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The purpose of this study was to find out the challenges of online-based leadership implementation in post-pandemic educational innovation applications at Public Aliyah Madrasah (MAN). This study uses a qualitative approach with purposive and snowball sampling techniques. The findings show that: The challenge in improving the quality and competitiveness of online-based schools after the pandemic is the need to develop superior human resources to prepare the community and nation to face the knowledge age as a competitive era. The challenge in Human Resources (HR) and online-based finance after the pandemic is to build a new structure that improves teacher coordination and collaboration that utilizes the expertise of all educators, ultimately leading to better working conditions and workplaces; As for the challenges in improving the quality of online-based leadership post-pandemic, namely leadership that is disruptive to the current progress and creative in terms of policies which include the stages of preparation, enlightenment, elaboration, and verification.

Despite the presence of UN peace operations for more than two decades, the human rights situation in the Democratic Republic of the Congo is still dire. This article illustrates the types of violations of human rights and hindrances to protect human rights in MONUSCO. Methodologically being a qualitative study, it is based on existing literature and key informant interviews. Killings of civilians, sexual and gender-based violence, child soldiers, war crimes and crimes against humanity are major types of human rights violations in the Democratic Republic of Congo. The study argues that due to structural challenges, like the bureaucratic structure of MONUSCO, inadequacy of budget and juristic limitation of the Peacekeeping Force, and operational challenges, like challenges in the protection of civilians and UN personnel, the paucity of logistics and manpower and also gender-based violence by some UN personnel and peacekeepers in MONUSCO, the UN forces failed to maintain and defend human rights properly.

Competing Interests: Declaration of competing interest Francisco Schlottmann and Mario A. Masrur have no conflicts of interest, financial ties, or funding/support to disclose.

Purpose: The success of metabolic and bariatric surgery (MBS) is impacted by significant pre-surgical attrition rates and poor postoperative follow-up. This study focused on geographic variations in attrition rates and surgical outcomes for MBS practice for which the patient population is drawn from nine Chicago neighborhoods, to examine whether suboptimal weight loss or reduced adherence to the program varied across neighborhoods., Methods: Patients who presented for their initial MBS consultation at the University of Illinois (UI) Health's program between January 2019 and December 2020 were identified from electronic medical records. Demographic and medical information was extracted, along with postoperative weight at 3, 6, and 12 months after surgery. The Chicago area was divided into nine geographic regions. The outcomes of interest were preoperative attrition rate, postoperative compliance to follow-up appointments, and postoperative weight loss for each group and by residential neighborhood., Results: A total of 1202 patients were included in this analysis, of whom 423 (35%) underwent surgery and 780 did not, representing a pre-surgical attrition rate of 64.9%. Age, sex, and race/ethnic distribution varied markedly across geographic regions. Postoperative weight loss varied significantly in neighborhoods with higher proportions of residents from racial/ethnic minority backgrounds. Preoperative attrition and postoperative compliance did not differ across geographic regions., Conclusion: Patients' residential neighborhoods may influence weight loss after MBS. Preoperative and postoperative compliance did not vary by residential neighborhood., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: Sleeve gastrectomy (SG) has become the most frequently performed bariatric operation in the United States. One of the main disadvantages of this procedure is the risk of developing gastroesophageal reflux disease (GERD) after the operation. We aimed to analyze different approaches for the treatment of GERD after SG. Methods: A literature review was performed to identify all possible treatment options for post-SG GERD. All the studies were assessed for full eligibility by manual assessment of their aims, methodology, results, and conclusions. Records were individually reviewed by the authors comparing outcomes and complications between procedures. Results: Although some studies have shown improvement or even resolution of GERD symptoms after SG, most patients develop or worsen symptoms. Lifestyle modifications along with medical therapy should be started on patients with GERD after SG. For those who are refractory to medication, endoscopic and surgical therapies can be offered. Conversion to Roux-en-Y gastric bypass (RYGB) is consistently effective in treatment of GERD and is the ideal therapy in patients with associated insufficient weight loss. Endoscopic and alternative surgical procedures are also available and have shown acceptable short-term outcomes. Conclusions: Several treatment options exist for the treatment of GERD after SG. Although conversion to RYGB remains the most effective therapy, other emerging endoscopic and surgical procedures could avoid the potential morbidity of this procedure and should be further evaluated. An evidence-based algorithm for the management of GERD after SG is proposed to guide decision making.

Current scientific literature is deficient in detailing the optimal timing for conducting bariatric surgery in relation to kidney transplantation. In this study, we performed a retrospective evaluation of kidney transplant recipients with BMI >35 kg/m 2 . It aimed to provide data on those who received both sleeve gastrectomy (SG) and kidney transplantation (KT) simultaneously, as well as on patients who underwent SG and KT at different times, either before or after. In addition, the acceptance levels of the bariatric surgery among different scenarios were assessed. Our findings demonstrated that combined KT and SG led to successful weight loss, in contrast to undergoing kidney transplant alone, while maintaining comparable rates of graft and patient survival. Weight loss was similar between recipients who had a combined operation and those who underwent SG following the transplant. Additionally, over a median time frame of 1.7 years, patients who underwent SG before KT exhibited a statistically significant reduction in BMI at the time of the transplant. Notably, our study highlights that patients offered the combined procedure were significantly more likely to undergo SG compared to those for whom SG was presented at a different operative time than the transplant., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Spaggiari, Martinino, Bencini, Masrur, Petrochenkov, Lian, Olazar, Di Cocco, Almario-Alvarez, Benedetti and Tzvetanov.)

