Port Closure Research Articles

Assessing vessel transportation delays affected by tropical cyclones using AIS data and a bayesian network: A case study of veronica in northwestern Australia

Tropical cyclones frequently disrupt maritime transportation systems, impacting the normal operation of vessels and causing transportation delays. Analyzing the occurrence and degree of vessel transportation delays under disaster conditions is one of the critical aspects of maritime transportation management. This article, based on Automatic Identification System (AIS) data, examined the real behavioral trajectories of vessels and delay characteristics during tropical cyclones. Taking the example of Tropical Cyclone Veronica, which occurred in the waters off northwestern Australia in 2019, we conducted a comprehensive analysis. This involved numerical simulations of the entire disaster process and the cleaning and matching of trajectory data for all affected vessels in the area. We delved deeply into the relationship between vessel behavior characteristics and tropical cyclones, identified factors contributing to delays, and, based on our findings, constructed a Bayesian network inference model for vessel transportation delays under disaster conditions. This model uses information such as tropical cyclone intensity, vessel basic attributes, behavior choices, and port disaster avoidance measures as its primary nodes. The research results indicate that vessel rerouting, vessel loss of control, and waiting for port entry are the three major sources of vessel delays during disasters. Key influencing factors contributing to these consequences include port closure measures, the duration of vessels being adversely affected by strong winds, vessel tendencies toward loss of control, and risk preferences. To control the extent of vessel delays more effectively, it is crucial to prioritize these sensitive factors and strengthen monitoring and management efforts. This model is driven by real data, providing an objective reflection of real-world scenarios, and its effectiveness has been validated through sensitivity analysis. The research perspective and algorithmic framework presented in this paper offer a novel paradigm and fresh perspective for the study of maritime transportation disasters. The research findings have significant implications for bolstering the resilience of maritime transportation networks, enhancing our comprehension and anticipation of delays, and ensuring the continuity, security, and efficiency of the global supply chain for goods.

Evaluation of Open (Hasson's) and Closed (Veress) Technique of Intraperitoneal Access for Creation of Pneumoperitoneum in Laparoscopic Surgery.

Background The creation of pneumoperitoneum is the first step in any laparoscopic surgery. There are various methods of creating pneumoperitoneum which can be divided into open or closed methods. The closed method involves the blind insertion of the Veress needle into the peritoneal cavity. The open technique involves making an incision and then dissecting the fascia to the peritoneal cavity to introduce the cannula under direct vision. This study was conducted to evaluate the safety and efficacy of open (Hasson's) and closed (Veress) techniques of intraperitoneal access for the creation of pneumoperitoneum in laparoscopic surgery. Material and methods The study was conducted in the Department of General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi. This was a prospective observational study and a total of 100 patients of laparoscopic surgeries fulfilling inclusion criteria were included in the study - 50 patients in group A undergoing the open method of creating pneumoperitoneum and 50 patients in group B undergoing the closed method of creating pneumoperitoneum were evaluated for the study period of 18 months from October 2020 through June 2022. Results The mean time to create pneumoperitoneum was 5.3 ± 1.41 minutes in the open method and 6.21 ± 1.36 minutes in the closed method. The mean time for umbilical port closure in our study was 7.33 ± 1.66 in the open group and 8.86 ± 2.19 in the closed group. In our study, there was no vascular or visceral injury noted in either of the methods used for the creation of pneumoperitoneum. Post-operative complications were almost equal in both the groups. Conclusions Both open and closed methods of intraperitoneal access are safe and effective for the creation of pneumoperitoneum during abdominal laparoscopy. The open method of creating pneumoperitoneum in laparoscopic surgery is a quicker method for the creation of pneumoperitoneum as compared to the closed method of intraperitoneal access.

