The environmental impact of climate change is unequivocal, and surgical practice, given its substantial carbon footprint, must also move toward sustainability. The primary aim of the study is to assess the environmental impact of surgical practice in breast cancer treatment and to identify interventions that can effectively reduce it. The secondary aim was to explore the feasibility and preliminary clinical performance of indocyanine green (ICG) compared with technetium-99m (99mTc) for sentinel lymph node mapping, within the context of a pilot project on sustainable surgical practices. At the Breast Surgery Clinic of Polyclinic San Martino IRCCS Hospital in Genoa, a prospective study was conducted from September 2024 to May 2025 to assess the effectiveness of a series of environmentally sustainable measures within the operating room. Thirty-four women diagnosed with HR-positive/HER2-negative, T1-T2, cN0 invasive breast cancer underwent quadrantectomy and sentinel lymph node biopsy (SLNB). Seventeen patients were treated using a conventional high-impact surgical protocol, while the remaining 17 were treated with a green protocol based on the "5R rule" (Reduce, Reuse, Recycle, Rethink, Research). Key strategies included the use of ICG for SLNB, local anesthesia with intravenous sedation, waste minimization, and the adoption of reusable surgical gowns, drapes, and instruments, along with the segregation of non-infectious plastic waste. Sentinel lymph node identification was achieved in 100% of patients in the 99mTc group and in 94.1% of patients in the ICG group. The green approach was operationally feasible and associated with preliminary indicators of reduced environmental burden, although a full quantitative analysis was beyond the scope of this pilot study. Patients avoided preoperative hospitalization, radiotracer administration, and, importantly, 58.8% were discharged the same day. Considering the pressing climate crisis, these findings highlight the feasibility and necessity of adopting sustainable practices in surgical oncology to mitigate greenhouse gas emissions while maintaining high-quality patient care.

Pancreatoduodenectomy (PD) is one of the most challenging surgical procedures among abdominal surgeries. The most common complication after PD is postoperative pancreatic fistula (POPF), which can be severe and entail other complications, such as post-pancreatectomy hemorrhage (PPH), which can be fatal. Several surgical techniques have been proposed to reduce the incidence of POPF and PPH. In this study, we describe inframesocolic pancreatic anastomosis, which involves segregating the pancreatic anastomosis into the inframesocolic area by mobilizing the pancreatic remnant and creating a small window into the transverse mesocolon. This surgical technique was performed in 17 patients, with promising results in terms of delayed PPH prevention. In particular, we had only one case of PPH that was successfully treated by placing a stent into the SMA. No other bleeding events were reported, even in cases of anastomotic leakage. In the context of mitigation strategies, this technique might be efficient in reducing the incidence of delayed PPH due to leakage of pancreatic juice into the supramesocolic area and consequent vascular erosion.

Venous ulcers are chronic open skin sores, difficult to heal, caused by bad microcirculation in patients with chronic venous insufficiency (CVI) and sustained venous hypertension. In this pilot supplement registry study, the efficacy and safety of oral Centellicum® (Centella Asiatica standardized extract, Horphag Research) 675 mg/day for 3 months as part of the management of venous ulcerations were evaluated. Study endpoints considered measuring the changes in the area of the ulceration and microcirculatory parameters in patients with CVI. 160 subjects with venous ulcers and CVI completed the study: 80 in the Centellicum® group, supplemented with 675 mg Centellicum® per day in addition to the best management treatment (BM) and 80 in the control group with only the BM. The control and treatment groups were comparable for age and sex distribution. Skin resting flux is generally abnormally increased at the peri malleolar region in CVI patients and around ulcerations. Both groups exhibited improvements in microcirculation, skin resting flux (RF) measured with Laser Doppler flowmetry (LDF), transcutaneous PO<inf>2</inf> and PCO<inf>2</inf>. However, the supplementation proved to be more effective than the best management only (P<0.05). After 90 days, the supplement group exhibited a significantly lower number of ulcerations and average ulcer area compared to the control group (P<0.05). In the Centellicum® group, the ulcer area decreased from 2.34±0.3 cm2 to 0.33±0.5 cm2, whereas in the control group, it only decreased from 2.4±0.5 cm2 to 1.61±0.7 cm2. The difference between the two management groups was statistically significant (P<0.021). The rate of completely closed ulcers was 96.2% in the Centellicum® group, significantly higher than the 83.7% healing rate observed in in the control group. Notably, after just one month, 65% (52/80) of ulcers in the Centellicum® group had completely healed, compared to only 18.75% (15/80) in the control group. Ulcer closure was the most critical clinical outcome observed. In venous ulcerations, Centellicum® supplementation in combination with ulcer management, improved microcirculation parameters and ulcer healing rate. Most of the treatments were done at home by the patients or by their tutors. This study indicates a potential role of Centellicum® in venous ulcers and CVI and suggests the need to plan larger and more prolonged healing studies.

