General Operator Research Articles

“Electrical impedance tomography during open heart surgery and on the cardiac icu is feasible to monitor ventilation in children with congenital heart disease”

Alveolar de recruitment is a common problem during general anesthesia and operations. Pediatric cardiac surgery with cardiopulmonary Bypass is associated with interruption of ventilation and might enhance loss of Ventilation compared to other surgical procedures. Electrical impedance tomography (EIT) allows for monitoring of ventilation distribution and can be helpful in detecting pulmonary de recruitment. This case series demonstrates for the first time that EIT is feasible during open heart surgery and in patients with open chest on the ICU using adapted belts in pediatric patients. It might be helpful to monitor changes in tidal volume distribution, to detect loss of Ventilation during surgery and to guide recruitment maneuvers. Study registration: NCT06270485, clincialtrials.gov, 02/02/2024.

Discrete global symmetries: gauging and twisted compactification

Discrete global symmetries of 4d N\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$ \\mathcal{N} $$\\end{document} = 2 SCFTs are studied via two operations: gauging and twisted compactification. We consider gauging of discrete symmetries in several well-known 4d N\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$ \\mathcal{N} $$\\end{document} = 2 SCFTs, including SU(n) SQCD with 2n flavors, theories of class S\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$ \\mathcal{S} $$\\end{document} of type A2n−1, and Argyres-Douglas theories of type (AN, AN), as well as propose new 4d SCFTs as a result. The wreathing technique, which involves gauging a subgroup of the automorphism group of the quiver diagram of the corresponding 3d mirror theory, is exploited. This allows us to understand several properties of discretely gauged theories, including moduli spaces and how discrete gauging affects the mixed ’t Hooft anomaly between the 1-form symmetry and the 0-form flavor symmetry. Many examples are viewed through the lens of the Argyres-Seiberg duality and its generalization. We also examine discrete gauging of SU(2) SQCD with 4 flavors by various ℤ2 and ℤ2 × ℤ2 subgroups of the permutation group S4 using the superconformal index. Regarding compactification, we propose a magnetic quiver for 4d N\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$ \\mathcal{N} $$\\end{document} = 2 SU(n) SQCD with 2n flavors compactified on a circle with a ℤ2 twist. The twisted compactification by non-invertible symmetries of the 4d N\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$ \\mathcal{N} $$\\end{document} = 4 SYM theory with gauge group SU(N) is revisited. The non-invertible symmetry naturally gives rise to a ℤk action on the scalar fields parametrizing the moduli space. Upon examining the ℤk invariant chiral ring of the Higgs branch, we find that, in addition to the largest branch of the moduli space that is expected to be captured by the ABJ(M) theory, there exist in general nilpotent operators that lead to a branch of the moduli space which is a radical ideal.

Influence of Supply Chain Technological Integration on the Performance of Formal Manufacturing Firms in Mombasa County, Kenya

Technological integration within the supply chain has emerged as a pivotal determinant for the growth and competitiveness of manufacturing companies amidst the rapidly evolving business landscape. However, in Kenya, numerous firms encounter challenges in embracing and assimilating the latest technological advancements into their supply chain operations. This study aimed to assess the impact of supply chain technological integration on the performance of formal manufacturing firms in Mombasa County. Grounded on the Innovation Diffusion Theory, the research targeted 50 general procurement managers, 100 warehouse managers, and 100 general operation managers across 50 manufacturing enterprises. Utilizing the Yamane formula, a sample size of 152 respondents was determined, and data was collected through questionnaires. Statistical analysis was conducted using SPSS. The findings show that by enhancing operational efficacy and efficiency, the integration of supply chain technology significantly enhances overall business performance. Consequently, the study concludes that supply chain technological integration plays a positive role in influencing firm performance among formal manufacturing enterprises in Mombasa County. To optimize performance, it is recommended that firms invest in robust and reliable technologies. Furthermore, there is a need for additional research to explore the impact of supply chain technological integration on firm performance across diverse industries and regions within Kenya.

