Francesco Rubino

Bio: Francesco Rubino is an academic researcher from European Institute. The author has contributed to research in topics: Type 2 diabetes & Remote surgery. The author has an hindex of 14, co-authored 21 publications receiving 4096 citations. Previous affiliations of Francesco Rubino include Louis Pasteur University & Catholic University of the Sacred Heart.

The Mechanism of Diabetes Control After Gastrointestinal Bypass Surgery Reveals a Role of the Proximal Small Intestine in the Pathophysiology of Type 2 Diabetes

Abstract: Summary Background Data:Most patients who undergo Roux-en-Y gastric bypass (RYGB) experience rapid resolution of type 2 diabetes. Prior studies indicate that this results from more than gastric restriction and weight loss, implicating the rearranged intestine as a primary mediator. It is unclear, ho

Transatlantic robot-assisted telesurgery

Abstract: ATM technology now enables operations to be performed over huge distances. The introduction of robotic and computer technology into surgical operations allows dexterity to be increased1,2,3 and surgical procedures to be carried out from a distance (telesurgery)4. But until now, the distance feasible for remote telesurgery was considered to be limited to a few hundred miles1 by the time lag of existing telecommunication lines. Here we show that robot-assisted remote telesurgery can be safely carried out across transoceanic distances. The ability to perform complex surgical manipulations from remote locations will eliminate geographical constraints and make surgical expertise available throughout the world, improving patient treatment and surgical training.

Effect of Duodenal–Jejunal Exclusion in a Non-obese Animal Model of Type 2 Diabetes: A New Perspective for an Old Disease

Abstract: Diabetes mellitus presently affects more than 150 million people worldwide,1 a number expected to double by the year 2025.2 More than 90% of patients suffer from the type 2 form,3 a progressive disorder associated with life-threatening complications and whose etiology remains still elusive. The resolution of type 2 diabetes has been observed as an additional outcome of surgical treatment of morbid obesity (body mass index [BMI] >40 kg/m2).4 Two procedures, the Roux-en-Y gastric bypass (RYGBP) and the biliopancreatic diversion (BPD), are more effective treatments for diabetes than other procedures5 and determine normal concentrations of plasma glucose, insulin, and glycosylated hemoglobin in 80–100% of morbidly obese patients.6–9 Because BMI is the dominant risk factor for diabetes10,11 and weight loss and hypocaloric diet reduce plasma glucose and improve insulin sensitivity in obese individuals,12 this antidiabetic effect of surgery has been interpreted as a conceivable result of the surgically induced weight loss and decreased caloric intake.13 Glycemic control, however, often occurs within days, long before significant weight loss,7,14,15 suggesting that the control of diabetes may be a direct effect of the operations rather than a secondary outcome of the amelioration of obesity-related abnormalities. Both the RYGBP and the BPD include, among other elements, the bypass of the duodenum and part of the jejunum (Fig. 1). Because several peptides released in this part of the bowel are involved in governing beta-cell function both in physiological16 and diabetic states,17,18 changes in the enteroinsular axis might explain their antidiabetic effect. FIGURE 1. Roux-en-Y gastric bypass (A) includes creation of a small gastric pouch while the jejunum is divided 30–50 cm distal to the ligament of Treitz. The distal limb of the jejunum is then anastomosed to the small gastric pouch and a jejuno–jejunostomy ... We speculated that if the control of diabetes is not a secondary outcome of the treatment of obesity but, rather, a direct effect of duodenal–jejunal exclusion, then similar results should also occur in nonobese individuals. To test this hypothesis, we studied the effect of a gastrojejunal bypass in Goto-Kakizaki (GK) rats, the most widely used animal model of nonobese type 2 diabetes.19 To specifically investigate the role of the duodenal–jejunal exclusion, avoiding possible influence from mechanical reduction of food intake and/or hormonal effects secondary to the bypass of the distal stomach, we performed a stomach-preserving gastrojejunal bypass leaving intact the original volume of the stomach (Fig. 2). FIGURE 2. Gastrojejunal bypass. The duodenum was separated from the stomach, and bowel continuity was interrupted at the level of the distal jejunum, (8 cm from the ligament of Treitz). The distal of the 2 limbs was directly connected to the stomach (gastrojejunal ...

Transcontinental robot-assisted remote telesurgery: feasibility and potential applications.

Abstract: Remote robot-assisted telesurgery is feasible and safe using terrestrial telecommunication lines, even through transcontinental distances. In addition to several potential benefits for the patient, remote surgery might improve surgical training and education. Future developments of computer technology and their surgical applications, particularly in the field of virtual reality three-dimensional reconstructions of patient’s specific anatomy and pathology, are the possible solutions to overcome the lack of direct patient-surgeon contact. Indeed, virtual reality systems may not only improve surgical performance by allowing preoperative simulations and rehearsal of surgical procedures ahead of time, but may also allow, thanks to real-time Internet teleconsultations, active intervention of the operating surgeon in the diagnostic process and in the evaluation of indications and contraindications to surgery.

