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There are few data on complications with gender affirming surgery. The aim of this study was to assess peri- and postoperative complications of laparoscopic hysterectomy and mastectomy performed in a single sitting in transgender men. Assessment of intra- and postoperative complications in a series of 65 transgender men (mean age 27, range 18–47) undergoing concomitant mastectomy and laparoscopic hysterectomy with salpingo-oophorectomy. Mean operating time was 292 ± 47 min. Thirty-four (52%) patients experienced complications: 28 (41%) DINDO grade I, 0 DINDO grade 2, 6 (11%) DINDO grade III. The six grade 3 complications consisted of 5 hematomas requiring evacuation after mastectomy and 2 vaginal tears requiring transvaginal repair. Three patients were readmitted within 30 days, all for postoperative bleeding/hematoma. In transgender men, performing laparoscopic hysterectomy and mastectomy at a single sitting has a modest rate of perioperative complications, and may improve resource utilization. Supplementary Information The online version contains supplementary material available at 10.1007/s43032-021-00724-x.

Background Peripheral nerve defects (PND) often cause lifelong physical disability, and the available treatment options are often not satisfactory. PND are usually bridged with an autologous nerve transplant or a nerve guidance conduit (NGC), when coaptation as preferred technique is not possible. The aim of this experimental study was to determine the effectiveness of a novel NGC for regeneration in the treatment of PND. Materials and methods A conduit made of gelatin with an innovative interior structure was tested for the repair of a 6-mm gap versus direct microsurgical suture repair without gap. Results We found that bridging the defect with this conduit was as effective as direct microsurgical coaptation without a defect. Conclusions This nerve conduit, effective in bridging neural defects, appears as an alternative to autologous nerve grafts, avoiding the problems related to nerve graft harvesting, host–donor differences in diameter, mismatches in number and pattern of fascicles, cross-sectional shape and area, and morbidity of the donor area.

Objective To determine how many FIGO (International Federation of Obstetrics and Gynecology) member societies have statements regarding opportunistic (incidental, prophylactic, risk-reducing) salpingectomy at the time of benign gynecologic surgery and to categorize statements as positive, negative or ambivalent. Study design The websites of the 130 FIGO member societies were searched for statements on opportunistic salpingectomy. We looked for separate statements and statements embedded in other documents such as clinical guidelines as well as statements by national societies of gynecologic oncology. If nothing was found on the websites we contacted societies by Email or fax. Results As of early 2018, 13 FIGO member societies representing 14 countries have statements regarding opportunistic salpingectomy. Nine were separate, stand-alone statements, four were embedded in other documents. Nine of the 13 statements (from Canada, Finland, U.S.A., Great Britain, Australia and New Zealand, Denmark, Austria, Turkey, and Japan) support consideration of opportunistic salpingectomy in appropriate women and four (from Germany, Sweden, Norway, and France) are ambivalent; there are no statements recommending against opportunistic salpingectomy. Conclusion In 2018 only a small minority of FIGO members have statements on opportunistic prophylactic salpingectomy. These statements are ambivalent or supportive, none is negative.

