Notes

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None of the 38 patients had intra- or postoperative complications. Donor renal vein was anastomosed to the right external iliac vein (n = 16), right common iliac vein (n = 2), and inferior vena cava (n = 1). Gonadal vein (n = 1) and deceased donor iliac vein (n = 2) were used to increase the right renal vein length in 3 cases. Four donor kidneys had 2 arteries reconstructed side by side. None of the recipients developed any vascular or urological complications.

The laparoscopic technique described is safe and allows better visualization of the right hilum, mainly the renal artery, and helps in stapling the renal vein and renal artery.
The laparoscopic technique described is safe and allows better visualization of the right hilum, mainly the renal artery, and helps in stapling the renal vein and renal artery.
This study was undertaken to analyze our outcomes after robotic fundoplication for GERD in patients with failed antireflux procedures, with type IV (i.e., giant) hiatal hernias, or after extensive intra-abdominal surgery with mesh, and to compare our results to outcomes predicted by the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Surgical Risk Calculator and to national outcomes reported by NSQIP.

100 patients undergoing robotic fundoplication for the aforementioned factors were prospectively followed.

100 patients, aged 67 (67 ± 10.3) years with body mass index (BMI) of 26 (25 ± 2.9) kg/m
underwent robotic fundoplication for failed antireflux fundoplications (43%), type IV hiatal hernias (31%), or after extensive intra-abdominal surgery with mesh (26%). Operative duration was 184 (196 ± 74.3) min with an estimated blood loss of 24 (51 ± 82.9) mL. Length of stay was 1 (2 ± 3.6) day. Two patients developed postoperative ileus. Two patients were readmitted within 3e robotic platform for complex operations and fundoplications to treat patients with GERD is safe and efficacious.
Perioperative outcomes of bariatric surgery in patients with super super obesity (SSO) (BMI ≥ 60 kg/m
) merit further investigation.

A retrospective review was conducted of patients with SSO who underwent surgery from Jun 2005 through Jun 2018 at a Metabolic and Bariatric Surgery Center of Excellence. Quantitative demographic data was summarized using descriptive statistics; categorical variables were compared using Fisher's exact test.

Two hundred fourteen procedures were performed, of which 208 were eligible for inclusion. Majority were female (65.4%). The mean age and BMI was 43 (17-68 years) and 65.9 kg/m
(60 95 kg/m
), respectively. Comorbidities included obstructive sleep apnea (74%), hypertension (59%), gastro-esophageal reflux disease (43%), osteoarthritis (41%), and diabetes mellitus (30%). Surgical approach 97 Roux-en-Y gastric bypasses (46%), 88 laparoscopic sleeve gastrectomies (42%), and 23 adjustable gastric bands (11%). Additional subset included primary (87%), conversion (7.7%), and revision (5.3%); majority being laparoscopic (75%) and robotic (24%). Complications via Clavien-Dindo classification one Grade I, one Grade II, three Grade IIIa, three Grade IIIb, and three Grade IVa. Thirty-day events 11 complications (5.3%; one leak [0.5%], one deep vein thrombosis [0.5%]), six re-admissions (3%), four re-operations (2%) repair of staple-line leak, repair of incisional hernia, uterine dilation and curettage, and cholecystectomy. No mortalities occurred. Complications occurred in 14.8% of conversion/revision cases, 3.9% in primary cases (
 = 0.0395) with no difference observed between laparoscopic (4.5%) and robotic (6.1%) modalities (
=
0.7051).

Bariatric surgery is feasible in patients with SSO. Revision procedures may increase risk of operative complications.
Bariatric surgery is feasible in patients with SSO. Revision procedures may increase risk of operative complications.
Despite limited data, acetaminophen, along with other agents, is commonly included in enhanced recovery after surgery (ERAS) protocols following laparoscopic hysterectomy. We aimed to systematically review the efficacy of acetaminophen on the management of postoperative pain after laparoscopic hysterectomy.

We searched PubMed, SCOPUS, Web of Science, and Cochrane Library databases for relevant clinical trials investigating the role of acetaminophen in the management of pain after laparoscopic hysterectomy. We performed the risk of bias according to Cochrane's risk of bias tool. We performed the analysis of homogeneous data under the fixed-effects model during the analysis of heterogeneous data under the random-effects model. The primary outcome was the assessment of pain score after 2, 6, 12, and 24 h.

A total of 495 patients in 13 trials were included in our meta-analysis. Acetaminophen was not superior at reducing postoperative pain scores. Further analysis at progressive temporal points revealed no fingle agent or to reduce opioid consumption.
To investigate outcomes and ascertain the safety and efficacy on patients having total laparoscopic hysterectomy (TLH), stratified by body mass index (BMI), focusing on high-BMI patients.

This was a retrospective cohort study that reviewed 2,266 patients with benign gynecologic diagnoses, early cervical, endometrial, and ovarian carcinoma from September 1996 to October 2017. BMI was from 14.5 to 74.2 and were classified as normal or underweight (<24.9); overweight (25.0-29.9); class I obese (>30.0-34.9); class II obese (35-39.9); or class III obese (>40.0). All patients underwent TLH.