EU-DEMO vacuum vessel port closure plate fastening developments

The EU-DEMO project, which has been in the Concept Design phase since 2021, is already focusing on the integration of the main system components but is also analysing variants to simplify this process. One of these is the fastening and sealing of vacuum vessel closures, known as port closure plates, in order to simplify the execution of the work with the aid of remote maintenance. Recognising the key role of industry, the fusion programme roadmap foresees intensive industry involvement in specific tasks. To provide a starting point for such collaboration, the Fusion Technology Department (FTD) has developed an initial design for a mechanical fastening solution based on the design of ship bulkhead doors. This could be combined with a welded seal, also developed to an early stage in FTD, which could cope with all load cases without additional measures. This system of easy to use fastening and reliable welded seal could be a significant simplification compared to other established technical solutions to this function. This paper presents the above issues and describes the current state of development. It also outlines initial plans to involve experienced industrial partners in these tasks.

Design and Development on the Remote Maintenance Tools and Strategy of the Port Closure Plate in DEMO

Design and Development on the Remote Maintenance Tools and Strategy of the Port Closure Plate in DEMO

Laparoscopic prepregnancy transabdominal cerclage: operative and pregnancy outcomes for a novel technique of suture placement using port closure device

Trans-abdominal cerclage (TAC) is an effective surgical intervention for preterm birth prevention. Placement of cervical suture using port closure device for pre-pregnancy laparoscopic abdominal cerclage has been used at our unit in recent years. We report operative and pregnancy outcomes for pre-pregnancy laparoscopic abdominal cerclage using the port closure device compared to traditional approach.For pre-pregnancy laparoscopic TAC(n=52), the port closure device approach is associated with lower blood loss at surgery and hospital length of stay (0.95+-4.4 mls vs 5.4+-15.7mls, p=0.007; 0.0(0.0-0.0) days vs 1.0(0.0-1.0) days, p<0.001). There were also trends towards shorter operating times (41.4+-15.3 minutes versus 50.1+-18.0, p=0.167) and lower peri-operative complications (0.0%, 0/21 vs 16.1%, 5/31, p=0.065) compared to traditional technique. There was no significant difference between the port closure device technique and traditional approach in rates of preterm birth rate in subsequent pregnancy (0.0%,0/9 vs 22.6%,7/39, p=0.248).Novel use of the port closure device for suture placement at pre-pregnancy laparoscopic cerclage for preterm birth prevention. This technique is associated with lower blood loss and length of stay, has trends in shorter operating times and peri-operative complications and similar rates of preterm birth.

Trocar Entry Site Hernias in Laparoscopic Sleeve Gastrectomy Patients: A Retrospective Cross-Sectional Study.

Introduction There is insufficient data regarding trocar access site hernias (TSH) in laparoscopic sleeve gastrectomy (LSG). This retrospective study aimed to identify the incidence and risk factors for hernia development in patients who did not undergo fascia repair at trocar entry sites. Materials and methods We retrospectively reviewed the records of 284 patients with morbid obesity who underwent LSG between January 2016 and December 2021. The fascia of the trocar entry site was not closed in any of the patients. Weight, body mass index (BMI), percentage of excess weight loss (%EWL), percentage oftotal weight loss (%TWL), comorbidities, and the occurrence of complications were recorded at one, six, 12, 18, and 24 months after surgery. Ultrasonography (USG) was performed and supplemented with computed tomography (CT) when necessary. Results All patients underwent a 24-month follow-up, during which four patients developed trocar site hernias, resulting in an overall prevalence of 1.4%. Of the total hernias, two occurred within the first 30 days. A single patient required surgical intervention for an incarcerated hernia on the 18th day. Before undergoing laparoscopic sleeve gastrectomy (LSG), the mean weight and body mass index (BMI) of the participants were 124.2 ± 16.7 kg and 43.4 ± 5.7 kg/m², respectively. After one year, the participants experienced a mean percentage of excess weight loss (EWL) of 77.1 ± 12.2% and a mean total weight loss (TWL) of 33.2 ± 6.2%. Hernia formation has been found to be associated with both type 2 diabetes (T2D) and female gender. Conclusion In laparoscopic sleeve gastrectomy (LSG), repair of the trocar port closure is not always necessary. The rates of hernia at port entry sites were similar between cases with and without fascial repair.

