 0.04). At 1 month, no differences were found between study groups. Similarly to other minimally invasive techniques, postoperative pain may arise after robotic pulmonary lobectomy. Paravertebral bloc can help to reduce postoperative pain as well as morphine and antalgic drugs administration and improve early mobilization.
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Affiliation(s)
- Riccardo Tajè
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Filippo Tommaso Gallina
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.
| | - Daniele Forcella
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Gabriele Alessandrini
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Maria Papale
- Department of Respiratory Physiology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Federica Sardellitti
- Anesthesiology and Intensive Care Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Federico Pierconti
- Anesthesiology and Intensive Care Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Cecilia Coccia
- Anesthesiology and Intensive Care Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Vincenzo Ambrogi
- Thoracic Surgery Department, Tor Vergata University Polyclinic, 00133, Rome, Italy
| | - Francesco Facciolo
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Enrico Melis
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
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Tacconi F, Mangiameli G, Voulaz E, Patirelis A, Carlea F, Rocca EL, Tamburrini A, Vanni G, Ambrogi V. Blood-Derived Systemic Inflammation Markers and Risk of Nodal Failure in Stage Ia Non-Small Cell Lung Cancer: A Multicentric Study. J Clin Med 2023; 12:4912. [PMID: 37568316 PMCID: PMC10419646 DOI: 10.3390/jcm12154912] [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: 05/19/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Unexpected spread to regional lymph nodes can be found in up to 10% of patients with early stage non-small cell lung cancer (NSCLC), thereby affecting both prognosis and treatment. Given the known relation between systemic inflammation and tumor progression, we sought to evaluate whether blood-derived systemic inflammation markers might help to the predict nodal outcome in patients with stage Ia NSCLC. METHODS Preoperative levels of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic inflammation score (SII, platelets × NLR) were collected from 368 patients who underwent curative lung resection for NSCLC. After categorization, inflammatory markers were subjected to logistic regression and time-event analysis in order to find associations with occult nodal spread and postoperative nodal recurrence. RESULTS No inflammation marker was associated with the risk of occult nodal spread. SII showed a marginal effect on early nodal recurrence at a quasi-significant level (p = 0.065). However, patients with T1c tumors and elevated PLR and/or SII had significantly shorter times to nodal recurrence compared to T1a/T1b patients (p = 0.001), while patients with T1c and normal PLR/SII did not (p = 0.128). CONCLUSIONS blood-derived inflammation markers had no value in the preoperative prediction of nodal status. Nevertheless, our results might suggest a modulating effect of platelet-derived inflammation markers on nodal progression after the resection of tumors larger than 2 cm.
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Affiliation(s)
- Federico Tacconi
- Thoracic Surgery and Breast Unit, Department of Surgical Sciences, Tor Vergata University Polyclinic, Viale Oxford 81, 00133 Rome, Italy; (A.P.); (F.C.); (E.L.R.); (G.V.); (V.A.)
| | - Giuseppe Mangiameli
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (G.M.); (E.V.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
| | - Emanuele Voulaz
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (G.M.); (E.V.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
| | - Alexandro Patirelis
- Thoracic Surgery and Breast Unit, Department of Surgical Sciences, Tor Vergata University Polyclinic, Viale Oxford 81, 00133 Rome, Italy; (A.P.); (F.C.); (E.L.R.); (G.V.); (V.A.)
| | - Federica Carlea
- Thoracic Surgery and Breast Unit, Department of Surgical Sciences, Tor Vergata University Polyclinic, Viale Oxford 81, 00133 Rome, Italy; (A.P.); (F.C.); (E.L.R.); (G.V.); (V.A.)
| | - Eleonora La Rocca
- Thoracic Surgery and Breast Unit, Department of Surgical Sciences, Tor Vergata University Polyclinic, Viale Oxford 81, 00133 Rome, Italy; (A.P.); (F.C.); (E.L.R.); (G.V.); (V.A.)
| | - Alessandro Tamburrini
- Unit of Cardio-thoracic Surgery, Southampton General Hospital, Tremona Road, Southampton SO166YD, UK;
| | - Gianluca Vanni
- Thoracic Surgery and Breast Unit, Department of Surgical Sciences, Tor Vergata University Polyclinic, Viale Oxford 81, 00133 Rome, Italy; (A.P.); (F.C.); (E.L.R.); (G.V.); (V.A.)
| | - Vincenzo Ambrogi
- Thoracic Surgery and Breast Unit, Department of Surgical Sciences, Tor Vergata University Polyclinic, Viale Oxford 81, 00133 Rome, Italy; (A.P.); (F.C.); (E.L.R.); (G.V.); (V.A.)
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Patirelis A, Carlea F, Lo Torto S, Tacconi F, Ambrogi V. The effectiveness of chest T-tube drainage in uniportal video-assisted thoracic surgery. Interdiscip Cardiovasc Thorac Surg 2023:ivad114. [PMID: 37471589 PMCID: PMC10363025 DOI: 10.1093/icvts/ivad114] [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] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/10/2023] [Accepted: 07/01/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVES Uniportal incision located at 4th or 5th intercostal space represents a problem for the correct drainage of distal areas of pleural cavity. The T-shaped tube can drain both the extremities of pleural space. In this study we evaluated the effectiveness of T-chest tube compared to classic chest tube after uniportal video-assisted thoracic surgery. METHODS We compared the effectiveness of T tube and classic 28 CH chest drainage after different surgical procedures in uniportal VATS: lobectomies, wedge resections, pleural and mediastinal biopsies. As primary end-points, drained effusion and evidence of pneumothorax at post-operative day 1, subcutaneous emphysema, tube kinking, obstruction and necessity of repositioning or post-operative thoracentesis were considered. Pain at 6 and 24 hours after surgery, pain at tube removal and mean hospitalization were analyzed as secondary end-points. RESULTS A total of 109 patients was selected for the study, 51 included to the T-tube group while the other 58 ones to the control group with classic drainage. Patients with T-tube showed a significantly lower rate of pneumothorax (29.4% vs 63.8%; p < 0.001), tube kinking (5.9% vs 27.6%; p = 0.003) and need of repositioning (2.0% vs 12.1%; p = 0.043). No significant results were obtained in subcutaneous emphysema (p = 0.26), tube obstruction (p = 0.32), drained effusion (p = 0.11) and need of post-operative thoracentesis (p = 0.18). Patients with T-tube complained of less pain 6 hours after surgery (p < 0.001). Conversely, T-tube removal was reported to be more painful (p < 0.001). CONCLUSIONS Chest T-tube can achieve significantly lower rate of postoperative pneumothorax, kinking and repositioning with less pain 6 hours after surgery compared to classic tube.
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Affiliation(s)
- Alexandro Patirelis
- Unit of Thoracic Surgery, Tor Vergata University Polyclinic, Viale Oxford 81, 00133, Rome, Italy
| | - Federica Carlea
- Unit of Thoracic Surgery, Tor Vergata University Polyclinic, Viale Oxford 81, 00133, Rome, Italy
| | - Sara Lo Torto
- Unit of Thoracic Surgery, Tor Vergata University Polyclinic, Viale Oxford 81, 00133, Rome, Italy
| | - Federico Tacconi
- Unit of Thoracic Surgery, Tor Vergata University Polyclinic, Viale Oxford 81, 00133, Rome, Italy
| | - Vincenzo Ambrogi
- Unit of Thoracic Surgery, Tor Vergata University Polyclinic, Viale Oxford 81, 00133, Rome, Italy
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Marziali V, Frasca L, Ambrogi V, Patirelis A, Longo F, Crucitti P. Prognostic significance of uncertain resection for metastasis in the highest mediastinal lymph node after surgery for clinical N0 non-small cell lung cancer. Front Surg 2023; 10:1115696. [PMID: 37396297 PMCID: PMC10308307 DOI: 10.3389/fsurg.2023.1115696] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 06/01/2023] [Indexed: 07/04/2023] Open
Abstract
Background The International Association for the Study of Lung Cancer defined types of surgical resection and considered the positivity of the highest mediastinal lymph node resected a parameter of "uncertain resection" (R-u). We investigated the metastases in the highest mediastinal lymph node, defined as the lowest numerically numbered station among those resected. We aimed to evaluate the prognostic value of R-u compared with R0. Materials and methods We selected 550 patients with non-small cell lung cancer at clinical Stage I, IIA, IIB (T3N0M0), or IIIA (T4N0M0) undergoing lobectomy and systematic lymphadenectomy between 2015 and 2020. The R-u group included patients with positive highest mediastinal resected lymph node. Results In the groups of patients with mediastinal lymph node metastasis, we defined 31 as R-u (45.6%, 31/68). The incidence of metastases in the highest lymph node was related to the pN2 subgroups (p < 0.001) and the type of lymphadenectomy performed (p < 0.001). The survival analysis compared R0 and R-u: 3-year disease-free survival was 69.0% and 20.0%, respectively, and 3-year overall survival was 78.0% and 40.0%, respectively. The recurrence rate was 29.7% in R0 and 71.0% in R-u (p-value < 0.001), and the mortality rate was 18.9% and 51.6%, respectively (p-value < 0.001). R-u variable showed a tendency to be a significant prognostic factor for disease-free survival and overall survival (hazard ratio: 4.6 and 4.5, respectively, p-value < 0.001). Conclusions The presence of metastasis in the highest mediastinal lymph node removed seems to be an independent prognostic factor for mortality and recurrence. The finding of these metastases represents the margin of cancer dissemination at the time of surgery, so it could imply metastasis into the N3 node or distant metastasis.
