Operative Costs Research Articles

Repairs and Breaks Prediction for Deep Neural Networks

With the increasing prevalence of software incorporating deep neural networks (DNNs), quality assurance for these software systems has become a crucial concern. To this end, various methods have been proposed to repair the misbehavior of DNNs by modifying their weights. However, these repair methods may not meet the developer's needs for a given dataset and model. In this study, we build prediction models for repair outcomes (i.e., repairs and breaks) to help determine whether the repair method is likely to work. By using our prediction models, developers and operators of DNNs can decide whether or not to apply a repair method, and if so, which method to use. Our prediction models utilize four metrics as explanatory metrics that represent the confidence or ambiguity in the DNN predictions. We experimented with four repair methods and 10 datasets. The experimental results demonstrate that our prediction models successfully select a repair method that meets developers’ needs in 16 out of 24 cases, resulting in an average time saving of 16.29% compared to the naive method. Based on these results, our prediction models can reduce costs for developers and operators when deciding whether to employ repair methods for real-world applications of DNNs.

Bus scheduling with heterogeneous Fleets: Formulation and hybrid metaheuristic algorithms

This paper focuses on optimizing mixed-fleet bus scheduling (MFBS) with vehicles of different sizes in public transport systems. We develop a novel mixed-integer nonlinear programming (MINLP) model to address the MFBS problem by optimizing vehicle assignment and dispatching programs. The model considers user costs, operator costs, and the crowding inconvenience of standing and sitting passengers. To tackle the complexity of the MFBS problem, we employ Genetic Algorithm (GA) and Grey Wolf Optimizer (GWO). Besides, we develop two hybrid metaheuristics, including GA-SA [a combination of GA and Simulated Annealing (SA)] and GWO-SA (a combination of GWO and SA), to improve optimization capabilities for the MFBS problem. We also employ a Taguchi approach to fine-tune the metaheuristics’ parameters. We widely examine and compare the metaheuristics’ performance across various-sized samples (small, medium, and large), considering solution quality, computational time, and the result stability of each algorithm. We also compare the metaheuristics’ solutions with the optimal solutions acquired by GAMS software in small and medium-scale samples. Our findings show that the GWO-SA outperforms the other metaheuristics. Applying our model to a real bus corridor in Santiago, Chile, we find that precise dispatching plans generated by more sophisticated/advanced algorithms (GA-SA and GWO-SA) lead to larger cost savings and improved performance compared to simpler algorithms (GA and GWO). Interestingly, utilizing more advanced algorithms makes a difference in terms of fleet planning in crowded scenarios, whereas for low and medium-demand cases, simpler dispatching algorithms could be used without a drop in accuracy.

Surgical Tray Optimization in the Setting of Cleft Lip and Palate Reconstruction: Implications for Operative Cost and Efficiency.

To assess surgical instrument usage in cleft lip (CL) and cleft palate (CP) surgery and create an optimized surgical tray with an associated cost-savings analysis. Prospective, observational study. Single institution, 6-month prospective review. A total of 10 primary CL surgeries and 10 primary CP surgeries were included in this study. Complete lists of surgical instruments utilized in CL and CP surgeries were collected. The average instrument UFs were 26.0% for CL and 22.6% for CP. The estimated costs were $33.15 to $290.29 for the original CL surgical tray and $10.20 to $63.80 for the optimized tray. For CP, the original tray's cost was estimated at $38.25 to $319.00, and the optimized tray at $9.18 to $57.42. This demonstrates a cost reduction of $22.95 to $226.49 for CL and $29.07 to 261.58 for CP. The idealized surgical instrument tray could contribute to reducing healthcare expenditures and promoting operating room efficiency, patient safety, and environmentally friendlier operating theaters.

Outcome of Transanal suture haemorrhoidopexy and Stapled haemorrhoidopexy -A prospective observational study

