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Abstract Laparoscopic donor nephrectomy was introduced in 1995 as a means of minimally invasive surgeries that entail kidney extraction from healthy individuals. Since then, it has widely overtaken the traditional open surgical approaches, especially in live donor nephrectomy procedures worldwide. Laparoendoscopic single-site surgery is considered a more optimized surgical approach utilizing a single incision instead of four. Various studies have scrutinized many of the risk factors related to such surgeries, most commonly: vascular problems, intraoperative organ injury, and postoperative ileus. Other rare complications have not been thoroughly explored due to their decreased prevalence. Internal hernias are considered a rare complication of laparoendoscopic single-site surgery with dangerous repercussions ranging from bowel obstruction to ischemia, and necrosis. Our study presents a rare case of a trans-mesenteric internal hernia following laparoendoscopic single-site surgery. The patient was relatively healthy with no serious medical conditions. However, the past medical history did record a diagnosis of irritable bowel syndrome a few years back. Knowing that the occurrence of internal hernias is infrequent, we recommend that mesenteric defects be taken seriously to avoid the risk of internal hernias and their complications.

Laparoscopic donor nephrectomy was introduced in 1995 as a means of minimally invasive surgeries that entail kidney extraction from healthy individuals. Since then, it has widely overtaken the traditional open surgical approaches, especially in live donor nephrectomy procedures worldwide. Laparoendoscopic single-site surgery is considered a more optimized surgical approach utilizing a single incision instead of four. Various studies have scrutinized many of the risk factors related to such surgeries, most commonly: vascular problems, intraoperative organ injury, and postoperative ileus. Other rare complications have not been thoroughly explored due to their decreased prevalence. Internal hernias are considered a rare complication of laparoendoscopic single-site surgery with dangerous repercussions ranging from bowel obstruction to ischemia, and necrosis. Our study presents a rare case of a trans-mesenteric internal hernia following laparoendoscopic single-site surgery. The patient was relatively healthy with no serious medical conditions. However, the past medical history did record a diagnosis of irritable bowel syndrome a few years back. Knowing that the occurrence of internal hernias is infrequent, we recommend that mesenteric defects be taken seriously to avoid the risk of internal hernias and their complications. [ABSTRACT FROM AUTHOR]

To address the shortcomings of the Dung Beetle Optimization (DBO) algorithm in ship power-system fault reconfiguration, such as low population diversity and an imbalance between global exploration and local exploitation, the authors of this paper propose an improved Dung Beetle Optimization (LESSDBO) algorithm. The improvements include optimizing the initial population using Latin hypercube sampling and an elite population strategy, optimizing parameters with an improved sigmoid activation function, introducing the sine–cosine algorithm (SCA) for position update optimization, and performing multi-population mutation operations based on individual quality. The LESSDBO algorithm was applied to simulate the fault reconfiguration of a ship power system, and it was compared with the traditional DBO, Genetic Algorithm (GA), and Modified Particle Swarm Optimization (MSCPSO) methods. The simulation results showed that LESSDBO outperformed the other algorithms in terms of convergence accuracy, convergence speed, and global search capability. Specifically, in the reconfiguration under Fault 1, LESSDBO achieved optimal convergence in seven iterations, reducing convergence iterations by more than 30% compared with the other algorithms. In the reconfiguration under Fault 2, LESSDBO achieved optimal convergence in eight iterations, reducing convergence iterations by more than 23% compared with the other algorithms. Additionally, in the reconfiguration under Fault Condition 1, LESSDBO achieved a minimum of four switch actions, which is 33% fewer than the other algorithms, on average. In the reconfiguration under Fault Condition 2, LESSDBO achieved a minimum of eight switch actions, which is a 5.9% reduction compared with the other algorithms. Furthermore, LESSDBO obtained the optimal reconfiguration solution in all 50 trials for both Faults 1 and 2, demonstrating a 100% optimal convergence probability and significantly enhancing the reliability and stability of the algorithm. The proposed method effectively overcomes the limitations of the traditional DBO in fault reconfiguration, providing an efficient and stable solution for the intelligent topology reconfiguration of ship power systems. [ABSTRACT FROM AUTHOR]

To address the shortcomings of the Dung Beetle Optimization (DBO) algorithm in ship power-system fault reconfiguration, such as low population diversity and an imbalance between global exploration and local exploitation, the authors of this paper propose an improved Dung Beetle Optimization (LESSDBO) algorithm. The improvements include optimizing the initial population using Latin hypercube sampling and an elite population strategy, optimizing parameters with an improved sigmoid activation function, introducing the sine–cosine algorithm (SCA) for position update optimization, and performing multi-population mutation operations based on individual quality. The LESSDBO algorithm was applied to simulate the fault reconfiguration of a ship power system, and it was compared with the traditional DBO, Genetic Algorithm (GA), and Modified Particle Swarm Optimization (MSCPSO) methods. The simulation results showed that LESSDBO outperformed the other algorithms in terms of convergence accuracy, convergence speed, and global search capability. Specifically, in the reconfiguration under Fault 1, LESSDBO achieved optimal convergence in seven iterations, reducing convergence iterations by more than 30% compared with the other algorithms. In the reconfiguration under Fault 2, LESSDBO achieved optimal convergence in eight iterations, reducing convergence iterations by more than 23% compared with the other algorithms. Additionally, in the reconfiguration under Fault Condition 1, LESSDBO achieved a minimum of four switch actions, which is 33% fewer than the other algorithms, on average. In the reconfiguration under Fault Condition 2, LESSDBO achieved a minimum of eight switch actions, which is a 5.9% reduction compared with the other algorithms. Furthermore, LESSDBO obtained the optimal reconfiguration solution in all 50 trials for both Faults 1 and 2, demonstrating a 100% optimal convergence probability and significantly enhancing the reliability and stability of the algorithm. The proposed method effectively overcomes the limitations of the traditional DBO in fault reconfiguration, providing an efficient and stable solution for the intelligent topology reconfiguration of ship power systems.

