Francesco Guerra

Verified

Francesco verified their affiliation via an institutional email.

Learn more

Verified

Francesco verified their affiliation via an institutional email.

Learn more

• MD
• Consultant at Azienda Usl Toscana Sud Est

Purpose Robotics has shown encouraging results for a number of technically demanding abdominal surgeries including pancreaticoduodenectomy, which has originally represented a relative contraindication to the application of the minimally-invasive technique. We aimed to investigate the perioperative, clinicopathologic, and oncological outcomes of rob...

Introduction how best to manage patients with colorectal cancer and synchronous liver metastasis is still controversial, with specific concerns of increased risk of postoperative complications following combined resection. We aimed at analyzing the influence of combined liver resection on the risk of anastomotic leak (AL) following colorectal resec...

PurposeMinimally invasive surgery has been universally accepted as a valid option for the treatment of diverticular disease, provided specific expertise is available. Over the last decade, there has been a growing interest in the application of robotic approaches for diverticular disease. We aimed at evaluating whether robotic colectomy may offer s...

Background Among patients with distant metastatic melanoma, the site of metastases is the most significant predictor of survival and visceral-nonpulmonary metastases hold the highest risk of poor outcomes. However, studies demonstrate that a significant percentage of patients may be considered candidates for resection with improved survival over no...

BACKGROUND The double-stapled technique is the most common method of colorectal anastomosis in minimally invasive surgery. Several modifications to the conventional technique have been described aiming to reduce the intersection between the stapled lines, as the resulting lateral dog-ears are considered as possible risk factors for anastomotic leak...

Background Although originally described as an open procedure, the application in the setting of minimally invasive surgery of the Pauli technique for parastomal hernia repair is gaining interest among surgeons owing to encouraging early results. We aimed at combining and analyzing the results of minimally invasive Pauli repair by assessing the ava...

Aim Ensuring an adequate distal resection margin (DRM) is a key factor in achieving the gold standard in surgical treatment for rectal surgery. The aim of this article is to describe our surgical technique and the usefulness of intraoperative ultrasonography (IOUS) for evaluating the DRM during robotic rectal surgery (RRS). Method Prospective data...

Objective For patients with T1b gallbladder cancer or greater, an adequate lymphadenectomy should include at least 6 nodes. Studies comparing short- and long-term outcomes of the open approach with those of laparoscopy and robotic approaches are limited, with small sample sizes, and there are none comparing laparoscopic and robotic approaches. This...

Central pancreatectomy (CP) is indicated for benign or low-grade pancreatic tumors located in the neck or proximal pancreatic body. This procedure is demanding and has a high rate of postoperative complications. Minimally invasive surgery is now commonly used for CP but it is still unclear whether the robotic approach offers any advantages over con...

Central pancreatectomy (CP) is a parenchymal-sparing technique indicated for the resection of selected lesions of the neck or proximal body of the pancreas.1,2 The risk of postoperative complications is theoretically doubled because the surgeon has to manage two cut surfaces of the pancreas. The video shows a fully robotic CP to treat a 62-year-old...

The minimally invasive approach for segmental resections of the transverse colon and splenic flexure is widely accepted. However, these segmental colorectal resections remain demanding in terms of lymph node dissections, vascular dissection and intracorporeal anastomosis. The robotic approach seems to offer some advantage in terms of harvested lymp...

Diverticular disease is a common benign condition in Western countries and it has a remarkable clinical and economic impact on public health. In recent years there has been a growing interest in the application of robotic platforms for diverticular disease. The evidence available in the literature is limited and shows that the robotic approach comp...

Over the last decade there has been a dramatic rise in the use of minimally invasive surgery for rectal cancer, with excellent results in terms of both functional and oncological outcomes. The need to perform more technically demanding surgeries featuring precise pelvic dissection is probably the situation in which the application of the robot may...

The last twenty years have seen a dramatic diffusion of totally minimally invasive right colectomy with intracorporeal anastomosis, mostly due to increasing experience and availability of new technologies. In this context, robotic surgery has been also expanding rapidly, with a number of referral centers dedicated to colorectal surgery reporting ex...

Aim: Intersphincteric resection (ISR) is an oncologically complex operation for very low-lying rectal cancers. Yet, definition, anatomical description, operative indications and operative approaches to ISR are not standardized. The aim of this study was to standardize the definition of ISR by reaching international consensus from the experts in th...

