Cochranehassing4003

5 ± 0.9 days, and no perforations of the pyloric mucosa, recurrent obstruction, surgical incision infections, and incision hernias. All of the patients had at least 3 months of follow-up, good growth and development, and the parents were satisfied with the postoperative scars. Conclusion A pyloric electrocoagulation chisel combined with a left-handed main operation in the treatment of congenital HPS by a single-site umbilical laparoscopic pyloromyotomy is safe and effective, and can achieve a satisfactory cosmetic effect.Background At the end of a laparoscopic major hepatectomy, an incision wide enough for specimen retrieval is required. Classically, Pfannenstiel (PF) incision is the type of access favored as service incision in laparoscopy. However, in specific settings the use of a midline (ML) incision can be favorable, with doubtful impaction on the outcomes of a purely laparoscopic operation. The aim of this study was to investigate on clinical outcomes after laparoscopic hemihepatectomies using PF/ML incisions in comparison with open. Methods The institutional clinical database of the Hepatobiliary Division at San Raffaele Hospital (Milan, Italy) was retrospectively reviewed identifying cases of laparoscopic and open hemihepatectomies. Three analyses were performed whole laparoscopic versus open; ML versus open; PF versus ML. Clinical outcomes such as intraoperative blood loss, operative time, postoperative morbidity, motility resumption, perceived pain, and length of stay (LOS) were used for comparisons. Results Laparoscopy was confirmed to be superior to open approach also in the present series in terms of lower blood loss (300 versus 400 mL, P = .041), fewer complications (14.2% versus 25.9%, P = .024), shorter hospitalization (5 versus 7 days, P = .033), and enhanced recovery in terms of better pain control (P = .035) and mobility resumption (P = .047). Similar outcomes were observed comparing ML alone with open (estimated blood loss 300 mL versus 400 mL, P = .039; complications 13.1% versus 25.9%, P = .037; LOS 5 days versus 7 days, P = .04; lower pain perception, P = .048 and faster mobility resumption, P = .046). No significant differences were observed in postoperative outcomes of PF versus ML. Conclusions Suprapubic and ML incisions at the end of a pure laparoscopic case lead to comparable outcomes between each other. MK-8245 The adoption of ML incision for specimen retrieval does not affect outcomes of minimal invasiveness.Background Our systematic review and meta-analysis examine the impact of minilaparoscopic cholecystectomy (MLC) versus conventional laparoscopic cholecystectomy (CLC). Some authors previously compared these surgical approaches without reaching any clear conclusion, since then, further trials have been performed, but an update was needed. Materials and Methods PubMed, EMBASE, and the CENTRAL were systematically searched for randomized controlled trials comparing MLC versus CLC up to August 2019. The outcome measures used for comparison were operative time (OT), overall morbidity, intra- and postoperative complications, conversion and reintervention rate, length of hospital stay (LOS), postoperative pain (POP), and cosmetic results. A meta-analysis of relevant studies was performed using RevMan 5.3. Results Fifteen studies, including 863 patients, were considered eligible to collect data and entered the meta-analysis. A total of 415 patients in the MLC group versus 448 in the CLC group were compared. No statistical difference as for overall morbidity, intra- and postoperative complications, conversion and reintervention rate, LOS, and cosmetic results were retrieved among the groups. CLC results faster and MLC shows to be the least painful. Conclusions According to the available high-level evidence, both surgical approaches resulted substantially equivalent to perform LC, with some advantages of CLC as for OT and of MLC concerning POP. As a consequence, we can conclude that either procedure is superior or inferior to the other one; actually, we are not able to suggest the adoption of any of the two on a routine basis.

The prevalence of opioid use disorder continues to rise in the United States, with a simultaneous increase in the diagnosis of both opioid use disorder during pregnancy and neonatal opioid withdrawal syndrome. Despite these increases in pregnancy-related care, little is known about hospital policy and policy implementation related to opioid use disorder in pregnancy. In addition, it is unknown whether policies might differ in rural or urban hospitals. To better examine these issues, Minnesota hospitals were surveyed regarding the existence and implementation of policies related to opioid use disorder in pregnancy and whether any policy implementation challenges had been identified.

From August to December 2017, the research team contacted all Minnesota hospitals that offered obstetric services (

 = 82) to survey challenges to implementing policies for opioid use disorder during pregnancy, among other questions. Fifty-nine hospitals had respondents (primarily obstetric department supervisors) who providedg hospital care for pregnancies affected by opioid use disorder, and these challenges were identified more frequently in rural locations. These non-urban hospitals may require increased state and federal support and funding.Traditional actuators, such as motors as well as hydraulic or pneumatic artificial muscles, demonstrate excessive noise, a heavy weight, and a large size, which limit their practical application in many areas. Therefore, for many decades, scientists have worked to develop new types of silent, small, and light actuators. In this article, a novel soft actuator (actuator3) with a high load-to-weight ratio from silicone and a low-boiling liquid (ethanol actuator3E or water actuator3W) is presented and is compared with two actuators (actuator1 and actuator2) fabricated according to a method described in the literature. Compared with actuator1 and actuator2, actuator3 shows a larger volume expansion, output force, and load-to-weight ratio when heated. Owing to the weaker stability and repeatability of actuator3E, many different kinds of applications based on actuator3W are proposed, such as robotic hands and underwater rolling robots with color variations. The experimental results demonstrate that the method proposed in this article may be a viable alternative for fabricating low-cost soft actuators with high load-to-weight ratios that can be useful for future applications of soft robots.