Feasibility of a self-powered movable seawall using microtidal energy in Japan

The technology for closing port entrances using movable gates as a tsunami countermeasure has recently garnered increasing attention in Japan. However, it is not possible to mechanically operate the gates if power is lost because of a disaster. Accordingly, this study proposes a self-powered movable seawall system that utilizes microtidal energy generated by port closure for operating the gates. As tidal ranges in Japan are not favorable for power generation, the feasibility of the proposed system was assessed at 56 ports throughout Japan. The self-powered system was found feasible at nine ports during both spring and neap tide and at 14 ports during spring tide, whereas the tidal range was too small to operate the system at the other 33 ports. Moreover, 20 feasible ports were located such that tsunamis are predicted to occur in the scenario of a megathrust earthquake, which has a 90 % occurrence probability in the next 40 years. Surplus electricity is expected to be generated on-site with the proposed system, even if a power outage occurs, which is especially valuable for urgent disaster response and business continuity in industrial areas. Our findings outline a synergistic system between disaster prevention and the use of renewable energy.

A cognitive task analysis of expert surgeons performing the robotic roux-en-y gastric bypass.

The safe and effective performance of a robotic roux-en-y gastric bypass (RRNY) requires the application of a complex body of knowledge and skills. This qualitative study aims to: (1)define the tasks, subtasks, decision points, and pitfalls in a RRNY; (2)create a framework upon which training and objective evaluation of a RRNY can be based. Hierarchical and cognitive task analyses for a RRNY were performed using semi-structured interviews of expert bariatric surgeons to describe the thoughts and behaviors that exemplify optimal performance. Verbal data was recorded, transcribed verbatim, supplemented with literary and video resources, coded, and thematically analyzed. A conceptual framework was synthesized based on three book chapters, three articles, eight online videos, nine field observations, and interviews of four subject matter experts (SME). At the time of the interview, SME had practiced a median of 12.5years and had completed a median of 424 RRNY cases. They estimated the number of RRNY to achieve competence and expertise were 25 cases and 237.5 cases, respectively. After four rounds of inductive analysis, 83 subtasks, 75 potential errors, 60 technical tips, and 15 decision points were identified and categorized into eight major procedural steps (pre-procedure preparation, abdominal entry & port placement, gastric pouch creation, omega loop creation, gastrojejunal anastomosis, jejunojejunal anastomosis, closure of mesenteric defects, leak test & port closure). Nine cognitive behaviors were elucidated (respect for patient-specific factors, tactical modification, adherence to core surgical principles, task completion,judicious technique & instrument selection, visuospatial awareness, team-based communication, anticipation & forward planning, finessed tissue handling). This study defines the key elements that formed the basis of a conceptual framework used by expert bariatric surgeons to perform the RRNY safely and effectively. This framework has the potential to serve as foundational tool for training novices.

A294 Bariatric Laparoscopic Port Closure: A Simple, Effective and Easy Technique that Prevents Incisional Hernias and Dimpling

A294 Bariatric Laparoscopic Port Closure: A Simple, Effective and Easy Technique that Prevents Incisional Hernias and Dimpling

A Comparative Study between Metal Clip Application and Suture Ligation of Cystic Duct in Laparoscopic Cholecystectomy