Background: Gastroesophageal reflux disease is a common gastrointestinal disorder with one of its most feared complications being Barrett's esophagus (BE). Currently, most of the recommendations of BE management are driven by the level of dysplasia. However, the length of BE might also be related to the risk of dysplasia/malignant transformation. We aimed to determine the appropriate management of BE based on its length. Materials and Methods: A systematic literature review was conducted with searches made on PubMed, Embase, and Cochrane databases. Long-segment BE (LSBE) was defined as 3 cm or longer and short-segment BE (SSBE) as under 3 cm. Studies evaluating the behavior and management of SSBE and/or LSBE were included for analysis. Results: LSBE have greater risk of dysplasia or progression to esophageal adenocarcinoma compared to SSBE. Despite this greater risk, LSBE and SSBE are currently managed similarly based on the presence and degree of dysplasia. Endoscopic and ablative techniques may have higher level of success and less complications in SSBE, compared to LSBE. Decreasing time interval between surveillance may be a viable option for managing LSBE. Conclusions: Although many algorithms of monitoring and treatment of BE remain the same regardless of segment length, current evidence suggests that more aggressive management for LSBE might be needed due to its higher risk of malignant progression.

Regular postoperative follow-up appointments are critical for assessing the effectiveness of the operation and ensuring adequate nutrition, as well as for prompt identification of any complications. In this study, we aimed to determine compliance to follow-up appointments after bariatric surgery and examine factors associated with compliance. We performed a retrospective analysis of all patients who underwent bariatric surgery at the University of Illinois at Chicago between January 1st 2019 and December 30th 2019. Demographics, socio-economic variables (type of insurance, education, income, distance to hospital), type of consultation (in person vs. telehealth), and type of surgery were ascertained. Follow-up rates at the 3-month, 6-month, 12-month and 24-month visits were 61.9%, 41.2%, 29.6%, and 6.5%, respectively. In multivariable logistic regression analysis, White patients (OR 5.13 95% CI 2.03-12.95) and those using telehealth (OR 5.84, 95% CI 3.01 - 11.38) were significantly more likely to be compliant with follow-up. Strategies for improving patient adherence to postoperative follow-up are needed, particularly among persons from racial/ethnic minority backgrounds who also experience both a disparately high burden of severe obesity and poor access to quality care., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Electroencephalography (EEG) is increasingly being used in pediatric neurology and provides opportunities to diagnose various brain illnesses more accurately and precisely. It is thought to be one of the most effective tools for identifying newborn seizures, especially in Neonatal Intensive Care Units (NICUs). However, EEG interpretation is time-consuming and requires specialists with extensive training. It can be challenging and time-consuming to distinguish between seizures since they might have a wide range of clinical characteristics and etiologies. Technological advancements such as the Machine Learning (ML) approach for the rapid and automated diagnosis of newborn seizures have increased in recent years. This work proposes a novel optimized ML framework to eradicate the constraints of conventional seizure detection techniques. Moreover, we modified a novel meta-heuristic optimization algorithm (MHOA), named Aquila Optimization (AO), to develop an optimized model to make our proposed framework more efficient and robust. To conduct a comparison-based study, we also examined the performance of our optimized model with that of other classifiers, including the Decision Tree (DT), Random Forest (RF), and Gradient Boosting Classifier (GBC). This framework was validated on a public dataset of Helsinki University Hospital, where EEG signals were collected from 79 neonates. Our proposed model acquired encouraging results showing a 93.38% Accuracy Score, 93.9% Area Under the Curve (AUC), 92.72% F1 score, 65.17% Kappa, 93.38% sensitivity, and 77.52% specificity. Thus, it outperforms most of the present shallow ML architectures by showing improvements in accuracy and AUC scores. We believe that these results indicate a major advance in the detection of newborn seizures, which will benefit the medical community by increasing the reliability of the detection process.

Human activity recognition (HAR) performs a vital function in various fields, including healthcare, rehabilitation, elder care, and monitoring. Researchers are using mobile sensor data (i.e., accelerometer, gyroscope) by adapting various machine learning (ML) or deep learning (DL) networks. The advent of DL has enabled automatic high-level feature extraction, which has been effectively leveraged to optimize the performance of HAR systems. In addition, the application of deep-learning techniques has demonstrated success in sensor-based HAR across diverse domains. In this study, a novel methodology for HAR was introduced, which utilizes convolutional neural networks (CNNs). The proposed approach combines features from multiple convolutional stages to generate a more comprehensive feature representation, and an attention mechanism was incorporated to extract more refined features, further enhancing the accuracy of the model. The novelty of this study lies in the integration of feature combinations from multiple stages as well as in proposing a generalized model structure with CBAM modules. This leads to a more informative and effective feature extraction technique by feeding the model with more information in every block operation. This research used spectrograms of the raw signals instead of extracting hand-crafted features through intricate signal processing techniques. The developed model has been assessed on three datasets, including KU-HAR, UCI-HAR, and WISDM datasets. The experimental findings showed that the classification accuracies of the suggested technique on the KU-HAR, UCI-HAR, and WISDM datasets were 96.86%, 93.48%, and 93.89%, respectively. The other evaluation criteria also demonstrate that the proposed methodology is comprehensive and competent compared to previous works.