Background Most serous ovarian cancers are now understood to originate in the fallopian tubes. Removing the tubes (salpingectomy) likely reduces the risk of developing high‐grade serous ovarian cancer. Numerous gynaecological societies now recommend prophylactic (or opportunistic) salpingectomy at the time of gynaecological surgery in appropriate women, and this is widely done. Salpingectomy at the time of non‐gynaecological surgery has not been explored and may present an opportunity for primary prevention of ovarian cancer. Methods This study investigated whether prophylactic salpingectomy with the intention of reducing the risk of developing ovarian cancer would be accepted and could be accomplished at the time of elective laparoscopic cholecystectomy. Women aged at least 45 years scheduled for elective laparoscopic cholecystectomy were recruited. They were counselled and offered prophylactic bilateral salpingectomy at the time of cholecystectomy. Outcome measures were rate of accomplishment of salpingectomy, time and procedural steps needed for salpingectomy, and complications. Results A total of 105 patients were included in the study. The rate of acceptance of salpingectomy was approximately 60 per cent. Salpingectomy was performed in 98 of 105 laparoscopic cholecystectomies (93·3 per cent) and not accomplished because of poor visibility or adhesions in seven (6·7 per cent). Median additional operating time was 13 (range 4–45) min. There were no complications attributable to salpingectomy. One patient presented with ovarian cancer 28 months after prophylactic salpingectomy; histological re‐evaluation of the tubes showed a previously undetected, focal serous tubal intraepithelial carcinoma. Conclusion Prophylactic salpingectomy can be done during elective laparoscopic cholecystectomy., Serous ovarian cancer is now understood to arise in the fallopian tubes. Prophylactic salpingectomy to reduce the risk of ovarian cancer is widely recommended at gynaecological surgery in appropriate women. This article explores prophylactic salpingectomy at the time of non‐gynaecological surgery. No harm, benefit still unclear

Introduction: Most serous ovarian cancers are now thought to originate in the fallopian tubes. This has raised the issue of performing incidental salpingectomy (also called elective, opportunistic, prophylactic or risk-reducing salpingectomy) at the time of benign gynecologic surgery or cesarean section. We conducted an online survey to ascertain the policies regarding incidental salpingectomy in Austria in late 2014. Material and Methods: All 75 departments of obstetrics and gynecology in public hospitals in Austria were surveyed for their policies regarding incidental salpingectomy at benign gynecologic surgery or cesarean section. Results: Sixty-six of 75 surveyed departments completed the questionnaire, resulting in a response rate of 88 %. Overall, 46 of 66 (70 %) units reported offering or recommending incidental salpingectomy at benign gynecologic surgery, 12 units (18 %) did not, and eight units (12 %) did not have a consistent policy. Salpingectomy was the preferred method for surgical sterilization, including sterilization at the time of cesarean section (71 % and 64 % of units, respectively). Conclusions: Incidental (elective, opportunistic, prophylactic, risk-reducing) salpingectomy is now widely offered at benign gynecologic surgery and cesarean section in Austria. Evidence for the role of the fallopian tubes in the origin of serous pelvic cancer has led to changes in clinical practice.

Access-related injuries are still an important consideration and may increase morbidity and mortality. This study aimed to present in detail a safe and easy technique for open insertion of the first trocar. This technique has been used routinely in the vast majority of laparoscopic procedures at first author’s department since 1998. The data were collected prospectively and analyzed retrospectively for the 11-year period of January 2005 through December 2015. The primary site of access is the umbilicus, but this technique can be used for all insertion points. A total of 2579 laparoscopic surgical interventions were performed. The abdominal access was established in 2252 patients in open and in 321 cases with blind puncture using a Veress needle. There were three cases (0.9 %) of accidental injuries with blind puncture and two cases (0.09 %) with open technique. Injuries sustained with open technique injuries were less severe and immediately discernable. None of the patients were converted to open technique. The method can be used easily and rapidly, even in obese patients. It is safer than blind puncture and reduces costs.

