Increase In Operative Time Research Articles

Six-year analysis of 30-day post-operative leaks for primary sleeve gastrectomy: a MBSAQIP database study.

Sleeve gastrectomy is the most performed bariatric surgery. Post-operative gastric sleeve leaks, although rare, are dreaded complications. This study aims to perform an updated investigation of the factors associated with sleeve leaks. This retrospective cohort study analyzed 692,554 cases from the MBSAQIP database (2016-2021) with CPT code 43,775 for primary sleeve gastrectomy. We excluded emergency operations, conversions/revisions, endoscopic interventions, patient with prior foregut surgery, and open operations. Multivariate logistic regression analysis (STATA version 15) was performed to identify factors associated with sleeve gastrectomy leaks. Out of 692,554 patients, 600,910 (86.77%) patients underwent laparoscopic sleeve gastrectomy, and 91,644 (13.23%) patients underwent robotic sleeve gastrectomy. 1179 (0.17%) developed leaks within 30days; 177(0.19%) were in the robotic group and 1002 (0.17%) in the laparoscopic group with no significant difference in leak rates between two groups on multivariate analysis. Black patients had lower odds of having leaks as compared to white patients (Odds Ratio (OR): 0.68 (0.56-0.82); p < 0.01). Hispanic patients had lower odds of having leak as compared to non-Hispanics. Factors associated with higher leak odds (p < 0.05) included hypertension, GERD, smoking, immunosuppression, increased operating time, and albumin < 3.5g/dl. Higher odds of leaks were observed in years 2016-2019 vs 2020-2021 (OR: 1.44 (1.25-1.65), p < 0.01). Higher odds of leak in operations with general surgeons compared to bariatric surgeons was found (OR: 1.46 (1.04-2.02), p = 0.02); observed only on robotic group on subgroup analysis (OR: 2.2 (1.2-4.2), p = 0.02). Staple line reinforcement, oversewing, and performance of leak test showed no differences in leak rate. Bougie size and distance from pylorus were not associated with changes in leak rate. This study provides updated insights into the factors associated with sleeve leaks, reinforcing information gained from prior studies. A higher association of leak among general surgeons could represent a learning curve for new robotic general surgeons. The overall decreasing trend for gastric sleeve leak is encouraging and may be a sign of improved techniques.

EAST plant data storage system based on IoTDB time series database

EAST (Experimental Advanced Superconducting Tokamak) has been in operation since 2006. With increasing operation time, the volume of plant data stored in MySQL has steadily grown to several billion rows. The current storage architecture centered around the relational database has shown poor performance when facing massive time series data, so it is crucial to adopt TSDB (Time Series Database) for storing plant data. In initial testing, IoTDB demonstrated a performance advantage of at least 2 times over other TSDBs in terms of both write throughput and large-scale queries for plant data management. However, as the inflexible underlying infrastructure of EAST, the plant database cannot be easily modified directly. To remedy this problem, we propose a MySQL-IoTDB Hierarchical Mechanism (MIHM). Specifically, we utilized a MySQL master–slave to IoTDB cluster design to seamlessly transfer the performance burden from relational database to TSDB IoTDB. Extensive tests on the EAST plant data demonstrate that MIHM-based plant data storage system has increased the write throughput by 20 times and the large-scale data querying speed by 100 times compared to previous systems.

The predictors of fungal infections after liver transplantation and the influence of fungal infections on outcomes