Background Comparative data on D2-robotic gastrectomy (RG) vs D2-open gastrectomy (OG) are lacking in the Literature. Aim of this paper is to compare RG to OG with a focus on D2-lymphadenectomy. Study design Data of patients undergoing D2-OG or RG for gastric cancer were retrieved from the international IMIGASTRIC prospective database and compared...

Background: Over the last decade, there has been growing diffusion of minimally invasive surgery in the setting of abdominal emergencies. However, right-colon diverticulitis is still mainly approached by conventional celiotomy. Materials and methods: A video vignette is presented showing the details of an emergent laparoscopic right colectomy as...

Background The adoption of robotic surgery for esophageal cancer has been expanding rapidly over the recent years. In the setting of two-field esophagectomy, different techniques exist for intrathoracic esophagogastric anastomosis, although the superiority of one over another has not been clearly demonstrated. Potential benefits in terms of anastom...

Background: A preliminary analysis from the COVID-Advanced Gastrointestinal Cancer Surgical Treatment (AGICT) study showed that the rate of minimally invasive surgery (MIS) for elective and urgent procedures did not decrease during the pandemic year. In this article, we aimed to perform a subgroup analysis using data from the COVID-AGICT study to e...

Background: This Italian multicentric retrospective study aimed to investigate the possible changes in outcomes of patients undergoing surgery for gastrointestinal cancers during the COVID-19 pandemic. Method: Our primary endpoint was to determine whether the pandemic scenario increased the rate of patients with colorectal, gastroesophageal, and...

Pylephlebitis is defined as a septic thrombophlebitis of the portal vein, usually secondary to infection in regions contiguous to or drained by the portal system. Although extremely uncommon in the modern era, pylephlebitis still carries an appreciable risk of severe morbidity and mortality, if unrecognized and left untreated. Herein we report the...

Background How best to manage colorectal cancer patients presenting resectable synchronous liver metastasis is still a matter of debate. A number of different available therapeutic strategies exist, with significant differences in terms of optimal timing and/or sequence of resection of the primary tumor and liver disease [1]. Over the last years, s...

The clinical benefit of extended prophylaxis for venous thromboembolism after laparoscopic surgery for cancer is unclear. The efficacy and safety of direct oral anticoagulants for this indication are unexplored. PROLAPS-II was a randomized, double-blind, placebo-controlled, investigator-initiated, superiority study aimed at assessing the efficacy a...

Background: Isolated pancreatic metastasis from melanoma is extremely uncommon and accounts for approximately only 2% of visceral disseminations of melanoma.1-3 Interestingly, pancreatic localizations disproportionately derive from primary ocular melanoma.1,2 Despite the currently available evidence on this argument being scarce, the survival outc...

Background The clinical benefit of extending prophylaxis for venous thromboembolism (VTE) beyond hospital discharge after laparoscopic surgery for cancer is unclear. The efficacy and safety of thromboprophylaxis with direct oral anticoagulants in cancer surgery is unexplored. Methods PROLAPS II is an investigator-initiated, prospective, randomized,...

We are very grateful for the opportunity to reply to Dr Mathew’s comments and to widen the discussion on this subject. More than 20 % of patients admitted as an emergency with small bowel obstruction (SBO) will require surgery, especially when there is risk of strangulation.

Background: The laparoscopic approach in gastric cancer surgery is being increasingly adopted worldwide. However, studies focusing specifically on laparoscopic gastrectomy with D2 lymphadenectomy are still lacking in the literature. This retrospective study aimed to compare the short-term and long-term outcomes of laparoscopic versus open gastrect...

Background: Minimally invasive gastrectomy is currently considered a valid option to treat gastric cancer and is gaining increasing acceptance. Recent reports have suggested that the application of robots may confer some advantages over conventional laparoscopy, but the role of robotic surgery in clinical practice is still uncertain. We aimed to c...

PurposeThe objective of this study was to investigate the risk of conversion associated with conventional laparoscopic surgery (LAP) versus robot-assisted surgery (ROB) in patients undergoing abdominal oncological surgery. Possible differences between ROB and LAP on postoperative overall and major morbidity, operative time, and length of hospitaliz...

Aim Although there is growing evidence supporting the feasibility of a minimally invasive approach for acute small bowel obstruction, inability to adequately evaluate compromised bowel segments has been cited as a main limitation. We report a novel application of extemporaneous ICG fluorescence to assess bowel viability where there is a concern for...

There is growing evidence supporting the use of minimally invasive resection in esophageal surgery, mainly due to reduced postoperative morbidity and faster recovery after surgery. In recent years, robot-assisted surgery has shown some potential benefits over conventional laparo-thoracoscopic esophagectomy. The purpose of this study is to report ou...