Chronic kidney disease (CKD) is a condition distinguished by structural and functional changes to the kidney over time. Studies show that 10% of adults worldwide are affected by some kind of CKD, resulting in 1.2 million deaths. Recently, CKD has emerged as a leading cause of mortality worldwide, making it necessary to develop a Computer-Aided Diagnostic (CAD) system to diagnose CKD automatically. Machine Learning (ML) based CAD system can be used by a clinician to automatically diagnoses mass people. Since ML models are considered a black box, it is also necessary to expose influential causes behind a model's prediction of a particular output. So that, a doctor can make a more rational decision based on the model's output and analysis of the features influence on the model. In this paper, we have used the XGBoost as the ML classifier to predict whether a patient has CKD or not. Using the XGBoost classifier, we have obtained an accuracy, precision, recall, and F1 score of [Formula: see text] and [Formula: see text] respectively using all [Formula: see text] features. Furthermore, we have used Biogeography Based Optimization (BBO) algorithm to find an effective subset of the features. The BBO algorithm selected almost half of the initial features. We have obtained an accuracy, precision, recall, and F1 score of [Formula: see text] and [Formula: see text] respectively using only 13 features selected by the BBO algorithm. Finally, we have explained the impact of the feature on the ML models using the SHapley Additive exPlanations (SHAP) analysis. Using SHAP analysis and BBO algorithm, we have found that hemoglobin and albumin mostly contribute to the detection of CKD., (© 2023. The Author(s).)

Despite the greater prevalence of obesity, African American (AA) adults represent a minority of bariatric surgery patients. The aim of this study was to determine variables associated with attrition among AA patients seeking bariatric surgery. We performed a retrospective analysis of a consecutive series of AA patients with obesity referred for surgery and who initiated the preoperative work-up as per insurance requirements. The sample was then divided between those undergoing surgery and those who did not receive surgery. The multivariable logistic regression analysis showed that male patients (OR 0.53 95% CI 0.28-0.98) and those with public insurance (OR 0.56, 95% CI 0.37 - 0.83) were significantly less likely to undergo surgery. The use of telehealth was strongly associated with receiving surgery (OR 3.53, 95% CI 2.36 - 5.29). Our results might help developing targeted strategies to reduce attrition rates among AA patients with obesity seeking bariatric surgery., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Length of stay after bariatric surgery has progressively shortened. Same-day discharge (SDD) has been reported for the 2 most common bariatric procedures, Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). The aim of this study is to evaluate the safety and success of SDD following SG and RYGB. Systematic literature search on SDD after bariatric surgery was conducted in Medline, Cochrane library, Google Scholar, and Embase. SDD was defined as discharging the patient during the day of the bariatric operation, without an overnight stay. The primary outcomes of interest were successful SDD, readmission, and morbidity rates. The secondary endpoints included reoperation and mortality rates. A proportion meta-analysis was performed to assess the outcomes of interest. A total of 14 studies with 33,403 patients who underwent SDD SG (32,165) or RYGB (1238) were included in the qualitative synthesis. Seven studies with 5000 patients who underwent SDD SG were included in the quantitative analysis, and pooled proportions (PPs) were calculated for the outcomes of interest. The SDD success rate was 63%-100% (PP: 99%) after SG and 88%-98.1% after RYGB. The readmission rate ranged from .6% to 20.8% (PP: 4%) after SDD SG and 2.4%-4% after SDD RYGB. Overall morbidity, reoperation, and mortality were 1.1%-10% (PP:4%), .3%-2.1% (PP: 1%), and 0%-.1% (PP: 0%), respectively, for SDD SG, and 2.5%-4%,1.9%-2.5%, and 0%-.9%, respectively, for SDD RYGB. SDD after SG seems feasible and safe. The outcomes of SDDRYGB seem promising, but the evidenceis stilllimitedto draw definitive conclusions. Selection criteria and perioperative protocolsmust be standardized to adequately introduce this practice., (Copyright © 2023 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Background: The utilization of the robot for inguinal hernia repairs has increased in the past years. The new Da Vinci Single Port (SP) system provides the benefits of single-incision procedures and might overcome the technical difficulties of previous single-incision techniques. The aim of this study was to evaluate the safety and feasibility of the SP transabdominal preperitoneal inguinal hernia repair (SP-TAPP) and compare its outcomes to the robotic multiport technique (MP-TAPP)., Methods: A prospective cohort of patients who underwent a robotic SP-TAPP and MP-TAPP between 2012 and 2022 was analyzed. Primary endpoints were same-day discharge, morbidity, and inguinal recurrence rates. Secondary endpoints included conversion, operative time, port-site incisional hernia, and chronic pain., Results: MP-TAPP and SP-TAPP were performed in 378 (81.3%) and 87 (18.7%) patients, respectively. Demographics were similar between groups. There were no conversions or intraoperative complications. Mean operative (MP-TAPP: 93.2 vs. SP-TAPP: 78.1 min, p = 0.003) and recovery time (MP-TAPP: 160.8 vs SP-TAPP: 112.6 min, p < 0.001) were significantly shorter in the SP group. Same-day discharge rate was higher (MP-TAPP: 86.5% vs. SP-TAPP: 97.7%, p = 0.001) after SP-TAPP; 30-day morbidity, readmissions, and chronic pain rates were similar between groups. After a mean follow-up of 30.6 months for MP-TAPP and 13.3 months for SP-TAPP, inguinal hernia recurrence and port-site incisional rates were similar between groups., Conclusion: Robotic SP-TAPP is safe and feasible. When compared to MP-TAPP, it showed similar postoperative morbidity, higher same-day discharge rates, and a quicker postoperative recovery. Further studies are needed to confirm the benefits of the SP platform., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: We aim to analyse the safety and feasibility of the DaVinci Single Port (SP) platform in general surgery., Methods: A prospective series of robotic SP transabdominal pre-peritoneal inguinal hernia repairs (SP-TAPP) and cholecystectomies (SP-C) (off-label) were analysed. Primary endpoints were safety and feasibility defined by the need for conversion and incidence of perioperative complications., Results: A total of 225 SP procedures were performed; 84 (37.3%) SP-TAPP (70 unilateral, 7 bilateral), and 141 (62.7%) SP-C. There were no conversions or additional ports placed. Mean console time was 17.6, 31.9, and 54 min for SP-C, unilateral, and bilateral SP-TAPP, respectively. There was no mortality, intraoperative or major postoperative complications. Mean LOS was 2.7 h for elective SP-TAPP and 2.3 h for SP-C., Conclusion: Robotic SP surgery is safe and feasible for two of the most performed general surgery operations. Further experience might allow expanding the applications of robotic single-incision surgery for other procedures., (© 2022 The Authors. The International Journal of Medical Robotics and Computer Assisted Surgery published by John Wiley & Sons Ltd.)

