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

Determination of parallele piped drag coeficiant with Jones and Betz measurement methods

Za mnoge inženirske namene je potrebno vsaj približno poznati koeficiente zračnega upora najrazličnejših predmetov. Vrednost koeficienta lahko v vetrovniku ugotovimo z dotičnimi metodami z nosilcem, ali pa z nedotično metodo meritve tlakov pred in za predmetom. Teoriji po Betzu in Jonesu nam iz teh meritev omogočata določitev približne vrednosti koeficienta zračnega upora, ki se od teoretičnih vrednosti razlikujejo v našem primeru do +/- 5%.To be able to perform various engineering procedures, we should at least approximately know drag coefficients of different objects. In the wind tunnel, the coefficient can be measured with converge method using a carrier, or with untouchable method of measuring pressure in front of and behind the object. Betz and Jones Theory enables us to pinpoint approxinate drag coefficients from these results, which in our case differ from theoretical results for +/- 5%

Digitalization of hydraulic press and handling device

Magistrska naloga obravnava digitalizacijo proizvodnega sistema sestavljenega iz zalogovnika, transportnih sistemov, robotske roke in hidravlične stiskalnice. Digitalizacija obravnavanega sistema hkrati postavlja smernice za razvoj digitalnega dvojčka, ki se v industriji uporablja za sprotno optimizacijo procesov. Fizične sisteme v nalogi obravnavamo kot digitalne modele, ki jih uvozimo v programsko okolje Visual Components ali pa jih izberemo v obstoječi knjižnici komponent programskega orodja. Podrobneje so prikazani vsi postopki za ustrezno pripravo in uvoz digitalnih modelov v navidezno okolje, nastavitev parametrov modelov in pripravo podatkov. V okviru naloge je za digitalni model hidravlične stiskalnice izdelan nov program, ki omogoča animacijo preoblikovalnega procesa. Z uporabo knjižnic, vključenih v okolje Visual Components, so bile v digitalno okolje vključene še druge naprave, ki so potrebne za izvedbo celotnega proizvodnega procesa. V okviru naloge smo izvedli tudi povezavo in sinhronizacijo med napravami s pomočjo vhodnih in izhodnih signalov. Na koncu naloge je prikazan primer uspešne animacije obravnavanega avtomatiziranega proizvodnega procesa.Master thesis describes the digitalisation of a manufacturing system consisting of a part container, transport systems, an industrial robot arm and a hydraulic press. The digitalisation of such a system sets the precedent for the development of a digital twin, which is used in industry for on-line process optimization. Physical systems are in this work considered as digital models, which we import into the workspace of Visual Components program, or which are chosen from an existing library of components within the program. All the processes of preparation and importation of digital models into the virtual environment are presented, as well as the setting of model parameters and data preparation. Within this thesis a new digital model of a hydraulic press is designed, which allows animation of the manufacturing process. By using libraries of Visual Components, several other machines were included within the workspace, all of which are required for this particular manufacturing operation. Within the thesis, the synchronisation between these machines using input and output signals was demonstrated. At the end, use case of successful animation of the automated production process is presented

Fellows perspective of HPB training in Latin America

Background: Currently, no standards for HPB training exist in Latin America. The aim of this work is to evaluate fellows' experience of HPB training and the areas of opportunity to improve. Methods: A 35 points survey was developed and distributed among fellows from dedicated HPB training programs in Latin America. The survey was applied by direct phone call (37%) or web based (63%), to fellows graduated between 2010 and 2014, from 7 different programs. Results: Thirty-nine fellows from Argentina, Brazil, Chile and México were considered with a response rate of 82% (32/39). Most fellows (90%) shared cases with more than one co-fellow. Scrubbing with chief residents ocurred to 60% of fellows; only 14% of fellows noted having a primary surgeon role in more than 70% of cases. Median number of major hepatectomies during training was 15 (1–100), Whipple procedures 6 (1–40), and major bile duct repair 20 (1–80). Limited funding was the main reason to avoid HPB programs outside the country of origin. Conclusion: HPB training in Latin America requires more operative volume and autonomy. Financial burden is the main limitation to pursue training overseas. A multinational fellowship that takes advantage of each center may overcome differences in volume and type of cases.Fil: Domínguez Rosado, Ismael. Instituto Nacional de la Nutrición Salvador Zubiran; MéxicoFil: Espinoza, Johana L.. Hospital Italiano; ArgentinaFil: Alvarez, Fernando A.. Hospital Italiano; ArgentinaFil: Vintimilla, Agustin. Universidade de Sao Paulo; BrasilFil: Quintero, Marco. Instituto Nacional de la Nutrición Salvador Zubiran; MéxicoFil: Barzallo, David. Instituto Nacional de la Nutrición Salvador Zubiran; MéxicoFil: Pekolj, Juan. Hospital Italiano; ArgentinaFil: Gondolesi, Gabriel Eduardo. Fundación Favaloro; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Schelotto, Pablo B.. Fundación Favaloro; ArgentinaFil: Herman, Paulo. Universidade de Sao Paulo; BrasilFil: Carneiro D'Albuquerque, Luiz A.. Universidade de Sao Paulo; BrasilFil: Andraus, Wellington. Universidade de Sao Paulo; BrasilFil: Padilla, Jorge. Beneficenca Portuguesa Hospital ; BrasilFil: Jarufe, Nicolas. Pontificia Universidad Católica de Chile; ChileFil: Chapa, Oscar. Hospital General de Mexico; MéxicoFil: Mercado, Miguel. Instituto Nacional de la Nutrición Salvador Zubiran; MéxicoFil: Chan, Carlos. Instituto Nacional de la Nutrición Salvador Zubiran; MéxicoFil: Alseidi, Adnan. Virginia Mason Medical Center; Estados Unido

