Open Approach Research Articles

Static Versus Expandable Cages in Minimally Invasive Lateral Lumbar Interbody Fusion

Study Design: A meta-analysis approach to a systematic review. Objective: Perform a systematic review to identify all reports directly comparing outcomes of lateral lumbar interbody fusion (LLIF) using static versus expandable interbody cages. Specifically focusing on periprocedural complications, intraoperative morbidity, and fusion outcomes. Summary of Background Data: Minimally invasive surgical techniques, particularly LLIF, have gained popularity for their potential to reduce muscle and soft tissue dissection, leading to faster postoperative recovery. LLIF has been associated with fewer complications compared with open posterior approaches. The introduction of expandable lumbar interbody devices aims to further reduce surgical difficulty and potential complications. However, concerns include a small graft window due to the expansion mechanism and higher costs. Methods: The Web of Science, Scopus, and PubMed databases were systematically queried in accordance with PRISMA guidelines to identify articles comparing outcomes following LLIF using static and expandable interbodies. The Newcastle-Ottawa Scale (NOS) was employed to assess the risk of bias (ROB) in the selected studies. Extracted data underwent effect-size meta-analysis with the PyMARE library, using P<0.05 to define statistical significance. Results: Of the 77 identified articles, 4 studies comprising 283 patients (mean age: 67.1 y, 55.8% female) met the inclusion and exclusion criteria. A total of 150 patients (53%) were treated with static interbodies compared with 133 (47%) receiving expandable interbodies. The groups did not differ significantly with respect to operative time (P=0.59), blood loss (P=0.89), length of stay (P=0.78), subsidence (P=0.49), 24-month mean disc height (P=0.11), 24-month mean ODI (P=0.58), or 24-month mean visual analog scale (VAS) back pain (P=0.81). The expandable group saw a trend toward improved fusion rates (97% vs. 92%, P=0.06). Conclusions: The present meta-analysis suggests the use of expandable (vs. static) interbodies in LLIF surgery may result in similar surgical morbidity, subsidence, and decompression. Further prospective comparative studies are merited to validate these results.

Postoperative outcomes after splenectomy: a 20-year single-center experience in Colombia.

Splenectomy indications are well documented; however, several infectious complications and potentially life-threatening conditions could arise after splenectomy. We aim to describe a 20-year single-center experience of postoperative outcomes after splenectomy and perform a subgroup analysis according to approach and surgical setting with a 30-day, 90-day, and 1-year follow-up. A retrospective cohort study was conducted between 2003 and 2023. We included all patients aged 18 years and older who underwent splenectomy. A description of clinical and operative variables with infectious outcomes was performed. Subgroup analyses were performed between open or laparoscopic approach and surgical setting. A total of 134 patients were included. Female patients constituted 52.99% (n = 71) of cases, with a mean age of 51.01 ± 20.79 years. The most frequent surgical indication for splenectomy was trauma in 31.34% (n = 42), and a laparoscopic approach was indicated in 41.79% (n = 56). Overwhelming post-splenectomy syndrome (OPSI) was evidenced in 2.24% (n = 3) of the population. Surgical characteristics such as operative time, intraoperative blood loss, and intensive care requirement and unit length of stay were higher in open and trauma patients. Our data describe the demographic, clinical and operative characteristics of patients undergoing splenectomy in Colombia, providing a solid basis for future research. The results obtained on overwhelming postsplenectomy syndrome (OPSI) and postoperative complications are comparable with those reported in the international literature, reinforcing the validity of our findings. Further prospective studies in this population are needed to optimize management strategies and improve clinical outcomes, particularly in higher risk subgroups.

Diverting ileostomy for treatment of ileoanal pouch dysfunction: a technical note.

The ileal pouch-anal anastomosis (IPAA) is a restorative procedure performed after proctocolectomy to improve quality of life in patients with colorectal conditions like ulcerative colitis, familial adenomatous polyposis, and selected cases of Crohn's disease and Lynch syndrome. However, severe pouch dysfunction can occur, often necessitating further surgical intervention. This technical note aims to describe the operative approach and perioperative management for diverting ileostomy as a treatment for dysfunctional ileoanal pouches. Indications for the procedure include complications such as pelvic sepsis, pouchitis, fistulas, and Crohn's disease of the pouch. Preoperative planning involves a multidisciplinary team, stoma site marking, and imaging to assess bowel integrity. The surgical technique utilizes laparoscopic access with careful adhesiolysis to minimize bowel injury, with intraoperative pouchoscopy to identify anatomical landmarks. An ileostomy is created by selecting a tension-free small bowel segment and approximating it to a pre-marked stoma site. Attention is given to preserving bowel length to allow for potential future restorative procedures. Postoperative care focuses on stoma management and addressing ongoing pouch dysfunction symptoms. Diverting ileostomy offers symptom relief for patients with pouch dysfunction while avoiding more complex procedures like pouch excision. It is a valuable option in managing pouch failure.

