RICARDO MINGARINI TERRA
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cardio-Pneumologia, Faculdade de Medicina - Docente
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/61 - Laboratório de Pesquisa em Cirurgia Torácica, Hospital das Clínicas, Faculdade de Medicina
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/61 - Laboratório de Pesquisa em Cirurgia Torácica, Hospital das Clínicas, Faculdade de Medicina
8 resultados
Resultados de Busca
Agora exibindo 1 - 8 de 8
- Adverse events after pleurodesis in patients with malignant pleural effusion(2020) TERRA, Ricardo Mingarini; COSTA, Priscila Berenice da; VEGA, Alberto Jorge Monteiro Dela; PEGO-FERNANDES, Paulo ManuelBackground: Malignant pleural effusion (MPE) is an important sign of advanced disease in metastatic cancer. Pleurodesis is one option to treat recurrent MPE. The Inflammatory response after pleurodesis may lead to important adverse events (AE) in a set of very ill patients. Methods: Retrospective analysis of patients submitted to pleurodesis (2009-2013). Clinical and laboratory data were collected. We compare the values in the day of pleurodesis, 2nd, 5th and 10th days after. Results: One hundred fourteen patients were undergone to pleurodesis with silver nitrate (46%), iodine (52%) and talc (2%). Female was the most frequent (86%) and the breast cancer was the most common primary site. The most frequent adverse event was low hemoglobin account (37), followed by pain (31). 68% of patients presented AEs and 28% had at least one AE with grade 3 or higher. The most altered was CRP that peaked in the 5th day after pleurodesis. Changes in CRP curve were less severe with the use of iodine when compared with the other two agents. Conclusions: Pleurodesis leads to important systemic inflammatory response detected by different serum markers. The occurrence of adverse events in this set of patients was great number of events with being marked as grade 3 or higher.
- Robotic lobectomy: how to teach thoracic residents(2021) TERRA, Ricardo Mingarini; LEITE, Pedro Henrique Cunha; VEGA, Alberto Jorge Monteiro DelaRobotic thoracic surgery emerged at the beginning of the 21st century and keep presenting the continuous development of its robotic systems, tools, and associated techniques. Strong clinical results including safety and oncological outcomes have fostered the dissemination of the robotic platform all over the world. However, there are still some safety concerns, especially regarding more elaborated procedures as lung resections, during the learning curve. In consequence, training programs for surgeons and surgery residents have been proposed to put into operation a strong and complete curriculum for robotic surgery and increase safety during the learning process. Also, the implementation of the training program makes the process complete and efficient. Lung lobectomies are complex procedures especially because of pulmonary arteries and pulmonary veins dissection, which demands quite accurate skills. Consequently, it is believed that specific training of thoracic surgery residents in robotic lobectomy is capital. The ideal curriculum must include technical content and broad psychomotor training using virtual reality models and also physical and animal models. Valid evaluation methods can be used from the first skill training to daily clinical practice. At the beginning as a console surgeon, the resident must initiate gradually with small procedures and progress to more complex surgeries before performing the whole lobectomy.
- Management of lung nodules in Brazil-assessment of realities, beliefs and attitudes: a study by the Brazilian Society of Thoracic Surgery (SBCT), the Brazilian Thoracic Society (SBPT) and the Brazilian College of Radiology (CBR)(2018) TSUKAZAN, Maria Teresa Ruiz; TERRA, Ricardo Mingarini; DETTERBECK, Frank; SANTORO, Ilka Lopes; HOCHHEGGER, Bruno; MEIRELLES, Gustavo de Souza Portes; FORTUNATO, Gustavo; PRADO, Gustavo FaibischewBackground: Pulmonary nodules are common; some are inconsequential while others are malignant. Management of solitary pulmonary nodule (SPN) in Brazil appears to be highly variable, potentially leading to suboptimal outcomes. Assessment of the variability and the association with the degree of availability of resources can provide a foundation for development of clinical guidelines for management of SPN specific for the Brazilian setting. Methods: A web-based survey was developed by thoracic surgeons, pulmonologists and radiologists to evaluate SPN perception and management. This survey was sent to their respective national societies members and answers collected between August and December 2016. That included multiple choice questions regarding age, specialty, SPN management, accessibility to exams and interventional procedures characterizing public (SUS) and supplementary private working settings. Results: A total of 461 questionnaires were answered. More than half of participants live in cities with over one million people. Specialties were reasonable equilibrated with 43.5% radiologists, 33.5% thoracic surgeons, 20.3% pulmonologists and 2.6% others. Most of the respondents work in both public and private sector (72.7%). Private has a similar reality compared to well-developed nations regarding exams accessibility and interventions. SUS setting has a significant variability access according to the participants. CT is only easily available in 31.9% of cases, PET-CT is easily available in 24.4%, bronchoscopy is easily available for 42.8%, transthoracic needle biopsy is only easily available in 13.9% and video-assisted thoracoscopic surgery (VATS) biopsy is not available in 19.5%. When there is a probability of malignancy of 50% or higher, 46.5% of participants would be comfortable recommending surgical biopsy. When the probability is higher than 10%, only 36.9% would be comfortable following up radiologically. Conclusions: Brazil has a very different setting for public and private patients regarding exams accessibility and management options. That might explain why participants have a higher tendency to choose interventional diagnosis and explains why current guidelines may not be applicable to developing countries reality.
