Thesis etd-10032023-181626 |
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Thesis type
Tesi di specializzazione (5 anni)
Author
COMANDATORE, ANNALISA
URN
etd-10032023-181626
Thesis title
Ritardo di svuotamento gastrico dopo duodenocefalopancreasectomia robotica: analisi dei fattori di rischio mediante studio caso-controllo e video analisi comparativa della curva di apprendimento
Department
PATOLOGIA CHIRURGICA, MEDICA, MOLECOLARE E DELL'AREA CRITICA
Course of study
CHIRURGIA GENERALE
Supervisors
relatore Prof. Morelli, Luca
Keywords
- conservazione del piloro
- delayed gastric emptying
- duodenocefalopancreasectomia
- duodenocefalopancreasectomia robotica
- gastroenteroanastomosi
- gastrojejunostomy
- pancreatoduodenectomy
- pylorus‐preservation
- ritardo di svuotamento gastrico
- robotic pancreatoduodenectomy
Graduation session start date
07/11/2023
Availability
None
Summary
Il ritardo dello svuotamento gastrico (RSG) rappresenta una delle complicanze post-operatorie più comuni dopo la duodenocefalopancreasectomia (DCP), soprattutto dopo la conservazione del piloro (PpDCP). Abbiamo valutato l'effetto di un approccio robotico sul RSG confrontando la PpDCP robotica (RPpDCP) e PpDCP open con un confronto caso-controllo 1:1. Da questo studio è emerso che l’RSG clinicamente rilevante risultava meno comune dopo la RPpDCP (p=0,028). La durata mediana della degenza ospedaliera risultava significativamente inferiore nel gruppo RPpDCP (p=0,013), suggerendo che il ridotto trauma tissutale robotico fosse associato a una minore incidenza di RSG. Parallelamente sono state individuate le curve di apprendimento per l'anastomosi gastroenterica durante la DCP robotica (RDCP) mediante l’Objective Structured Assessment of Technical Skills (OSATS) per valutare il valore predittivo di tale punteggio per il RSG. I video sono stati analizzati in una coorte multicentrica retrospettiva (LAELAPS3) da due valutatori in cieco. L'analisi della curva di apprendimento dei punteggi OSATS dell'anastomosi gastrica ha identificato un punto critico in 34 casi di RDCP in cui il RSG di grado B/C era del 25,7% inizialmente e dell'11,5% dopo tale punto (P=0,035) mostrando un valore predittivo significativo per il RSG di grado B/C (P<0,001). L'OSATS potrebbe servire come strumento per la valutazione delle anastomosi gastroenteriche robotiche, risultando utile nei programmi di training.
Delayed gastric emptying (DGE) is one of the most common postoperative complications after pancreatoduodenectomy (PD), especially after pylorus preservation (PpPD). We evaluated the effect of the robotic approach on DGE by comparing robotic PpPD (R-PpPD) and open PpPD with a 1:1 case-control matching. This study demonstrated that clinically relevant DGE was less common after R-PpPD (p=0.028). The median length of hospital stay was significantly shorter in the R-PpPD group (p=0.013), suggesting that reduced robotic tissue trauma is associated with a lower incidence of DGE. In parallel, learning curves for gastroenteric anastomosis during robotic PD (RPD) were identified using the Objective Structured Assessment of Technical Skills (OSATS) to assess the predictive value of this score for DGE. Videos were analyzed in a retrospective multicenter cohort (LAELAPS-3) by two blinded evaluators. Learning curve analysis of OSATS scores of gastric anastomosis identified a critical point in 34 cases of RPD in which grade B/C DGE was 25.7% initially and 11.5% after that point (P=0.035), showing a significant predictive value for grade B/C DGE (P<0.001). OSATS could be useful as a tool for the evaluation of robotic gastroenteric anastomoses, being helpful in training programs.
Delayed gastric emptying (DGE) is one of the most common postoperative complications after pancreatoduodenectomy (PD), especially after pylorus preservation (PpPD). We evaluated the effect of the robotic approach on DGE by comparing robotic PpPD (R-PpPD) and open PpPD with a 1:1 case-control matching. This study demonstrated that clinically relevant DGE was less common after R-PpPD (p=0.028). The median length of hospital stay was significantly shorter in the R-PpPD group (p=0.013), suggesting that reduced robotic tissue trauma is associated with a lower incidence of DGE. In parallel, learning curves for gastroenteric anastomosis during robotic PD (RPD) were identified using the Objective Structured Assessment of Technical Skills (OSATS) to assess the predictive value of this score for DGE. Videos were analyzed in a retrospective multicenter cohort (LAELAPS-3) by two blinded evaluators. Learning curve analysis of OSATS scores of gastric anastomosis identified a critical point in 34 cases of RPD in which grade B/C DGE was 25.7% initially and 11.5% after that point (P=0.035), showing a significant predictive value for grade B/C DGE (P<0.001). OSATS could be useful as a tool for the evaluation of robotic gastroenteric anastomoses, being helpful in training programs.
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