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Background: Robotic-assisted surgery (RAS) potentially reduces workload and shortens the surgical learning curve compared to conventional laparoscopy (CL). The present study aimed to compare robotic-assisted cholecystectomy (RAC) to laparoscopic cholecystectomy (LC) in the initial learning phase for novices. Methods: In a randomized crossover study, medical students (n = 40) in their clinical years performed both LC and RAC on a cadaveric porcine model. After standardized instructions and basic skill training, group 1 started with RAC and then performed LC, while group 2 started with LC and then performed RAC. The primary endpoint was surgical performance measured with Objective Structured Assessment of Technical Skills (OSATS) score, secondary endpoints included operating time, complications (liver damage, gallbladder perforations, vessel damage), force applied to tissue, and subjective workload assessment. Results: Surgical performance was better for RAC than for LC for total OSATS (RAC = 77.4 ± 7.9 vs. LC = 73.8 ± 9.4; p = 0.025, global OSATS (RAC = 27.2 ± 1.0 vs. LC = 26.5 ± 1.6; p = 0.012, and task specific OSATS score (RAC = 50.5 ± 7.5 vs. LC = 47.1 ± 8.5; p = 0.037). There were less complications with RAC than with LC (10 (25.6%) vs. 26 (65.0%), p = 0.006) but no difference in operating times (RAC = 77.0 ± 15.3 vs. LC = 75.5 ± 15.3 min; p = 0.517). Force applied to tissue was similar. Students found RAC less physical demanding and less frustrating than LC. Conclusions: Novices performed their first cholecystectomies with better performance and less complications with RAS than with CL, while operating time showed no differences. Students perceived less subjective workload for RAS than for CL. Unlike our expectations, the lack of haptic feedback on the robotic system did not lead to higher force application during RAC than LC and did not increase tissue damage. These results show potential advantages for RAS over CL for surgical novices while performing thei, Medical Instruments & Bio-Inspired Technology

Understanding the key dynamical and microphysical mechanisms driving precipitation in the Snowy Mountains region of southeast Australia, including the role of orography, can help improve precipitation forecasts, which is of great value for efficient water management. An intensive observation campaign was carried out during the 2018 austral winter, providing a comprehensive range of ground-based observations across the Snowy Mountains. We used data from three vertically pointing rain radars, cloud radar, a PARSIVEL disdrometer, and a network of 76 pluviometers. The observations reveal that all of the precipitation events were associated with cold front passages. About half accumulated during the frontal passage associated with deep, fully glaciated cloud tops, while the rest occurred in the postfrontal environment and were associated with clouds with supercooled liquid water (SLW) tops. About three-quarters of the accumulated precipitation was observed under blocked conditions, likely associated with blocked stratiform orographic enhancement. Specifically, more than a third of the precipitation resulted from moist cloudless air being lifted over stagnant air, upwind from the barrier, creating SLW-top clouds. These SLW clouds then produced stratiform precipitation mostly over the upwind slopes and mountain tops, with hydrometeors reaching the mountain tops mostly as rimed snow. Two precipitation events were studied in detail, which showed that during unblocked conditions, orographic convection invigoration and unblocked stratiform enhancement were the two main mechanisms driving the precipitation, with the latter being more prevalent after the frontal passage. During these events, ice particle growth was likely dominated by vapor deposition and aggregation during the frontal periods, while riming dominated during the postfrontal periods.

Marine boundary layer clouds and precipitation observed in a sustained period of open mesoscale cellular convection (MCC) over the Southern Ocean (SO) are investigated using Clouds, Aerosols, Precipitation, Radiation, and atmospherIc Composition Over the southeRn oceaN 2016 observations, Himawari‐8 products, and numerical simulations. The shallow convection was characterized by the presence of supercooled liquid water and mixed‐phase clouds in the sub‐freezing temperature range, consistent with earlier in‐situ observations where ice multiplication is found to be active in producing large quantities of ice in open MCC clouds. Ice‐phase precipitation was observed to melt below cloud base with evidence of cold pools produced in a decoupled boundary layer. Convection‐permitting simulations using the weather research and forecasting model were able to reproduce many of the surface meteorological features and their evolution. However, the evolution of the boundary layer height and the degree of decoupling were poorly simulated, along with the absence of cold pools. The observed cloud morphology and microphysical characteristics were also not well reproduced in the control simulation with the Thompson microphysics scheme, where too much supercooled water was simulated in a too homogenous cloud field. Sensitivity experiments with modified microphysical parameters led to a higher production of glaciated clouds and precipitation. Sensitivity experiments with different boundary layer schemes and vertical resolution, however, showed a smaller impact. A bias of ∼4°C in the initial boundary conditions of the sea surface temperature is discussed. This study highlights the challenge of representing the complex physical processes that underpin the cloud, precipitation, and boundary layer characteristics of the open MCC over the SO.

The fate of engineered nanoparticles in the aquatic-terrestrial transition zone is decisive for their effect in the environment. However, our knowledge on processes within this interface is rather low. Therefore, we used a floodplain stream mesocosm to enhance our understanding of the long-term distribution and biological effects of citrate-coated silver nanoparticles (Ag-NPs) in this ecosystem. Parallel to pulsed dosing of Ag-NPs, we observed fluctuating but successively increasing concentrations of aqueous Ag, 88–97% of which was categorized as particles. The remaining dissolved fraction was mainly complexed with natural organic matter (NOM). The major Ag fraction (50%) was associated with the uppermost sediment layer. The feeding activity of benthic amphipods was largely unaffected, which could be explained by the low Ag concentration and complexation of released Ag+ with NOM. According to our hypothesis, only a small nanoparticle fraction (6%) moved to the terrestrial area due to aquatic aging and enrichment of Ag-NPs in sediments and biota. Nanoparticle infiltration in deeper sediment and soil layers was also limited. We expect that a small fraction of nanoparticles remaining in the water for several weeks can be transported over large distances in rivers. The Ag-NPs accumulated in the top layer of sediment and soil may serve as a source of toxic Ag+ ions or may be remobilized due to changing physico-chemical conditions. Furthermore, the high enrichment of Ag-NPs on algae (up to 250 000-fold) and leaves (up to 11 000-fold) bears risk for organisms feeding on those resources and for the transfer of Ag within the food web.