Purpose: Same-day discharge (SDD) after bariatric surgery is gaining popularity. We aimed to analyze the safety of SDD after Roux-en-Y gastric bypass (RYGB) and compare its outcomes to inpatients discharged on postoperative days 1-2., Materials and Methods: We performed a retrospective analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database for the period 2015-2020. Patients who underwent primary laparoscopic RYGB and were discharged the same day of the operation (SDD-RYGB) and inpatients discharged on postoperative days 1-2 (In-RYGB) were compared. Primary outcomes of interest were overall morbidity, serious morbidity, readmission, reoperation, intervention, and mortality rates., Results: A total of 167,188 patients were included; 2156 (1.3%) SDD-RYGB and 165,032 (98.7%) In-RYGB. Mean age (SDD-RYGB: 44.5 vs. In-RYGB: 44.6 years), proportion of females (SDD-RYGB: 81.4% vs. In-RYGB: 80.6%), and mean body mass index (SDD-RYGB: 45.8 vs. In-RYGB: 45.9 kg/m 2 ) were similar between groups. Overall morbidity (SDD-RYGB: 11.3% vs. In-RYGB: 10.2%; OR: 1.2, p = 0.08), serious morbidity (SDD-RYGB: 3.1% vs. In-RYGB: 3%; OR: 1.03, p = 0.81), reoperation (SDD-RYGB: 1.4% vs. In-RYGB: 1.2%; OR: 1.16, p = 0.42), readmission (SDD-RYGB: 4.8% vs. In-RYGB: 4.8%; OR: 1.01, p = 0.89), and mortality (SDD-RYGB: 0.04% vs. In-RYGB: 0.09%; OR: 0.53, p = 0.53) were comparable between groups. SDD-RYGB had lower risk of 30-day interventions (SDD-RYGB: 1.1% vs. In-RYGB: 1.6%; OR: 0.64, p = 0.04) compared to In-RYGB., Conclusion: Same-day discharge after RYGB seems to be safe and has comparable outcomes to admitted patients. Standardized patient selection criteria and perioperative management protocols are needed to further increase the safety of this practice., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: To date, no anti-reflux operations have been reported with the new da Vinci Single-Port (single port (SP)) robotic platform. We aimed to describe this novel surgical approach and evaluate its safety and feasibility., Methods: All robotic SP operations were performed under an Institutional Review Board approved protocol., Results: Two patients underwent robotic SP anti-reflux surgery through a single incision of 2.7 cm (one Nissen-fundoplication and one re-Redo Nissen-fundoplication). The mean docking-time was 2.5 (2-3) minutes and mean console-time was 147 (119-155) minutes. No additional ports were needed, and no intraoperative complications occurred. Patients tolerated a soft diet on postoperative day 1 and were discharged on POD-2 and 3., Conclusion: Robotic SP anti-reflux surgery appears to be safe and feasible. This platform offers similar advantages to the multiport robotic surgery, while adding lower invasiveness and an improved cosmesis. Further studies are needed to confirm our results and evaluate long-term outcomes of this surgical approach., (© 2022 The Authors. The International Journal of Medical Robotics and Computer Assisted Surgery published by John Wiley & Sons Ltd.)

In recent years, the omnipresence of cardiac problems has been recognized as an epidemic. With the correct and quick diagnosis, both mortality and morbidity from cardiac disorders can be dramatically reduced. However, frequent medical check-ups are pricey and out of reach for a large number of people, particularly those living in low-income areas. In this paper, certain time-honored statistical techniques are used to determine the factors that lead to heart disease. Also, the findings were validated using various promising machine learning tools. Feature importance approach was employed to rank the clinical parameters of the patients based on the correlation of heart disease. In the case of statistical investigations, nonparametric tests such as the Mann Whitney U test and the Chi square test, as well as correlation analysis with Pearson correlation and Spearman Correlation were used. For additional validation, seven of the potential feature important based ML algorithms were applied. Moreover, Borda count was implemented to acknowledge the combined observation of those ML models. On top of that, SHAP value was calculated as a feature importance technique and for detailed evaluation. This research reveals two aspects of heart disease diagnosis.We found that eight clinical traits are sufficient to diagnose cardiac disorders, in which three traits are the most important sign of heart disease. One of the discoveries of this investigation uncovered chest pain, number of major blood vessels, thalassemia, age, maximum heart rate, cholesterol, oldpeak, and sex as sufficient clinical signs of individuals for the diagnosis of cardiac disorders. Over the above, considering the findings of all three approaches, chest pain, the number of major blood vessels, and thalassemia were identified as the prime factors of heart disease. The research also found, fasting blood sugar does not have a direct impact on cardiac disease. These findings will have the potency to be incredibly useful in clinical investigations as well as risk assessment for patients. Limiting the most critical features can have a significant impact on the diagnosis of heart disease and reduce the severity of health risks and death of patients., (© 2022. The Author(s).)