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Affiliation(s)
| | - Luca Frasca
- Department of Thoracic Surgery, University Campus Bio-Medico, Rome, Italy
- Microbiology, Immunology, Infectious Diseases, and Transplants (MIMIT), University Tor Vergata, Rome, Italy
| | - Vincenzo Ambrogi
- Department of Thoracic Surgery, University Tor Vergata, Rome, Italy
| | | | - Filippo Longo
- Department of Thoracic Surgery, University Campus Bio-Medico, Rome, Italy
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Ambrogi V, Bolli E, Ceccarelli M, Kaciulis S, Mezzi A, Montanari R, Pakhomova E, Richetta M, Varone A. Surface modifications of biodegradable AZ31 alloy after immersion in physiological solution. SURF INTERFACE ANAL 2023. [DOI: 10.1002/sia.7195] [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: 01/20/2023]
Affiliation(s)
- V. Ambrogi
- Dipartimento di Scienze Chirurgiche, Università di Roma “Tor Vergata” Via del Politecnico 1 00133 Roma Italy
| | - E. Bolli
- Dipartimento di Ingegneria Industriale, Università di Roma “Tor Vergata” Via del Politecnico 1 00133 Roma Italy
- ISMN ‐ CNR
| | - M. Ceccarelli
- Dipartimento di Ingegneria Industriale, Università di Roma “Tor Vergata” Via del Politecnico 1 00133 Roma Italy
| | | | | | - R. Montanari
- Dipartimento di Ingegneria Industriale, Università di Roma “Tor Vergata” Via del Politecnico 1 00133 Roma Italy
| | - E. Pakhomova
- Dipartimento di Ingegneria Meccanica, Chimica e dei Materiali, Università di Cagliari Via Marengo 2 09123 Cagliari Italy
| | - M. Richetta
- Dipartimento di Ingegneria Industriale, Università di Roma “Tor Vergata” Via del Politecnico 1 00133 Roma Italy
| | - A. Varone
- Dipartimento di Ingegneria Industriale, Università di Roma “Tor Vergata” Via del Politecnico 1 00133 Roma Italy
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Marziali V, Frasca L, Ambrogi V, Patirelis A, Longo F, Crucitti P. Non-Lobe Specific Metastases in Occult N2 after Lobectomy for Clinical N0 Non-Small Cell Lung Cancer. Int J Cancer Med 2023; 6:58-68. [PMID: 36790951 PMCID: PMC9924359] [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] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
OBJECTIVES Non-small cell lung cancer can spread into lobe specific stations and non-lobe-specific mediastinal lymph nodes. We evaluated frequency and features of non-lobe specific nodal metastases, focusing especially on the prognostic value of only non-lobe specific N2-metastases after lobectomy. METHODS We performed a retrospective review of 550 patients with non-small cell lung cancer with clinical N0, undergoing lobectomy and systematic or lobe specific node dissection. We evaluated disease free and overall survival rates using Kaplan-Meier method and significance was tested by log-rank test. RESULT Occult N2 disease was detected in 68 patients (8.1%), 26 of them (38.2%) had metastases in non-lobe specific stations. Comparing patients with lobe and non-lobe specific lymph node metastases, 3-years DFS rate was 44.4% vs. 20.0% (p-value = 0.009), while 3-years OS rate was 87.3% vs. 26.7% (p-value <0.001). Among patients with non-lobe specific metastases 16 of them (61.5%) had only non-lobe specific metastases, the remaining 10 patients (38.5%) had metastatic lymph node at the same time in non-lobe specific station but also in lobe-specific stations. Comparing post-operative survival between patients with only non-lobe specific metastases and synchronous lobe and non-lobe specific metastases, 3-years DFS rate was 12.5% vs. 41.3% respectively (p-value = 0.03), and 3-years OS rate was 12.5% vs 76.7% (p-value = 0.002). CONCLUSION In patients with occult N2 disease, the finding of a metastatic lymph node in a non-lobe specific station relates with significant lower survival rate. The subset of patients who presented only non-lobe specific node metastases showed a significant lower survival rate compared to the remaining occult N2.
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Affiliation(s)
| | - Luca Frasca
- Department of Thoracic Surgery, University Campus Bio-Medico, Rome, Italy,PhD course in Microbiology, Immunology, Infectious Diseases, and Transplants (MIMIT), University Tor Vergata, Rome, Italy
| | - Vincenzo Ambrogi
- Department of Thoracic Surgery, University Tor Vergata, Rome, Italy
| | | | - Filippo Longo
- Department of Thoracic Surgery, University Campus Bio-Medico, Rome, Italy
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11
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Puglisi L, Ceccarelli M, Taje R, Ambrogi V. An experimental characterization of ventilation motions in healthy subjects. Clin Biomech (Bristol, Avon) 2022; 100:105769. [PMID: 36228417 DOI: 10.1016/j.clinbiomech.2022.105769] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 09/17/2022] [Accepted: 09/23/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Existing devices detect main breathing data and none is aimed to monitor biomechanics of ventilation motions with small wearable device. METHODS The used device has been designed for noninvasive wearing to detect main motion parameters of a rib during ventilation in an experimental campaign with 218 subjects. Experimental activity is carried out by testing in vivo with human volunteers for an experimental characterization of ventilation motions as related to normal breathing, maximal breathing and coughing. FINDINGS Findings can be summarized from a numerical analysis of experimental results in terms of statistical values of ventilation motion parameters in rotation and acceleration as function of age and sex of the tested subjects. The discussed campaign reporting results on healthy patients was carried out with the aim to build a reference database of normal conditions against which the status of patients with both thoracic and ventilation problems can then be judged. Females showed significantly larger lateral-to-lateral movements during basal breathing and lateral-to-lateral Z-axis movements during maximal breathing and cough. Males demonstrated wider antero-posterior Y-axis and cranio-caudal X-axis movements during maximal breathing, while antero-posterior movements prevailed during cough. Older participants demonstrated larger lateral-to-lateral Z-axis and antero-posterior Y-axis movements during basal breathing. Young participants showed more significant increments along antero-posterior Y-axis from basal to maximal breathing and basal to cough, demonstrating a more efficient muscular activity. INTERPRETATION The ventilation motion during ventilation act is useful to detect the status of ventilation and can give indications for diagnostics and medical solutions even in thoracic surgery.
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Affiliation(s)
- Lucrezia Puglisi
- Department of Surgical Sciences, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Marco Ceccarelli
- Department of Industrial Engineering, University of Rome Tor Vergata, 00133 Rome, Italy.
| | - Riccardo Taje
- Department of Surgical Sciences, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Vincenzo Ambrogi
- Department of Surgical Sciences, University of Rome Tor Vergata, 00133 Rome, Italy.
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12
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Puglisi L, Ceccarelli M, Ambrogi V. An Experimental Study of Feasibility of a Mini-Invasive Fixator for Rib Osteosynthesis. J Med Device 2022. [DOI: 10.1115/1.4055861] [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: 11/08/2022] Open
Abstract
Abstract
Alternatives to the current invasive rib implants are discussed as from the current solutions with their constraints and disadvantages mainly in surgery application and clinical consequences. A novel rib fixator is presented with an experimental validation and characterization for a potential implementation in facilitating osteosynthesis of multifractured ribs. Testing is designed with lab facilities replicating normal breathing and coughing. Results of lab test with a Ribolution rib fixator prototype are discussed from experiences with pig ribs with satisfactory results in behavior and numerical values.
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Affiliation(s)
- Lucrezia Puglisi
- Department of Surgical Sciences, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Marco Ceccarelli
- Department of Industrial Engineering, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Vincenzo Ambrogi
- Department of Surgical Sciences, University of Rome Tor Vergata, 00133 Rome, Italy
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13
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Voulaz E, Perroni G, Russo A, Patirelis A, Mangiameli G, Alloisio M, Ambrogi V. Thymomectomy versus complete thymectomy in early-stage non-myasthenic thymomas: a multicentric propensity score-matched study. Interact Cardiovasc Thorac Surg 2022; 35:6611721. [PMID: 35723542 PMCID: PMC9240760 DOI: 10.1093/icvts/ivac167] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 06/03/2022] [Accepted: 06/15/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Emanuele Voulaz
- IRCCS Humanitas Research Hospital, Department of Thoracic Surgery , Milan, Italy
- Department of Biomedical Sciences, Humanitas University , Milan, Italy
| | - Gianluca Perroni
- Division of Thoracic Surgery, Department of Thoracic Surgery, Tor Vergata University Polyclinic , Rome, Italy
| | - Anna Russo
- Division of Thoracic Surgery, Department of Thoracic Surgery, Tor Vergata University Polyclinic , Rome, Italy
| | - Alexandro Patirelis
- Division of Thoracic Surgery, Department of Thoracic Surgery, Tor Vergata University Polyclinic , Rome, Italy
| | - Giuseppe Mangiameli
- IRCCS Humanitas Research Hospital, Department of Thoracic Surgery , Milan, Italy
- Department of Biomedical Sciences, Humanitas University , Milan, Italy
| | - Marco Alloisio
- IRCCS Humanitas Research Hospital, Department of Thoracic Surgery , Milan, Italy
- Department of Biomedical Sciences, Humanitas University , Milan, Italy
| | - Vincenzo Ambrogi
- Division of Thoracic Surgery, Department of Thoracic Surgery, Tor Vergata University Polyclinic , Rome, Italy
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14
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Ambrogi V, Patirelis A, Tajè R. Non-intubated Thoracic Surgery: Wedge Resections for Peripheral Pulmonary Nodules. Front Surg 2022; 9:853643. [PMID: 35465435 PMCID: PMC9021407 DOI: 10.3389/fsurg.2022.853643] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/28/2022] [Indexed: 11/17/2022] Open
Abstract
The feasibility of performing pulmonary resections of peripheral lung nodules has been one of the main objectives of non-intubated thoracic surgery. The aim was to obtain histological characterization and extend a radical intended treatment to oncological patients unfit for general anesthesia or anatomic pulmonary resections. There is mounting evidence for the role of wedge resection in early-stage lung cancer treatment, especially for frail patients unfit for general anesthesia and anatomic resections with nodules, demonstrating a non-aggressive biological behavior. General anesthesia with single lung ventilation has been associated with a higher risk of ventilator-induced barotrauma and volotrauma as well as atelectasis in both the dependent and non-dependent lungs. Nonetheless, general anesthesia has been shown to impair the host immune system, eventually favoring both tumoral relapses and post-operative complications. Thus, non-intubated wedge resection seems to definitely balance tolerability with oncological radicality in highly selected patients. Nonetheless, differently from other non-surgical techniques, non-intubated wedge resection allows for histological characterization and possible oncological targeted treatment. For these reasons, non-intubated wedge resection is a fundamental skill in the core training of a thoracic surgeon. Main indications, surgical tips, and post-operative management strategies are hereafter presented. Non-intubated wedge resection is one of the new frontiers in minimal invasive management of patients with lung cancer and may become a standard in the armamentarium of a thoracic surgeon. Appropriate patient selection and VATS expertise are crucial to obtaining good results.
