CURRICULUM VITAE ET STUDIORUM ALBERTO AREZZO

Profile

General Surgeon and Digestive Endoscopist for operative procedures, with an academic role, mainly dedicated to clinical and research activities, deeply involved in numerous projects sponsored by the European Commission, the National Ministry of Health, the Ministry of the National University, Foundations and private companies.

PERSONAL DATA

Arezzo, Alberto, CF RZZLRT68M09D969Z

male, born on 08.09.1968 in Genoa, Italian

Professional address: Department of Surgical Sciences, University of Turin, Corso A.M.Dogliotti 14, 10126 Turin, Italy, tel +39 011 6336641, alberto.arezzo@unito.it

Written and spoken languages: English, German, French, Italian

2. CURRENT POSITION

Distinguished Professor of Surgery at the 1st General Surgery Unit, Department of Surgical Sciences, University of Turin since October 1st, 2024, by direct call according to Law 2005/230 and amendments.

He dedicates 10% of his working time to teaching, 40% to research, 50% to clinical.

3. TRAINING & EDUCATION / DIPLOMAS

1981-1986 Diploma in classical studies (Baccalaureate) at Liceo Classico A.D’Oria, Genoa 1986-1992: Faculty of Medicine (6 years), University of Genoa, Italy.

19.10.1992, Degree in Medicine and Surgery, University of Genoa, Italy, 110/110 cum laude.

1992-1997: School of General Surgery (5 years), University of Genoa, Italy and University of Tuebingen, Germany.

10.27.1997, Certificate of Specialisation in General Surgery, University of Genoa, Italy and University of Tuebingen, Germany, 50/50 with honours, discussing the thesis “Robotics and positioning systems for laparoscopic surgery”, supervisor Prof. Gerhard Buess, University of Tuebingen.

4. CLINICAL PROFESSIONAL ROLES

1.11.1997-30.06.1999: Research Fellow in Surgery, University of Tuebingen, Germany

Research Fellow at the Minimally Invasive Surgery Section of the Eberhart Karls University of Tuebingen, Germany, Director Prof. Med. Gerhard Buess, pioneer of endoscopic surgery. There he learned laparoscopic techniques and was trained in transanal endoscopic microsurgery directly by the inventor as a mentor. Tuebingen also represented a unique environment to be introduced to high-level international research activity, mainly in the field of new technology development. Here he learned to write a scientific article, producing a substantial number of relevant articles in international journals in just a few years

30.06.1999 – 19.01.2004  – Level 1 Medical Director – Surgery, ASL 1 Liguria

where he consolidated his experience in endoscopic surgery, including emergency surgery, and founded a Digestive Endoscopy Service, training colleagues and nurses.

20.01.2004 – 31.10.2007 – Level 1 Medical Director – Surgery, International Evangelic Hospital, Genoa

where he led the Endoscopic Surgery department, dedicating himself mainly to digestive surgery (stomach, colon, rectum) and participated in the activity of the Digestive Endoscopy Service, mainly carrying out operative procedures.

1.11.2007 – 30.09.2014  – Assistant Professor of Surgery, University of Turin.

at the Department of Surgical Sciences, directed by Prof. Mario Morino, pioneer of endoscopic surgery, covering a special role for Endoscopic Surgery, dedicating himself mainly to digestive surgery (stomach, colon, rectum including transanal endoscopic microsurgery and combined techniques) including emergencies and participated in the activity of the Digestive Endoscopy Service, mainly carrying out operative procedures.

1.10.2014 – 30.09.2024  – Associate Professor, General Surgery, University of Turin by direct call according to Law 2010/240 and amendments.

at the same Department of Surgical Sciences, progressively covering roles of greater responsibility. Since March 2019 he has been responsible for the General Surgery Department I/Dogliotti (Director Prof. M.Morino).

10.1.2024 – today – Distinguished Professor, General Surgery, University of Turin by direct call according to Law 2005/230 and amendments at the same Department of Surgical Sciences, progressively covering roles of greater responsibility. Since March 2019 he has been responsible for the General Surgery Department 1U Dogliotti (Director Prof. M.Morino)

To date, he has performed more than ten thousand operations, mainly colorectal, open, laparoscopic and transanal surgery, including emergencies. He is considered an expert in the field of colorectal surgery and transanal endoscopic microsurgery.

5. ACADEMIC ROLES AND TEACHINGS

1997 – 1999 – Researcher in Surgery, University of Tuebingen, Germany

where he worked as a Teacher and Tutor of the Advanced Laparoscopic Surgery and Transanal Endoscopic Microsurgery courses at the Training Center, Director Prof. Gerhard Buess.

2007 – today – Researcher, then Associate Professor and now Distinguished Professor of Surgery, General Surgery, University of Turin where, at the Department of Surgical Sciences, he holds the following courses in 6 different Master’s / Bachelor’s degree courses:

• General Surgery (SCB0229) in english
  MedInTO Medicine and Surgery – University of Turin – Orbassano
• Medical-surgical emergencies (channel A) (SME0739)
  Master’s Degree in Medicine and Surgery – University of Turin – Turin
• Endocrine, Metabolic and Gastroenteric Diseases – Module of General Surgery (SCB0211) in english
  MedInTO Medicine and Surgery – University of Turin – Orbassano
• Clinical methodology – Module of Surgery (SCB0426) in english
  MedInTO Medicine and Surgery – University of Turin – Orbassano
• BIOTECHNOLOGIES APPLIED TO SURGERY (SME0904)
  Master’s Degree in Medicine and Surgery – Class LM-9 – University of Turin – Turin
• General surgery insights (MED2898D)
  Master’s Degree Course in Diagnostic Technical Health Professions Sciences
• RESEARCH 2 (Search implementation) (MED2898)
  Master’s Degree Course in Diagnostic Technical Health Professions Sciences
• General surgery – D.M. 270/04 – (Channel A) (SSP0399C)
  Degree Course in Nursing – A.O.U. City of Health and Science of Turin
• Clinical nursing in the surgical area (Channel A) – D.M. 270/04 – (SSP0399)
  Degree Course in Nursing – A.O.U. City of Health and Science of Turin
• Clinical Nursing in the Surgical Area – Channel A (MSL0265)
  Degree course in Nursing – University of Turin – Orbassano
• INTERNSHIP in MINI-INVASIVE THERAPY AND TECHNOLOGICAL INNOVATION (SME0919)
  Master’s Degree Course in Medical Biotechnology – Class LM-9

At the Doctorate Course in Bioengineering and Medical-Surgical Sciences, in collaboration with the University of Turin and the Polytechnic of Turin, he holds the Doctorate Courses

• Principles, materials and applications of robotics in biomedicine (1). (01RHCRR) in english
• Principles, materials and applications of robotics in biomedicine (2). (01GPKRR) in english
• Planning, management and analysis of clinical and laboratory research (01QZURR) in english

He was elected next Coordinator of the Doctorate Course in Bioengineering and Medical-Surgical Sciences, in collaboration with the University of TURIN and the Polytechnic of Turin.

Over the years he has been part of the following Doctoral Boards:

• ROBOTICS AND COMPUTER INNOVATIONS APPLIED TO SURGICAL SCIENCES, 2008/2010 (25 and 26 cycle), Università degli Studi di ROMA “Tor Vergata”
• BIOTECHNOLOGICAL INNOVATIONS AND TECHNIQUES APPLIED TO SURGICAL SCIENCES, 2010/2011 (27 cycle), Università degli Studi di ROMA “Tor Vergata”
• BIOTECHNOLOGICAL INNOVATIONS AND TECHNIQUES APPLIED TO SURGICAL, NUTRITIONAL AND FORENSIC SCIENCES 2011/2012 (28 cycle), Università degli Studi di ROMA “Tor Vergata”
• DOCTORATE IN TECHNOLOGIES APPLIED TO SURGICAL SCIENCES, 2012/2013 (29. cycle), Università degli Studi di TORINO
• BIOENGINEERING AND MEDICAL-SURGICAL SCIENCES, 2013/2019 (30, 31, 32, 33, 34, 35. cycle), Politecnico di TORINO / Università degli Studi di TORINO
• BIOMEDICAL AND BIOTECHNOLOGICAL SCIENCES, 2019/2021 (36 e 37. cycle), Università degli Studi di FERRARA
• MEDICAL, OMICS AND ONCOLOGY SCIENCES, 2022/2023 (38 e 39. cycle), Università degli Studi di FERRARA

He holds the following courses in various Schools of Specialisation at the University of Turin:

• Scientific English, School of Specialisation in General Surgery
• Operative Digestive Endoscopy 1, School of Specialisation in General Surgery
• Operative Digestive Endoscopy 2, School of Specialisation in General Surgery
• General Surgery, School of Specialisation in Pathological Anatomy
• General Surgery, School of Specialisation in Maxillofacial Surgery
• General Surgery, School of Specialisation in Neurosurgery
• General Surgery, School of Specialisation in Vascular Surgery
• General Surgery, School of Specialisation in Nuclear Medicine

He was Director, Scientific Coordinator, Teacher and Tutor of the following Level I and II Masters at the University of TURIN:

• Teacher and Tutor of the Level II University Master in Advanced Laparoscopy for Doctors
• Director, Teacher and Tutor of the Level II University Master in Operative Digestive Endoscopy for Doctors
• Coordinator, Teacher and Tutor of the Level I University Master’s Degree in Digestive Endoscopy for nurses

Since 1.11.07 he has been qualified as Assistant Professor of Surgery.

