Prof. Dr. Majno-Hurst
Head of Department
The EOC Department of surgery has seen with enthusiasm the challenge of becoming player in the Swiss academic surgical scene, also in view of the upcoming Master of Biomedicine of USI. Research has become part of the curriculum for young surgeons in Lugano and Bellinzona, and will be included in the structured training programme (Dr. M. Arigoni, Dr. M. Guigli-Poretti). A short summary of main projects is provided. Several projects are conducted together by surgeons in the different hospitals. Working as a single Department rather than as four different smaller units is indeed one of the aims of the new Board.
General, Visceral and Vascular Surgery
Perioperative medicine and preparation for surgery Several papers were published as a result of the collaboration between the department of surgery and anaesthetics, including thoracic surgery (Dr. D. La Regina, PD Dr. S. Cafarotti, PD Dr. A. Saporito). In Lugano, 2 publications on enhanced recovery after surgery concept (Prof. Dr. D. Christoforidis) are being finalised while another project on easily accessible ways to optimize the physical conditions of patients undergoing complex operations is starting (Dr. R. C. Balzarotti, Dr. R. Poggi, Dr. A. Cristaudi).
Colorectal and pelvic floor surgery
Several clinical projects are under way, as well as two translational projects: the LiBReCA study has started recruiting patients with rectal cancer undergoing neoadjuvant therapy at the Regional Hospital of Lugano and Clinica Moncucco to assess the value of liquid biopsies (free tumoral circulating DNA) to predict tumour response and identify complete responders. The project is funded by Fondazione San Salvatore, ABREOC and Fondo Ricerca Moncucco (CHF 255’000).
Another translational project focuses on the impact of intestinal microbiota in modulating the immune response to colorectal cancer. This has resulted in the appointment of PD Dr. G. Iezzi, a leader in the field, and in the winning of competitive funds by the SNF and the Gebert Rüf Foundation (CHF 860’000). This project will be conducted in close collaboration with the Department of Oncology and the two institutes for basic research (IOR and IRB) in Bellinzona.
The Regional Hospital of Mendrisio Surgical Unit has contributed to the SAKK multicenter study on reconstruction after low anterior rectum resection and collaborates to the investigation of minimally invasive endoscopic techniques for treatment of complex anal fistulas and pilonidal diseases (Dr. P. Meinero). In proctological and pelvic floor disease, there is a close collaboration with the Units of Urology and Gynaecology, and a very specialised monthly clinic with the participation of Dr. P.A. Lehur, an international expert in the field. An international congress on the pelvic floor is held in Mendrisio.
Projects are under way concerning the contribution of radiology to hepatobiliary surgery, the prediction of the presence of bile duct gallstones, the standardisation of surgical difficulty in obtaining clear surgical margins, a system for grading the difficulty of minor liver resections, and new concepts in surgical liver anatomy.
This field is growing rapidly on the academic side, with collaborations with a prominent fellow programme in Montreal, and taking advantage of the high rate of follow- up of local patients. Several projects have been proposed on the gastroesophageal reflux disease (i.e. a multicentre study with the University of Montreal focusing on the effect of concomitant hernia repair and sleeve gastrectomies). New procedures have been described
recently in Bariatric Surgery.
The SADI-S (single anastomosis duodenal ileoststomysleeve) is becoming popular because of low complication rates and good weight loss in super-obese patients. Research projects on this topic is our priority: this procedure will be performed in selected cases from all surgeons of our bariatric team.
Since 2016, the dedicated Regional Hospital of Mendrisio Endocrine Surgery Team (Dr. F. Fasolini, Dr. G. Peloni) participates to the European Eurocrine register. Projects are under way concerning the use of intraoperative neurophysiologic monitoring in preventing recurrent laryngeal nerve palsy and intraoperative study of autofluorescence
and ICG angiography for enhancing identification and preservation of parathyroid glands.
Research work is concentrating on endovascular treatments of complex aortic and peripheral vascular disease, and arteriovenous fistulas for vascular access for dialysis.
Abdominal wall surgery
Several papers on inguinal hernia management have been published, focusing on minimally-invasive approach and cost-effectiveness.
This is an issue of growing concern. The financial aspect of minimally-invasive surgery and complications in the era of DRG have been topics for several publications.
Projects are under way to assess the learning curve of simulation-based anti-reflux surgery through the use of laparoscopy models and synthetic tissue.
The treatment of chronic wounds is subject of interest at Regional Hospital of Mendrisio in network with the Italian Academy of Wound Care and the University of Foggia, with an international masterclass on the subject.
The Orto-Trauma research group (Prof. Dr. Ch. Candrian) is composed of a clinical research team (Dr. G. Filardo, Dr. M. Delcogliano), and a Regenerative Medicine Technologies Laboratory (Dr. M. Moretti).
More than 10 researchers, including medical doctors, biomedical engineers, and biologists, work side by side with the orthopaedic surgeons. Studies have a special focus on regenerative medicine, traumatology, ligamentous knee surgery and shoulder surgery. The
Regenerative Medicine Technologies Lab works on translational research projects (including SNF projects) funded for improving therapies and diagnostics of orthopaedic diseases, based on the generation of biological substitutes as musculoskeletal tissue grafts and of in vitro 3D models for disease characterization and development of new diagnostic tools.
Research is focusing on 1. preoperative imaging in flap surgery (evaluation of vessel course and extent of skin perfusion using angio-RM and thermography to avoid irradiation (collaboration with PD Dr. F. Del Grande and Dr. V. Tobe), 2. tissue preconditioning in elective breast surgery using local heat to accelerate wound healing and reduce the rate of wound-breakdown (collaboration with Prof. Dr. H. G. Machens, TU München), 3. handling of an autonomous vacuum system to stabilize skin grafts and local flaps (collaboration with Smith & Nephew). Finally, projects are under way to study the quality of life in oncoplastic breast surgery and prepectoral implant-based breast reconstruction, a new trend to avoid problems related to subpectoral implantposition (collaboration with Dr. F. Meani).
The Urology unit of Regional Hospital of Bellinzona and Valli is collaborating in a swiss trial on stone disease (NOSTONE TRIAL) as well as a participating center in Global Prevalence Study on Infections in Urology.
The Urology unit of Regional Hospital of Bellinzona and Valli is collaborating with the IOSI in several trials:
- An exploratory proof of mechanism study to assess the effect of Ruxolitinib on tumor infiltrating myeloid cells and additional immune subsets in prostate cancer patients.
- Development of in vitro models for the study of prostate cancer and personalized therapies.
- A prospective exploratory proof-of valid biomarkers in blood to predict the response to therapy in prostate cancer patients, a single center study.
- The MAP-CAT Study – Multidisciplinary approach to prostate cancer treatment.
The new Neurourology Unit (Regional Hospital of Bellinzona and Valli and Regional Hospital of Lugano) is focusing most of its research activities on neuromodulation for lower urinary tract disorders in both non neurological and neurological patients. Different trials have been or are being submitted to Ethics committee:
- An international multicentre randomized control trial on transcutaneous tibial nerve stimulation.
- A prospective, single arm, interventional, self-controlled pilot study to assess the performance and safety of the new generation, wireless, MR compatible, implantable tibial nerve stimulator system in patients affected of Multiple Sclerosis.
- A retrospective study on pudendal neuromodulation.