Preoperative investigation practices for elective surgical patients: clinical audit

BackgroundThe findings of pre-operative investigations help to identify risk factors that may affect the course of surgery or post-operative recovery by contributing to informed consent conversations between the surgical team and the patient, as well as guiding surgical and anesthetic planning. Certainly, preoperative tests are valuable when they offer additional information beyond what can be gathered from a patient’s history and physical examination alone. Preoperative testing practices differ significantly among hospitals, and even within the same hospital, clinicians may have varying approaches to requesting tests. This study aimed to investigate preoperative testing practices and compare them with the latest guidelines from the National Institute for Health and Care Excellence (NICE).MethodsThis three-month institutionally based study was carried out at the Debre Tabor Comprehensive Specialized Hospital from May 1 to July 30, 2023, including individuals aged 16 years and older who were not pregnant and had undergone elective surgery in the gynecological, orthopedic, and general units. Data on the sociodemographic characteristics, the existence of comorbidities, the invasiveness of surgery, and the tests taken into consideration by the guideline were gathered using a self-administered questionnaire. After rigorously analyzing and revising the results of preoperative investigation approaches, we compared them to the standard of recommendations. Moreover, the data was analyzed and graphically presented using Microsoft Excel 2013.ResultsDuring the data collection period, 247 elective patients underwent general, orthopedic, and gynecological operations. The majority of patients, 107 (43.32%), were between the ages of 16 and 40 and had an American Society of Anesthesiologists (ASA) class one (92.71%). 350 investigations were requested in total. Of these, 71 (20.28%) tests were ordered without a justified reason or in contravention of NICE recommendations.ConclusionsIn our hospital’s surgical clinical practice, unnecessary preoperative testing is still common, especially when it comes to organ function tests, electrocardiograms (ECGs), and complete blood counts (FBCs). When deciding whether preoperative studies are required, it is critical to consider aspects including a complete patient history, a physical examination, and the invasiveness of the surgery.

Holographic torus correlators in AdS3 gravity coupled to scalar field

This paper investigates holographic torus correlators of generic operators at conformal infinity and a finite cutoff within AdS3 gravity coupled with a free scalar field. Using a near-boundary analysis and solving the gravitational boundary value problem, we solve Einstein’s equation and calculate mixed correlators for massless and massive coupled scalar fields. The conformal Ward identity on the torus has been reproduced holographically, which can be regarded as a consistency check. Further, recurrence relations for a specific class of higher-point correlators are derived, validating AdS3/CFT2 with non-trivial boundary topology. While the two-point scalar correlator is accurately computed on the thermal AdS3 saddle, the higher-point correlators associated with scalar and stress tensor operators are explored.

A Quantitative Analysis of Intraoperative Distractions and When They Occur During General Surgical Operations.

Introduction Distractions in operating theatres prevent team members from concentrating on the complex tasks required for a successful operation. This can be a potential hazard to care for, and previously, correlations have been made between increased theatre distractions and adverse events. However, it remains unclear how frequently such events occur during routine care in theatres. The present study aims to quantify distractions and analyse any differences between staff groups, operative stages, and modes of operation. Methods A single-centre prospective study was conducted to assess disruptions in general surgical theatres. Events were recorded using a previously described categorization system on a proforma by a single researcher. The source and severity of distraction were recorded, as well as the mode of operation (elective/emergency), stage of operation, and staff team (scrubbed/floor). Results A total of 4,219 minutes of surgery were observed over four weeks, and 1,095 distraction events were recorded. Of the 14 elective and nine emergency procedures recorded, there was a mean of 54.8 distractions per procedure and a frequency of one distraction every three minutes and 51 seconds (15.6 hr-1). Irrelevant communication relating to the patient's case was the most common source, accounting for 24.7% of all distractions. The most frequently disrupted stage of the procedure for scrubbed staff was during anastomosis/resection for both elective and emergency procedures, with 16.9 and 32.6 distractions occurring per hour, respectively. Scrubbed staff were significantly more susceptible to distraction in emergency procedures than the floor staff. Discussion Our study reflects previous assessments with irrelevant communications and emergency procedures yielding the highest prevalence of distraction. This investigation provides novel information about the different stages of general surgery and the frequency of distractions that occur.

On generalized fractional operators and related function spaces with applications

The application of fractional calculus-based mathematical models in physics is a well-established practice. However, a challenge arises due to the variety of fractional operators used in these models and the search for solutions in different function spaces. This paper proposes a unified approach to this issue by applying general fractional operators that can capture and extend previous attempts, with appropriate parameters that align with the features of the phenomena being modeled. The main goal is to establish invariant spaces for these operators. This will simplify the application of various proof techniques.