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15
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Taje R, Elia S, Cristino B, Tacconi F, Natali G, Ambrogi V, Pompeo E. Thoracic surgery in the COVID-19 era: an Italian university hospital experience. Cardiothorac Surg 2021; 29:21. [PMID: 38624720 PMCID: PMC8600487 DOI: 10.1186/s43057-021-00059-y] [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] [Received: 08/27/2021] [Accepted: 11/09/2021] [Indexed: 01/08/2023] Open
Abstract
Background Aims of this study were to assess the results of anti-COVID19 measures applied to maintain thoracic surgery activity at an Italian University institution through a 12-month period and to assess the results as compared with an equivalent non-pandemic time span. Methods Data and results of 646 patients operated on at the department of Thoracic Surgery of the Tor Vergata University Policlinic in Rome between February 2019 and March 2021 were retrospectively analyzed. Patients were divided in 2 groups: one operated on during the COVID-19 pandemic (pandemic group) and another during the previous non-pandemic 12 months (non-pandemic group). Primary outcome measure was COVID-19 infection-free rate. Results Three patients developed mild COVID-19 infection early after surgery resulting in an estimated COVID-19 infection-free rate of 98%. At intergroup comparisons (non-pandemic vs. pandemic group), a greater number of patients was operated before the pandemic (352 vs. 294, p = 0.0013). In addition, a significant greater thoracoscopy/thoracotomy procedures rate was found in the pandemic group (97/151 vs. 82/81, p = 0.02) and the total number of chest drainages (104 vs. 131, p = 0.0001) was higher in the same group. At surgery, tumor size was larger (19.5 ± 13 vs. 28.2 ± 21; p < 0.001) and T3-T4/T1-T2 ratio was higher (16/97 vs. 30/56; p < 0.001) during the pandemic with no difference in mortality and morbidity. In addition, the number of patients lost before treatment was higher in the pandemic group (8 vs. 15; p = 0.01). Finally, in 7 patients admitted for COVID-19 pneumonia, incidental lung (N = 5) or mediastinal (N = 2) tumors were discovered at the chest computed tomography. Conclusions Estimated COVID-19 infection free rate was 98% in the COVID-19 pandemic group; there were less surgical procedures, and operated lung tumors had larger size and more advanced stages than in the non-pandemic group. Nonetheless, hospital stay was reduced with comparable mortality and morbidity. Our study results may help implement efficacy of the everyday surgical care.
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Affiliation(s)
- Riccardo Taje
- Department of Thoracic Surgery, Policlinico Tor Vergata University, V.le Oxford, 81, 00133 Rome, Italy
| | - Stefano Elia
- Department of Thoracic Surgery, Policlinico Tor Vergata University, V.le Oxford, 81, 00133 Rome, Italy
| | - Benedetto Cristino
- Department of Thoracic Surgery, Policlinico Tor Vergata University, V.le Oxford, 81, 00133 Rome, Italy
| | - Federico Tacconi
- Department of Thoracic Surgery, Policlinico Tor Vergata University, V.le Oxford, 81, 00133 Rome, Italy
| | - Gianluca Natali
- Department of Thoracic Surgery, Policlinico Tor Vergata University, V.le Oxford, 81, 00133 Rome, Italy
| | - Vincenzo Ambrogi
- Department of Thoracic Surgery, Policlinico Tor Vergata University, V.le Oxford, 81, 00133 Rome, Italy
| | - Eugenio Pompeo
- Department of Thoracic Surgery, Policlinico Tor Vergata University, V.le Oxford, 81, 00133 Rome, Italy
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16
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Tacconi F, Chegai F, Perretta T, Ambrogi V. Real-Time Pleural Elastography: Potential Usefulness in Nonintubated Video-Assisted Thoracic Surgery. J Chest Surg 2021; 54:433-435. [PMID: 33767023 PMCID: PMC8548183 DOI: 10.5090/jcs.20.121] [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] [Received: 09/23/2020] [Revised: 10/22/2020] [Accepted: 11/03/2020] [Indexed: 11/29/2022] Open
Abstract
Pleural adhesions are a major challenge in standard and nonintubated video-assisted thoracic surgery. The currently available imaging techniques help to assess the presence and extent of pleural adhesions, but do not provide information on tissue deformability, which is crucial for intraoperative management. In this report, we describe the utilization of real-time elastography mapping of pleural adhesions. This technique enabled us to detect areas with softer adhesions, and helped establish the surgical plan in a difficult case of a patient scheduled for nonintubated video-assisted thoracic surgery.
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Affiliation(s)
- Federico Tacconi
- Unit of Thoracic Surgery, Interventional Radiology, Molecular Imaging and Radiotherapy, Tor Vergata University Hospital, Rome, Italy
| | - Fabrizio Chegai
- Department of Diagnostic Imaging, Interventional Radiology, Molecular Imaging and Radiotherapy, Tor Vergata University Hospital, Rome, Italy
| | - Tommaso Perretta
- Department of Diagnostic Imaging, Interventional Radiology, Molecular Imaging and Radiotherapy, Tor Vergata University Hospital, Rome, Italy
| | - Vincenzo Ambrogi
- Unit of Thoracic Surgery, Interventional Radiology, Molecular Imaging and Radiotherapy, Tor Vergata University Hospital, Rome, Italy
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17
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Massaro G, Stifano G, Ambrogi V, Anemona L, Mariano EG, Chiricolo G, Martuscelli E, Sangiorgi GM. A thymic hyperplasia-related reversible complete atrioventricular block: When compression is more important than compressor. J Electrocardiol 2021; 69:68-70. [PMID: 34600403 DOI: 10.1016/j.jelectrocard.2021.09.012] [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] [Received: 07/06/2021] [Revised: 08/26/2021] [Accepted: 09/16/2021] [Indexed: 11/30/2022]
Abstract
A 19-year-old patient presented for syncope with third-degree AV block (TDAVB) at ECG. A chest-CT showed a thymic mass that could be responsible for TDAVB due to extrinsic vagal nerve compression. Thymectomy led to complete AV block resolution. An extrinsic vagal compression mechanism should be considered among causes of complete atrioventricular block.
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Affiliation(s)
- Gianluca Massaro
- Division of Cardiology, "Tor Vergata" University Hospital, 00133 Rome, Italy.
| | - Giuseppe Stifano
- Division of Cardiology, "Tor Vergata" University Hospital, 00133 Rome, Italy
| | - Vincenzo Ambrogi
- Unit of Thoracic Surgery, "Tor Vergata" University of Rome, 00133 Rome, Italy
| | - Lucia Anemona
- Anatomic Pathology, Department of Experimental Medicine, "Tor Vergata" University of Rome, 00133 Rome, Italy
| | | | - Gaetano Chiricolo
- Division of Cardiology, "Tor Vergata" University Hospital, 00133 Rome, Italy; Department of Biomedicine and Prevention, "Tor Vergata" University of Rome, 00133 Rome, Italy
| | - Eugenio Martuscelli
- Division of Cardiology, "Tor Vergata" University Hospital, 00133 Rome, Italy; Department of Biomedicine and Prevention, "Tor Vergata" University of Rome, 00133 Rome, Italy
| | - Giuseppe Massimo Sangiorgi
- Division of Cardiology, "Tor Vergata" University Hospital, 00133 Rome, Italy; Department of Biomedicine and Prevention, "Tor Vergata" University of Rome, 00133 Rome, Italy
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18
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Tacconi F, Carlea F, La Rocca E, Vanni G, Ambrogi V. Systemic Inflammation after Uniport, Multiport, or Hybrid VATS Lobectomy for Lung Cancer. Thorac Cardiovasc Surg 2021; 70:258-264. [PMID: 34404095 DOI: 10.1055/s-0041-1731824] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Different video-assisted thoracic surgery (VATS) approaches can be adopted to perform lobectomy for non-small cell lung cancer. Given the hypothetical link existing between postoperative inflammation and long-term outcomes, we compared the dynamics of systemic inflammation markers after VATS lobectomy performed with uniportal access (UNIVATS), multiportal access (MVATS), or hybrid approach (minimally invasive hybrid open surgery, MIHOS). METHODS Peripheral blood-derived inflammation markers (neutrophil-to-lymphocyte [NTL] ratio, platelet-to-lymphocyte [PTL] ratio, and systemic immune-inflammation index [SII]) were measured preoperatively and until postoperative day 5 in 109 patients undergoing UNIVATS, MVATS, or MIHOS lobectomy. Differences were compared through repeated-measure analysis of variance, before and after 1:1:1 propensity score matching. Time-to-event analysis was also done by measuring time to NTL normalization, based on the reliability change index for each patient. RESULTS After UNIVATS, there was a faster decrease in NTL ratio (p = 0.015) and SII (p = 0.019) compared with other approaches. MVATS exhibited more pronounced PTL rebound (p = 0.011). However, all these differences disappeared in matched analysis. After MIHOS, NTL ratio normalization took longer (mean difference: 0.7 ± 0.2 days, p = 0.047), yet MIHOS was not independently associated with slower normalization at Cox's regression analysis (p = 0.255, odds ratio: 1.6, confidence interval: 0.7-4.0). Furthermore, surgical access was not associated with cumulative postoperative morbidity, nor was it with incidence of postoperative pneumonia. CONCLUSION In this study, different VATS approaches resulted into unsubstantial differences in postoperative systemic inflammatory response, after adjusting for confounders. The majority of patients returned back to preoperative values by postoperative day 5 independently on the adopted surgical access. Further studies are needed to elaborate whether these small differences may still be relevant to patient management.
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Affiliation(s)
- Federico Tacconi
- Department of Surgery, Unit of Thoracic Surgery, Tor Vergata University Polyclinic, Rome, Italy
| | - Federica Carlea
- Department of Surgery, Unit of Thoracic Surgery, Tor Vergata University Polyclinic, Rome, Italy
| | - Eleonora La Rocca
- Department of Surgery, Unit of Thoracic Surgery, Tor Vergata University Polyclinic, Rome, Italy
| | - Gianluca Vanni
- Department of Surgery, Unit of Thoracic Surgery, Tor Vergata University Polyclinic, Rome, Italy
| | - Vincenzo Ambrogi
- Department of Surgery, Unit of Thoracic Surgery, Tor Vergata University Polyclinic, Rome, Italy
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19
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Vanni G, Materazzo M, Pellicciaro M, Amir S, Tacconi F, Ambrogi V, Buonomo OC. Breast Textured Implants Determine Early T-helper Impairment: BIAL2.20 Study. Anticancer Res 2021; 41:2123-2132. [PMID: 33813423 DOI: 10.21873/anticanres.14984] [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] [Received: 02/09/2021] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Surgical stress has been correlated with higher rate of postoperative complications. Breast implants' surfaces (textured or smooth) represent an immunological stimulus. Our prospective study (BIAL2.20) evaluated post-operative leukocytes response at baseline and postoperative day (POD) 1 and 2 after implant-based breast reconstruction. PATIENTS AND METHODS Between January and July 2020, 41 patients underwent reconstruction with textured (n=23) or smooth (n=18) implants. A full blood count and lymphocyte subsets were collected before surgery, on POD1 and POD2. Data were evaluated as difference and relative difference from baseline by two-way analysis of variance test (2-way-ANOVA). Mann-Whitney U-test was performed at each POD, whenever between-group 2-way-ANOVA reached statistical significance. RESULTS Within-group-analysis showed statistically significant total leukocytosis in both groups. Within-group-analysis of lymphocytes subsets demonstrated statistically significant lymphopenia in the textured group for T-lymphocytes, and T-helper cells. Between-group-analysis showed statistically significant lymphopenia in T-helper subsets in the textured group at POD1 and POD2, when compared with the smooth group. CONCLUSION Textured implants demonstrated a statistically significant impairment of T-helper trend during POD1 and POD2 when compared to smooth implants by between-group 2-way-ANOVA.