The primary objective of this study was to assess the incidence, timing, risk factors of fungal infections (FIs) within 3 months after liver transplantation (LT). The secondary objective was to evaluate the impact of FIs on outcomes. Four hundred and ten patients undergoing LT from January 2015 until January 2023 in a tertiary university hospital were included in the present retrospective cohort study to investigate the risk factors of FIs and to assess the impacts of FIs on the prognosis of LT recipients using logistic regression. The incidence of FIs was 12.4% (51/410), and median time from LT to the onset of FIs was 3 days. By univariate analysis, advanced recipient age, prolonged hospital stay prior to LT, high Model for End Stage Liver Disease (MELD) score, use of broad-spectrum antibiotics, and elevated white blood cell (WBC) count, increased operating time, massive blood loss and red blood cell transfusion, elevated alanine aminotransferase on day 1 and creatinine on day 3 after LT, prolonged duration of urethral catheter, prophylactic antifungal therapy, the need for mechanical ventilation and renal replacement therapy were identified as factors of increased post-LT FIs risk. Multivariate logistic regression analysis identified that recipient age ≥ 55 years[OR = 2.669, 95%CI: 1.292–5.513, P = 0.008], MELD score at LT ≥ 22[OR = 2.747, 95%CI: 1.274–5.922, P = 0.010], pre-LT WBC count ≥ 10 × 109/L[OR = 2.522, 95%CI: 1.117–5.692, P = 0.026], intraoperative blood loss ≥ 3000 ml [OR = 2.691, 95%CI: 1.262–5.738, P = 0.010], post-LT duration of urethral catheter > 4 d [OR = 3.202, 95%CI: 1.553–6.602, P = 0.002], and post-LT renal replacement therapy [OR = 5.768, 95%CI: 1.822–18.263, P = 0.003] were independently associated with the development of post-LT FIs. Post-LT prophylactic antifungal therapy ≥ 3 days was associated with a lower risk of the development of FIs [OR = 0.157, 95%CI: 0.073–0.340, P < 0.001]. As for clinical outcomes, FIs had a negative impact on intensive care unit (ICU) length of stay ≥ 7 days than those without FIs [OR = 3.027, 95% CI: 1.558–5.878, P = 0.001] but had no impact on hospital length of stay and 1-month all-cause mortality after LT. FIs are frequent complications after LT and the interval between the onset of FIs and LT was short. Risk factors for post-LT FIs included high MELD score at LT, advanced recipient age, pre-LT WBC count, massive intraoperative blood loss, prolonged post-LT duration of urethral catheter, and the need for post-LT renal replacement therapy. However, post-LT prophylactic antifungal therapy was independently associated with the reduction in the risk of FIs. FIs had a significant negative impact on ICU length of stay.

Utilization of Ureteral Access Sheath in Retrograde Intrarenal Surgery: A Systematic Review and Meta-Analysis.

Background and Objectives: This paper evaluates the efficacy and safety of ureteral access sheath (UAS) utilization in retrograde intrarenal surgery (RIRS). Materials and Methods: We searched PubMed, Embase, and the Cochrane Library up to 30 August 2023. The inclusion criteria comprised English-language original studies on RIRS with or without UAS in humans. The primary outcome was SFR, while the secondary outcomes included intraoperative and postoperative complications, the lengths of the operation and the hospitalization period, and the duration of the fluoroscopy. Subgroup analyses and a sensitivity analysis were performed. Publication bias was assessed using funnel plots and Egger's regression tests. Dichotomous variables were analyzed using odds ratios (ORs) with 95% confidence intervals (CIs), while mean differences (MDs) were employed for continuous variables. Results: We included 22 studies in our analysis. These spanned 2001 to 2023, involving 12,993 patients and 13,293 procedures. No significant difference in SFR was observed between the UAS and non-UAS groups (OR = 0.90, 95% CI 0.63-1.30, p = 0.59). Intraoperative (OR = 1.13, 95% CI 0.75-1.69, p = 0.5) and postoperative complications (OR = 1.29, 95% CI 0.89-1.87, p = 0.18) did not significantly differ between the groups. UAS usage increased operation times (MD = 8.30, 95% CI 2.51-14.10, p = 0.005) and fluoroscopy times (MD = 5.73, 95% CI 4.55-6.90, p < 0.001). No publication bias was detected for any outcome. Conclusions: In RIRS, UAS usage did not significantly affect SFR, complications, or hospitalization time. However, it increased operation time and fluoroscopy time. Routine UAS usage is not supported, and decisions should be patient-specific. Further studies with larger sample sizes and standardized assessments are needed to refine UAS utilization in RIRS.

Влияние анатомии полостной системы почек на результаты микроперкутанной нефролитотрипсии.