The role of 25-hydroxy vitamin D (25(OH)D) in predicting surgical complications has been increasingly studied in various fields, with limited research on its impact in colorectal surgery. This study aimed to assess the predictive value of preoperative vitamin D levels for postoperative complications and compare it with albumin levels, a known nutritional marker. The secondary objective was to identify cutoff values for both markers to identify at-risk patients for targeted nutritional interventions. This single-center, retrospective study included patients undergoing colorectal surgery between June 2023 and August 2024. Preoperative 25(OH)D, albumin, and other nutritional markers (blood glucose, folate, vitamin B12) were measured during a nutritional assessment one month before surgery. These markers were analyzed in relation to postoperative complications. Lower preoperative levels of both 25(OH)D and albumin were significantly associated with postoperative complications (P=0.039 and P=0.012, respectively). Univariate analysis identified ASA score, folate, 25(OH)D, and albumin as predictors, with multivariate analysis confirming albumin (P=0.044) as significant, while 25(OH)D showed a trend (P=0.086). Optimal cutoff values were 14.4 ng/mL for 25(OH)D and 3.6 g/dL for albumin. Lower 25(OH)D and albumin levels were associated with postoperative complications. Preoperative nutritional assessment is critical for identifying high-risk patients and implementing corrective interventions.

Respiratory disorders can be broadly classified into two primary categories: those triggered by infectious agents and those stemming from noninfectious factors. The infectious group comprises a wide array of pathogens, including bacteria, viruses, and fungi. In contrast, the noninfectious category encompasses conditions such as immune system dysfunctions, as well as both malignant and benign tumors. Given the intricate and diverse nature of these diseases, accurate diagnosis often requires more than just routine clinical assessments and conventional imaging techniques. To address this complexity, the medical community has increasingly turned to minimally invasive diagnostic methods, which provide enhanced precision in managing complex cases. This comprehensive review delves into the utilization of these cutting-edge minimally invasive technologies within the field of respiratory medicine. It meticulously outlines their current applications, highlights their benefits and limitations, and also explores potential directions for future research endeavors, aiming to shed light on the evolving landscape of respiratory disease diagnosis and management.

The aim of the article is to explore the relationship between serum albumin, exercise endurance, and pulmonary complications after lobectomy. Overall, 166 lung cancer patients who were treated in our hospital from January 2020 to June 2023 were selected to analyze the incidence of postoperative pulmonary complications and the differences in clinical data between patients with and without pulmonary complications. Logistic regression equations were used to analyze the influencing factors of postoperative pulmonary complications. There were 46 patients with postoperative pulmonary complications, incidence rate was 27.71%; Among the 46 patients, eight had two or more complications. The age of patients with pulmonary complications was 69.29±6.65 years old, which was higher than that of patients without pulmonary complications (P<0.05). The proportions of surgical time ≥4 hours, intraoperative blood loss ≥50 mL, and preoperative albumin <35 g/L in patients with pulmonary complications were 58.70%, 65.22% and 76.09%, respectively, which were significantly higher than those in patients without pulmonary complications (P<0.05). Patients with pulmonary complications had peak expiratory flow rate (PEF), peak oxygen uptake as a percentage of expected value (VO<inf>2</inf>%P), kilogram oxygen uptake (VO<inf>2</inf>/kg), anaerobic threshold (AT), oxygen pulse as percentage of expected value (O<inf>2</inf>pulse%P), respiratory rate (BF), and 6-Minute Walking Test (6-MWT), which were 291.10±43.34 L/min, 55.54±12.21%, 16.21±4.32 mL, 44.45±10.02%, 71.18±15.56 L, 26.68±6.67 times and 410.04±45.54 m, which were significantly lower than patients without pulmonary complications (P>0.05). Logistic regression analysis showed that age, surgical time, preoperative albumin, VO<inf>2</inf>% P, and 6-MWT were the influencing factors for postoperative pulmonary complications (P<0.05). Serum albumin, cardiopulmonary motility indicators, and 6MWT are associated with the occurrence of pulmonary complications after lobectomy, and the occurrence of pulmonary complications is influenced by patient age and surgical time.