Minimal Access Research Articles

An emerging, less explored Subcutaneous onlay laparoscopic approach for ventral hernias with concomitant diastasis recti.

Ventral Hernia (VH) is a common issue in patients with Diastasis Recti (DR). VH with concomitant DR presents a challenging scenario for surgical repair due to complexity of abdominal wall defects. Traditional open surgical procedure is associated with prolonged discomfort and poor cosmesis and resultant patients' unacceptability. Minimal access surgery such as Sub Cutaneous Onlay Laparoscopic Approach (SCOLA), offers innovative solution in addressing both hernia defects and DR comprehensively and circumvent drawbacks of open surgery. In this prospective observational study, 33 patients with VH and DR underwent SCOLA in a tertiary care hospital in Jamnagar, India over a period of 15months. Reconstruction of abdominal wall was done by suturing hernia defect, plication of DR and onlay polypropylene mesh augmentation by using this technique. No recurrence was detected at follow up from 4 to 18month. Overall patient satisfaction rate was 90.9%. We conclude that, the SCOLA is a promising advancement in the treatment of patients of VH with DR with many benefits.

Novel technique of laparoscopic mid-urethral autologous rectus fascial sling for stress urinary incontinence.

Serious concerns have been raised over the safety of vaginal mesh tapes for stress urinary incontinence (SUI). Autologous rectus fascial sling and the more recent 'sling on a string' through a laparotomy are gaining popularity as native tissue options for SUI. We describe a novel technique of laparoscopic mid-urethral autologous rectus fascial sling for SUI. Ten patients underwent this new technique safely. At 12 months, all patients reported cure of SUI with normal voiding. The advantages of this technique include the minimal access approach, introduction of the sutures under laparoscopic guidance, and avoidance of over-tightening of the sling.

Hestia to Demeter: Reducing Agrochemical Pollution to Empower Women Farmers

The 2020 Farm to Fork strategy by the European Commission aimed to reduce agrochemical pollutants and protect biodiversity but stirred controversy due to conflicts between intensive agriculture demands and environmental priorities. Strict limits on agrochemical residues required farmers to produce less. The de-intensification and agroecology prone policy impacted livelihoods, sparking political upheaval. Due to lack of pesticide alternatives and extension services, Lebanese exports have faced challenges complying with residue restrictions. Agricultural laborers and consumers are exposed to high levels of pesticide residue. Undocumented refugee women form a significant part of the agricultural workforce, and women led agricultural cooperatives have minimal access to funding, exacerbating gender inequity. The American University of Beirut (AUB) has played a pivotal role in agroecology research, rural development, and gender equity. Knowledge transfer promotes civic awareness and private sector partnerships. Local Natural enemies and parasites emerged as a residue-free alternative to agrochemicals. Biocontrol-based integrated pest management holds great potential for mitigating pesticides hazards to human and environmental health. Launching the “natural predators” initiative from women-run farms holds a great promise in dually resolving the problems of agrochemical pollution and gender equity in the agricultural sector. Empowering women in agriculture aims to transform their role from care work to farm management. This paper focuses on the technical aspects of developing “natural enemies” as pesticides alternative for Lebanese agriculture, aiming to overcome export challenges and revitalize the economy. "Farm to Fork meets Hestia to Demeter" underscores AUB's commitment to sustainability aligns climate action with gender equity. By supporting women entrepreneurs and addressing climate change's impact on public health, the initiative contributes to AUB's broader mission of advancing Lebanon and the region through Education for Sustainable Development.

The role of clinical exchange programs in postgraduate obgyn training: A case-study of the FIGO-WATOG One World Exchange.