Background: Transanal suture haemorrhoidopexy is the preferred treatment due to its low cost, less post operative complication and decreased chance of recurrence in grade II and grade III Hemorrhoids. Objective: To compare the post-operative outcome of transanal suture haemorrhoidopexy and stapled haemorrhoidopexy in patients with grade II and III haemorrhoids. Methods: This study was conducted in the Department of Colorectal Surgery, Shaheed Suhrawardy Medical College hospital over a period of one-year. Sixty-two patients with haemorrhoids were enrolled in this study according to selection criteria. Data were collected, compiled and tabulated according to key variables. Qualitative data were expressed as frequency with percentage and quantitative data as mean with standard deviation. Quantitative data were analyzed by student’s t-test and qualitative data by Chi-square test. Data were processed and analyzed by using software SPSS 22.0. For all analyses p-value <0.05 was considered statistically significant. Result: Mean age of the patients was 49.38 ± 7.17 years and 52.45 ± 6.17 years in Stapled hemorrhoidopexy and Trans anal suture hemorrhoidopexy group respectively (p>0.05). Males were predominant in both the two groups. In stapled hemorrhoidopexy group, grade of hemorrhoids was II (51.6%) and III (48.4%) whereas in Transanal suture hemorrhoidopexy group, grade of hemorrhoids was II (38.7%) and III (61.3%) (p>0.05). Operative time was lower in Stapled hemorrhoidopexy (26.93 ± 1.59 min) than Transanal suture hemorrhoidopexy (27.74 ± 1.63 min). Per operative bleeding was found more in stapled group. Most of the patients stayed in the hospital only one day in both the two groups. Only four patients in Stapled hemorrhoidopexy group and one patient in Transanal suture hemorrhoidopexy group stayed more than one day. Post-operative pain according to VAS was lower in Stapled hemorrhoidopexy group (1.90 ± 0.54) than Transanal suture hemorrhoidopexy group (2.09 ± 0.30) after 24 hours of the surgery. But there was no significant difference in pain after 7 days of surgery between the two groups. Post-operative complications were more in stapled hemorrhoidopexy than Trans anal suture hemorrhoidopexy, but not statistically significant. Recurrence (bleeding & prolapse) found more in stapled group than suture hemorrhoidopexy group. Treatment cost was significantly lower in trans anal suture hemorrhoidopexy. Conclusion: Based on this study, transanal suture hemorrhoidopexy showed less intra and post-operative hemorrhage, shorter duration of hospital stay, lower post-operative complications, and lower recurrence rate when compared to stapled hemorrhoidopexy. However, these differences were not statistically significant. The only statistically significant difference was in the operative cost, which was in favor of transanal suture hemorrhoidopexy. J Shaheed Suhrawardy Med Coll 2023; 15(1): 45-49

Robotic Versus Laparoscopic Gastrectomy for Gastric Cancer: The Largest Systematic Reviews of 68,755 Patients and Meta-analysis.

This meta-analysis aimed to compare the efficacy of robotic gastrectomy (RG) and laparoscopic gastrectomy (LG) in treating gastric cancer (GC). A comprehensive literature search across PubMed, MEDLINE, and Web of Science identified 86 eligible studies, including 68,755 patients (20,894 in the RG group and 47,861 in the LG group). The analysis revealed that RG was associated with superior outcomes in several areas: more lymph nodes were harvested, intraoperative blood loss was reduced, postoperative hospital stays were shorter, and the time to first flatus and oral intake was shortened (all p<0.001). Additionally, RG resulted in lower incidences of conversion to open surgery (OR=0.62, p=0.004), reoperation (OR=0.68, p=0.010), overall postoperative complications (OR=0.82, p<0.001), severe complications (OR=0.65, p<0.001), and pancreatic complications (OR=0.60, p=0.004). However, RG had longer operative times and higher costs (both p<0.001). No significant differences were found between RG and LG in terms of resection margin distance, mortality, anastomotic leakage, or recurrence rates. RG is a safe and effective surgical option for patients of GC, but further improvements in operative duration and costs are needed.

Study on the effect of mitigation strategies for rail corrugation in metro lines

Rail corrugation appears as a periodic irregularity on the rail running surface that causes severe dynamic loads at the wheel-rail interface. These dynamic forces may generate ground-borne vibrations that propagate from the line to the surrounding buildings causing discomfort to residents. Rail grinding is the most used countermeasure for the mitigation of corrugation. However, this maintenance operation determines high operative costs if frequently performed and must be carefully scheduled. To this end, it is important to assess the effectiveness of other mitigation solutions that may prevent or slow down its growth. The main objective of this study is to investigate the formation of rail corrugation on a sharp curve of the Cityringen underground line in Copenhagen. A wheel-rail interaction model is developed in the frequency domain to identify the root causes of the problem on the specific curve and predict the corrugation wavelength. Once the accuracy of the model is tested against experimental observations on the reference curve, it is used to explore the effectiveness of different mitigation actions, such as the use of friction modifiers, the variation of the speed, track design and track gauge. The results indicate that friction modifiers and speed variation are the most effective measures.