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Affiliation(s)
- Gianluca Vanni
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Marco Materazzo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy;
| | - Marco Pellicciaro
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Sadri Amir
- Plastic Surgery, Great Ormond Street Hospital, London, U.K
| | - Federico Tacconi
- Division of Thoracic Surgery, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Vincenzo Ambrogi
- Division of Thoracic Surgery, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Oreste Claudio Buonomo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
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Abstract
Repeat surgical resection (redo) for pulmonary metastases is a questionable, albeit intriguing topic. We performed an extensive review of the literature, to specifically analyze results of redo pulmonary metastasectomies. We reviewed a total of 3,523 papers. Among these, 2,019 were excluded for redundancy and 1,105 because they were not completely retrievable. Out of 399 eligible papers, 183 had missing information or missing abstract, while 96 lacked data on survival. A total of 120 papers dated from 1991 onwards were finally included. Data regarding mortality, major morbidity, prognostic factors and long-term survivals of the first redo pulmonary metastasectomies were retrieved and analyzed. Homogeneity of data was affected by the lack of guidelines for redo pulmonary metastasectomy and the risks of bias when comparing different studies has to be considered. According to the histology sub-types, redo metastasectomies papers were grouped as: colorectal (n=42), sarcomas (n=36), others (n=20) and all histologies (n=22); the total number of patients was 3,015. Data about chemotherapy were reported in half of the papers, whereas targeted or immunotherapy in 9. None of these associated therapies, except chemotherapy in two records, did significantly modify outcomes. Disease-free interval before the redo procedure was the prevailing prognostic factor and nearly all papers showed a significant correlation between patients’ comorbidities and prognosis. No perioperative mortality was reported, while perioperative major morbidity was overall quite low. Where available, overall survival after the first redo metastasectomy ranged from 10 to 72 months, with a 5-years survival of approximately 50%. The site of first recurrence after the redo procedure was mainly lung. Despite the data retrievable from literature are heterogeneous and confounding, we can state that redo lung metastasectomy is worthwhile when the lesions are resectable and the perioperative risk is low. At present, there are no “non-surgical” therapeutic options to replace redo pulmonary metastasectomies.
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Affiliation(s)
- Vincenzo Ambrogi
- Thoracic Surgery Unit, Tor Vergata University Polyclinic, Rome, Italy
| | | | - Riccardo Tajé
- Tor Vergata University School of Medicine, Rome, Italy
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21
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Tacconi F, Chegai F, Perretta T, Ambrogi V. Real-Time Pleural Elastography: Potential Usefulness in Nonintubated Video-Assisted Thoracic Surgery. J Chest Surg 2021. [PMID: 33767023 DOI: 10.5090/kjtcs.20.121] [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] Open
Abstract
Pleural adhesions are a major challenge in standard and nonintubated video-assisted thoracic surgery. The currently available imaging techniques help to assess the presence and extent of pleural adhesions, but do not provide information on tissue deformability, which is crucial for intraoperative management. In this report, we describe the utilization of real- time elastography mapping of pleural adhesions. This technique enabled us to detect areas with softer adhesions, and helped establish the surgical plan in a difficult case of a patient scheduled for nonintubated video-assisted thoracic surgery.
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Affiliation(s)
- Federico Tacconi
- Unit of Thoracic Surgery, Interventional Radiology, Molecular Imaging and Radiotherapy, Tor Vergata University Hospital, Rome, Italy
| | - Fabrizio Chegai
- Department of Diagnostic Imaging, Interventional Radiology, Molecular Imaging and Radiotherapy, Tor Vergata University Hospital, Rome, Italy
| | - Tommaso Perretta
- Department of Diagnostic Imaging, Interventional Radiology, Molecular Imaging and Radiotherapy, Tor Vergata University Hospital, Rome, Italy
| | - Vincenzo Ambrogi
- Unit of Thoracic Surgery, Interventional Radiology, Molecular Imaging and Radiotherapy, Tor Vergata University Hospital, Rome, Italy
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22
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Ambrogi V, Carlea F, La Rocca E, Mineo TC. Awake surgery for lung metastasectomy. Video-assist Thorac Surg 2020. [DOI: 10.21037/vats-2020-lm-06] [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: 11/06/2022]
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23
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Ambrogi V, Tacconi F, Sellitri F, Tamburrini A, Perroni G, Carlea F, La Rocca E, Vanni G, Schillaci O, Mineo TC. Subxiphoid completion thymectomy for refractory non-thymomatous myasthenia gravis. J Thorac Dis 2020; 12:2388-2394. [PMID: 32642144 PMCID: PMC7330301 DOI: 10.21037/jtd.2020.03.81] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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] [Indexed: 11/12/2022]
Abstract
Background Completion thymectomy may be performed in patients with non-thymomatous refractory myasthenia gravis (MG) to allow a complete and definitive clearance from residual thymic tissue located in the mediastinum or in lower neck. Hereby we present our short- and long-term results of completion thymectomy using subxiphoid video-assisted thoracoscopy. Methods Between July 2010 and December 2017, 15 consecutive patients with refractory non-thymomatous myasthenia, 8 women and 7 men with a median age of 44 [interquartile range (IQR) 38.5–53.5] years, underwent video-thoracoscopic completion thymectomy through a subxiphoid approach. Results Positron emission tomography (PET) showed mildly avid areas [standardized uptake value (SUV) more than or equal to 1.8] in 11 instances. Median operative time was 106 (IQR, 77–141) minutes. No operative deaths nor major morbidity occurred. Mean 1-day postoperative Visual Analogue Scale value was 2.53±0.63. Median hospital stay was 2 (IQR, 1–3.5) days. A significant decrease of the anti-acetylcholine receptor antibodies was observed after 1 month [median percentage changes −67% (IQR, −39% to −83%)]. Median follow-up was 45 (IQR, 21–58) months. At the most recent follow-up complete stable remission was achieved in 5 patients. Another 9 patients had significant improvement in bulbar and limb function, requiring lower doses of corticosteroids and anticholinesterase drugs. Only one patient remained clinically stable albeit drug doses were reduced. One-month postoperative drop of anti-acetylcholine receptor antibodies was significantly correlated with complete stable remission (P=0.002). Conclusions This initial experience confirms that removal of ectopic and residual thymus through a subxiphoid approach can reduce anti-acetylcholine receptor antibody titer correlating to good outcome of refractory MG.
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Affiliation(s)
- Vincenzo Ambrogi
- Department of Surgery, Division of Thoracic Surgery, Myasthenia Gravis Unit, Policlinico Tor Vergata University, Rome, Italy
| | - Federico Tacconi
- Department of Surgery, Division of Thoracic Surgery, Myasthenia Gravis Unit, Policlinico Tor Vergata University, Rome, Italy
| | - Francesco Sellitri
- Department of Surgery, Division of Thoracic Surgery, Myasthenia Gravis Unit, Policlinico Tor Vergata University, Rome, Italy
| | | | - Gianluca Perroni
- Postgraduate School of Thoracic Surgery, Tor Vergata University, Rome, Italy
| | - Federica Carlea
- Postgraduate School of Thoracic Surgery, Tor Vergata University, Rome, Italy
| | - Eleonora La Rocca
- Postgraduate School of Thoracic Surgery, Tor Vergata University, Rome, Italy
| | - Gianluca Vanni
- Department of Surgery, Division of Thoracic Surgery, Myasthenia Gravis Unit, Policlinico Tor Vergata University, Rome, Italy
| | - Orazio Schillaci
- Department of Biomedicine and Prevention, Nuclear Medicine Unit, Tor Vergata University, Rome, Italy
| | - Tommaso Claudio Mineo
- Department of Surgery, Division of Thoracic Surgery, Myasthenia Gravis Unit, Policlinico Tor Vergata University, Rome, Italy
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Vanni G, Materazzo M, Perretta T, Meucci R, Anemona L, Buonomo C, Dauri M, Granai AV, Rho M, Ingallinella S, Tacconi F, Ambrogi V, Chiaravalloti A, Schillaci O, Petrella G, Buonomo OC. Impact of Awake Breast Cancer Surgery on Postoperative Lymphocyte Responses. In Vivo 2020; 33:1879-1884. [PMID: 31662515 DOI: 10.21873/invivo.11681] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 07/10/2019] [Revised: 07/22/2019] [Accepted: 07/24/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Surgical stress and anesthesia affect the patient's immune system. Analysis of the lymphocyte response after breast-conserving surgery was conducted to investigate the differences between effects after general and local anesthesia. MATERIALS AND METHODS Fifty-six patients with breast cancer were enrolled for BCS through local or general anesthesia. Total leukocytes, total lymphocytes, lymphocyte-subsets including CD3+, CD19+, CD4+, CD8+, CD16+CD56+ and CD4+/CD8+ ratio was examined at baseline and on postoperative days 1, 2 and 3. RESULTS Baseline data showed no statistical difference between the two groups. Within-group ANOVA test showed significant differences for total leukocyte count (p<0.001), total lymphocyte count (p=0.009) and proportion of natural-killer cells (p=0.01) in the control group. Between-group analysis showed lower median values of total lymphocytes in the awake surgery group on postoperative days 1, 2 and 3 (p=0.001, p=0.02 and p=0.01, respectively) when compared to the control group. Patients who underwent surgery under general anesthesia had higher total lymphocyte counts on postoperative day 2 (p=0.04). CONCLUSION In this randomized study, breast-conserving surgery plus local anesthesia had a lower impact on postoperative lymphocyte response when compared to the same procedure performed under general anesthesia.