Since 1.11.08 he has been qualified as Aggregate Professor of Surgery.

Since 1.10.14 he has been qualified as Associate Professor of Surgery.

Since 1.10.24 he has been qualified as Distinguished Professor of Surgery.

6. ADMINISTRATIVE ROLES AND ACADEMIC BODIES

• since 2018 Coordinates the activities of the laboratory of the Minimally Invasive Therapy and Innovation Center (MITIC) at the Department of Surgical Sciences of the University of TURIN.
• elected next (40th cycle) Coordinator of the Doctorate Course in BIOENGINEERING AND MEDICAL-SURGICAL SCIENCES, in collaboration with the University of TURIN and the Polytechnic of Turin.
• until the 29th cycle Vice-Coordinator of the local Doctorate Course in TECHNOLOGIES APPLIED TO SURGICAL SCIENCES
• then until the 35th cycle Vice-Coordinator of the local Doctorate Course in BIOENGINEERING AND MEDICAL-SURGICAL SCIENCES
• until 2020 Director of the Local University Master’s Degree in Operative Digestive Endoscopy for Doctors.
• until 2020 Scientific Coordinator of the local Level I University Master’s Degree in Digestive Endoscopy for nurses.
• Member of the Teaching/Scientific Committee for the MD/PhD program of the students of the local School of Medicine
• Member of the Council of the local Department of Surgical Sciences
• Member of the Research Commission of the local Department of Surgical Sciences

7. POSITIONS AND AWARDS IN SCIENTIFIC SOCIETIES

• He is currently a member of
• EAES, European Association for Endoscopic Surgery
• iSMIT, International Society for Medical Innovation and Technology
• ESCP, European Society for ColoProctology
• SICE, Italian Society of Endoscopic Surgery
• SICCR, Italian Society of Colorectal Surgery
• UEG, United European Gastroenterology
• ESGE, European Society for Gastrointestinal Endoscopy
• ASGE, American Society for Gastrointestinal Endoscopy
• ECTA, Eurasian Colorectal Technology Association
• SIED, Italian Society of Digestive Endoscopy

He holds or has held the following official elective roles within them

• elected General Secretary of EAES, European Association for Endoscopic Surgery (2021-2023 and renewed 2023-2025)
• elected Chairman of the Technology Committee of EAES, European Association for Endoscopic Surgery (2017-2021)
• member of the Program Committee of the EAES, European Association for Endoscopic Surgery (2020-2023)
• elected Vice-President of SICE, Italian Society of Endoscopic Surgery (2017-2019)
• elected General Secretary of SICE, Italian Society of Endoscopic Surgery (2019-2021)
• elected President of iSMIT, International Society for Medical Innovation and Technology (2017-2018)
• member of the Board of iSMIT, International Society for Medical Innovation and Technology (2005- )
• member of the UEG e-learning Task Force (2012-2014)
• member of the UEG Future Trends Committee (2014-2017)
• member of the UEG Scientific Committee (2017-2022)
• Coordinator of the EURO NOTES Clinical Registry (www.euronotes.world.it)

He has obtained the following recognitions from international societies

• 2017 Certificate of Appreciation from the Korean Society for Endoscopic and Laparoscopic Surgery (KSELS)
• 2017 Diploma of Excellence of the Romanian Association of Endoscopic Surgery (ARCE)
• 2019 Korean Society for Endoscopic and Laparoscopic Surgery (KSELS) Plaque of Appreciation
• 2022 Taiwan Society for Surgery (TSS) Certificate of Appreciation
• 2022 Honorary Member of the Romanian Association of Endoscopic Surgery (ARCE)

8. OFFICES AND RECOGNITIONS OF INTERNATIONAL UNIVERSITIES

March 2024 appointed Visiting Professor at St. Marks’ Hospital, Imperial College London (UK).

July 2024 appointed Visiting Professor at Lankenau Medical Centre, Colorectal Cancer Department, Philadelphia (USA).

9. ORGANIZATION OF COURSES AND CONFERENCES

He participated in the organisation of the following national and international conferences:

• 2021 Annual World Congress for Endoscopic Surgery (WCES) and EAES, Barcelona, Spain
• 2020-21-22-23-24 Annual Congress European Association for Endoscopic Surgery (EAES)
• 2019-20-21-22 United European Gastroenterology Week 2019, 2020, 2021, 2022
• 2019 – NEXT – Novelties in Endoscopy 4 Therapy, Turin, Italy
• 2018-19-20-21 Wintermeeting European Association for Endoscopic Surgery (EAES)
• 2017 XXIX Congress Society for Medical Innovation and Technology (SMIT), Turin, Italy
• 2013 113th National Congress of the Italian Society for Surgery (SIC), Turin, Italy
• 2011 Annual Congress European Association for Endoscopic Surgery (EAES), Turin, Italy

10. KEYNOTE LECTURES AT COURSES AND CONFERENCES

• The Road Ahead for Endoluminal Surgery, Annual Congress Spanish Society for Surgery, Madrid, 2024
• Autonomous flexible surgical robots, The Hamlyn Symposium on Medical Robotics, London, 2023 e 2024
• The Unmet medical needs for endoluminal robots, The Hamlyn Symposium on Medical Robotics, London, 2023 e 2024
• The Road Ahead for Endoluminal Surgery, ARCE Romanian Association for Endoscopic Surgery Congress, Timisoara, 2022
• Flexible endoscopy going forward – A new flexible robotic platform, 30th European Association for Surgical Endoscopy EAES Congress, 2022
• The Road Ahead for Endoluminal ColoRectal Surgery, Meeting Taiwan Surgical Association 2022
• Flexible robots for intraluminal surgery, Wintermeeting European Association for Surgical Endoscopy EAES, 2022
• Endoluminal Robotics. The Future of MIS, AIS Channel online, 2021
• Transanal Surgery in Early Rectal Cancer, Russian School of Colorectal Surgery, Moskow, 2021
• The Road Ahead for Endoluminal Intervention, IEEE International Conference on Robotics and Automation (ICRA) Congress, online, 2021
• AI for Gastrointestinal Endoscopy and Surgery – Current State and Future, UEG Webinar, 2021
• The Road Ahead for Endoluminal Intervention, iSMIT Society for Medical Innovation and Technology Congress, online, 2020
• Application of Robotics in GI Endoscopy ‒ 3rd space, University of Zagreb, 2019
• Which is the Role of Surgical Transanal Endoscopic Microsurgery, AIMS, Milan, 2019
• Large Polyps, Surgery is Needed!, United European Gastroenterology Week (UEGW), Barcelona, 2019
• The Road Ahead for Endoluminal Intervention, Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), Baltimore, 2019
• Micro-Robots and New Technologies in Colorectal Surgery, European Colorectal Congress, St Gallen (SWI), 2018
• The Road Ahead for Endoluminal Intervention, iSMIT Society for Medical Innovation and Technology Congress, Seoul (KR), 2018
• Transanal Endoscopic Microsurgery: The New Standard, Annual Congress Italian Society Surgery (SIC), 2018
• The Road Ahead for Endoluminal Intervention, CRAS – New Technologies for Computer and Robot Assisted Surgery, London, 2018
• The Road Ahead Endoluminal Intervention, The Hamlyn Symposium Medical Robotics, London, 2018
• New Technologies in Rectal Cancer Surgery, International Coloproctology Meeting, Turin, 2018
• The flexible endoscope as a tool for colorectal surgery Technology Symposium, 21st European Association for Surgical Endoscopy EAES Congress, 2013
• Surgical Robotics Practice. Evaluating Effectiveness and Acceptance of Robots in Surgery, IEEE International Conference on Robotics and Automation (ICRA) Annual Congress, 2013
• Systematic Review and Meta-analysis of Endoscopic Submucosal Dissection vs. Transanal Endoscopic Microsurgery for Non-invasive Large Rectal Lesions, 20th European Surgical Association ESA Congress, 2013
• Sir Alfred Cuschieri Lecture “Innovative flexible endoscopy: a tool for surgeons again”, 20th European Association for Surgical Endoscopy EAES Congress, 2012

11. PRIZES AND AWARDS

During his career he has received the following awards from national and international institutions:

• 1991 Scholarship from the Italian Secretariat of Medical Students (SISM) for a period of 4 weeks at the Surgical Clinic of Uppsala University (Sweden), Director Prof. G. Svenson
• 1992 Scholarship from the Italian Secretariat of Medical Students (SISM) for a period of 4 weeks at the Surgical Clinic of the University of Helsinki (Finland), Director Prof. J Ahonen
• 1993 “Ettore Ruggeri” scholarship awarded by the board of directors of the Italian Society of Surgery (SIC) on the occasion of the 95th Congress of the Society, Milan, October 1993
• 1996 Scholarship awarded by the Deutscher Akademischer Austausch Dienst (German Academic Exchange Service) aimed at the research project on the topic of “Solo Surgery”, at the Minimally Invasive Surgery Section of the University of Tuebingen, Germany, Dir. Prof. G.F.Buess
• 1998 Karl Storz E.A.E.S. Prize awarded by the Board of Directors of the European Association of Endoscopic Surgery (E.A.E.S.) for the work “Experimental trial on Solo Surgery, Comparison of different positioning systems”, presented in the Karl Storz E.A.E.S. session. Awards, on the occasion of the VI Congress of the Society held in Rome in June 1998
• 1999 City of Sanremo Award, for the work “Full thickness endoluminal resection using flexible endoscopy. Technical study on 13 cases”, assigned by the scientific committee as the best work presented during the meeting of the Italian Society of Coloproctology (SICCR), held in Sanremo (IM), 20 and 21 May 1999.
• 1999 Research grant, for one year, at the Section of Minimally Invasive Surgery of the University of Tuebingen, Germany, Director Prof. G.F. Buess, for a research project on minimally invasive robotic surgery, sponsored by the Karl Storz Endoskope
• 1999 “Paride Stefanini” Award, for the video “Shadow optics. An endoscope with optimised lighting”, awarded by the jury as the best video presented during the V National Congress of the Italian Society of Endoscopic Surgery, held in Turin on 19-21 September 1999.
• 2011 Gerhard Buess Award – Best Technology Presentation of the EAES, European Association for Endoscopic Surgery.
• 2012 Gerhard Buess Award – Best Technology Presentation of the EAES, European Association for Endoscopic Surgery.
• 2012 Olympus EAES Award – Best Video presentation of the EAES, European Association for Endoscopic Surgery.
• 2012 MADE in RESEARCH Award, from the University of Turin 2i3T Incubator
• 2012 Life Sciences Award – Italian Venture Capitalist FORUM, held in Turin
• 2013 STARTUP Company Challenge Award Piedmont, Italy (15,000 euros)