Preoperative Care Intensity and Cost for Renal Colic: Implications for Surgical Value-Based Reforms.

The aim of this study was to identify preoperative patient/facility factors associated with postoperative and total episode-related costs using renal colic as a model surgical condition to improve value-based payment models. Using state Healthcare Cost and Utilization Project data, we performed a retrospective cohort study examining perioperative costs for individuals presenting to an emergency department for renal colic and who ultimately underwent definitive surgical management. We estimated multivariable ordered and binary logistic regressions to examine the association between preoperative and operative cost quartiles on the probability of specific postoperative cost quartiles after accounting for hospital and individual factors. We also performed logistic regressions to identify patients who deviated from predicted perioperative cost pathways. Among 2736 individuals included in our analysis, episode-related costs ranged from $4536 (bottom quartile) to $26,662 (top quartile). Individuals in the highest preoperative cost quartile experienced an 11.7% higher probability of remaining in the highest postoperative cost quartile relative to those in the lowest preoperative cost quartile (95% CI, 0.0709-0.163; P < .001). Delays in surgery (95% CI, 0.0869-0.163; P < .001) and Medicaid vs private insurance (95% CI, 0.01-0.0728; P < .01) were associated with a 12.5% and 4.1% higher probability of being in the top quartile of preoperative costs, respectively. Treating facility experience with value-based payment models did not influence perioperative costs. Using renal colic as a model surgical condition, our novel findings suggest that preoperative costs are associated with both postoperative and total episode-related costs and should be accounted for when designing future value-based payment models.

Workflow improvement and financial gain after integration of high-throughput sample processing system with flow cytometer in a high-volume pathology laboratory: Results from a prospective comparative study using Lean principles

BackgroundHighly efficient clinical laboratories are essential for monitoring many human illnesses. Ampath Laboratory Services, the largest pathology lab in South Africa, analyzes large numbers of peripheral blood samples for CD4 levels yearly. ObjectiveTo assess productivity and quality of a newer integrated automated solution, the BD FACSDuet™ Sample Preparation System/BD FACSLyric™ Flow Cytometer using conventional assessment methods and Lean concepts. Materials and methodsThis prospective study compared the performance of the BD FACS™ Sample Preparation Assistant [SPA] III and BD FACSCanto™ II Flow Cytometer with the newly introduced integrated system (BD FACSDuet™/BD FACSLyric™). They were validated for accuracy, precision, and external quality assessment. Process mapping and Lean assessment helped identify steps leading to waste. An economic model was developed to characterize workflow and economic impact associated with total daily hands-on time, processing time, and reworks. ResultsStrong linear correlation was present between both systems. Precision and accuracy studies revealed that all coefficient of variation (CV)% values were below 20 % of allowable limits. External proficiency assessments were within limits. The fully automated workflow of BD FACSDuet™/BD FACSLyric™ permitted better consistency with significantly shorter processing time and batch processing and reduced operator interventions. Lean assessment identified defects with motion, over-processing, waiting, and non-utilized talent. Significant reductions in hands-on and total daily processing time that could increase daily specimen testing efficiency and fewer reworks were associated with the BD FACSDuet™/BD FACSLyric™. Lean improvements translated to significant economic savings associated with operator costs and unnecessary reagent consumption. ConclusionBD FACSDuet™/BD FACSLyric™ is an accurate, reliable, and cost-effective fully automated system for high-volume flow cytometry labs that perform T-cell enumeration using a single-platform and single-tube approach.

Sterile Draping of Operative Microscopes in Breast Free Flaps and Surgical Site Infections.