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Affiliation(s)
- Gianluca Vanni
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Marco Materazzo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Tommaso Perretta
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy
| | - Rosaria Meucci
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy
| | - Lucia Anemona
- Anatomic Pathology, Department of Experimental Medicine, Policlinico Tor Vergata University, Rome, Italy
| | - Chiara Buonomo
- Department of Emergency and Admission, Critical Care Medicine, Pain Medicine and Anesthetic Science, Policlinico Tor Vergata University, Rome, Italy
| | - Mario Dauri
- Department of Emergency and Admission, Critical Care Medicine, Pain Medicine and Anesthetic Science, Policlinico Tor Vergata University, Rome, Italy
| | | | - Maurizio Rho
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Sara Ingallinella
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Federico Tacconi
- Division of Thoracic Surgery, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Vincenzo Ambrogi
- Division of Thoracic Surgery, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Agostino Chiaravalloti
- Department of Biomedicine and Prevention, Policlinico Tor Vergata University, Rome, Italy.,IRCCS Neuromed, UOC Medicina Nucleare, Pozzilli, Italy
| | - Orazio Schillaci
- Department of Biomedicine and Prevention, Policlinico Tor Vergata University, Rome, Italy.,IRCCS Neuromed, UOC Medicina Nucleare, Pozzilli, Italy
| | - Giuseppe Petrella
- Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Oreste Claudio Buonomo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
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Abstract
Nonintubated thoracic surgery arose as supplemental evolution of minimally invasive surgery and is gaining popularity. A proper nonintubated thoracic surgery unit is mandatory and should involve surgeons, anesthesiologists, intensive care physicians, physiotherapists, psychologists, and scrub and ward nurses. Surgical training should involve experienced and young surgeons. It deserves a step-by-step approach and consolidated experience on video-assisted thoracic surgery. Due to difficulty in reproducing lung and diaphragm movements, training with simulation systems may be of scant value; instead, preceptorships and invited proctorships are useful. Preoperatively, patients must be fully informed. Effective intraoperative communication with patients and among the surgical team is pivotal.
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Affiliation(s)
- Federico Tacconi
- Department of Surgical Sciences, Tor Vergata University, Via Montpellier 1, Rome 00133, Italy; Division of Thoracic Surgery, Tor Vergata University Hospital, Viale Oxford 81, Rome 00133, Italy
| | - Tommaso Claudio Mineo
- Department of Surgical Sciences, Tor Vergata University, Via Montpellier 1, Rome 00133, Italy
| | - Vincenzo Ambrogi
- Department of Surgical Sciences, Tor Vergata University, Via Montpellier 1, Rome 00133, Italy; Division of Thoracic Surgery, Tor Vergata University Hospital, Viale Oxford 81, Rome 00133, Italy; Postgraduate Training Course in Thoracic Surgery, Tor Vergata University, Rome 00133, Italy.
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26
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Ambrogi V, Mineo TC. Nonintubated Thoracic Surgery. Thorac Surg Clin 2020. [DOI: 10.1016/s1547-4127(19)30078-7] [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: 10/25/2022]
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28
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Affiliation(s)
- Vincenzo Ambrogi
- Department of Surgical Sciences, Tor Vergata University, Rome, Italy; Division of Thoracic Surgery, Tor Vergata University Policlinic, Policlinico Tor Vergata University, Viale Oxford 81, Rome 00133, Italy.
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He J, Liu J, Zhu C, Dai T, Cai K, Zhang Z, Cheng C, Qiao K, Liu X, Wang G, Xu S, Yang R, Fan J, Li H, Jin J, Dong Q, Liang L, Ding J, He K, Liu Y, Ye J, Feng S, Jiang Y, Huang H, Zhang H, Liu Z, Feng X, Xia Z, Ma M, Duan Z, Huang T, Li Y, Shen Q, Tan W, Ma H, Sun Y, Chen C, Cui F, Wang W, Li J, Hao Z, Liu H, Liang W, Zou X, Liang H, Yang H, Li Y, Jiang S, Ng CSH, González-Rivas D, Pompeo E, Flores RM, Shargall Y, Ismail M, Ambrogi V, Elkhouly AG, Sung SW, Ang K. Expert consensus on tubeless video-assisted thoracoscopic surgery (Guangzhou). J Thorac Dis 2019; 11:4101-4108. [PMID: 31737292 DOI: 10.21037/jtd.2019.10.04] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jianxing He
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Jun Liu
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Chengchu Zhu
- Department of Thoracic Surgery, Taizhou Hospital, Taizhou 318000, China
| | - Tianyang Dai
- Department of Thoracic Surgery, Southwest Medical University Affiliated Hospital, Luzhou 646000, China
| | - Kaican Cai
- Department of Thoracic Surgery, Nanfang Hospital of Southern Medical University, Guangzhou 510120, China
| | - Zhifeng Zhang
- Department of Thoracic Surgery, Jieyang People's Hospital, Jieyang 522000, China
| | - Chao Cheng
- Department of Thoracic Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510120, China
| | - Kun Qiao
- Department of Thoracic Surgery, Third People's Hospital of Shenzhen, Shenzhen 518000, China
| | - Xiang Liu
- Department of Thoracic Surgery, Second Affiliated Hospital of the University of South China, Hengyang 420100, China
| | - Guangsuo Wang
- Department of Thoracic Surgery, People's Hospital of Shenzhen, Shenzhen 518000, China
| | - Shun Xu
- Department of Thoracic Surgery, First Affiliated Hospital of China Medical University, Shenyang 110000, China
| | - Rusong Yang
- Department of Thoracic Surgery, Nanjing Chest Hospital, Nanjing 210000, China
| | - Junqiang Fan
- Department of Thoracic Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
| | - Hecheng Li
- Department of Thoracic Surgery, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200000, China
| | - Jiang Jin
- Department of Thoracic Surgery, Taizhou Hospital, Taizhou 318000, China
| | - Qinglong Dong
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Lixia Liang
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Jinfeng Ding
- Department of Anesthesia, Taizhou Hospital, Taizhou 318000, China
| | - Kaiming He
- Department of Thoracic Surgery, Southwest Medical University Affiliated Hospital, Luzhou 646000, China
| | - Yulin Liu
- Department of Anesthesia, Southwest Medical University Affiliated Hospital, Luzhou 646000, China
| | - Jing Ye
- Department of Anesthesia, Nanfang Hospital of Southern Medical University, Guangzhou 510120, China
| | - Siyang Feng
- Department of Thoracic Surgery, Nanfang Hospital of Southern Medical University, Guangzhou 510120, China
| | - Yu Jiang
- Department of Anesthesia, Nanfang Hospital of Southern Medical University, Guangzhou 510120, China
| | - Haoda Huang
- Department of Thoracic Surgery, Jieyang People's Hospital, Jieyang 522000, China
| | - Huankai Zhang
- Department of Anesthesia, Jieyang People's Hospital, Jieyang 522000, China
| | - Zhenguo Liu
- Department of Thoracic Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510120, China
| | - Xia Feng
- Department of Anesthesia, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510120, China
| | - Zhaohua Xia
- Department of Thoracic Surgery, Third People's Hospital of Shenzhen, Shenzhen 518000, China
| | - Mingfei Ma
- Department of Anesthesia, Third People's Hospital of Shenzhen, Shenzhen 518000, China
| | - Zhongxin Duan
- Department of Anesthesia, Second Affiliated Hospital of the University of South China, Guangzhou 510120, China
| | - Tonghai Huang
- Department of Thoracic Surgery, People's Hospital of Shenzhen, Shenzhen 518000, China
| | - Yali Li
- Department of Anesthesia, People's Hospital of Shenzhen, Shenzhen 518000, China
| | - Qiming Shen
- Department of Thoracic Surgery, First Affiliated Hospital of China Medical University, Shenyang 110000, China
| | - Wenfei Tan
- Department of Thoracic Surgery, First Affiliated Hospital of China Medical University, Shenyang 110000, China
| | - Hong Ma
- Department of Anesthesia, First Affiliated Hospital of China Medical University, Shenyang 110000, China
| | - Yang Sun
- Department of Anesthesia, Nanjing Chest Hospital, Nanjing 210000, China
| | - Congcong Chen
- Department of Anesthesia, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
| | - Fei Cui
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Wei Wang
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Jingpei Li
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Zhexue Hao
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Hui Liu
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Wenhua Liang
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Xusen Zou
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Hengrui Liang
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Hanyu Yang
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Yingfen Li
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Shunjun Jiang
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Calvin S H Ng
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | | | - Eugenio Pompeo
- Department of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy
| | - Raja M Flores
- Department of Thoracic Surgery, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yaron Shargall
- Division of Thoracic Surgery, McMaster University, St. Joseph's Healthcare, Hamilton, Canada
| | - Mahmoud Ismail
- Department of Thoracic Surgery, Klinikum Ernst von Bergmann, Academic Hospital of the Charité - Universitätsmedizin Humboldt University Berlin, Potsdam Germany
| | - Vincenzo Ambrogi
- Department of Surgery and Experimental Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Ahmed G Elkhouly
- Department of Cardiothoracic Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Sook Whan Sung
- Department of Thoracic & Cardiovascular Surgery, Ewha Womens University Seoul Hospital, Gangseo, Seoul, Republic of Korea
| | - Keng Ang
- Department of Thoracic Surgery, Nottingham City Hospital and Glenfield Hospital, Leicester, UK
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30
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Stenger Moura F, Perioli L, Pagano C, Vivani R, Ambrogi V, Bresolin T, Ricci M, Schoubben A. Chitosan composite microparticles: A promising gastroadhesive system for taxifolin. Carbohydr Polym 2019; 218:343-354. [DOI: 10.1016/j.carbpol.2019.04.075] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/23/2019] [Accepted: 04/24/2019] [Indexed: 02/06/2023]
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Ambrogi V, Perroni G, Mineo TC. Awake non-intubated pulmonary metastasectomy. J Vis Surg 2019. [DOI: 10.21037/jovs.2019.03.11] [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: 11/06/2022]
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32
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Ambrogi V, Migliore M. Professor Tommaso Claudio Mineo (1945-2018). J Thorac Cardiovasc Surg 2019. [DOI: 10.1016/j.jtcvs.2018.12.068] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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33
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Mineo TC, Sellitri F, Ambrogi V. Thymectomy for thymoma spanning three decades at Tor Vergata thoracic surgery center. J Vis Surg 2018. [DOI: 10.21037/jovs.2018.07.16] [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: 11/06/2022]
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Zagoriti Z, Lagoumintzis G, Perroni G, Papathanasiou G, Papadakis A, Ambrogi V, Mineo TC, Tzartos JS, Poulas K. Evidence for association of STAT4 and IL12RB2 variants with Myasthenia gravis susceptibility: What is the effect on gene expression in thymus? J Neuroimmunol 2018; 319:93-99. [PMID: 29576322 DOI: 10.1016/j.jneuroim.2018.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 12/06/2017] [Revised: 03/13/2018] [Accepted: 03/14/2018] [Indexed: 12/14/2022]
Abstract
Myasthenia gravis (MG) is an autoimmune disease mediated by the presence of autoantibodies that bind mainly to the acetylcholine receptor (AChR) in the neuromuscular junction. In our case-control association study, we analyzed common variants located in genes of the IL12/STAT4 and IL10/STAT3 signaling pathways. A total of 175 sporadic MG patients of Greek descent, positively detected with anti-AChR autoantibodies and 84 ethnically-matched, healthy volunteers were enrolled in the study. Thymus samples were obtained from 16 non-MG individuals for relative gene expression analysis. The strongest signals of association were observed in the cases of rs6679356 between the late-onset MG patients and controls and rs7574865 between early-onset MG and controls. Our investigation of the correlation between the MG-associated variants and the expression levels of each gene in thymus did not result in significant differences.
