Fernando Elli - Academia.edu (original) (raw)

Papers by Fernando Elli

Emerging science journal, Apr 1, 2024

Despite the location (Earth or Space), surgical simulation is a vital part of improving technical... more Despite the location (Earth or Space), surgical simulation is a vital part of improving technical skills and ensuring patients' safety in the real procedure. The purpose of this study is to describe the Space System for Minimally Invasive Surgery (SY-MIS©) project, which started in 2016 under the supervision of the Center for Space Systems (C-SET). The process connects the best features of the following machines: Biomedik Surgeon, Space Biosurgeon, SP-LAP 1, and SP-LAP 2, which were defined using the VDI 2221 guidelines. This research uses methods based on 3 standards: i) Biomedical design: ISO 9001-13485 / FDA 21 CFR 820.30 / ASTM F1744-96(2016); ii) Aerospace human factors: HF-STD-001; iii) Mechatronics design: VDI 2206. The results depict the conceptual biomedical design of a novel training system named Surgical Engineering and Mechatronic System (SETY©), which integrates the use of 2 laparoscopic tools and 2 anthropomorphic mini-robotic arms (6 DOF). It has been validated by the Evaluation of Technical Criteria, getting a total score of 90% related to clinical assessment, machine adaptability, and robustness. The novelty of the research lies in the introduction of a new procedure that covers the simultaneous use of laparoscopic and robotic systems, named Hybrid Cyber-Physical Surgery (HYS©). In conclusion, the development of SY-MIS© promotes the use of advanced technologies to improve surgical procedures and humanmachine medical cooperation for the next frontier of habitability on other planets.

Obesity surgery, Mar 19, 2024

Journal of laparoendoscopic & advanced surgical techniques. Part A/Journal of laparoendoscopic & advanced surgical techniques, Apr 1, 2024

Current surgery reports, Apr 10, 2024

Gastroenterology, May 1, 2023

Obesity Surgery, Nov 2, 2022

Obesity Surgery, Jul 1, 2019

Introduction/Purpose Bariatric surgery (BS) has emerged as a cornerstone procedure to prevent and... more Introduction/Purpose Bariatric surgery (BS) has emerged as a cornerstone procedure to prevent and treat obesity-related comorbidities. As the Hispanic population continues to grow in the USA, their importance to the healthcare system cannot be understated. We aimed to assess the use of BS and related healthcare outcomes in Hispanics using a national database. Materials and Methods Case-control study using the 2010 to 2014 National Inpatient Sample datasets. BS use in Hispanics compared to non-Hispanics was the primary outcome. Secondary outcomes included inpatient mortality, morbidity, resource use, length of hospital stay, hospital costs, and total hospitalization charges. Propensity scores were used to match Hispanic patients with BS with non-Hispanic patients with BS using sex, age, and Charlson Comorbidity Index as covariates. A multivariate model was then used to adjust for additional confounding factors. Results From the 105,435 patients who underwent BS, a propensity-matched cohort of 20,440 was created (10,945 Hispanics). Mean (SD) age was 45 (17.2) years, and 73,594 (69.8%) were women. The prevalence of BS in Hispanics was 21/100,000 persons (281/100,000 admissions) compared to 36/100,000 persons (337/100,000 admissions) for non-Hispanics. On multivariate analysis, Hispanics displayed adjusted propensity-matched odds of 0.88 of having BS (P < 0.01). No differences were seen in the surgical approach performed. Hispanics and non-Hispanics had similar mortality, morbidity, hospital length of stay, and costs. Conclusion Despite higher obesity rates, the use of BS is lower in Hispanics. For those who underwent BS, no difference in clinical outcomes and minor differences in resource use were observed.

This chapter reviews the technique and outcomes of robot-assisted Roux-en-Y gastric bypass (RYGB)... more This chapter reviews the technique and outcomes of robot-assisted Roux-en-Y gastric bypass (RYGB). With the rise in obesity and bariatric procedures, surgeons are encountering patients with high body mass index (BMI) and revisional bariatric procedures. The use of digital platforms holds great promise for these complex procedures. Many specialists consider RYGB, which involves two anastomoses (gastrojejunostomy and jejunojejunostomy), to be the gold-standard surgical procedure for morbid obesity. Robotic surgery is currently considered to be an attractive technology that could help perform RYGB, given its well-described advantages. It is also the most-studied robotic bariatric procedure. This chapter describes the instrumentation, patient positioning, operating room setup, surgical technique, and outcomes of robot-assisted RYGB.