Operative microscopes are traditionally draped in single-use plastic to prevent infection theoretically. The necessity of this routine in breast free flap surgery is unclear. Alternatively, sterile wrapping of microscope handles would reduce operating room waste and provide a more cost-effective and environmentally sustainable approach to sterility. This study aimed to determine whether the draping technique used during abdominally based free flaps (Ab-FF) influenced the rate of surgical site infections. We conducted a retrospective review of Ab-FF performed consecutively between March 2017 and August 2022. Patient demographics, comorbidities, perioperative data, and postoperative complications were collected. The primary outcomes included postoperative surgical site infections and environmental impact. Of the 281 identified breasts reconstructed with Ab-FF, operating microscopes were sterilely covered with microscope drapes (n = 215) or handle covers (n = 66) composed of polyethylene-based plastic. Overall, postoperative infections occurred in 9.3% of cases (n = 26) in either the recipient breast (n = 11, 3.9%) or abdominal donor site (n = 15, 5.3%), primarily due to S. aureus and Streptococcus species . The handle (n = 6, 9.1%) and drape (n = 20, 9.3%) cohorts had similar infection rates with no sequelae of operative complications. In multivariate analysis, radiation was the only independent predictor of postoperative infection, while bilateral reconstructions were independently protective. Replacing a microscope drape with a handle reduces carbon emissions by 1276 grams of CO 2 and direct costs by $7.84 per item. The principles of "Lean and Green" surgery prioritize reducing operating room generated waste to achieve financial and environmental sustainability. This cohort study of 281 breast free flaps demonstrates that switching from whole microscope draping to handle wrapping was not associated with an increased rate or odds of infection. Adopting a microscope handle wrapping protocol decreased the carbon footprint and operative costs. The results of this study offer evidence to support adoption and further exploration of pragmatic, cost-effective, and sustainable approaches to microsurgical breast reconstruction.

Robotic One Anesthetic Diagnosis and Treatment: A Novel Program for Lung Cancer Care

BackgroundEarly diagnosis and treatment of lung cancer can improve patient outcomes. To reduce the delay between diagnosis and treatment, we initiated a Robotic One Anesthetic Diagnosis and Treatment (ROADAT) program for lung nodules that combined robotic navigational bronchoscopy, liquid rapid on-site evaluation (ROSE), and surgical resection in the same setting. MethodsA retrospective review was conducted of patients who underwent the ROADAT procedure from December 1, 2021, through January 31, 2024. These patients were compared with sequential controls from the same time window, who would have been ROADAT candidates but underwent diagnosis and treatment using a standard lung nodule workup. ResultsThere were 36 patients in the ROADAT group and 35 controls. Of the 36 ROADAT patients, 31 (86%) underwent lung resections. When final pathology was available, ROSE was concordant in 91% (29 of 32) of cases. Compared with robotic lobectomies alone, ROADAT procedures that resulted in lobectomies added 73 minutes (P = .003). However, total operating room time for when lobectomy and biopsy were done in separate settings was 54 minutes shorter in the ROADAT group (P = .028). Direct (ROADAT, $19,244; controls, $21,737; P = .004) procedure costs and total (ROADAT, $26,668; controls, $29,882; P = .005) procedure costs were lower in the ROADAT group for patients who underwent lobectomy. Time from detection to resection was 35 days shorter in the ROADAT group (ROADAT, 82 days; controls, 117 days; P = .001). ConclusionsThe ROADAT procedure reduced time from nodule detection to surgical resection compared with the standard approach. Liquid-based ROSE had high concordance with final pathology. Total operative time, direct costs, and total costs were lower for the ROADAT procedure.

Contemporary use of 3D printed jigs and guides for osteotomies around the knee: a systematic review

Background. With improved accessibility of imaging and additive manufacturing, custom targeting guides and jigs are now widely accepted across many areas of orthopaedics. During orthopedic surgery, patient-specific guides assist in the accurate drilling and cutting of bone in conjunction with meticulous pre-operative planning. Given their increased uptake, it is important to define the lessons learned from recent clinical experience, and to document the reported benefits when using this technology intra-operatively. The aim of this review is to evaluate the potential benefits of patient-specific guides for osteotomies about the knee, and to clarify what evidence currently exists to support their use. Methods. A systematic review of PubMed, Embase, and Web of Science was performed for studies investigating the use of intra-operative patient-specific guides for realignment osteotomies about the knee. Randomised controlled trials, non-randomised studies, observational studies, case series, and case reports, as well as in vitro studies, were included. Screening was conducted with the Covidence software, and risk of bias was assessed with the Risk Of Bias In Non-Randomized Studies of Interventions (ROBINS-I) tool. Results. A total of 38 studies satisfied the inclusion criteria: 21 of these included patient-specific instrumentation (PSI) for high tibial osteotomy, 6 with distal femoral osteotomy, 4 — for combined tibial/femoral rotational corrective osteotomies, 4 — in double-level osteotomies, and 6 — for intra-articular osteotomies. The main outcomes reported were accuracy of surgical correction, typically with reference to pre-operative plans, and execution accuracy based on radiographic measurements. Other common outcomes were operative time, intra-operative fluoroscopy, and operative costs. Many studies were observational in nature, with no control groups available for suitable comparison. Conclusions. For corrective osteotomies about the knee, the literature suggests PSI has very strong potential to improve accuracy in achieving pre-operative targets. This was reported for both opening and closing wedge osteotomies of the femur, and for high tibial osteotomy. Some contradictory results have been reported for high tibial osteotomy, based on limited evidence from small studies that in many instances lacked controls for comparative analysis. Additional controlled trials are necessary to confirm the benefits of PSI for osteotomies about the knee, considering it has not yet been conclusively validated. The literature currently available indicates PSI can improve the accuracy of corrective osteotomies about the knee.

