Adrenal sparing giant adrenal cyst excision by 3D laparoscopic approach: a case report

Adrenal cyst is rare clinical entity. Usually they are asymptomatic, non-functional, <10 cm in size and often discovered incidentally. We report a left adrenal cyst in 58-year-old woman measuring 23 cm in diameter, displacing left kidney infero-medially and pancreas anteriorly, because of its huge size. She presented with left flank pain over a 6-month period. Serial abdominal ultrasound and CT imaging revealed left suprarenal cystic mass of size 10 cm to begin with and gradually increased to size of 23 cm over period of 10 years when she became symptomatic. All laboratory and endocrine function tests were normal. 3D laparoscopic surgery done and cyst was completely removed with preservation of adrenal gland. Histopathological examination revealed a benign endothelial adrenal cyst. The postoperative course was uneventful and patient had no evidence of recurrence during follow-up. The giant adrenal cysts are relatively rare and represent great surgical challenge during resection.

Global importance of large-diameter trees

Aim: To examine the contribution of large‐diameter trees to biomass, stand structure, and species richness across forest biomes. Location: Global. Time period: Early 21st century. Major taxa studied: Woody plants. Methods: We examined the contribution of large trees to forest density, richness and biomass using a global network of 48 large (from 2 to 60 ha) forest plots representing 5,601,473 stems across 9,298 species and 210 plant families. This contribution was assessed using three metrics: the largest 1% of trees ≥ 1 cm diameter at breast height (DBH), all trees ≥ 60 cm DBH, and those rank‐ordered largest trees that cumulatively comprise 50% of forest biomass. Results: Averaged across these 48 forest plots, the largest 1% of trees ≥ 1 cm DBH comprised 50% of aboveground live biomass, with hectare‐scale standard deviation of 26%. Trees ≥ 60 cm DBH comprised 41% of aboveground live tree biomass. The size of the largest trees correlated with total forest biomass (r2 = .62, p < .001). Large‐diameter trees in high biomass forests represented far fewer species relative to overall forest richness (r2 = .45, p < .001). Forests with more diverse large‐diameter tree communities were comprised of smaller trees (r2 = .33, p < .001). Lower large‐diameter richness was associated with large‐diameter trees being individuals of more common species (r2 = .17, p = .002). The concentration of biomass in the largest 1% of trees declined with increasing absolute latitude (r2 = .46, p < .001), as did forest density (r2 = .31, p < .001). Forest structural complexity increased with increasing absolute latitude (r2 = .26, p < .001). Main conclusions: Because large‐diameter trees constitute roughly half of the mature forest biomass worldwide, their dynamics and sensitivities to environmental change represent potentially large controls on global forest carbon cycling. We recommend managing forests for conservation of existing large‐diameter trees or those that can soon reach large diameters as a simple way to conserve and potentially enhance ecosystem services

Three-dimensional versus two-dimensional laparoscopy in urology: A randomized study

Introduction: Conventional two-dimensional (2D) laparoscopy systems have the drawback of poor depth perception and spatial orientation. Three-dimensional (3D) laparoscopic systems have stereoscopic vision in which depth perception is achieved by different unique images received by each eye. We evaluated 3D laparoscopy in comparison with conventional 2D laparoscopy in urological procedures in a prospective randomized study. Materials and Methods: Over a 19 month study period, 108 patients scheduled to undergo various urological procedures were randomized to either conventional 2D or 3D laparoscopy (2D n = 53; 3D n = 55). A single senior surgeon performed all the surgeries. Parameters such as total operative time, dissection and suturing time, blood loss, hospital stay, complications (Clavien-Dindo), and visual analog scale (VAS) score for pain were assessed. The subjective assessment of the operating surgeon of superiority and inferiority of either technology on parameters defining surgical skills was recorded using a Likert scale. Results: The total operative time (P < 0.0003), blood loss (P < 0.028), dissection, suturing and stenting time (P < 0.0001), and the State-Trait Anxiety Inventory for Adults score (P < 0.0001) was significantly in favor of 3D laparoscopy. Post operative pain, hospital stay, and complications after surgery were similar in both groups. The subjective assessment of the operating surgeon also favored the 3D system. Conclusion: Our study showed significant advantages of the 3D system over 2D laparoscopy. These advantages include enhanced operative performance and greater surgeon comfort

Laparoscopic resection of extra-adrenal pheochromocytoma in paediatric age

Today, in the era of minimally invasive surgery, paediatric laparoscopy has become widely popular. Extra-adrenal pheochromocytoma is a very rare entity, especially in the paediatric age group and utility of the laparoscopic approach is not established in this population. Early diagnosis and surgical excision are integral part of treatment of childhood pheochromocytoma. We present a case study of a child with hormonally active extra-adrenal pheochromocytoma that was resected laparoscopically. Laparoscopic approach provides excellent exposure with magnification and allows proper identification of the tumour and its relation to surrounding structures; complete resection of tumour was achieved with adequate vascular control. With our initial experience, we suggest laparoscopic resection is an appropriate and feasible tool in such cases

Hybrid Surface Design for Robust Superhydrophobicity

Surfaces may be rendered superhydrophobic by engineering the surface morphology to control the extent of the liquid-air interface and by the use of low-surface-energy coatings. The droplet state on a superhydrophobic surface under static and dynamic conditions may be explained in terms of the relative magnitudes of the wetting and antiwetting pressures acting at the liquid-air interface on the substrate. In this paper, we discuss the design and fabrication of hollow hybrid superhydrophobic surfaces which incorporate both communicating and noncommunicating air gaps. The surface design is analytically shown to exhibit higher capillary (or nonwetting) pressure compared to solid pillars with only communicating air gaps. Six hybrid surfaces are fabricated with different surface parameters selected such that the Cassie state of a droplet is energetically favorable. The robustness of the surfaces is tested under dynamic impingement conditions, and droplet dynamics are explained using pressure-based transitions between Cassie and Wenzel states. During droplet impingement, the effective water hammer pressure acting due to the sudden change in the velocity of the droplet is determined experimentally and is found to be at least 2 orders of magnitude less than values reported in the literature. The experiments show that the water hammer pressure depends on the surface morphology and capillary pressure of the surface. We propose that the observed reduction in shock pressure may be attributed to the presence of air gaps in the substrate. This feature allows liquid deformation and hence avoids the sudden stoppage of the droplet motion as opposed to droplet behavior on smooth surfaces