Introduction. The structure of the calyx-pelvic system may affect the results of treatment in patients with single and multiple renal calculi. The aim of the study was to evaluate the clinical significance of the anatomy of the renal cavity system during micropercutaneous nephrolithotripsy. Material and methods. Sixty-one patients with kidney stones up to 2 cm participated in the study. All patients were subjected to micropercutaneous nephrolithotripsy (PNL) and divided into two groups. Group A included 34 patients with single renal concrements, group B was formed by 27 patients with multiple stones. The studied parameters were: efficiency, number of percutaneous accesses, operation time, number and structure of complications. All the studied parameters were correlated with variants of the anatomical structure of the renal pelvis system according to the classification of R. Takazawa. Type I was characterized by the presence of a single pelvis, type II is represented by a branched pelvis system. Results and discussion. Operative treatment was successful in 46 (75.4%) patients. In group A, «stone-free state» was achieved in 15 (83,3%) patients with type I structure of the single pelvis and in 13 (81.3%) observations with branched pelvis (p&gt;0.05). In group B stones were removed in 11 (73,3%) cases with type I structure of the cavity system and in 7 (58,3%) patients with branched pelvis (p&lt;0,05). In patients with single stones, multiple accesses were performed only in 1 (2,9%) episode. In group B, multiple accesses were performed in 13 (48,1%) cases with a tendency to increase this indicator in type II of the pelvis structure. The average duration of operative treatment was 70,9±9 min. The operation time in the group with single stones at I and II types of the cavity architectonics was 62,5±5 min and 64,1±7 min respectively (p&gt;0,05). In group B the duration of micro-PNL in case of solitary pelvis was significantly lower than in patients with branched type of pelvis system – 80,5±6 min vs. 96,3±11 min respectively (p&lt;0,05). The total number of complications among all categories of patients amounted to 15 (24,6%) cases. In group A undesirable consequences were recorded in 3 (16,7%) observations in case of type I single pelvis and in 3 (18,8%) patients with branched pelvis (p&gt;0,05). In group B, complications were established in 4 (26,7%) patients with type I pelvis and in 5 (41,7%) cases with branched variant of the cavity system (p&lt;0,05). Conclusion. The architecture of the renal pelvis system in patients with single stones up to 2 cm does not significantly affect the results of surgery and is important only in percutaneous access. The branched type of renal cavity structure (type II according to R. Takazawa classification) is accompanied by decreased efficiency and increased operation time, number of accesses and complications in patients with multiple renal stones.

Identification of Shield Tunnel Segment Joint Opening Based on Annular Seam Pressure Monitoring.

Tunnels for subways and railways are a vital part of urban transportation systems, where shield tunneling using assembled segmental linings is the predominant construction approach. With increasing operation time and varying geological conditions, shield tunnels usually develop defects that compromise both structural integrity and operational safety. One common issue is the separation of segment joints that may cause water/mud penetration and corrosion. Existing inspection strategies can only detect openings after their occurrence, which cannot provide early warnings for predictive maintenance. To address this issue, this work proposes a multi-point seam contact pressure monitoring method for joint opening identification. It first derived the theoretical correlation between contact pressure distribution and segment opening; then, a finite element model was established to explore the stress and deformation responses under combined axial and bending loads. Finally, multi-point piezoelectric film sensors were implemented on a scaled segment model to validate the theoretical and numerical analyses. Results indicate that the multi-point monitoring method can effectively identify opening amounts at the segment joints with an average error of 8.8%, confirming the method's feasibility. These findings support the use of this monitoring technique for early detection and assessment of joint openings in shield tunnels.

Types of Short-Duration Electrical Stimulation-Induced Efficiency in the Axonal Regeneration and Recovery: Comparative in Vivo Study in Rat Model of Repaired Sciatic Nerve and its Tibial Branch after Transection Injury.

The restoration of adequate function and sensation in nerves following an injury is often insufficient. Electrical stimulation (ES) applied during nerve repair can promote axon regeneration, which may enhance the likelihood of successful functional recovery. However, increasing operation time and complexity are associated with limited clinical use of ES. This study aims to better assess whether short-duration ES types (voltage mode vs. current mode) are able to produce enhanced regenerative activity following peripheral nerve repair in rat models. Wistar rats were randomly divided into 3 groups: no ES (control), 30-minute ES with a current pulse, and 30-minute ES with a voltage pulse. All groups underwent sciatic nerve transection and repair using a silicone tube to bridge the 6-mm gap between the stumps. In the 2 groups other than the control, ES was applied after the surgical repair. Outcomes were evaluated using electrophysiology, histology, and serial walking track analysis. Biweekly walking tracks test over 12 weeks revealed that subjects that underwent ES experienced more rapid functional improvement than subjects that underwent repair alone. Electrophysiological analysis of the newly intratubular sciatic nerve at week 12 revealed strong motor function recovery in rats that underwent 30-minute ES. Histologic analysis of the sciatic nerve and its tibial branch at 12 weeks demonstrated robust axon regrowth in all groups. Both types of short-duration ES applied during nerve repair can promote axon regrowth and enhance the chances of successful functional recovery.