Patients' characteristics were similar across all BMI classes except for age, postoperative pathological diagnoses, and whether a cystoscopy was performed. see more Surgical duration, and estimated blood loss were similar across BMI classes. Overweight and obese class III patients had lower odds of staying >1 day compared to patients of normal BMI (OR = 0.65,
= .015). Obese class II patients had fewer complications compared to normal BMI patients (OR = 0.27,
= .013), but patients from other high BMI categories did not show any difference compared to patients with normal BMI. The rate of unplanned laparotomy was statistically, but not clinically, higher in obese class III patients (1.8% versus .7%,
= 0.011), most often due to large fibroids. The mean reoperation rate was 2.7%, with the lowest rate (.5%) among obese class II patients, and the highest rate (3.9%) among the normal BMI patients.

TLH is feasible and safe for obese women, regardless of BMI. Obesity is not a contraindication to good outcomes from laparoscopic surgery.
TLH is feasible and safe for obese women, regardless of BMI. Obesity is not a contraindication to good outcomes from laparoscopic surgery.
Spigelian hernias (SH) are a rare variant of abdominal wall defects that require prompt surgical intervention. With the advancement of abdominal wall surgery capabilities, there are several possible approaches of repairing SH. The aim of the study was to present our experience in performing laparoscopic or robotic transabdominal preperitoneal (TAPP) repairs of SH and discuss the advantages of TAPP in such hernias.

Retrospective review of a prospectively maintained database of SH TAPP repairs between February 1, 2015 and February 29, 2020. Data included clinical details, size and location of fascial defect, presence of concomitant hernias, surgery duration, length of stay (LOS), mesh type, mesh size, and fixation method. Follow up visits at 1 month postoperative and telephone survey for pain assessment and subsequent hernia-related treatment.

During the study period 16 patients underwent TAPP SH repairs, 13 laparoscopically and 3 robotic. Seven (44%) patients had a concomitant inguinal hernia with 1 patient having bilateral inguinal defects. Mean surgery duration and mean LOS were 78 (range 41 - 120) minutes & 1.6 (range 1 - 3) days, respectively. Immediate postoperative complications included 2 seromas and 1 port-site hematoma. Mean telephone survey follow up was 17 months (range 3 - 49). Mean visual analogue scale scores were significantly lower at follow-up compared to discharge (1.9 vs 0.5, P = 0.0015).

Advantages of TAPP SH repair include low postoperative chronic pain, potential low wound complications, intra-abdominal visualization of hernia contents, and repairing of concomitant inguinal hernias simultaneously.
Advantages of TAPP SH repair include low postoperative chronic pain, potential low wound complications, intra-abdominal visualization of hernia contents, and repairing of concomitant inguinal hernias simultaneously.This study highlights a survey on 5783 kindergarten teachers' occupational commitment and its influencing factors in the socioeconomic context of China during the COVID-19 pandemic. Data were collected through the WenJuanXing public online platform. Quantitative analysis results showed that kindergarten teachers' occupational commitment was optimistic on the whole during this period, among which the affective commitment and the normative commitment were satisfactory, but the continuing commitment needed to be strengthened. The type of kindergartens, the personnel affiliation, the educational background, and the professional post of kindergarten teachers had significant impacts on their occupational commitment. The income reduction was negatively correlated with and predictive of kindergarten teachers' occupational commitment. Anti-epidemic action and career confidence were positively correlated with and predictive of kindergarten teachers' occupational commitment. Furthermore, anti-epidemic action, income reduction, and career confidence had joint predictive effects on kindergarten teachers' occupational commitment. More related backgrounds and suggestions have been discussed.The second and third waves of coronavirus disease-2019 (COVID-19) pandemic have hit the world. Even after more than a year, the economy is yet to return to a semblance of normality. The conference/meeting room is one of the critical sections of offices that might be difficult not to use. This study analyzes the distribution of the virus-laden droplets expelled by coughing inside a conference room, the effect of ventilation rates, and their positioning. The efficacy of masks is studied to get quantitative information regarding the residence time of the droplets. The effects of evaporation, turbulent dispersion, and external forces have been considered for calculating the droplets' trajectories. We have analyzed six cases, of which two are with masks. Change in the ventilation rate from four air changes per hour (ACH) to eight resulted in a 9 % increment in the number of droplets entrained in the outlet vent, while their average residence time was reduced by ∼   8   s . The shift in the vents' location has significantly altered droplets' distribution inside a conference room. It results in ∼   1.5 % of the injected droplets reaching persons sitting across the table, and a similar indoor environment is not recommended. Wearing a mask in the case of eight ACH has presented the best scenario out of the six cases, with a 6.5 % improvement in the number of droplets entrained in the outlet vent and a 9   s decrease in their average residence time compared to the case without a mask. No droplets have reached persons sitting across the table when the infected person is wearing the mask, which follows that a social distancing of 6   ft with a mask is adequate in indoor environments.
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