Port Installation Research Articles

Critical View of Safety Dissection and Rouviere's Sulcus for Safe Laparoscopic Cholecystectomy: A Descriptive Study.

Objective: To determine the importance of a critical view of safety (CVS) techniques and Rouviere's sulcus (RS) in laparoscopic cholecystectomy (LC) and its relation to biliary duct injuries (BDIs) and to determine the frequency and the type of RS. Design, Setting, and Participants: A descriptive study was carried out among 76 patients presenting to the surgery department of a tertiary care center in Nepal. The study population included all patients in the age group 16-80 years undergoing LC. Outcome Measures: The main outcome of interest was to calculate the percentage of BDIs along with the frequency and the type of RS. Results: A total of 76 patients were enrolled in the study, out of which 57(75%) were female patients with a male-to-female ratio of 1:3 and a mean age of 45.87 ± 15.33 years. Seventy-one (93.4%) patients were diagnosed with symptomatic gallstone disease. The CVS was achieved in 75 (98.7%) of the cases, whereas in 1 case, the CVS could not be achieved, and in the same patient routine LC was converted into open cholecystectomy owing to the difficult laparoscopic procedure. In 56 (73.7%) cases, RS was first visible to the operating surgeons after port installation, alignment, and adequate traction of the gallbladder; in 20 (26.3%) cases, RS was not originally apparent. Conclusion: According to the findings of this study and the literature's critical assessment of safety, this method will soon become a gold standard for dissecting gall bladder components. The technique needs to be extended further, especially for training purposes. Major difficulties can be avoided by identifying RS before cutting the cystic artery or duct during LC.

8154 Comparison of Surgical Outcomes of Hysterectomy by Vaginal Notes Versus Single-Port Access (SPA) Surgery

<h3>Study Objective</h3> The objective of the present study is to compare the patient characteristics, operative details, and post-operative outcomes among patients who underwent vNOTES against those who underwent SPA laparoscopic surgery for benign gynecologic diseases. <h3>Design</h3> Prospective outcome study. <h3>Setting</h3> Tertiary university teaching hospital. <h3>Patients or Participants</h3> The patients who were planned to undergo vNOTES or SPA laparoscopic surgery between April 2020 and June 2021 were prospectively enrolled. The surgical method was determined by a single surgeon after the evaluation of imaging results and physical exams. Those who demonstrated favorable pelvic conditions without any evidence of adhesion were scheduled for vNOTES. <h3>Interventions</h3> vNOTES hysterectomy vs. SPA TLH. <h3>Measurements and Main Results</h3> A total of 33 patients underwent vNOTES hysterectomy while 40 patients received SPA laparoscopic hysterectomy. All surgeries were performed by one surgeon. The proportion of the patients who had history of vaginal delivery was significantly higher in the vNOTES group. The operative time for port installation was significantly longer in the vNOTES group, but the total operative time was shorter in the vNOTES group compared to the SPA group. The post-operative pain scores 12 hours after the operations were also significantly less in the vNOTES group. Other surgical information and immediate post-operative outcomes were comparable between the two groups. <h3>Conclusion</h3> The present study demonstrated that the early operative outcomes of vNOTES hysterectomy were comparable to those of SPA hysterectomy. It also highlights the importance of adequate patient selection when determining surgical methods based on imaging results and physical exams.

Comparison of Surgical Outcomes of Hysterectomy by Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) versus Single-Port Access (SPA) Surgery.

Single-port access (SPA) laparoscopic surgery and vaginal natural orifice transluminal endoscopic surgery (vNOTES) have many advantages. The objective of the present study is to compare patient characteristics, operative details, and postoperative outcomes between the two surgical methods. Patients who were planned to undergo vNOTES or SPA laparoscopic surgery between April 2020 and June 2021 were prospectively enrolled. The surgical method was determined by a single surgeon after imaging results evaluation and a physical exam. Those who had favorable pelvic conditions without any evidence of adhesion were scheduled for vNOTES. A total of 33 patients underwent a vNOTES hysterectomy while 40 patients received a SPA laparoscopic hysterectomy. All surgeries were performed by one surgeon. The proportion of the patients who had a history of vaginal delivery was significantly higher in the vNOTES group. The operative time for port installation was significantly longer in the vNOTES group, but the total operative time was shorter compared to the SPA group. The postoperative pain scores 12 h after the operations were also significantly lower in the vNOTES group. Other surgical outcomes were comparable between the two groups. The present study demonstrated that the early operative outcomes of vNOTES hysterectomy were comparable to those of SPA hysterectomy. It also highlights the importance of adequate patient selection when determining surgical methods based on imaging results and physical examinations.

