Robotic versus Laparoscopic versus Open Gastrectomy: A Meta-Analysis

Marano, Alessandra,Choi, Yoon Young,Hyung, Woo Jin,Kim, Yoo Min,Kim, Jieun,Noh, Sung Hoon The Korean Gastric Cancer Association 2013 Journal of gastric cancer Vol.13 No.3

Purpose: To define the role of robotic gastrectomy for the treatment of gastric cancer, the present systematic review with meta-analysis was performed. Materials and Methods: A comprehensive search up to July 2012 was conducted on PubMed, EMBASE, and the Cochrane Library. All eligible studies comparing robotic gastrectomy versus laparoscopic gastrectomy or open gastrectomy were included. Results: Included in our meta-analysis were seven studies of 1,967 patients that compared robotic (n=404) with open (n=718) or laparoscopic (n=845) gastrectomy. In the complete analysis, a shorter hospital stay was noted with robotic gastrectomy than with open gastrectomy (weighted mean difference: -2.92, 95% confidence interval: -4.94 to -0.89, P=0.005). Additionally, there was a significant reduction in intraoperative blood loss with robotic gastrectomy compared with laparoscopic gastrectomy (weighted mean difference: -35.53, 95% confidence interval: -66.98 to -4.09, P=0.03). These advantages were at the price of a significantly prolonged operative time for both robotic gastrectomy versus laparoscopic gastrectomy (weighted mean difference: 63.70, 95% confidence interval: 44.22 to 83.17, P<0.00001) and robotic gastrectomy versus open gastrectomy (weighted mean difference: 95.83, 95% confidence interval: 54.48 to 137.18, P<0.00001). Analysis of the number of lymph nodes retrieved and overall complication rates revealed that these outcomes did not differ significantly between the groups. Conclusions: Robotic gastrectomy for gastric cancer reduces intraoperative blood loss and the postoperative hospital length of stay compared with laparoscopic gastrectomy and open gastrectomy at a cost of a longer operating time. Robotic gastrectomy also provides an oncologically adequate lymphadenectomy. Additional high-quality prospective studies are recommended to better evaluate both short and long-term outcomes.

Stochastic optimum design of linear tuned mass dampers for seismic protection of high towers

Marano, Giuseppe Carlo,Greco, Rita,Palombella, Giuseppe Techno-Press 2008 Structural Engineering and Mechanics, An Int'l Jou Vol.29 No.6

This work deals with the design optimization of tuned mass damper (TMD) devices used for mitigating vibrations in high-rise towers subjected to seismic accelerations. A stochastic approach is developed and the excitation is represented by a stationary filtered stochastic process. The effectiveness of the vibration control strategy is evaluated by expressing the objective function as the reduction factor of the structural response in terms of displacement and absolute acceleration. The mechanical characteristics of the tuned mass damper represent the design variables. Analyses of sensitivities are carried out by varying the input and structural parameters in order to assess the efficiency of the TMD strategy. Variations between two different criteria are also evaluated.

Stochastic optimum design criterion of added viscous dampers for buildings seismic protection

Marano, Giuseppe Carlo,Trentadue, Francesco,Greco, Rita Techno-Press 2007 Structural Engineering and Mechanics, An Int'l Jou Vol.25 No.1

In this study a stochastic approach for linear viscous dampers design adopted for seismic protection of buildings is developed. Devices optimal placement into the main structure and their mechanical parameters are attained by means of a reliability-based optimum design criterion, in which an objective function (O.F.) is minimized, subject to a stochastic constraint. The seismic input is modelled by a non stationary modulated Kanai Tajimi filtered stochastic process. Building is represented by means of a plane shear type frame model. The selected criterion for the optimization searches the minimum of the O.F., here assumed to be the cost of the seismic protection, i.e., assumed proportional to the sum of added dampings of each device. The stochastic constraint limits a suitable approximated measure of the structure failure probability, here associated to the maximum interstorey drift crossing over a given threshold limit, related, according with modern Technical Codes, to the required damage control.