BACKGROUND: Symptoms of obstruction in the intestinal tract involve the small intestine in three quarters of cases and the large intestine in one-quarter. The most common causes of an acute small intestinal obstruction are postoperative adhesions (64.8%) and strangulated hernias (14.8%). The overall incidence of postoperative small bowel obstruction is 4.6%. Because it offers a conservative and targeted means of removing the obstruction, laparoscopy is increasingly used for acute small bowel obstruction. With proper selection of patients, the success rate is very high. This work presents the selection criteria, technique and results for a three-year period. METHODS: Twenty-one patients, 13 men and 8 women aged 28 to 69 years, underwent surgery between January 2008 and December 2010. Selection criteria for a laparoscopic procedure were anesthesia risk of not more than ASA 3, diameter of the dilatated loop of small intestine of not more than 5 cm, radiological image of a change in caliber as an indication of a focal passage disorder, exclusion of paralytic ileus, and no history of diffuse peritonitis. The patients underwent surgery in general anesthesia. The approach for the first trocar was umbilical in 18 cases and in the right or left flank in three cases, but always with open technique. Three trocars were always used. RESULTS: In 7 patients, there was an isolated band from a previous operation, usually an appendectomy; in 5 cases there were postoperative adhesions and a band. Three patients had a volvulus and in one of them, a 20 cm segment of the small intestine was already gangrenous. Two patients had an incarcerated hernia, one inguinal and one Bochdalek. Two patients had a stenosing tumor in the terminal ileum, one of which was a carcinoid and the other, the first manifestation of a lymphoma. One patient had an endometriosis focus as stenosis focus and another had a massively inflamed Meckel's diverticulum that obstructed passage in the small intestine. Two patients – the volvulus with small intestinal gangrene and the Bochdalek hernia – required conversion to open technique. One patient with diffuse adhesions and a band had to undergo open surgery 10 days later. There was no case of an intraoperative accidental intestinal injury. All the patients who underwent laparoscopy were discharged within a week. Hospitalization was significantly longer for the converted patients. The patient with the Boachdalek hernia died after 26 days of irreversible cardiopulmonary failure. CONCLUSIONS: With strict selection, laparoscopic treatment of small intestinal obstruction is a valuable option in visceral acute surgery. Patients with an isolated focal obstruction seem to benefit from laparoscopic surgery on the basis of reduced perioperative morbidity and short hospitalization.

BACKGROUND: According to the basic idea of minimally invasive surgery, reduction of surgical trauma, the caliber of instruments in needlescopic surgery is reduced to a few millimeters. The reduction in caliber can reduce power transmission to the instruments and impair view and light of the optic, which can cause limitations in its application. This study aimed to analyze the technique and results of needlescopic laparoscopy using the example of cholecystectomy. METHODS: From 2007 to 2010, 124 patients underwent needlescopic and 130 conventional laparoscopic cholecystectomy. The trocar sites were always the same as for conventional laparoscopic cholecystectomy; a 10 mm trocar was introduced transumbilically in open technique and a total of three 2 mm trocars were used on the epigastrium and the right subcostal space. Intraoperative cholangiography was routine as in conventional laparoscopy. RESULTS: All procedures were completed laparoscopically. Three cases (2.4%) required conversion to conventional laparoscopy. In 11 cases (9%), intraoperative cholangiography could not be performed. In 6 patients (5%), there were intraoperative complications such as opening of the gallbladder with spilling of the stones. The bile duct was never injured and there were no re-operations; hemoglobin never fell below 11 g/dl. There was significantly less need for analgesics in the first 3 days than with conventional laparoscopic cholecystectomy. Patient satisfaction was scored as 10 (very good) on a scale from 1–10 by 117 patients (94%). CONCLUSIONS: In contrast to NOTES and single port surgery, minilaparoscopy adheres to the basic principles of laparoscopy. With selected patients, needlescopic technique reduces postoperative pain, and has a better cosmetic result with higher patient satisfaction.