To evaluate the role of clinical exchange programs in postgraduate obgyn training using the International Federation of Gynecology and Obstetrics (FIGO)-World Association of Trainees in Obstetrics and Gynecology (WATOG) One World Exchange (OWE), a clinical exchange program held in France in October 2023, as a case-study. This was a cross-sectional study. A 31-item structured questionnaire designed with Google Forms was electronically distributed to the 51 obgyn postgraduate trainees (OWE fellows) who participated in the OWE, to collect information about the exchange. Collected data was analyzed using IBM Statistical Product and Service Solutions (SPSS) Statistics for Windows. The survey response rate was 68.6%. The mean age of the respondents was 33.0 ± 4.0 years. Majority of the them were females (26, 74.3%), married (19, 54.3%), at least in their third year of training (30, 85.7%) and from Africa (11, 31.4%). During the period of the exchange program, fellows observed various obstetric and gynecologic procedures, including open and minimal access procedures, with more than one-fifth (8, 22.9%) of them reporting that they were allowed to assist in some of these procedures. The fellows noted salient differences in practice between their exchange hospitals and their home countries. An overwhelming majority (30, 85.7%) of the fellows believed the OWE was beneficial and would positively impact their clinical practices back in their home countries. Clinical exchange programs like the OWE provide valuable benefits in improving the clinical knowledge and skills of postgraduate obgyn trainees.

Active constrained motion control for a robot-assisted endoscope manipulator in pediatric minimal access surgery.

Robot-assisted laparoscopic surgery has three main system requirements: safety, simplicity, and intuitiveness. However, accidental movement of the endoscope due to body fatigue and misunderstanding of the verbal orders between the surgeon and assistant will contribute to highly unexpected tool-tissue interactions, particularly in pediatric minimal access surgery with restricted working space. This study introduces a compact, lightweight endoscope manipulator with a mechanical remote-center-motion function. Using a custom-designed human-machine interface, the surgeon can intuitively control the movement of the endoscope manipulator over their view. In addition, an active constrained motion control algorithm is proposed to generate a forbidden-region constraint for avoiding collisions between the endoscope tip and surrounding organs in a pediatric abdominal cavity with restricted space. Simulations and experiments demonstrate the performance of the proposed compact endoscope manipulator and the active constrained surface tracking control scheme.

Meningkatkan Kemampuan Bernalar Kritis Peserta Didik Pada PAK Dengan Model Pembelajaran PBL Berbantu Power Point Kelas 8 SMP N 2 Wonoboyo Satu Atap Temanggung

Education in Indonesia plays a crucial role in forming competent and competitive human resources. However, despite various reforms, the Indonesian education system still faces various challenges. One of them is the gap in the quality of education between regions, which is reflected in the differences in the results of the National Examination and the Human Development Index (HDI) in various provinces. In response to this, the government implemented the Independent Curriculum which aims to increase learning flexibility and develop 21st-century competencies in students. However, its implementation is still constrained, especially in remote areas with minimal access to quality learning resources. SMP N 2 Wonoboyo Satu Atap in Temanggung Regency, Central Java, is an example of a school that faces this challenge. Located on a mountain slope with limited access, this school serves a community that is predominantly a farmer. This condition has an impact on educational priorities that are often neglected due to economic demands. One of the main problems in this school is the low critical thinking skills of students, especially in Catholic religious subjects. The causal factors include limited learning media, monotonous teaching methods, and lack of support for learning at home. To overcome this problem, innovation in learning methods is needed. Problem-Based Learning (PBL) approach supported by power point media can be a solution. This method invites students to actively solve real problems that are relevant to the subject matter. Based on this background, Classroom Action Research entitled "Improving Students' Critical Reasoning Skills in PAK with PBL Learning Model Assisted by Power Point Class 8 SMP N 2 Wonoboyo Satu Atap Temanggung" is expected to improve students' critical reasoning skills.

Challenges of minimally- invasive orthopaedic surgery practice in Nigeria - a national survey of residents’ perceptive