- Robotic lung resection: a narrative review of the current role on primary lung cancer treatment(2022) ROCHA JUNIOR, Eserval; TERRA, Ricardo MingariniBackground and Objective: Robotic-assisted thoracic surgery (RATS) has increasingly been applied to primary lung cancer treatment. Given the many facilities provided by the robotic platform in the manipulation of tissues and precision of movements, there is continuous enquiring about its contribution to the improvement of surgical outcomes. Also, the possibility to perform complex resections in a minimally invasive way using a robotic approach starts to become possible as the centers' learning curve expands. We propose to perform a review of the current status of robotic surgery for lung cancer focusing on key frontier points: sublobar resections, quality of lymphadenectomy, complex resections, postoperative outcomes, and innovative technologies to arrive. Methods: We performed a narrative review of the literature aggregating the most current references available in English. Key Content and Findings: According to the current data, the flourishing of the robotic platform seems to be in line with the spread of sublobar resections. The technological benefits inherent to the platform, also seem to promote an increase in the quality of lymphadenectomy and a shorter learning curve when compared to video-assisted thoracic surgery (VATS) with equivalent oncological results. Its application in complex resections such as bronchial sleeve already presents consistent results and new technology acquisitions such as three-dimensional reconstructions, augmented reality and artificial intelligence tend to be implemented collaborating with the digitization of surgery. Conclusions: Robotic surgery for lung cancer resection is at least equivalent to the VATS approach considering the currently available literature. However, more practice time and prospective clinical trials are needed to identify more exact benefits.
- Health-related quality of life evaluation in patients with non-surgical benign tracheal stenosis(2018) BIBAS, Benoit Jacques; CARDOSO, Paulo Francisco Guerreiro; SALATI, Michele; MINAMOTO, Helio; TAMAGNO, Mauro Federico Luiz; TERRA, Ricardo Mingarini; PEGO-FERNANDES, Paulo ManuelBackground: The primary objective of the study was to evaluate the health-related quality of life (HRQL) of patients with benign post-intubation tracheal stenosis considered as unfit for surgical treatment. Secondary objectives were: (I) to determine if clinical variables (gender, age, total treatment time, and type of tracheal device) could influence HRQL and (II) to compare the results with a normal standardized population. Methods: Prospective study between August-2014 and December-2016 including patients with tracheal stenosis treated with silicone stents, T-Tubes or tracheostomy. Candidates to airway resection and reconstruction were excluded from the analysis. HRQL was assessed with the SF-36 Health Questionnaire. Backward stepwise regression model analyzed the influence of clinical variables on the SF-36 domains and component summaries. Norm-based results were compared with normative data. Alpha error was 5%. Results: Ninety-three patients (62M/31F; mean age 38 +/- 14 years) were included. Mean overall HRQL in all 8 SF-36 domains was poor. Lowest scores were in the role physical (mean 31.7 +/- 38), bodily pain (mean 39.2 +/- 35), and role emotional domain (mean 48.7 +/- 40). The physical component summary (PCS) was more affected than the mental (P<0.001). Norm-based results indicated that most domains and both physical and mental summaries were below the mean for the USA normative population. ]btal stenting time significantly influenced the physical (P=0.001) and mental component summaries (P=0.001). Conclusions: Quality of life of patients with benign tracheal stenosis is severely impaired, and norm-based results indicate that the HRQL is below normative data. Physical and mental discomfort seems to be attenuated by total treatment time.
