Minerva urologica e nefrologica = The Italian journal of urology and nephrology
Traditional surgical therapy for the sterility-causing afflictions of the deferens has produced p... more Traditional surgical therapy for the sterility-causing afflictions of the deferens has produced poor results. Recently however the adoption of microsurgical techniques and the use of an operating microscope (ideal for small structures) have considerably increased the number of positively resolved cases. The greatest successes have been obtained in the reversal of vasectomies the resectioning of stenotical segments and the reconstruction of the continuity of the deferens. Presently the goal is to examine the various techniques of microsurgical vaso-vasostomy adopted by the various authors to obtain a more complete continuity and reimpermeability of the anastomosis of the deferens. Of the microsurgical techniques for deferential anastomosis; the Silber technique involves a double muco-mucosa and muscular layer. The Hamidinia technique involves tying off the 5th suture and cutting it so that the deferential opening is still visible before the final suture is tied off. With the Jenkins and Blacklock technique a 21-guage hypodermic needle is inserted into the deferential opening in the direction of the epididymis and brought out of the wall at .5 cm. The Willscher and Novicki technique uses a plexiglas stabilizer; the ends of deferens are brought together and then sutured. The Arnold and Belker technique uses a foldable clamp which brings the 2 ends together. In the Microsurgery Department of the 3rd Surgical Clinic of La Sapienza University in Rome a 2-layer deferento-deferential technique derived from Silber is used. An attempt is made to save the deferential artery dissecting it from the deferens by about 1 cm and performing an accurate hemostasis with a bipolar scalpel. A clamp is used for the 2 ends. The procedure begins by suturing the mucosa in its frontal position inserting a triple strand of thread that is then sectioned in such a way that the strands can be tied off as if they related to 3 separate points. Although the results of the technique have been very positive it is felt that there is still much room for improvement.
The results of pancreas transplantation have greatly improved in recent years. The path to furthe... more The results of pancreas transplantation have greatly improved in recent years. The path to further improvements goes through extensive experimental researches. This study describes the effects of different procedures as hemodynamic asset and postoperative outcome. Twenty-nine swine underwent a total pancreatectomy, and were stratified into five groups. Group one (n = 5) served as control. Group two (n = 7) was autotransplanted. Group three (n = 6) and group four (n = 6) underwent allotransplantation; the first without immunosuppression and the second treated with cyclosporine and steroids. In group five (n = 5) Langerhans Islets transplantation was performed. Survival was different depending on which methodology was applied. The postoperative survival was 7 +/- 2 days in group one, 24 +/- 16 days in group two, 17 +/- 7 days in group three, 27 +/- 8 days in group four and 12 +/- 6 days in group five. The postoperative glucose control was normal in group two and group four while a sev...
INTRODUCTION: Simulation and training in surgery are very promising tools for enhancing a surgeon... more INTRODUCTION: Simulation and training in surgery are very promising tools for enhancing a surgeon's skill base. Accurate tracking of hand movements can be a strategy for objectively gauging a surgeon's dexterity, although "open" work is much more difficult to evaluate than are laparoscopic tasks. To the authors' knowledge, a system taking into account the movements of each finger joint has never been applied to open surgery simulation. This work intends to make up for this shortcoming and to perform a data analysis of the surgeon's entire gesture. MATERIALS AND METHODS: The authors developed a sensory glove to measure flexion/extension of each finger joint and wrist movement. Totally 9 experts and 9 novices performed a basic suturing task and their manual performances were recorded within 2 days of measurements. Intraclass correlation coefficients were calculated to assess the ability of the executors to repeat and reproduce the proposed exercise. Wilcoxon signed-rank tests and Mann-Whitney U-tests were used to determine whether the 2 groups differ significantly in terms of execution time, repeatability, and reproducibility. Finally, a questionnaire was used to gather operators' subjective opinions. RESULTS: The experts needed a similar reduced execution time comparing the 2 recording sessions (p ¼ 0.09), whereas novices spent more time during the first day (p ¼ 0.01). Repeatability did not differ between the 2 days, either for experts (p ¼ 0.26) or for novices (p ¼ 0.86). The 2 groups performed differently in terms of time (p o 0.001), repeatability (p ¼ 0.01), and reproducibility (p o 0.001) of the same gesture. The system showed an overall moderate repeatability (intraclass correlation coefficient: experts ¼ 0.64; novices ¼ 0.53) and an overall high reproducibility. The questionnaire revealed performers' positive feedback with the glove. CONCLUSIONS: This initial experience confirmed the validity and reliability of the proposed system in objectively assessing surgeons' technical skill, thus paving the way to a more complex project involving open surgery simulation.