Clinical efficacy of open palmar approach combined with distal radial cancellous bone transplantation and internal fixation in the treatment of scaphoid nonunion

BackgroundTo investigate the clinical efficacy of the open palmar approach combined with distal radial cancellous bone transplantation and internal fixation in the treatment of scaphoid nonunion.MethodsFrom March 2019 to March 2022, our center conducted a clinical observation on 19 patients with scaphoid nonunion, including 14 males and 5 females, aged 18–63 years, with an average age of (43.5 ± 15.5) years. The surgical approach involved open palmar access combined with distal radial cancellous bone transplantation and internal fixation, followed by three months of immobilization with a splint. Postoperative x-ray examinations were performed at 6 months to observe bone graft healing and functional recovery.ResultsFollow-up of the 19 patients ranged from 6 to 24 months, with an average of 18 months. All patients achieved bony union, with an average healing time of 6 months. Postoperatively, wrist joint function was assessed using the modified Mayo wrist joint function scoring criteria: excellent in 15 cases, good in 2 cases; an excellent and good rate of 89.5%.ConclusionThe open palmar approach combined with distal radial cancellous bone transplantation and internal fixation is effective in treating scaphoid nonunion. The procedure is minimally invasive, allowing complete exposure of the fractured end of the scaphoid and the distal radius through the same incision. It facilitates easy cleaning of the fracture end, as well as convenient bone harvesting, grafting, and internal fixation. The postoperative efficacy is reliable, demonstrating significant advantages in the treatment of scaphoid nonunion.

Endovascular Repair of Zone 0 Ascending Aortic Aneurysm: A Review of Current Knowledge and Developing Technology.

Aortic aneurysms represent the 15th leading cause of death in men and women over 55 years of age. Where historically these lesions were all addressed via an open approach, endovascular aortic repair has entirely altered the way that surgeons approach aortic lesions. Although it was initially employed for patients who were poor surgical candidates, endovascular repair is now standard for abdominal aortic aneurysms and aneurysms in the descending thoracic aorta. Open surgery remains the gold standard for management of ascending aneurysms, in part due to the limitations portended by the anatomy of the ascending aorta, although increasing evidence suggests that endovascular approaches are feasible and may sometimes be optimal for patient outcomes. Here, we present some of the anatomical and technical challenges of the endovascular approach to these "Zone 0" aneurysms, the associated complications, and the current state of device development.

MS O09 - OGC Long-term oncological outcomes following totally minimally invasive, hybrid and open oesophagectomy for cancer

Abstract Background There has been a significant shift in the surgical management of oesophageal cancer, with increased popularity of minimally invasive oesophagectomy in comparison to open approaches. Data thus far has largely focused on the peri-operative and short-term benefits with limited study on long-term oncological outcomes. This study aims to explore patterns of oesophageal cancer recurrence and survival following minimally invasive and open oesophagectomy. Method This was a retrospective review of consecutive patients who underwent open (OO), hybrid (HO) and minimally invasive (MIO) oesophagectomy for cancer at a regional oesophago-gastric centre in the UK between 2014-2023. Follow-up data was obtained from the centre’s established surgical database, in addition to the regional radiology, MDT and electronic patient records to record survival, recurrence, and patterns of recurrence (locoregional, haematological, distal nodal, peritoneal and number of recurrence sites). Results 437 patients (170 OO; 132 HO; 135 MIO) were included. There was no difference in baseline data between the groups. Overall survival rates at 1-, 3-, and 5-year were 88%, 64% and 54%. Recurrence rates at 1-, 3-, and 5-year were 17%, 35% and 41%. Haematological and locoregional recurrence made up 37% and 33% of all recurrence types. 52% of patients had one type of recurrence at diagnosis. After adjusting for disease stage, there was no significant difference between operative approaches with respect to survival and recurrence rates (at 1,3 and 5 years), time to recurrence, or patterns of recurrence. Conclusion This study found no significant difference in long-term oncological outcomes when comparing different minimally invasive and open surgical approaches to oesophagectomy. MIO can continue to be offered to patients as a safe alternative to open surgery. Further multi-centre prospective research is required to validate these results.