Benthic Foraminifera of Tropical Estuarine-Lagoonal-Bays System, in the Suape Harbor, Brazil: A Case Study

ABSTRACT The Suape Industrial Port Complex is one of the main Brazilian public ports that has caused several geomorphological changes in Ipojuca and Suape estuarine-lagoonal-bays since its construction. The present study deals with the first status on the Suape port ecosystem, recorded from 41 sediment samples throughout the Massangana/Tatuoca and Ipojuca/Merepe estuarine systems. Species diversity values are higher in the seaward part of the bays and decreases toward the inner parts. The dominance of Ammonia tepida in the inner portions of the bays is indicative of environmental instability and pollution of coastal waters. Eggerella spp., unusual in Brazilian fauna, was present only in the innermost portion of the Tatuoca estuary, in the dredged channel, where heavy metal impacts have been reported. Amphistegina gibbosa, Triloculina oblonga, and Quinqueloculina lamarckiana are represented on the outside of the bays and are indicative of high hydrodynamic marine environments. The Ipojuca and Merepe rivers presented the highest ecological index, possibly attributed to the marine and terrestrial/mangrove influence for the region. We infer that geomorphological transformation caused by the Suape Port installation modified and established environments with distinct characteristics, mainly in the Suape Bay dredged area, indicative of possible eutrophication of this environment. The new data may be useful for determining environmental conditions and establishing new ways to monitor the consequences of anthropogenic interference and dredging in the Massangana/Tatuoca and Ipojuca/Merepe estuarine systems.

Hysterectomy and Adnexal Procedures by Vaginal Natural Orifice Transluminal Endoscopic Surgery (VNH): Initial Findings From a Korean Surgeon.

Objective: To evaluate feasibility and safety of hysterectomy and adnexal procedures by vaginal natural orifice transluminal endoscopic surgery (vNOTES).Study Design: This is a prospective observational study at a tertiary center and teaching University hospital. We enrolled prospectively 34 patients with benign diseases sequentially.Results: We measured baseline characteristics, surgical data, and pain score (VAS) after surgery. We surveyed before/after surgery. The time of port installation and each stage of surgery was measured. The learning curve was assessed through the graph according to the number of operations using linear and logarithmic regression curve estimation. The complications of surgery were investigated. The median age of the patients was 47.5 years (38–73). Median BMI was 22.4 (18.2–30.0). 20 cases of leiomyoma, four cases of adenomyosis, three cases of uterine prolapse, four cases of endometrial hyperplasia, and three cases of CIN were diagnosed. The median uterine weight was 180.0 g. The median port-installation time was 15.0 min (range, 4–35 min) and median total operation time was 85.5 min (range 43.0–132.0). Complications occurred in three patients. Two cases of bladder injury happened during vesicovaginal space dissection before the installation of the Wound Retractor (WR). One patient underwent transumbilical single-port surgery because of late-onset postoperative bleeding on the 13th postoperative day. The mean postoperative VAS scores were 3.36 immediately after surgery and 3.06, 2.79, and 2.45 at 6, 12, and 24 h after surgery, respectively. In continuous variable analysis, we detected a correlation between port-installation time and postoperative VAS ≥4 (pain score as need for medication). Based on a learning curve, port-installation time and total operation time appeared to reach the proficiency level by the 10th case.Conclusions: Although there were three complications, vNOTES offers advantages to patients and surgeons. More surgical techniques will be developed in vNOTES.