12. ROLES IN SCIENTIFIC JOURNALS

He is currently Editor in Chief of Minimally Invasive Therapy and Allied Technologies (MITAT), Taylor & Francis Ed., the official journal of iSMIT.

He was Assistant Editor and then Associate Editor of the Journal Techniques in Coloproctology, Springer Verlag Ed., the official journal of ECTA and SICCR, till 31.12.2023.

He was a member of the editorial board of Surgical Endoscopy, Springer Verlag Ed., the official journal of SAGES & EAES.

He was a member of the editorial board of the UEG Journal, SAGE Ed., the official magazine of the UEG.

He is a member of the editorial board of the World Journal of Gastrointestinal Surgery

He is a reviewer of the magazines:

• Annals of Surgery
• British Journal of Surgery
• Surgical Endoscopy
• Techniques in Coloproctology
• Minimally Invasive Therapy and Allied Technologies (MITAT)
• Colorectal Disease
• Gastrointestinal Endoscopy
• Endoscopy

13. REGISTERED PROSPECTIVE CLINICAL TRIALS

• from 1.01.08 to 1.11.15 Coordinator of the ESCO – Enteral Stents for Colonic Obstruction study (multicentre, prospective, randomized, controlled study on the use of the stent for neoplastic occlusion of the left colon as a “bridge to surgery” vs. emergency surgery ), international multicentre randomised and controlled study sponsored by EAES, European Association for Endoscopic Surgery, with P.I. Prof. Mario Morino. NCT00591695
• from 1.06.11 to 1.01.14 Coordinator of the NERATEM study – NEOADJUVANT SHORT-COURSE RADIOTHERAPY FOLLOWED BY TRANSANAL ENDOSCOPIC MICROSURGERY FOR T1-T2 N0 EXTRAPERITONEAL RECTAL CANCER (monometric, prospective study for “early” rectal tumours treated with short-course CRT and subsequent local excision), with as P.I. Prof. Mario Morino.
• from 1.01.12 to 31.12.19 Coordinator of the TEMENDO study – Transanal Endoscopic Microsurgery Versus Endoscopic Submucosal Dissection For Large Rectal Adenomas (multicentre, prospective, controlled study on the use of TEM – Transanal Endoscopic Microsurgery vs. ESD – Endoscopic Submucosal Dissection), multicentre international randomised and controlled study sponsored by the EAES, European Association for Endoscopic Surgery, with as P.I. Prof. Mario Morino. NCT01023984
• from 1.2.17 to 31.1.20 he participated in the Intracorporeal or Extracorporeal Anastomosis After Laparoscopic Right Colectomy study (multicentre, prospective, randomised, controlled study on the type of anastomosis after laparoscopic right hemicolectomy), an international multicenter randomised and controlled study, with as P.I. Prof. Mario Morino. NCT03045107
• from 1.6.19 to 1.6.20 Coordinator of the COLORAL1 study (multicentre, prospective, randomised, controlled study on preoperative oral antibiotic prophylaxis in colorectal surgery), international multicentre randomised and controlled study sponsored by the Italian Society of Endoscopic Surgery SICE and the EAES, European Association for Endoscopic Surgery, with as P.I. Prof. Mario Morino. NCT04438655
• since 1.5.22 he has participated in the CLASSICA 1 study: Validating AI in Classifying Cancer in Real-Time Surgery Study 1 (multicentre, prospective study on the use of Artificial Intelligence and Fluorescence to typify sessile lesions of the rectum before transanal endoscopic surgery – TEM) , international multicentre, with as P.I. Prof. Ronan Cahill. NCT05793554

14. FUNDING (GRANTS) FOR RESEARCH ACTIVITIES

• 1996 Scholarship from the Deutscher Akademischer Austausch Dienst (DAAD) (1.5.96 – 31.10.96) for a 6-month project in robotic surgery, at the University of Tuebingen
• 1999 Research grant from the Karl Storz Endoskope, for a study on robotic surgery using the FIPS & TISKA prototypes for positioning laparoscopic instruments (1.12.98 – 30.11.99) (DM 48,000)
• 2010 Research Grant from the EURO NOTES Foundation (1.10.10 – 30.09.12) (EUR 20,000) for the study “A pilot study on a new anchoring mechanism for surgical applications based on mucoadhesives”
• 2010 Research Grant from EAES, European Association for Endoscopic Surgery (1.10.11 – 30.09.14) (EUR 50,000) for the study “MUSIC, Multi-port versus Single-port Colecystectomy”
• Finalised Research 2011/12 of the Ministry of Health for the study “Treatment with GLP-1 agonists vs. endoscopic procedures in the management of obesity and type II diabetes mellitus: a randomised clinical trial” (1.10.14 – 30.09.17) (EUR 253,000)
• 2013 Finalised Research of the Ministry of Health for the study “Preclinical development and validation of an endoscopic robot with soft wire to replace colonoscopy” (1.12.16 – 30.11.19) (EUR 274,000)
• from 1.12.01 to 30.11.03 local Principal Investigator of an international consortium for a Research Project called CLEANTEST on Cleaning, sterilisation and design of instruments for endoscopic surgery sponsored by the European Community in the context of the V TMR (FP5) (EUR 365,000) representing the Saint Charles Hospital in Bordighera (IM)
• from 1.09.06 to 31.08.11 partner of an international consortium for a Research Project called VECTOR on the development of a robotic capsule for GI endoscopy sponsored by the European Community, sponsored by the European Community within the VI TMR (FP6) for a total of EUR 9,000,000 of contribution representing iSMIT, International Society for Medical Innovation and Technology.
• from 1.1.12 to 31.12.15 local Principal Investigator of an international consortium for a Research Project called STIFF-FLOP on the Flexible and Learnable Manipulator STIFFness controllable for surgical operations sponsored by the European Community within the VII TMR (FP7), as as scientific director both for the University of Turin and for the EAES, European Association for Endoscopic Surgery, for a total contribution of EUR 7,350,000.
• from 1.12.15 to 31.05.19 local Principal Investigator of an international consortium for a Research Project called EndoVESPA (Endoscopic Versatile robotic guidance, diagnosis and theraPy of magnetic-driven soft-tethered endoluminAl robots), later renamed ENDOO, sponsored by the European Community within the HORIZON 2020 Framework, as scientific director of the University of Turin, for a total contribution of 4,350,000 euros.
• author of the “Departments of Excellence” Project 2018-2022 on Robotic Surgery, assigned by the Ministry of the University to the Department of Surgical Sciences of the University of Turin, for 8,700,000 euros.
• from 1.01.20 to 31.12.21 PI and Coordinator of the ENDOLUMINAIRE-C (Endoluminal Integrated Resection Robot Embedded in the Colon) Ex-Post 2019 Project, sponsored by the San Paolo Foundation and the University of Turin, for a contribution of EUR 75,000
• from 1.04.21 to 31.03.22 Coordinator of the Proof-of-Concept study on RED – Robot for Endoscopic Dissection sponsored by the University of Turin, with P.I. Prof. Mario Morino for a contribution of EUR 40,000.
• from 1.01.22 to 31.12.23 PI and Coordinator of the ENDOLUMINAIRE-C Project (Intelligent Multi-modal Sensorised Eversion Robot for One-shot Painless Screening Colonoscopy and Early Colorectal Cancer Semi-autonomous Microsurgery) Ex-Post 2021, sponsored by the San Paolo Foundation and University of Turin, for a contribution of EUR 50,000
• from 1.5.2022 to 30.4.2026 partner of an international consortium for a Research Project called CLASSICA (VALIDATING AI IN CLASSIFYING CANCER IN REAL-TIME SURGERY), sponsored by the European Community within HORIZON EUROPE, as scientific director at the the University of Turin and the European Association of Endoscopic Surgery (EAES), for a total contribution of approximately EUR 6,000,000
• from 1.1.23 to 31.12.26 partner of an international consortium for a Research Project called PALPABLE on the development of a Multi-sensing instrument for Minimally Invasive Surgery sponsored by the European Community within HORIZON EUROPE, as scientific director of the University of Turin, for a total contribution of approximately EUR 4,000,000.
• from 23.05.23 to 25.04.25 P.I and Coordinator of the TRAPEZIO TI-RED Project (Towards Intelligent Robotic Endoscopic Dissection) on ENDOLUMINAIRE-C (Sensorised Eversion Robot for One-shot Painless Screening Colonoscopy and Early Colorectal Cancer Semi-autonomous Microsurgery), sponsored from the San Paolo Turin Foundation, for a contribution of EUR 110,000
• from 1.10.23 to 30.09.25 P.I. and Coordinator of the PRIN Proof-of-Concept project on TIRED – Towards Intelligent Robot for Endoscopic Dissection sponsored by the Ministry of the University for a contribution of EUR 250,000, in collaboration with Prof Bruno Siciliano, Federico II University of Naples.
• from 01.03.2024 to 28.02.2026 PI and Coordinator of the LIFTT Proof of Concept Project for RED – Robot for Endoscopic Dissection, a miniaturised robotic device applicable to a flexible endoscope for the surgical dissection of superficial neoplasms of the gastrointestinal tract, sponsored by the Foundation San Paolo Turin, for a contribution of EUR 100,000
• from 01.07.2024 to 30.06.2030 P.I. and corresponding of the ERC Synergy Grant (ERC SyG-2023) in the HORIZON EUROPE (ENDOTHERANOSTICS) framework for Multi-sensor Eversion Robot Towards Intelligent Endoscopic Diagnosis and Therapy, consortium including Prof. Kaspar Althoefer (Centre for Advanced Robotics @ Queen Mary (ARQ), Faculty of Science and Engineering, Queen Mary University of London (QMUL) United Kingdom, Prof. Sebastien Ourselin, Dean, School of Biomedical Engineering and Imaging Sciences and Director of the Wellcome/EPSRC Center for Medical Engineering and Deputy Director of London Medical Imaging and Artificial Intelligence Center for Value Based Healthcare, Faculty of Engineering King’s College London (KCL) United Kingdom and Prof. Bruno Siciliano, C.R.E.A.T.E. (CREATE) IT Research Consortium, funded with EUR 10,000,000.
• from 01.01.2025 to 31.12.2028 partner of an international consortium for a Research Project called TENTACLE on the development of a InnovaTivE in situ 4D biopriNTing for regenerAtion of CoLorEctal mucosa and submucosa sponsored by the European Community within HORIZON EUROPE, as scientific director of the University of Turin, for a total contribution of approximately EUR 8,000,000.
• from 01.04.2025 to 31.03.2028 partner of an international consortium for a Research Project called DAEDALUS on the development of a ADvAnced 4D biomAteriaLs for mucosa and sub-mUcosa treatment in patients affected by intestinal diseases sponsored by the European Community within HORIZON EUROPE, as scientific director of the University of Turin, for a total contribution of approximately EUR 8,000,000.