Introduction. Moderate obesity (BMI 30–35 kg/m2) affects 25% of the western population. The role ... more Introduction. Moderate obesity (BMI 30–35 kg/m2) affects 25% of the western population. The role of bariatric surgery in this context is currently debated, reserved for patients with comorbidity, as an alternative to conservative medical treatment. We describe our experience in moderately obese patients treated with bariatric surgery.Materials and Methods. Between September 2011 and September 2012, 25 patients with grade I obesity and comorbidities underwent bariatric surgery: preoperative mean BMI 33.2 kg/m2, 10 males, mean age 42 years. In presence of type 2 diabetes mellitus (T2DM) (56%), gastric bypass was performed; in cases with hypertension (64%) and obstructive sleep apnea (OSA) (12%), sleeve gastrectomy was performed. All operations were performed laparoscopically.Results. Mean follow-up was 12.4 months. A postoperative complication occurred: bleeding from the trocar site was resolved with surgery in local anesthesia. Reduction in average BMI was 6 points, with a value of 2...
Background: Gastro-jejunal anastomotic leak and internal hernia can be life-threatening complicat... more Background: Gastro-jejunal anastomotic leak and internal hernia can be life-threatening complications of laparoscopic Roux-en-Y gastric bypass (LRYGBP), ranging from 0.1-4.3% and from 0.8-4.5% respectively. The safety and efficacy of a fibrin glue (Tissucol ®) was assessed when placed around the anastomoses and over the mesenteric openings for prevention of anastomotic leaks and internal hernias after LRYGBP. Methods: A prospective, randomized, multicenter, clinical trial commenced in January 2004. Patients with BMI 40-59 kg/m 2 , aged 21-60 years, undergoing LRYGBP, were randomized into: 1) study group (fibrin glue applied on the gastro-jejunal and jejuno-jejunal anastomoses and the mesenteric openings); 2) control group (no fibrin glue, but suture of the mesenteric openings). 322 patients, 161 for each arm, will be enrolled for an estimated period of 24 months. Sex, age, operative time, time to postoperative oral diet and hospital stay, early and late complications rates are evaluated. An interim evaluation was conducted after 15 months. Results: To April 2005, 204 patients were randomized: 111 in the control group (mean age 39.0±11.5 years, BMI 46.1±8.2) and 93 in the fibrin glue group (mean age 42.9±11.7 years, BMI 46.9±6.4). There was no mortality or conversion in both groups; no differences in operative time and postoperative hospital stay were recorded. Time to postoperative oral diet was shorter for the fibrin glue group (P=0.0044). Neither leaks nor internal hernias have occurred in the fibrin glue group. The incidence of leaks (2 cases, 1.8%) and the overall reoperation rate were higher in the control group (P=0.0165). Conclusion: The preliminary results suggest that Tissucol ® application has no adverse effects, is not time-consuming, and may be effective in preventing leaks and internal hernias in morbidly obese patients undergoing LRYGBP.