X-ray endovascular surgery for in-hospital acute ischemic stroke

The OBJECTIVE was to determine the efficacy of endovascular surgery for in-hospital acute ischemic stroke (AIS) and to identify predictors of unfavorable AIS outcome.METHODS AND MATERIALS. We performed 42 endovascular thrombectomies for in-hospital AIS in patients treated in the hospital for another pathology. Neurological defiCIT was determined by NIHSS scale, thrombectomy efficacy was evaluated by the degree of cerebral revascularization by mTICI scale, functional outcome was determined by Rankin scale (mRS). Multivariate analysis with evaluation of clinical and laboratory, neuroimaging data, and analysis of surgical technique was performed to identify factors contributing to adverse stroke outcome.RESULTS. The mean age of patients was 73.8±11.8 years old. Neurological defiCIT before surgery was 12.8±6.7 points by to NIHSS. Thrombolytic therapy was used in one third of cases, thrombectomy in 92.9 %, and carotid artery stent ing in 2 cases. Successful revascularization (mTICI2b-3) was achieved in 83.3 % of cases. The significant reduction in neurological defiCIT after surgery was achieved to NIHSS 6.0±5.9 points, mRS 2.7±2.1. The mortality rate amounted to 16.7 % of cases. Poor functional outcome (mRS3-5) was significantly associated with: female gender, older age, presence of cardiovascular pathology, recurrent stroke, postoperative tachycardia, low renal tubular filtration rate, hypocoagulation, low cardiac ejection fraction, low aortic valve opening amplitude, high pulmonary hypertension, large left atrial volume, initial severe neurological defiCIT, poor collaterals in the area of cerebral ischemia, proximal internal carotid artery occlusion, hemorrhagic saturation, increased operation time, low degree of revascularization (mTICI0-2a).CONCLUSION. Endovascular surgery has demonstrated its safety and high efficacy in the treatment of in-hospital AIS in surgical hospitalized patients. Endovascular thrombectomies allow to significantly reduce neurological defiCIT and decrease mortality in the severe category of patients with cardioembolic AIS. clinical, laboratory, hemodynamic and neuroimaging factors influencing on poor functional outcome of in-hospital AIS have been determined.

Evaluating the efficacy of laparoscopic radical antegrade modular pancreatosplenectomy in selected early-stage left-sided pancreatic cancer: a propensity score matching study

BackgroundLaparoscopic radical pancreatectomy is safe and beneficial for recectable pancreatic cancer, but the extent of resection for early-stage tumors remains controversial.MethodsConsecutive patients with left-sided pancreatic cancer who underwent either laparoscopic radical antegrade modular pancreatosplenectomy (LRAMPS, n = 54) or laparoscopic distal pancreatosplecnectomy (LDP, n = 131) between October 2020 and December 2022 were reviewed. The preoperative radiological selection criteria were as follows: (1) tumor diameter ≤ 4 cm; (2) located ≥ 1 cm from the celiac trunk; (3) didn’t invade the fascial layer behind the pancreas.ResultsAfter 1:1 propensity score matching (LRAMPS, n = 54; LDP, n = 54), baseline data were well-balanced with no differences. LRAMPS resulted in longer operation time (240.5 vs. 219.0 min, P = 0.020) and higher intraoperative bleeding volume (200 vs. 150 mL, P = 0.001) compared to LDP. Although LRAMPS harvested more lymph nodes (16 vs. 13, P = 0.008), there were no statistically significant differences in lymph node positivity rate (35.2% vs. 33.3%), R0 pancreatic transection margin (94.4% vs. 96.3%), and retroperitoneal margin (83.3% vs. 87.0%) rate. Postoperative complications did not significantly differ between the two groups. However, LRAMPS was associated with increased drainage volume (85.0 vs. 40.0 mL, P = 0.001), longer time to recover semi-liquid diet compared to LDP (5 vs. 4 days, P < 0.001) and increased daily bowel movement frequency. Tumor recurrence pattern and recurrence-free survival were comparable between the two groups, but the adjuvant chemotherapy regimens varied, and the completion rate of the 6-month intravenous chemotherapy was lower in the LRAMPS group compared to the LDP group (51.9% vs. 75.9%, P = 0.016).ConclusionsLRAMPS did not provide oncological benefits over LDP for left-sided pancreatic cancer within the selection criteria, but it increased operation time, intraoperative bleeding, and postoperative bowel movement frequency. These factors impacted the regimen selection and completion of adjuvant chemotherapy, consequently compromising the potential benefits of LRAMPS in achieving better local control.Graphical

Surgical Treatment for Endometrial Cancer, Hysterectomy Performed via Minimally Invasive Routes Compared with Open Surgery: A Systematic Review and Network Meta-Analysis.

