00:00Professor Lungo, why does embo-diep reconstruction represent a paradigm shift after mastectomy?
00:08It's a paradigm shift not so much for the procedure itself, but for how the entire process is being reformulated.
00:16Our breast reconstruction process with embo-diep has been reviewed in every detail,
00:23it has been studied, it has been carefully re-evaluated and we have introduced a whole series of improvements
00:34which allowed us to optimize it to the point of making it a one-night surgery procedure.
00:41One-night surgery means that the patient undergoes surgery, sleeps one night in the hospital, and is discharged the next day.
00:50This obviously allows for a whole series of benefits for the patient both from a psychological and
01:00biological
01:01Up to now, they had never been optimized to this extent for this type of procedure.
01:08The benefits concern both the psychological and biological parts.
01:14When the patient undergoes surgery, he has no memory of the surgery itself.
01:21due to the anesthesia coverage, but he remembers the hospitalization very well.
01:27Hospitalization in itself is a condition for the patient that is defined as an emergency state.
01:37with a release of endogenous substances such as catecholamines or cortisol
01:43which are typical of that emergency state, but which have the effect of increasing the inflammatory response to the surgical insult.
01:53Obviously, the more the patient is returned to his normal life, the more these effects are reduced to a minimum.
02:02Another very important effect is the psychological aspect for the patient.
02:06During hospitalization, the patient perceives what the English call sick identity,
02:15that is, he feels sick, he feels ill and this alters all his physiological mechanisms,
02:23his daily life, his circadian rhythm because at night in hospitals people sleep little,
02:29because there is a noise, so to speak, in the background for all the activities that are routinely carried out even during the
02:38Night.
02:39Obviously this is reduced in such a fast process, although the intervention is still a major intervention,
02:47of high surgical technique, of reconstructive microsurgery,
02:54we achieve this through a multidisciplinary, multispecialist approach,
03:00to minimize hospitalization, with all the benefits that this entails,
03:08without absolutely neglecting patient safety.
03:11We have over 99% success rate in this type of surgery.
03:17and is absolutely in line with the large centers that perform a high volume of reconstructive microsurgery in the world.
03:25So the real turning point is precisely in giving back,
03:30Today we no longer talk about complications, about transplant survival in terms of excellent results,
03:36but not even to reduce hospitalization, but to reduce the time of the patient's life dedicated to the hospital,
03:47that is, immediately return the patient to his life,
03:50help him recover his social role and his identity in the home environment
03:56and minimize any biological consequences that hospitalization could alternatively cause.
04:04So, how did you manage to reduce the surgery time and discharge the patients within 24 hours?
04:12We achieved this through a multidisciplinary study of the entire process.
04:18We have had many meetings with our neuropsychologists,
04:22we have seen that the patient must be educated from the first visit.
04:28From the first visit the patient is trained on the entire process,
04:36he is explained how he should behave before, during and after,
04:41the patient comes, the patient identifies a caregiver,
04:45which is involved in the healing process and during convalescence,
04:51is that the caregiver is trained by us and our nurses before discharge
04:57on how to manage the patient in a home environment
05:02for the next 48 hours after discharge,
05:07therefore for the earliest phase of home care.
05:11This obviously allowed us to optimize the preparatory phase of the surgical intervention.
05:16with the awareness of rapid discharge,
05:21the intraoperative phase with a whole series of anesthesiological adjustments,
05:25but when we talk about anesthesiology it is not only the part of the drugs that induce anesthesia,
05:33but everything that concerns the management of the patient's rheology,
05:39that is, the infusion of fluids, the management of the quantity of blood,
05:44all these details that allow a quicker recovery of the patient
05:49and a lower inflammatory response.
05:52And then there is the technical part of the surgery.
05:55which is obviously optimized because it is performed in multi-equip,
05:59precisely to avoid overlaps in surgical times.
06:04All this allows to eliminate the so-called surgical background noise,
06:10that is, everyone only thinks about their own part and that's it.
06:17There are no overlaps in skills.
06:19This optimizes the entire path.