The Internet of Things (IoT) is essential in innovative applications such as smart cities, smart homes, education, healthcare, transportation, and defense operations. IoT applications are particularly beneficial for providing healthcare because they enable secure and real-time remote patient monitoring to improve the quality of people's lives. This review paper explores the latest trends in healthcare-monitoring systems by implementing the role of the IoT. The work discusses the benefits of IoT-based healthcare systems with regard to their significance, and the benefits of IoT healthcare. We provide a systematic review on recent studies of IoT-based healthcare-monitoring systems through literature review. The literature review compares various systems' effectiveness, efficiency, data protection, privacy, security, and monitoring. The paper also explores wireless- and wearable-sensor-based IoT monitoring systems and provides a classification of healthcare-monitoring sensors. We also elaborate, in detail, on the challenges and open issues regarding healthcare security and privacy, and QoS. Finally, suggestions and recommendations for IoT healthcare applications are laid down at the end of the study along with future directions related to various recent technology trends.

Background: The demand for revisional bariatric surgery has increased, and bariatric conversions (BC) to a different procedure represent most of the revisional cases. The 2020 Metabolic and Bariatric Surgery Accreditfnation and Quality Improvement Program (MBSAQIP) database was expanded to include additional variables on BC. This study aims to analyze the indications and outcomes of BC., Methods: A retrospective analysis of the 2020 MBSAQIP database was performed. Patients who underwent BC were included in the analysis. Index procedures, rates, and indications for BC of the different bariatric operations were described. Outcomes of the most frequent BC were analyzed., Results: A total of 168,548 bariatric surgeries were done; 20,387 (12.1%) were revisional, and from those 15,031 (73.7%) were BC. The most converted index operations were sleeve gastrectomy (SG) (49.3%) and adjustable gastric banding (AGB) (45.9%). The most frequent conversions were SG to Roux-en-Y gastric bypass (RYGB) (40.3%) for gastroesophageal reflux disease (GERD) (54.2%) and weight loss failure (WLF) (35.8%), AGB to SG (27%) or RYGB (16.2%) for WLF (67% and 61.3%, respectively), and SG to biliopancreatic diversion with duodenal switch (3.2%) or single anastomosis duodeno-ileal bypass (2%) for WLF (91.2% and 92.4%, respectively). Postoperative overall morbidity, serious morbidity, reoperation, and mortality rates ranged from 5.3 to 20.8%, 2.3 to 19.2%, 1.5 to 10%, and 0 to 0.8%, respectively., Conclusions: BC represents the most frequent revisional bariatric procedure. GERD and WLF are the main causes for BC. Further research is needed to define the ideal BC according to the index procedure and indication., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Despite being equally affected by obesity, females represent the vast majority of obese patients undergoing bariatric surgery. We aimed to identify potential gender disparities among African American (AA) patients seeking bariatric surgery at our institution. Demographics, presence of comorbidities, socio-economic variables, type of consultation, and attrition rates were compared among male and female patients. A total of 710 patients were referred for bariatric surgery; 468 (65.9%) were AA: 68 (14.5%) male and 400 (85.5%) female. Male patients were older, were more frequently married, and had higher prevalence of obesity-related comorbidities, as compared to female patients. Male patients showed significantly higher high school graduation rates, higher income, and longer distance to the hospital. The use of telehealth was similar in both groups. Male patients had significantly higher attrition rates (73.5% vs. 56.7%, p=0.009). Strategies to better promote and increase access to bariatric surgery to male patients should be prioritized., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Lane detection plays a vital role in making the idea of the autonomous car a reality. Traditional lane detection methods need extensive hand-crafted features and post-processing techniques, which make the models specific feature-oriented, and susceptible to instability for the variations on road scenes. In recent years, Deep Learning (DL) models, especially Convolutional Neural Network (CNN) models have been proposed and utilized to perform pixel-level lane segmentation. However, most of the methods focus on achieving high accuracy while considering structured roads and good weather conditions and do not put emphasis on testing their models on defected roads, especially ones with blurry lane lines, no lane lines, and cracked pavements, which are predominant in the real world. Moreover, many of these CNN-based models have complex structures and require high-end systems to operate, which makes them quite unsuitable for being implemented in embedded devices. Considering these shortcomings, in this paper, we have introduced a novel CNN model named LLDNet based on an encoder-decoder architecture that is lightweight and has been tested in adverse weather as well as road conditions. A channel attention and spatial attention module are integrated into the designed architecture to refine the feature maps for achieving outstanding results with a lower number of parameters. We have used a hybrid dataset to train our model, which was created by combining two separate datasets, and have compared the model with a few state-of-the-art encoder-decoder architectures. Numerical results on the utilized dataset show that our model surpasses the compared methods in terms of dice coefficient, IoU, and the size of the models. Moreover, we carried out extensive experiments on the videos of different roads in Bangladesh. The visualization results exhibit that our model can detect the lanes accurately in both structured and defected roads and adverse weather conditions. Experimental results elicit that our designed method is capable of detecting lanes accurately and is ready for practical implementation.

Background: Despite the high success rate associated with Heller myotomy in the treatment of primary achalasia, symptom persistence or relapse occurs in approximately 10-20% of patients. Unfortunately, the ideal treatment after failed myotomy is not well established yet. We present a didactical video with a stepwise technique to perform a robotic revisional procedure after failed Heller myotomy., Methods: In this report, each surgical step is thoroughly described and visually represented with useful technical tips that might help in improving surgical results of revisional Heller myotomy., Results: In patients with previous surgical myotomy, the robotic platform with its high-definition magnified view and EndoWrist instruments allow for a safe and precise redo surgical myotomy., Conclusions: Despite its improved surgical capabilities, the role of robotic redo Heller myotomy in the treatment algorithm of patients with recurrent symptoms after failed surgical myotomy should be further explored., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Laparoscopic sleeve gastrectomy is one of the most common bariatric surgical procedures. Despite being easier to perform than other bariatric procedures, it is not free of complications. Leaks are some of the most severe events, and are observed in around 0.5-6% of cases. Use of the near-infrared indocyanine green (ICG) perfusion test during sleeve gastrectomy seems to be promising. However, its application in sleeve gastrectomy is still in fieri. Similarly, ICG is not commonly used in Roux-en-Y gastric bypass. This report presents the main evidence from selected literature regarding the use of ICG during sleeve gastrectomy and Roux-en-Y gastric bypass, along with our remarks. It also provides intraoperative video clips and photographs showing the use of ICG in this surgical field.