Light detection and ranging (LiDAR) is a widely used technology for the acquisition of three-dimensional (3D) information about a wide variety of physical objects and environments. However, before conducting a campaign, a test is typically conducted to assess the potential of the utilized algorithm for information retrieval. It might not be a real campaign but rather a simulation to save time and costs. Here, a multi-platform LiDAR simulation model considering the location, direction, and wavelength of each emitted laser pulse was developed based on the large-scale remote sensing (RS) data and image simulation framework (LESS) model, which is a 3D radiative transfer model for simulating passive optical remote sensing signals using the ray tracing algorithm. The LESS LiDAR simulator took footprint size, returned energy, multiple scattering, and multispectrum LiDAR into account. The waveform and point similarity were assessed with the LiDAR module of the discrete anisotropic radiative transfer (DART) model. Abstract and realistic scenes were designed to assess the simulated LiDAR waveforms and point clouds. A waveform comparison in the abstract scene with the DART LiDAR module showed that the relative error was lower than 1%. In the realistic scene, airborne and terrestrial laser scanning were simulated by LESS and DART LiDAR modules. Their coefficients of determination ranged from 0.9108 to 0.9984 . Their mean was 0.9698 . The number of discrete returns fitted well and the coefficient of determination was 0.9986 . A terrestrial point cloud comparison in the realistic scene showed that the coefficient of determination between the two sets of data could reach 0.9849 . The performance of the LESS LiDAR simulator was also compared with the DART LiDAR module and HELIOS++. The results showed that the LESS LiDAR simulator is over three times faster than the DART LiDAR module and HELIOS++ when simulating terrestrial point clouds in a realistic scene. The proposed LiDAR simulator offers two modes for simulating point clouds: single-ray and multi-ray modes. The findings demonstrate that utilizing a single-ray simulation approach can significantly reduce the simulation time, by over 28 times, without substantially affecting the overall point number or ground pointswhen compared to employing multiple rays for simulations. This new LESS model integrating a LiDAR simulator has great potential in terms of simultaneously simulating LiDAR data and optical images based on the same 3D scene and parameters. As a proof of concept, the normalized difference vegetation index (NDVI) results from multispectral images and the vertical profiles from multispectral LiDAR waveforms were simulated and analyzed. The results showed that the proposed LESS LiDAR simulator can fulfill its design goals. [ABSTRACT FROM AUTHOR]

This study aimed to identify football players at high risk (HR) for anterior cruciate ligament (ACL) injury via a four-test battery and assess possible factors affecting classification. Ninety-one professional and semi-professional male athletes participated in a field-based pre-season screening. The cut-off points of the test battery were 10% acknowledged inter-limb asymmetry limit for quadriceps and hamstring isometric strength and single-leg triple hop for distance, in addition to the upper limit of 6 errors in the landing error scoring system (LESS). Additional assessment of hip adductors and core stability completed the global functional profile of the players. Sixty-one players were identified as HR and thirty as low-risk (LR) for ACL injury. Discriminant analysis showed that the proposed test battery classified accurately 78.0% of them, with 91.8 sensitivity and 61.9% specificity. Only four misclassified players in the LR group were at risk of inadequate treatment. All participants were considered healthy, and history of a previously rehabilitated injury did not interfere with the results. LESS seems to be the best predictor for injury-risk grouping. Prone bridge time was also a whole-body variable discriminating between groups. The proposed test battery provides a promising option for field-based pre-season ACL risk assessment of football players and needs to be studied prospectively. [ABSTRACT FROM AUTHOR]

The product of leaf area index (LAI) and clumping index (CI) quantifies the effective leaf abundance and distribution across the landscape, and therefore, governs the radiation absorption, evapotranspiration, and carbon assimilation processes in the terrestrial ecosystems. Previous studies were mainly focused on developing inversion methods applicable to large scale for retrieving LAI and CI from multi-angular satellite observations. However, a few studies focused on quantifying the sensitivity of canopy bidirectional reflectance distribution function (BRDF) to changes in CI in a forward manner, hampering an accurate understanding of the relationship between CI and BRDF. In this study, we simulated how BRDF responds to changes in CI in Qinghai spruce (Picea crassifolia) forests based on a 3D radiative transfer model LESS and ground-measured data. We found that the LESS model effectively simulated the hot-spot, roof, and bowl-edge characteristics of the canopy BRDF by changing the sun-sensor geometry. We constructed forest scenes with variable CI (ranging from 0.4 to 0.8) to investigate the clumping effect on BRDF with different solar and observation angles. The red band bidirectional reflectance factor (BRF) showed higher sensitivity to changes in CI than that in the near-infrared (NIR) band. Canopy BRFs in the red band along the principal plane and cross principal planes measured in different seasons showed consistent sensitivity to changes in CI, suggesting that the red band BRF is helpful for CI inversion for forests with different levels of foliage clumping. In the NIR band, canopy BRFs along the principal plane measured in growing seasons [with solar zenith angle (SZA) 40°) were sensitive to changes in CI in highly clumped forests (with CI ranging from 0.4 to 0.6). However, canopy BRF in the NIR band showed low sensitivity to changes in CI in highly clumped forests (CI

Стаття присвячена обґрунтуванню важливості використання гнучких технологій в управлінні як однією командою, так і великою кількістю команд. Розглянуто сутність управління процесами взаємовідносин у командах. Обґрунтовано характеристики ефективних команд. Визначено сутність, цінності, принципи, переваги та недоліки Agile-філософії. Обґрунтовано використання підходів Scrum для управління однією командою. Визначено особливості управління великою кількістю команд та запропоновано адаптувати Scrum до управління декількома командами в компанії через використання методологія LeSS (Large-Scale Scrum або «Scrum на великих масштабах», LeSS Huge). Розроблено рекомендації для українських підприємств щодо впровадження Agile-методів для підвищення конкурентоспроможності команд та їх адаптації під зміни зовнішнього середовища.

Optical remote sensing allows to efficiently monitor forest ecosystems at regional and global scales. However, most of the widely used optical forward models and backward estimation methods are only suitable for forest canopies in flat areas. To evaluate the recent progress in forest remote sensing over complex terrain, a satellite-airborne-ground synchronous Fine scale Optical Remote sensing Experiment of mixed Stand over complex Terrain (FOREST) was conducted over a 1 km×1 km key experiment area (KEA) located in the Genhe Reserve Areain 2016. Twenty 30 m×30 m elementary sampling units (ESUs) were established to represent the spatiotemporal variations of the KEA. Structural and spectral parameters were simultaneously measured for each ESU. As a case study, we first built two 3D scenes of the KEA with individual-tree and voxel-based approaches, and then simulated the canopy reflectance using the LargE-Scale remote sensing data and image Simulation framework over heterogeneous 3D scenes (LESS). The correlation coefficient between the LESS-simulated reflectance and the airborne-measured reflectance reaches 0.68–0.73 in the red band and 0.56–0.59 in the near-infrared band, indicating a good quality of the experiment dataset. More validation studies of the related forward models and retrieval methods will be done.