Background: Minimally invasive orthopaedic surgery (MIOS) practice globally has been on a gradual increase, however the current state in Nigeria is not same. Objectives: To determine the challenges of minimally invasive orthopaedic surgery (MIOS) practice in Nigeria and proffer realistic suggestions to improve the current state in Nigeria. Methodology: A descriptive cross-sectional online survey conducted among senior orthopaedic surgery residents across all specialist hospitals in Nigeria. Data was analysed with the SPSS software version 20. Significance was set at p<0.05. Mean and S.D scores were calculated for responses with Likert scales of 1-5 (5- strongly agree). Results: 48 residents completed and submitted the questionnaire, response rate of about 70.6%.The results showed that the most significant factors affecting minimally invasive orthopaedic surgery practice in Nigeria were lack of funds (72.9% of respondents), unavailability of equipment and implants (60.4%), limited number of trainers and fellows skilled in minimal access surgery (54.2%). The narrowest Standard deviation reflecting closest precisions in perspectives of the challenges was a S.D of 0.794, Mean 4.02, which stated that there are very few courses on training of MIOS procedures. Conclusion: Funds, training, equipment availability were the major challenges of minimally invasive orthopaedic surgery practice in Nigeria. Keywords: Minimally- invasive orthopaedic surgery; residents’ perceptive; Nigeria.

A comparison of surgical outcomes of endoscopic versus microscopic myringoplasty

BackgroundThere is a gradual transition from open to minimal access surgeries in Otorhinolaryngology. Myringoplasty can be done with either microscope or endoscope. Use of both the techniques has been reported in literature. However, there is no clear consensus over which is better than the other. The current study was done with the aim of comparing the hearing outcomes post myringoplasty by endoscopic versus microscopic technique. MethodsHundred patients of chronic otitis media mucosal inactive were recruited and divided into two groups, A and B. The patients in group A underwent endoscopic myringoplasty while those in group B underwent conventional microscopic myringoplasty. All patients underwent pure tone audiometry (PTA) and oto-endoscopy prior to and six months post-surgery. The study outcomes in the form of air-bone (AB) gap on PTA, successful closure of tympanic membrane perforation, pain scores, duration of hospital stay and occurrence of complications were compared. ResultsThe post-operative AB gap on PTA and pain score was lesser in the endoscopic technique as compared to microscopic technique. The reduction in AB gap post-surgery, duration of hospital stay, proportion of patients with closure of AB gap to ≤10 dB, successful closure of tympanic membrane perforation, and taste alteration were similar in both groups. ConclusionEndoscopic technique for myringoplasty can be recommended in view of similar or slightly better surgical and functional outcomes, wider field of view and better visualisation of middle ear by the endoscopes.

Robotic-assisted versus video-assisted thoracoscopic surgery for thymic epithelial tumours, from the European Society of Thoracic Surgeons Database.

Minimally invasive thymectomy is an accepted approach for early-stage thymic epithelial neoplasia, reducing pain and length of stay compared with open surgery. In this study, we compare robotic and video-assisted thymectomy to assess pathological resection status, overall and disease-free survival. Data were retrieved from the European Society of Thoracic Surgeons prospectively maintained thymic database. Eighty-two international centres were invited to participate in the ESTS registry. Thirty-seven centres agreed to take part. We included all patients who had undergone complete thymectomy for malignancy through a minimally invasive approach and excluded patients in whom complete data were not available. Between October 2001 and May 2021, a total of 899 patients with thymic malignancy underwent minimal access surgical resection and were included in the study. A propensity matched analysis was conducted with interrogation of 732 patients. Median age was 55 years, and 408 (56%) patients were female. Propensity matched was performed with 1:1 matching for surgical approach (video assisted = 366, robot assisted = 366). Robot-assisted surgery conferred significantly lower odds of incomplete resection (R1; 0.203 95% CI 0.13-0.317; P < 0.001). However, there was no difference in terms of overall and disease-free survival between the 2 techniques. In this analysis, after adjusting for thymoma stage, the odds of incomplete surgical resection were higher in patients undergoing video-assisted surgery than robotic. However, there was no difference in overall or disease-free survival. With data maturation and increased follow-up, this would need repeat analysis and perhaps may provide more credence to the concept of a prospective randomized study to compare outcomes in thymic epithelial neoplasia by surgical approach with a standardized pathological work-up.

Less-Invasive Technique for Non-stabilized Mandibular Fracture in Mouse Models.