Clinical: Diagnosis and outcome S61 about drug side effects, the danger signs to watch for or how... more Clinical: Diagnosis and outcome S61 about drug side effects, the danger signs to watch for or how to manage their condition after going home. Conclusions: There are many positive findings from the United Kingdom survey of IBD inpatient care over 1 2 of adults and children rated their care as 'very good' or 'excellent'. Patients clearly value coordinated care. There are a number of areas for potential improvement and greater involvement of IBD nurses at ward level could play a key role. All admitted IBD patients should receive input from specialist multidisciplinary teams with experience of managing these complex disorders.
Hypothesis: Complications after laparoscopic adjustable gastric banding as treatment for morbid o... more Hypothesis: Complications after laparoscopic adjustable gastric banding as treatment for morbid obesity may require a major reintervention. A minimally invasive approach represents an attractive management alternative for such complications.
The assessment of hand functions after hand surgery treatment is essential to address the optimal... more The assessment of hand functions after hand surgery treatment is essential to address the optimal rehabilitation procedures for any patient. To this aim, the current procedures anachronistically rely mainly on manual goniometers (highly prone to human errors) and know-how of experienced medical staffs (potentially prone to biased judgment), so that there is room for improvements in objective measurements of hand capabilities and new technological systems are very welcome. In particular, systems based on sensory glove are gaining more and more relevance in acquiring hand movement capabilities. Within this frame, in this research the Range of Motion (ROM) for all fingers and the ability of participants (health vs. patient subjects) to repeat two ADL (Activities of Daily Living)-based tasks were investigate. As a result, the glove-based system was evaluated in its feasibility for the assessment of hand function in clinical practice and rehabilitation settings
2011 IEEE International Symposium on Medical Measurements and Applications, 2011
The understanding of surgical gesture, by means of measuring apparatus, can play a key role for a... more The understanding of surgical gesture, by means of measuring apparatus, can play a key role for a possible evaluation of the surgical performance and the human factors characterizing it. To this aim a neural network classification algorithm can be helpful, since combines good generalization performances along with a parsimonious architecture when dealing with high dimensional classification problems. So, here it is presented and proposed the development of an innovation in surgical training system, as a fundamental objective support for training of novice surgeons.
Minerva urologica e nefrologica = The Italian journal of urology and nephrology
Traditional surgical therapy for the sterility-causing afflictions of the deferens has produced p... more Traditional surgical therapy for the sterility-causing afflictions of the deferens has produced poor results. Recently however the adoption of microsurgical techniques and the use of an operating microscope (ideal for small structures) have considerably increased the number of positively resolved cases. The greatest successes have been obtained in the reversal of vasectomies the resectioning of stenotical segments and the reconstruction of the continuity of the deferens. Presently the goal is to examine the various techniques of microsurgical vaso-vasostomy adopted by the various authors to obtain a more complete continuity and reimpermeability of the anastomosis of the deferens. Of the microsurgical techniques for deferential anastomosis; the Silber technique involves a double muco-mucosa and muscular layer. The Hamidinia technique involves tying off the 5th suture and cutting it so that the deferential opening is still visible before the final suture is tied off. With the Jenkins and Blacklock technique a 21-guage hypodermic needle is inserted into the deferential opening in the direction of the epididymis and brought out of the wall at .5 cm. The Willscher and Novicki technique uses a plexiglas stabilizer; the ends of deferens are brought together and then sutured. The Arnold and Belker technique uses a foldable clamp which brings the 2 ends together. In the Microsurgery Department of the 3rd Surgical Clinic of La Sapienza University in Rome a 2-layer deferento-deferential technique derived from Silber is used. An attempt is made to save the deferential artery dissecting it from the deferens by about 1 cm and performing an accurate hemostasis with a bipolar scalpel. A clamp is used for the 2 ends. The procedure begins by suturing the mucosa in its frontal position inserting a triple strand of thread that is then sectioned in such a way that the strands can be tied off as if they related to 3 separate points. Although the results of the technique have been very positive it is felt that there is still much room for improvement.