The Optical, Spectroscopic, and Infrared Remote Imaging System OSIRIS is the scientific camera system onboard the Rosetta spacecraft (Figure 1). The advanced high performance imaging system will be pivotal for the success of the Rosetta mission. OSIRIS will detect 67P/Churyumov-Gerasimenko from a distance of more than 106 km, characterise the comet shape and volume, its rotational state and find a suitable landing spot for Philae, the Rosetta lander. OSIRIS will observe the nucleus, its activity and surroundings down to a scale of ~2 cm px−1. The observations will begin well before the onset of cometary activity and will extend over months until the comet reaches perihelion. During the rendezvous episode of the Rosetta mission, OSIRIS will provide key information about the nature of cometary nuclei and reveal the physics of cometary activity that leads to the gas and dust coma. OSIRIS comprises a high resolution Narrow Angle Camera (NAC) unit and a Wide Angle Camera (WAC) unit accompanied by three electronics boxes. The NAC is designed to obtain high resolution images of the surface of comet 67P/Churyumov-Gerasimenko through 12 discrete filters over the wavelength range 250–1000 nm at an angular resolution of 18.6 μrad px−1. The WAC is optimised to provide images of the near-nucleus environment in 14 discrete filters at an angular resolution of 101 μrad px−1. The two units use identical shutter, filter wheel, front door, and detector systems. They are operated by a common Data Processing Unit. The OSIRIS instrument has a total mass of 35 kg and is provided by institutes from six European countries. The support of the national funding agencies of Germany (DLR), France (CNES), Italy (ASI), Sweden (SNSB), and Spain (MEC) is gratefully acknowledged. Substantial support for the development of the Data Processing Unit was provided by the ESA Technical Directorate through the Technical Research Programme. In addition to the formal co-authors of this paper (comprising lead scientists, Co-Is, project managers, and lead engineers ), the project was supported by an enormous number of scientists, engineers, and technicians involved in the day-to-day development of the hardware. These include J. C. Blanc, D. Pouliquen, M. Saisse (France), A. Alvarez, A. L. Arteaga, A. Carretero, M. Fernández, H. Guerrero, P. Gutiérrez, J. L. Lizondo, V. Luengo, J. A. Martín, M. A. Martín, J. Meseguer, J. M. Mi, L. Moreno, J. Navarro, A. Núñez, E. Ragel, D. Rodríguez, G. Rosa, A. Sanchez, J. C. Sanmartín, G. Tonellotto (Spain), W. Boogaerts, W. Engelhardt, K. Eulig, B. Fiethe, A. Fischer, M. Gartner, K. Grabig, K. Kellner, A. Kiihn. W. Kiihn. J. Knollenberg, W. Neumann, J. Nitsch, P. Rüffer, H. Schüddekopf, U. Schiihlc. I. Sebastian, S. Stelzer, U. Strohmeyer, T. Tzscheetzsch, M. Wassermeyer (Germany), B. Johlander (ESTEC), M. Baessato, P. F. Brunello, S. Casotto, F. Don-, M. Lazzarin, E. Marchetti, F. Marzari, P. G. Nicolosi, F. Perón, F. Rampazzi, B. Saggin, G. Tondello, S. Verani, P. Zambolin ' (Italy), J. Lagerros, and B. Davidsson (Sweden). Peerreview

S. K. Solanki et. al., ©2017 The American Astronomical Society. All rights reserved.The Sunrise balloon-borne solar observatory, consisting of a 1 m aperture telescope that provides a stabilized image to a UV filter imager and an imaging vector polarimeter, carried out its second science flight in 2013 June. It provided observations of parts of active regions at high spatial resolution, including the first high-resolution images in the Mg ii k line. The obtained data are of very high quality, with the best UV images reaching the diffraction limit of the telescope at 3000 Å after Multi-Frame Blind Deconvolution reconstruction accounting for phase-diversity information. Here a brief update is given of the instruments and the data reduction techniques, which includes an inversion of the polarimetric data. Mainly those aspects that evolved compared with the first flight are described. A tabular overview of the observations is given. In addition, an example time series of a part of the emerging active region NOAA AR 11768 observed relatively close to disk center is described and discussed in some detail. The observations cover the pores in the trailing polarity of the active region, as well as the polarity inversion line where flux emergence was ongoing and a small flare-like brightening occurred in the course of the time series. The pores are found to contain magnetic field strengths ranging up to 2500 G, and while large pores are clearly darker and cooler than the quiet Sun in all layers of the photosphere, the temperature and brightness of small pores approach or even exceed those of the quiet Sun in the upper photosphere., The German contribution to Sunrise and its reflight was funded by the Max Planck Foundation, the Strategic Innovations Fund of the President of the Max Planck Society (MPG), DLR, and private donations by supporting members of the Max Planck Society, which is gratefully acknowledged. The Spanish contribution was funded by the Ministerio de Economía y Competitividad under Projects ESP2013-47349-C6 and ESP2014-56169-C6, partially using European FEDER funds. The National Center for Atmospheric Research is sponsored by the National Science Foundation. The HAO contribution was partly funded through NASA grant number NNX13AE95G. This work was partly supported by the BK21 plus program through the National Research Foundation (NRF) funded by the Ministry of Education of Korea. L.G. acknowledges research funding from the State of Lower Saxony, Germany. SDO is a mission of NASA's Living With a Star (LWS) program. The SDO/HMI data were provided by the Joint Science Operation Center (JSOC). The National Solar Observatory (NSO) is operated by the Association of Universities for Research in Astronomy (AURA) Inc. under a cooperative agreement with the National Science Foundation.