This study aimed to identify football players at high risk (HR) for anterior cruciate ligament (ACL) injury via a four-test battery and assess possible factors affecting classification. Ninety-one professional and semi-professional male athletes participated in a field-based pre-season screening. The cut-off points of the test battery were 10% acknowledged inter-limb asymmetry limit for quadriceps and hamstring isometric strength and single-leg triple hop for distance, in addition to the upper limit of 6 errors in the landing error scoring system (LESS). Additional assessment of hip adductors and core stability completed the global functional profile of the players. Sixty-one players were identified as HR and thirty as low-risk (LR) for ACL injury. Discriminant analysis showed that the proposed test battery classified accurately 78.0% of them, with 91.8 sensitivity and 61.9% specificity. Only four misclassified players in the LR group were at risk of inadequate treatment. All participants were considered healthy, and history of a previously rehabilitated injury did not interfere with the results. LESS seems to be the best predictor for injury-risk grouping. Prone bridge time was also a whole-body variable discriminating between groups. The proposed test battery provides a promising option for field-based pre-season ACL risk assessment of football players and needs to be studied prospectively.

Introduction To describe laparoendoscopic single‐site simple nephrectomy and reduced port simple nephrectomy for inflammatory nonfunctioning kidney. Case presentation Case 1: a 58‐year‐old female with fever was referred to our hospital. Computed tomography demonstrated a markedly atrophic right kidney and mild hydronephrosis. Case 2: a 64‐year‐old male with a history of several intra‐abdominal surgeries visited our hospital with a complaint of left back pain and fever. Computed tomography demonstrated left marked hydronephrosis, thinning of renal parenchyma, and duplicated inferior vena cava. After antibiotic treatment, transperitoneal reduced port simple nephrectomy and retroperitoneal laparoendoscopic single‐site simple nephrectomy were performed in Case 1 and 2, respectively, because the function of the affected kidney was almost lost on renography. Although adhesion was slightly noted around the renal hilum in Case 1, neither conversion to laparotomy nor placement of additional ports was needed. Conclusion Laparoendoscopic single‐site simple nephrectomy and reduced port simple nephrectomy for inflammatory nonfunctioning kidney may be options for experienced laparoscopic surgeons.

The benefits of agile frameworks applied to small projects have aroused interest in the large-scale software industry. However, applying them in scaled environments has meant facing multiple challenges, including communication, coordination, and cooperation. Scaled frameworks emerge in response to these challenges, describing the implementation guides to achieve the agile large-scale transformation. However, a lack of conceptual clarity regarding the elements prescribed by these frameworks was identified in the literature. This article introduces the Scaled Agile Model reference model, which integrates the experience reported in the literature and the fundamental attributes of scaled agile frameworks: SAFe, LeSS, Nexus, and DAD. A protocol was followed for the harmonization of multiple models, which allowed integrating and obtaining a reference model from the results of the harmonization of frameworks and the literature found. Additionally, SAM was evaluated for clarity, suitably, and completeness through a focus group. Thus, the proposed reference model defines sixteen roles, three levels of scale, and 34 practices grouped into 8 categories. The results suggest a good acceptance by the experts who evaluated the proposal. Likewise, the proposed model aims to be of great practical benefit for companies that want to scale, companies that are scaling, or companies that have already scaled and want to evaluate their implementation. [ABSTRACT FROM AUTHOR]

Los beneficios de los marcos ágiles aplicados en proyectos pequeños han despertado el interés de la industria de software a gran escala. Sin embargo, aplicarlos en ambientes escalados ha significado superar múltiples desafíos, entre ellos: comunicación, coordinación y cooperación. Como respuesta a estos desafíos, surgen los marcos escalados, que describen guías de implementación para lograr la transformación a gran escala; no obstante, se identificó en la literatura una falta de claridad conceptual con respecto a los elementos prescritos por estos marcos. Este artículo presenta el modelo de referencia Scaled Agile Model (SAM), el cual integra la experiencia reportada en la literatura y los atributos fundamentales de los marcos escalados SAFe, LeSS, Nexus y DAD. Se siguió una estrategia de armonización de múltiples modelos que permitió integrar y obtener un modelo de referencia en función de los resultados de la armonización de los marcos y la literatura encontrada. SAM fue evaluado en términos de claridad, idoneidad y completitud mediante un grupo focal. El modelo de referencia propuesto define 16 roles, 3 niveles de escalamiento y 34 prácticas, agrupadas en 8 categorías de prácticas. Los hallazgos sugieren una buena aceptación por parte de los expertos que evaluaron la propuesta. Asimismo, el modelo propuesto pretende ser de gran beneficio práctico para las empresas que desean escalar sus prácticas, que las estén escalando o que ya escalaron y quieren evaluar su implementación.

This article compares the compilation speed of the SCSS and LESS preprocessor codes. Each preprocessor has its own syntax, which is transpiled into the CSS stylesheet language in the further development of the web page. These technologies serve the same purpose - to simplify and speed up the writing of page views, but are based on different programming languages - Ruby (SCSS) and JavaScript (LESS). For the purposes of the research, a test application was created, a series of tests was carried out on various sets of codes, the results were collected, which allowed to identify a preprocessor with a faster compilation speed, which turned out to be the LESS preprocessor.

BackgroundA vesicovaginal fistula (VVF) is an abnormal fistulous tract between the bladder and vagina, causing continuous loss of urine via the vagina. VVF is a relatively uncommon condition, but there is a drastically higher prevalence in the developing world. Furthermore, iatrogenic postoperative VVF is most common in developed countries, compared to mainly obstetric trauma in developing countries. In this review we focus on the development of current management techniques for VVF.MethodsMedline was searched to identify articles related to urogenital fistulae, including VVF. Based on these reports we focus on the aetiology, clinical presentation, diagnosis and management of VVF. This in-depth review includes the optimal surgical timing, different surgical approaches (including minimally invasive techniques such as laparoscopic and robotic surgery), recommendations for postoperative care, surgical complications, and the need for further research in the use of robotic surgery to treat this condition.ResultsIn all, 60 articles were identified and included in this review; eight were related to the aetiology, 12 to diagnosis, and 40 to the management of VVF. A thorough evaluation of VVF is imperative for planning the repair. Although the surgeonís experience typically influences the surgical approach, special situations will dictate the best approach.ConclusionThe treatment of genitourinary fistulae with robotic assistance continues to develop, but further research is necessary to fully understand the use of this technology.