ЗАБРУДНЕННЯ АЕРОЗОЛЬНИМИ ЧАСТИНКАМИ, ЩО ПОВ'ЯЗАНЕ З ЕКСПОРТОМ ФОСФАТУ У ПОРТУ АННАБА

For several decades, airborne particulate matter (PM) pollution has become one of the major concerns of policymakers across the globe, due to its adverse effects on climate, human health, environment and various socio-economic sectors. The process of phosphate export in bulk is one of the main source generating air pollutants, such as PM emissions of different shapes, concentrations and particle sizes, which can cause respiratory diseases. The objective of this work is to determine the dust level generated by the processes of unloading, storage and loading of phosphate in bulk to ships, by the company of the port installation at the port of Annaba (East of Algeria). The PM measurement campaign was carried out according to the NF X 43-014. It was performed on 08 sampling points located at the port of Annaba and in a periphery with a radius of up to 2.3 km. The recorded results show very high levels of dust in 05 samples series largely exceeding the acceptable threshold (1000 mg/m²/day). The level of heavy metals in dust was evaluated by the analysis of Atomic Absorption Spectrometry. EDAX analysis showed that the phosphate PM have an angular morphology elongated particles and hook-shaped.

Advantages and disadvantages of femoral port systems in hematоlogical patients with superior vena cava syndrome

Background. In the superior vena cava syndrome, vein catheterisation provides an alternative for vascular access. Few reports describe the usage of femoral ports.Aim. Description of pros and contras for femoral port installation in patients with haematological malignancies and the superior vena cava syndrome.Materials and methods. This prospective non-randomised, single-centre study included 163 haematological patients implanted 72 ports in superior vena cava, 35 — in inferior vena cava and inserted with 156 non-tunnelled femoral catheters. Catheterisation properties, complications, duration of use and reasons for port and catheter removal were registered.Results. No significant differences were observed between ports in superior and inferior vena cava as per the frequency of urokinase use in catheter dysfunction, catheter dislocation, catheter-associated bloodstream and pocket infections. Differences were revealed in the catheter-associated thrombosis rate, which was higher with femoral access (17.0 % or 0.9/1000 catheter days vs. 8.3 % or 0.2/1000 catheter days, p = 0.017). Ports in inferior vena cava had a lesser duration of use than in superior vena cava (p = 0.0001). Unlike femoral ports, non-tunnelled femoral catheters had higher rates of catheter-associated thrombosis (9/1000 vs. 0.9/1000 catheter days, p = 0.002) and infection (4.9/1000 vs. 0.3/1000 catheter days, p = 0.002). One lymphoma therapy course required one femoral port or 1 to 14 (median 3) non-tunnelled femoral catheters.Conclusion. Femoral port implantation is a necessary measure in patients with the superior vena cava syndrome. It has advantages in terms of catheterisation frequency, lower infectious and thrombotic complication rates compared to non-tunnelled femoral catheters.

Comparing two judgment scales of AHP with a case study: reaching a decision on a dry port location

Determining the most appropriate location for a new dry port installation is generally a very complex and sensitive process that requires reasoned consideration of many criteria. In this article, we aimed to determine the best location for a dry port that would support the container terminals within the hinterland of Kocaeli ports by applying analytic hierarchy process (AHP) with a case study. The city of Kocaeli, located in the northwest part of Turkey, is the second rank after Istanbul in terms of export capacity. We identified a total of five locations as the candidates of a dry port in the Gulf of Kocaeli. After reviewing the literature and taking the opinions of the 85 experts from the relevant sectors, we developed seven criteria to be a basis in the AHP study and weighted the factors. We carried out the pairwise comparisons, in relation to the knowledge gained through the survey. Two different judgment scales—the Saaty’s fundamental scale and the balanced scale—were used in the pairwise comparison stage. After the comparisons, the variance related to the consistency ratios and the range of the sensitivity was also observed. In conclusion, at the end of this AHP, one of the options has remarkably placed the top rank for the most suitable location of a new dry port. It is assessed that the arguments for the criteria of the method in this study can be taken as a sample for future studies in different regions of the world.