International experience for laparoscopic major liver resection

Although minor laparoscopic liver resections (LLRs) appear as standardized procedures, major LLRs are still limited to few expert teams. The aim of this study was to report the combined data of 18 international centers performing major LLR. Variables evaluated were number and type of LLR, surgical indications, number of synchronous colorectal resections, details on technical points, conversion rates, operative time, blood loss and surgical margins. From 1996 to 2014, a total of 5388 LLR were carried out including 1184 major LLRs. The most frequent indication for laparoscopic right hepatectomy (LRH) was colorectal liver metastases (37.0%). Seven centers used hand assistance or hybrid approach selectively for LRH mostly at the beginning of their experience. Seven centers apply Pringle's maneuver routinely. The conversion rate for all major LLRs was 10% and mean operative time was 291 min. Mean estimated blood loss for all major LLR was 327 ml and negative surgical margin rate was 96.5%. Major LLRs still remain challenging procedures requiring important experience in both laparoscopy and liver surgery. Stimulating the younger generation to learn and accomplish these techniques is the better way to guarantee further development of this surgical field

International Summit on Laparoscopic Pancreatic Resection (ISLPR) "Coimbatore Summit Statements"

The International Summit on Laparoscopic Pancreatic Resection (ISLPR) was held in Coimbatore, India, on 7th and 8th of October 2016 and thirty international experts who regularly perform laparoscopic pancreatic resections participated in ISPLR from four continents, i.e., South and North America, Europe and Asia. Prior to ISLPR, the first conversation among the experts was made online on August 26th, 2016 and the structures of ISPLR were developed. The aims of ISPLR were; i) to identify indications and optimal case selection criteria for minimally invasive pancreatic resection (MIPR) in the setting of both benign and malignant diseases; ii) standardization of techniques to increase the safety of MIPR; iii) identification of common problems faced during MIPR and developing associated management strategies; iv) development of clinical protocols to allow early identification of complications and develop the accompanying management plan to minimize morbidity and mortality. As a process for interactive discussion, the experts were requested to complete an online questionnaire consisting of 65 questions about the various technical aspects of laparoscopic pancreatic resections. Two further web-based meetings were conducted prior to ISPLR. Through further discussion during ISPLR, we have created productive statements regarding the topics of Disease, Implementation, Patients, Techniques, and Instrumentations (DIPTI) and hereby publish them as "Coimbatore Summit Statements"

Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka

The use of laparoscopy for liver surgery is increasing rapidly. The Second International Consensus Conference on Laparoscopic Liver Resections (LLR) was held in Morioka, Japan, from October 4 to 6, 2014 to evaluate the current status of laparoscopic liver surgery and to provide recommendations to aid its future development. Seventeen questions were addressed. The first 7 questions focused on outcomes that reflect the benefits and risks of LLR. These questions were addressed using the Zurich-Danish consensus conference model in which the literature and expert opinion were weighed by a 9-member jury, who evaluated LLR outcomes using GRADE and a list of comparators. The jury also graded LLRs by the Balliol Classification of IDEAL. The jury concluded that MINOR LLRs had become standard practice (IDEAL 3) and that MAJOR liver resections were still innovative procedures in the exploration phase (IDEAL 2b). Continued cautious introduction of MAJOR LLRs was recommended. All of the evidence available for scrutiny was of LOW quality by GRADE, which prompted the recommendation for higher quality evaluative studies. The last 10 questions focused on technical questions and the recommendations were based on literature review and expert panel opinion. Recommendations were made regarding preoperative evaluation, bleeding controls, transection methods, anatomic approaches, and equipment. Both experts and jury recognized the need for a formal structure of education for those interested in performing major laparoscopic LLR because of the steep learning curve

Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka

The use of laparoscopy for liver surgery is increasing rapidly. The Second International Consensus Conference on Laparoscopic Liver Resections (LLR) was held in Morioka, Japan, from October 4 to 6, 2014 to evaluate the current status of laparoscopic liver surgery and to provide recommendations to aid its future development. Seventeen questions were addressed. The first 7 questions focused on outcomes that reflect the benefits and risks of LLR. These questions were addressed using the Zurich-Danish consensus conference model in which the literature and expert opinion were weighed by a 9-member jury, who evaluated LLR outcomes using GRADE and a list of comparators. The jury also graded LLRs by the Balliol Classification of IDEAL. The jury concluded that MINOR LLRs had become standard practice (IDEAL 3) and that MAJOR liver resections were still innovative procedures in the exploration phase (IDEAL 2b). Continued cautious introduction of MAJOR LLRs was recommended. All of the evidence available for scrutiny was of LOW quality by GRADE, which prompted the recommendation for higher quality evaluative studies. The last 10 questions focused on technical questions and the recommendations were based on literature review and expert panel opinion. Recommendations were made regarding preoperative evaluation, bleeding controls, transection methods, anatomic approaches, and equipment. Both experts and jury recognized the need for a formal structure of education for those interested in performing major laparoscopic LLR because of the steep learning curve