OGC SO13 - Recurrence Patterns after Minimally Invasive vs. Left Thoracoabdominal Oesophagectomy for distal oesophageal and junctional adenocarcinomas

Abstract Background Oesophageal cancer is a leading cause of cancer-related death worldwide, with oesophagec-tomy being the primary treatment for curable disease. This study compares loco-regional and distal disease recurrence patterns between minimally invasive oesophagectomy (MIO) and left thoracoabdominal oesophagectomy (LTAO) using a matched dataset. The definition of loco-regional recurrence remains unclear in the literature. In this study, loco-regional recur-rence is categorised as recurrence in the oesophageal bed, anastomosis, or local nodes in the mediastinum and upper abdomen. Method Patients from 2014 to 2021 were identified and followed until 31/12/2023. Data on MIOs and LTAO were collected from a prospectively maintained database. Gastroesophageal junction and distal oesophagus adenocarcinomas were included, and all received neoadjuvant chemotherapy. Out of 302 eligible patients, 104 were successfully matched. The primary outcome was overall cancer recurrence. Categorical variables were compared using chi-square tests, and non-parametric contin-uous variables with Mann-Whitney U tests. Propensity score matching, accounted for baseline differences. Logistic regression generated propensity scores for age, gender, and tumour stage. Operative approach was the dependant variable. The groups were then selected using ‘nearest neighbour’ matching. Results The study compared 52 cases each of LTAO and MIO. Postoperative complications were similar, LTAO (58%) and MIO (52%) P=0.554. The R0 resection rate was higher in LTAO (90%) compared to MIO (81%) P=0.163. Recurrence was significantly higher in LTAO (42%) than MIO (23%) P=0.037. Local recurrence rates were 15% for LTAO and 8% for MIO P=0.22. Distant recurrence was 35% for LTAO and 21% for MIO P=0.111. Notably, peritoneal recurrence was significantly higher in LTAO (12%) P=0.012. There was no difference in median time to recurrence. Mortality rate was similar: 38% for LTAO and 35% for MIO P=0.684. Conclusion The study found that while postoperative complications and mortality rates were similar between LTAO and MIO, LTAO had a significantly higher overall recurrence rate and notably higher peritoneal recurrence. There was no significant difference in median time to recurrence between the two groups. These findings suggest that MIO may be associated with better long-term outcomes in terms of recurrence.

OGC SO37 - Pyloric drainage interventions for delayed gastric conduit emptying after oesophagectomy: A single centre analysis

Abstract Background Oesophagectomy in combination with perioperative multimodal therapy is the cornerstone of modern curative treatment for resectable oesophageal cancer. Delayed gastric emptying (DGE) is a common postoperative complication that results from the anatomical and physiological changes in the gastric conduit after an oesophageal resection. It is associated with an increased risk of pneumonia, anastomotic leak and prolonged hospital stay. Although several prophylactic pyloric drainage interventions have been postulated to mitigate the risk of DGE, the optimal modality remains debatable. This study aimed to define the incidence, evaluate prognostic factors, and characterise the management of DGE following oesophagectomy. Method Consecutive patients who underwent an oesophagectomy for oesophageal cancer between January 2022 and March 2024 were retrospectively identified from a hospital database. Pyloric drainage procedures consisted of expectant management, endoscopic/open pyloric Botox and pyloroplasty. Univariable and multivariable analyses were performed to define the incidence of DGE after each pyloric drainage modality, evaluate prognostic factors for DGE, and characterise the need for subsequent intervention in the management of DGE. Results The study cohort comprised 137 patients – mean age 66 years, male 78%. The incidence of DGE was 31%. Pyloroplasty had the lowest incidence of DGE (16%) followed by endoscopic botox (21%). Intra-operative pyloric drainage reduced the risk of DGE (p=0.03). The modality of prophylactic pyloric drainage used significantly influenced the risk of developing DGE (p=0.028). No significant differences were identified between patient demographics, operative approach, and oncological variables in the development of DGE. On multivariable analysis, pyloroplasty was associated with a reduced risk of DGE (OR 0.27, 95% CI 0.09 – 0.71). DGE did not influence overall survival. Conclusion DGE is a common postoperative complication which affects up to 39% of patients undergoing oesophagectomy. Patients who did not undergo a prophylactic pyloric drainage procedure during the index oesophagectomy were at an increased risk of developing DGE. Most patients with DGE (71%) require further intervention via endoscopy and botox injection. Pyloroplasty as a prophylactic drainage modality significantly reduced the risk of developing DGE compared to endoscopic botox. Further prospective randomised controlled trials are required to validate these findings.