Modeling the cortical response elicited by wrist manipulation via a nonlinear delay differential embedding.

Regarding motor processes, modeling healthy people's brains is essential to understand the brain activity in people with motor impairments. However, little research has been undertaken when external forces disturb limbs, having limited information on physiological pathways. Therefore, in this paper, a nonlinear delay differential embedding model is used to estimate the brain response elicited by externally controlled wrist movement in healthy individuals. The aim is to improve the understanding of the relationship between a controlled wrist movement and the generated cortical activity of healthy people, helping to disclose the underlying mechanisms and physiological relationships involved in the motor event. To evaluate the model, a public database from the Delft University of Technology is used, which contains electroencephalographic recordings of ten healthy subjects while wrist movement was externally provoked by a robotic system. In this work, the cortical response related to movement is identified via Independent Component Analysis and estimated based on a nonlinear delay differential embedding model. After a cross-validation analysis, the model performance reaches 90.21% ± 4.46% Variance Accounted For, and Correlation 95.14% ± 2.31%. The proposed methodology allows to select the model degree, to estimate a general predominant operation mode of the cortical response elicited by wrist movement. The obtained results revealed two facts that had not previously been reported: the movement's acceleration affects the cortical response, and a common delayed activity is shared among subjects. Going forward, identifying biomarkers related to motor tasks could aid in the evaluation of rehabilitation treatments for patients with upper limbs motor impairments.

Spectral flow and localisation in AdS3 string theory

We study string theory in three-dimensional Anti-de Sitter spacetime in the path integral formalism. We derive expressions for generic spectrally-flowed near-boundary vertex operators in the Wakimoto representation, and relate their correlation functions to covering maps from the worldsheet to the target space boundary. We show that the path integral structurally reproduces correlation functions of the dual symmetric orbifold theory. By rephrasing spectral flow as the introduction of a background gauge field, we provide a path integral derivation of the localisation property of the near boundary theory. We then focus on the case of IIB string theory on AdS3 × S3 × \U0001d54b4 with k = 1 units of NS-NS flux, where the relationship between correlation functions and covering maps can be made sharp. We also comment on the relation of the k = 1 theory and twistor theory.

Efficient characterizations of multiphoton states with an ultra-thin optical device

Metasurface enables the generation and manipulation of multiphoton entanglement with flat optics, providing a more efficient platform for large-scale photonic quantum information processing. Here, we show that a single metasurface optical device would allow more efficient characterizations of multiphoton entangled states, such as shadow tomography, which generally requires fast and complicated control of optical setups to perform information-complete measurements, a demanding task using conventional optics. The compact and stable device here allows implementations of general positive operator valued measures with a reduced sample complexity and significantly alleviates the experimental complexity to implement shadow tomography. Integrating self-learning and calibration algorithms, we observe notable advantages in the reconstruction of multiphoton entanglement, including using fewer measurements, having higher accuracy, and being robust against experimental imperfections. Our work unveils the feasibility of metasurface as a favorable integrated optical device for efficient characterization of multiphoton entanglement, and sheds light on scalable photonic quantum technologies with ultra-thin optical devices.

De-projecting the EFThedron

The space of Wilson coefficients of EFT that can be UV completed into consistent theories was recently shown to be described analytically by a positive geometry, termed the EFThedron. However, this geometry, as well as complementary numerical methods of semi-definite programming, have so far focused on the positivity of the partial wave expansion, which allows bounding only ratios of couplings. In this paper we describe how the unitarity upper bound of the partial waves can be incorporated. This new problem can be formulated in terms of the well known L-moment problem, which we generalize and solve from a geometrical perspective. We find the non-projective generalization of the EFThedron has an infinite number of non-linear facets, which in some cases have remarkably simple descriptions. We use these results to derive bounds on single couplings, finding that the leading derivative operators are bounded by unity, when normalized by the cut-off scale and loop factors. For general operators of mass dimension 2k we find the upper bound is heavily suppressed at large k, with an 1/k fall-off.