- Global status of the robotic thoracic surgery(2021) TERRA, Ricardo Mingarini; LEITE, Pedro Henrique Cunha; VEGA, Alberto Jorge Monteiro DelaRobotics has taken its place in thoracic surgery since the end of the 20th century. Since then, it has been developed worldwide with many different applications, such as the treatment of mediastinal tumors and lung cancer. Although, the contradictory results comparing this new technology to other minimally invasive techniques may raise some skepticism, the high quality of the instrument and images provided by the robot brings a whole new perspective for the thoracic surgeon, since the robotic platform can ally the ease of movement obtained with open technique with the advantages of the minimally invasive surgery. When it comes to the implementation of a robotic program the costs of RATS are an important issue. However, it is necessary to take into account not only the cost of the robotic platform itself but also the maintenance expenses, disposable tools, and training programs. Nevertheless, the cost of the robotic surgery is expected to decrease in the coming years and like the instrumentation, virtual reality will see improvements. Many different countries around the world have contributed with original articles for the development of the robotic thoracic surgery and in this paper, we aim at describing the global status of the robotic thoracic surgery.
- An adaptation of the Hungarian model: the Brazilian model(2018) TSUKAZAN, Maria Teresa Ruiz; TERRA, Ricardo Mingarini; BIBAS, Benoit Jacques; SALATI, MicheleThe Brazilian Society of Thoracic Surgery (BSTS) has the mission of improving patient care quality and thoracic surgery education. In order to achieve those goals, an overview of thoracic surgery activity in Brazil was necessary. BSTS had a clear need to start a national database. In 2015, BSTS joined European Society of Thoracic Surgeons (ESTS) Database platform. This partnership was a great choice not only for having a consolidated database, but also for allowing the development of shared educational and scientific projects. The strategy for BSTS database project was selecting committed group of surgeons, establishing implementation phases and setting milestones.
- Practice patterns and trends in surgical treatment for chronic lung infections: a survey from the Brazilian Society of Thoracic Surgery(2023) MARIANI, Alessandro Wasum; D'AMBROSIO, Paula Duarte; ROCHA JUNIOR, Eserval; NETO, Antero Gomes; FORTUNATO, Sergio Tadeu Lima; TERRA, Ricardo Mingarini; PEGO-FERNANDES, Paulo ManuelBackground: Chronic lung infections represent a diversity of clinical entities that combined respond to significant public health, particularly in developing countries. However, there is no data regarding the practice patterns, surgeons' preferences, and technological usage, especially among Brazilian surgeons, in the setting of the surgical treatment of chronic lung infections. We, therefore, surveyed Brazilian thoracic surgeons from the Brazilian Society of Thoracic Surgery (SBCT) about practice patterns and trends in surgical treatment for chronic lung infections. Methods: A cross-sectional anonymous survey of all thoracic surgeons from the Brazilian Society was conducted in 2019. As the study was purely descriptive no further statistical evaluation was performed. Results: The responsive rate was 34% (259/766) from 23 of the 26 states in Brazil. A total of 141 (54.4%) participants reported their institution as a surgical reference for chronic infection lung disease, only 13.1% of surgeons have a high-volume service (more than 11 cases operated annually). The majority (76.2%) of respondents performed 1-5 surgical resection to treat tuberculosis (TB) sequelae, but only 62 (30.1%) had performed more than one resection to treat active TB. Chronic lung infection (76%) and hemoptysis (66%) were the most common symptoms as surgical indications. A proportion of 42.2% of the respondents do not have and/or perform routine drug sensitivity tests. In addition, 19.3% of respondents were not familiar with the recommendations of surgery in the treatment of pulmonary TB. Video-assisted thoracoscopic surgery (VATS) is available for 80% of respondents, while robotic surgery is for only 10%. Most (86%) surgeons have access to surgical staplers. Among the structural resources, respiratory isolation beds in the intensive care unit (ICU) (80%) and ward (79%) are frequently available resources. However, less than 12% of surgeons have in their institution a specific operating room for sputum-positive patients. Conclusions: Lung resection for chronic infectious disease is an essential area of activity for thoracic surgeons in Brazil, which occurs mainly in the public sphere, with no concentration of cases per surgeon or institution. The lack of adequate resources in many centers justifies the creation of reference centers for improving care for these patients.