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Affiliation(s)
- Zoi Zagoriti
- Laboratory of Molecular Biology and Immunology, Department of Pharmacy, School of Health Sciences, University of Patras, University Campus, Rio, 26504 Patras, Greece.
| | - George Lagoumintzis
- Laboratory of Molecular Biology and Immunology, Department of Pharmacy, School of Health Sciences, University of Patras, University Campus, Rio, 26504 Patras, Greece
| | - Gianluca Perroni
- Department of Surgery and Experimental Medicine, Tor Vergata University, Rome, Italy
| | - George Papathanasiou
- Laboratory of Molecular Biology and Immunology, Department of Pharmacy, School of Health Sciences, University of Patras, University Campus, Rio, 26504 Patras, Greece
| | - Andreas Papadakis
- Laboratory of Molecular Biology and Immunology, Department of Pharmacy, School of Health Sciences, University of Patras, University Campus, Rio, 26504 Patras, Greece
| | - Vincenzo Ambrogi
- Department of Surgery and Experimental Medicine, Tor Vergata University, Rome, Italy
| | - Tommaso Claudio Mineo
- Department of Surgery and Experimental Medicine, Tor Vergata University, Rome, Italy
| | - John S Tzartos
- Department of Neurobiology, Hellenic Pasteur Institute, 127 Vasilissis Sofias Avenue, 11521 Athens, Greece; Tzartos NeuroDiagnostics, 3, Eslin street, Athens 115 23, Greece
| | - Konstantinos Poulas
- Laboratory of Molecular Biology and Immunology, Department of Pharmacy, School of Health Sciences, University of Patras, University Campus, Rio, 26504 Patras, Greece.
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Abstract
Aims and background The neodymium: yttrium-aluminium-garnet (Nd:YAG) laser has been successfully employed in parenchyma-sparing resection of pulmonary nodular lesions. We report our experience with limited resection using a noncontact Nd: YAG laser applied through a thoracotomic approach. Methods During the period March 1987-October 1993, we performed parenchyma-sparing resections of 66 pulmonary nodular lesions with a noncontact Nd:YAG laser in 47 patients. Nodules were approached through postero-lateral thoracotomy (n= 40), median sternotomy (n= 5) or staged bilateral thoracotomy (n= 2). Fifty-two lesions were located in a peripheral position and the others (n= 14) at various depths within the parenchyma. Results Fifteen lesions were benign: hamartoma (n= 5), chronic pneumonic infiltrate (n= 3), tuberculoma (n= 3), asbestosis (n= 2), Wegener's granuloma (n= 1). Twelve lesions were attributable to primary lung cancer and 33 were metastatic lesions. Another 6 lesions turned out to be necrotic metastases following chemotherapy. There were no perioperative deaths. Pulmonary re-expansion was shortly obtained: mean drainage time was 4.31 ± 3.9 days. Only one patient presented a prolonged drainage time (11 days); in this case, the air leak was successfully treated by tissue glue sealant trans-drainage infiltration. Follow-up ranged from 2 to 96 months. No case of relapse on the resection site has been observed. Conclusions The results suggest that Nd:YAG laser resection is safe and worthwhile in patients with multiple lesions and borderline pulmonary function.
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Affiliation(s)
- T C Mineo
- Cattedra di Chirurgia Toracica, Tor Vergata, Università di Roma, Italy
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36
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Mineo TC, Tamburrini A, Schillaci O, Ambrogi V. Onset and Evolution of Clinically Apparent Myasthenia Gravis After Resection of Non-myasthenic Thymomas. Semin Thorac Cardiovasc Surg 2018. [PMID: 29522809 DOI: 10.1053/j.semtcvs.2018.02.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 11/11/2022]
Abstract
Patients with thymoma and without clinical or electromyographical myasthenic signs may occasionally develop myasthenia several years after thymectomy. Hereby, we investigated the predictors and the evolution of this peculiar disease. We performed a retrospective analysis in 104 consecutive patients who underwent thymectomy between 1987 and 2013 for thymoma without clinical or electromyographic signs of myasthenia gravis. Predictors of post-thymectomy onset of myasthenia gravis were investigated with univariate time-to-disease analysis. Evolution of myasthenia was analyzed with time-to-regression analysis. Eight patients developed late myasthenia gravis after a median period of 33 months from thymectomy. No significant correlation was found for age, gender, Masaoka's stage, and World Health Organization histology. Only high preoperative serum acetylcholine-receptor antibodies titer (>0.3 nmol/L) was significantly associated with post-thymectomy myasthenia gravis at univariate time-to-disease (P = 0.003) analysis. Positron emission tomography was always performed in high-titer patients, and increased metabolic activity was detected in 4 of these patients. Surgical treatment through redo-sternotomy or video-assisted thoracoscopy was performed in these last cases with a remission in all patients after 12, 24, 32 and 48 months, respectively. No patient under medical treatment has yet developed a complete remission. In our study the presence of preoperative high-level serum acetylcholine receptor antibodies was the only factor significantly associated with the development of post-thymectomy myasthenia gravis. The persistence of residual islet of ectopic thymic tissue was one of the causes of the onset of myasthenia and its surgical removal was successful.
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Affiliation(s)
- Tommaso Claudio Mineo
- Department of Surgery and Experimental Medicine, Multidisciplinary Myasthenia Gravis Unit, Policlinico Tor Vergata University, Rome, Italy.
| | | | - Orazio Schillaci
- Department of Biomedicine and Prevention, Nuclear Medicine Unit, Tor Vergata University, Rome, Italy; IRCCS Neuromed, Pozzilli, Italy
| | - Vincenzo Ambrogi
- Department of Surgery and Experimental Medicine, Multidisciplinary Myasthenia Gravis Unit, Policlinico Tor Vergata University, Rome, Italy
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Ambrogi V, Gallina FT, Mineo TC. Early and Long-Term Outcomes After Non-Intubated, Non-Resectional Lung Volume Reduction Surgery. EMJ 2018. [DOI: 10.33590/emj/10314293] [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] Open
Abstract
Objective: In 2001, the introduction of non-resectional lung volume reduction surgery (LVRS) enabled surgery under non-intubated anaesthesia. This study compares this combined technique to a group of patients with a similar disorder who refused non-intubated anaesthesia.
Methods: Between January 2001 and October 2015, 108 patients with severe emphysema underwent non-resectional LVRS under non-intubated anaesthesia. During the same period, another 15 patients scheduled for LVRS refused non-intubated surgery and underwent the same procedure under traditional intubated modality. Respiratory and functional parameters were evaluated. Time to residual volume recurrence and overall survival were analysed with the Kaplan–Meier method.
Results: Thirteen cases (12%) required intubation due to tenacious pleuropulmonary adhesions (n=7) or intolerance (n=6). Compared with the intubated group, the non-intubated group were found to have significantly better results in post-operative partial pressure of carbon dioxide in arterial blood (PaCO2) (45±8 versus 52±8 mmHg; p=0.04), global operative time (41±24 versus 72±31 minutes; p=0.01), non-fatal complication rate (13.6% versus 33.3%; p=0.029), and especially postoperative pneumonia rate (3.1% versus 33.3%; p=0.004); patient satisfaction for anaesthesia was also improved in the non-intubated group (3.6±1.2 versus 2.8±1.7; p=0.03). Mean air leakage (5.3±3.5 versus 6.1±4.6 days), hospital stay (6.3±4.8 versus 8.0±6.1 days), and 90 days postoperative mortality rate (1.0% versus 6.6%) were lower, yet not significantly, in the non-intubated cohort. All mean respiratory and symptomatic parameters significantly improved in both groups, with no intergroup significant difference, and persisted for 4 years after surgery. Mean follow-up for the non-intubated group was 78±30 months. Analysis of time to residual volume recurrence and overall survival showed no statistically significant intergroup difference.
Conclusion: Non-intubated, non-resectional LVRS presents a 90-day postoperative non-fatal complication rate and patient satisfaction for non-intubated anaesthesia that are significantly better than intubated procedures. The long-term outcomes were similar between both groups.
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Affiliation(s)
- Vincenzo Ambrogi
- Thoracic Surgery, Official Awake Thoracic Surgery Research Group & Multidisciplinary Lung Volume Reduction Group, Policlinico Tor Vergata University, Rome, Italy; Minimally Invasive Thoracic Surgery Unit, Policlinico Tor Vergata University, Rome, Italy
| | - Filippo Tommaso Gallina
- Thoracic Surgery, Official Awake Thoracic Surgery Research Group & Multidisciplinary Lung Volume Reduction Group, Policlinico Tor Vergata University, Rome, Italy
| | - Tommaso Claudio Mineo
- Thoracic Surgery, Official Awake Thoracic Surgery Research Group & Multidisciplinary Lung Volume Reduction Group, Policlinico Tor Vergata University, Rome, Italy
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Roselli M, Mineo T, Martini F, Mariotti S, Ambrogi V, Spila A, D'Alessandro R, Basili S, Guadagni F, Ferroni P. Soluble Selectin Levels in Patients with Lung Cancer. Int J Biol Markers 2018. [DOI: 10.1177/172460080201700107] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Increased expression of selectins has been found on endothelial cells of venules and capillaries in the tumor stroma of non-small cell lung cancer, suggesting their functional role in the process of chemotaxis for tumor cells. The present study was aimed at analyzing the role of both soluble (s)P-selectin and sE-selectin levels in association with clinico-pathological variables in 116 patients with lung cancer, 38 patients with benign diseases and 59 healthy donors. The results obtained showed that sP-selectin and sE-selectin levels were higher in patients with lung cancer compared to normal donors (p<0.02 and p<0.005, respectively). No differences were observed among patients with various benign diseases for both selectins. Increased levels of sP-selectin and sE-selectin were significantly associated with squamous lung cancer at late stages (p<0.05), but not adenocarcinoma. Both sP- and sE-selectin were independently related to the stage of squamous lung cancer by stepwise regression analysis (p<0.02 and p<0.03, respectively), while only sE-selectin was independently related to the presence of distant metastasis in the same histotype (p<0.02). These results suggest that measurement of plasma soluble selectins might represent a useful laboratory parameter in the management of patients with squamous lung cancer.