A decentralized energy management scheme for a DC microgrid with correlated uncertainties and integrated demand response

Secure operation of a DC microgrid with high penetration of renewables and electric vehicle load is challenging. This paper proposes a decentralized energy management scheme for a grid-connected renewable integrated community DC microgrid considering the water-energy nexus. Uncertainties of renewable generation, plug-in electric vehicle load, electricity demand, electricity price in the day-ahead wholesale market, ambient temperature, and water demand are modelled using a probabilistic approach. Correlation between the input random variables is modelled using Copula theory. Flexibilities on the consumer side across multiple entities (temperature-dependent loads, electric vehicles, and water supply system storage) are coordinated to form an “integrated demand response entity”, which is further coordinated with the DC microgrid operator side flexibility (electrochemical storage) to support system operation. A distributed dynamic pricing scheme is used to implement the integrated demand response program. The objectives of the energy management scheme are to minimize the DC microgrid operator’s operating cost and consumers’ electricity cost. The decentralized algorithm is solved by the “alternating direction method of multipliers”. Simulation studies on a six-bus DC microgrid test system demonstrate that the proposed strategy reduces the operating cost of the DC microgrid operator by ∼19.28% and the electricity cost of the consumers by ∼13.82%.

Prediction and analysis of wheel flange wear on small curved track considering wheel-rail conformal and lubricated contact

Wheel flange wear on curved tracks is a significant issue that poses a threat to the safety of rail vehicles and leads to increased maintenance costs for railway operators. This study aims to develop a numerical model to predict wheel flange wear on small radius curves. The model integrates an efficient wheel-rail conformal contact model with laboratory-tested wear coefficients. By using virtual penetration and influence coefficients for conformal geometries, the model accurately simulates the conformal contact between the wheel flange and the rail gauge corner. The validity of the wheel flange wear prediction model is confirmed through field tracking testing. Using the proposed model, the effects of track layout parameters and solid lubricants on wheel flange wear are investigated. This study provides theoretical guidance for the operation and maintenance of the wheel-rail system to reduce wear.

Experimental study of the optimal design and performance of a mixed-flow dew-point indirect evaporative cooler

Evaporative cooling technologies represent a promising alternative to face the emerging cooling energy poverty, owing to their low production and operative costs. High performance can be achieved through more complex designs, such as dew point indirect evaporative cooling (DIEC) systems. Recent literature explores improvements on these systems, like flow configuration, materials, and water distribution. This study proposes a compact mixed-flow DIEC system made of polycarbonate plates covered with two possible wicking materials. Three water distribution systems are also studied. The prototypes are experimentally characterised by varying the inlet air temperature, humidity, volume flow, and working-to-intake air ratio. The best performing design is evaluated in terms of temperature drop, dew-point effectiveness, wet-bulb effectiveness, and cooling capacity. Results are consistent with those in the literature for equivalent heat transfer areas. The use of a wicking material improves the cooling capacity by up to 1.45. The type of material is less relevant, which enables to select the most economic and accessible option. External nozzles for water distribution offers temperature drops of more than 1 °C and better cooling capacities of approximately 100 W than inlet water distributors.