Introduction: Laparoscopic cholecystectomy has been performed for decades and is a fairly standardized procedure throughout the world. Occlusion of the cystic duct is popularly done with the help of metal clips. There are many other techniques described in the literature to deal with occlusion of the Cystic Duct. Suture ligation of the duct is one such way.To evaluate the effectiveness in term of cost, safety, and complication in occlusion of cystic duct with suture ligation compared to clip application. Materials and Methods: A prospective cross sectional comparative study was carried out From June 2020 to November 2020. Data were collected from 80 patients undergone laparoscopic cholecystectomy for Gall stone diseases. 40 patients were enrolled in each group by consecutive purposive sampling. Complete history was taken. Thorough clinical examination was done. Relevant investigations report was collected. Results: Female patients were predominant in both groups and most of the patients were underweight. Mean time for ligation was more in occlusion of cystic duct with clip application. Bile leakage was found and duration of drain in situ was more in occlusion with clip application. Cost was high in occlusion with clip application. Conclusion: : Time for ligation, Bile leakage, mean duration of drain in situ (days), and cost of Cystic Duct occlusion and port closure were significantly higher in Laparoscopic Cholecystectomy with conventional Clip application of Cystic Duct group in comparison to Laparoscopic Cholecystectomy with ligation of the Cystic duct with no-1vicryl by extra corporeal knotting group. Medicine Today 2023 Vol.35(1): 27-30

Port Closure Due to the Covid-19 Pandemic in the Law of Carriage of Goods By Sea and Unidroit Principles of International Commercial Contracts

Port closure as an effort to slow the spread of the Covid-19 virus has had various impacts, such as port congestion which has led to delays and drastically increased transportation costs. This study examines the impacts caused by port closures and legal remedies that can be taken based on international sea transport law. Losses due to port closures cannot be borne by the carrier based on the conventions of sea shipping law as long as the carrier can prove that the fault was not his own. The closure of the port can be categorized as a hardship, in which there are fundamental changes that affect the agreement, namely the increase in shipping costs and delays. efforts that can be made based on the UPICC are renegotiation, and if it fails, the parties can seek a dispute settlement through the courts. In implementing the agreement, the parties must prioritize the principle of good faith and prove that the losses incurred and losses did not originate from themselves.

Retaining the epigastric trocar, until rest all ports closed decreases post-operative shoulder pain in laparoscopic cholecystectomy patients

Background: Laparoscopic cholecystectomy has become the mainstay of treatment for gallstone disease cases due to its lower morbidity and pain compared to open techniques. Unfortunately, the use of carbon dioxide to insufflate the abdomen is the main contributor to post-operative shoulder pain. Aims and Objectives: The aim of the study was to evaluate the effectiveness of retaining the epigastric port trocar in position until rest all ports closed after completion of lap cholecystectomy in decreasing the post-operative shoulder pain. Materials and Methods: A prospective, randomized, and clinical trial was done in AIIMS hospital, Bhubaneswar, on 102 patients who have undergone laparoscopic cholecystectomy. The patients were alternatively selected, one in the study group (52) and the other in the control group (50). For those patients in the study group, after the completion of the surgery, the epigastric port trocar is retained in position until the rest of all ports were closed. In the control group, all trocars were removed and port closure was done. The patients were evaluated for the next 24 h for post-operative shoulder pain. A numerical rating scale (NRS) was used to assess shoulder pain on patient arrival to the ward, at 4, 6, 12, and 24 h postoperatively. One hundred and two patients were included in the final data analysis. Results: NRS pain scores were significantly lower in the study group at 6, 12, and 24 h post-laparoscopic cholecystectomy compared to the control group with no additional requirement of IV analgesics. Conclusion: Retaining the epigastric trocar in position is an easy way that is beneficial in reducing post-operative shoulder pain post laparoscopic cholecystectomy surgery.

DEMO vacuum vessel port closure plate sealing and fixation activities

DEMO should be as close as possible to a future fusion power plant, produce electricity and have a high level of availability. In the current Concept Design phase, the design is to be further elaborated and industry is to be increasingly involved as a partner in the development. An essential component will be the vacuum vessel (VV), which has to fulfil many tasks. It serves as a first confinement barrier and houses in-vessel components (IVCs) that are necessary for operation. The VV has numerous openings - the ports. These are closed during DEMO operation by so-called port closure plates (PCPs). All handling of the PCPs and IVCs, as well as inspection throughout the operational phase, must be done through remote maintenance tools and without the presence of personnel. Within the framework of qualified partners from industry the fastening and sealing of the PCPs is studied. Many requirements are associated with the technical implementation. As the development of DEMO is still in an early phase, the present goal is not yet the development to a high degree of maturity. Instead the review of established industrial solutions regarding their suitability to DEMO as well as the identification of adapted solutions with more attractive features for the DEMO application are aimed for. In this paper, the background as well as the status of this task is explained.