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Affiliation(s)
- M. Roselli
- Clinical Oncology Section, Department of Surgery, Tor Vergata University, Rome
| | - T.C. Mineo
- Thoracic Surgery, Tor Vergata University, Rome
| | - F. Martini
- Department of Experimental Medicine and Pathology, La Sapienza University, Rome
| | - S. Mariotti
- Clinical Oncology Section, Department of Surgery, Tor Vergata University, Rome
| | - V. Ambrogi
- Thoracic Surgery, Tor Vergata University, Rome
| | - A. Spila
- Laboratory of Clinical Pathology, Regina Elena Cancer Institute, Rome
| | - R. D'Alessandro
- Laboratory of Clinical Pathology, Regina Elena Cancer Institute, Rome
| | - S. Basili
- Department of Medical Therapy, La Sapienza University, Rome - Italy
| | - F. Guadagni
- Laboratory of Clinical Pathology, Regina Elena Cancer Institute, Rome
| | - P. Ferroni
- Department of Experimental Medicine and Pathology, La Sapienza University, Rome
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Roselli M, Mineo T, Basili S, Mariotti S, Martini F, Bellotti A, Ambrogi V, Spila A, D’Alessandro R, Gazzaniga P, Guadagni F, Ferroni P. Vascular endothelial growth factor (VEGF-A) plasma levels in non-small cell lung cancer: relationship with coagulation and platelet activation markers. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1613557] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryPlatelet activation, commonly found in lung cancer patients, may cause the release of angiogenic factors, such as vascular endothelial growth factor (VEGF-A). The present study was designed to investigate whether plasma VEGF-A levels were associated to different stages of non-small cell lung cancer (NSCLC). Moreover, sP-selectin, prothrombin fragment 1+2 (F1+2),thrombin-antithrombin III complex (TATc) and D-dimer levels were measured to test the hypothesis of an involvement of platelet and coagulation activation in tumor angiogenesis. VEGF-A, sP-selectin, F1+2, TATc and D-dimer levels were elevated in 65 patients with NSCLC, particularly in metastatic patients. sP-selectin (p <0.003) and F1+2 (p <0.005) levels were independently associated to VEGF-A. In addition, patients with positive levels of both sP-selectin and F1+2 had the highest levels of VEGF-A. In conclusion, our findings support the hypothesis that thrombin generation might induce platelet activation and VEGF-A release in NSCLC.
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Ambrogi V, Schillaci O, Gallina FT, Mineo TC. Value of nonintubated thoracoscopic biopsy for mediastinal masses. Video-assist Thorac Surg 2017. [DOI: 10.21037/vats.2017.10.03] [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: 11/06/2022]
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Abstract
AbstractAzobenzene is by far the most studied photochromic molecule and its applications range from optical storage to bio-engineering. To exploit the great potential of azobenzene, one must achieve deep understanding of its photochemistry as single molecule in solution AS WELL AS in-chain moiety and pendent group in macromolecular structures. With the advent of computer-aided simulation scientists have been able to match experimental data with computational models. In this chapter, a review on the modeling of azobenzene-containing molecules in different conditions and environments IS provided with a special focus on advanced applications of photo-controllable materials, such as molecular machines and photoactivation of bio-molecules.
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Abstract
In the history of thoracic surgery, the advent of video-assisted thoracic surgery (VATS) had on effect equivalent to that provoked by a true revolution. VATS successfully allowed minor, major and complex procedures for various lung and mediastinal pathologies with small incision instead of the traditional accesses. These small incisions abolished ugly scars, generated less acute and chronic pain, reduced hospital stay and costs, allowed faster return to normal day life activities. Conventional VATS was initially performed through 3-4 ports and rapidly evolved to uniportal or single portal access [uniportal video-assisted thoracic surgery (uniVATS)]. First uniportal procedures were published in 2000. In 2010, uniportal technique for lobectomy was described. Focused experimental courses, live surgery events, the internet media favored the rapid diffusion of this technique over the world. Major and complex uniVATS lung resections involving segmentectomy, pneumonectomy, bronchoplasty and vascular reconstruction, redo VATS, en bloc chest wall resections have been accomplished with satisfactory outcomes. Interestingly, different uniportal approaches and techniques are emerging from a number of VATS centers particularly experienced in the mini-invasive thoracic surgery. As confidence grew, in 2014, the first uniVATS left upper lobectomy via the subxiphoid approach was reported. This novel technique is quite challenging but appropriate patient selection as well as availability of dedicated instruments allowed to perform procedures safely. The diffusion of uniVATS paralleled with the development of nonintubated awake anesthesia technique. In 2007 the first nonintubated lobectomy was described. In 2014 the first single port VATS lobectomy in a nonintubated patient with lung cancer of the right middle lobe was accomplished. The nonintubated uniVATS represents an intriguing technique, so that very experienced thoracoscopic surgeons may enroll to surgery elderly and high risk patients. Decreased postoperative pain and hospitalization, faster access to the radio-chemotherapy and diminished inflammatory response are important benefits of the modern approach to the thoracic pathologies. The history of uniVATS documented a constant and irresistible progress. This technique may further provide unthinkable surprises in next future.
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Affiliation(s)
- Tommaso Claudio Mineo
- Department of Surgery and Experimental Medicine, Official Group of Awake Thoracic Surgery Research, Policlinico Tor Vergata University, Rome, Italy
| | - Vincenzo Ambrogi
- Department of Surgery and Experimental Medicine, Official Group of Awake Thoracic Surgery Research, Policlinico Tor Vergata University, Rome, Italy.,Thoracic Surgery, Official Group of Awake Thoracic Surgery Research, Policlinico Tor Vergata University, Rome, Italy
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Guillot-Tantay C, Chartier-Kastler E, Mozer P, Bitker MO, Richard F, Ambrogi V, Denys P, Léon P, Phé V. [Male neurogenic stress urinary incontinence treated by artificial urinary sphincter AMS 800™ (Boston Scientific, Boston, USA): Very long-term results (>25 years)]. Prog Urol 2017; 28:39-47. [PMID: 29102375 DOI: 10.1016/j.purol.2017.09.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 03/23/2017] [Revised: 08/03/2017] [Accepted: 09/26/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of the study was to report the very long-term functional outcomes of artificial urinary sphincter (AUS) in male neurological patients. MATERIAL AND METHODS Male neurological patients diagnosed with stress urinary incontinence due to sphincter deficiency and undergoing AUS (AMS 800®) implantation between 1985 and 1992 were enrolled. Continence, defined by no pad/condom usage, explantation and revision rates were reported. RESULTS Fourteen patients with a median age of 27.3 years (IQR: 27.3-40.8) were included: four had a spinal cord injury and ten a spina bifida. Prior continence surgery was reported by 6 patients (42.9 %). Artificial urinary sphincter was implanted in a peribulbar (n=4) or periprostatic position (n=10). Median follow-up was 18.3 years (IQR: 10.1-20.3). At last follow-up, all patients were alive. Three native devices were still in place, eight were revised (four of them were secondarily explanted) and three were explanted due to erosion or infection. The 5-, 10-, 15-, 20-year explantation-free survival rates were respectively 85.7, 62.3, 52.0, 39.0 %. The 5-, 10-, 15-, 20-year revision-free survival rates were respectively 78.6, 42.9, 28.6, 7.1 %. At last follow-up, 50 % patients were continent. CONCLUSION In the very long run, AUS provided a 50 % continence rate in male neurological patients but the revision rates were important. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- C Guillot-Tantay
- Service d'urologie et de transplantation rénale, hôpital universitaire La Pitié Salpêtrière, Assistance publique-Hôpitaux de Paris, faculté de médecine Pierre et Marie Curie, Sorbonne universités, université Paris 6, 47-83, boulevard de L'hôpital, 75013 Paris, France.
| | - E Chartier-Kastler
- Service d'urologie et de transplantation rénale, hôpital universitaire La Pitié Salpêtrière, Assistance publique-Hôpitaux de Paris, faculté de médecine Pierre et Marie Curie, Sorbonne universités, université Paris 6, 47-83, boulevard de L'hôpital, 75013 Paris, France
| | - P Mozer
- Service d'urologie et de transplantation rénale, hôpital universitaire La Pitié Salpêtrière, Assistance publique-Hôpitaux de Paris, faculté de médecine Pierre et Marie Curie, Sorbonne universités, université Paris 6, 47-83, boulevard de L'hôpital, 75013 Paris, France
| | - M-O Bitker
- Service d'urologie et de transplantation rénale, hôpital universitaire La Pitié Salpêtrière, Assistance publique-Hôpitaux de Paris, faculté de médecine Pierre et Marie Curie, Sorbonne universités, université Paris 6, 47-83, boulevard de L'hôpital, 75013 Paris, France
| | - F Richard
- Service d'urologie et de transplantation rénale, hôpital universitaire La Pitié Salpêtrière, Assistance publique-Hôpitaux de Paris, faculté de médecine Pierre et Marie Curie, Sorbonne universités, université Paris 6, 47-83, boulevard de L'hôpital, 75013 Paris, France
| | - V Ambrogi
- Service d'urologie et de transplantation rénale, hôpital universitaire La Pitié Salpêtrière, Assistance publique-Hôpitaux de Paris, faculté de médecine Pierre et Marie Curie, Sorbonne universités, université Paris 6, 47-83, boulevard de L'hôpital, 75013 Paris, France
| | - P Denys
- Service de médecine physique et réadaptation, hôpital Raymond-Poincaré, Assistance publique-Hôpitaux de Paris, UFR des sciences de la santé Simone Veil, université Versailles-Saint-Quentin-en-Yvelines, 104, boulevard Raymond-Poincaré, 92380 Garches, France
| | - P Léon
- Service d'urologie et de transplantation rénale, hôpital universitaire La Pitié Salpêtrière, Assistance publique-Hôpitaux de Paris, faculté de médecine Pierre et Marie Curie, Sorbonne universités, université Paris 6, 47-83, boulevard de L'hôpital, 75013 Paris, France
| | - V Phé
- Service d'urologie et de transplantation rénale, hôpital universitaire La Pitié Salpêtrière, Assistance publique-Hôpitaux de Paris, faculté de médecine Pierre et Marie Curie, Sorbonne universités, université Paris 6, 47-83, boulevard de L'hôpital, 75013 Paris, France
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Mineo TC, Fabbi E, Ambrogi V. Nonintubated uniportal nonresectional videothoracoscopic lung volume reduction surgery. Video-assist Thorac Surg 2017. [DOI: 10.21037/vats.2017.08.15] [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: 11/06/2022]
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Abstract
BACKGROUND More than 15 years ago, we started a program of uniportal video-assisted thoracoscopies (VATS) lung metastasectomy in non-intubated local anesthesia. Hereby we present the short and long-term results of this combined surgical-anesthesiological technique. METHODS Between 2005 and 2015, 71 patients (37 men and 34 women) with pulmonary oligometastases, at the first episode, underwent uniportal VATS metastasectomy under non-intubated anesthesia. RESULTS Four patients (5.6%) required intubation for intolerance. Mean number of lesions resected per patient was 1.51. There was no mortality. The study group demonstrated a significant reduction of operative time from the beginning of the experience (P=0.001), good level of consciousness at Richmond scale and quality of recovery after both 24 and 48 hours. Median hospital stay was 3 days and major morbidity rate was 5.5%. Both disease-free survival and overall survival were similar to those achieved with intubated surgery. CONCLUSIONS VATS lung metastasectomy in non-intubated local anesthesia was safely performed in selected patients with oligometastases with significant advantages in overall operative time, hospital stay and economical costs. Long-term results were similar.
