Andrea Peri

Policlinico San Matteo Pavia Fondazione IRCCS, Ticinum, Lombardy, Italy

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Publications (8)17.08 Total impact

  • Cirugía Española 02/2013; 91(2):67–71. DOI:10.1016/j.ciresp.2012.07.005 · 0.89 Impact Factor
  • Cirugía Española 12/2012; · 0.87 Impact Factor
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    ABSTRACT: Hand-assisted laparoscopic surgery (HALS) is a safe therapeutic approach to remove megaspleens of any size. Conventional laparoscopic splenectomy for splenomegaly is difficult because of limited exposure and complex vascular control, with increased risk of intraoperative bleeding and conversion to open surgery. HALS can overcome some of these limitations, reducing the risk of conversion to open surgery and resulting in a postoperative course similar to that of conventional laparoscopy. Single-institution single-surgeon retrospective review. University hospital. An analysis was performed of all patients with splenomegaly (splenic weight, >700 g) seen during a 10-year period. Preoperative data, indications for splenectomy, splenic weight, operative variables, clinical outcome, and rates of conversion to open surgery, complications, and operative mortality were compared between patients undergoing HALS vs conventional laparoscopy. Splenomegaly was present in 85 patients, of whom 43 underwent HALS splenectomy and 42 underwent conventional laparoscopic splenectomy. The HALS group had larger spleens. Rates of conversion to open surgery and operative mortality were similar in the HALS group vs the conventional laparoscopy group (2.3% [1 of 43] vs 2.4% [1 of 42] and 2.3% [1 of 43] vs 0.0% [0 of 42], respectively), with no difference in hospital length of stay in the absence of morbidity. Portal system thrombosis was the most serious complication. HALS can minimize surgical trauma in patients with massive splenomegaly who otherwise would be candidates only for open surgery and results in a clinical outcome similar to that of conventional laparoscopy. With the availability of HALS, any patient with splenomegaly can be offered a minimally invasive surgical option. Portal system thrombosis is common, regardless of the surgical technique.
    Archives of surgery (Chicago, Ill.: 1960) 07/2011; 146(7):818-23. DOI:10.1001/archsurg.2011.149 · 4.32 Impact Factor
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    ABSTRACT: According to literature evidence, simulation is of the utmost importance for training and innovative surgical strategies assessment. At present commercial physical simulators are limited to single or only a few anatomical structures and these are often just standard anatomies. This paper describes a strategy to produce patient-specific abdominal silicone organs with realistic shapes and colors, starting from radiological images. Synthetic organs can be assembled in a complex physical simulator or, if paired with electromagnetic sensors, in a hybrid environment (mixed reality) to quantify deformations caused by surgical action. A physical trunk phantom with liver, gallbladder, pancreas and a sensorized stomach has been developed. It is coupled with consistent radiological images and a 3D model of the entire upper abdomen. The simulator has been evaluated in quantitative and qualitative terms to quantify its accuracy and utility, respectively. This simulator can be used in the field of abdominal surgery to train students and as a testing environment to assess and validate innovative surgical technologies.
    International Journal of Medical Robotics and Computer Assisted Surgery 06/2011; 7(2):202-13. DOI:10.1002/rcs.390 · 1.49 Impact Factor
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    ABSTRACT: Transvaginal recovery of the kidney has recently been reported, in a donor who had previously undergone a hysterectomy, as a less-invasive approach to perform laparoscopic live-donor nephrectomy. Also, robotic-assisted laparoscopic kidney donation was suggested to enhance the surgeon's skills during renal dissection and to facilitate, in a different setting, the closure of the vaginal wall after a colpotomy. We report here the technique used for the first case of robotic-assisted laparoscopic live-donor nephrectomy with transvaginal extraction of the graft in a patient with the uterus in place. The procedure was carried out by a multidisciplinary team, including a gynecologist. Total operative time was 215 min with a robotic time of 95 min. Warm ischemia time was 3 min and 15 s. The kidney was pre-entrapped in a bag and extracted transvaginally. There was no intra- or postoperative complication. No infection was seen in the donor or in the recipient. The donor did not require postoperative analgesia and was discharged from the hospital 24 h after surgery. Our initial experience with the combination of robotic surgery and transvaginal extraction of the donated kidney appears to open a new opportunity to further minimize the trauma to selected donors.
    American Journal of Transplantation 12/2010; 10(12):2708-11. DOI:10.1111/j.1600-6143.2010.03305.x · 6.19 Impact Factor
  • Conf Proc ICABB, International Conference on Applied Bionics and Biomechanics, Venice, Italy; 01/2010
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    ABSTRACT: Techniques of mixed reality can successfully be used in preoperative planning of laparoscopic and robotic procedures and to guide surgical dissection and enhance its accuracy. A computer-generated three-dimensional (3D) model of the vascular anatomy of the spleen was obtained from the computed tomography (CT) dataset of a patient with a 3-cm splenic artery aneurysm. Using an environmental infrared localizer and a stereoscopic helmet, the surgeon can see the patient's anatomy in transparency (augmented or mixed reality). This arrangement simplifies correct positioning of trocars and locates surgical dissection directly on top of the aneurysm. In this way the surgeon limits unnecessary dissection, leaving intact the blood supply from the short gastric vessels and other collaterals. Based on preoperative planning, we were able to anticipate that the vascular exclusion of the aneurysm would result in partial splenic ischemia. To re-establish the flow to the spleen, end-to-end robotic anastomosis of the splenic artery with the Da Vinci surgical system was then performed. Finally, the aneurysm was fenestrated to exclude arterial refilling. The postoperative course was uneventful. A control CT scan 4 weeks after surgery showed a well-perfused and homogeneous splenic parenchyma. The final 3D model showed the fenestrated calcified aneurysm and patency of the re-anastomosed splenic artery. The described technique of robotic vascular exclusion of a splenic artery aneurysm, followed by re-anastomosis of the vessel, clearly demonstrates how this technology can reduce the invasiveness of the procedure, obviating an otherwise necessary splenectomy. Also, the use of intraoperative mixed-reality technology proved very useful in this case and is expected to play an increasing role in the operating room of the future.
    Surgical Endoscopy 10/2009; 24(5):1204. DOI:10.1007/s00464-009-0703-0 · 3.31 Impact Factor
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    ABSTRACT: To evaluate and discuss all the potential complications affecting morbidity of patients treated with surgery for primary achalasia. A review of the available English literature published to date has been conducted. All articles reporting surgical experience in achalasia were examined and then were selected only those specifically inherent to the topic at issue. Mucosal perforation is the main intra-operative complication while persistence or recurrence of the disease and gastro-esophageal reflux are those mostly affecting patients afterwards, even at long-term follow-up. A few other less common morbidities, as well as the technical considerations useful to minimize and manage each complication mentioned, are reported. Minimally invasive surgery for achalasia consent to treat patients with a low rate of perioperative complications that can be managed with conservative approach in the majority of cases. Risk of esophageal cancer exists in these patients and remains although surgical therapy. Laparoscopic Heller myotomy along with partial fundoplication is a safe and effective procedure that should be considered as the treatment of choice at first evaluation of achalasic patients rather than endoscopic techniques. Robotic technology may add further contribution in diminishing perioperative complications. Achalasia, Complication, Heller esophagomyotomy.