The results of pancreas transplantation have greatly improved in recent years. The path to furthe... more The results of pancreas transplantation have greatly improved in recent years. The path to further improvements goes through extensive experimental researches. This study describes the effects of different procedures as hemodynamic asset and postoperative outcome. Twenty-nine swine underwent a total pancreatectomy, and were stratified into five groups. Group one (n = 5) served as control. Group two (n = 7) was autotransplanted. Group three (n = 6) and group four (n = 6) underwent allotransplantation; the first without immunosuppression and the second treated with cyclosporine and steroids. In group five (n = 5) Langerhans Islets transplantation was performed. Survival was different depending on which methodology was applied. The postoperative survival was 7 +/- 2 days in group one, 24 +/- 16 days in group two, 17 +/- 7 days in group three, 27 +/- 8 days in group four and 12 +/- 6 days in group five. The postoperative glucose control was normal in group two and group four while a sev...
INTRODUCTION: Simulation and training in surgery are very promising tools for enhancing a surgeon... more INTRODUCTION: Simulation and training in surgery are very promising tools for enhancing a surgeon's skill base. Accurate tracking of hand movements can be a strategy for objectively gauging a surgeon's dexterity, although "open" work is much more difficult to evaluate than are laparoscopic tasks. To the authors' knowledge, a system taking into account the movements of each finger joint has never been applied to open surgery simulation. This work intends to make up for this shortcoming and to perform a data analysis of the surgeon's entire gesture. MATERIALS AND METHODS: The authors developed a sensory glove to measure flexion/extension of each finger joint and wrist movement. Totally 9 experts and 9 novices performed a basic suturing task and their manual performances were recorded within 2 days of measurements. Intraclass correlation coefficients were calculated to assess the ability of the executors to repeat and reproduce the proposed exercise. Wilcoxon signed-rank tests and Mann-Whitney U-tests were used to determine whether the 2 groups differ significantly in terms of execution time, repeatability, and reproducibility. Finally, a questionnaire was used to gather operators' subjective opinions. RESULTS: The experts needed a similar reduced execution time comparing the 2 recording sessions (p ¼ 0.09), whereas novices spent more time during the first day (p ¼ 0.01). Repeatability did not differ between the 2 days, either for experts (p ¼ 0.26) or for novices (p ¼ 0.86). The 2 groups performed differently in terms of time (p o 0.001), repeatability (p ¼ 0.01), and reproducibility (p o 0.001) of the same gesture. The system showed an overall moderate repeatability (intraclass correlation coefficient: experts ¼ 0.64; novices ¼ 0.53) and an overall high reproducibility. The questionnaire revealed performers' positive feedback with the glove. CONCLUSIONS: This initial experience confirmed the validity and reliability of the proposed system in objectively assessing surgeons' technical skill, thus paving the way to a more complex project involving open surgery simulation.
Introduction. Moderate obesity (BMI 30–35 kg/m2) affects 25% of the western population. The role ... more Introduction. Moderate obesity (BMI 30–35 kg/m2) affects 25% of the western population. The role of bariatric surgery in this context is currently debated, reserved for patients with comorbidity, as an alternative to conservative medical treatment. We describe our experience in moderately obese patients treated with bariatric surgery.Materials and Methods. Between September 2011 and September 2012, 25 patients with grade I obesity and comorbidities underwent bariatric surgery: preoperative mean BMI 33.2 kg/m2, 10 males, mean age 42 years. In presence of type 2 diabetes mellitus (T2DM) (56%), gastric bypass was performed; in cases with hypertension (64%) and obstructive sleep apnea (OSA) (12%), sleeve gastrectomy was performed. All operations were performed laparoscopically.Results. Mean follow-up was 12.4 months. A postoperative complication occurred: bleeding from the trocar site was resolved with surgery in local anesthesia. Reduction in average BMI was 6 points, with a value of 2...