1886 Hysterectomy and Adnexal Procedures by Vaginal Natural Orifice Transluminal Endoscopic Surgery (Vnotes): Korean Surgeons’ Initial Reports

Study Objective To evaluate feasibility and safety of hysterectomy and adnexal procedures by vNOTES. Design Prospective observational study. Setting Prepare the surgery under general anesthesia and allow the patient to take a Trendelenburg posture. Patients or Participants Most of benign diseases except malignant disease were selected from the surgical candidates. Interventions There is no intervention other than surgery. Measurements and Main Results The first 26 patients were treated with vNOTES. Basic patient characteristics were measured, and the time of port installation and each stage of surgery was measured. The learning curve was assessed through the graph according to the number of operations using linear and logarithmic regression curve estimation. The complications of surgery were investigated. The median age of the patients was 47.5 years (38-73). Median BMI was 22.4 (18.2-30.0). Median EBL was measured as 100 ml (20.0-500). The median value of hemoglobin changes before and after surgery was 1.8 (0.2-4.5). The day of hospitalization from the day of surgery was 3 days (3-8). 18 (69.2%) cases had previous vaginal delivery history. 5 cases had previous Cesarean section. Five patients previously underwent a Cesarean section, two of which were Pfannenstiels incision and three of whom were low midline incision. The median portal time was 15 min (4-35) and the median total time was 85 min (43.1-132.0). From the 5th case in the learning curve, the port installation time was significantly shortened. Complications occurred during surgery in three patients who had undergone previous Cesarean section surgery. Two cases of bladder injury occurred during port installation due to adhesion of Cesarean section site and bladder. One case was a reoperation for intraperitoneal hemorrhage on the 13th postoperative day. There were no other complications. Conclusion To date, vNOTES does not seem to lag much behind other surgical methods in our institution. vNOTES is currently undergoing a prospective study, including pain and cosmetic aspects.

MODIFICAÇÕES NA GEOMORFOLOGIA MARINHA A PARTIR DE ESTRUTURAS PORTUÁRIAS: O CASO DO MUCURIPE, FORTALEZA/CE

O litoral de Fortaleza/CE apresenta desde o século XIX importantes alterações na linha de costa, principalmente devido a obras portuárias e de estruturas mitigatórias de erosão. A pesquisa teve como objetivo analisar a evolução batimétrica do litoral norte de Fortaleza desde o início de operação do porto do Mucuripe em 1945. A área de estudo foi delimitada pelo espigão do Titanzinho e o emissário submarino, porém foi enfatizado o entorno portuário. Foi realizada a construção de modelos digitais batimétricos a partir das cartas náuticas da Diretoria de Hidrografia e Navegação – DHN entre 1945 e 2014. Evidenciou-se devido às constantes intervenções antrópicas a presença de dois setores: um adjacente a ponta do Mucuripe, com o substrato diretamente modificado por atividades de gerenciamento portuário e um segundo setor, que seria o restante da área submersa até o emissário submarino. O primeiro setor é marcado pela criação de áreas eminentemente deposicionais devido ao molhe do Titã (efeito sombra hidrodinâmica), Titanzinho (barramento da deriva litorânea) e pelo Píer (devido ao efeito sombra do Titã e do avanço da bacia de evolução). Verifica-se que o sotamar do Titã e entornos do Píer foram sucessivamente dragados desde a década de 1950, além da criação do canal de acesso do porto na década de 1970. O segundo setor é marcado pela presença dominante de feições arenosas, destaca-se um banco longitudinal subparalelo a linha de costa de cerca de 2 Km². Esta feição apresentou grandes variações espaço-temporais desde a instalação das estruturas portuárias, no entanto a sua gênese estaria relacionada a duas possíveis origens: efeito morfodinâmico do promontório do Mucuripe no redirecionamento dos processos (pretéritos e atuais) e/ou como uma antiga barreira costeira, que posteriormente foi afogada devido à elevação do nível relativo do mar no Quaternário Superior. Destacam-se quatro complexos rochosos – o Recife do Meireles, o Recife Grande, a Pedra do Justin, e o Recife da Velha. No fim do setor dois (praia da Leste), tem a presença do emissário submarino com cerca de 3 km de comprimento e uma área de descarte de sedimentos dragados. Este setor se apresenta parcialmente modificado pelas estruturas portuárias, onde as principais alterações ocorrem nas proximidades da linha de costa (espigões e enrocamentos). Verifica-se que a morfologia do litoral submarino de Fortaleza apresenta grandes modificações (aprofundamento do leito, criação de altos sedimentares) nas proximidades do Porto do Mucuripe e na linha de costa, devido às estruturas rígidas de proteção e operação portuária.

