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Objective: To perform a cost-analysis during the implementation of robot-assisted pancreatoduodenectomy (RPD) in a high-volume center., Background: Many high-volume centers are implementing RPD as alternative to open pancreatoduodenectomy (OPD) but the persevering concerns about increased costs of RPD versus OPD have not been addressed by large studies., Methods: Post-hoc cost-analysis of consecutive RPD versus OPD in a singly high-volume center (Jan 2015-May 2024). The eligibility criteria for RPD (i.e. no vascular contact, no chronic and necrotizing pancreatitis, and BMI<35 kg/m2) were used to select patients undergoing OPD, to minimize selection bias. Primary outcomes were total hospital costs and total hospital stay. Sensitivity analyses excluded the first half of the RPD experience., Results: Overall, 588 patients undergoing pancreatoduodenectomy were included (214 RPD, 374 OPD). Total hospital stay was shorter after RPD (10 [6-17] vs. 12 [8-21] days, P=0.001). Mean total hospital costs were €4,804 higher for RPD (€27,307 vs. €22,503, P=0.010). Outcomes improved in the second half of the RPD experience (n=107): total hospital stay (12 [7-23] to 9 [6-15] days, P<0.001), pancreatic fistula (48.6% to 31.8%, P=0.012), delayed gastric emptying (33.6% to 15.0%, P=0.001), and operative time (373 [341-411] to 310 [272-352] minutes, P<0.001). Consequently, costs per RPD procedure decreased with €11,058 (€32,836 to €21,778, P=0.001). Costs in the second half of the OPD experience remained stable (€24,025 to €21,013, P=0.210). Hence, total costs for RPD and OPD became comparable in the second half (€21,778 vs. €21,013, P=0.644)., Conclusion: Implementing RPD is associated with considerable additional costs compared to OPD. With growing experience, both the outcomes and cost-efficiency of RPD improve, with costs decreasing by approximately a third, leading to similar costs as OPD. Large scale randomized trials will have to confirm these findings., Competing Interests: Conflicts of interest: JEM and MGB received a grant from KWF (Dutch Cancer Society) and Intuitive Surgical for the investigator-initiated DIPLOMA-2 and DIPLOMA-2×2 randomized trials which include robot-assisted pancreatoduodenectomy. MGB, SF and FD are clinical proctors for Intuitive Surgical., (Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.)

Herbal dust, a waste byproduct from filter-tea production, was annealed to form ash that can be incorporated into natural rubber as an eco-friendly filler. Three types of herbal dust ash (HDA), green tea, hibiscus, and lemon balm, were added at two different contents, 2.5 and 5 phr, into the rubber compound, while the content of carbon black, as a filler, was maintained at 50 phr in all samples. The impact of HDA type and content on the rheological and mechanical properties of rubber products was evaluated. Rheological analysis showed that HDA samples exhibited slightly lower maximum torque values (around 11.6 dNm) than ash-free samples (13.53 dNm), yet maintained vulcanization effectiveness with minimal impact on torque or cure rate metrics. Mechanical testing found that samples with 2.5 phr of lemon balm ash achieved comparable properties to samples without added ash, while samples with added hibiscus preserved crosslinking density and hardness. The addition of HDA led to decreases in tensile strength, elongation at break, and hardness values, with slight changes suggesting its applicability in similar industrial contexts. The findings highlight HDAs potential as a cost-effective, sustainable filler for rubber production, contributing to circular economy practices by repurposing significant amounts of tea waste into high-quality rubber materials.

Background: Laparoscopic sleeve gastrectomy (SG) is one of the effective methods of weight loss. It is essential to determine patients' regret and predictive factors to improve their quality of life and comfort. No study has investigated decision regret and affecting factors in patients undergoing SG in Turkey., Objectives: The study aimed to determine the relationship of decision regret with quality of life and comfort level in patients undergoing SG., Setting: The research was carried out with patients who had undergone SG in a private hospital in the west of Turkey., Methods: The research was conducted as a descriptive, correlational, and cross-sectional study. Data were collected between March and May 2023, and the study was completed with 286 patients. Data were collected using the Personal Information Form, Decision Regret Scale (DRS), Quality of Life Following Obesity Surgery Scale (QoL-OS), and Comfort Scale., Results: Patients' mean score on the DRS was 5.27 ± 13.41 (0-100), the total mean score on the QoL-OS-Biopsychosocial dimension was 79.57 ± 9.35 (18-90), the mean score on the QoL-OS-Complications dimension was 17.17 ± 4.60 (7-35), and the environmental comfort score average was 8.87 ± 2.23 (0-10). Patients' decision regret was significantly affected by the QoL-OS-Biopsychosocial Area dimension in the first place (Beta = -.516; P < .001), social comfort in the second place (Beta = -.278; P < .001), postoperative weight gain in the third place (Beta = .221; P < .001), and complication development in the fourth place (Beta = .163; P < .001)., Conclusions: The study revealed that patients' decision regret levels were very low up to 3 years after surgery and found that low postoperative quality of life and social comfort level, postoperative weight gain, and complications affected decision regret., (Copyright © 2025 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)