Endoscopic evaluation of velopharyngeal function in cleft lip palate patients – A correlation with speech analysis

Speech abnormalities due to velopharyngeal insufficiency (VPI) significantly affect communication skills, self-esteem, and scholastic performance. It leads to a poor social, emotional, educational, and behavioral development and a poor quality of life overall in cleft lip palate (CLP) patients. Its early diagnosis and severity assessment using video-nasoendoscopy and speech assessment can significantly contribute to management. The present study evaluated VPI in CLP patients using both tools. A total of 48 patients with repaired cleft palate were subjected to speech and video-nasoendoscopic assessment. Speech assessment measured severity of hypernasality, speech intelligibility, and voice quality. Video-nasoendoscopy evaluated velopharyngeal port closure to grade the severity of VPI. The speech assessment and video-nasoendoscopy findings were analyzed and correlated. There was a moderately strong statistically significant negative correlation between the grade of VPI and hypernasality (r=-0.542, p=0.000). There was a stronger statistically significant negative correlation of grade of velopharyngeal port insufficiency with speech intelligibility (r=-0.634, p=0.000). About 72% of the patients had abnormal voice quality. This study is the first attempt at diagnosing and grading VPI on a quantitative scoring based on a ratio scale for the motion of soft palate and pharyngeal walls. The strong correlation between endoscopic grading and speech analysis findings warrants further evaluation of nasoendoscopic grading of VPI in more studies.

Periphery and Forefront: The Evolution of the Status of Coastal Areas and Territorial Seas in Ancient Zhoushan Islands

In the early stage of China, due to the mainland regime’s control over the Zhoushan Islands, the sea border of Zhoushan Islands was in the marginal position of the country. This marginal position was caused by objective reasons, namely “objective periphery”. The abandonment of the county-level administrative system of Zhoushan Islands in the Tang Dynasty due to Yuan Chao’s uprising in Wengshan was a subjective marginalization of the status of Zhoushan Islands in the sea, that is, “subjective periphery”. The subjective periphery is completely different from the objective periphery in nature. It reflects the consciousness of the rulers at that time on a more important level. The maritime policy towards Zhoushan Islands in the Song and Yuan Dynasties not only reflected the ruler’s consciousness and the positive attitude of active openness in policy, but also reflected the forefront status of Zhoushan Islands, which was the “active forefront” period of Zhoushan Islands. The maritime embargo policy and port closure policy in the Ming and Qing Dynasties are the manifestation of the rulers’ active periphery of Zhoushan Islands, but Zhoushan Islands is still the passive forefront of the national sea. The changes of the policies of the successive regimes towards the sea and forefront of Zhoushan Islands are not only the embodiment of the national consciousness at that time, but also the embodiment of the national destiny.

Octyl cyanoacrylate skin adhesive with or without subcuticular suture for skin closure after implantable venous port placement for oncology patients: a propensity-score matching analysis