Robotic Gastrectomy: The Current State of the Art

Marano, Alessandra,Hyung, Woo-Jin The Korean Gastric Cancer Association 2012 Journal of gastric cancer Vol.12 No.2

Since the first laparoscopic gastrectomy for cancer was reported in 1994, minimally invasive surgery is enjoying its wide acceptance. Numerous procedures of this approach have developed, and many patients have benefited from its effectiveness, which has been recently demonstrated for early gastric cancer. However, since laparoscopic surgery is not exempt from some limitations, the robotic surgery system was introduced as a solution by the late 1990's. Many experienced surgeons have embraced this new emerging method that provides undoubted technical and minimally invasive advantages. To date, several studies have concentrated to this new system, and have compared it with open and laparoscopic approach. Most of them have reported satisfactory results concerning the post-operative short-term outcomes, but almost all believe that the role of robotic gastrectomy is still out of focus, especially because long-term outcomes that can prove robotic oncologic equivalency are lacking, and operative costs and time are higher in comparison to the open and laparoscopic ones. This article is a review about the current status of robotic surgery for the treatment of gastric cancer, especially, focusing on the technical aspects, comparisons to other approaches and future prospects.

Robotic versus Laparoscopic versus Open Gastrectomy: A Meta-Analysis

Alessandra Marano,형우진,최윤영,김유민,김지은,노성훈 대한위암학회 2013 Journal of gastric cancer Vol.13 No.3

Purpose: To define the role of robotic gastrectomy for the treatment of gastric cancer, the present systematic review with meta-analysis was performed. Materials and Methods: A comprehensive search up to July 2012 was conducted on PubMed, EMBASE, and the Cochrane Library. All eligible studies comparing robotic gastrectomy versus laparoscopic gastrectomy or open gastrectomy were included. Results: Included in our meta-analysis were seven studies of 1,967 patients that compared robotic (n=404) with open (n=718) or laparoscopic (n=845) gastrectomy. In the complete analysis, a shorter hospital stay was noted with robotic gastrectomy than with open gastrectomy (weighted mean difference: -2.92, 95% confidence interval: -4.94 to -0.89, P=0.005). Additionally, there was a significant reduction in intraoperative blood loss with robotic gastrectomy compared with laparoscopic gastrectomy (weighted mean difference:-35.53, 95% confidence interval: -66.98 to -4.09, P=0.03). These advantages were at the price of a significantly prolonged operative time for both robotic gastrectomy versus laparoscopic gastrectomy (weighted mean difference: 63.70, 95% confidence interval: 44.22to 83.17, P<0.00001) and robotic gastrectomy versus open gastrectomy (weighted mean difference: 95.83, 95% confidence interval:54.48 to 137.18, P<0.00001). Analysis of the number of lymph nodes retrieved and overall complication rates revealed that these outcomes did not differ significantly between the groups. Conclusions: Robotic gastrectomy for gastric cancer reduces intraoperative blood loss and the postoperative hospital length of stay compared with laparoscopic gastrectomy and open gastrectomy at a cost of a longer operating time. Robotic gastrectomy also provides an oncologically adequate lymphadenectomy. Additional high-quality prospective studies are recommended to better evaluate both short and long-term outcomes.

Robotic Gastrectomy: The Current State of the Art

Alessandra Marano,형우진 대한위암학회 2012 Journal of gastric cancer Vol.12 No.2

Since the first laparoscopic gastrectomy for cancer was reported in 1994, minimally invasive surgery is enjoying its wide acceptance. Numerous procedures of this approach have developed, and many patients have benefited from its effectiveness, which has been recently demonstrated for early gastric cancer. However, since laparoscopic surgery is not exempt from some limitations, the robotic surgery system was introduced as a solution by the late 1990's. Many experienced surgeons have embraced this new emerging method that provides undoubted technical and minimally invasive advantages. To date, several studies have concentrated to this new system, and have compared it with open and laparoscopic approach. Most of them have reported satisfactory results concerning the post-operative short-term outcomes, but almost all believe that the role of robotic gastrectomy is still out of focus, especially because long-term outcomes that can prove robotic oncologic equivalency are lacking, and operative costs and time are higher in comparison to the open and laparoscopic ones. This article is a review about the current status of robotic surgery for the treatment of gastric cancer, especially, focusing on the technical aspects, comparisons to other approaches and future prospects.

