Ferrari A.,Breast Unit |
Sgarella A.,Breast Unit |
Zonta S.,General Surgery Unit I
Nipple Sparing Mastectomy: Minimally Invasive Video-Assisted Technique | Year: 2013
This book describes in detail three different techniques for minimally invasive video-assisted breast surgery: nipple-sparing mastectomy with a hand-held external retractor, with a single-port device, and with robotic assistance. All three techniques can be employed for radical treatment of breast cancer or for risk reduction surgery, and the last two are brand new. The techniques are clearly explained with the aid of numerous high-quality illustrations. All surgical stages are covered in detail, and helpful information is provided on key aspects of surgical anatomy, diagnostic workup, instrumentation, and postoperative management. Nipple Sparing Mastectomy is the first manual to cover these techniques, which are likely to become standard in the field of oncological breast surgery. It will be invaluable for breast surgeons who are skilled in nipple-sparing mastectomy and oncoplastic techniques or are working in breast units that offer genetic counseling to high-risk patients. © Springer-Verlag Italia 2013.
Zonta S.,General Surgery Unit I |
De Martino M.,University of Pavia |
Podetta M.,University of Geneva |
Vigano J.,General Surgery Unit I |
And 7 more authors.
Surgical Infections | Year: 2015
Background: Acute generalized peritonitis secondary to complicated diverticulitis is a life-threatening condition; the standard treatment is surgery. Despite advances in peri-operative care, this condition is accompanied by a high peri-operative complication rate (22%-25%). No definitive evidence is available to recommend a preferred surgical technique in patients with Hinchey stage III/IV disease. Methods: A matched case-control study enrolling patients from four surgical units at Italian university hospital was planned to assess the most appropriate surgical treatment on the basis of patient performance status and peritonitis exposure, with the aim of minimizing the surgical site infection (SSI). A series of 1,175 patients undergoing surgery for Hinchey III/IV peritonitis in 2003-2013 were analyzed. Cases (n=145) were selected from among those patients who developed an SSI. The case:control ratio was 1:3. Cases and control groups were matched by age, gender, body mass index, and Hinchey grade. We considered three surgical techniques: T1=Hartman's procedure; T2=sigmoid resection, anastomosis, and ileostomy; and T3=sigmoid resection and anastomosis. Six scoring systems were analyzed to assess performance status; subsequently, patients were divided into low, mild, and high risk (LR, MR, HR) according to the system producing the highest area under the curve. We classified peritonitis exposition as P1=<12 h; P2=12-24 h; P3=>24h. Univariable and multivariable analyses were performed. Results: The Apgar scoring system defined the risk groups according to performance status. Lowest SSI risk was expected when applying T3 in P1 (OR=0.22), P2 (OR=0.5) for LR and in P1 (OR=0.63) for MR; T2 in P2 (OR=0.5) in LR and in P1 (OR=0.61) in MR; T1 in P3 (OR=0.56) in LR; in P2 (OR=0.63) and P3 (OR=0.54) in MR patients, and in each P subgroup (OR=0.93;0.97;1.01) in HR. Conclusions: Pre-operative assessment based on Apgar scoring system integrated with peritonitis exposure in complicated diverticulitis may offer a ready-to-use tool for reducing SSI-related complications and applying appropriate treatment, reducing the need for disabling ostomy. © Copyright 2015, Mary Ann Liebert, Inc.