On the impact of Industrial Internet of Things (IIoT) - mining sector perspectives

ABSTRACT The application of the Internet of Things (IoT) in industrial systems and other new technological advancements led to the development of the Industrial Internet of Things (IIoT). IIoT can help overcome the shortcomings of the conventional monitoring and control system while enabling enterprises to create a unified monitoring system to automate operations, provide a safe working environment, enforce compliance effectively, and regulate environmental issues. Given the advantages that IoT brings to the forefront, it makes sense that so many mining companies have raised their investment following the implementation of IoT-enabled solutions in their organisations. To increase safety, productivity, and environmental sustainability in mining operations, this article examines the current state of information technology in the mineral industry with an emphasis on the implications and challenges brought on by the technological diversity of various systems and devices used in those activities. The study contributes valuable insights into the integration of IoT technologies in the mining industry, highlighting its potential to improve safety, efficiency, and sustainability. The paper paves the way for future research and development efforts aimed at overcoming the challenges of adopting IIoT in mining operations by identifying gaps and proposing a comprehensive IoT architecture. The innovations of the study are encapsulated in its approach to detailing the application of IoT technologies in enhancing mining operations and the establishment of an overall IIoT architecture suitable for the general operations in the mining industry.

Collaborative Methods of Resolving Road Graphic Conflicts Based on Cartographic Rules and Generalization Operations

The resolution of road graphic conflicts is a key aspect of map generalization, which involves both scale reduction and the symbolization of map features. This study proposes collaborative methods of road graphic conflict resolution considering different road characteristics. These methods consider both geometric and semantic characteristics, and they incorporate the bend characteristics of roads, the road symbol size, and road semantics. Constrained Delaunay triangulation skeleton lines are used to categorize road graphic conflicts, which are made up of four independent conflict types and four group conflict types. Based on their characteristics, three collaborative methods are designed to deal with the different types of road graphic conflicts: collaboration between deletion and the snake displacement model, collaboration between the snake displacement model and collinearity, and collaboration among simplification, smoothing, and the beam displacement model. Two types of independent conflicts can be processed using only one simple operation. This study summarizes the cartographic rules for resolving road graphic conflicts, and these are used along with geometric features to drive the collaborative methods or one simple operation presented here. The experimental results indicate that the method proposed in this study can effectively resolve road graphic conflicts.

Demystifying the association of center-level operative trauma volume and outcomes of emergency general surgery

BackgroundRecent studies have demonstrated a positive volume-outcome relationship in emergency general surgery. Some have advocated for the sub-specialization of emergency general surgery independent from trauma. We hypothesized inferior clinical outcomes of emergency general surgery with increasing center-level operative trauma volume, potentially attributable to overall hospital quality. MethodsAdults (≥18 years) undergoing complex emergency general surgery operations (large and small bowel resection, repair of perforated peptic ulcer, lysis of adhesions, laparotomy) were identified in the 2016 to 2020 Nationwide Readmissions Database. Multivariable risk-adjusted models were developed to evaluate the association of treatment at a high-volume trauma center (reference: low-volume trauma center) with clinical and financial outcomes after emergency general surgery. To evaluate hospital quality, mortality among adult hospitalizations for acute myocardial infarction was assessed by hospital trauma volume. ResultsOf an estimated 785,793 patients undergoing a complex emergency general surgery operation, 223,116 (28.4%) were treated at a high-volume trauma center. Treatment at a high-volume trauma center was linked to 1.19 odds of in-hospital mortality (95% confidence interval 1.12–1.27). Although emergency general surgery volume was associated with decreasing predicted risk of mortality, increasing trauma volume was linked to an incremental rise in the odds of mortality after emergency general surgery. Secondary analysis revealed increased mortality for admissions for acute myocardial infarction with greater trauma volume. ConclusionWe note increased mortality for emergency general surgery and acute myocardial infarction in patients receiving treatment at high-volume trauma centers, signifying underlying structural factors to broadly affect quality. Thus, decoupling trauma and emergency general surgery services may not meaningfully improve outcomes for emergency general surgery patients. Our findings have implications for the evolving specialty of emergency general surgery, especially for the safety and continued growth of the acute care surgery model.