In total he has obtained funding of EUR 67 million,

of which more than EUR 17 million for his own institution.


15. RESEARCH ACTIVITY

15.1 Laparoscopic Robotic Surgery

In 1997 I defended a thesis on robotics and positioning systems for endoscopic surgery at the University of Tuebingen, at the end of the technological development of several prototypes in collaboration with the Nuclear Research Center of Karlsruhe (Germany) called ARTEMIS (7 DoF robot manipulator ), FIPS^[1] (4 DoF remote-controlled optical positioning system) and TISKA^[2] (4 DoF passive retractor positioning system) later acquired by Karl Storz Endoskope (Tuttlingen) for further development and commercialisation. He conducted comparative studies with alternatives available at the time, such as AESOP (Computer Motion, Goleta, CA, USA) and EndoAssista (Armstrong Healthcare, UK), supplied to the Laboratory of the Section for Minimally Invasive Surgery of the University of Tuebingen, where he worked under the guidance of Prof. Gerhard Buess. This resulted in a series of conference papers and publications^[3]. The development continued with the development of a simpler alternative system, so-called Tuebingen Ball-Trocar, later acquired by Braun Aesculap (Tuttlingen, Germany) and marketed as ENDOFREEZE^[4], purely mechanical.

The robotic surgery project continued with the development of a laparoscopic optic positioning system, called EPOS, in collaboration with the National Forschung Zentrum Karlsruhe and the company Innomedic (Karlsruhe, Germany).

In 2012, thanks to funding from the European Community within the VII TMR (FP7) of the     STIFF-FLOP^[5] project (STIFFness controllable Flexible and Learn-able manipulator for surgical OPerations), the conception and creation of the first soft robot and flexible for laparoscopic surgery. The development of the technology presents more than one problem as it is truly innovative, but it represents the beginning of a new era in the field of robotics for surgery. The tests continue throughout the 4 years of the project until the final validation on a human cadaver model on 12.10.2015 in Dundee (UK), in the presence of Sir Alfred Cuschieri, pioneer of laparoscopic techniques.

In 2018, thanks to the funding deriving from the “Departments of Excellence” Project 2018-2022 on Robotic Surgery, assigned by the Ministry of the University to the Department of Surgical Sciences of the University of Turin, as well as the support of the company Intuitive Surgical (Seattle, USA) which provided us with a da Vinci Research Kit (dVRK) system, research in this area has resumed. The dVRK system has been equipped with freeware software from Johns Hopkins University with related controllers, and is routinely used as hardware for the development of control and automation software. Several robotic systems have been acquired for the MITIC Laboratory. First of all, a Flex Robot system^[6][7][8] (Medrobotics, USA) was acquired, the first flexible endoscopic robot for endoluminal surgery, which was used in approximately 30 surgical procedures in the operating room, significantly contributing to the improvement of the system on the market, as well as to the development of a longer system always for transanal applications, and a thinner one for applications for the upper digestive tract, transoral endogastric. Then a prototype of the Precision system^[9] (Precision Robotics, London & Hong Kong) for transanal and single-port laparoscopic surgery was acquired. The system is based on two arms with an innovative 9 DoF design, with a continuum robots structure. The system is still being optimised in the laboratory, in close collaboration with the company that chose our center for development consultancy, before being taken to the operating room for transanal surgery applications. The system will therefore shortly acquire the CE mark, followed by clinical trials in the operating room. Finally, the laboratory is equipped with 2 KUKA LBR Med 14 R820 which are used as a basis for the development of new effectors, as they are also programmable via software.

15.2 Endoluminal and Transluminal Robotic Surgery

In parallel to this, the research on surgical robots has focused on miniaturised robots for endoluminal applications, i.e. a miniature robotic device applicable to a flexible endoscope for the surgical dissection of superficial tumours of the gastro-intestinal tract. In 2013, the RED patent “A miniature robotic device applicable to a flexible endoscope for the surgical dissection of gastro-intestinal tract surface neoplasms (WO 2014147556 A1)” was presented. The system, designed together with the group of Prof Paolo Dario, director of the CRIM Lab of the Scuola di Studi Superiori Sant’Anna di Pisa (SSSA) – Pontedera campus, envisaged in the first version the creation of a cap to be positioned on the tip of a standard endoscope, equipped with two robotic arms with 3 DoF each, moved by piezoelectric micromotors. The prototype was extensively tested in the laboratory until reaching the conclusion that the 3 DoF are absolutely sufficient to represent a significant aid in dissection techniques, but the motorised mechanical structure represents an obstacle due to poor dexterity and the piezoelectric motors have sufficient power to exercise law enforcement of 1.5 N necessary, but have extremely limited duration. Again with SSSA we have therefore moved, thanks to the Proof-of-Concept RED (RED 2.0) – Robot for Endoscopic Dissection funding sponsored by the University of Turin, to a different design, based on soft-robotics technology, i.e. insufflatable tubular structures , capable of changing shape based on internal pressures, thus guaranteeing the 3 DoF of the first version.

I have recently received three grants for this project, one LIFTT Proof of Concept for RED – Robot for Endoscopic Dissection, sponsored by the San Paolo Turin Foundation to build an “advanced” prototype that can be tested more effectively in the laboratory, a second called TRAPEZIO – TIRED also sponsored by the San Paolo Torino Foundation and with similar objectives to the previous one, and a third PRIN Proof-of-Concept TIRED – Towards Intelligent Robot for Endoscopic Dissection sponsored by the Ministry of the University, in collaboration with Prof Bruno Siciliano, of the Federico II University of Naples, to develop an effective control and semi-automation software system while keeping the operator responsible for the procedure (so-called human in the loop). Results are expected at the end of 2025.

The ENDOTHERANOSTICS (Multi-sensor Eversion Robot Towards Intelligent Endoscopic Diagnosis and Therapy) project is part of the same research line, a recent winner of the ERC Synergy Grant (ERC SyG-2023) in the HORIZON EUROPE framework. This is a project that will usher in a new era for colonoscopy screening, advancing the frontiers of medical imaging and robotics. A growing-end robot or “eversion robot” will be created with a sleeve-like structure to reach deep into empty spaces and sense the environment through multimodal imaging and sensing. It will also act as a conduit to transfer miniaturised instruments to the remote site within the colon for diagnosis and therapy (theranostics). With these features, the system will be able to offer:

1. painless colon cleansing in preparation for endoscopy;
2. real-time polyp detection and tissue characterisation through AI-assisted multimodal imaging;
3. Effective removal of polyps by transporting a “miniature mobile operating room” equipped with microsurgical instruments to the target through the lumen of the eversion robot.

