https://hdl.handle.net/10807/1 Mon, 21 Sep 2026 10:15:24 GMT 2026-09-21T10:15:24Z https://hdl.handle.net/10807/346955 Titolo: Impacts on functional and oncological outcomes of Robotic-assisted Radical Prostatectomy 10 years after the US Preventive Service Taskforce recommendations against PSA screening Autori: Moschovas, Marcio Covas; Jaber, Abdel; Saikali, Shady; Sandri, Marco; Bhat, Seetharam; Rogers, Travis; Gamal, Ahmed; Loy, David; Patel, Evan; Reddy, Sumeet; Sighinolfi, Maria Chiara; Rocco, Bernardo; Harvey, Tadzia; Ficarra, Vincenzo; Patel, Vipul Abstract: Objective: In the following years after the United States Preventive Service Task Force (USP-STF) recommendation against prostate cancer screening with PSA in 2012, several authors worldwide described an increase in higher grades and aggressive prostate tumors. In this scenario, we aim to evaluate the potential impacts of USPSTF recommendations on the functional and oncological outcomes in patients undergoing robotic-assisted radical prostatectomy (RARP) in a referral center. Material and Methods: We included 11396 patients who underwent RARP between 2008 and 2021. Each patient had at least a 12-month follow-up. The cohort was divided into two groups based on an inflection point in the outcomes at the end of 2012 and the beginning of 2013. The inflection point period was detected by Bayesian regression with multiple change points and regression with unknown breakpoints. We reported continuous variables as median and interquartile range (IQR) and categorical variables as absolute and relative percent frequencies. Results: Group 1 had 4760 patients, and Group 2 had 6636 patients, with a median followup of 109 and 38 months, respectively. In the final pathology, Group 2 had 9.5% increase in tumor volume, 24% increase on Gleason > 4+3 (ISUP 3), and 18% increase on > pT3. This translated to a 6% increase in positive surgical margins and 24% reduction in full nerve sparing in response to the worsening pathology. There was a significant decline in postoperative outcomes in Group 2, including a 12-month continence reduction of 9%, reduction in potency by 27%, and reduction of trifecta by 22%. Conclusions: The increasing number of high-risk patients has led to worse functional and oncologic outcomes. The initial rapid rise in PSM was leveled by the move towards more partial nerve sparing. Among some historical changes in prostate cancer diagnosis and management in the period of our study, the USPSTF recommendation coincided with worse outcomes of prostate cancer treatment in a population who could benefit from PSA screening at the appropriate time. Mon, 01 Jan 2024 00:00:00 GMT https://hdl.handle.net/10807/346955 2024-01-01T00:00:00Z https://hdl.handle.net/10807/346954 Titolo: Pre-operative prediction of extracapsular extension of prostate cancer: first external validation of the PRECE model on an independent dataset Autori: Sighinolfi, Maria Chiara; Assumma, Simone; Cassani, Alessandra; Sarchi, Luca; Calcagnile, Tommaso; Terzoni, Stefano; Sandri, Marco; Micali, Salvatore; Noel, Jonathan; Moschovas, M Covas; Seetharam, Bhat; Bozzini, Giorgio; Patel, Vipul; Rocco, Bernardo Abstract: Introduction: The PRECE is a model predicting the risk of extracapsular extension (ECE) of prostate cancer: it has been developed on more than 6000 patients who underwent robotic radical prostatectomy (RARP) at the Global Robotic Institute, FL, USA. Up to now, it is the single tool predicting either the side and the amount of ECE. The model has a free user-friendly interface and is made up from simple and available covariates, namely age, PSA, cT, GS and percent of positive core, the latter topographically distributed within the prostate gland. Despite the successful performance at internal validation, the model is still lacking an external validation (EV). The aim of the paper is to externally validate the PRECE model on an Italian cohort of patients elected to RARP. Methods: 269 prostatic lobes from 141 patients represented the validation dataset. The EV was performed with the receiver operating characteristics (ROC) curves and calibration, to address the ability of PRECE to discriminate between patients with or without ECE. Results: Overall, an ECE was found in 91 out of the 269 prostatic lobes (34%). Twenty-five patients out of pT3 had a bilateral ECE. The ROC curve showed an AUC of 0.80 (95% CI 0.74–0.85). Sensitivity and specificity were 77% and 69%, respectively. The model showed an acceptable calibration with tendency towards overestimation. Conclusions: From the current EV, the PRECE displays a good predictive performance to discriminate between cases with and without ECE; despite preliminary, outcomes may support the generalizability of the model in dataset other than the development one. Sun, 01 Jan 2023 00:00:00 GMT https://hdl.handle.net/10807/346954 2023-01-01T00:00:00Z