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In March 2020, a Suburban Taskforce was established by Members of Parliament (MPs) in the UK. This Taskforce argued that the experiences of suburbs in England were poorly understood by policy-makers and developers, practitioners, and the general public. Over the two years of research and engagement that followed, a key consideration to emerge was the management of change and particularly in the context of growth pressures evident in Outer London. This has synergies with recent trends in suburban research that turn away from negative framings of places in extended metropolitan areas, such as 'edgeness' (not in the city) and 'in-between-ness' (neither urban nor rural activity). Instead, there is increasing focus on suburban cultural dynamics and political ecology. Drawing on these ideas, this paper looks at suburbs as landscapes with natural and built elements, as well as diverse activities, and focuses on the processes of blending. The evidence and views presented to the Taskforce are used to investigate the blended landscapes of Outer London. The paper explores the elements and development rationalities in two London Boroughs, Sutton and Waltham Forest, and the context that shapes choices. The findings suggest that, while not discounting the significance of growth pressures and limits to local control, suburban landscapes are heavily influenced by responses to local socio-economic concerns, historic urban form, and the politics of local development. The paper concludes by reflecting on the directions of change in the study areas, and the significance of dynamics of ongoing blending of the landscapes across outer parts of major cities.

Electromechanical morcellation—so called power morcellation—is a minimally invasive approach to remove bulky lesions such as uterine fibroids. The spread of benign and malignant tissue due to morcellation is a major concern that might limit the use of laparoscopic interventions. We present an in vitro evaluation of the safety characteristics of a four-port endobag with closable trocar sleeves, and describe physical properties of the bag that may or may not allow passage through the hole. In addition, we report our preliminary experience of this tool when used for laparoscopic supracervical hysterectomies. The behavior of the endobag during the extraction process was analyzed by extracting opened and re-sealed bags filled with 20 ml blue dye solution through a wooden template, with incisions measuring 10 to 24 mm. The endobag was used in 50 subtotal hysterectomies during the morcellation procedure. In the in vitro test, no dye loss was recorded for incisions measuring 11–24 mm. The mean force required to pull the bag through the template was inversely proportional to incision size. No bag rupture occurred during the surgical procedures. The mean time taken to prepare the bag for morcellation was 7.1 min (range, 4–14 min), the mean duration of subtotal hysterectomy was 53.4 min (range, 20–194 min). The mean weight of the removed body of the uterus was 113.8 g (range, 13–896 g), the mean weight of tissue and fluid remaining in the bag after morcellation 7.9 g (range, 0–39 g). In the in vitro setting, the improved endobag signifies greater patient safety during bag extraction, along with less tissue traumatization due to a smaller incision in the abdominal wall. The improved ergonomic features of the bag permit the insertion of three trocars in the lower abdomen and avoid closure of unused access ports. Our preliminary experience has shown that the device can be used under routine conditions. Failure rates will be evaluated in future studies.

Despite concerns about the loss of industry, industrial land, and buildings in high-value post-industrial cities, there is concurrently a renewed enthusiasm around the potential of “new” urban manufacturing and its contribution to the socio-economic diversity of cities. Yet, little is known about how planning policy can best support the retention and growth of urban manufacturing. To advance this agenda, this article proposes that we need a better understanding of industrial building typologies and resultant urban form. Using concepts developed by Julienne Hanson to analyse residential morphologies undergoing transformation under modernism, we apply these concepts to investigate the industrial, mixed-use contexts in two areas of London with concentrations of urban manufacturing—Hackney Mare Street and Old Kent Road. The research presented examines how both areas have evolved historically to produce distinctive urban tissues and a range of industrial building typologies. The article reveals that, despite territorial similarities in the late 19th century, the mixed land uses and smaller plot sizes of Hackney Mare Street have allowed for a more resilient development pattern, whereas the greater separation of land uses, large plot sizes, and inward-facing development in the Old Kent Road has facilitated its reimagination for large-scale regeneration. We conclude that greater attention needs to be paid to the relationship between urban manufacturing and built urban form if policies that aim to protect or support the revival of manufacturing in cities are to avoid negative unintended consequences.

Introduction: Many laparoscopic procedures in modern urogynecology require an access to the retropubic space. In view of controversies regarding the use of mesh implants for the repair of ...