Background: With the rising number of bariatric surgeries performed annually, there has also been an increase in revisional bariatric surgeries (RBS). The aim of this study is to evaluate the safety and postoperative outcomes of RBS performed with a minimally invasive approach., Methods: Retrospective analysis on a prospectively collected database of patients who underwent minimally invasive RBS between 2012 and 2019. Primary endpoints were conversion rate, major morbidity, mortality, and 30-day reoperation rate. Comparative analysis of laparoscopic adjustable gastric banding (LAGB) conversion to sleeve gastrectomy (SG) vs. conversion to Roux-en-Y gastric bypass (RYGB) was performed., Results: A total of 221 patients underwent minimally invasive RBS, 137 (62%) laparoscopically and 84 (38%) robotically. The most common RBS were LAGB to SG (59.3%) and LAGB to RYGB conversions (16.7%). The main indication was weight loss failure (88.7%). Conversion rate, major morbidity, and mortality were 0.9, 3.2, and 0.4%, respectively. Urgent reoperation was required in 3.2% of cases. Total weight loss at 1 and 2-years follow- were 14.3 and 17.3%, respectively. Comparative analysis of LAGB conversion to SG vs. RYGB showed similar major morbidity (SG: 2.3% vs. RYGB 0%, p = 1). Greater total weight loss was achieved in LAGB to RYGB conversions at 1-year (SG: 14.8% vs. RYGB 25.3%, p < 0.001)., Conclusions: Minimally invasive RBS can be performed safely in a broad patient population with low conversion and complication rates, and improved weight loss outcomes. LAGB to RYGB conversions are associated with greater weight loss. Further randomized trials are needed to draw more conclusive recommendations., Competing Interests: FB has an education agreement with intuitive. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Xie, Dreifuss, Schlottmann, Cubisino, Mangano, Vanetta, Baz, Valle, Bianco, Gangemi and Masrur.)

Background: Same-day discharge after sleeve gastrectomy (SG) is gaining popularity. We aimed to determine risk factors associated with readmission in patients who underwent same-day discharge SG., Methods: We performed a retrospective analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database for the period 2015-2018. Patients who underwent SG and were discharged the same day of the operation were included in the analysis. Multivariable logistic regression analysis was performed to determine risk factors for readmission., Results: A total of 466,270 SG were performed during the study period; 14,624 (3.1%) patients were discharged the same day and were included in the analysis. Mean age was 43.4 (14.7-80) years and 11,718 (80.1%) were female. Mean preoperative BMI was 43.7 ± 7.4 kg/m 2 . Mean operative time was 58.3 ± 32.4 min. Thirty-day reoperation, reintervention, and mortality rates were 0.7%, 0.7%, and 0.1%, respectively. Readmission rates were similar in same-day discharge and inpatient SG (2.9% vs. 3%, p = 0.5). Female sex (OR 1.52, 95% CI 1.15-2.00), preoperative gastroesophageal reflux disease (OR 1.33, 95% CI 1.08-1.64), renal insufficiency (OR 3.06, 95% CI 1.01-9.32), and intraoperative drain placement (OR 1.78, 95% CI 1.37-2.31) were independent risk factors for readmission following same-day discharge SG., Conclusions: Same-day discharge SG appears to be safe and is associated with low readmission rates. However, the identification of preoperative and intraoperative variables associated with higher risk of readmission might help defining safer and more effective same-day discharge protocols., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Bariatric surgery has been demonstrated to be effective in achieving significant weight loss and remission of obesity-related comorbidities. However, a percentage of patients fail to lose enough weight, regain weight, or experience postoperative complications, requiring additional interventions. Revisional bariatric surgeries (RBS) involve the wide spectrum of procedures that aim to treat complications of the index operation or achieve further weight loss. These are technically challenging procedures due to adhesions of the internal organs, reduced working space, and a distorted anatomy. Indications, timing, and type of operation for RBS are not standardized, and there is no consensus on the best surgical approach. Some authors claim a robotic platform could be advantageous in these types of procedures that are performed in reduced, deep operating fields, or those requiring precision and accuracy. This review examines the most current and representative literature on the outcomes of robot-assisted RBS. Included studies demonstrate the safety and feasibility of the robotic approach for RBS. However, long operative times and high costs remain major drawbacks of the device. Finally, if we consider that many centers have not yet completed the learning curve for robot-assisted RBS, the potential for improved outcomes seems promising.

Introduction: Gallstone ileus is an uncommon complication of long-term cholelithiasis. Emergent operations for gallstone ileus are associated with high postoperative morbidity. When feasible, the minimally invasive approach might help to improve the postoperative outcomes., Presentation of Case: A 63-year-old female was admitted for abdominal pain and vomiting. Computed tomography (CT) scan showed a cholecystoduodenal fistula and a 5 × 3 cm gallstone in the jejunum causing obstruction. An emergent laparoscopy was performed, and a gallstone was found inside the jejunum 40 cm distal to the ligament of Treitz. The 5 cm gallstone was extracted through an antimesenteric enterotomy. The jejunum was then closed transversally using interrupted sutures. The postoperative course was uneventful, and the patient was discharged on postoperative day 3., Discussion: Surgery is the mainstream treatment for gallstone ileus. Multiple operations and surgical approaches have been described: enterolithotomy (EL), one-stage surgery (EL, cholecystectomy, and fistula closure), bowel resection, and two-stage surgery (EL and delayed cholecystectomy with fistula closure). The choice of the procedure depends on the patient's characteristics, comorbidities, and experience of the surgical team., Conclusion: In the emergency setting, a simple enterolithotomy with primary closure seems to be the optimal approach to solve the intestinal obstruction with low postoperative morbidity. The laparoscopic approach to gallstone ileus results in additional benefits for patients' recovery., (Copyright © 2021. Published by Elsevier Ltd.)