Non-stabilized fractures can be made at mandibular sites in mice, thus making it possible to analyze bone repair using an endochondral ossification mode. To most accurately reflect this process in vivo, it is necessary to have a standardized protocol to avoid excessive bone loss and soft tissue damage, particularly at the mandibular site, an anatomical site characterized by minimal access. To our knowledge, we describe for the first time a less-invasive protocol of non-stabilized mandibular fracture in mice. Adult mice are anesthetized with isoflurane and receive a preoperative dose of buprenorphine by subcutaneous injection. A submandibular approach is performed, with a skin incision made along the inferior border of the mandible. The masseter muscle is elevated in a subperiosteal plane along the mandibular ramus with a periosteal elevator. A vertical and complete fracture of the ramus is performed from the basilar border to the coronoid notch (between condylar and coronoid processes), using a piezoelectric bone surgery device under saline serum irrigation at the basilar edge and scissors to complete the fracture of the mandibular ramus. The skin approach is closed by silk sutures. This detailed procedure for non-stabilized mandibular fractures offers an efficient procedure allowing minimal bone loss and soft tissue damage. This technique ensures successful and consistent results to accurately reflect the process of endochondral bone repair in mouse models.

Intranasal therapies for neonatal hypoxic-ischemic encephalopathy: Systematic review, synthesis, and implications for global accessibility to care.

Neonatal hypoxic-ischemic encephalopathy (HIE) is the leading cause of neurodevelopmental morbidity in term infants worldwide. Incidence of HIE is highest in low and middle-income communities with minimal access to neonatal intensive care and an underdeveloped infrastructure for advanced neurologic interventions. Moreover, therapeutic hypothermia, standard of care for HIE in high resourced settings, is shown to be ineffective in low and middle-income communities. With their low cost, ease of administration, and capacity to potently target the central nervous system, intranasal therapies pose a unique opportunity to be a more globally accessible treatment for neonatal HIE. Intranasal experimental therapeutics have been studied in both rodent and piglet models, but no intranasal therapeutics for neonatal HIE have undergone human clinical trials. Additional research must be done to expand the array of treatments available for use as intranasal therapies for neonatal HIE thus improving the neurologic outcomes of infants worldwide.

Comparative evaluation of different endodontic access cavity designs on canal transportation and centering ability using bondent platinum file system on mandibular molar – An in vitro cone-beam computed tomography study

ABSTRACT Aim: This study aimed to compare the effects of different endodontic access cavity designs on canal transportation (CT) and centering ability (CA) using the bondent platinum file system on mandibular molars, utilizing cone-beam computed tomography (CBCT). Methodology: Thirty extracted human permanent mandibular molars which fulfilled the inclusion criteria were divided into three groups, Group 1 (TEC): Traditional endodontic access cavity (control group), Group 2 (CEC): Conservative endodontic access cavity, and Group 3 (TrEC): Truss endodontic access cavity. The teeth were scanned using CBCT initially followed by random allocation into three groups. Root canals were prepared using Bondent platinum file system in mesiobuccal and mesiolingual canals using #25.06 file and in distal canal #30.06 file. Postpreparation, CBCT scans to assess CT and CA at 3 mm, 5 mm, and 7 mm from the apex. Data analysis was performed using a one-way analysis of variance and Tukey’s post hoc test. Results: Significant differences (P &lt; 0.01) in mean CT and CA were observed between Group 1 (TEC) and Groups 2 (CEC) and 3 (TrEC). Dentin removal was highest at 3 mm, followed by 5 mm and 7 mm. The distal canal showed the greatest dentin loss compared to other canals. Conclusion: Minimal access cavity designs (CEC and TrEC) demonstrated less CT and improved CA compared to the traditional access cavity design (TEC). Study limitations acknowledged that conservative access cavity designs result in less deviation (CT) and better centering of the prepared canals compared to the traditional approach (TEC). These results imply the potential benefits of adopting less invasive access cavity designs in endodontic practice to enhance treatment outcomes.