Association of socioeconomic vulnerability with outcomes after emergency general surgery

PurposeSocial determinants of health are increasingly recognized to shape health outcomes. Yet, the effect of socioeconomic vulnerability on outcomes after emergency general surgery remains under-studied. MethodsAll adult (≥18 years) hospitalizations for emergency general surgery operations (appendectomy, cholecystectomy, laparotomy, large bowel resection, perforated ulcer repair, or small bowel resection), within 2 days of non-elective admission were tabulated in the 2016 to 2020 Nationwide Readmissions Database. Socioeconomic vulnerability was defined using relevant diagnosis codes and comprised economic, educational, healthcare, environmental, and social needs. Patients demonstrating socioeconomic vulnerability were considered Vulnerable (others: Non-Vulnerable). Multivariable models were constructed to evaluate the independent associations between socioeconomic vulnerability and key outcomes. ResultsOf ∼1,788,942 patients, 177,764 (9.9%) were considered Vulnerable. Compared to Non-Vulnerable, Vulnerable patients were older (67 [55–77] vs 58 years [41–70), P < .001), more often insured by Medicaid (16.4 vs 12.7%, P < .001), and had a higher Elixhauser Comorbidity Index (4 [3–5] vs 2 [1–3], P < .001). After risk adjustment and with Non-Vulnerable as a reference, Vulnerable remained linked with a greater likelihood of in-hospital mortality (adjusted odds ratio 1.64, confidence interval 1.58–1.70) and any perioperative complication (adjusted odds ratio 2.02, confidence interval 1.98–2.06). Vulnerable also experienced a greater duration of stay (β+4.64 days, confidence interval +4.54–4.74) and hospitalization costs (β+$1,360, confidence interval +980–1,740). Further, the Vulnerable cohort demonstrated increased odds of non-home discharge (adjusted odds ratio 2.44, confidence interval 2.38–2.50) and non-elective readmission within 30 days of discharge (adjusted odds ratio 1.29, confidence interval 1.26–1.32). ConclusionSocioeconomic vulnerability is independently associated with greater morbidity, resource use, and readmission after emergency general surgery. Novel interventions are needed to build hospital screening and care pathways to improve disparities in outcomes.

Laparoskopik Kolesistektomi Sonrası Bulantı ve Kusmanın Önlenmesinde Deksametazon ve Gabapentinin Etkinliği ve Karşılaştırılması

Objective: Postoperative nausea and vomiting (PONV) is a common postoperative complication. The aim of this study was to investigate the efficacy of gabapentin and dexamethasone as new treatment strategies in the treatment of PONV. Methods: This retrospective study included a total of 136 ASA I-II patients aged 18-70 years who underwent elective cholecystectomy. Group D (n=66) received 4 mg intravenously dexamethasone after anesthesia induction and Group G (n=70) received 600 mg gabapentin oral treatment. Standard DII and V5 lead ECG, automatic non-invasive blood pressure and peripheral oxygen saturation monitoring was applied to all patients in the general operating room, anesthesia maintenance was provided with total intravenous anesthesia after orotracheal intubation and at the end of surgery, patients were transferred to the postoperative care unit. Nausea and vomiting symptoms, pain scores and the time and dose of additional antiemetic/analgesic requirements in the first 24 hours were monitored. Results: There were no statistically significant demographic differences between the groups and the results showed that both dexamethasone and gabapentin were effective in preventing PONV. The need for rescue antiemetic therapy was similar in both groups (p=0.2). Significantly less postoperative analgesic was required in the gabapentin group than in the dexamethasone group. Conclusion: Antiemetic drug prophylaxis should be administered to patients at high risk of PONV and treatment with different groups of antiemetic drugs should be considered. Dexamethasone and gabapentin can be considered effective drugs for the prevention of PONV. Keywords: Postoperative nausea and vomiting, dexamethasone, gabapentin, laparoscopic surgery, laparoscopic cholecystectomy

Hypoelliptic functional inequalities

In this paper we derive a variety of functional inequalities for general homogeneous invariant hypoelliptic differential operators on nilpotent Lie groups. The obtained inequalities include Hardy, Sobolev, Rellich, Hardy–Littllewood–Sobolev, Gagliardo–Nirenberg, Caffarelli–Kohn–Nirenberg and Heisenberg–Pauli–Weyl type uncertainty inequalities. Some of these estimates have been known in the case of the sub-Laplacians, however, for more general hypoelliptic operators almost all of them appear to be new as no approaches for obtaining such estimates have been available. The approach developed in this paper relies on establishing integral versions of Hardy inequalities on homogeneous Lie groups, for which we also find necessary and sufficient conditions for the weights for such inequalities to be true. Consequently, we link such integral Hardy inequalities to different hypoelliptic inequalities by using the Riesz and Bessel kernels associated to the described hypoelliptic operators.

