Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy

Background A reliable system for grading operative difficulty of laparoscopic cholecystectomy would standardise description of findings and reporting of outcomes. The aim of this study was to validate a difficulty grading system (Nassar scale), testing its applicability and consistency in two large prospective datasets. Methods Patient and disease-related variables and 30-day outcomes were identified in two prospective cholecystectomy databases: the multi-centre prospective cohort of 8820 patients from the recent CholeS Study and the single-surgeon series containing 4089 patients. Operative data and patient outcomes were correlated with Nassar operative difficultly scale, using Kendall’s tau for dichotomous variables, or Jonckheere–Terpstra tests for continuous variables. A ROC curve analysis was performed, to quantify the predictive accuracy of the scale for each outcome, with continuous outcomes dichotomised, prior to analysis. Results A higher operative difficulty grade was consistently associated with worse outcomes for the patients in both the reference and CholeS cohorts. The median length of stay increased from 0 to 4 days, and the 30-day complication rate from 7.6 to 24.4% as the difficulty grade increased from 1 to 4/5 (both p < 0.001). In the CholeS cohort, a higher difficulty grade was found to be most strongly associated with conversion to open and 30-day mortality (AUROC = 0.903, 0.822, respectively). On multivariable analysis, the Nassar operative difficultly scale was found to be a significant independent predictor of operative duration, conversion to open surgery, 30-day complications and 30-day reintervention (all p < 0.001). Conclusion We have shown that an operative difficulty scale can standardise the description of operative findings by multiple grades of surgeons to facilitate audit, training assessment and research. It provides a tool for reporting operative findings, disease severity and technical difficulty and can be utilised in future research to reliably compare outcomes according to case mix and intra-operative difficulty

Phenomenological description of scaling laws of sediment transport

In this paper, we seek the scaling laws of sediment transport under a turbulent flow by applying the phenomenological theory of turbulence. The results show that at the threshold of sediment motion, the densimetric Froude number follows a “(1+σ)/4” scaling law with the relative roughness number (ratio of particle size to flow depth), where σ is the spectral exponent. For the bedload transport, the bedload transport intensity follows a “3/2” and “(1+σ)/4” scaling laws with the transport stage function and the relative roughness, respectively. For the scour in a contracted stream, the dimensionless scour depth follows a “4/(3–σ)”, “– 4/(3–σ)” and “–(1+σ)/(3–σ)” scaling laws with the densimetric Froude number, the channel contraction ratio and the relative roughness, respectively

Phenomenology of meandering of a straight river

In this study, at first, we analyse the linear stability of a straight river. We find that the natural perturbation modes maintain an equilibrium state by confining themselves to a threshold wavenumber band. The effects of river aspect ratio, Shields number and relative roughness number on the wavenumber band are studied. Then, we present a phenomenological concept to probe the initiation of meandering of a straight river, which is governed by the counter-rotational motion of neighbouring large-scale eddies in succession to create the processes of alternating erosion and deposition of sediment grains of the riverbed. This concept is deemed to have adequately explained by a mathematical framework stemming from the turbulence phenomenology to obtain a quantitative insight. It is revealed that at the initiation of meandering of a river, the longitudinal riverbed slope obeys a universal scaling law with the river width, flow discharge and sediment grain size forming the riverbed. This universal scaling law is validated by the experimental data obtained from the natural and model rivers

Turbulence in Wall-Wake Flow Downstream of an Isolated Dunal Bedform

This study examines the turbulence in wall-wake flow downstream of an isolated dunal bedform. The streamwise flow velocity and Reynolds shear stress profiles at the upstream and various streamwise distances downstream of the dune were obtained. The results reveal that in the wall-wake flow, the third-order moments change their signs below the dune crest, whereas their signs remain unaltered above the crest. The near-wake flow is featured by sweep events, whereas the far-wake flow is controlled by the ejection events. Downstream of the dune, the turbulent kinetic energy production and dissipation rates, in the near-bed flow zone, are positive. However, they reduce as the vertical distance increases up to the lower-half of the dune height and beyond that, they increase with an increase in vertical distance, attaining their peaks at the crest. The turbulent kinetic energy diffusion and pressure energy diffusion rates, in the near-bed flow zone, are negative, whereas they attain their positive peaks at the crest. The anisotropy invariant maps indicate that the data plots in the wall-wake flow form a looping trend. Below the crest, the turbulence has an affinity to a two-dimensional isotropy, whereas above the crest, the anisotropy tends to reduce to a quasi-three-dimensional isotropy