Navigating the barriers to multi-regional research administrative data access: Forward thinking solutions

In 2021, aware of both the importance of pan-Canadian data access for advancing health research and the conditions and requirements that make administrative data access onerous, HDRN Canada worked with CATCO the Canadian arm of an international COVID-19 clinical trial to create a roadmap for navigating the barriers to multi-regional administrative data access in Canada. While developing the roadmap, data access request processes were studied in real time for a multi-region study seeking access to link administrative data to clinical trial data, at the individual level. The intent was to move beyond anecdotal evidence and document the specific nature of policy and processes that hamper data access. The case study allowed the study team to define the barriers permitting application of tangible mitigating measures. In 2022, barriers such as the lack of ability to share data across provincial borders became too great to continue the study. Although the roadmap was not completed, insights were gained for waypoints along the path enabling HDRN Canada to make important process improvement to harmonize data access across regions. Solutions to challenges with data access request forms, regional data flows, data sharing partner relationships, data sharing agreements, and REB and project reviews were identified. Recently pan-Canadian initiatives have released important guidance for addressing data access challenges. The adoption of this guidance is paramount to ensure Canada continues to meaningfully contribute to health research. Forward thinking solutions to data access challenges today will establish the necessary infrastructure for a future with minimal data access barriers.

Sexual and reproductive health focus group discussions with Syrian men and women living as refugees in the Bekaa Valley, Lebanon

BackgroundConflict in Syria since 2011 led to over one million Syrians fleeing to Lebanon, predominantly from economically disadvantaged areas with low literacy and high child marriage rates. Over 90% live in extreme poverty, in informal tented settlements with minimal access to education, healthcare or employment. Displacement and poverty have further increased early marriages and unplanned pregnancies, and curtailed access to sexual and reproductive healthcare (SRH) in the Bekaa valley. This is exacerbated by increasing rates of sexual and gender-based violence (SGBV), intimate partner violence and domestic violence.Study designWe aimed to explore SRH beliefs and practices and teach on key SRH topics through focus group discussions (FGD) and questionnaires, co-designed with Syrian practitioners, conducted with Syrian men and women. FGD were recorded, transcribed and thematically analysed. Questionnaires collected demographics and explored SRH beliefs and practices.Findings24 FGD with 203 participants, 72.4% female and 27.6% men. 90.1% participants were married with an average age-gap of 6.3 years between partners. Teenage marriage rates were 55.6% for women, and 47.4% delivered their first child before the age of 20. 43.6% participants were not using any contraception. Findings demonstrate the impacts of SRH cultural norms and changes due to displacement, financial crisis, and increased exposure to technology and NGOs.ConclusionsSRH is multifaceted and contested, requiring systemic improvements in access to care, employment and education. This small but important proof-of-concept study demonstrates the possibility of engaging men and women in SRH discussion; paramount to empowering communities and challenging intergenerational SGBV.

Comparing oncological outcomes of robotic versus open surgery in the treatment of endometrial cancer.

Robotic surgery has been incorporated in the treatment of endometrial cancer, with evidence suggesting that minimal access surgery offers advantages over laparotomy including less blood loss, lower rate of perioperative complications, and accelerated postoperative recovery. The laparoscopic approach to cervical cancer (LACC) study has recently demonstrated inferior survival outcomes in cervical cancer patients treated with minimal access surgery including robotic surgery. It is, therefore, imperative that further evaluation of the latter in endometrial cancer is performed. A retrospective analysis of clinical data was performed. We compared two different types of surgery performed for the treatment of FIGO stage 1 to 3 endometrial cancer; open surgery performed in the years 2013-2015 vs robotic surgery performed in 2017-2019, after the implementation of the robotic program in our institution. Main outcome measures were recurrence-free survival and overall survival, with secondary outcomes including surgical morbidity and postoperative recovery. We compared 123 patients who had open surgery with 104 patients who underwent robotic surgery. One case from the second group was converted to open surgery due to the inability to complete it robotically. After a median follow-up of 68months, there was no difference in recurrence-free survival or overall survival between the two groups. Length of stay after an operation was significantly different with mean hospital stay of 1.6days after robotic surgery and 5days after open surgery (p = 0.001). No significant difference was identified in the rate of complications (p = 0.304). Our analysis has demonstrated that robotic surgery offers better perioperative outcomes without compromising the oncological safety.