The duodenum is traditionally reached and dissected by an anterior approach. Optimal exposure is achieved via complete hepatic flexure mobilization and kocherization of the duodenum and head of the pancreas, which can be technically challenging and time-consuming, especially in the setting of minimally invasive surgery. On the contrary, an inframes...

Background Major hepatectomy is still regarded as a technically demanding procedure for which minimally invasive surgery remains limited to selected cases in experienced centers and robotic platforms may provide some advantages over conventional laparoscopy in this setting. We aimed to combine and meta‐analyze the available literature upon this top...

Background: Our systematic review and meta-analysis examine the impact of minilaparoscopic cholecystectomy (MLC) versus conventional laparoscopic cholecystectomy (CLC). Some authors previously compared these surgical approaches without reaching any clear conclusion, since then, further trials have been performed, but an update was needed. Material...

Along the last decade minimally invasive distal pancreatectomy (DP) is gaining wide diffusion in clinical practice due to a number of advantages as compared to the conventional open resection. When the procedure is performed with the intent to preserve the spleen, robotic surgery has shown some advantages over conventional laparoscopy. By describin...

Background: Hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal metastases (PM) is considered to be feasible, safe and to improve survival. Aim: To investigate whether an immune response is activated following HIPEC for PM. Methods: Six patients were enrolled in this study. Peripheral blood samples were obtained from each patient...

There are demonstrations that the prognosis of patients with isolated pulmonary dissemination of pancreatic cancer is more favorable than that of patients with other patterns of disease progression. The aim of this systematic review with meta-analysis was to evaluate the oncological outcomes of pulmonary vs. non-pulmonary metastasis of patients wit...

A 47‐year old woman with a history of Crohn's disease (CD) was admitted to our hospital due to abdominal pain, vomiting and fever. She complained of passing small amounts of air in the urine during the last two weeks. Abdominal computed tomography and magnetic resonance‐enterography were performed, revealing the presence of a colovesical fistula, w...

Background: over the last years there has been a growing interest toward the application of minimally invasive surgery in the management of cholecystectomy-related injury to the biliary tract. The aim of this analysis is to identify and combine the available evidence on the argument, with particular reference to major injuries to the main bile duc...

Background The aim of this study was to report on the application of a minimally invasive technique to the radical extirpation of primary and recurrent pilonidal disease. This technique does not require specific equipments, is ordinarily performed under local anesthesia on an outpatient basis, and provides optimal cosmetic results. Methods A total...

Background: Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods...

Background: Total pancreatectomy is an obligatory surgical procedure in locally advanced or centrally located pancreatic neoplasms to achieve complete tumour clearance. Owing to sound understanding of tumour biology and evolution in intervention technique and improved postoperative care, nowadays the indications of total pancreatectomy have taken a...

A 62-year-old woman who had recently been treated for pelvic inflammatory disease presented with abdominal pain. On laparoscopy, adhesions between the anterosuperior hepatic surface and the abdominal wall were seen, a finding consistent with the Fitz-Hugh–Curtis syndrome.

Purpose The role of subcutaneous prophylactic drainage in preventing postoperative abdominal wound complications is still controversial. We aimed to elucidate whether any difference in the incidence of surgical site infection (SSI) exists between patients with or without subcutaneous suction drain following clean-contaminated abdominal surgery. Me...

Aim Robotic surgery is thought to have a role in widening the application of minimally invasive liver surgery. Nonetheless, data concerning surgical results for liver malignancies are presently still lacking. We aimed to evaluate the surgical and oncological outcomes of ultrasound guided robotic liver resections for hepatic malignancies. Methods A...

Although end colostomy closure following Hartmann’s procedure is a major surgery that is traditionally performed by conventional celiotomy, over the last decade there has been a growing interest toward the application of different minimally invasive techniques. We aimed at evaluating the relative outcomes of conventional surgery versus minimally in...

Background Current evidence supporting robotics to perform minimally invasive liver resection is based on single center case series reporting surgical outcomes in heterogeneous groups of patients. On the contrary, relatively scarce data specifically focusing on secondary hepatic malignancies is available. The objective of this study is to assess sh...

Background: The laparoscopic methods for major abdominal surgery are gaining increasing acceptance worldwide. Despite its relatively recent introduction in clinical practice, robotics has been accepted as an effective option to perform high-demanding procedures such as those required in hepatobiliary surgery. Some potential advantages over convent...