Unique technical and clinical challenges will be addressed by PIs, each bringing complementary expertise, supported by their own institutions with broad experience and exceptional facilities. The synergy and added value evident in this team will lead to innovations not possible through independent research. EndoTheranostics findings will revolutionise colorectal cancer theranostics, impacting the quality of life of millions of individuals. Ultimately, it will launch a new era for endoluminal intervention with applications that go beyond medicine. The project is based on collaborative work in a consortium including Prof. Kaspar Althoefer (Centre for Advanced Robotics @ Queen Mary (ARQ), Faculty of Science and Engineering, Queen Mary University of London (QMUL) UK, Prof. Sebastien Ourselin, Dean, School of Biomedical Engineering and Imaging Sciences and Director of the Wellcome/EPSRC Center for Medical Engineering and Deputy Director of the London Medical Imaging and Artificial Intelligence Center for Value Based Healthcare, Faculty of Engineering King’s College London (KCL) United Kingdom and Prof. Bruno Siciliano, C.R.E.A.T.E. (CREATE) IT Research Consortium. The testing, assembly and validation of the prototypes will take place at the MITIC Lab directed by me.

15.3 Colon neoplasms

A first line of research concerned treatment strategies in cases of neoplastic occlusion of the left colon^[10],^[11]. With the ESCO study we have demonstrated that the use of bridge-to-surgery stents and subsequent elective surgery significantly reduce both morbidity and mortality and the use of a stoma compared to emergency surgery. We subsequently demonstrated by evaluating the 3-year results that the use of a stent does not increase the risk of disseminating neoplastic disease, in particular it does not increase the number of distant metastases compared to the emergency surgery group, as reported by others in studies not prospective. This has also contributed both to the rehabilitation of the use of stents in occluded patients and, thanks also to an extensive meta-analysis of the literature, to the drafting of the ESGE (European Society for Gastrointestinal Endoscopy) guidelines^[12] on the use of stents in patients suffering from occluding colon cancer.

A second line of research concerned the use of fluorescence to verify tissue perfusion^[13] after resection and before anastomosis. We have participated in several studies and performed an important meta-analysis of the available data which demonstrated a significant reduction in the reduction of anastomotic leaks in the group in which fluorescence is used. This also contributed to the drafting of the EAES (European Association for Endoscopic Surgery) guidelines^[14] on the use of fluorescence in endoscopic surgery.

A third line of research concerned the packaging technique after laparoscopic right hemicolectomy, of intracorporeal versus extracorporeal ileo-transverse anastomosis^[15]. The RCT study we conducted demonstrated equivalence in terms of complications, although real benefits in terms of pain reduction, size of surgical access, and post-operative recovery appear limited.

15.4 Rectal neoplasms

A first line of research consists of the study of “organ-sparing” strategies and “watch-and-wait” strategies in selected patients. These paths are based on the close collaboration of interconnected disciplines within a multidisciplinary team. Such multidisciplinary forums are becoming standard in the treatment of rectal cancer in the Western world. We were pioneers of this both with the NERATEM^[16] study (see above) and with the PARTTLE^[17] study, the analysis of an Individual Patient Database consisting of over 500 patients treated with an organ-sparing strategy (i.e. CRT followed by local transanal excision). The results of our studies were confirmed by the important GRECCAR 2 study, multicentre and randomised, which demonstrated comparable results in oncological outcomes for up to 5 years by comparing post-CRT local excision in “responder” patients and total mesorectal excision . We also performed a meta-analytic study on an Individual Patient Database made up of patients from published series forming part of case series of Transanal Endoscopic Microsurgery (TEM) or Endoscopic Submucosal Dissection (ESD) for similar indications, i.e. sessile lesions of the rectum up to 18 cm from the anal margin and over 20 mm in diameter. In this study we demonstrated that ESD has a 5 times higher risk than TEM of requiring radical salvage surgery consisting of anterior rectal resection.

The second line of research consists of investigating the feasibility of sentinel lymph node concepts associated with local excision^[18],^[19]. The experience began in Tuebingen in the late 1990s, where Gerhard Buess, inventor of Transanal Endoscopic Microsurgery (TEM), worked and where I began my clinical and academic career. At the time, Technetium probes were used, just like the breast, but they didn’t work. Today this is possible with the use of advanced imaging systems, such as fluorescence injected at the margins of the neoplasm. We have proven the feasibility of the technique and the technology. Its validation is missing. The principle is to offer the patient a local excision using TEM and through the same breach to penetrate the mesorectum from the inside, sampling lymph nodes to verify their sentinel role histopathologically. All this without crossing the mesorectal fascia, therefore respecting the oncological criteria, and allowing for possible radicalisation with standard TME as reported in approximately ⅓ of cases in the same GRECCAR 2 study.

Therefore, 2 preliminary studies are needed.

1. checks on MR images that there is correspondence between the primary lesion and the sentinel lymph nodes, i.e. that the lymph nodes are “in the same quadrant” as the primary lesion, so that they can be reached through the gap of the local excision^[20].
2. verifies on histological pieces of Total Mesorectal Excision that this is true, with the limitations of the poor finding of N+ post-RT.

These studies have currently been underway for approximately 24 months in Molinette, Turin.

A third line of research is represented by the study of “sphincter-sparing” techniques. Although minimally invasive approaches have improved surgeons’ ability to navigate deep into the pelvis, visualisation of the lower pelvis remains difficult. TransAnal Total Mesorectal Excision (taTME)^[21],^[22] is a surgical technique that uses transanal endoscopic dissection to perform rectal and mesorectal dissection with a “bottom up” approach. TaTME is typically combined with abdominal dissection to complete rectal and mesorectal mobilisation. Total transanal mesorectal excision (taTME) is a minimally invasive technique that allows with precise indications and contraindications to perform a significant portion of TME dissection for rectal cancer from “bottom up” helping to increase the rate of surgery” sphincter-sparing” reducing both the rate of infiltrated distal margin and the need to resort to amputation of the rectum via the abdomino-perineal route. We have been performing the technique since 2011 and have contributed to the largest international registry which has contributed to the validation and affirmation of the technique as an important tool in the armamentarium of the modern colorectal surgeon.

A fourth line of research is represented by the research project called CLASSICA^[23], Validating AI in Classifying Cancer in Real-Time Surgery (multicentre, prospective study on the use of Artificial Intelligence and Fluorescence to typify sessile lesions of the rectum before transanal endoscopic surgery – TEM). This is a project sponsored by the European Community within Horizon Europe. Building on groundbreaking research in artificial intelligence (AI) analysis of fluorescence and perfusion in tumour tissues, this project clinically validates the use of AI-based imaging and decision support in real-time cancer surgery . Cancer and healthy tissue have radically different local blood perfusion patterns. This perfusion can be captured using near-infrared video after systemic injection of fluorophore (indocyanine green). Video analysis can digitally identify cancer regions by monitoring perfusion in the initial seconds after dye administration by comparing the fluorescence signal in these areas to those of adjacent normal tissue within the same endolaparoscopic field of view. The application of artificial intelligence methods (including computer vision and machine learning techniques) has allowed this differential classification to occur in real time so that better, personalised surgical decisions can be made during an operation. In this project, we transform our existing AI solution research prototype into a standard operating room surgical tool and validate its performance, reliability, usability and acceptance in five leading oncology surgery centres across Europe (500 patients). Validation studies address (a) generalisability across clinics; (b) biopsy and tumour identification; and (c) optimised resection of large (>3 cm) rectal polyps, a key area of current surgical practice where the greatest clinical challenge is to ensure accurate patient selection for curative therapy. This project will end in 2026 and will significantly contribute to optimising the “organ-sparing” techniques mentioned above.

A fifth line of research is represented by the research project called PALPABLE^[24] on the development of a Multi-sensing instrument for Minimally Invasive Surgery sponsored by the European Community within Horizon Europe. The tool will serve to overcome the current barriers of both endoluminal and laparoscopic ultrasound endoscopy, and will allow to increase sensory feedback during minimally invasive surgery, both laparoscopic and endoluminal. The probe (5 mm diameter, 15-20 mm length) incorporates multiple sensing modes and a thin, flexible, pneumatically actuated end effector (3 DoF, 180 degrees) with distributed sensors for distributed tactile sensing. The probe consists of photonic sensing elements and a sphere held at the end of a circular tunnel by a constant air flow. The ball is free to rotate in all directions and can move in the channel when pressed against the airflow. When rolling on the fabric, the displacement depends on the stiffness of the fabric and is picked up by the optical fibre above it. The change in optical intensity in the sensing element is used to identify changes in tissue stiffness. The measurement principle used is the extrinsic modulation of the light intensity provided through optical fibres. A non-planar photonic circuit (200μm waveguide, 8bit color depth) for the touch sensor array is developed and interfaced with the probe; this circuit will be engraved on an ultra-thin polymer foil. Foil sensing elements are distributed around and along the probe for multiple sensor inputs for palpation (e.g. stiffness), distance and curvature which are then fused to provide the overall tissue situation. The use of thin sheets allows for easy integration with the probe and a simple manufacturing process to enable low costs in large volumes. The final effector is made of disposable or sterilisable materials; both options will be explored with regards to recyclability or reusability respectively. Results are expected by the end of 2026 when tests on a human cadaver model are scheduled.