Obesity Surgery, Jul 16, 2023

Surgery for Obesity and Related Diseases, Jun 1, 2023

American Surgeon, Aug 31, 2020

Background: Recent studies have shown an increase in the incidence of gastric cancer (GC) among y... more Background: Recent studies have shown an increase in the incidence of gastric cancer (GC) among young adults in Asia and Latin America. However, it is unknown if a similar trend is happening in the United States (US). Methods: A retrospective review of the National Cancer Data Base was conducted to identify patients diagnosed with gastric adenocarcinoma between the years of 2004 and 2013. Results: A total of 93 734 patients were included. The 2 age groups below 40 did not see a change in GC incidence; however, age groups above 40 had increasing incidence. Patients aged 18-25 had the largest proportion of stage 4 disease and a poor survival (median 11.5 months), compared to older patients. Conclusion: Despite the increasing trend of GC among individuals, the incidence of GC among young adults is not increasing. However, this subpopulation presents at more advanced stages (clinical stage 4) and thus has worse survival.

Obesity Surgery, Dec 7, 2018

Background Indications and outcomes of bariatric surgery in the elderly remain controversial. We ... more Background Indications and outcomes of bariatric surgery in the elderly remain controversial. We aimed to evaluate and compare safety and early outcomes of bariatric procedures in this age group. Study Design We performed a retrospective case-control study of Mayo Clinic bariatric surgery patients from January 1, 2016, to January 31, 2018. Data collection included surgery type, sex, age, body mass index (BMI), and comorbidities (hypertension, diabetes mellitus, hyperlipidemia, and obstructive sleep apnea (OSA)). Patients aged 65 years old or older were matched with controls younger than 65 years by body mass index (BMI). We assessed length of stay (LOS), perioperative and early postoperative outcomes, short-term weight loss, and complications. Results We included 150 bariatric patients, with a case-to-control ratio of 1:2. After laparoscopic sleeve gastrectomy, no significant difference was found in LOS between groups (2.4 vs 2.6 days; P = 0.52), 1-month BMI difference (3.35 vs 3.88; P = 0.17), mean nadir excess BMI loss (%EBL) (22.14 vs 23.2; P = 0.75), or complication rate (0% vs 3.3%; P > 0.99). Similarly, the laparoscopic or robotic-assisted Roux-en-Y gastric bypass (RYGB) cohort showed no difference in LOS (2.65 vs 2.54 days; P = 0.68), 1-month BMI difference (4.72 vs 4.53; P = 0.68), %EBL (31.7 vs 26.6; P = 0.13), or complication rate (11.7% vs 5.71%; P = 0.43). Conclusion Although the sample size is small to draw definitive conclusions, bariatric surgery in patients 65 years or older seems to be safe, with similar outcomes and complication rates as in younger patients, regardless of procedure performed.

Current Treatment Options in Gastroenterology, May 16, 2023

Obesity Surgery, Oct 27, 2022

Journal of gastrointestinal oncology, Oct 1, 2021

Background: Determining the best approach for esophageal cancer and predicting accurate prognosis... more Background: Determining the best approach for esophageal cancer and predicting accurate prognosis are critical. Multiple studies evaluated characteristics associated with overall survival, and several prediction models have been developed. This study aimed to evaluate existing models and perform external validation of selected models. Methods: A retrospective investigation of a multi-site institutional enterprise for patients with a diagnosis of esophageal cancer between 2013-2014 was performed. Selected survival prediction models included the

Surgical Endoscopy and Other Interventional Techniques, May 2, 2023

Esophagus, Oct 15, 2019

Background Despite the effectiveness of antireflux fundoplication for typical gastroesophageal re... more Background Despite the effectiveness of antireflux fundoplication for typical gastroesophageal reflux disease, outcomes regarding surgical therapy for patients with gastroesophageal reflux disease-related chronic cough are currently unclear. The purpose of this study was to evaluate whether antireflux surgery for patients with chronic cough is effective, and to assess the correlation between indexes, such as symptom index and symptom association probability, and response to surgery. Methods We performed a retrospective review of a prospectively collected database from a 3-site institution from 2013 to 2017. Of 1149 patients who underwent antireflux surgery, 41 presented with chronic cough as a main symptom related to gastroesophageal reflux disease. Preoperatively, patients underwent a symptom assessment, esophagogastroduodenoscopy, esophageal 24-h pH monitoring, and manometry. Patients were followed up at 6 weeks and 12 months post-surgery. Results Thirty-three (80.5%) patients underwent Nissen fundoplication, while 8 (19.5%) underwent Toupet fundoplication. Isolated chronic cough was present in 8 (19.5%) patients, and median (range) DeMeester score was 28.9 (0.3-96.7). After 12-month follow-up, chronic cough was absent in 28 (68.3%) patients (P = .02). Typical reflux symptoms responded well to surgery, but response was not optimal. Postoperative dysphagia and atypical reflux symptoms were slightly worse on longterm follow-up; however, differences were not significant (P ≥ .2). When examining how the different symptom indexes correlated with complete, partial, or no response in patients with gastroesophageal reflux disease-related cough, there was no notable agreement on predicted response to surgery. Conclusions Antireflux surgery, although less predictable, is effective for the treatment of gastroesophageal reflux diseaserelated chronic cough.

