Laparoscopic-assisted surgery for colon cancer.
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Colectomy↗
Biomedical subjects
Francesco Rubino
Publications and source records attributed to Francesco Rubino.
Advances in virtual reality are wide ranging.
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Education, Medical, Graduate↗
Transcontinental robot-assisted remote telesurgery: feasibility and potential applications.
OBJECTIVE: To show the feasibility of performing surgery across transoceanic distances by using dedicated asynchronous transfer mode (ATM) telecommunication technology. SUMMARY BACKGROUND DATA: Technical limitations and the issue of time delay for transmission of digitized information across existing telecommunication lines had been a source of concern about the feasibility of performing a complete surgical procedure from remote distances. METHODS: To verify the feasibility and safety in humans, the authors attempted remote robot-assisted laparoscopic cholecystectomy on a 68-year-old woman with a history of abdominal pain and cholelithiasis. Surgeons were in New York and the patient in Strasbourg. Connections between the sites were done with a high-speed terrestrial network (ATM service). RESULTS: The operation was carried out successfully in 54 minutes without difficulty or complications. Despite a round-trip distance of more than 14,000 km, the mean time lag for transmission during the procedure was 155 ms. The surgeons perceived the procedure as safe and the overall system as perfectly reliable. The postoperative course was uneventful and the patient returned to normal activities within 2 weeks after surgery. CONCLUSIONS: Remote robot-assisted surgery appears feasible and safe. Teletransmission of active surgical manipulations has the potential to ensure availability of surgical expertise in remote locations for difficult or rare operations, and to improve surgical training worldwide.
Aged↗
Potential of surgery for curing type 2 diabetes mellitus.
OBJECTIVE: To review the effect of morbid obesity surgery on type 2 diabetes mellitus, and to analyze data that might explain the mechanisms of action of these surgeries and that could answer the question of whether surgery for morbid obesity can represent a cure for type 2 diabetes in nonobese patients as well. SUMMARY BACKGROUND DATA: Diabetes mellitus type 2 affects more than 150 million people worldwide. Although the incidence of complications of type 2 diabetes can be reduced with tight control of hyperglycemia, current therapies do not achieve a cure. Some operations for morbid obesity not only induce significant and lasting weight loss but also lead to improvements in or resolution of comorbid disease states, especially type 2 diabetes. METHODS: The authors reviewed data from the literature to address what is known about the effect of surgery for obesity on glucose metabolism and the endocrine changes that follow this surgery. RESULTS: Series with long-term follow-up show that gastric bypass and biliopancreatic diversion achieve durable normal levels of plasma glucose, plasma insulin, and glycosylated hemoglobin in 80% to 100% of severely obese diabetic patients, usually within days after surgery. Available data show a significant change in the pattern of secretion of gastrointestinal hormones. Case reports have also documented remission of type 2 diabetes in nonmorbidly obese individuals undergoing biliopancreatic diversion for other indications. CONCLUSIONS: Gastric bypass and biliopancreatic diversion seem to achieve control of diabetes as a primary and independent effect, not secondary to the treatment of overweight. Although controlled trials are needed to verify the effectiveness on nonobese individuals, gastric bypass surgery has the potential to change the current concepts of the pathophysiology of type 2 diabetes and, possibly, the management of this disease.
Biliopancreatic Diversion↗
Ambulatory radioguided parathyroidectomy.
Primary hyperparathyroidism (HPT) is a common disease that occurs in one of 500 women and one of 2,000 men over the age of 40. In 85% to 90% of patients, primary HPT is caused by a solitary parathyroid adenoma. Recent advances in evaluation and surgical management of HPT, including improved localization techniques and intraoperative parathyroid hormone (PTH) monitoring, have permitted a more targeted approach to parathyroid surgery.
Humans↗
[Laparoscopic appendectomy: retrospective studies of 172 consecutive procedures].
The aim of our study was to assess the efficacy and safety of laparoscopic appendectomy, as performed by experienced and trainee surgeons in a Unit of General Surgery. From June 1997 to May 2002, 172 patients underwent laparoscopic appendectomy. Age below 13 years was an exclusion criterion. There was no single protocol for the diagnosis and surgical technique adopted by the different surgeons. The average operating time was 65.3 min (range: 41-106 min). There were 9 conversions to open surgery (5.2%) and 9 postoperative complications (5.5%) out of a total of 162 patients undergoing the laparoscopic procedure. Oral intake was resumed on post-operative day 2 and the average hospital stay was 3.4 days (range: 3-5 days). In conclusion, laparoscopic appendectomy proved to be safe and effective, even when performed by surgeons with only limited experience of minimally invasive surgery.
Adolescent↗
A new device for sentinel node detection in laparoscopic colon resection.
OBJECTIVE: To test the feasibility of using a newly developed device for laparoscopic lymphatic mapping of the colon by simultaneous and quantitative detection of both tissue coloration and radioactivity. METHODS: Four pigs were used in this study. In each animal, both blue dye and radioisotope injections were utilized. Lymphatic mapping was performed laparoscopically in the sigmoid mesocolon and in the right mesocolon. A solution containing a mix of 35 microcuries of Technetium Tc-99 sulfur Colloid and 1 mL of a vital blue dye was administered subserosally by percutaneous insertion of a 25 gauge needle under laparoscopic control. The new device for automated sentinel-node detection consists of a gamma-probe coupled with a laser device and can be passed through a regular 10-mm trocar. The device detects simultaneously both radioactivity and quantitative tissue coloration. Nodes showing a radioactivity at least 5 times higher than that of the background or that had a blue colorant concentration were considered our sentinel nodes. RESULTS: Laparoscopic simultaneous and quantitative detection of sentinel nodes was feasible in all pigs. One or more sentinel nodes were identified by either the blue dye or radioisotopic technique in both the sigmoid and right mesocolon. Quantitative tissue coloration detection led to the recognition of additional nodes that were not apparently colored to the naked eye. CONCLUSION: Laparoscopic sentinel node detection using a device combining gamma and color detection is feasible in the porcine model. The significance of nodes apparently clear but positive with the quantitative detection technique should be further evaluated.
Animals↗