Introduction Our Emotional Schemas dictate how we deal with our own emotions, therefore, how we interpret and face different events that occur in our everyday life. Maladaptive schemas have been proven to be at fault for the inability to face different challenges. Objectives This study aims to find the differences in emotional schemas between subjects with history of psychiatric disorder and subjects without a psychiatric disorder. Methods We realized a case-control study matched for age and gender, and analyzed the answers of 28 subjects (14 women and 14 men) to Leahy Emotional Schema Scale (LESS); 14 of which have a personal history of psychiatric disorders, while the remaining 14 had no such history. The LESS evaluation was part of a bigger study and was addressed to the general population, over 18 years old. The test was applied online, with the informed consent of the subjects. Results The mean age of the participants was 40.28±13.98. Out of the 14 subjects with a psychiatric diagnosis, 71,43% have a job, 21,43% are retired and 1% are still studying. There was a significant difference between the two groups regarding the Higher Values dimension of the Emotional Schemas (p=0.0419). Also, the question regarding the feeling of shame when it comes to their own feeling, showed significant difference between the two groups (p=0.0211). Conclusions As opposed to the subjects without a history of psychiatric disorder, those who do have a psychiatric diagnosis, feel more often devalued and ashamed, therefore having a lower self-esteem.

In the field of minimally invasive surgery, there is a constant drive to devise and execute the most minimally invasive surgeries possible. By the very nature of laparoscopy and robotic surgery, what one can accomplish with several ports of a given size will invariably be studied and attempted with fewer ports and with ports of smaller sizes. After researching the literature, we were not able to find any single port hysterectomies performed through a port size of smaller than 15 mm. We were able to perform, described here, a technique for performing laparoscopic hysterectomy through a single port of only 11 mm in diameter. We illustrate the technique in the accompanying video and believe the technique to be safe and reproducible. [ABSTRACT FROM AUTHOR]

Background: The use of clinical field assessment tools is popular in sports rehabilitation settings. The purpose of these tools is not only prediction of injury but also to assist in development of injury prevention programs. Landing Error Scoring System (LESS) is a clinical tool that evaluates biomechanical performance during a jump-landing task with particular focus on aspects related to an increased risk for ACL injury. Objective: Of this study was to find the most common faulty biomechanics in football players. Method: This is an evaluation-based study which predicts the risk of ACL injuries in 30 football players based on their jump landing mechanics. This evaluation was carried out with the help of software Kinovea that helps in analysis of joint kinematics. The data captured with the help of off-the-shelf cameras in frontal and sagittal planes and analysed. The frequency of common errors was identified. Result: It was found out that 20% of the players had poor landing mechanics having maximum errors, 20% had moderate errors, while 13% had good score and 47% had excellent landing mechanics. The most common error was knee valgus at initial contact, stance width wider and knee valgus displacement. Conclusion: LESS is beneficial in identification of faulty biomechanics. LESS when used along with Kinovea helps analyse common jump landing errors. Knee valgus along with internal rotation of tibia was found to be the common error which predisposes footballers to ACL injury. [ABSTRACT FROM AUTHOR]

Abstract Digital transformation is rapidly causing major, even disruptive changes in many industries. Moreover, global developments like digital platforms (cloud) and IoT create fundamentally new connections at many levels between objects, organizations and people (systems-of-systems). These are by nature dynamic and often work in real time – further increasing the complexity. These systemic changes bring up new profound questions: What are those new software-intensive systems like? How are they created and developed? Which principles should guide such organizational design? Agile enterprises are by definition proficient with such capabilities. What solutions are the current scaled agile frameworks such as SAFe and LeSS proposing, and why? In this paper, we aim to recognize the design principles of future software organizations, and discuss existing experiences from various different organizations under transformations, and the insights gained. The purpose is to systematize this by proposing a competence development impact-mapping grid for new digitalization drivers and goals with potential solutions based on our agile software enterprise transformation experiences. Our research approach is based on the resource-based and competence-based views (RBV, CBV) of organizations. We point out how most decision-making in companies will be more and more software-related when companies focus on software. This has profound impacts on organizational designs, roles and competencies. Moreover, increasing data-intensification poses new demands for more efficient organizational data processing and effective knowledge utilization capabilities. However, decisive systematic transformations of companies bring new powerful tools for steering successfully under such new business conditions. We demonstrate this via real-life examples.

W pracy przedstawiono przykład interpretacji badań polowych, sondowań statycznych CPT oraz testów dylatometrem Marchettiego SDMT. Badania przeprowadzono na gruntach lessowych ma terenie Lublina. Wykonano 4 testy CPT oraz 4 sejsmiczne testy SDMT. Opisano metodę wyprowadzania parametrów geotechnicznych z badań polowych. W szczególności przeanalizowano formuły do obliczania modułu ściśliwości na podstawie oporu stożka qc. Część z parametrów zinterpretowano z wykorzystaniem własnych formuł. Porównano wartości parametrów odkształceniowych oszacowanych odmiennymi metodami, dla różnych zakresów odkształceń.

Objective: The objective of the study is to compare the intra- and post-operative outcomes of laparoendoscopic single-site surgery (LESS) and conventional laparoscopic surgery (CLS) in mature cystic teratoma (MCT) of the ovary. Methods: We reviewed 254 patients who underwent surgery (cystectomy) for ovarian MCT from March 1, 2014, to August 31, 2016. During the study period, 216 patients underwent LESS and 38 patients underwent CLS. The outcome measures included operation time, estimated blood loss, changing hemoglobin (Hb) level, postoperative pain, and complications. Statistical analysis was performed using SPSS 24. Results: There was no statistically significant difference in age, body mass index, sexual experience, cyst size, operative time, adhesiolysis, preoperative Hb, Hb changes, postoperative pain scores (visual analog scale), hospital days, and complications between the two groups. In emergent situation, the frequency of CLS was high as three cases (7.9%) versus one case (0.5%, P = 0.007) with LESS. As the year progressed, the frequency of LESS increased. There were one case of re-operation for bleeding control and transfusion, one case of postoperative peritonitis and transfusion, and one case of postoperative transfusion in LESS. During LESS, additional port(s) was/were created in 13 cases (6.0%, P = 0.249). Conclusions: LESS is not inferior to CLS in MCT surgery, and LESS is useful for the surgery of MCT. Our study demonstrates that LESS confers feasibility, convenience, and safety regarding cystectomy of MCT. [ABSTRACT FROM AUTHOR]