A method of laparoscopic installation of port systems for intra-abdominal chemotherapy in patients with advanced ovarian cancer

Ovarian cancer is one of the leading causes of death in the world, in 80% of cases the diagnosis is made at a late stage. In 50% of cases, a relapse occurs even after the optimal treatment has been performed. The initial treatment of ovarian cancer, regardless of the stage of the tumor process, begins with surgical treatment, and at the second stage, combined chemotherapy is performed. Since the tumor process in ovarian cancer, as a rule, local, limited in the abdominal cavity, in order to reduce the toxicity of chemotherapy drugs on the body as a whole, the alternative options for the administration of chemotherapy drugs is intra-abdominal, which allows increasing the concentration of the drug directly in the tumor locus. Purpose of research. In our study, we want to describe the laparoscopic method of placement of intra-abdominal port systems, assess the disadvantages and advantages, as well as the risks of complications in the case of port installation at the first stage of treatment (intraoperative port installation during laparotomy) and at stage 2 (laparoscopic). Materials and methods. Technically, the implantation of the intraperitoneal port system in order to carry out subsequent chemotherapy courses was carried out in two ways: 1) intraoperative; 2) laparoscopic approaches. In the first case, the installation is carried out directly after the implementation and evaluation of the surgical intervention. In the second, the intraperitoneal catheter is implanted with laparoscopic access after revision and assessment of the quality of cytoreductive surgery. The study included 77 patients with ovarian cancer stage Ic-IV, who underwent optimal cytoreduction at the first stage of treatment (residual tumor up to 1 cm in diameter). At the second stage of treatment, patients were planned to undergo intra-abdominal chemotherapy with palixaxel drugs in combination with intravenous cisplatin. Port systems in 56 cases (72.7%) were installed intraoperatively and in 21 cases (27.3%) laparoscopically. Results. In total, port systems were installed in 77 patients, of which - in 56 cases intraoperatively and in 21 cases laparoscopically. However, a total of 30 (38.9%) laparoscopic interventions were performed: in 21 (27.2%) cases a port system was installed, in 6 (7.8%) cases during laparoscopy contraindications were detected for port implantation, in 3 (3.9%) cases required a reinstallation of the port system due to complications arising after intraoperative implantation. As described above, 6 patients had contraindications for installing port systems, of which in 4 (5.2%) cases, it turned out to be a marked adhesive disease after primary cytoreduction, in two patients (2.6%) non-optimal amount of cytoreductive interventions in the first stage. Multiple metastases in the peritoneum of up to 3 cm in diameter were visualized in one patient, which did not correspond to the protocol of the operation, the patient subsequently received standard treatment; in the second case, there was a large omentum with metastatic lesions. The patient was re-operated in the optimal volume and intraperitoneal intraperitoneal port system was installed intraoperatively. Thus, in 7.8% of cases, the protocol data of the operation did not match the laparoscopic data. Conclusion. The method of laparoscopic implantation of intra-abdominal port systems is safe and effective, which in comparison with the intraoperative installation method provides several advantages: additional revision of the abdominal cavity to assess the optimality of cytoreductive surgery performed at the first stage, assessment of the degree of adhesions in the abdominal cavity, which in turn affects the uniform distribution of the drug.