Potential of Surgery for Curing Type 2 Diabetes Mellitus

Abstract: Diabetes mellitus type 2 is an epidemic health problem, affecting more than 150 million people worldwide. This number is expected to double in the first decades of the third millennium. 1 Recently, evidence for reduction of complications of type 2 diabetes with tight control of hyperglycemia has been reported, 2 but current therapies, including diet, exercise, behavior modification, oral hypoglycemic agents, and insulin, rarely return patients to euglycemia. 3 Morbid obesity, in which patients exceed their ideal weight by at least 100 lb or are more than 200% of ideal body weight, is a condition with high mortality and morbidity because of its association with severe comorbid diseases such as hypertension, diabetes, hyperlipidemia, and cardiopulmonary failure. In these patients, surgery represents the most effective therapy in that it achieves significant and durable weight loss as well as resolution or amelioration of comorbidities. 4 Current indications for surgery in morbidly obese patients include body mass index (BMI) greater than 40 or greater than 35 if comorbidities are present. 5 Several operative procedures are performed for treatment of morbid obesity. Roux-en-Y gastric bypass (GBP) is usually done by dividing the stomach with a stapler to create a small gastric pouch, while the jejunum is divided 30 to 50 cm distal to the ligament of Treitz. The distal limb of the jejunum is then anastomosed to the small gastric pouch and a jejunojejunostomy is performed 50 to 150 cm distal from the gastrojejunostomy. Most studies report a weight loss of 60% to 70% of excess body weight. 6,7 In recent series, operative mortality ranges between 0% and 1.5%, 8–10 and the overall incidence of major complications, including anastomotic leaks, pulmonary embolus, and bowel occlusions, is between 0.6%11 and 6%. 12 Biliopancreatic diversion (BPD), introduced by Scopinaro in 1978, includes a gastric resection and diversion of the biliopancreatic juice to the terminal ileum to significantly reduce the absorption of nutrients. 13 In this operation, an enteroentero-anastomosis is performed between the proximal limb of the transected jejunum and ileum, 50 to 100 cm 14 proximally to the ileocecal valve. In a series of 2,241 patients reported by Scopinaro et al, the BPD resulted in a mean permanent reduction of about 75% of the initial excess weight, with an operative mortality of 0.5%. 15 Gastroplasties, which include gastric banding and vertical banded gastroplasty, reduce the volume of the stomach by annular banding or vertical stapling but without bypassing the proximal foregut. Up to 65% of excess weight loss at 5 years has been reported, 16 but there is considerable variation in results among different authors, and a significant number of patients require reoperation for inadequate weight loss. 17 Bariatric surgery is now increasingly being performed laparoscopically, resulting in a similar percentage of weight loss with respect to the open series 18,19 and reduced recovery time and perioperative complications. 20

Bariatric surgery: a systematic review and meta-analysis.

Abstract: ContextAbout 5% of the US population is morbidly obese. This disease remains largely refractory to diet and drug therapy, but generally responds well to bariatric surgery.ObjectiveTo determine the impact of bariatric surgery on weight loss, operative mortality outcome, and 4 obesity comorbidities (diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea).Data Sources and Study SelectionElectronic literature search of MEDLINE, Current Contents, and the Cochrane Library databases plus manual reference checks of all articles on bariatric surgery published in the English language between 1990 and 2003. Two levels of screening were used on 2738 citations.Data ExtractionA total of 136 fully extracted studies, which included 91 overlapping patient populations (kin studies), were included for a total of 22 094 patients. Nineteen percent of the patients were men and 72.6% were women, with a mean age of 39 years (range, 16-64 years). Sex was not reported for 1537 patients (8%). The baseline mean body mass index for 16 944 patients was 46.9 (range, 32.3-68.8).Data SynthesisA random effects model was used in the meta-analysis. The mean (95% confidence interval) percentage of excess weight loss was 61.2% (58.1%-64.4%) for all patients; 47.5% (40.7%-54.2%) for patients who underwent gastric banding; 61.6% (56.7%-66.5%), gastric bypass; 68.2% (61.5%-74.8%), gastroplasty; and 70.1% (66.3%-73.9%), biliopancreatic diversion or duodenal switch. Operative mortality (≤30 days) in the extracted studies was 0.1% for the purely restrictive procedures, 0.5% for gastric bypass, and 1.1% for biliopancreatic diversion or duodenal switch. Diabetes was completely resolved in 76.8% of patients and resolved or improved in 86.0%. Hyperlipidemia improved in 70% or more of patients. Hypertension was resolved in 61.7% of patients and resolved or improved in 78.5%. Obstructive sleep apnea was resolved in 85.7% of patients and was resolved or improved in 83.6% of patients.ConclusionsEffective weight loss was achieved in morbidly obese patients after undergoing bariatric surgery. A substantial majority of patients with diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea experienced complete resolution or improvement.