06:23What long-term advantages does autologous tissue offer over implants?
06:30The prosthesis is not a lifelong device.
06:34The prosthesis is an implantable device that is subject to wear and tear over time.
06:40Like any other implantable prosthesis, it has a limited lifespan.
06:47Prostheses inserted for reconstructive reasons,
06:50According to our Ministry of Health, they have an average lifespan of around 7 years.
06:55If the patient is undergoing post-oncological adjuvant therapies,
07:01This time is even reduced to 4 years.
07:04This means that on average, in a time span between 4 and 7 years,
07:09the patient must continually replace the prosthesis
07:12because a complication of the implantable device occurs.
07:21Differently, autologous tissue, although it is a more demanding intervention,
07:28clearly it is a definitive intervention because it is not an intervention that requires future revisions.
07:38They are your own tissues, they stabilize in a single intervention or at most another small one may be necessary
07:46intervention
07:46or two other small breast shape refinement procedures,
07:52but once the final result is achieved it is forever, it is definitive.
07:56I believe that this is the greatest advantage compared to the sacrifice of having an operation which is more expensive anyway.
08:02challenging of implanting a prosthesis.
08:05Here, professor, precisely regarding this, autologous tissue, discharge within 24 hours,
08:13How has the way patients experience this procedure changed?
08:19The patients are, at first, a little worried, a little surprised, I would say,
08:27even more than concerned about this, let's say, approach that reduces the entity, let's say,
08:37the physical and psychological commitment of the patient, because obviously they are not used to hearing
08:43that such an intervention can be so rapid in recovery.
08:50But their experience afterwards is wonderful, because they are even amazed at the speed
08:59with which they recover and forget the intervention and even positively associate the whole process,
09:09because this speed of recovery makes them develop the intensity and biological commitment of their body.
09:18Although, I repeat, it is still a complex reconstructive microsurgery procedure.
09:26Why does this technique require such a high level of specialization and, above all, why is it not yet available everywhere?
09:37This technique, I'll give you a very pragmatic example,
09:44Learning and teaching how to make a prosthetic reconstruction involves a much shorter training period
09:56than learning and teaching how to perform microsurgical reconstruction.
10:06A commitment that, as far as microsurgical reconstruction is concerned, requires no less than 10 years of training.
10:15This is obviously to get to 10 years, to get to optimisation and to have absolutely safe and reliable results.
10:25And this clearly implies working, having a great motivation to learn these types of procedures.
10:35It's a great investment of time for kids who want to take this longer learning journey.
10:46and then it must be supported by the possibility and opportunity to work in centres where many are already being done
10:58of these interventions annually.
11:01And this obviously exposes them to a longer path than learning to do a reconstruction that
11:11it's the prosthetic one.
11:13In her opinion, looking to the future, the Policlinico is among the top five in the world for this study,
11:22What are the goals and future prospects?
11:27So, for us, being discharged the next day almost became, I wouldn't say an anachronism, but we moved forward.
11:37Yes, we have moved forward because today we are trying to further optimize our entire process.
11:47Today we are even able, we are evaluating on an experimental basis, to place the patients on the same day.
11:56So today we are evaluating these interventions and we are experimenting with the possibility of performing them as day hospital procedures.
12:06But this will be, we will see the feasibility once we have confirmed that we can maintain the adequate level of security.
12:19It is absolutely identical to what we are used to, that is, with a success rate of over 99%.
12:28Well, in conclusion, someone might think of ever shorter hospital stays and greater savings for the National Health Service.
12:39What does he reply?
12:41I reply that the primary concern is the patient's safety.
12:48Safety means not only the success of the intervention, but also preserving the memory of the intervention,
12:58have a memory of the intervention and of the entire treatment process as a positive memory.
13:07As we have seen, we have already observed, the benefits of this approach are first of all physical and psychological for the
13:24patient.
13:25A patient who arrives already approved by the experience of neoplasia and who needs to recover his/her health as soon as possible
13:34life,
13:35his identity and his place in the world, his sociality.
13:39If our national health system also benefits from this, then so be it.
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