Beyond the last mile: different spatial strategies to integrate on-demand services into public transport in a simplified city

AbstractIntegrating on-demand services into public transport networks might be the best way to face the current situation in which these new technologies have increased congestion in most cities. When cooperating with on-demand services rather than competing with them, public transport would not risk losing users, and could attract some passengers from private modes thanks to an increased quality of service. This fact has engendered a growing literature discussing how to design such an integrated system. However, all of that research has imposed that on-demand mobility is to solve the so-called “last-mile problem”, serving only as a feeder that connects the exact origins/destinations with the traditional public transit network. As it induces a large number of transfers and it precludes some scale-effects to be triggered, in this paper we challenge that imposition and investigate if this is the best spatial integration strategy. To do so, we study a simplified linear city in a morning peak situation, where we propose seven different line structures, all of them combining a traditional fixed line with on-demand ride-pooling (ODRP): three direct structures, where ODRP can serve full trips, three semi-direct, where a single ODRP vehicle can serve the largest part of a trip, and a base case in which ODRP is restricted to the first and final legs only. Our results show that the base case is optimal only under very specific demand patterns, or when transfer penalties are disregarded. Our analytical approach reveals relevant operational aspects of such integrated systems: namely, that the base case can help increase directness (diminishing detours), and that ODRP can help shorten the routes of the fixed services to decrease operator costs.

Association between race, post operative outcomes and costs for inpatient and outpatient total joint arthroplasty

Background: While factors like readmissions and costs have been compared between care settings for total joint arthroplasty, little research has analyzed readmission and cost differentials stratified by patient characteristics within each care setting. This study will unveil such differences with regard to race and co-morbidity status. Methods: Retrospective binary-logistic-regression and OLS regression were employed on de-identified inpatient and outpatient orthopedic surgical data gathered from an academic medical center from 2016-2020. Data elements included surgical setting, covariates (age, gender, race, obesity, smoking status), Elixhauser comorbidity indices, surgical times, and cost. Results: African American (AA) inpatients had significantly greater odds of return to hospital (7 day, 30 day, 90 day) when compared to Caucasian inpatients (P&lt;0.01-0.05). AA inpatients less than 65 yr old had significantly increased odds of returning to the hospital and getting readmitted (7 day, 30 day) when compared to AA inpatients older than 65 and all Caucasian inpatients (P&lt;0.05). Asian inpatients had significantly greater odds of 90 day return (P&lt;0.05). AA outpatients had significantly greater odds of 30 day return when compared to Caucasian outpatients. Age and time spent in the OR directly correlated with increased costs (P&lt;0.05, P&lt;0.01). Increased comorbidities correlated with increased costs only for inpatients (P&lt;0.05). Conclusion: All AA patients, but specifically those less than 65 yr of age, experience increased readmissions and returns to hospital following the same procedure when compared to their Caucasian counterparts. Medicaid patients experience greater costs, Medicare-Managed patients experienced decreased costs. Co-morbidites were directly related to costs in the inpatient setting.

Development of a Cost-Driven, Real-Time Management Strategy for e-Mobility Hubs Including Islanded Operation

The installation of electric vehicle supply equipment (EVSE) increases demand and peak loads, potentially straining existing energy distribution infrastructure. Dispersed and inadequately planned placement of charging points (CPs) can disrupt the electrical grid, surpass contracted demand thresholds, and require infrastructure upgrades, thereby incurring unfeasible costs for Distribution System Operators (DSOs). In this context, it is necessary to recognize the role of business models in enabling effective electrification of the transportation sector. In response to these challenges, this paper introduces a novel e-mobility hub management strategy, tailored for implementation in the Brazilian context. The proposed strategy revolves around a microgrid configuration encompassing dispatchable and photovoltaic generation, a battery energy storage system (BESS), EVSE infrastructure, and local loads. Moreover, this centralized controller facilitates the implementation of dynamic pricing and demand-response mechanisms, integral to business models seeking to integrate EVSE into the distribution grid. To validate the efficacy of the proposed solution, hardware-in-the-loop (HIL) simulations of the microgrid system are conducted. These simulations, incorporating the centralized controller, serve as a tool for assessing system performance and viability before on-site equipment deployment. Finally, this paper concludes with the insights gleaned from test analysis and its discussion through a selection of the most expressive scenarios, including islanded and connected operation modes.

Cost-effectiveness of robotic vs laparoscopic distal pancreatectomy. Results from the national prospective trial ROBOCOSTES.