Istotną, z praktycznego punktu widzenia, właściwością gruntów stosowanych jako materiał nasypowy lub zasypowy w budownictwie ziemnym jest zagęszczalność. Wskaźnik uziarnienia wykorzystywanych w tym celu piasków, pospółek lub żwirów charakteryzuje się stosunkowo niewielką wartością, zazwyczaj wahającą się w granicach 2,5–4,0, co pozwala na określenie ich jako trudno lub średnio zagęszczalnych. W pracy przedstawiono wyniki badań, jakie przeprowadzono w celu określenia wpływu modyfi kacji składu granulometrycznego gruntu niespoistego – piasku średniego, za pomocą dodatku pyłu lessowego na zagęszczenie. Za grunt mało spoisty przyjęto pył lessowy pochodzący z terenu Lublina. Grunty te zajmują znaczną powierzchnię obszaru miasta, a ich częste występowanie w strefi e przypowierzchniowej, czyni je łatwo dostępnymi. Badania wykonano na próbie piasku średniego o uziarnieniu naturalnym, która stanowiła próbę kontrolną oraz dwóch mieszaninach piasku średniego z pyłem lessowym, sporządzonych w stosunku objętościowym 1:1 i 2:1. Każdy z gruntów poddano analizie sitowej i areometrycznej. Uzyskano krzywe uziarnienia, a także określono procentową zawartość poszczególnych frakcji. Analiza wyników składu granulometrycznego pozwoliła na wyznaczenie wskaźnika różnoziarnistości, który dla piasku średniego wynosił 1,71 zaś dla mieszanin piasku z pyłem lessowym wzrósł do 21,8 (w przypadku próbki materiałów zmieszanych w stosunku 1:1) oraz 13,3 (dla próbki materiałów zmieszanych w stosunku 2:1). Uzyskane wyniki sugerują, iż modyfi kacja piasku średniego pyłem lessowym pozwala na zmianę klasyfikacji wytworzonej mieszaniny z gruntu trudno zagęszczalnego na dobrze zagęszczalny, a zatem możliwe jest uzyskanie większego zagęszczenia. W celu potwierdzenia tej tezy wykonano badania zagęszczenia i wilgotności optymalnej w aparacie Proctora wg metody I, dla każdego z trzech badanych gruntów. W przypadku próby kontrolnej maksymalna uzyskana gęstość objętościowa szkieletu gruntowego wynosiła 1,751 g/cm3 przy wilgotności 11,96%. Próbki piasku łączonego z pyłem lessowym w stosunku objętościowym 1:1 oraz 2:1 wykazały maksymalne gęstości objętościowe odpowiednio 2,076 i 2,079 g/cm3 przy wilgotności około 7%. W czasie badania stwierdzono plastyczność gruntu uzyskanego przez połączenie piasku i pyłu lessowego w stosunku objętościowym 1:1 przy wilgotności powyżej 14,25%, co wynika z faktu, iż piasek o takiej zawartości pyłu stanowi grunt na granicy gruntów spoistych i niespoistych. Zwiększona plastyczność uniemożliwia zagęszczenie badanego gruntu przy wilgotności powyżej 14,5% ze względu na powstające odkształcenia oraz wykazywaną spójność. Na podstawie przeprowadzonych badań stwierdzono, iż modyfi kacja uziarnienia piasku średniego pyłem lessowym w proporcji 2:1 pozwala na uzyskanie największego zagęszczenia w badanych warunkach. Wyniki badania sugerują, iż dzięki połączeniu piasku ze stosunkowo łatwo dostępnym pyłem lessowym można osiągnąć wymierne korzyści w postaci lepszego zagęszczenia gruntu, co pozwala na jego zastosowanie w budownictwie ziemnym jako grunt nasypowy lub zasypowy oraz na wykorzystanie gruntu rodzimego na terenach lessowych.

Objective: The purpose of this study was to compare clinical outcomes of conventional laparoscopic surgery and laparoendoscopic single-site surgery (LESS) in the surgical treatment of tubal ectopic pregnancy. Material and methods: A total of 156 patients were diagnosed with ectopic pregnancies by ultrasonography and serum β-human chorionic gonadotrophin (β-hCG) levels at Pusan National University Yangsan Hospital from January 2009 through December 2013. We excluded 28 patients who only received medical treatment, 15 patients who underwent surgery by laparotomy for severe hypovolemic shock, and 30 patients who presented with less than 1 L of hemoperitoneum. Of the 83 patients with massive hemoperitoneum, 38 patients had LESS performed while the remaining 45 patients underwent conventional laparoscopic surgery. Results: In this study, there were no statistically significant differences in clinical outcomes in either surgical method except for operative time. Operative time of LESS was significantly shorter than conventional surgery for patients with more than 500 mL of hemoperitoneum. Conclusion: LESS is a safe and feasible surgical approach in the treatment of tubal ectopic pregnancy. At the same time, LESS has been shown to be more effective than conventional laparoscopic surgery in handling massive hemoperitoneum of more than 1 L, which is a common complication of ectopic pregnancy.

A afecção congênita mais comum nos animais domésticos é denominada de criptorquidismo, sendo caracterizada pela não migração de um ou ambos os testículos até o escroto. O objetivo deste trabalho é relatar a técnica de criptorquidectomia videoassistida, através de um único acesso (LESS) sem dispositivos específicos, em um gato siamês com dois anos de idade e 3,9kg de massa corporal. Utilizou-se um único portal de 5 mm, inserido na linha média ventral na região pré-púbica. Por esse portal, a cavidade foi insuflada com CO2 medicinal, permitindo a obtenção do pneumoperitônio (8mmHg) a uma velocidade de 1 l/min. Após o inventário da cavidade abdominal, com o auxílio de um endoscópio de 5mm e 25o, identificou-se o testículo ectópico. Com a utilização de uma pinça de apreensão para mini laparoscopia (3mm), introduzida ao lado do trocarte (pelo mesmo acesso), o testículo foi fixado e tracionado para o exterior da cavidade abdominal para realização de hemostasia, não sendo necessária a ampliação da ferida cirúrgica. Após a secção dos vasos testiculares, o testículo foi totalmente liberado e o coto vascular devolvido à cavidade abdominal. O presente relato demonstra que a cirurgia laparoscópica por um único acesso (LESS) pode ser utilizada com sucesso no diagnóstico e tratamento de casos de criptorquidismo em gatos, com as possíveis vantagens que o acesso apresenta em relação à cirurgia convencional.