Background: Total hysterectomy with bilateral salpingo-oophorectomy via minimally invasive surgery (MIS) has emerged as the standard of care for early-stage endometrial cancer (EC). Prior systematic reviews and meta-analyses have focused on outcomes reported solely from randomised controlled trials (RCTs), overlooking valuable data from non-randomised studies. This inaugural systematic review and network meta-analysis comprehensively compares clinical and oncological outcomes between MIS and open surgery for early-stage EC, incorporating evidence from randomised and non-randomised studies. Methods: This study was prospectively registered on PROSPERO (CRD42020186959). All original research of any experimental design reporting clinical and oncological outcomes of surgical treatment for endometrial cancer was included. Study selection was restricted to English-language peer-reviewed journal articles published 1 January 1995-31 December 2021. A Bayesian network meta-analysis was conducted. Results: A total of 99 studies were included in the network meta-analysis, comprising 181,716 women and 14 outcomes. Compared with open surgery, laparoscopic and robotic-assisted surgery demonstrated reduced blood loss and length of hospital stay but increased operating time. Compared with laparoscopic surgery, robotic-assisted surgery was associated with a significant reduction in ileus (OR = 0.40, 95% CrI: 0.17-0.87) and total intra-operative complications (OR = 0.38, 95% CrI: 0.17-0.75) as well as a higher disease-free survival (OR = 2.45, 95% CrI: 1.04-6.34). Conclusions: For treating early endometrial cancer, minimal-access surgery via robotic-assisted or laparoscopic techniques appears safer and more efficacious than open surgery. Robotic-assisted surgery is associated with fewer complications and favourable oncological outcomes.

The impact of resident training on robotic operative times: is there a July Effect?

It is unknown whether the July Effect (a theory that medical errors and organizational inefficiencies increase during the influx of new surgical residents) exists in urologic robotic-assisted surgery. The aim of this study was to investigate the impact of urology resident training on robotic operative times at the beginning of the academic year. A retrospective chart review was conducted for urologic robotic surgeries performed at a single institution between 2008 and 2019. Univariate and multivariate mix model analyses were performed to determine the association between operative time and patient age, estimated blood loss, case complexity, robotic surgical system (Si or Xi), and time of the academic year. Differences in surgery time and non-surgery time were assessed with/without resident presence. Operative time intervals were included in the analysis. Resident presence correlated with increased surgery time (38.6 min (p < 0.001)) and decreased non-surgery time (4.6 min (p < 0.001)). Surgery time involving residents decreased by 8.7 min after 4 months into the academic year (July–October), and by an additional 5.1 min after the next 4 months (p = 0.027, < 0.001). When compared across case types stratified by complexity, surgery time for cases with residents significantly varied. Cases without residents did not demonstrate such variability. Resident presence was associated with prolonged surgery time, with the largest effect occurring in the first 4 months and shortening later in the year. However, resident presence was associated with significantly reduced non-surgery time. These results help to understand how new trainees impact operating room times.

Optimal maintenance policies for three-unit parallel production systems considering yields

Many production facilities consist of multiple parallel units to facilitate the completion of production plans, yet these devices are inevitably prone to malfunctions with increased operating time. Therefore, developing the optimal maintenance policy to maximize the production capacity of production facilities is a crucial issue. This paper focuses on determining the optimal maintenance policy for a three-unit production system, aiming to maximize its yield. The optimal solution is provided based on the given maintenance policy, and a general optimal maintenance policy for the system is derived. The properties related to the optimal maintenance policy are analyzed. The proposed model offers two notable contributions when compared to existing research. Firstly, a maintenance policy based on the number of visits and yields is developed. Secondly, the parallel assumption of the system and the assumption that the subsystems satisfy any distribution are in line with reality, enriching the research on maintenance strategies for production systems. To illustrate the results of the model, a numerical example is presented.