PINK: a tender X-ray beamline for X-ray emission spectroscopy.

A high-flux beamline optimized for non-resonant X-ray emission spectroscopy (XES) in the tender X-ray energy range has been constructed at the BESSY II synchrotron source. The beamline utilizes a cryogenically cooled undulator that provides X-rays over the energy range 2.1 keV to 9.5 keV. This energy range provides access to XES [and in the future X-ray absorption spectroscopy (XAS)] studies of transition metals ranging from Ti to Cu (Kα, Kβ lines) and Zr to Ag (Lα, Lβ), as well as light elements including P, S, Cl, K and Ca (Kα, Kβ). The beamline can be operated in two modes. In PINK mode, a multilayer monochromator (E/ΔE ≃ 30-80) provides a high photon flux (1014 photons s-1 at 6 keV and 300 mA ring current), allowing non-resonant XES measurements of dilute substances. This mode is currently available for general user operation. X-ray absorption near-edge structure and resonant XAS techniques will be available after the second stage of the PINK commissioning, when a high monochromatic mode (E/ΔE ≃ 10000-40000) will be facilitated by a double-crystal monochromator. At present, the beamline incorporates two von Hamos spectrometers, enabling time-resolved XES experiments with time scales down to 0.1 s and the possibility of two-color XES experiments. This paper describes the optical scheme of the PINK beamline and the endstation. The design of the two von Hamos dispersive spectrometers and sample environment are discussed here in detail. To illustrate, XES spectra of phosphorus complexes, KCl, TiO2 and Co3O4 measured using the PINK setup are presented.

Interrupt Latency Accurate Measurement in Multiprocessing Embedded Systems by Means of a Dedicated Circuit

Modern multiprocessing embedded applications require, in many cases, two different environments on the same platform: one that meets real-time requirements and another one with a general purpose operating system. Although several technologies can be used, two of the most popular are virtualization based on hypervisors and asymmetric multiprocessing software. However, using these tools introduces latency, which must be measured to verify compliance with real-time requirements. With the aim of facilitating these measurements, this work provides a hardware tool that is more precise and easier to use than other existing software solutions. The paper also studies the interrupt latency generated by different hypervisors and asymmetric multiprocessing frameworks in a Zynq UltraScale+ platform. This research work facilitates the accurate study of the temporal response of multiprocessor embedded systems, which allows for evaluating their suitability for applications with real-time requirements.

Application of pocket-first technique for implantation of totally implantable venous access ports.

While vascular puncture is always performed before making port pocket in the implantation of totally implantable venous access ports (TIVAP), some surgeons preferred to make port pocket first. This study seeks to verify the safety and feasibility for the pocket-first technique. The study retrospectively reviewed 447 patients who undergone TIVAP implantation from July 2017 to November 2022. All the patients were divided into two groups based on vascular puncture first or making port pocket first. The general information, operation information and post-operative complications were reviewed and analyzed. All the operations were performed successfully. No difference was observed in the sex, age, height, weight, BMI, port location and total complication rate between the two groups. The operation time of the Puncture Group and the Pocket Group were 46.9 ± 22.4min and 33.8 ± 13.6min ( P<0.00001 ). In the patients of SCV approach, the operation time between the two groups were 37.4 ± 14.8min and 33.5 ± 10.9min ( P<0.05 ). Multivariate analysis showed the variable BMI and first procedure were independent prognostic factors for operation time. In the cases using SCV/AxV approach the variable first procedure was the only independent prognostic factor for operation time (P = 0.002). The pocket-first technique can be considered as a safe, feasible and convenient technique for TIVAP implantation. The time consuming is significantly shortened compared with the puncture-first technique and this advantage may be more obvious when using SCV/AxV approach.