Empowering minorities and everyone in participatory budgeting: an agent-based modelling perspective.

Currently, there are increasing attempts to better involve citizens in political decision processes. A successful approach in that regard has been participatory budgeting (PB), which allows citizens to propose projects and then decide how to distribute a given budget over them. Meanwhile, the literature on collective intelligence (CI) has also shown the ability of groups to solve complex problems. Thus, by combining CI and PB, it should be possible for citizens to identify problems and create their own solutions. In this article, we study this possibility by using agent-based models. Specifically, we first show that a system combining CI and PB produces solutions that strongly penalize minorities if the solution quality depends on group size. Then, we introduce an approach that can overcome this issue. Indeed, by using a common knowledge base for the storage of partial solutions, the quality of solutions of minorities can benefit from the work of the majority, thereby promoting fairness. Interestingly, this approach also benefits majorities, as the quality of their solutions is further improved by the work of the minorities, thus reaching better solutions for everyone. This stresses the potential and importance of an open innovation approach, which is committed to information sharing.This article is part of the theme issue 'Co-creating the future: participatory cities and digital governance'.

Neighbourly Networks:

This paper argues that currently operative approaches to the protection of Indigenous rights and capabilities cannot help but fall short of accommodating relational, co-creative dynamics of Indigenous being in the world due to insufficient engagement with the participationalist, networked understandings of Indigenous paradigms. Discussions during the preparation of the United Nations’ Declaration of the Rights of Indigenous Peoples (UNDRIP), in a necessary first step, focused on responses to shared histories of subjugation by colonial powers,(1) and on safeguarding Indigenous rights and capabilities in relation to the powers exercised by what have since become encapsulating nation states. While the respect implied in the safeguarding of such rights and capabilities constitutes a crucial first step towards fruitful forms of coexistence, its conception from within a predominantly representationalist, Newtonian, post-Enlightenment Western paradigm necessarily falls short – at least as yet – of allowing space for Indigenous forms of networked, often acausal relationships of inter-species kinship to thrive. As a corollary, it also entails limitations remaining operative with regards to any potential networking between networks: to the extent that an Indigenous network’s own ability to thrive is impeded, so is the ability of its neighbouring networks to fruitfully interact with its contribution to inter-network co-creative activity and thriving. Understandings on their own terms are going to be needed of Indigenous conceptions of agency residing in inter-species relationship, so that space can be opened up for Indigenous societies not only to exercise rights and capabilities at bounded individual or group level, but also to practise participationalist ways of dynamically centering the co-creative agency of relationships.

Abstract 4136013: Pre-operative Frailty Status and Short-term Complications Among Adults Undergoing Transcatheter Aortic Valve Replacement

Introduction: The use of Transcatheter Aortic Valve Replacement(TAVR) has provided a safer alternative to open surgical approaches. The introduction of frailty scoring systems has proven effective in improving healthcare approaches and outcomes in various aspects of medicine. As there is a paucity of data on the impact of frailty among TAVR patients, we aim to conduct a retrospective study to investigate further. Methods: Our study analyzed adult cases with a primary procedural code for TAVR among hospitalizations between 2016 and 2021 through the National Inpatient Sample(NIS). Frailty status was explored through the criteria of Gilbert’s frailty index. Multivariable regression models helped evaluate differences in short-term outcomes and complications between them. Results: Our study involved 374200 cases of TAVR that were divided into LFR(285425 cases, 76.3%), IFR(86005 cases, 23.0%), and HFR(2770 cases, 0.7%). Compared to patients with LFR, patients with MFR and HFR showed higher odds of several complications, including cardiogenic shock(MFR: aOR 6.933, p<0.001, HFR: aOR 13.303, p<0.001), acute kidney injury(MFR: aOR 9.737, p<0.001, HFR: aOR 26.685, p<0.001 ), use of invasive mechanical ventilation(MFR: aOR 10.763, p<0.001,HFR: aOR 39.432, p<0.001), events of acute myocardial infarction(MFR: aOR 3.32, p<0.001, HFR: aOR 6.021, p<0.001), need for transfusion of blood products(MFR: aOR 3.027, p< 0.001, HFR: aOR 5.938,p<0.001), post-procedural bleeding(MFR: aOR 2.475, p<0.001, HFR: aOR 3.277, p<0.001), IABP use(MFR: aOR 4.942, p<0.001, HFR: aOR 9.703, p<0.001), and need for pericardiocentesis(MFR: aOR 3.804, p<0.001, HFR: aOR 4.217, p<0.001). Moreover, patients with MFR and HFR reported higher mortality risks than those with LFR(MFR: aOR 6.375, p<0.001, HFR: aOR 16.035, p<0.001 )(Table 1). Conclusion: Our study confirms the higher odds of various complications with increasing frailty status, including all-cause in-hospital death. A careful assessment of pre-operative frailty status along with close monitoring of pre-, peri-, and post-operative status will help improve the outcomes and provide care in a timely fashion.