Purpose: The number of bariatric revisional procedures is growing. Scarce evidence is available regarding the role and postoperative outcomes of robotic-assisted revisional bariatric surgery (RRBS). The aim of this study is to evaluate the safety and postoperative outcomes of RRBS., Materials and Methods: A retrospective analysis of a prospectively collected database of patients who underwent RRBS between 2012 and 2019 was performed. Primary outcomes of interest were 30-day major morbidity, mortality, length of hospital stay (LOS), urgent reoperation rates, and percentage of total weight loss (%TWL)., Results: RRBS was performed in 76 patients; among these 60 (78.9%) underwent conversion to Roux-en-Y gastric bypass (C-RYGB). Failed weight loss (76%) and gastroesophageal reflux (9.2%) were the main indications for revision. Primary bariatric procedures included gastric band (LAGB) (50%), sleeve gastrectomy (SG) (40.8%), and RYGB (6.6%). Major morbidity and mortality rates were 3.9% and 1.3%, respectively. Mean LOS was 2.1 days, and 3 patients (3.9%) required urgent reoperation. The %TWL at 3, 6, 12, and 24 months was 10.2%, 16.6%, 18.3%, and 22.4% respectively. Comparative analysis of C-RYGB after failed LAGB and SG showed similar morbidity. Higher readmission rates (SG: 22.2% vs. LAGB: 0%, p = 0.007) and lower %EWL at 3, 6, 12, and 24 months were found in C-RYGB after SG., Conclusion: This is one of the largest single-center series of RRBS published in the literature; the data indicate that robotic approach for revisional bariatric surgery is safe and helps achieving further weight loss. RRBS outcomes might be influenced by the primary procedure.

Patients with obesity have limited access to kidney transplantation, mainly due to an increased incidence of surgical complications, which could be reduced with selective use of robotic-assisted surgery. This prospective randomized controlled trial compares the safety and efficacy of combining robotic sleeve gastrectomy and robotic-assisted kidney transplant to robotic kidney transplant alone in candidates with class II or III obesity. Twenty candidates were recruited, 11 were randomized to the robotic sleeve gastrectomy and robotic-assisted kidney transplant group and 9 to the robotic kidney transplant group. At 12-month follow-up, change in body mass index was -8.76 ± 1.82 in the robotic sleeve gastrectomy and robotic-assisted kidney transplant group compared to 1.70 ± 2.30 in the robotic kidney transplant group (P = .0041). Estimated glomerular filtration rate, serum creatinine, readmission rates, and graft failure rates up to 12 months were not different between the two groups. Length of surgery was longer in the robotic sleeve gastrectomy and robotic-assisted kidney transplant group (405 minutes vs. 269 minutes, p = .00304) without increase in estimated blood loss (120 ml vs. 117 ml, p = .908) or incidence of surgical complications. Combined robotic-assisted kidney transplant and sleeve gastrectomy is safe and effective compared to robotic-assisted kidney transplant alone., (© 2020 The American Society of Transplantation and the American Society of Transplant Surgeons.)

Introduction: Minimally invasive liver resections (MILR) have been gaining popularity over the last decades. MILR provides superior peri-operative outcome. Despite these advantages, the penetrance of MILR in the clinical setting has been limited, and it was slowed down, among other factors, also by the laparoscopic technological limitations., Evidence Acquisition: A literature review has been carried out (Pubmed, Embase and Scopus platforms) focusing on the role of robotic surgery in MILR., Evidence Synthesis: The literature review results are presented and our additional remarks on the topic are discussed., Conclusions: Robotic MILR has been helping to expand the penetrance of MIS in liver surgery by making possible increasingly more challenging procedures. Minor resections still represent most of the robotic liver surgery data currently available. Robotic liver surgery is safe and effective, and it shows perioperative outcomes comparable with laparoscopic and open surgery. The oncological efficacy, within the limitations of the current level of evidence (mostly retrospective studies and literature heterogeneity), seems to show promising result. High quality prospective randomized studies, the use of prospective registry data, and multi-institutional efforts are needed.

Background: RPD (Robotic pancreatoduodenectomy) was first performed by P. C. Giulianotti in 2001 (Arch Surg 138(7):777-784, 2003). Since then, the complexity and lack of technique standardization has slowed down its widespread utilization. RPD has been increasingly adopted worldwide and in few centres is the preferred apporached approach by certain surgeons. Some large retrospective series are available and data seem to indicate that RPD is safe/feasible, and a valid alternative to the classic open Whipple. Our group has recently described a standardized 17 steps approach to RPD (Giulianotti et al. Surg Endosc 32(10): 4329-4336, 2018). Herin, we present an educational step-by-step surgical video with short technical/operative description to visually exemplify the RPD 17 steps technique., Methods: The current project has been approved by our local Institutional Review Board (IRB). We edited a step-by-step video guidance of our RPD standardized technique. The data/video images were collected from a retrospective analysis of a prospectively collected database (IRB approved). The narration and the images describe hands-on operative "tips and tricks" to facilitate the learning/teaching/evaluation process., Results: Each of the 17 surgical steps is visually represented and explained to help the in-depth understanding of the relevant surgical anatomy and the specific operative technique., Conclusions: Educational videos descriptions like the one herein presented are a valid learning/teaching tool to implement standardized surgical approaches. Standardization is a crucial component of the learning curve. This approach can create more objective and reproducible data which might be more reliably assessed/compared across institutions and by different surgeons. Promising results are arising from several centers about RPD. However, RPD as gold standard-approach is still a matter of debate. Randomized-controlled studies (RCT) are required to better validate the precise role of RPD.