A sixth line of research is represented by the two research projects called TENTACLE and DAEDALUS which aims to generate a bioprinting system to replace in vivo the diseased rectum in patients with familial adenomatous polyposis (FAP) and ulcerative colitis (UC). Both familial adenomatous polyposis (FAP) and ulcerative colitis (UC) seriously compromise the quality of life of patients. These diseases could benefit from the removal of the intestinal mucosa and submucosa. Among them, familiar adenomatous polyposis (FAP) and ulcerative colitis (UC) seriously compromise the patients’ quality of life. These pathologies could benefit from the removal of the intestinal mucosa and submucosa, however no strategies exist nowadays for their replacement. Then, when their removal is necessary, the patients undergo a proctocolectomy (i.e., surgical removal of the rectum and all or part of the colon) with a subsequent ileal pouch. Although preserving the patient’s continence, the procedure is burdened by significant complications. In this scenario, TENTACLE and DAEDALUS pioneers a radically new strategy for the surgical treatment of UC and FAP, providing an innovative in situ 4D bioprinting strategy, for the regeneration of colorectal mucosa and submucosa. The TENTACLE and DAEDALUS in situ 4D bioprinting suite include: i) a colonoscopic bioprinter, featuring an extrusion-based bioprinting unit, an valvejet printhead, a mesh delivery system and a photocrosslinking device; ii) in silico tools for personalizing the bioprinting procedure; iii) two novel bespoken bioink formulations containing patients’ cells, including suitable functionalization strategies. The mucosal formulation will feature a 4D shape morphing behavior to recreate the colorectal mucosal crypts. Within TENTACLE and DAEDALUS, the entire procedure will be validated ex vivo and in vivo, thus paving the way for translating the bioprinting suite toward the clinics, by: i) identifying a GMP-compliant cell expansion protocol, ii) scaling up of the manufacturing routes, iii) promoting involvement and acceptance of surgeons and patients, iv) aligning with the EU regulation. Collectively, our project will introduce a minimally invasive alternative to proctocolectomy and is expected to have a high impact on the quality of life of patients affected by FAP and UC

15.5 Colon diverticulitis

I started dealing with diverticula of the colon with the GISDIC^[25] study, the result of over 1000 patients observed for diverticulitis in the emergency room and followed for over 10 years from the first observation. The study published in 2012 in the British Journal of Surgery demonstrated that prophylactic surgery was inadvisable, even in young subjects, and that it was rather on the basis of quality of life that elective surgery for recurrent diverticula should be planned.

This was followed by a second observational study on laparoscopic peritoneal lavage called the LLO-study^[26], also published in 2018 in the British Journal of Surgery which demonstrated a high success rate in controlling sepsis in selected patients with acute perforated diverticulitis and Hinchey III peritonitis, with low rates of operative mortality, reoperation and stoma formation.

As a consequence of these studies he was involved in the SAGES / EAES Task Force which led to the drafting of the “EAES and SAGES 2018 Consensus Conference on acute diverticulitis management: evidence-based recommendations for clinical practice” Guidelines^[27] and produced a related Cochrane^[28].

15.6 Techniques and technologies for Operative Digestive Endoscopy

A first line of research concerns the design of new systems for flexible endoscopy. Since 1998 I have been working on new systems for flexible endoscopy to replace the already obsolete standard endoscopy technology. The first system produced in collaboration with SSSA was the vermiform robot for colonoscopy called EMIL, then marketed as ENDOTICS. The system, renewed over the years, is still on the market, but has only partially solved the initial problems, i.e. it is now equipped with an operating channel to guarantee minimal operation, but it is still excessively slow and does not guarantee the completion of the procedure in all cases. cases.

The VECTOR^[29] project was born in 2006, for the development of a robotic capsule for gastrointestinal endoscopy sponsored by the European Community, sponsored by the European Community within the VI TMR (FP6) in which I represented the iSMIT, International Society for Medical Innovation and Technology . This capsule was designed to be swallowable and allow the screening of all neoplasms of the digestive tract, from the esophagus to the rectum. In relation, the lack of maneuverability of the capsule equipped with exclusively passive and peristaltic movement, the impossibility of distending the lumen, and the absence of operation due to lack of operating channels significantly limited its use. The technical difficulty in building a reasonably sized capsule that had a battery on board capable of lasting long enough to complete the test meant that the initial project was abandoned at the end of the financing in 2011. However, two interesting “derivatives” were born. very similar to each other. In both cases it was a colonoscopy capsule, with magnets on board, capable of navigating within an external magnetic field governed by a permanent magnet attached to a Kuka Med LBR-type robot. The first project was called “Preclinical development and validation of an endoscopic robot with soft wire to replace colonoscopy” in collaboration with Prof Pietro Valdastri and financed in 2013 by the Finalised Research funds of the Ministry of Health and had as its main objective that of studying inflammatory bowel diseases. The second project was called EndoVESPA^[30] (Endoscopic Versatile robotic guidance, diagnosis and therapy of magnetic-driven soft-tethered endoluminAl robots), then ENDOO, sponsored by the European Community within the HORIZON 2020 Framework. This was made up of an international consortium coordinated by Prof Paolo Dario and SSSA. Both projects ended with extreme success. The first found financiers in the USA which led to the creation of the start-up Atlas Endoscopy^[31], with which we produced 26 FDA marked prototypes, 5 of which last October were used in the USA to perform a complete colonoscopy at men volunteer successfully. The second project is still waiting for funding to continue.

A second line of research concerns the design of new accessories to increase the operability of existing endoscopic instruments. Here we distinguish the creation of the Over The Scope Clip (OTSC)^[32],^[33] by the Ovesco company (Tuebingen, Germany), which represents an irreplaceable tool which has been in the clinical practice of every digestive endoscopy service for 15 years now both for the control of bleeding refractory to others treatments, both for acute and chronic leaks and fistulas of the digestive tract. With this device I completed a study in 2007 on 10 porcine models subjected by me to transgastric cholecystectomy using a flexible endoscope^[34] (gastroscopy) in which the transgastric access was successfully synthesised with OTSC clips.

A third line of research concerns the topic of endoluminal resection of “early” lesions. In this context, in 1998 I contributed to the design and validation on an ex-vivo and in-vivo animal model (swine model) of a device called Full Thickness Resection Device (FTRD)^[35]. The device consisted of a mechanical stapler mounted on a flexible overtube, equipped with two forceps for manipulating tissues. The instrument produced for Boston Scientific (Boston, MA, USA) demonstrated extreme effectiveness in pre-clinical tests, but the company decided to abandon the project in 2001 because it was deemed too expensive. Today the name FTRD is associated with a version of the OTSC clip which is used for full thickness resections with a diathermic loop, following synthesis of the future breach with the OTSC clip.

In this area, a fourth line of research concerns the Endofundoplication System (EFS)^[36], conceived and developed between 1999 and 2003 to allow an entirely transoral approach to fundoplication. The system consisted of a flexible multifunctional oral introduction tube (18 mm) as the key component, with a specially designed retroverse forceps that was used to grasp and invalidate the lower esophageal sphincter (LES) of the esophagus. The EFS system was finally studied in a consecutive series of experiments on 10 animals in the domestic pig with excellent pathological results. The system comes closer to the form and function of a classic fundoplication than any other technique proposed at the time of our development. The system was then successfully commercialised, and is still available on the market, under the name Esophyx^[37] (EndoGastric Solutions, USA).

Finally, a fifth line of research is represented by the endoscopic treatment of anastomotic leaks in colorectal surgery using endoluminal VAC therapy, assisted by sponge (EVT). Endo-SPONGE® (B.Braun Surgical) is an endoscopic vacuum system that achieves consolidation of the dehiscence in approximately 85% of cases with consequent closure of any protective stoma. Having acquired extensive experience in the use of the device since 2009, we have contributed to improving the device and technique, up to the drafting of guidelines^[38]. We have collaborated with B.Braun Surgical for use in the esophagus both as a treatment for surgical anastomotic dehiscences and as a prevention of leaks. Similarly we have experimented with the use of Endo-SPONGE® to prevent leakage in low colorectal anastomoses. We are currently collaborating with B.Braun Surgical to validate a derivative product for the treatment of perianal fistulas to replace the “seton”.

15.7 Sustainability in Surgery

From 1.12.01 to 30.11.03 I was Local Principal Investigator of a Research Project called CLEANTEST^[39] – Testing and measurement procedure for the validation of the cleaning behaviour of reusable surgical devices, conducted by an international consortium, on Cleaning, sterilisation and design of instruments for endoscopic surgery, sponsored by the European Community within the V TMR (FP5). The study made it possible to optimise the manufacturing of steel surgical instruments so as to make them easily reprocessable in automatic instrument washing machines, as well as optimising the reprocessing programs in the same automatic instrument washing machines, so as to preserve the environment while making the use of reusable tools, and by minimising the production of polluting waste detergents.

Years of conferences followed to disseminate the results of the Project and raise awareness among the scientific community.

