I dati riportati in questo studio, in accordo con i dati iniziali riportati in letteratura, permettono di dire che la nuova piattaforma robotica da Vinci Xi rappresenta un reale miglioramento per la chirurgia mini-invasiva del retto. Il da Vinci Xi supera i limiti di esposizione e flessibilità del da Vinci Si rendendo fattibile la resezione del retto con tecnica totalmente robotica con una procedura che necessita di un singolo docking, evitando la necessità del posizionamento di altri trocar o una nuova sistemazione delle braccia robotiche. I vantaggi tecnici offerti dal da Vinci Xi sono associati a un più breve tempo di docking e tempo operatorio e facilita l’esecuzione di un intervento di resezione del retto con tecnica full robotic anche in pazienti più difficili come pazienti di sesso maschile e/o obesi. Questi vantaggi potrebbero tradursi in una riduzione dei costi e in una maggiore versatilità. Il tasso di conversione, i risultati anatomopatologici e i risultati funzionali non sembrano essere migliorati con l’introduzione del da Vinci Xi, ma ulteriori studi sono necessari per ottenere dei risultati conclusivi.
Inoltre, la disponibilità della suturatrice robotica per il da Vinci Xi dotata della tecnologia Endowrist ha permesso un ulteriore miglioramento della chirurgia mini-invasiva del retto. Essa ha infatti permesso una resezione sicura del retto essendo totalmente automatizzata e totalmente controllata dall’operatore. Con la nuova suturatrice robotica la sezione del retto avviene con l’assistenza robotica e senza i limiti dell’approccio laparoscopico con l’uso delle suturatici manuali laparoscopiche. Questi risultati preliminari indicano che l’uso della nuova suturatrice robotica ha dei vantaggi intraoperatori quali un ridotto numero di cariche usate durante la sezione del retto e che questo possa essere associato a un minor rischio di fistola anastomotica. Inoltre, a causa della minore incidenza di fistola anastomotica, l’intervallo di tempo medio tra la chirurgia del retto e l’intervento di chiusura della ileostomia risulta essere minore nel gruppo Endowrist. Tuttavia anche questi dati preliminari particolarmente
incoraggianti necessitano di studi futuri su un maggior numero di pazienti per ottenere delle conclusioni definitive.
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Ringraziamenti
E finalmente ci siamo, forse è davvero finita! Così voglio fermarmi un attimo per cercare le parole giuste per ringraziare tutte le persone che hanno reso possibile il raggiungimento di questo traguardo.
In primis desidero ringraziare il mio relatore, il Prof. Luca Morelli, che mi ha trasmesso la passione per la chirurgia, mi ha dato la possibilità di crescere professionalmente e mi ha trasmesso l’importanza e la voglia di essere sempre aggiornato e al passo coi tempi.
Voglio ringraziare tutti i medici e tutti gli specializzandi che ho incontrato nei diversi reparti che ho frequentato in questi anni, le loro spiegazioni ed i loro insegnamenti sono stati preziosi e mi hanno fatto crescere in questo lungo e duro percorso durato sei anni.
Ringrazio i miei genitori, le mie sorelle e tutte le persone che mi sono state vicine in questo percorso, spronandomi a dare sempre il massimo, supportandomi nei momenti difficili, non risparmiandosi mai nell’incoraggiarmi e nel convincermi che tutto sarebbe andato per il meglio.
E last but not least grazie a Martina, mia moglie, che ha veramente respirato questi anni con me, che mi ha supportato e sopportato in ogni momento, che non si è mai tirata indietro dal darmi una mano, che ha gioito con me quando raggiungevo un determinato traguardo e che mi ha sostenuto nei momenti difficili che ci sono stati lungo questo percorso.