Many urogynecological and surgical laparoscopic interventions require access to the retropubic space, also known as the space of Retzius. Especially in patients with a history of previous surgery in this area or in general in the lower abdomen, the preparation may be complicated by adhesions and scar tissue. The necessity to combine several laparoscopic procedures in one surgical session may require consideration of the most appropriate way to approach the retropubic space.We describe and discuss three different options to access the space of Retzius via laparoscopy: the medial transperitoneal, the extraperitoneal and the lateral transperitoneal approach. For all approaches, we used one umbilical trocar and two trocars in the lower abdomen.An algorithm was developed to select the most appropriate access route to the retropubic space, depending on the history of previous surgeries and accompanying interventions.The knowledge of different access routes to the retropubic space offers the possibility of adjusting the surgical procedure to the individual constellation of the patient.

Unprotected power morcellation can lead to a spread of previously undiagnosed malignancy. We present a new containment bag with two closable trocar insertion sites to reduce this risk. This pilot study was designed to assess the feasibility of this device under everyday conditions.The containment bag was used in ten laparoscopic supracervical hysterectomies. We evaluated time requirement for bag insertion into the abdominal cavity and in-bag morcellation. A 2000 ml polyurethane morcellation bag was used for all interventions. All surgeries were carried out in a three-trocar setting.We carried out ten supracervical hysterectomies. No intraoperative complications and no bag ruptures occurred. The meantime requirement to insert the bag and prepare the specimen for morcellation was 10.5 min (range, 7-19 min). The mean specimen weight was 191.9 g (range, 32-710 g). Mean morcellation time was 10.5 min (range, 3-28 min), mean weight of remaining tissue and fluid in the bag after morcellation was 12.1 g (range, 7-19 g).The presented data demonstrate that the endobag can be successfully applied in the clinical routine. Further studies are required to evaluate additional characteristics, such as individual learning curve and time requirements.

Electromechanical power morcellation is an important tool of modern laparoscopy. Recent reports on the spread of previously undetected malignancy by power morcellation indicate the need for additional protective devices to reduce this risk. We conducted a study to obtain the first data concerning the safety of an endobag with three closable ports during morcellation and subsequent bag extraction under in vitro conditions, mimicking the settings in our operating theater. The second purpose of the study was to establish a minimal width of the skin incision necessary to safely extract the sealed bag after morcellation. The morcellation test was carried out on 11 stained porcine muscle tissue samples with one additional sample as a control. The insufflation pressure was set at 12 mmHg. After filling the endobag with blue dye solution, an additional extraction test was conducted by pulling the closed bag through a template with apertures of various diameters. For each opening, a series of ten bag extractions was carried out. No loss of solid material or fluid was recorded during the morcellation test. The extraction test showed a loss of fluid for template openings smaller than 18 mm. The force necessary to extract the bag was inversely related to the width of the aperture. The data suggest that under the evaluated conditions, the use of a closable morcellation bag can considerably improve the patient’s safety during morcellation. Further studies are necessary to evaluate the influence of the bag on operating time, intervention costs and complications.

OBJECTIVE The incidence of vulvar squamous cell carcinomas located between the clitoris and urethra in young women is rising in distinct geographic regions, but characteristics of the tumors indicating certain carcinogenic mechanisms are unknown. The present study aimed at characterizing these vulvar cancers for their human papillomavirus (HPV), p16(INK4a), and p53 status, revealing potential pathways of carcinogenesis. MATERIALS AND METHODS Squamous cell vulvar cancers of the anterior fourchette were retrospectively collected from 8 German hospitals, with additional squamous cell cancers located at other sites of the vulva from 2 of the hospitals. All tumors were analyzed for HPV DNA by polymerase chain reaction and for p16(INK4a) and p53 expression by immunohistochemistry. RESULTS Potentially HPV-associated tumors (HPV and p16(INK4a) positive, 21.4% [27/126] of the anterior fourchette and 27.7% [13/47] from other locations), p53-overexpressing tumors (35.7% [45/126] and 29.8% [14/47]), and a third group (HPV/p16(INK4a) negative/p53 not overexpressed, 42.9% [54/126] and 42.6% [20/47]) were observed among tumors from the anterior fourchette as well as among vulvar cancers from other locations. Women with vulvar cancers of the anterior fourchette were of young age irrespective of the HPV/p16(INK4a)/p53 status. CONCLUSIONS Different types of vulvar cancers can be found in squamous cell tumors of the anterior fourchette, similar to the finding in vulvar cancers from other locations and to what has previously been reported for vulvar squamous cell carcinomas in general.