https://hdl.handle.net/10807/346953 Titolo: Impact of hands-on practice with HugoRAS and Versius System simulators on the attractiveness of robotic surgery among medical and nurse undergraduate students Autori: Sighinolfi, Maria Chiara; Terzoni, Stefano; Scanferla, Elena; Bianchi, Pietro Paolo; Formisano, Giampaolo; Gaia, Giorgia; Marconi, Anna Maria; Chiumello, Davide; Patel, Vipul; Moschovas, Marcio Covas; Turri, Filippo; Dell'Orto, Paolo; Maruccia, Serena; Grasso, Angelica; Sangalli, Mattia; Centanni, Stefano; Stocco, Matteo; Assumma, Simone; Sarchi, Luca; Calcagnile, Tommaso; Panio, Enrico; Bozzini, Giorgio; Rocco, Bernardo Abstract: The scenario of robotic surgery is rapidly evolving with the introduction of new robotic systems. A structured learning program in robotic surgery during academic education is often lacking, especially for undergraduates; as a result, many students may be unaware of indications to robotic surgery and technological progress. The aim of the study is to evaluate the knowledge and interest toward robotic surgery of medical and nurse students, and to analyze how the attractiveness may change after a hand-on training course with new simulators of Hugo RAS and Versius System. We performed a cross-sectional study involving medical and nurse students recruited on a voluntary basis at ASST Santi Paolo and Carlo, Milan; participants were invited to join a hands-on practice simulation with the Hugo RAS and/or Versius Trainer Simulator. Before the hand-on exercise, students were asked to fulfill an online anonymous questionnaire addressing knowledge and interest toward robotic surgery. After a 2-h hands-on exercises at the Hugo RAS and/or at the Versius Trainer simulator (preceded by a brief lecture on robotic surgery and new systems), participants were asked to complete a second-round questionnaire to evaluate changes in attractiveness toward robotic surgery. Data were recorded in a database; after a descriptive analysis of the variables, median values were compared with the Mann–Whitney U test, frequencies with the Fisher’s exact test and in the case of paired observations (before and after the simulation), the Mc Nemar test was used. Forty-one undergraduates agreed to participate. Twenty-three nursing students and 18 medical students were recruited. Some of them had a basic knowledge in robotic surgery and were able to figure out some surgical indications, given the presence of a robotic program already settled up at the institution. Before the hands-on course, 44.0% nurse students and 36.6% of medical students were interested in surgical disciplines and robotic surgery. After the simulation, all students (100%) reported a high level of interest in robotic surgery and some of them required for a dedicated internship (p < 0.001). The students provided also feedback on the perceived ease-of-use of the robotic simulators (on a scale 0–10); overall, the median score was 8, IQR [7–8], with no differences between nursing and medical students (p = 0.482). In conclusion, the study demonstrates a great interest toward robotic surgery as a part of medical and nurse education. A hands-on simulation further improved the interest of undergraduates from both backgrounds. The technological progress with the availability of new surgical systems will be the future challenge of training programs and should be considered at all levels of education. Sun, 01 Jan 2023 00:00:00 GMT https://hdl.handle.net/10807/346953 2023-01-01T00:00:00Z https://hdl.handle.net/10807/346952 Titolo: Second opinions in high-stakes credence goods markets: transparency as a discipline mechanism Autori: Colombo, Ferdinando; Ursino, Giovanni Abstract: We study second opinions in fixed-price credence goods markets, in which strategic experts have strong incentives to overtreat consumers, a phenomenon often observed in healthcare. This setting has been largely overlooked in the literature, likely because second opinions are ineffective: strategic experts always overtreat, and consumers never seek a second opinion. We depart from the benchmark by introducing a share of honest experts – who never overtreat – and a degree of transparency, defined as the probability that an expert providing a second opinion knows that the consumer has already received a prior recommendation. We show that if transparency exceeds a critical threshold, second opinions discipline strategic experts, provided the share of honest experts is neither too low nor too high. We identify the level of transparency that maximizes legitimate welfare – defined as the sum of the consumer’s expected utility and the expected utility experts derive from behaving honestly. Unlike in low-stakes environments, full transparency – though it never maximizes legitimate welfare – still performs better than no transparency. Thu, 01 Jan 2026 00:00:00 GMT https://hdl.handle.net/10807/346952 2026-01-01T00:00:00Z