by Professor Luigi Marano, University of Siena
Over the last years, the increase of intraoperative safety for patients and surgeons as well as the concept of “precision surgery” have been advocated as main topics of surgical research, particularly as regards the minimally invasive approaches. The proper patient-specific preoperative planning is mandatory to achieve a meticulous knowledge of the target anatomy, thus helping surgeons to imagine in their minds critical steps and potential complications of surgery. In addition, the more the anatomy is complex due to native anatomic anomalies, disease-related distortions or prior surgical interventions, the harder is the surgical strategy to apply especially in minimally invasive settings.
The rise of robot-assisted surgery for a variety of surgical procedures in the past decade has significantly reshaped surgical practice but patient safety remains an issue of paramount interest. It is postulated that robotic platform allows surgeons to operate more precisely during difficult procedures compared to conventional laparoscopy providing high resolution three dimensional (3D) operative views and improved depth perception, as well as superior instrument handling with a vastly increased range of movement. Three-dimensional (3D) printing, in addition to the standard medical imaging techniques, may represent a useful tool to preoperatively provide a good representation of surgical scenario performing safe surgery in complex cases. It is considered a groundbreaking form of additive manufacturing technology used to transform digital objects from a common volumetric dataset acquired by multi-detector computed tomography (MDCT) or magnetic resonance (MRI) into physical models with the use of a printer. The 3D models provide the surgeon an opportunity to review the procedure, to prepare, and to problem solve before the patient enters the operating room. Recently, the technology has been utilized to plan operative interventions also in spinal surgery, neurosurgery, and cardiac surgery, but few data are still available in the literature about their role in upper gastrointestinal surgery. Indeed, the detailed understanding of the surgical anatomy of the esophagogastric junction is undoubtedly not possible by solely using standard 2D computed tomography scan, and this is particularly true in cases of complex anatomy. Moreover, to the best of our knowledge, data reporting the combination of 3D printing technology and robotic esophagogastric surgery are never published. The feasibility of such merged technologies is demonstrated on the single case of gastroesophageal reflux disease with complex anatomy due to a markedly tortuous descending aorta.
About Luigi Marano
Luigi Marano was born in Maddaloni (CE), Italy, in 1983. He qualified from the Second University of Naples, Italy, in 2007 and he was admitted to the General Surgical Training in Naples the following year. He qualified as a board certified Surgeon in 2014 and during his experience he expressed subspecialty interests in upper gastrointestinal surgery and surgical oncology. To further this interest he was awarded a 2nd level Master’s Degree in “Surgical Gastrointestinal Oncology” at Catholic University of Sacred Heart of Rome, Italy, in 2013. Luigi continued his academic career as a Ph.D. student from 2013 to 2016 focused on “Biotechnologies applied to surgical sciences” at the Second University of Naples. After his Ph.D. degree, he achieved a position of Consultant Surgeon at Multidisciplinary Robotic Surgery, “San Matteo degli Infermi” Hospital, AUSL Umbria 2, Spoleto (PG), Italy. Luigi is the author of several peer-reviewed articles, reviews and book chapters mainly focused on upper gastrointestinal surgery and surgical oncology. He is a member of the European Society of Surgical Oncology (ESSO) and the Italian Society of Surgical Oncology (SICO). Actually, he is Assistant Professor of Surgery at the Department of Medicine, Surgery, and Neurosciences – University of Siena, Siena, Italy.
About University of Siena
Students in Siena can be part of a real community of people motivated by a thirst for knowledge and learning, with attentive and approachable academic staff and many innovative services at their disposal. The careful organization of teaching, the quality of lessons (which is monitored regularly), the services to facilitate studying such as efficient and well-organized libraries and laboratories, as well as the welcoming, orientation and continuous tutoring activities, support for disabled students and those in difficulty are just some of the University of Siena’s strong points. The University of Siena runs first and second level degree courses taught in Italian and/or English language. Students can also choose from a wide selection of postgraduate courses, including doctoral degree programmes, specialization schools and master’s programmes, the latter being designed to offer specific training in the most innovative sectors.