Surgical Endoscopy and Other Interventional Techniques, Sep 12, 2018

Background: In the era of high-resolution manometry (HRM), non-achalasia EJOO can be detected in ... more Background: In the era of high-resolution manometry (HRM), non-achalasia EJOO can be detected in patients with symptoms of GERD such as heartburn, regurgitation and dysphagia. The purpose of this study was to evaluate the presentation and outcomes of surgical intervention in patients with EJOO. Methods: This is a retrospective review in patients with EJOO who underwent surgical intervention from May 2014 through November 2016. EJOO was defined as a relaxation pressure > upper limit of normal, ± elevated intrabolus pressure and intact peristalsis. Patients were stratified into two groups based on type of surgical intervention: antireflux surgery (ARS) and myotomy. Surgery type was selected based on presenting symptoms, endoscopic findings and pH testing. Demographics, presenting symptoms, and preoperative objective testing results were analyzed. Surgical outcomes were assessed using a Likert scale (1-5), where 1 and 5 represented no improvement and complete symptomatic resolution, respectively. Independent t-test and Chi-Square tests were used to compare groups. Results: A total of 1832 patients underwent HRM, of which 161 (9%) were diagnosed with EJOO and 56 of these underwent surgery. ARS (fundoplication, n=23; magnetic sphincter augmentation, n=13) was performed in 36 patients and myotomy (POEM, n=14; Heller with fundoplication, n=6) in 20 patients. There was no difference in age and BMI between groups, and more women were in the ARS group (p=0.027). Although all symptom types were present in both groups, the primary presenting symptoms were heartburn in the ARS group (70% vs. 35%, p=0.008) and dysphagia in the myotomy group (33% vs. 85%, p<0.001). The secondary symptom was regurgitation in both groups (p=0.72). Preoperative PPI use was more common in the ARS group (p=0.030). Presence of hiatal hernia (p=0.041), esophagitis (p=0.010) and abnormal DeMeester score (DMS) (p=0.015), were higher in ARS patients. There was no difference in lower esophageal sphincter (LES) length between groups; however, LES resting pressure (p=0.008), relaxation pressure (p=0.009), and intrabolus pressure (p=0.021) were higher in the myotomy group. There was no difference in esophageal peristaltic pressure or distal contractile integral. Mean follow-up for ARS and myotomy groups were 3.66 and 3.11 months, respectively. Symptomatic improvement was observed equally in both ARS and myotomy groups (p=0.309), with mean postoperative scores of 4.31 and 4.06, respectively. Conclusion: EJOO likely results from two distinct mechanisms, which include GERD induced chronic fibrosis and a variant of achalasia. Although the majority of these patients are referred with symptoms of GERD, almost 50% had a negative DMS. The surgical approach in these patients should be weighted on the primary presenting symptom and objective testing as the approaches are diametrically opposed.

Anticancer Research, Feb 1, 2020

Background/Aim: We aimed to evaluate disparities in presentation and treatment of gastric cancer ... more Background/Aim: We aimed to evaluate disparities in presentation and treatment of gastric cancer (GC), including time between diagnosis and treatment, based on race, focusing on Japanese patients within the USA. Patients and Methods: The National Cancer Database was queried for patients diagnosed with GC between 2004-2013. Clinical and treatment variables were summarized by race (White, non-Japanese Asian, Japanese). The association between race and overall survival (OS) was evaluated using the log-rank test. Results: A total of 79,481 patients were included. Japanese patients received surgery the earliest after diagnosis in all stages. Regarding radiotherapy, white patients had the shortest waiting time followed by Asian and Japanese patients. Asian patients had better OS at both 3 and 5 years of followup. White patients were associated with the lowest OS. Conclusion: Japanese and Asian GC patients have better OS compared to White patients. Moreover, there were disparities in time to both GC diagnosis and treatment, with Japanese patients being sooner diagnosed and surgically treated, which may ultimately impact patient experience.