Andrea Peri

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

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Publications (12)23.39 Total impact

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    ABSTRACT: Background Randomized studies could not demonstrate significant outcome benefit after single-incision laparoscopic cholecystectomy compared to classic four-port laparoscopic cholecystectomy (CLC). The new robotic single-site platform might offer potential benefits on local inflammation and postoperative pain due to its technological advantages. This prospective randomized double-blind trial compared the short-term outcomes between single-incision robotic cholecystectomy (SIRC) and CLC. Methods Two groups of 30 eligible patients were randomized for SIRC or CLC. During the first postoperative week, patients and study monitors were blinded to the type of procedure performed by four dressing tapes applied on the abdomen. Pain was assessed at 6 h and on day 1, 7 and 30 after surgery, along with a 1–10 cosmetic score. Results No significant difference in postoperative pain occurred in the two groups at any time point nor for any of the abdominal sites. Nineteen (63 %) SIRC patients reported early postoperative pain in extra-umbilical sites. Intraoperative complications which might influence postoperative pain, such as minor bleeding and bile spillage, were similar in both groups and no conversions occurred. The cosmetic score 1 month postoperatively was higher for SIRC (p < 0.001). Two SIRC patients had wound infection, one of which developed an incisional hernia. Conclusions SIRC does not offer any significant reduction of postoperative pain compared to CLC. SIRC patients unaware of their type of operation still report pain in extra-umbilical sites like after CLC. The cosmetic advantage of SIRC should be balanced against an increased risk of incisional hernias and higher costs. Trial registration number ACTRN12614000119695 (http:// www. anzctr. org. au).
    No preview · Article · Oct 2015 · Surgical Endoscopy
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    ABSTRACT: Three-dimensional printing technology is rapidly changing the way we produce all sort of objects, having also included medical applications. We embarked in a pilot study to assess the value of patient-specific 3-D physical manufacturing of spleno-pancreatic anatomy in helping during patient's counseling and for preoperative planning. Twelve patients scheduled for a laparoscopic splenectomy underwent contrast CT and subsequent post-processing to create virtual 3-D models of the target anatomy, and 3-D printing of the relative solid objects. The printing process, its cost and encountered problems were monitored and recorded. Patients were asked to rate the value of 3-D objects on a 1-5 scale in facilitating their understanding of the proposed procedure. Also 10 surgical residents were required to evaluate the perceived extra value of 3-D printing in the preoperative planning process. The post-processing analysis required an average of 2; 20 h was needed to physically print each model and 4 additional hours to finalize each object. The cost for the material employed for each object was around 300 euros. Ten patients gave a score of 5, two a score of 4. Six residents gave a score of 5, four a score of 4. Three-dimensional printing is helpful in understanding complex anatomy for educational purposes at all levels. Cost and working time to produce good quality objects are still considerable.
    No preview · Article · Jul 2015 · Surgical Endoscopy
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    ABSTRACT: Immunoglobulin G4-related disease (IgG4-RD) is a newly recognized fibroinflammatory condition which can potentially involve any organ. Some characteristic histopathologic features with lymphoplasmacytic infiltrate, an increased number of IgG4+ cells, storiform fibrosis and obliterative phlebitis are the mainstay for diagnosis. Serum IgG4 levels often increase. We report the case of a patient with perivascular fibrotic lesions involving the aortic arch and the splenic hilum, with a surgical biopsy-proven diagnosis of IgG4-related disease. The patient is now undergoing a low-dose corticosteroid maintenance therapy without evidence of new localizations of the disease. This case highlights the need for increasing awareness and recognition of this new, emerging clinical condition.
    No preview · Article · Nov 2014
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    ABSTRACT: The volume of available clinical outcomes of robotic laparoendoscopic single-site surgery (R-LESS) has considerably grown since the pioneering description of the first successful clinical series of single-port robotic procedures. The feasibility of robot-assisted single-incision urologic and colorectal, as well as of many gynecologic, procedures has been demonstrated. A novel set of single-site instruments specifically dedicated to LESS is now commercially available for use with the da Vinci Si Surgical System, and both experimental and clinical uses have been reported. However, the current robotic systems were specifically designed for LESS. The ideal robotic platform should have a low external profile, the possibility of being deployed through a single-access site, and the possibility of restoring intra-abdominal triangulation while maintaining the maximum degree of freedom for precise maneuvers and strength for reliable traction. © Springer International Publishing Switzerland 2014. All rights reserved.
    No preview · Article · May 2014
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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.
    No preview · Article · Oct 2013

  • No preview · Article · Feb 2013 · Cirugía Española

  • No preview · Article · Dec 2012 · Cirugía Española
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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.
    No preview · Article · Jul 2011 · Archives of surgery (Chicago, Ill.: 1960)
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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.
    No preview · Article · Jun 2011 · International Journal of Medical Robotics and Computer Assisted Surgery
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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.
    Full-text · Article · Dec 2010 · American Journal of Transplantation

  • No preview · Conference Paper · Jan 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.
    Full-text · Article · Oct 2009 · Surgical Endoscopy