Robot-assisted Microsurgery for Autologous Breast Reconstruction - Robotic Breast Reconstruction

With the introduction of novel surgical robots and surgical microscopes for the special needs of open microsurgery, the concept of robotic-assisted microsurgery is gaining popularity. While initial preclinical studies indicate a steep learning curve, favourable ergonomics and improved precision, albeit with an increased operating time, data on the clinical application of the new systems is still limited. This study describes our first clinical experience with robotic-assisted autologous breast reconstruction and outlines the opportunities and limitations of the approach. Our retrospective data analysis included a total of 28 patients who underwent unilateral robotic-assisted autologous breast reconstruction between July 2022 and August 2023. We applied a combined approach using the Symani Surgical System together with the RoboticScope. Descriptive evaluation of patient characteristics, surgical data and complications was performed. Average patient age was 54.3±11.1 years and average BMI was 26.5±3.5 kg/m2. Twenty-six patients received a DIEP flap and 2 patients received a PAP flap, the flaps being connected to the internal mammary artery in 22 cases, to a perforator of the internal mammary artery in 5 cases, and to a branch of the thoracodorsal artery in one case. The average incision-suture time was 267±89 min, with an average ischaemia time of 86±20 min and duration of the arterial anastomosis of 29±12 min. In two cases, immediate intraoperative anastomosis revision was performed, but no flap loss occurred. The results of this study demonstrate the safe feasibility of robot-assisted autologous breast reconstruction using a combination of Symani and RoboticScope. In the future, special attention should be paid to minimally invasive techniques of flap harvest and connecting vessel preparation.

Surgical impact of bilateral transient occlusion of uterine and utero-ovarian arteries during laparoscopic myomectomy

The objective of this article is to compare the amount of intraoperative blood loss during laparoscopic myomectomy when performing bilateral transient clamping of the uterine and utero-ovarian arteries versus no intervention. It´s a randomized controlled prospective study carried out in the Department of Obstetrics and Gynecology Ramón y Cajal University Hospital and HM Montepríncipe-Sanchinarro University Hospital, Madrid, Spain, in women with fibroid uterus undergoing laparoscopic myomectomy. Eighty women diagnosed with symptomatic fibroid uterus were randomly assigned to undergo laparoscopic myomectomy without additional intervention (Group A) or temporary clamping of bilateral uterine and utero-ovarian arteries prior to laparoscopic myomectomy (Group B). Estimated blood loss, operating time, length of hospital stay, and postoperative hemoglobin values were compared in both groups. The number of fibroids removed was similar in both groups (p = 0.77). Estimated blood loss was lower in the group of patients with prior occlusion of uterine arteries (p = 0.025) without increasing operating time (p = 0.17) nor length of stay (p = 0.17). No patient had either intra or postoperative complications. Only two patients (2.5%) required blood transfusion after surgery. We conclude that temporary clamping of bilateral uterine arteries prior to laparoscopic myomectomy is a safe intervention that reduces blood loss without increasing operative time.

Effectiveness of Continuous versus Interrupted Closure of Midline Wound in Emergency Laparotomies in Terms of Wound Dehiscence

Background: Midline laparotomy is widely recognized as the preferred technique for abdominal surgeries due to its simplicity and the effective exposure it provides. Despite its prevalence, the optimal method for closing the incision remains a topic of debate among surgeons, particularly when balancing the risk of wound dehiscence with the practicalities of surgical practice. The mechanical properties of suture materials and techniques, such as continuous versus interrupted suturing, directly influence wound integrity during the critical postoperative period. Objective: The aim of this study was to compare the effectiveness and complication rates of continuous versus interrupted suturing techniques in midline laparotomies, with a focus on the incidence of wound dehiscence. Methods: This randomized controlled trial included 180 patients undergoing emergency laparotomy, divided into two groups: continuous closure (Group A) and interrupted closure (Group B). The study was conducted at Lady Reading Hospital MTI, Peshawar, with ethical committee approval. Participants were informed, consented, and demographic data were recorded. Suture techniques were performed by an experienced surgeon, and patients were monitored for wound dehiscence up to the 15th postoperative day. Data were analyzed using SPSS version 25. Results: Group A reported a wound dehiscence rate of 14.4%, with an effectiveness rate of 85.6%. In comparison, Group B showed a significantly lower dehiscence rate of 5.6% and an effectiveness rate of 94.4%. The age-wise distribution of effectiveness indicated no statistically significant difference between the groups across various age ranges, with P-values ranging from 0.2766 to 0.6037. Gender-wise, males and females also did not show significant differences in effectiveness between the two groups. Conclusion: Interrupted suturing for midline laparotomy closures showed a lower incidence of wound dehiscence compared to continuous suturing. However, factors such as increased surgery time and cost, along with postoperative issues like stitch sinus formation, need consideration. Further large-scale studies are recommended to evaluate the long-term outcomes and provide a more comprehensive assessment of the two techniques.