In 2018 I was asked to create and coordinate the activity of a dedicated Task Force^[40] within the EAES, European Association for Endoscopic Surgery to promote campaigns in favour of the sustainability of surgery. In collaboration with Tim Horemann of Delft University and member of the Technology Committee of the EAES and the company Green Cycl, we have developed a project called EvalueWaste (EvalueWaste: A Framework for Circular Hospitals). The project was presented at the Call: HORIZON-HLTH-2023-CARE-04 (Ensuring access to innovative, sustainable and high-quality health care (Single stage – 2023)) Topic: HORIZON-HLTH-2023-CARE-04-03 . Type of Action: HORIZON-RIA. Within healthcare practices, the use of single-use medical devices results in high volumes of healthcare waste. Legislation is unclear in the definition of medical waste and it is recognised that disposal of infectious waste can be complex. EvalueWaste has the ambition to replace single-use models commonly seen for surgical products with circular concepts and to reuse energy and wastewater in hospitals. EvalueWaste will develop an evidence-based hospital waste management framework that provides new technologies and guidelines for the reprocessing (reuse) of healthcare waste (metals and plastics) and for the reuse of energy and water in hospitals. First, EvalueWaste will develop new and safe ways to separate and transport waste from operating rooms and waste reprocessing technologies for hospitals and waste treatment centres. Secondly, EvalueWaste will develop new technologies to reuse water and transform energy from water and steam in the hospital’s central sterilisation and supply departments. Guidelines and standards will be developed to ensure safe and environmentally friendly processes. Third, EvalueWaste will provide open source simulation and benchmarking software so that every hospital around the world can inform, monitor and compare their waste streams and calculate the economic benefits and environmental impact of using our technologies. This will allow hospitals and governments to establish a baseline environmental footprint for healthcare waste streams and identify hotspots alongside realistic measures to reduce their footprint. With the EvalueWaste framework we aim to provide evidence of the effectiveness of our technology in reducing the healthcare footprint, which will form the basis for future legislation. Unfortunately, the Proposal was the first of the unfunded ones, so we will submit it again in the next few months to the next CALL for the same objective.

In the meantime, the Task Force has joined forces with a similar working group from the American Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), whose collaboration has resulted in a position paper on sustainability issues in the operating room^[41], a survey on and perspectives on sustainability among surgeons^[42], and a review in the field to identify articles that report the impact of gastrointestinal surgical care on the environment^[43].

^[1] Buess GF, Arezzo A, Schurr MO, Ulmer F, Fisher H, Gumb L, Testa T, Nobman C. A new remote-controlled endoscope positioning system for endoscopic solo surgery. The FIPS endoarm. Surg Endosc. 2000 Apr;14(4):395-9.

^[2] Schurr MO, Arezzo A, Neisius B, Rininsland H, Hilzinger HU, Dorn J, Roth K, Buess GF. Trocar and instrument positioning system TISKA. An assist device for endoscopic solo surgery. Surg Endosc. 1999 May;13(5):528-31.

^[3] Arezzo A, Schurr MO, Braun A, Buess GF. Experimental assessment of a new mechanical endoscopic solosurgery system: Endofreeze. Surg Endosc. 2005 Apr;19(4):581-8. doi: 10.1007/s00464-003-9132-7.

^[4] Arezzo A, Schurr MO, Braun A, Buess GF. Experimental assessment of a new mechanical endoscopic solosurgery system: Endofreeze. Surg Endosc. 2005 Apr;19(4):581-8. doi: 10.1007/s00464-003-9132-7.

^[5] Schurr MO, Arezzo A, Neisius B, Rininsland H, Hilzinger HU, Dorn J, Roth K, Buess GF. Trocar and instrument positioning system TISKA. An assist device for endoscopic solo surgery. Surg Endosc. 1999 May;13(5):528-31.

^[6] Morino M, Forcignanò E, Arezzo A. Initial clinical experience with a novel flexible endoscopic robot for transanal surgery. Tech Coloproctol. 2022 Apr;26(4):301-308.

^[7] Morino M, Forcignanò E, Arezzo A. Early clinical adoption of a flexible robotic endoscope for local excision of rectal lesions. Br J Surg. 2021 Sep 27;108(9):e296.

^[8] Arezzo A, Forcignanò E, Morino M. Robotic endoscopic submucosal dissection and full-thickness excision for laterally spreading tumors of the rectum. Minim Invasive Ther Allied Technol. 2022 Mar;31(3):377-379.

^[9] https://www.pruk.ltd/

^[10] Arezzo A, Balague C, Targarona E, Borghi F, Giraudo G, Ghezzo L, Arroyo A, Sola-Vera J, De Paolis P, Bossotti M, Bannone E, Forcignanò E, Bonino MA, Passera R, Morino M. Colonic stenting as a bridge to surgery versus emergency surgery for malignant colonic obstruction: results of a multicentre randomised controlled trial (ESCO trial). Surg Endosc. 2017 Aug;31(8):3297-3305.

^[11] Arezzo A, Forcignanò E, Bonino MA, Balagué C, Targarona E, Borghi F, Giraudo G, Ghezzo L, Passera R, Morino M; collaborative ESCO study group. Long-term Oncologic Results After Stenting as a Bridge to Surgery Versus Emergency Surgery for Malignant Left-sided Colonic Obstruction: A Multicenter Randomized Controlled Trial (ESCO Trial). Ann Surg. 2020 Nov;272(5):703-708.

^[12] van Hooft JE, Veld JV, Arnold D, Beets-Tan RGH, Everett S, Götz M, van Halsema EE, Hill J, Manes G, Meisner S, Rodrigues-Pinto E, Sabbagh C, Vandervoort J, Tanis PJ, Vanbiervliet G, Arezzo A. Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2020. Endoscopy. 2020 May;52(5):389-407.

^[13] Arezzo A, Bonino MA, Ris F, Boni L, Cassinotti E, Foo DCC, Shum NF, Brolese A, Ciarleglio F, Keller DS, Rosati R, De Nardi P, Elmore U, Fumagalli Romario U, Jafari MD, Pigazzi A, Rybakov E, Alekseev M, Watanabe J, Vettoretto N, Cirocchi R, Passera R, Forcignanò E, Morino M. Intraoperative use of fluorescence with indocyanine green reduces anastomotic leak rates in rectal cancer surgery: an individual participant data analysis. Surg Endosc. 2020 Oct;34(10):4281-4290.

^[14] Cassinotti E, Al-Taher M, Antoniou SA, Arezzo A, Baldari L, Boni L, Bonino MA, Bouvy ND, Brodie R, Carus T, Chand M, Diana M, Eussen MMM, Francis N, Guida A, Gontero P, Haney CM, Jansen M, Mintz Y, Morales-Conde S, Muller-Stich BP, Nakajima K, Nickel F, Oderda M, Parise P, Rosati R, Schijven MP, Silecchia G, Soares AS, Urakawa S, Vettoretto N. European Association for Endoscopic Surgery (EAES) consensus on Indocyanine Green (ICG) fluorescence-guided surgery. Surg Endosc. 2023 Mar;37(3):1629-1648. doi: 10.1007/s00464-023-09928-5.

^[15] Allaix ME, Degiuli M, Bonino MA, Arezzo A, Mistrangelo M, Passera R, Morino M. Intracorporeal or Extracorporeal Ileocolic Anastomosis After Laparoscopic Right Colectomy: A Double-blinded Randomized Controlled Trial. Ann Surg. 2019 Nov;270(5):762-767.

^[16] Arezzo A, Arolfo S, Allaix ME, Munoz F, Cassoni P, Monagheddu C, Ricardi U, Ciccone G, Morino M. Results of neoadjuvant short-course radiation therapy followed by transanal endoscopic microsurgery for t1-t2 n0 extraperitoneal rectal cancer. Int J Radiat Oncol Biol Phys. 2015 Jun 1;92(2):299-306.

^[17] Arezzo A, Lo Secco G, Passera R, Esposito L, Guerrieri M, Ortenzi M, Bujko K, Perez RO, Habr-Gama A, Stipa F, Picchio M, Restivo A, Zorcolo L, Coco C, Rizzo G, Mistrangelo M, Morino M. Individual participant data pooled-analysis of risk factors for recurrence after neoadjuvant radiotherapy and transanal local excision of rectal cancer: the PARTTLE study. Tech Coloproctol. 2019 Sep;23(9):831-842.

^[18] Arezzo A, Arolfo S, Mistrangelo M, Mussa B, Cassoni P, Morino M. Transrectal sentinel lymph node biopsy for early rectal cancer during transanal endoscopic microsurgery. Minim Invasive Ther Allied Technol. 2014 Jan;23(1):17-20.

^[19] Morino M, Verra M, Famiglietti F, Arezzo A. Natural orifice transluminal endoscopic surgery (NOTES) and colorectal cancer? Colorectal Dis. 2011 Nov;13 Suppl 7:47-50.

^[20] Ammirati, C. A., Arezzo, A., Gaetani, C., Strazzarino, G. A., Faletti, R., Bergamasco, L., … Morino, M. (2024). Can we apply the concept of sentinel lymph node in rectal cancer surgery? . Minimally Invasive Therapy & Allied Technologies, 1–7. https://doi.org/10.1080/13645706.2024.2404046

^[21] Penna M, Hompes R, Arnold S, Wynn G, Austin R, Warusavitarne J, Moran B, Hanna GB, Mortensen NJ, Tekkis PP; TaTME Registry Collaborative. Transanal Total Mesorectal Excision: International Registry Results of the First 720 Cases. Ann Surg. 2017 Jul;266(1):111-117.

^[22] Francis N, Penna M, Mackenzie H, Carter F, Hompes R; International TaTME Educational Collaborative Group. Consensus on structured training curriculum for transanal total mesorectal excision (TaTME). Surg Endosc. 2017 Jul;31(7):2711-2719.

^[23] https://classicaproject.eu/

^[24] https://palpable-project.eu/

^[25] Binda GA, Arezzo A, Serventi A, Bonelli L; Italian Study Group on Complicated Diverticulosis (GISDIC); Facchini M, Prandi M, Carraro PS, Reitano MC, Clerico G, Garibotto L, Aloesio R, Sganzaroli A, Zanoni M, Zanandrea G, Pellegrini F, Mancini S, Amato A, Barisone P, Bottini C, Altomare DF, Milito G. Multicentre observational study of the natural history of left-sided acute diverticulitis. Br J Surg. 2012 Feb;99(2):276-85.

