Marco Bortolami will miss Italy's three end-of-year internationals after undergoing surgery on his problem shoulder.
The veteran lock has struggled to recover from the shoulder he dislocated against Argentina in early June.
The former Gloucester player suffered complications following two previous operations which meant he underwent surgery for a third time in Parma at the weekend.
The Italian Rugby Federation have confirmed he has to wear a brace for at least one month and he will then have another check-up.
Bortolami, who skippered Italy at the 2007 World Cup, will miss Tests against Tonga (November 10), New Zealand (Nov 17) and Australia (Nov 24).