To compare peri-operative outcomes of skin closure with octyl cyanoacrylate (OCA) skin adhesive (Dermabond) with or without subcuticular sutures after deep dermal suturing for implantable venous port placement closure. Seven hundred and ninety-two single-lumen implantable venous port insertions for chemotherapy were reviewed from September 2019 to March 2021 in a retrospective single-centre study. Propensity-score matching by a 1:1 nearest neighbour algorithm was conducted to control for confounding baseline differences. Distances were determined by logistic regression. Propensity-score matching was performed based on the following variables: age at procedure, gender, race, operator's seniority, use of anchoring polypropylene suture (PROLENE), port model, and volume of intra-operative local analgesia. The primary outcome was wound dehiscence at the first follow-up (∼1 week). The 792 port insertions were conducted in 302 males (38.1%), median age 63 years (IQR: 54-69). Of the 656 wounds closed with subcuticular sutures and skin adhesive, 136 were matched in a 1:1 fashion against procedures closed without a subcuticular suture. No significant differences were demonstrated in pain scores, bleeding, swelling, bruising, fever, wound dehiscence, and discharge at postoperative day 1 (POD1) and at first follow-up between the groups (all p>0.05). Of note, no significant differences in wound dehiscence at first follow-up was found in both unmatched (p=0.133) and matched cohorts (McNemar-Bowker's χ2=1.167, p=0.761). These findings suggest that the omission of subcuticular sutures during implantable venous port closure may not compromise peri-operative outcomes when OCA skin adhesives were used.

Effect of Varied Tube Phonation in Water Exercises on Nasometric and Electroglottographic parameters: Modification in Terms of Fluid Density and Tube Submerged Depth

Within the scope of semi-occluded vocal tract exercises (SOVTEs), we aimed to examine the effects of four exercise combinations, which involved various fluid densities and tube submersion depths, on acoustic and electroglottographic (EGG) parameters. Four procedures (P) were applied consecutively to 30 female participants with normal voices using different tube submersion depths and fluid densities, including P1 (2 cm, water), P2 (2 cm, nectar), P3 (10 cm, water), and P4 (10 cm, nectar). Nasometric (Nasometer II model 6450) and EGG (Electroglottograph model 6103) measurements were taken before the procedures were initiated (pre-test) and at the end of each procedure. In addition, EGG measurements were taken for each procedure during the application. For all three velar positions (oral passage, oro-nasal passage, nasal passage), the only procedure that caused a significant change compared to the pre-test stage in regard to nasalance score was P2 (2 cm nectar) in common. All other procedures except P1 (2 cm water) significantly increased velar closure compared to pre-test levels. However, when the differences between the exercises were examined, the least velar closure, compared to the other procedures, was obtained after P4 (10 cm nectar). While there was no significant difference between the procedures in the EGG measurements during the exercise, a significantly higher tendency to contact was observed after the procedures with a denser consistency, and an increase in the fundamental frequency (fo) values occurred in the pairwise comparisons of the procedures in the measurements after the exercises. In SOVTEs in which water phonation is performed with a tube, the use of a fluid with a consistency denser than water can be considered a particularly promising approach. In addition, exercises performed with increasing consistencies in 2 cm depth can provide more vocal cord and velopharyngeal port closure by increasing EGG-CQ and nasalance score values. However, more care should be taken while increasing the consistency at a submersion depth of 10 cm.

Speech Outcomes of Treatment for Velopharyngeal Insufficiency: Combined Use of an Overlapping Intravelar Veloplasty and Dynamic Sphincter Pharyngoplasty.

Velopharyngeal insufficiency involving a large velopharyngeal gap and poor lateral wall movement is referred to as a "black hole" and remains a challenging problem for cleft surgeons. The effect of the pharyngeal flap on this form of velopharyngeal insufficiency is still debatable because a wide pharyngeal flap is associated with a high incidence of airway obstruction. The present study aimed to evaluate the speech outcomes of combined overlapping intravelar veloplasty and dynamic sphincter pharyngoplasty for the treatment of velopharyngeal insufficiency. Between March 2016 and June 2019, 15 patients with velopharyngeal insufficiency were treated with a combination of overlapping intravelar veloplasty and dynamic sphincter pharyngoplasty. Preoperative speech evaluation was performed on the basis of perceptual speech evaluation, nasometry, and nasoendoscopy. Postoperative speech evaluation using the same approach as that used preoperatively was performed after completion of speech therapy. All 15 patients achieved satisfactory velopharyngeal port closure and speech phonation after completion of speech therapy. No additional procedures were performed to improve velopharyngeal port closure and speech production. The preoperative and postoperative results of perceptual speech evaluation, nasometry, and nasoendoscopy evaluation were significantly different (P < 0.01). Combined treatment with overlapping intravelar veloplasty and dynamic sphincter pharyngoplasty can correct the velopharyngeal insufficiency "black hole" with highly reliable results and minimal risk of airway obstruction.

