ExoMars 2016 Schiaparelli Module Trajectory and Atmospheric Profiles Reconstruction: Analysis of the On-board Inertial and Radar Measurements

On 19th October 2016 Schiaparelli module of the ExoMars 2016 mission flew through the Mars atmosphere. After successful entry and descent under parachute, the module failed the last part of the descent and crashed on the Mars surface. Nevertheless the data transmitted in real time by Schiaparelli during the entry and descent, together with the entry state vector as initial condition, have been used to reconstruct both the trajectory and the profiles of atmospheric density, pressure and temperature along the traversed path. The available data-set is only a small sub-set of the whole data acquired by Schiaparelli, with a limited data rate (8 kbps) and a large gap during the entry because of the plasma blackout on the communications. This paper presents the work done by the AMELIA (Atmospheric Mars Entry and Landing Investigations and Analysis) team in the exploitation of the available inertial and radar data. First a reference trajectory is derived by direct integration of the inertial measurements and a strategy to overcome the entry data gap is proposed. First-order covariance analysis is used to estimate the uncertainties on all the derived parameters. Then a refined trajectory is computed incorporating the measurements provided by the on-board radar altimeter. The derived trajectory is consistent with the events reported in the telemetry and also with the impact point identified on the high-resolution images of the landing site. Finally, atmospheric profiles are computed tacking into account the aerodynamic properties of the module. Derived profiles result in good agreement with both atmospheric models and available remote sensing observations

2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy.

Bile duct injury (BDI) is a dangerous complication of cholecystectomy, with significant postoperative sequelae for the patient in terms of morbidity, mortality, and long-term quality of life. BDIs have an estimated incidence of 0.4-1.5%, but considering the number of cholecystectomies performed worldwide, mostly by laparoscopy, surgeons must be prepared to manage this surgical challenge. Most BDIs are recognized either during the procedure or in the immediate postoperative period. However, some BDIs may be discovered later during the postoperative period, and this may translate to delayed or inappropriate treatments. Providing a specific diagnosis and a precise description of the BDI will expedite the decision-making process and increase the chance of treatment success. Subsequently, the choice and timing of the appropriate reconstructive strategy have a critical role in long-term prognosis. Currently, a wide spectrum of multidisciplinary interventions with different degrees of invasiveness is indicated for BDI management. These World Society of Emergency Surgery (WSES) guidelines have been produced following an exhaustive review of the current literature and an international expert panel discussion with the aim of providing evidence-based recommendations to facilitate and standardize the detection and management of BDIs during cholecystectomy. In particular, the 2020 WSES guidelines cover the following key aspects: (1) strategies to minimize the risk of BDI during cholecystectomy; (2) BDI rates in general surgery units and review of surgical practice; (3) how to classify, stage, and report BDI once detected; (4) how to manage an intraoperatively detected BDI; (5) indications for antibiotic treatment; (6) indications for clinical, biochemical, and imaging investigations for suspected BDI; and (7) how to manage a postoperatively detected BDI

Double-stapling technique for transhiatal distal esophageal resection: Feasibility test in a cadaver model.

OBJECTIVES: To assess the feasibility of a new surgical technique for the resection of the distal third of the esophagus and/or cardias for neoplasm. METHODS: This surgical technique consists of two steps: For this purpose we built a stainless steel support bar for the anvil that is thinner than the freespace of a standard linear suturing stapler (TATM). The support bar holds up a push rod that can be adapted to the hooking-unhooking of the anvil. RESULTS: We performed our new technique on five cadavers. We did not encounter any difficulty during the procedures. We tested the anastomosis with hydropneumatic assessment without recording any leaks. The esophago-enteric anastomosis was then opened without finding any mechanical defects related to the procedure. CONCLUSION: It can often be very difficult to fashion a safe hand-sewn pouch or a purse string around the anvil of an EEATM during the resection of the distal third of the esophagus or the cardias by a trans-hiatal approach. Moreover, there is no standardized procedure to minimize anastomotic leak. To avoid these mechanical problems we designed this innovative procedure, which is considered to be reproducible without significant training

Supplementary Material for: Safety and Efficacy of a Novel Double-Stapling Technique for Distal Esophageal Resection and Esophago-Jejunal Anastomosis

<i>Background:</i> The purpose of this study was to evaluate safety and efficacy of a new esophagojejunal anastomosis (EJA) technique allowing the insertion of the anvil of a common circular stapler without hand-sewn securing. <i>Methods:</i> From August 2014 to May 2015, 20 consecutive patients with esophagogastric junction adenocarcinoma underwent surgery. EJA was performed using a new technique; the free margins of the esophageal stump were suspended and the anvil of a circular stapler on a new dedicated and registered support bar (characterized by a push-rod making possible to hook-unhook the anvil of the circular stapler) was inserted into the lumen. Subsequently, the linear suturing stapler was closed over the bar and fired to suture the distal stump of the esophagus; the bar was retracted and the push-rod of the anvil was pulled out through the linear suture. Finally, the anastomosis was performed using a circular stapler. <i>Results:</i> There were no intraoperative complications, and R0 resection was achieved in all cases. Postoperative course has been uneventful for 18 patients (90%). Only 1 patient (5%) developed fistula, conservatively treated. <i>Conclusions:</i> Our preliminary clinical experience suggested that this technique was safe and efficient (for all online suppl. material, see www.karger.com/doi/10.1159/000446856)