Gold standard nephroureterectomy, chemoprophylaxis and surveillance in upper tract urothelial carcinoma.

The purpose of this review is to summarize the most recent evidence on surgical management, strategies to reduce tumor recurrence, and surveillance regimens in patients diagnosed with upper tract urothelial carcinoma (UTUC) and elected for radical treatment. Minimally invasive surgery is gaining momentum in the surgical management of UTUC. Chemoprophylaxis is still the gold standard to reduce intravesical recurrence after radical nephroureterectomy (RNU). Novel surveillance strategies have been proposed to adapt follow-up regimens to patients' characteristics. Minimally invasive surgery has been associated with comparable oncological outcomes to the open approach while improving postoperative morbidity. In these cases, bladder cuff excision (BCE) is mostly performed by an extravesical approach, that demonstrates a noninferiority compared to the intravesical one in terms of oncological outcomes. Although lymphadenectomy is recommended in patients with high-risk tumors, its benefits are still unclear. Currently, there is a lack of recent prospective trials on chemoprophylaxis to reduce intravesical recurrence post RNU, making single-dose postoperative chemotherapy instillation the standard treatment. Although novel risk stratification models were released by international urological guidelines, their validity is mainly nonevidence-based. Risk-adapted follow-up strategies incorporating cystoscopy and cross-sectional imaging accounting for individual patient factors should be implemented.

SURG-20. DEVELOPING ENDOSCOPIC RESECTION OF COLLOID CYSTS: A 25-YEAR EXPERIENCE IN 200 PATIENTS

Abstract Endoscopic resection is a legitimate treatment alternative for third ventricular colloid cysts. Increasing experience and the development of new surgical instruments and techniques have allowed this approach to reach clinical prominence. In this study, we review our 25-year experience with endoscopic resection of colloid cysts, assess factors predictive of operative success, and critically analyze our evolving clinical practice. Therefore, a prospective database was used to review all patients that had endoscopic removal of a third ventricular colloid cyst between 1995 and 2021. Demographics, imaging features, presenting symptomatology, operative approach, surgical outcomes, and complications were analyzed in 5-year intervals to determine changing patterns over time. Bivariate analyses were carried out to understand factors predisposing to outcome. Kaplan-Mayer curves were used to analyze time-to-recurrence. Over this 25-year continuum an increase in the proportion of treated patients who were asymptomatic (p < 0.001) was observed. The rate of recurrence and length of stay all decreased over time (p < 0.001) – now, with median length of stay of 1 day. The rate of complete cyst removal (CCR) increased (p < 0.001). Rate of major complications or need for postoperative CSF diversion remained low. Bivariate analyses indicated how incomplete cyst removal (ICR) was associated with recurrence. In conclusion, our 25-year experience posits endoscopic resection as an increasingly safe approach to third ventricular colloid cysts, with low recurrence rates and negligible complications. These results are attributed in-part to a continuous adaptation related to instrumentation, technique, perioperative strategy, and experience.

Stability of complement value problems for p-Lévy operators

We set up a general framework tailor-made to solve complement value problems governed by symmetric nonlinear nonlocal integro-differential p-Lévy operators. A prototypical example of integro-differential p-Lévy operators is the well-known fractional p-Laplace operator. Our main focus is on nonlinear integro-differential equations in the presence of Dirichlet, Neumann and Robin conditions and we show well-posedness results. Several results are new even for the fractional p-Laplace operator but we develop the approach for general translation-invariant nonlocal operators. We also bridge the gap from nonlocal to local, by showing that solutions to the local Dirichlet and Neumann boundary value problems associated with p-Laplacian are strong limits of the nonlocal ones.