Although several studies report that the robotic approach is more costly than laparoscopy, the cost-effectiveness of robotic distal pancreatectomy (RDP) over laparoscopic distal pancreatectomy (LDP) is still an issue. This study evaluates the cost-effectiveness of the RDP and LDP approaches across several Spanish centres. This study is an observational, multicenter, national prospective study (ROBOCOSTES). For one year from 2022, all consecutive patients undergoing minimally invasive distal pancreatectomy were included, and clinical, QALY, and cost data were prospectively collected. The primary aim was to analyze the cost-effectiveness between RDP and LDP. During the study period, 80 procedures from 14 Spanish centres were analyzed. LDP had a shorter operative time than the RDP approach (192.2min vs 241.3min, p = 0.004). RDP showed a lower conversion rate (19.5% vs 2.5%, p = 0.006) and a lower splenectomy rate (60% vs 26.5%, p = 0.004). A statistically significant difference was reported for the Comprehensive Complication Index between the two study groups, favouring the robotic approach (12.7 vs 6.1, p = 0.022). RDP was associated with increased operative costs of 1600 euros (p < 0.031), while overall cost expenses resulted in being 1070.92 Euros higher than the LDP but without a statistically significant difference (p = 0.064). The mean QALYs at 90days after surgery for RDP (0.9534) were higher than those of LDP (0.8882) (p = 0.030). At a willingness-to-pay threshold of 20,000 and 30,000 euros, there was a 62.64% and 71.30% probability that RDP was more cost-effective than LDP, respectively. The RDP procedure in the Spanish healthcare system appears more cost-effective than the LDP.

Techno-Economic Assessment of Industrial Vanadium Flow Batteries Based on Experimental Data

This work presents a techno-economic model based on experimental and market data to provide forecasts of the profitability of vanadium flow batteries (VFBs), which are emerging as a promising technology for specific stationary energy services [1‒2]. Each component affecting the capital and operative costs was analyzed and the impact of side phenomena on capacity losses was considered. Relevant economic parameters were taken from real market data: discount rate was calculated based on the Capital Asset Pricing Model (CAPM) to account for real market conditions; the electricity price follows an arbitrage strategy to profit of the daily price fluctuations taken from the historical data of the Italian energy market [3‒4]. Technical parameters are taken from large-area multi-cell stack, rather than from small single cell experiments, thus allow to characterize the behavior of real industrial reactors [5‒6]. The economic performance indicators obtained are the capital cost, the operative cost, the Levelized Cost of Storage (LCOS) and the Net Present Value (NPV). The resulting values are: a discount rate of 9.12% and electricity prices of 200 € MWh–1 in selling and of 100 € MWh–1 in buying. Capital costs and LCOS were calculated for different system power and energy (E/P) ratings. At E/P = 2 h, the values of capital costs and LCOS were in the range of 800 – 900 € kWh–1 and 0.50 – 0.55 € kWh–1, respectively, whereas at E/P = 10 h they reduced to 350 – 380 € kWh–1 and 0.29 – 0.32 € kWh–1, respectively. In addition, a NPV analysis was carried out in order to evaluate whether these capital costs could provide a profit. The analysis suggests that only at capital cost < 105 € kWh–1 the break-even point (NPV = 0) was reached. The result is that the assumed techno-economic scenario VFBs were not profitable for every considered E/P. A perspective analysis was developed to reveal when VFBs can become profitable. Different screenings were made on both technical and economic parameters. At a technical level, a power density of 0.25 W cm–2, a RTE = 85%, a SOC = 90%, and a reduced number of regenerating processes in the lifespan (Nreg = 4) were considered. Regarding the economic parameters, a discount rate of 7 % was assumed, an electricity selling price of 250 € MWh–1 and a purchasing price of 75 € MWh–1 were used, compatible with a more pronounced Duck Curve of the daily electricity price, induced by the expansion of renewable energy sources expected in the near future. Under this scenario, the system costs decreased considerably: at E/P = 2 h, the Capital Costs and LCOS ranged as 530 – 570 € kWh–1 and 0.25 – 0.27 € kWh–1, respectively, whereas at E/P = 10 h, the Capital Costs and LCOS ranges as 260 – 270 € kWh–1 and around 0.17 € kWh–1, respectively. The latter figures made VFBs profitable for E/P in the range of 4 – 10 hours, as shown in the figure below.

Robotic-assisted neck dissection

The neck dissection has had several evolutions in the last decades, most recently with the addition of the robotic neck dissection to the head and neck surgeon's arsenal. The robotic neck dissection has emerged as a viable option for patients and offers a minimally invasive approach to the cervical lymphatic system. The major advantage includes the avoidance of a visible neck scar, while its limitations include increased operative time and cost. After several iterations, the retro-auricular/modified facelift incision has developed into the surgical approach of choice, offering excellent cosmesis while securing oncologic effectiveness. In this chapter we describe this approach in detail.