Background. Pancreatic neuroendocrine tumors (PanNETs) are relatively rare neoplasms with a low to mild malignant potential. They can be further divided into functioning and nonfunctioning, according to their secretive activity. Surgery is an optimal approach, but the classic open approach is challenging, with some patients having long hospitalizat...

Résumé Introduction Plusieurs études ont suggéré la faisabilité de la chirurgie robotique (CR) dans des indications techniquement difficiles telles que la duodénopancréatectomie céphalique (DPC), initialement considérée comme une contre-indication relative à la chirurgie mini-invasive. Le but de cette étude était d’analyser les résultats périopéra...

Robotic surgery has been proposed over the last decade as a valid option to treat gastrointestinal malignancies in a minimally invasive method, yielding encouraging results. The authors examine the outcomes of a consecutive series of patients with stromal gastrointestinal neoplasms who were operated on using a totally robotic technique. There were...

Background: Recent reports have suggested that the use of the robot might reduce the rate of pancreatic complications following minimally invasive radical gastrectomy. Methods: By meta-analyzing the available literature, we aimed to elucidate possible differences between conventional laparoscopic and robotic radical gastrectomy on pancreatic mor...

Parenchymal sparing procedures are gaining interest in pancreatic surgery and recent studies have reported that minimally invasive pancreatic enucleation may be associated with enhanced outcomes when compared with traditional surgery. By meta‐analyzing the available data from the literature, minimally invasive surgery is not at higher risk of pancr...

Background: Over recent decades, minimally invasive esophagectomy has gained popularity and is increasingly performed worldwide. The aim of this work was to investigate the perioperative, clinicopathologic, and oncological outcomes of robot-assisted esophagectomy on a consecutive series of totally robotic procedures. Methods: All patients receiv...

Background: Liver resection may be complicated by unpredictable intraoperative bleeding. Pringle's maneuver was the first attempt to control bleeding,but the main problem is the duration of ischemia. Robotic surgery thanks to the magnified view,three-dimensional visualization associated and fine movement allow to perform good parenchymal dissectio...

Background: Anastomotic leakage is one of the most feared complications of rectal resections. The role of drains in limiting this occurrence or facilitating its early recognition is still poorly defined. We aimed to study whether the presence of prophylactic pelvic drains affects the surgical outcomes of patients undergoing rectal surgery with ext...

Background: Postoperative pancreas-related complications are quite uncommon but potentially life-threatening occurrences that may occasionally complicate the postoperative course of gastrectomy. A number of reports have described such conditions after both standard open and minimally invasive surgery. Our study has the purpose to systematically de...

Background: Anastomosis technique following right sided colonic resection is widely variable and may affect patient outcomes. This study aimed to assess the association between leak and anastomosis technique (stapled versus handsewn) METHODS: This was a prospective, multicentre, international audit including patients undergoing elective or emergen...

Pelvic floor and lower gastrointestinal tract complications as a consequence of vaginal childbirth are issues that have a great impact on women’s well-being. They are also of great social and economic importance, even if the role of childbirth on pelvic and anorectal disorders is still an area of debate. Levator ani and anal sphincter injuries are...

Aim The anastomosis technique used following right-sided colonic resection is widely variable and may affect patient outcome. This study aimed to assess the association between leak and anastomosis technique (stapled vs handsewn). Method This was a prospective, multicentre, international audit including patients undergoing elective or emergency rig...

Minimally invasive surgical approaches in transplantation are gaining increasing interest, and many centers are reporting their, mainly laparoscopic, experiences. Robotic surgery (RS) has some hypothetical advantages over traditional laparoscopy, and has been successfully applied, although infrequently to organ transplantation. Our goal was to revi...

Background: Pilonidal disease is a quite common chronic inflammatory disease that causes discomfort, embarrassment and absence from work or school. In line with its acquired pathogenesis, a number of surgical alternatives to conventional en bloc excision have been proposed over the last decades, yielding encouraging results. We reviewed our experi...

Aim: Rectourethral fistula (RUF) is a rare complication of radical prostatectomy. We report a trans-perineal approach using a fibrin sealant haemostatic patch. Method: Five consecutive patients who developed RUF following radical prostatectomy had a direct transperineal repair with a haemostatic patch (TachoSil(®) ) and were assessed at a median...

Fecal incontinence surgery is still young, associated with elevated morbidity and with variable long-term outcomes (Findlay and Maxwell-Armstrong Int J Colorectal Dis 26: 265–273, 2011). Artificial bowel sphincter (ABS) is still considered an optional surgical treatment together after conservative and less-invasive surgical procedures failure. To d...