Trends in Robotic Port Closure and Hernia Risk by Surgical Specialty

<h3>Study Objective</h3> Determine if the rate of robotic fascial port closure differs by surgical specialty and assess the relationship between fascial closure and port-site hernias after a robotic-assisted surgery. <h3>Design</h3> Retrospective chart review of patients undergoing robotic surgery by gynecologists, urologists and general surgeons in which a 10 mm assistant port was used. <h3>Setting</h3> Urban Teaching Hospital with dual-console robotic teaching program. <h3>Patients or Participants</h3> Patients on the Gynecology, Urology, and General Surgery services at the University of Colorado between in 2019 who underwent a robot-assisted surgical procedure with or without fascial closure. <h3>Interventions</h3> Fascial closure or non-closure of the 10 mm laparoscopic port sites. <h3>Measurements and Main Results</h3> A total of 361 patients underwent robotic-assisted laparoscopy for gynecologic, urologic and general surgery procedures during the study period. Gynecologists were most likely to suture close the 10 mm fascial ports with 99% closure rate. General Surgeons closed the fascial port 87% of the time. Urologists were significantly less likely to close the 10 mm fascial port site with a 26% closure rate (P<0.001). The overall hernia rate was low for all cases at 0.6%. The fascial hernia rate was 0% for Gynecological procedures, 0.8% for Urological procedures, and 0% for General Surgery procedures. There was no difference in the hernia rates between the surgical specialties (P=0.89). There also no difference between the hernia rates whether the fascial port was closed or not (0% vs 1.1%, P=0.64). <h3>Conclusion</h3> There are differences between surgical specialties in the decision to close a 10 mm laparoscopic port with Gynecologists and General Surgeons suturing the fascia closed more commonly than Urologists. Despite this difference in practice, the hernia risk is very low in robotic surgery.

Fuel Bunker Management Strategies Within Sustainable Container Shipping Operation Considering Disruption and Recovery Policies

This paper endeavors to explore the sustainable container shipping problem considering fuel bunker management and provide adequate recovery policies for countering disruption within maritime transportation. This paper addresses the environmental concerns related to fuel consumption and carbon emission within shipping operations and simultaneously presents strategies for countering disruption within the maritime transportation domain. Several studies addressed bunker fuel management strategies, but overlooked the need for integrating it with shipping operations. This paper aims to bridge this research gap by proposing a novel mathematical model and presenting a heuristic procedure combined with a variable neighborhood search algorithm for maximizing the shipping company's profitability, while addressing the vessel routing and scheduling decisions, container loading and unloading operations, selection of bunkering ports, and determining bunkered amount for heavy fuel oil and marine diesel oil. Recovery strategies such as port swapping and rescheduling of vessel route are considered to deal with disruptions related to weather adversities. An illustrative example is presented depicting the realistic scenario and providing results associated with ship routes, vessel speed, bunkering ports, bunkered amounts, fuel consumed by the vessel on each sailing leg, arrival and departure time of the ships, etc. Insights obtained from the analysis performed based on the fuel price, ship's bunkering capacity, adverse weather conditions on various routes, port closure, carbon tax, and fuel consumption provide useful information for shipping company managers. Managerial implications are presented with regard to the impact of fuel prices and carbon tax on shipping operation from the perspective of overall operational cost. Moreover, the results provide important policy insights for shipping company managers in terms of possessing alternate vessel route options for normal scenario and disrupted scenarios including weather adversities on sailing leg or port closure.