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With the aim of minimising the patient’s postoperative pain, expediting recovery and improving cosmesis, the idea of performing a laparoscopic procedure through a single abdominal incision was introduced. In the present report, we describe five different access routes to the prostate that may be at the surgeon’s disposal with the potential of decreasing patient’s perioperative morbidity. Robotic radical prostatectomy has been refined and became a standard of care in surgery for localised prostate cancer. The advent of single-port robotic surgery has prompted the re-discovery of different access routes to the prostate and ideally all of them are feasible. The potential for avoiding the abdominal cavity will decrease the surgical morbidity and minimise the surgical dissection. In the near future, each of the described approaches could be chosen on the basis of the patient’s preoperative comorbidities, body habitus, anatomy, and disease characteristics and location. [ABSTRACT FROM AUTHOR]

Current computational trends related to turbulent gas-liquid flow are discussed, together with the developments and open challenges needed to bring the discipline to a mature stage. The contribution presents the possibilities offered today by turbulent scale-resolving strategies (Large-Eddy Simulation, LES) to treat complex, multiphase flow topology in system components, and transcending more conventional kinetic energy dissipation-based models combined with phase-average approaches. The LES approach of turbulent gas-liquid flows introduced here under its sub-variants LESS and LEIS (Large-Eddy & Structures Simulation and Large-Eddy & Interface Simulation) is based on unifying the phase averaging concept and the turbulent-scale filtering operations into one single process. The paper is written in the spirit of a review, albeit it provides enough derivation details including the connection between the supergrid (resolved) and subgrid (unresolved) physics. A particular attention is paid here to the various attempts to model the underlying subgrid physics, including DNS-based model upscaling. A brief review of LEIS and LESS applications to phase-change heat transfer problems is provided, too. While the LESS variant based on the filtered multi-fluid equations is best suited for a range of problems in which one of the phases is dispersed in the other, LEIS provides further accuracy by directly predicting interface dynamics and turbulence motions down to the grid level. The paper addresses also the required developments for more complex multi-scale, multi-fluid flow problems, including a new approach termed as ARM, short for All-Regime Multiphase flow model. [ABSTRACT FROM AUTHOR]

This is to describe a case of a morbidly obese (BMI = 40) female with retrocaval ureter treated with laparoendoscopic single-site surgery. A JJ stent was positioned. A 2 cm umbilical access was created. A single port platform was positioned. The entire ureter was mobilized posterior to the vena cava and transected where the dilated portion ended. The distal ureter was repositioned lateral to the inferior vena cava. Anastomosis was done. A 3 mm trocar was used to assist suturing. At 4-month follow-up, CT revealed no evidence of obstruction of the right kidney and the patient was symptomless. Although challenging, in a morbidly obese patient, LESS repair for retrocaval ureter is feasible.

Background: Applications for natural orifice translumenal endoscopic surgery (NOTES) to access the abdominal cavity have increased in recent years. Despite potential advantages of transanal and transcolonic NOTES for colorectal pathology, it has not been widely applied in the clinical setting. This study describes a series of nine patients for whom we performed transanal retrograde ("Down-to-Up") total mesorectal excision for rectal cancer. Materials And Methods: Under IRB approval, informed consent was obtained from each patient with rectal adenocarcinoma. Rectosigmoidectomy with total mesorectal excision was performed using low rectal translumenal access to the mesorectal fascia and subsequent dissection in a retrograde fashion. This was achieved using either a single port device or flexible colonoscope with endoscopic instrumentation and laparoscopic assistance. This was followed by transanal extraction of the specimen and hand-sewn anastomosis. Results: Mean operative time was 311 min. Mean hospital stay was 7.56 days. Complications occurred in two patients, and consisted of one anastomotic leakage with reoperation and one intraoperative conversion to open surgery because of impossibility to dissect the specimen. TME specimen integrity was adequate in six patients. Conclusion: This series suggests that a retrograde mesorectal dissection via a NOTES technique is feasible in patients with rectal adenocarcinoma. This technique may act as a complimentary part of operative treatment for rectal cancer alongside other minimally invasive strategies. Long-term follow up will be needed to assess oncological results.

Background: According to the precepts of reduced surgical trauma and better cosmesis, an intermediate laparoscopic appendectomy technique between the conventional three-trocar procedure and Laparoendoscopic Single Site Surgery (LESS) was performed, based on literature review and experience of the surgical team. Patients and Methods: Patients with early stage acute appendicitis and a favourable anatomical presentation were selected. The procedure was performed with two ports: A 10 mm trocar at the umbilicus site for laparoscope and a 5 mm one just above the pubic bone for grasper. The appendix was secured by external wire traction through a right iliac fossa puncture with 14-gauge intravenous catheter. Results: From August 2009 to December 2012, we performed 42 cases; two required conversion to a conventional laparoscopic technique. There were no complications in the remaining, no wound infections and a mean operation time of 64.5 minutes. Conclusion: The use of two-port laparoscopic appendectomy can act as a LESS intermediate step procedure, without loss of instrumental triangulation and maintenance of appropriate counter-traction. This technique can be used as an alternative to the three-port laparoscopic procedure in patients with initial presentation of appendicitis and a favourable anatomical position.