Introduction. Even the most modern technology has failed to induce satisfactory functional regeneration of traumatically severed peripheral nerves. Delayed neural regeneration and in consequence, slower neural conduction seriously limit muscle function in the area supplied by the injured nerve. This study aimed to compare a new nerve coaptation system involving an innovative prosthesis with the classical clinical method of sutured nerve coaptation. Besides the time and degree of nerve regeneration, the influence of electrostimulation was also tested. Methods. The sciatic nerve was severed in 14 female Göttingen minipigs with an average weight of 40.4 kg. The animals were randomized into 2 groups: One group received the new prosthesis and the other underwent microsurgical coaptation. In each group, according to the randomization a part of the animals received postoperative electrostimulation. Postoperative monitoring and the stimulation schedule covered a period of 9 months, during which axonal budding was evaluated monthly. Results. The data from the pilot study indicate that results with the nerve prosthesis were comparable with those of conventional coaptation. Conclusion. The results indicate that implantation of the nerve prosthesis allows for good and effective neural regeneration. This new and simple treatment option for peripheral nerve injuries can be performed in any hospital with surgical facilities as it does not involve the demanding microsurgical suture technique that can only be performed in specialized centers.

Fistulas are abnormal communications between two epithelial surfaces, either between two portions of the intestine, between the intestine and some other hollow viscus, or between the intestine and the skin of the abdominal wall. The etiology of intestinal fistulas is in most cases a result of multiple contributing factors. Despite significant advances in their management over the past decades, intestinal fistulas remain a major clinical problem, with a high overall mortality rate of up to 30% due to the high rate of complications. This paper aims to describe classification systems based on the anatomy, physiology and etiology that may be helpful in the clinical management of intestinal fistulas.On the basis of anatomical differences, fistulas can be classified based by the site of origin, by site of their openings, or as simple or complex. Physiologic classification as low, moderate or high output fistulas is most useful for the non-surgical approach. Concerning the etiology, we classified the possible causes as (postoperative) trauma, inflammation, infection, malignancy, radiation injury or congenital.Fistula formation can cause a number of serious or debilitating complications ranging from disturbance of fluid and electrolyte balance to sepsis and even death. They still remain an important complication following gastrointestinal surgery.