Hand Assisted Transperitoneal versus Retroperitoneal Laparoscopic Nephrectomy (A Comparative Study): Our Experience in Prince Hussein Urology Center

Aim: Hand assisted laparoscopic nephrectomy could be an excellent alternative option to the open approach for benign renal conditions. Besides that, renal malignant processes can be managed by the previous mentioned hand-assisted laparoscopic technique of nephrectomy. In this research the outcomes and the complications of transperitoneal and retroperitoneal approaches of hand assisted laparoscopic nephrectomy were estimated for the differences. Methods: Retrospectively (223) hand assisted laparoscopic nephrectomies (transperitoneal grid iron incision (group1, N= 112) vs. retroperitoneal Pfannenstiel incision (group2, N=111) which were done between September 2022 and June 2024 in Prince Hussein Urology Center were enrolled in this study. Demographic and categorical data of both groups were compared herein. Follow-up period is between 3 and 18 months. Results: Patients’ ages were between (35 and 62 years). There were no differences in patient demographic, and most of categorical data between the both groups. The mean duration of the transperitoneal procedure was significantly shorter than that of the retroperitoneal approach (197.3 and 238.5 minutes, respectively, P < 0.05). While the lower incidence of incisional hernia, blood loss, solid organs impact, and bowel injury were in group2 (P < 0.05). Conclusion: Hand-assisted laparoscopic retroperitoneal nephrectomy is superior to transperitoneal approach in regards to incisional hernia incidence, operative blood loss, and organs injury. Due to the steeper learning in the retroperitoneal approach, the operative period can be equal to or shorter than that of the transperitoneal technique after the surgeons used to and getting more experience in this approach.

Simulating the Landau-Zener sweep in deeply sub-Ohmic environments.

With the goal to study dissipative Landau-Zener (LZ) sweeps in realistic solid-state qubits, we utilize novel methods from non-Markovian open quantum system dynamics that enable reliable long-time simulations for sub-Ohmic environments. In particular, we combine a novel representation of the dynamical propagator, the uniform time evolving matrix product operator method, with a stochastic realization of finite temperature fluctuations. The latter greatly reduces the computational cost for the matrix product operator approach, enabling convergence in the experimentally relevant deeply sub-Ohmic regime. Our method allows the exact simulation of dynamical protocols with long operation times, such as the LZ sweep, in challenging parameter regimes that are realized in current experimental platforms.

A Multi-Objective Energy Optimization Model for Renewable Energy Systems with Hybrid Energy Storage

Building a Renewable Energy System (RES) is a viable way to address resource depletion and accomplish decarbonization. This study presents a hybrid power system that combines wind, solar, battery, and thermal energy storage. It also examines the co-optimization of scheduling and operation for multiple objectives. The hybrid system combines the affordability of thermal energy storage (TES) with the adaptability of batteries to effectively address the issue of intermittent RES. A new approach for integrated operation is offered, which relies on the electrical block's operation limit. The planning-operation co-optimization system considers minimizing the Net Present Cost (NPC) and reducing power supply likelihood todetermine the best operation limit and sizing decision factors. The co-optimization issue is addressed using novel multi-objective decision-making (MO-DM). This approach incorporates the Decision-Maker (DM) preferences data to direct the evolutionary process toward the desired area. In addition, a data-driven prediction model captures the risks and losses associated with wind generation. The case study's findings indicate the following: (1) The data-driven system has a higher level of precision in wind power projection when compared with commonly used physical simulations. (2) The suggested MO-DM exhibits superior integration, variety, and robustness achievement in the DMchosen area compared to others. (3) The combined battery-thermal energy storing structure achieves improved economy and dependability through the optimum organized operation approach, in contrast to using a single energy storage system under various testing constraints.