The Texas Landscape: Accounting for Migrant Mortality and the Challenges of a Justice of the Peace Medicolegal System

Executive Summary This paper details the structural and resource challenges in Texas related to identifying migrant decedents, investigating their deaths, repatriating them, and adhering to legal and ethical requirements in addressing this humanitarian tragedy. While actors working on migrant decedent investigations in Arizona can map and provide accurate counts of migrant deaths, this is not yet possible for Texas cases. Texas’ mixed Medical Examiner/Justice of the Peace medicolegal system suffers from fragmentation across county jurisdictions, lack of resources, and minimal access to investigative tools for transnational families. These challenges produce a landscape where unidentified presumed migrants may structurally disappear (e.g., buried in temporarily marked graves as unidentified persons with no investigation or case tracking). The article highlights the work of Operation Identification (OpID), a humanitarian project formed to assist border counties with recovering, identifying, and repatriating migrant decedents. OpID’s extensive community outreach and collaboration with governmental and nongovernmental partners in the United States and Latin America have improved practices in some Texas counties. However, systemic change is still needed to address this humanitarian disaster. The article proposes that presumed migrant decedents be managed using a disaster victim identification (DVI) approach, which prioritizes identification, rather than how and why someone dies. It also proposes the establishment of regional Migrant Identification Centers (MICs) to streamline identification and repatriation efforts, while ensuring compliance with Texas law by Justices of the Peace (JPs). Centralization, the article argues, can lead to more accurate counts of migrant deaths and lay the groundwork for greater resources. The article also supports increased access to national databases including the National Combined DNA Indexing System (CODIS) and the National Missing and Unidentified Persons System (NamUs). It argues that transnational families of missing persons be afforded expanded access to investigative tools (e.g., NamUs)

Analisis Hubungan Antara Kualitas Air Bersih dengan Kejadian Penyakit Diare di Wilyah Kerja Puskesmas Tobeo Utara Kabupaten Halmahera Utara

Background: Diarrhea is one of the diseases based on the environment, poor sanitation such as minimal access to clean water, the existence of poor human feces disposal and poor personal hygiene greatly affect the increase in diarrhea cases. Diarrhea itself in the North Tobelo Health Center is 1,090 cases. This study aims to determine the relationship between well construction, well distance and clean water quality to the incidence of diarrhea.Methods: The sample in this study was 88 respondents. The sampling technique used was simple random sampling..Result: The results of this study indicate that there is a significant relationship between well construction and clean water quality and the incidence of diarrhea (p-value 0.001), there is a significant relationship between well distance and clean water quality and the incidence of diarrhea (p-value 0.004), there is a significant relationship between clean water quality and the incidence of diarrhea (p-value 0.004)Conclusion : There is a significant relationship between well construction, the distance of the well from the source of pollution and the quality of clean water that does not meet the requirements.

Sexual harassment prevention application with a Moerija Cultural approach for students with special needs

In Indonesia, the government is trying to safeguard and protect children from sexual crimes. Sexual crimes are particularly vulnerable to students with special needs. These students have limitations and minimal access to sexual education, making them frequent targets of sexual harassment and abuse. Students with special needs are at a higher risk of becoming victims of sexual violence due to their unique vulnerabilities. The impact of such abuse includes inferiority, anxiety, panic, and even depression. This must be addressed immediately, as it can disrupt the psychological and emotional development of students with special needs, hindering their potential to thrive and compete in the increasingly competitive digital era. The aim of this community service activity is to provide digital media with a local Moerija cultural approach to introduce sexual and application-based education. The method used in these community service activities is participant active learning, ensuring engagement and practical application. The results obtained are the development of an application designed to prevent sexual violence, utilizing a culturally relevant Moerija approach to raise awareness and enhance protective measures.