Objective: To demonstrate the feasibility of endoscopic extraperitoneal single site (EESS) inguinal hernia repair and compare it outcomes with the conventional totally extraperitoneal (TEP) technique. Background : TEP inguinal hernia repair is a widely accepted alternative to conventional open technique with several perioperative advantages. Transumbilical laparoendoscopic singlesite surgery (LESS) is an emerging approach and has been reported for a number of surgical procedures with superior aesthetic results but other advantages need to be proven. Patients and Methods : Thirty-eight uncomplicated inguinal hernias were repaired by EESS approach between January 2010 and January 2011. All procedures were performed through a 25 cm infraumbilical incision using the Alexis wound retractor attached to a surgical glove and three trocars. Body mass index, age, operative time, blood loss, complications, conversion rate, analgesia requirement, hospital stay, return to normal activities and patient satisfaction with aesthetic results were analysed and compared with the last 38 matched-pair group of patients who underwent a conventional TEP inguinal hernia repair by the same surgeon. Results: All procedures were performed successfully with no conversion. In both unilateral and bilateral EESS inguinal repairs, the mean operative time was longer than conventional TEP (55± 20 vs. 40± 15 min, P = 0.049 and 70± 15 vs. 55± 10 min, P = 0.014). Aesthetic result was superior in the EESS group (2.88± 0.43 vs. 2.79± 0.51, P = 0.042). There was no difference between the two approaches regarding blood loss, complications, hospital stay, time until returns to normal activities and analgesic requirement. Conclusion: EESS inguinal hernia repair is safe and effective, with superior cosmetic results in the treatment of uncomplicated inguinal hernias. Other advantages of this new technique still need to be proven.

Digital transformation is rapidly causing major, even disruptive changes in many industries. Moreover, global developments like digital platforms (cloud) and IoT create fundamentally new connections at many levels between objects, organizations and people (systems-of-systems). These are by nature dynamic and often work in real time - further increasing the complexity. These systemic changes bring up new profound questions: What are those new software-intensive systems like? How are they created and developed? Which principles should guide such organizational design? Agile enterprises are by definition proficient with such capabilities. What solutions are the current scaled agile frameworks such as SAFe and LeSS proposing, and why? In this paper, we aim to recognize the design principles of future software organizations, and discuss existing experiences from various different organizations under transformations, and the insights gained. The purpose is to systematize this by proposing a competence development impact-mapping grid for new digitalization drivers and goals with potential solutions based on our agile software enterprise transformation experiences. Our research approach is based on the resource-based and competence-based views (RBV, CBV) of organizations. We point out how most decision-making in companies will be more and more software-related when companies focus on software. This has profound impacts on organizational designs, roles and competencies. Moreover, increasing data-intensification poses new demands for more efficient organizational data processing and effective knowledge utilization capabilities. However, decisive systematic transformations of companies bring new powerful tools for steering successfully under such new business conditions. We demonstrate this via real-life examples. [ABSTRACT FROM AUTHOR]

Background: Despite the growing interest concerning the laparo-endoscopic single-site surgery (LESS) procedure, LESS presents multiple difficulties and challenges that are likely to increase the surgeon's cognitive cost, in terms of both cognitive load and performance. Nevertheless, there is currently no objective index capable of assessing the surgeon cognitive cost while performing LESS. We assessed if gaze-based indices might offer unique and unbiased measures to quantify LESS complexity and its cognitive cost. We expect that the assessment of surgeon's cognitive cost to improve patient safety by measuring fitness-for-duty and reducing surgeons overload.Methods: Using a wearable eye tracker device, we measured gaze entropy and velocity of surgical trainees and attending surgeons during two surgical procedures (LESS vs. multiport laparoscopy surgery [MPS]). None of the participants had previous experience with LESS. They performed two exercises with different complexity levels (Low: Pattern Cut vs. High: Peg Transfer). We also collected performance and subjective data.Results: LESS caused higher cognitive demand than MPS, as indicated by increased gaze entropy in both surgical trainees and attending surgeons (exploration pattern became more random). Furthermore, gaze velocity was higher (exploration pattern became more rapid) for the LESS procedure independently of the surgeon's expertise. Perceived task complexity and laparoscopic accuracy confirmed gaze-based results.Conclusion: Gaze-based indices have great potential as objective and non-intrusive measures to assess surgeons' cognitive cost and fitness-for-duty. Furthermore, gaze-based indices might play a relevant role in defining future guidelines on surgeons' examinations to mark their achievements during the entire training (e.g. analyzing surgical learning curves). [ABSTRACT FROM AUTHOR]

Objectives To define the learning curve of laparoendoscopic single-site surgery (LESS) of an experienced laparoscopist. Patients and methods Patients who had LESS, since its implementation in December 2009 until December 2014, were retrospectively analysed. Procedures were divided into groups of 10 and scored according to the European Scoring System for Laparoscopic Operations in Urology. Different LESS indications were done by one experienced laparoscopist. Technical feasibility, surgical safety, outcome, as well as the number of patients required to achieve professional competence were assessed. Results In all, 179 patients were included, with mean (SD) age of 36.3 (17.5) years and 25.4% of the patients had had previous surgeries. Upper urinary tract procedures were done in 65.9% of patients and 54.7% of the procedures were extirpative. Both transperitoneal and retroperitoneal LESS were performed in 92.8% and 7.2% of the patients, respectively. The intraoperative and postoperative complication rates were 2.2% and 5.6% (Clavien–Dindo Grade II 3.9% and IIIa 1.7%), respectively. In all, 75% of intraoperative complications and all conversions were reported during the first 30 LESS procedures; despite the significantly higher difficulty score in the subsequent LESS procedures. One 5-mm extra port, conversion to conventional laparoscopy and open surgery was reported in 14%, 1.7%, and 1.1% of the cases, respectively. At mean (SD) follow-up of 39.7 (11.4) months, all the patients that underwent reconstructive LESS procedures but one were successful. Conclusion In experienced hands, at least 30 LESS procedures are required to achieve professional competence. Although difficult, both conversion and complication rates of LESS are low in experienced hands. [ABSTRACT FROM AUTHOR]

While laparoendoscopic single-site surgery (LESS) appears to be feasible and safe, instrument triangulation, tissue handling, and other bimanual tasks are difficult even for experienced surgeons. Novel technologies emerged to overcome LESS' procedural and ergonomic difficulties of "tunnel vision" and "instrument clashing." Surgeon kinematics, self-reported workload and upper body discomfort were used to compare straight, bent and two articulating instruments while performing two basic surgical tasks in a LESS simulator. All instruments resulted in bilateral elevation and rotation of the shoulders, excessive forearm motion and flexion and ulnar deviation of wrists. Surgeons' adopted non-neutral upper extremity postures and performed excessive joint excursions to compensate for reduced freedom of movement at the single insertion site and to operate the instrument mechanisms. LESS' cosmetic benefits continue to impact laparoscopic surgery and by enabling performance through improved instruments, ergonomic improvement for LESS can reduce negative impact on surgeon well-being and patient safety. [ABSTRACT FROM AUTHOR]