Robotic Intraoperative Tracheobronchial Repair during Minimally Invasive 3-Stage Esophagectomy

Alessandra Marano,Silvia Palagi,Luca Pellegrino,Felice Borghi 대한흉부외과학회 2021 Journal of Chest Surgery (J Chest Surg) Vol.54 No.2

Tracheobronchial injury (TBI) is an uncommon but potentially fatal event. Iatrogenic le- sions during bronchoscopy, endotracheal intubation, or thoracic surgery are considered the most common causes of TBI. When TBI is detected during surgery, concomitant sur- gical treatment is recommended. Herein we present a case of successful robotic primary repair of iatrogenic tracheal and left bronchial branch tears during a robot-assisted hybrid 3-stage esophagectomy after neoadjuvant chemoradiotherapy. A robotic approach can facilitate the repair of this injury while reducing both the potential risk of conversion to open surgery and the associated increased risk of postoperative respiratory complications.

Stochastic optimum design of linear tuned mass dampers for seismic protection of high towers

Giuseppe Carlo Marano,Rita Greco,Giuseppe Palombella 국제구조공학회 2008 Structural Engineering and Mechanics, An Int'l Jou Vol.29 No.6

This work deals with the design optimization of tuned mass damper (TMD) devices used for mitigating vibrations in high-rise towers subjected to seismic accelerations. A stochastic approach is developed and the excitation is represented by a stationary filtered stochastic process. The effectiveness of the vibration control strategy is evaluated by expressing the objective function as the reduction factor of the structural response in terms of displacement and absolute acceleration. The mechanical characteristics of the tuned mass damper represent the design variables. Analyses of sensitivities are carried out by varying the input and structural parameters in order to assess the efficiency of the TMD strategy. Variations between two different criteria are also evaluated.

Stochastic optimum design criterion of added viscous dampers for buildings seismic protection

Giuseppe Carlo Marano,Francesco Trentadue,Rita Greco 국제구조공학회 2007 Structural Engineering and Mechanics, An Int'l Jou Vol.25 No.1

In this study a stochastic approach for linear viscous dampers design adopted for seismic protection of buildings is developed. Devices optimal placement into the main structure and their mechanical parameters are attained by means of a reliability-based optimum design criterion, in which an objective function (O.F.) is minimized, subject to a stochastic constraint. The seismic input is modelled by a non stationary modulated Kanai Tajimi filtered stochastic process. Building is represented by means of a plane shear type frame model. The selected criterion for the optimization searches the minimum of the O.F., here assumed to be the cost of the seismic protection, i.e., assumed proportional to the sum of added dampings of each device. The stochastic constraint limits a suitable approximated measure of the structure failure probability, here associated to the maximum interstorey drift crossing over a given threshold limit, related, according with modern Technical Codes, to the required damage control.

Nanoporous Microtubes Obtained from a Cu-Ni Metallic Wire

Emanuele Francesco Marano,Danilo Lussana,Alberto Castellero,Marcello Baricco 대한금속·재료학회 2016 METALS AND MATERIALS International Vol.22 No.2

Nanoporous microtubes of a nickel-copper alloy were obtained from a Cu-44Ni-1Mn (wt%) commercial wire (200 μm diameter). A new synthesis method was established through three steps: 1) partial oxidation of the wire at 1173 K in air, 2) removal of the inner unoxidized core by chemical etching, 3) reduction in 10 bar hydrogen atmosphere. During oxidation, the segregation of Cu and Ni occurred because of their different diffusion coefficients in the corresponding oxides. As a consequence, pores were formed by Kirkendall effect and due to selective chemical etching of the different oxides. Additional porosity formed because of volume contraction during reduction with hydrogen. After reduction, the microtube shows a composition gradient from the inner wall (almost pure nickel) to the outer wall (almost pure copper). The process allowed to obtain microtubes with tuneable wall thickness and inner pores around 180 ± 80 nm. The morphological features developed suggest improved capillarity properties for applications in MEMS.