Bariatric Surgery versus Intensive Medical Therapy for Diabetes — 5-Year Outcomes

Abstract: BackgroundLong-term results from randomized, controlled trials that compare medical therapy with surgical therapy in patients with type 2 diabetes are limited. MethodsWe assessed outcomes 5 years after 150 patients who had type 2 diabetes and a body-mass index (BMI; the weight in kilograms divided by the square of the height in meters) of 27 to 43 were randomly assigned to receive intensive medical therapy alone or intensive medical therapy plus Roux-en-Y gastric bypass or sleeve gastrectomy. The primary outcome was a glycated hemoglobin level of 6.0% or less with or without the use of diabetes medications. ResultsOf the 150 patients who underwent randomization, 1 patient died during the 5-year follow-up period; 134 of the remaining 149 patients (90%) completed 5 years of follow-up. At baseline, the mean (±SD) age of the 134 patients was 49±8 years, 66% were women, the mean glycated hemoglobin level was 9.2±1.5%, and the mean BMI was 37±3.5. At 5 years, the criterion for the primary end point was met by 2...

Bariatric surgery. A systematic review and meta-analysis

Abstract: CONTEXT About 5% of the US population is morbidly obese. This disease remains largely refractory to diet and drug therapy, but generally responds well to bariatric surgery. OBJECTIVE To determine the impact of bariatric surgery on weight loss, operative mortality outcome, and 4 obesity comorbidities (diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea). DATA SOURCES AND STUDY SELECTION Electronic literature search of MEDLINE, Current Contents, and the Cochrane Library databases plus manual reference checks of all articles on bariatric surgery published in the English language between 1990 and 2003. Two levels of screening were used on 2738 citations. DATA EXTRACTION A total of 136 fully extracted studies, which included 91 overlapping patient populations (kin studies), were included for a total of 22,094 patients. Nineteen percent of the patients were men and 72.6% were women, with a mean age of 39 years (range, 16-64 years). Sex was not reported for 1537 patients (8%). The baseline mean body mass index for 16 944 patients was 46.9 (range, 32.3-68.8). DATA SYNTHESIS A random effects model was used in the meta-analysis. The mean (95% confidence interval) percentage of excess weight loss was 61.2% (58.1%-64.4%) for all patients; 47.5% (40.7%-54.2%) for patients who underwent gastric banding; 61.6% (56.7%-66.5%), gastric bypass; 68.2% (61.5%-74.8%), gastroplasty; and 70.1% (66.3%-73.9%), biliopancreatic diversion or duodenal switch. Operative mortality (< or =30 days) in the extracted studies was 0.1% for the purely restrictive procedures, 0.5% for gastric bypass, and 1.1% for biliopancreatic diversion or duodenal switch. Diabetes was completely resolved in 76.8% of patients and resolved or improved in 86.0%. Hyperlipidemia improved in 70% or more of patients. Hypertension was resolved in 61.7% of patients and resolved or improved in 78.5%. Obstructive sleep apnea was resolved in 85.7% of patients and was resolved or improved in 83.6% of patients. CONCLUSIONS Effective weight loss was achieved in morbidly obese patients after undergoing bariatric surgery. A substantial majority of patients with diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea experienced complete resolution or improvement.

Clinical Practice Guidelines for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient—2013 Update: Cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery

Abstract: The development of these updated guidelines was commissioned by the AACE, TOS, and ASMBS Board of Directors and adheres to the AACE 2010 protocol for standardized production of clinical practice guidelines (CPG). Each recommendation was re-evaluated and updated based on the evidence and subjective factors per protocol. Examples of expanded topics in this update include: the roles of sleeve gastrectomy, bariatric surgery in patients with type-2 diabetes, bariatric surgery for patients with mild obesity, copper deficiency, informed consent, and behavioral issues. There are 74 recommendations (of which 56 are revised and 2 are new) in this 2013 update, compared with 164 original recommendations in 2008. There are 403 citations, of which 33 (8.2%) are EL 1, 131 (32.5%) are EL 2, 170 (42.2%) are EL 3, and 69 (17.1%) are EL 4. There is a relatively high proportion (40.4%) of strong (EL 1 and 2) studies, compared with only 16.5% in the 2008 AACE-TOS-ASMBS CPG. These updated guidelines reflect recent additions to the evidence base. Bariatric surgery remains a safe and effective intervention for select patients with obesity. A team approach to perioperative care is mandatory with special attention to nutritional and metabolic issues.