Open donor nephrectomy via singular pararectal extraperitoneal mini-incision: single-center experience with 425 consecutive cases

BackgroundLaparoscopic techniques have been successfully implemented for living kidney donation. However, open surgical procedures also yield excellent perioperative outcomes. Endoscopic donor nephrectomy is associated with minimal trauma but is difficult for right-sided nephrectomies. Here, an open nephrectomy approach using a singular pararectal extraperitoneal mini-incision (SPEM) and the perioperative results are presented to elucidate whether open surgery is still justified in the modern era of endoscopic surgery.MethodsIn this single-center retrospective study, all living kidney donations performed at the Department of General, Visceral and Transplant Surgery of the Hannover Medical School from January 2007 to December 2017 were assessed. Donor characteristics, operation time, transfusion requirements, perioperative complications, and graft outcomes were analyzed.ResultsOut of a total of 1681 kidney transplantations, 425 living kidney donations (25.2%) were performed. Donors were primarily female (273; 64.2%) and had a median age and body-mass index of 53 (24–76) years and 25.3 (16.8–36.4) kg/m2, respectively. The left kidney was harvested in 50.1% (211) of cases. Median operative time was 95 (48–212) min. Intraoperative transfusion was not required in any of the donors. Intraoperative complications were observed in 2.6% of cases (11), with injury of the donor kidney (5; 1.2%) and acute hemorrhage (3; 0.7%) being the most common complications. Postoperative complications were hematomas (32; 7.7%), seromas (28; 6.7%), and wound infections (7; 1.7%). Except for a single surgical revision owing to colon perforation (1; 0.002%), no other major complications (Clavien–Dindo ≥ IIIa) were observed in any of the donors. The donor’s and recipient’s median estimated glomerular filtration rate at discharge was 55 (29–114) and 51 (14–129) ml/min/1.73 m2, respectively. Initial nonfunction occurred in seven cases (1.6%).ConclusionsUnlike the endoscopic technique, SPEM is equally suitable for right- and left-sided nephrectomy. SPEM nephrectomy is safe and results in minimal trauma. Despite performing SPEM nephrectomy in the era of endoscopic surgery, this technique provides excellent results with regard to donor and graft outcomes.

Roadmap for a European Open Science Alliance for ATM Research

To meet the future challenges of air transport and air traffic management (ATM), higher levels of transparency and access to the underlying data will be a key enabler. We here propose an Open Science Alliance for ATM, advocating for open data in such a framework. The benefits of adopting an open science approach are to be found, inter alia, through the independent verification and validation of reported impacts/results and achieved performance levels, i.e., through reproducibility. We consider that this can only be achieved through: (1) open access to scientific methods and data utilised; (2) open access to (analytical) code and methods; (3) open review of reported analyses/research. The proper application of such practices will reduce the innovation cycles in ATM, which is much needed by industry and society. Steps for forming an Open Science Alliance for ATM are described. We propose further initial, specific recommendations for supporting open data and improved access for research.

The Role of Robotic Cystectomy in the Salvage and Palliative Setting: A Retrospective, Single-Center, Cohort Study

Introduction: This article compares surgical and survival outcomes of robot-assisted and open radical cystectomy with cutaneous ureterostomy for the treatment of frail bladder cancer patients with limited life expectancy. Methods: The institutional database was searched for cystectomy cases with cutaneous ureterostomy, from 1 June 2016 to 31 August 2022. The study population was split into two groups, according to the surgical approach. The baseline characteristics and surgical outcomes were compared. Logistic regression analyses identified predictors of major bleeding events (hemoglobin loss ≥ 3.5 g/dL or blood transfusion) and re-operation within 30 days from surgery. The Kaplan–Meier method estimated the impact of the robotic approach on overall survival and Cox regression analysis assessed its predictors. Results: A total of 145 patients were included: 30% (n = 43) underwent robotic cystectomy. Patients’ characteristics and tumor stages distribution were comparable in the two groups but those receiving a minimally invasive treatment showed significantly reduced times to flatus, bowel and hospital discharge (all p < 0.001). Although operation times were longer in this cohort, major bleeding events (60% vs. 89%) and postoperative severe complications (0 vs. 8%) (both p < 0.001) were less frequent compared to the open approach. A logistic regression showed that robotic surgery independently predicted major bleeding events (OR: 0.26; 95%CI 0.09–0.72; p = 0.02) but not the need for re-intervention. A Kaplan–Meier analysis showed that robotic cystectomy was associated with a significant advantage in terms of overall survival (LogRank = 0.03), and this result was confirmed by Cox regression analysis (HR: 0.39; 95%CI 0.14–0.94; p = 0.04). Conclusions: Robotic cystectomy with cutaneous ureterostomy may represent a viable option to treat frail bladder cancer patients, as the minimally invasive approach reduces the risk of bleeding and serious complications and provides a prompt restoration of bowel function and a shorter hospital stay compared to open surgery.