Purpose: To assess the safety and effectiveness of LESS compared to conventional hysterectomy.Methods: The systematic review and meta-analysis was performed according to the MOOSE guideline, and quality of evidence was assessed using GRADE. Different databases were searched up to 4th of August 2016. Randomized controlled trials and cohort studies comparing LESS to the conventional laparoscopic hysterectomy were considered for inclusion.Results: Of the 668 unique articles, 23 were found relevant. We investigated safety by analyzing the complication rate and found no significant differences between both groups [OR 0.94 (0.61, 1.44), I 2 = 19%]. We assessed effectiveness by analyzing conversion risk, postoperative pain, and patient satisfaction. For conversion rates to laparotomy, no differences were identified [OR 1.60 (0.40, 6.38), I 2 = 45%]. In 3.5% of the cases in the LESS group, an additional port was needed during LESS. For postoperative pain scores and patient satisfaction, some of the included studies reported favorable results for LESS, but the clinical relevance was non-significant. Concerning secondary outcomes, only a difference in operative time was found in favor of the conventional group [MD 11.3 min (5.45-17.17), I 2 = 89%]. The quality of evidence for our primary outcomes was low or very low due to the study designs and lack of power for the specified outcomes. Therefore, caution is urged when interpreting the results.Conclusion: The single-port technique for benign hysterectomy is feasible, safe, and equally effective compared to the conventional technique. No clinically relevant advantages were identified, and as no data on cost effectiveness are available, there are currently not enough valid arguments to broadly implement LESS for hysterectomy. [ABSTRACT FROM AUTHOR]

Epiphrenic divericula are uncommon disorders of the lower oesophagus, which are symptomatic in only 15-20% of cases. The optimum treatment modality for such cases remains an oesophageal diverticulectomy with long myotomy with or without an antireflux operation. Recently, this is increasingly being done through the laparoscopic approach. Here we describe the first reported case of oesophageal diverticulectomy through the laparoendoscopic single site approach. A 57-year-old man presented to us with 6 months history of dysphagia and regurgitation. Patient was investigated with upper gastrointestinal (UGI) endoscopy, barium swallow, CECT chest and abdomen, oesophageal manometry and 24 hour pH study. He was diagnosed to have lower oesophageal diverticulum with mildly elevated pressure readings in manometric studies with normal peristalsis. Based on his symptoms, he was taken up for surgery. A laparoscopic transhiatal oesophageal diverticulectomy with myotomy was done through laparoendoscopic single site technique. The procedure lasted 160 min. There was no intraoperative complication. Gastrograffin study was done on postoperative day 2 following which he was started on liquids. He made an uneventful recovery and was discharged on fourth day. He remained asymptomatic on follow up. Oesophageal diverticulectomy is possible through laparoendoscopic single site approach if necessary expertise is available.

The objective was to give a general overview of common complications and rates reported in the current literature during performance of a variety of urologic procedures using laparo-endoscopic single-site surgery or LESS. A search of published reports using Pubmed and MEDLINE was performed with the following search terms: laparo-endoscopic single-site surgery, LESS or laparo-endoscopic single-site surgery complications within the date range of 2005--2011. Studies that were deemed appropriate and relevant to the current symposium were chosen for review. Overall complication rates were reported as ranging between 10% and 25%. In general, reconstructive procedures had consistently higher rates of complications than their extirpative/ablative counterparts (27% vs. 8%). There remain insufficient data to comment on differences in the rates or types of complications related to variations in the approach (transperitoneal vs. retroperitoneal), site of surgery (upper tract vs. lower tract) or specific technique used (instruments, access devices, robotic platforms, etc.). Complication rates associated with LESS in urology appear only slightly higher than with conventional laparoscopy. However, with proper patient selection and careful application of these techniques, proofs of concept and technical feasibility have been shown in several series. There continues to be a need for more standardization of the technique and reporting as well as more collaborative efforts to fully address questions of safety and efficacy of these new procedures.

In the last decade, laparoendoscopic single-site surgery (LESS) has been touted to be the part of the ′evolution′ of minimally invasive surgery. The hope is that reduced access points will ultimately decrease pain, morbidity, convalescence, and improve cosmesis. However, what is unique about LESS is that while laparoscopic literature sought to demonstrate superiority of the technique over that of open surgery, the publications on LESS generally seem to seek to demonstrate equivalence with laparoscopy, with the major focus being on cosmesis. Unfortunately, even in that regard the objective cosmesis data is lacking. Furthermore, patients rate cosmesis the least important of all factors. LESS has also been associated with increased risk of complication, increased surgical cost, and longer operative times. In the current review, an objective assessment of the literature will be used for comparison between current standard laparoscopic techniques and LESS with the hopes of answering the question: is LESS really more?

Scarless surgery is the Holy Grail of surgery and the very raison d′etre of Minimal Access Surgery was the reduction of scars and thereby pain and suffering of the patients. The work of Muhe and Mouret in the late 80s, paved the way for mainstream laparoscopic procedures and it rapidly became the method of choice for many intra-abdominal procedures. Single-incision laparoscopic surgery is a very exciting new modality in the field of minimal access surgery which works for further reducing the scars of standard laparoscopy and towards scarless surgery. Natural orifice translumenal endoscopic surgery (NOTES) was developed for scarless surgery, but did not gain popularity due to a variety of reasons. NOTES stands for natural orifice translumenal endoscopic surgery, a term coined by a consortium in 2005. NOTES remains a research technique with only a few clinical cases having been reported. The lack of success of NOTES seems to have spurred on the interest in single-incision laparoscopy as an eminently doable technique in the present with minimum visible scarring, rendering a ′scarless′ effect. Laparo-endoscopic single-site surgery (LESS) is, a term coined by a multidisciplinary consortium in 2008 for single-incision laparoscopic surgery. These are complementary technologies with similar difficulties of access, lack of triangulation and inadequate instrumentation as of date. LESS seems to offer an advantage to surgeons with its familiar field of view and instruments similar to those used in conventional laparoscopy. LESS remains a evolving special technique used successfully in many a centre, but with a significant way to go before it becomes mainstream. It currently stands between standard laparoscopy and NOTES in the armamentarium of minimal access surgery. This article outlines the development of LESS giving an overview of all the techniques and devices available and likely to be available in the future.