Robot-assisted Microsurgery: Lessons Learned from 50 Consecutive Cases.

The potential of robot-assisted surgery in plastic and reconstructive surgery remains to be established, especially in free tissue transfer. This prospective study aimed to present our experience and findings from the first 50 consecutive cases of robot-assisted microsurgery using the Symani surgical system. A prospective database was maintained, recording patient demographics and surgical details for all cases of robot-assisted microsurgery in a large academic institution. All surgeons underwent an intensive training program with the Symani surgical system. A total of 50 patients who underwent robot-assisted microsurgical reconstruction were identified. Free microsurgical tissue transfer was performed in 45 cases, targeted muscle reinnervation in four cases, and lymphovenous anastomoses in a single case. A total of 94 robot-assisted anastomoses and coaptations were performed, (46 venous and 30 arterial anastomoses, 16 nerve coaptations, two lymphovenous anastomoses). Six cases involved perforator-to-perforator anastomoses. Ninety-eight percent of attempted anastomoses were completed using the robot. Size-mismatch anastomoses, seen in 37.8% of cases, took significantly longer. Minor complications occurred in three cases and major in six cases. There were three cases of microvascular compromise requiring revision. One partial flap loss and no complete flap loss occurred. Our study highlights the immense potential of robot-assisted microsurgery, and a feasible and effective modality for various microsurgical procedures, with outcomes comparable to those of conventional microsurgery. Despite challenges, such as increased operating times and higher costs, the technology offers significant advantages, such as enhanced precision and motion scaling. We identify a slow learning curve and a necessity for higher caseloads.

Meta-analysis of the effectiveness and safety of robotic-assisted versus laparoscopic transabdominal preperitoneal repair for inguinal hernia.

Inguinal hernia is a common global disease. This study aims to investigate the effectiveness and safety of robot-assisted transabdominal preperitoneal repair (RTAPP) and laparoscopic transabdominal preperitoneal repair (LTAPP) for inguinal hernia. We conducted a thorough search in Cochrane Library, Embase, and PubMed for relevant clinical studies. After applying inclusion and exclusion criteria, the quality of selected studies was assessed using the Jadad scale for randomized controlled studies and the Newcastle-Ottawa scale for observational studies. Meta-analysis was performed using RevMan 5.3 software. A total of ten studies were included, comprising two randomized controlled studies and eight non-randomized controlled studies. Meta-analysis results revealed no statistically significant differences between the RTAPP group and the LTAPP group regarding hospital stay [MD = 0.21 days, 95% CI (-0.09, 0.51), P = 0.17], incidence of seroma [OR = 0.85, 95% CI(0.45, 1.59), P = 0.61], overall complication rate [OR = 1.22, 95% CI(0.68, 2.18), P = 0.51], readmission rate [OR = 1.31, 95% CI(0.23, 7.47), P = 0.76], and recurrence rate [OR = 0.82, 95% CI(0.22, 3.07), P = 0.77]. However, the RTAPP group had longer operation time compared to the LTAPP group [MD = 14.02 minutes, 95% CI (6.65, 21.39), P = 0.0002], and the cost of the RTAPP procedure was higher than that of the LTAPP procedure [MD = $4.17 thousand, 95% CI (2.59, 5.76), P<0.00001]. RTAPP for inguinal hernia is a safe and feasible approach, however, it is associated with increased operation time and treatment costs.