^[26] Binda GA, Bonino MA, Siri G, Di Saverio S, Rossi G, Nascimbeni R, Sorrentino M, Arezzo A, Vettoretto N, Cirocchi R; LLO Study Group. Multicentre international trial of laparoscopic lavage for Hinchey III acute diverticulitis (LLO Study). Br J Surg. 2018 Dec;105(13):1835-1843.

^[27] Francis NK, Sylla P, Abou-Khalil M, Arolfo S, Berler D, Curtis NJ, Dolejs SC, Garfinkle R, Gorter-Stam M, Hashimoto DA, Hassinger TE, Molenaar CJL, Pucher PH, Schuermans V, Arezzo A, Agresta F, Antoniou SA, Arulampalam T, Boutros M, Bouvy N, Campbell K, Francone T, Haggerty SP, Hedrick TL, Stefanidis D, Truitt MS, Kelly J, Ket H, Dunkin BJ, Pietrabissa A. EAES and SAGES 2018 consensus conference on acute diverticulitis management: evidence-based recommendations for clinical practice. Surg Endosc. 2019 Sep;33(9):2726-2741.

^[28] Abraha I, Binda GA, Montedori A, Arezzo A, Cirocchi R. Laparoscopic versus open resection for sigmoid diverticulitis. Cochrane Database Syst Rev. 2017 Nov 25;11(11):CD009277. doi: 10.1002/14651858.CD009277.pub2. PMID: 29178125; PMCID: PMC6486209.

^[29] https://cordis.europa.eu/project/id/033970

^[30] https://cordis.europa.eu/project/id/688592

^[31] https://www.atlasendoscopy.com/

^[32] https://ovesco.com/otsc-system/

^[33] Haito-Chavez Y, Law JK, Kratt T, Arezzo A, Verra M, Morino M, Sharaiha RZ, Poley JW, Kahaleh M, Thompson CC, Ryan MB, Choksi N, Elmunzer BJ, Gosain S, Goldberg EM, Modayil RJ, Stavropoulos SN, Schembre DB, DiMaio CJ, Chandrasekhara V, Hasan MK, Varadarajulu S, Hawes R, Gomez V, Woodward TA, Rubel-Cohen S, Fluxa F, Vleggaar FP, Akshintala VS, Raju GS, Khashab MA. International multicenter experience with an over-the-scope clipping device for endoscopic management of GI defects (with video). Gastrointest Endosc. 2014 Oct;80(4):610-622.

^[34] Arezzo A, Kratt T, Schurr MO, Morino M. Laparoscopic-assisted transgastric cholecystectomy and secure endoscopic closure of the transgastric defect in a survival porcine model. Endoscopy. 2009 Sep;41(9):767-72.

^[35] Full thickness resection device (FTRD) for endoluminal removal of large bowel tumours: development of the instrument and related experimental studies. Minim Invasive Ther Allied Technol. 2001 Nov;10(6):301-9.

^[36] Schurr MO, Kalanovic D, Arezzo A, Fleisch C, Buess G. Development of a transoral fundoplication device and related experimental research. Minim Invasive Ther Allied Technol. 2008;17(1):50-6.

^[37] https://www.endogastricsolutions.com/providers/tif-2-0-procedure/esophyx-device/

^[38] Bemelman WA, Arezzo A, Banasiewicz T, Brady R, Espín-Basany E, Faiz O, Jimenez-Rodriguez RM. Use of sponge-assisted endoluminal vacuum therapy for the treatment of colorectal anastomotic leaks: expert panel consensus. BJS Open. 2022 Sep 2;6(5):zrac123.

^[39] https://cordis.europa.eu/project/id/G6ST-CT-2001-50121

^[40] https://eaes.eu/sustainability-in-surgical-practice/

^[41] Johnson SM, Marconi S, Sanchez-Casalongue M, Francis N, Huo B, Alseidi A, Alimi YR, Pietrabissa A, Arezzo A, Frountzas M, Bellato V, Potapov O, Barach P, Rems M, Bello RJ, Nijhawan S, Oslock WM, Sathe TS, Hall RP, Miller B, Samreen S, Chung J, Marfo N, Lim RB, Vandeberg J, Eussen MM, Bouvy ND, Sylla P. Sustainability in surgical practice: a collaborative call toward environmental sustainability in operating rooms. Surg Endosc. 2024 Aug;38(8):4127-4137.

^[42] Sathe TS, Alseidi A, Bellato V, Ganjouei AA, Foroutani L, Hall RP, Potapov O, Bello RJ, Johnson SM, Marconi S, Francis N, Barach P, Sanchez-Casalongue M, Nijhawan S, Oslock WM, Miller B, Samreen S, Chung J, Marfo N, Huo B, Lim RB, Vandeberg J, Alimi YR, Pietrabissa A, Arezzo A, Frountzas M, Rems M, Eussen MMM, Bouvy ND, Sylla P. Perspectives on sustainability among surgeons: findings from the SAGES-EAES sustainability in surgical practice task force survey. Surg Endosc. 2024 Aug 19. doi: 10.1007/s00464-024-11137-7. Epub ahead of print. PMID: 39160314

^[43] Huo B, Eussen MMM, Marconi S, Johnson SM, Francis N, Oslock WM, Marfo N, Potapov O, Bello RJ, Lim RB, Vandeberg J, Hall RP, EdM AAMD, Sanchez-Casalongue M, Alimi YR, Pietrabissa A, Arezzo A, Frountzas M, Bellato V, Barach P, Rems M, Nijihawan S, Sathe TS, Miller B, Samreen S, Chung J, Bouvy ND, Sylla P. Scoping review for the SAGES EAES joint collaborative on sustainability in surgical practice. Surg Endosc. 2024 Aug 22

16. RESEARCH ACTIVITY FUNDED BY PRIVATE INVESTORS

• 1997 – 1999 partner of several projects in the field of flexible endoscopy with Boston Scientific, microvasive endoscopy (Boston, MA, USA) on the treatment of endoluminal GERD, resection of large colon polyps, endoluminal clips and staplers
• 1997 – 1999 principal investigator of a research project on robotics in endoscopic surgery with Karl Storz Endoskope GmbH (Tuttlingen, Germany)
• 1997 – 1999 coordinator of a research project on gastroesophageal reflux with Willy Ruesch GmbH (Kernen, Germany) for the creation of a balloon for intraoperative calibration of laparoscopic Nissen fundoplication
• 1999 – 2001 coordinator of a research project on robotics in endoscopic surgery with the National Forschung Zentrum Karlsruhe and the Innomedic company (Germany) for the creation of a robotic arm for controlling the laparoscopic optics
• 2003 – 2008 partner of OVESCO GmbH (Tuebingen, Germany) for the testing and clinical use of a newly developed and large nitinol clip for flexible endoscopy
• 2002 – 2004 Consultant for Boston Scientific (Boston, MA, USA) for a project to create and validate a disposable endoscope for colonoscopy
• 2003 – 2005 Consultant for Ethicon Endosurgery (Johnson & Johnson Medical) Italy for a project for the creation and validation of a disposable endoscope for colonoscopy
• 2003 – 2005 Consultant for Bbraun Aesculap (Tuttlingen, Germany) for the development and clinical testing of ENDOFREEZE, a passive positioning system for laparoscopic instruments with 4 DoF
• 2005 – 2007 Consultant for Johnson & Johnson Medical Europe, Inscope Division for the creation of a set of flexible instruments for endoscopic surgery through natural orifices (NOTES)
• 2009 – 2010 Consultant for Johnson & Johnson Medical Europe, Titan project
• from 2010 to date Consultant for Bbraun Aesculap (Tuttlingen, Germany), non-continuously for the design of different VAC devices for different applications (rectum, esophagus, perianal fistulas, etc.)
• 2011 Consultant for Johnson & Johnson Medical USA, Gemini project
• 2015 Consultant for Teleflex Medical (Morrisville, NC, USA) for the validation of small caliber laparoscopic surgery instruments
• 2019 -2022 Consultant for Medrobotics (Boston, MA, USA) for the validation and development of a flexible robot for endoluminal transanal endoscopic surgery
• 2023 Consultant for SurgeonAI Ltd. (Ra’anana, Israel) for the validation an AI software for endoscopic surgery images
• 2024 Consultant for Human Xtension (Netanya 4250574, Israel) for the validation a hand-held robot for endoscopic surgery

17. PATENTS

• A miniature robotic device applicable to a flexible endoscope for the surgical dissection ofgastro-intestinal tract surface neoplasms (WO 2014147556 A1)
• A connecting device for creating an anastomosis between a hollow organ and a conduit (WO 2013004263 A1)
• A device for translumenal diversion of bile (WO 2012007044 A1)
• System and method for modifying the location at which biliopancreatic secretions interact with the gastrointestinal tract (WO 2012007050 A1).
• A miniature soft-robotic device applicable to a flexible endoscope for the surgical dissection of gastro-intestinal tract surface neoplasms (pending)
• A miniature automatic suturing device for endoscopic surgery (pending)
• In 2012, the University of Turin authorized him to set up the Spin-Off RED – Robot for Endoscopic Dissection, in collaboration with the Scuola Superiore Sant’Anna in Pisa, for the creation of RED, a micro-robot on a flexible support for endoluminal surgical applications

18. PUBLICATIONS

75 Surgical Endoscopy
12 Cochrane Review
6 Annals of Surgery
7 British Journal of Surgery