Minimal Access vs Conventional Nipple-Sparing Mastectomy

While nipple-sparing mastectomy (NSM) for breast cancer was only performed using the open method in the past, its frequency using endoscopic and robotic surgical instruments has been increasing rapidly. However, there are limited studies regarding postoperative complications and the benefits and drawbacks of minimal access NSM (M-NSM) compared with conventional NSM (C-NSM). To examine the differences in postoperative complications between C-NSM and M-NSM. This was a retrospective multicenter cohort study enrolling 1583 female patients aged 19 years and older with breast cancer who underwent NSM at 21 university hospitals in Korea between January 2018 and December 2020. Those with mastectomy without preserving the nipple-areolar complex (NAC), clinical or pathological malignancy in the NAC, inflammatory breast cancer, breast cancer infiltrating the chest wall or skin, metastatic breast cancer, or insufficient medical records were excluded. Data were analyzed from November 2021 to March 2024. M-NSM or C-NSM. Clinicopathological factors and postoperative complications within 3 months of surgery were assessed. Statistical analyses, including logistic regression, were used to identify the factors associated with complications. There were 1356 individuals (mean [SD] age, 45.47 [8.56] years) undergoing C-NSM and 227 (mean [SD] age, 45.41 [7.99] years) undergoing M-NSM (35 endoscopy assisted and 192 robot assisted). There was no significant difference between the 2 groups regarding short- and long-term postoperative complications (<30 days: C-NSM, 465 of 1356 [34.29%] vs M-NSM, 73 of 227 [32.16%]; P = .53; <90 days: C-NSM, 525 of 1356 [38.72%] vs M-NSM, 73 of 227 [32.16%]; P = .06). Nipple-areolar complex necrosis was more common in the long term after C-NSM than M-NSM (C-NSM, 91 of 1356 [6.71%] vs M-NSM, 5 of 227 [2.20%]; P = .04). Wound infection occurred more frequently after M-NSM (C-NSM, 58 of 1356 [4.28%] vs M-NSM, 18 of 227 [7.93%]; P = .03). Postoperative seroma occurred more frequently after C-NSM (C-NSM, 193 of 1356 [14.23%] vs M-NSM, 21 of 227 [9.25%]; P = .04). Mild or severe breast ptosis was a significant risk factor for nipple or areolar necrosis (odds ratio [OR], 4.75; 95% CI, 1.66-13.60; P = .004 and OR, 8.78; 95% CI, 1.88-41.02; P = .006, respectively). Conversely, use of a midaxillary, anterior axillary, or axillary incision was associated with a lower risk of necrosis (OR for other incisions, 32.72; 95% CI, 2.11-508.36; P = .01). Necrosis occurred significantly less often in direct-to-implant breast reconstruction compared to other breast reconstructions (OR, 2.85; 95% CI, 1.11-7.34; P = .03). The similar complication rates between C-NSM and M-NSM demonstrates that both methods were equally safe, allowing the choice to be guided by patient preferences and specific needs.

ICTS and e-Governance in Africa

Information and Communication Systems (ICTs) have widely affected the world of governance which has led to a growth in e-governance in African countries. Public institutions have slowly adapted ICTs in order to achieve new levels of efficiency and more effective means of service delivery. These technologies continue to strengthen not only communication with society, but also further fosters the accountability and transparency of governments and government officials. A common dispute against ICTs in Africa is based on the knowledge that some African countries have a questionable ICT readiness due to weak infrastructure. For instance, Frans and Pather (2021:1) elaborate on the costliness of data in a country like South Africa which has easily led to numerous households having minimal access to the internet. Furthermore, due to high levels of poverty and rural areas in some African countries, many people do not have access to smartphones, nevertheless data or internet connection. However, in this time, the Covid-19 pandemic has accentuated the need to be 'in the know' for many people, which has thus led to a high demand for ICTs in countries (Frans and Pather, 2021:1). With the assistance and utilisation of secondary sources, this paper aims to highlight the benefits that come with incorporating ICTs in government as a mechanism to foster a relationship between government and its people. Through the consideration and incorporation of governance principles such as accountability, transparency, decision-making and participation, this paper will elaborate on how these principles can be achieved in African countries through the use of ICTs in governance. This research will further observe the following countries as case studies: Ghana, Rwanda, Egypt, Kenya and South Africa. The study analyses these countries’ approaches in incorporating ICT and how it has benefitted them and will further benefit them. It will explore various aspects that determine a country's ICT readiness whilst further considering the risks, limitations and benefits that an incorporation of ICTs in governance brings. Keywords: ICTs, Technology, Governance, Governments