Surgical education resources that I wrote during my professional life, freely downloadable and usable under the Creative Commons license.
They are my notes, that I used to study and improve myself. I hope they can be useful to other doctors for their training.
BOWEL SONOGRAPHY NOTES
It is better for a surgeon to be able to perform the ultrasound examination himself rather than just requesting it. After the sixth surgical sense, the seventh is the ultrasound scanning. The ultrasound examination of the intestinal loops is a fascinating one: to improve myself, I collected some of the most significant images I have observed in my professional life, along with some advice, in a booklet. I gladly come back to consult it periodically.
REDUCING SURGICAL SITE INFECTIONS (2004)
It is an analysis and discussion (a work I did in 2004) of the most relevant aspects for the prevention of infectious complications in surgery. Although dated, most of the arguments remain current. ITALIAN VERSION ONLY, SORRY, TRANSLATION IN PROGRESS...
WOUND DRESSING HANDBOOK
A short handbook from my course on how to dress surgical wounds and drains. ITALIAN VERSION ONLY, SORRY, TRANSLATION IN PROGRESS...
ANATOMY IN RELATION TO LEFT COLECTOMY
My most popular educational video that, after its publication on YouTube, was also requested by the Harvard University.
LAPAROSCOPIC RIGHT COLECTOMY TECHNIQUE
My original technique, meant to be taught. It is easy to perform, because it is built to easily identify the dissection planes reducing the risk of errors, and to be ergonomic and reproducible. Suitable for training residents, this technique has shown optimal oncological results even in the hands of less experienced surgeons, and is conceived according to the principles of complete mesocolic excision.
Video available on my YouTube channel.
TECHNIQUE of LAPAROSCOPIC RESECTION OF THE LEFT COLIC FLEXURE
I devised this technique to make this operation reproducible and simple, since it is not frequently performed by surgeons and i couldn't find in the literature a technique that convinced me. It combines the principles of my right hemicolectomy technique with the vascular ligation time typical of the laparoscopic left colectomy technique.
LAPAROSCOPIC WITZEL JEJUNOSTOMY TECHNIQUE
The difficulty of performing this operation laparoscopically is too often underestimated. From a technical point of view it requires advanced skill. In the literature there are countless attempts to reproduce the original Witzel technique as in open surgery, but none of them come close to the original: all these techniques use artifices to overcome the difficulties of laparoscopic execution, testifying to how much this intervention is anything but trivial. It took me two years to design and refine the details of my personal technique, but in the end I am satisfied, because I consider it a concentrate of efficiency and economy of movement, and the result is identical to taht of the original Witzel technique.
Video available on my YouTube channel.
the LAPAROSCOPY ENHANCED HIPEC technique (LE-HIPEC)
The closed abdomen HIPEC technique does not guarantee the uniform treatment of the entire abdominal cavity. The alleged superiority of the open abdomen HIPEC technique is not supported by sound scientific evidence, and recent works show that it does not guarantee a homogeneous hyperthermia.
These defects were already known: proof of this is the presence in medical literature of several technical variants, which rely on expedients to improve the circulation of the perfusion fluid (use of rubber expanders, use of carbon dioxide bubble diffusers , shaking the patient, and so on).
As a consequence of my doubts about the validity of the traditional HIPEC techniques, and the result of four years of continuous research, I invented the LE-HIPEC technique to allow the manipulation of the abdominal organs within a closed abdomen, using laparoscopy during the perfusion of chemotherapy in the abdomen. In the literature there are countless articles that propose techniques of “laparoscopic HIPEC”, but inevitably they describe a laparoscopic surgical resection of a limited carcinomatosis, followed by a closed abdomen perfusion, through drainage tubes inserted through the laparoscopic ports. The Laparoscopy Enhanced (LE-HIPEC) technique, on the other hand, consists in using laparoscopy during the perfusion time: instead of just shaking the abdomen, the surgeon uses laparoscopic ports to access the abdominal cavity and move the viscera, freeing them from adhesions and making the perfusion fluid come into good contact. It is based on physical principles that I have analyzed and presented in the rationale you find below. For the skeptics, I invite you to consult my YouTube channel.
the LE-HIPEC technique concept
My criticisms of the open abdomen technique (Coliseum)
Video of the LE-HIPEC technique
POSITIONING OF PATIENT AND PORTS FOR LAPAROSCOPY
A collection of my personal patterns.
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