The first science flight of the balloon-borne \Sunrise telescope took place in June 2009 from ESRANGE (near Kiruna/Sweden) to Somerset Island in northern Canada. We describe the scientific aims and mission concept of the project and give an overview and a description of the various hardware components: the 1-m main telescope with its postfocus science instruments (the UV filter imager SuFI and the imaging vector magnetograph IMaX) and support instruments (image stabilizing and light distribution system ISLiD and correlating wavefront sensor CWS), the optomechanical support structure and the instrument mounting concept, the gondola structure and the power, pointing, and telemetry systems, and the general electronics architecture. We also explain the optimization of the structural and thermal design of the complete payload. The preparations for the science flight are described, including AIV and ground calibration of the instruments. The course of events during the science flight is outlined, up to the recovery activities. Finally, the in-flight performance of the instrumentation is briefly summarized., Comment: 35 pages, 17 figures

Valence-band density of states from sputter-deposited epitaxial metastable (GaAs${)}_{1\mathrm{\ensuremath{-}}\mathit{x}}$(${\mathrm{Ge}}_{2}$${)}_{\mathit{x}}$ alloys have been acquired by high-resolution x-ray photoelectron spectroscopy (XPS). Based upon a comparison of XPS results and previously published models of electronic and atomic structure, we conclude that (1) the virtual-crystal approximation is not valid for this system, (2) there are no significant numbers of Ga-Ga and As-As bonds, and (3) Ge is not incorporated randomly. The electronic and atomic structure of these metastable alloys is determined primarily by the large energy-level differences among Ga, As, and Ge atoms.

Introduction HELLP affects about 1% of all pregnancies and up to 20% of pregnant women with severe preeclampsia/eclampsia. Clinical symptoms are typically associated with right upper epigastric pain, headache and visual disturbance. In about 15–20% patients present without hypertension and/or proteinuria. Objectives After delivery symptoms and lab tests of HELLP resolve gradually within 3–4 days, in case of persistent disease awareness for other thrombotic micorangiopathies has to be raised. Methods We present a case of a 26 year old primigravida, who presented in her 35+1 week of gestational age in our labour ward with epigastric pain and starting labour. Further clinical signs (mild hypertension and proteinuria) and her massively deranged lab results suggested severe HELLP with haemolytic anaemia and profound thrombocytopenia (9G/l). After ordering a thrombelastogram (TEG) and short preparation with cortison and blood products an uneventful cesarean section was performed. A healthy boy was born (2480 g/47 cm length; Apgar 7/8/10; umbilical a/v pH 7.29/7.30), but unfortunately his mother’s recovery took an unexpected course, continuing lab tests suggested a thrombotic microangiopathy (TTP/aHUS) and accordingly therapy was started, but nevertheless she died on day 13 after delivery. Results We discuss her disease, management and differential diagnosis in review of the literature. Conclusions In pregnant patients with severe thrombocytopenia and microangiopathic haemolytic anaemia and other symptoms suggesting severe HELLP other thrombotic microangiopathies have to be excluded.

The OSIRIS cameras on-board ESA’s spacecraft ROSETTA use a new version of thinned CCD42-40 CCDs with anti-blooming. Marconi employed its lateral shielded anti-blooming technique, which was already developed and applied to the CCD47 production line. The performance of the anti-blooming in particular is described here in as well as other basic detector characteristics such as excellent charge transfer efficiency, low spurious charge generation and dark charge reduction by clock dithering. Furthermore, reduced repeatability performance is reported due to trapped charge in thinned CCD42-40 devices. The release time is temperature dependent. Operations at room temperature require special attention whereas a pre-flash to saturation is widely sufficient to fill the traps in cooled devices for a longer observation period.

Results of biased and unbiased Co-60 irradiation to 50 krd (Si) of 14 bit ADCs AD9243 (Analog Devices), LTC1419 (Linear Technology) and 16-bit ADS-937 (DATEL) are presented. Supply currents, reference voltage, Signal-to-Noise-and-Distortion ratio (SINAD) and standard deviation were monitored.

We describe the design of the Sunrise Filter Imager (SuFI) and the Image Stabilization and Light Distribution (ISLiD) unit onboard the Sunrise balloon borne solar observatory. This contribution provides the necessary information which is relevant to understand the instruments working principles, the relevant technical data, and the necessary information about calibration issues directly related to the science data., Comment: accepted for publication in Solar Physics on 4 September 2010