Encapsulation of Er-doped GeO2 nanofilms by Al2O3 atomic layers: Surficial sensitivity to trimethylaluminum and improvement on electroluminescence

Based on previous results of the Er-doped GeO2 nanofilms fabricated by atomic layer deposition (ALD), the interfacial reactions of Al2O3 precursor within the GeO2/Al2O3:Er nanolaminates are investigated. The ALD pulse of Al(CH3)3 etches the as-deposited GeO2 nanofilm, while the oxidation of Al(CH3)3 by ozone realizes the deposition of atomic Al2O3 layer onto GeO2 surface. The Al2O3 atomic layers with ≥4 ALD cycles improve the thermal stability of the ALD GeO2 nanofilms, which restrain the formation of nanograins and also the reduction of film thickness during high-temperature annealing, giving rise to smooth GeO2/Al2O3:Er nanolaminates. For the 1530 nm electroluminescence (EL) from the silicon-based devices fabricated using the GeO2/Al2O3:Er nanolaminates annealed at 800 °C, the excitation efficiency is tripled to 22.1 %. The conduction of the energetic electrons resulting in the EL emissions still confirms to the trap-assisted tunneling mechanism within these amorphous GeO2/Al2O3:Er nanolaminates. The prototype devices based on the Al2O3-inserted nanolaminates exhibit comparatively increased operation time. These GeO2/Al2O3:Er nanolaminates with enhanced stability and improved optoelectronics performance pave the way for the practical utilization of ALD GeO2 nanofilms.

A study of early laparoscopic cholecystectomy in mild acute gallstone pancreatitis

Abstract Background: Acute pancreatitis, secondary to gallstones, is a challenging situation in terms of decision regarding the timing of surgical intervention. There are studies which show no difference in terms of conversion rate, complication rate, and technical difficulty when timings of laparoscopic cholecystectomy (LC) are performed in acute biliary pancreatitis. The present study is done to evaluate the efficacy, safety, and outcome of early LC in patients of mild gallstone pancreatitis (GP) in index hospital admission. Patients and Methods: A total of 107 patients were included in the study. The patients having mild GP were classified as per Glasgow’s modification of Ranson’s criteria underwent LC in index admission, control group A, in which LC was carried out after interval of 6–8 weeks of discharge and control B group comprised patients of gallstones who do not have pancreatitis. Results: The adhesions were mostly fibrinous in the study group and fibrous in the control A group amounting to increased operating time in the control A group.A2- Increased GB thickness and GB wall edema found in patients of acute cholecystitis in study group amounted lesser chances of GB perforation and spillage of bile, better planes of dissection because of surrounding oedematous tissue and subsequently lesser operating time. No increased intraoperative complications were noted in the study group. The total duration of hospital stay was significantly reduced in the study group. Recurrent hospital admission was observed in the control A group due to other biliary events. Conclusion: LC in the index admission decreases hospital stay and prevents further attacks of pancreatitis in future. Proper selection, categorization of patients, and early operation are not associated with any increased anesthetic and surgical hazard.

Predicting Conversion from Laparoscopic to Open Cholecystectomy Using a Perioperative Gallbladder Scoring System

Background: Gallstones and associated consequences are a leading cause of elective and emergency laparoscopic and open surgical procedures. Since the first laparoscopic Cholecystectomy in 1985, laparoscopic Cholecystectomy has been the gold standard for treating symptomatic gallstones. Several pre-operative scoring systems can tell you if a laparoscopic cholecystectomy for gall bladder surgery will be difficult based on different anatomical, imaging, and laboratory findings. However, few intraoperative scoring systems can tell if the surgery will be complicated. Some authors recently considered the most prominent essentials confronting surgeons during laparoscopic Cholecystectomy. Aim of the study: This study attempted a planned assessment of a recently reported intra-operative gallbladder scoring framework (G10) to decide if it might predict the result of surgery, essentially the ability to complete the operation laparoscopically. Patient and methods: Eight hundred thirty-seven patients admitted to laparoscopic Cholecystectomy for symptomatic gall stones were enrolled in this prospective study from 1st January 2018 to 31st 2021, performed in Rizgary and Hawler Teaching hospitals in Erbil, Iraq. Results: Among 837 patients, the mean age was 42.3 (range 14–71), 581 (69.4%) were female, and 256 (30.6%) were male. The mean operation time was 32.7 minutes, ranging from 15 to 150 minutes, and 63 (7.6%) patients were converted to open Cholecystectomy because of intraoperative difficulties. The most significant correlations were found with distended and/or contracted gall bladders, the inability to grasp the wall with traumatic forceps, an impacted stone in the Hartman's pouch, and pus or bile outside the gall bladder. Conclusion: New intraoperative scoring systems are valuable in predicting difficulties and preventing increased operation time and possible injuries; the main points of difficulties are distended or contracted gallbladder, large stone impaction, difficulty grasping the wall of the gall bladder, and the presence of bile or pus outside the gall bladder.