Background: Gastro-jejunal anastomotic leak and internal hernia can be life-threatening complicat... more Background: Gastro-jejunal anastomotic leak and internal hernia can be life-threatening complications of laparoscopic Roux-en-Y gastric bypass (LRYGBP), ranging from 0.1-4.3% and from 0.8-4.5% respectively. The safety and efficacy of a fibrin glue (Tissucol ®) was assessed when placed around the anastomoses and over the mesenteric openings for prevention of anastomotic leaks and internal hernias after LRYGBP. Methods: A prospective, randomized, multicenter, clinical trial commenced in January 2004. Patients with BMI 40-59 kg/m 2 , aged 21-60 years, undergoing LRYGBP, were randomized into: 1) study group (fibrin glue applied on the gastro-jejunal and jejuno-jejunal anastomoses and the mesenteric openings); 2) control group (no fibrin glue, but suture of the mesenteric openings). 322 patients, 161 for each arm, will be enrolled for an estimated period of 24 months. Sex, age, operative time, time to postoperative oral diet and hospital stay, early and late complications rates are evaluated. An interim evaluation was conducted after 15 months. Results: To April 2005, 204 patients were randomized: 111 in the control group (mean age 39.0±11.5 years, BMI 46.1±8.2) and 93 in the fibrin glue group (mean age 42.9±11.7 years, BMI 46.9±6.4). There was no mortality or conversion in both groups; no differences in operative time and postoperative hospital stay were recorded. Time to postoperative oral diet was shorter for the fibrin glue group (P=0.0044). Neither leaks nor internal hernias have occurred in the fibrin glue group. The incidence of leaks (2 cases, 1.8%) and the overall reoperation rate were higher in the control group (P=0.0165). Conclusion: The preliminary results suggest that Tissucol ® application has no adverse effects, is not time-consuming, and may be effective in preventing leaks and internal hernias in morbidly obese patients undergoing LRYGBP.
Clinical: Diagnosis and outcome S61 about drug side effects, the danger signs to watch for or how... more Clinical: Diagnosis and outcome S61 about drug side effects, the danger signs to watch for or how to manage their condition after going home. Conclusions: There are many positive findings from the United Kingdom survey of IBD inpatient care over 1 2 of adults and children rated their care as 'very good' or 'excellent'. Patients clearly value coordinated care. There are a number of areas for potential improvement and greater involvement of IBD nurses at ward level could play a key role. All admitted IBD patients should receive input from specialist multidisciplinary teams with experience of managing these complex disorders.
Hypothesis: Complications after laparoscopic adjustable gastric banding as treatment for morbid o... more Hypothesis: Complications after laparoscopic adjustable gastric banding as treatment for morbid obesity may require a major reintervention. A minimally invasive approach represents an attractive management alternative for such complications.
The assessment of hand functions after hand surgery treatment is essential to address the optimal... more The assessment of hand functions after hand surgery treatment is essential to address the optimal rehabilitation procedures for any patient. To this aim, the current procedures anachronistically rely mainly on manual goniometers (highly prone to human errors) and know-how of experienced medical staffs (potentially prone to biased judgment), so that there is room for improvements in objective measurements of hand capabilities and new technological systems are very welcome. In particular, systems based on sensory glove are gaining more and more relevance in acquiring hand movement capabilities. Within this frame, in this research the Range of Motion (ROM) for all fingers and the ability of participants (health vs. patient subjects) to repeat two ADL (Activities of Daily Living)-based tasks were investigate. As a result, the glove-based system was evaluated in its feasibility for the assessment of hand function in clinical practice and rehabilitation settings
2011 IEEE International Symposium on Medical Measurements and Applications, 2011
The understanding of surgical gesture, by means of measuring apparatus, can play a key role for a... more The understanding of surgical gesture, by means of measuring apparatus, can play a key role for a possible evaluation of the surgical performance and the human factors characterizing it. To this aim a neural network classification algorithm can be helpful, since combines good generalization performances along with a parsimonious architecture when dealing with high dimensional classification problems. So, here it is presented and proposed the development of an innovation in surgical training system, as a fundamental objective support for training of novice surgeons.
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Papers by A. Gaspari