횡류식 도로터널의 급배기구 개도율 최적화 프로그램 개발 연구

도심지 터널에 주로 적용되는 횡류식 환기방식은 환기구간 거리가 길어질수록 환기성능이 저하되므로 균일한 풍량분배가 필요하다. 본 연구에서는 환기구간 거리가 길어져도 균일한 풍량분배를 통해 설계값의 환기성능을 확보할 수 있도록 급배기구의 개도율을 최적화하는 프로그램을 개발하였으며, TUNVEN DUCT 프로그램과의 비교를 통해 프로그램의 예측 성능을 검증하였다. 이를 위해 반횡류 급기 환기방식을 적용하였으며, 두 프로그램은 유사한 포트 크기 및 풍량 분배를 예측하고 있으며, 계산값의 변동범위는 각각 11.71% 와 1.36% 인 것으로 나타났다. 이 프로그램은 다양한 터널 연장 및 급배기 포트 설치 조건에 대한 신속한 분석이 가능하므로, 횡류식 및 반횡류 환기방식의 포트 최적화 설계에 상당히 유용할 것으로 판단된다. The transverse ventilation system, commonly applied to urban tunnel, is necessary to be distributed with airflow uniformly. In this study, we developed a program that can optimize the opening ratio of ports to ensure ventilation performance of design criteria through a uniform airflow distribution even though ventilation interval becomes longer. And program's prediction performance was verified by comparison with TUNVEN DUCT program. For comparison, Semi-transverse ventilation system was applied. Both programs predicted a similar port size and air flow distribution, and the variation range of the calculated values was 11.71% and 1.36%, respectively. This program is very useful for port optimization design of transverse and semi-transverse ventilation system, because it is possible to analyze various tunnel lengths and supply/exhaust port installation conditions.

Application of 3D Printing to the Manufacturing of Groundwater Velocity Probes

AbstractFor the purposes of risk mitigation and remediation design, Darcy's Law calculations, that are typically used to estimate flow direction and magnitude, can be usefully supplemented with more direct measurements. The point velocity probe (PVP), which measures groundwater velocity by conducting a mini‐tracer test across a cylindrical probe surface, was developed to address this need. Laboratory and field experiments have shown that these probes can provide accurate velocity magnitude and direction measurements at the centimeter scale. In an effort to streamline the production of PVPs, three‐dimensional (3D) printing was investigated. The 3D printer produces a plastic probe body with designated detector and injection port locations. The subsequent installation of injection lines and detector wires requires, for a single‐port probe, no longer than 1–2 h of assembly time, compared to approximately 10 h to assemble previous designs (mainly determined by injection port installation). Probes can be printed in batches with the number of units made depending on the printer and probe size. Laboratory tests of the original PVP models yielded velocity magnitudes and directions with average errors (from expected values) of ±9% to ±15% and ±8°, respectively. A printed PVP was tested in a nested storage tank system (NeST) packed with sand that mimics flow conditions through a sandy aquifer. The probe was tested at multiple pumping rates with the injector port at angles of (α =) 30°, 45°, and 75° from the expected linear flow direction. The printed PVPs provided an average magnitude percent error of ±13.5% and an average direction error of ±4°. This shows that in laboratory tests, printed PVPs performed as well as the original probes previously reported, making them viable units for field applications as well as being quicker to assemble than the earlier designs.

Palaeogeography of Carthage (Tunisia): Coastal change during the first millennium bc

Abstract New geological data were recovered from 16 sediment sections cored in and around the Cothon, the harbour of ancient Carthage. They show a relatively thin (less than 5 m) post-mid-Holocene sediment accumulation over a late Pleistocene calcarenite bedrock surface. Analyses of core sediment samples for granulometry and microfossil remains, combined with four radiocarbon dates, have suggested several palaeogeographic reconstructions of the coastline of Carthage and placed constraints on the nature and location of any Punic port installation pre-dating the visible remains of the 3rd century bc . We also propose a geologically and historically plausible reconstruction of Scipio's siege and capture of the city in 146 bc .

Rust‐inhibiting chlorinated rubber primers based on non‐toxic active pigments

Summary Chlorinated rubber primers formulated with active pigments, which are claimed to be non‐toxic and non‐polluting, are investigated; they are designed for the protection of ships (above the waterline), port installation, industrial plants, bridges, etc.

Errata: Feasibility and Financial Studies of a Port Installation

Errata: Feasibility and Financial Studies of a Port Installation

Feasibility and Financial Studies of a Port Installation

Feasibility and Financial Studies of a Port Installation

Feasibility and Financial Studies of a Port Installation

The subject of this paper is a computer simulation of the operations of an iron ore unloading port. The object of the work was first, to estimate the advantages of reducing some of the delays caused by the port's physical limitations, and second, to estimate the capacity of the existing system and determine whether this could be modified to handle estimated future foreign ore requirements.