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Affiliation(s)
- Tommaso Claudio Mineo
- Department of Surgery and Experimental Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Francesco Sellitri
- Department of Surgery and Experimental Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Eleonora Fabbi
- Department of Thoracic Surgery, Official Awake Thoracic Surgery Research Group, Policlinico Tor Vergata University of Rome, Rome, Italy
| | - Vincenzo Ambrogi
- Department of Surgery and Experimental Medicine, Tor Vergata University of Rome, Rome, Italy.,Department of Thoracic Surgery, Official Awake Thoracic Surgery Research Group, Policlinico Tor Vergata University of Rome, Rome, Italy
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Mineo TC, Sellitri F, Vanni G, Gallina FT, Ambrogi V. Immunological and Inflammatory Impact of Non-Intubated Lung Metastasectomy. Int J Mol Sci 2017; 18:ijms18071466. [PMID: 28686211 PMCID: PMC5535957 DOI: 10.3390/ijms18071466] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 06/20/2017] [Accepted: 06/28/2017] [Indexed: 12/22/2022] Open
Abstract
Background: We hypothesized that video-assisted thoracic surgery (VATS) lung metastasectomy under non-intubated anesthesia may have a lesser immunological and inflammatory impact than the same procedure under general anesthesia. Methods: Between December 2005 and October 2015, 55 patients with pulmonary oligometastases (at the first episode) successfully underwent VATS metastasectomy under non-intubated anesthesia. Lymphocytes subpopulation and interleukins 6 and 10 were measured at different intervals and matched with a control group composed of 13 patients with similar clinical features who refused non-intubated surgery. Results: The non-intubated group demonstrated a lesser reduction of natural killer lymphocytes at 7 days from the procedure (p = 0.04) compared to control. Furthermore, the group revealed a lesser spillage of interleukin 6 after 1 (p = 0.03), 7 (p = 0.04), and 14 (p = 0.05) days. There was no mortality in any groups. Major morbidity rate was significantly higher in the general anesthesia group 3 (5%) vs. 3 (23%) (p = 0.04). The median hospital stay was 3.0 vs. 3.7 (p = 0.033) days, the estimated costs with the non-intubated procedure was significantly lower, even excluding the hospital stay. Conclusions: VATS lung metastasectomy in non-intubated anesthesia had significantly lesser impact on both immunological and inflammatory response compared to traditional procedure in intubated general anesthesia.
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Affiliation(s)
- Tommaso Claudio Mineo
- Department of Surgery and Experimental Medicine, Tor Vergata University of Rome, Rome 00173, Italy.
| | - Francesco Sellitri
- Department of Surgery and Experimental Medicine, Tor Vergata University of Rome, Rome 00173, Italy.
- Department of Thoracic Surgery, Official Awake Thoracic Surgery Research Group, Policlinico Tor Vergata University of Rome, Roma 00133, Italy.
| | - Gianluca Vanni
- Department of Surgery and Experimental Medicine, Tor Vergata University of Rome, Rome 00173, Italy.
| | - Filippo Tommaso Gallina
- Department of Surgery and Experimental Medicine, Tor Vergata University of Rome, Rome 00173, Italy.
| | - Vincenzo Ambrogi
- Department of Surgery and Experimental Medicine, Tor Vergata University of Rome, Rome 00173, Italy.
- Department of Thoracic Surgery, Official Awake Thoracic Surgery Research Group, Policlinico Tor Vergata University of Rome, Roma 00133, Italy.
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Manach Q, Bouquot M, Rouprêt M, Ambrogi V, Richard F, Bitker MO, Chartier-Kastler E, Phé V. [Placement of tension-free vaginal tape in women with stress urinary incontinence: Long-term functional outcomes in a prospective series]. Prog Urol 2017; 27:640-646. [PMID: 28651995 DOI: 10.1016/j.purol.2017.05.009] [Citation(s) in RCA: 2] [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] [Received: 09/22/2016] [Revised: 04/01/2017] [Accepted: 05/25/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate the long-term functional outcomes after retropubic tension-free vaginal tape (TVT) placement to treat female stress urinary incontinence (SUI). METHODS From September 1998 to September 2000, we prospectively enrolled all consecutive women in our center suffering SUI caused by urethral hypermobility. All women had a retropubic TVT inserted by the same surgeon. Patients were evaluated at 1, 3, 6 and 12 months postoperatively, and annually thereafter. Postoperative assessment included a measurement of post-voiding residual volume, urinalysis, a 1-hour pad test, a urinary symptom questionnaire, and an assessment of quality-of-life. Objective continence (defined as no urine leakage at clinical examination) and subjective continence (defined as no urine leakage, whatever the mechanism, reported by the patient) were reported. RESULTS Overall, 58 consecutive women (median age 59; IQR 49-67; min 21-max 78) were evaluated. Median follow-up was 10.2years (IQR 1.4-16.0; min 1-max 13.2). At the last follow-up, objective and subjective continence rates were 93% and 78%, respectively and remained stable in the long run. Pad tests, urinary symptom questionnaire scores and quality-of-life were significantly improved. Self-intermittent catheterisation was required by three women. A section of one TVT and removal of another tape was undertaken in two women with chronic pelvic pain. One patient had a chronic urinary infection. Rate of de novo urgency was 10%. CONCLUSIONS TVT implantation offered good and stable functional long-term outcomes. This procedure enhanced quality-of-life and had low morbidity. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Q Manach
- Service d'urologie, hôpital universitaire Pitié-Salpêtrière, faculté de médecine Pierre-et-Marie-Curie, Sorbonne universités, université Paris 6, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
| | - M Bouquot
- Service d'urologie, hôpital universitaire Pitié-Salpêtrière, faculté de médecine Pierre-et-Marie-Curie, Sorbonne universités, université Paris 6, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
| | - M Rouprêt
- Service d'urologie, hôpital universitaire Pitié-Salpêtrière, faculté de médecine Pierre-et-Marie-Curie, Sorbonne universités, université Paris 6, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
| | - V Ambrogi
- Service de santé publique, informatique médicale et biostatistique, hôpital universitaire Pitié-Salpêtrière, faculté de médecine Pierre-et-Marie-Curie, Sorbonne universités, université Paris 6, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'hôpital, 75651 Paris cedex 13, France.
| | - F Richard
- Service d'urologie, hôpital universitaire Pitié-Salpêtrière, faculté de médecine Pierre-et-Marie-Curie, Sorbonne universités, université Paris 6, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
| | - M O Bitker
- Service d'urologie, hôpital universitaire Pitié-Salpêtrière, faculté de médecine Pierre-et-Marie-Curie, Sorbonne universités, université Paris 6, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
| | - E Chartier-Kastler
- Service d'urologie, hôpital universitaire Pitié-Salpêtrière, faculté de médecine Pierre-et-Marie-Curie, Sorbonne universités, université Paris 6, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
| | - V Phé
- Service d'urologie, hôpital universitaire Pitié-Salpêtrière, faculté de médecine Pierre-et-Marie-Curie, Sorbonne universités, université Paris 6, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
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Nasti G, Sanchez S, Gunkel I, Balog S, Roose B, Wilts BD, Teuscher J, Gentile G, Cerruti P, Ambrogi V, Carfagna C, Steiner U, Abate A. Patterning of perovskite-polymer films by wrinkling instabilities. Soft Matter 2017; 13:1654-1659. [PMID: 28138668 DOI: 10.1039/c6sm02629j] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Organic-inorganic perovskites are semiconductors used for applications in optoelectronics and photovoltaics. Micron and submicron perovskite patterns have been explored in semitransparent photovoltaic and lasing applications. In this work, we show that a polymeric medium can be used to create a patterned perovskite, by using a novel and inexpensive approach.
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Affiliation(s)
- G Nasti
- Department of Chemical, Materials and Production Engineering, University of Naples "Federico II", Piazzale Tecchio 80, 80125 Napoli, Italy and Institute for Polymers, Composites and Biomaterials (IPCB-CNR), via Campi Flegrei 34, 80078 Pozzuoli (NA), Italy and Institute of Applied Sciences and Intelligent System, Via Campi Flegrei 34, Pozzuoli (NA), Italy
| | - S Sanchez
- Adolphe Merkle Institute, University of Fribourg, Chemin des Verdiers 4, CH-1700 Fribourg, Switzerland.
| | - I Gunkel
- Adolphe Merkle Institute, University of Fribourg, Chemin des Verdiers 4, CH-1700 Fribourg, Switzerland.
| | - S Balog
- Adolphe Merkle Institute, University of Fribourg, Chemin des Verdiers 4, CH-1700 Fribourg, Switzerland.
| | - B Roose
- Adolphe Merkle Institute, University of Fribourg, Chemin des Verdiers 4, CH-1700 Fribourg, Switzerland.
| | - B D Wilts
- Adolphe Merkle Institute, University of Fribourg, Chemin des Verdiers 4, CH-1700 Fribourg, Switzerland.
| | - J Teuscher
- Group for Photochemical Dynamics, Institute of Chemical Sciences and Engineering, École Polytechnique Fédérale de Lausanne, Station 6, CH-1015 Lausanne, Switzerland
| | - G Gentile
- Institute for Polymers, Composites and Biomaterials (IPCB-CNR), via Campi Flegrei 34, 80078 Pozzuoli (NA), Italy
| | - P Cerruti
- Institute for Polymers, Composites and Biomaterials (IPCB-CNR), via Campi Flegrei 34, 80078 Pozzuoli (NA), Italy
| | - V Ambrogi
- Department of Chemical, Materials and Production Engineering, University of Naples "Federico II", Piazzale Tecchio 80, 80125 Napoli, Italy
| | - C Carfagna
- Institute for Polymers, Composites and Biomaterials (IPCB-CNR), via Campi Flegrei 34, 80078 Pozzuoli (NA), Italy
| | - U Steiner
- Adolphe Merkle Institute, University of Fribourg, Chemin des Verdiers 4, CH-1700 Fribourg, Switzerland.
| | - A Abate
- Adolphe Merkle Institute, University of Fribourg, Chemin des Verdiers 4, CH-1700 Fribourg, Switzerland.
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