AI (Artificial intelligence) is an interdisciplinary field aimed at the development of algorithms to endow machines with the capability of executing cognitive tasks. The number of publications regarding AI and surgery has increased dramatically over the last two decades. This phenomenon can partly be explained by the exponential growth in computing power available to the largest AI training runs. AI can be classified into different sub-domains with extensive potential clinical applications in the surgical setting. AI will increasingly become a major component of clinical practice in surgery. The aim of the present Narrative Review is to give a general introduction and summarized overview of AI, as well as to present additional remarks on potential surgical applications and future perspectives in surgery.

Background: Leakage of the anastomosis after colonic/rectal surgery is a serious complication. One of the most important causes of anastomotic leakage is impaired vascularization. A microvascular tissue deficit is very often not intraoperatively de visu detectable under white light. Near-infrared indocyanine green (ICG)-enhanced fluorescence is a cutting-edge technology that may be useful for detecting microvascular impairment and potentially preventing anastomotic leakage., Aim: The aim of this narrative review was to evaluate the feasibility and the usefulness of intraoperative assessment of vascular anastomotic perfusion in colorectal surgery using an indocyanine green (ICG) fluorescent tracer., Material and Methods: A PubMed/MedLine, Embase, and Scopus narrative literature review was performed, in which "colorectal surgery" and "indocyanine green" were used as key words. The inclusion criteria were 1) manuscripts written in English; 2) full text is available; 3) topic related to the use of ICG fluorescence for the assessment of tissue perfusion during laparoscopic or robotic colorectal surgery; and 4) sample: adult patients, benign or malignant disease. Exclusion criteria included 1) case reports; 2) topic not related to the use of ICG fluorescence for the evaluation of tissue perfusion during laparoscopic or robotic colorectal surgery; 3) manuscripts that focused solely on other applications of ICG technology; and 4) any study type not showing original data. Results and Critical Discussion: The intraoperative visual assessment of tissue viability under white light may lead to an underestimation of microvascular blood flow impairment. ICG can be safely used in cases of minimally invasive colonic surgery and also low anterior resections. This technology may be useful when deciding whether to intraoperatively change a previously planned resection/anastomotic level, which could decrease theoretically the occurrence of anastomotic leakage., Conclusions: Near-infrared ICG technology is a very useful approach. Multiple preliminary studies suggest that this technique may be used to predict anastomotic leakage. However, evaluation of the ICG signal is still too subjective. Some reliable scoring/grading parameters related to the ICG signal need to be defined. Additionally, more prospective, randomized, and adequately powered studies are required to completely reveal the true potential of this surgical technological innovation.

Background: Minimally invasive surgical techniques (MISTs) could have tremendous benefits in resource-poor environment. There is growing interest in MISTs in most low- and middle-income countries (LMIC), but its adoption has remained limited; this is largely due to high cost of the initial setup, lack of technological backup and limited access to training among others. An affordable laparoscopic setup will go a long way in improving access to MISTs., Methods: A common zero degrees 10 mm scope is attached on the camera of a low-price smartphone. Two elastic bands are used to fix the scope right in front of the smartphone's main camera; alternatively, a low-cost camera coupler can be used. The device is covered with sterile transparent drapes and a light source connected with a fiber-optic cable for endoscopic use. The image can be seen in real time on a common TV screen through an HDMI connection to the smartphone, with a sterile drape., Results: We were able to perform the five tasks of the Fundamentals of Laparoscopic Surgery curriculum, using our vision system with proficiency. In a pig model, we performed a tubal ligation to simulate an appendectomy and we were able to suture. No major differences were measured between the two connection systems., Conclusions: A low-cost laparoscopic camera system can benefit surgeons and trainees in LMICs. The system is already attractive for use during training, but further studies are needed to evaluate its potential clinical role in LMICs.

Background: Minimally invasive pancreaticoduodenectomy (MIPD) was introduced in the attempt to improve the outcomes of the open approach. Laparoscopic pancreaticoduodenectomy (LPD) was first reported by Gagner and Pomp (Surg Endosc 8:408-410, 1994). Unfortunately, due to its complexity and technical demand, LPD never reached widespread popularity. Since it was first performed by P. C. Giulianotti in 2001, Robotic PD (RPD) has been gaining ground among surgeons. MIPD is included as a surgical option in the latest NCCN Guidelines. However, lack of surgical standardization, however, has limited the reproducibility of MIPD and made the acquisition of the technique by other surgeons difficult. We provide an accurate description of our standardized step-by-step RDP technique., Methods: We took advantage of our 15-year long experience and > 150 cases performed to provide a step-by-step guidance of our RPD standardized technique. The description includes practical "tips and tricks" to facilitate the learning curve and assist with the teaching/evaluation process., Results: 17 surgical steps were identified as key components of the RPD procedure. The steps reflect the subdivision of the RPD into several parts which help to understand a strategy that takes into accounts specific anatomical landmarks and the demands of the robotic platform., Conclusions: Standardization is a key element of the learning curve of RPD. It can potentially provide consistent, reproducible results that can be more easily evaluated. Despite promising results, full acceptance of RPD as the 'gold standard' is still work in progress. Randomized-controlled trials with the application of a standardized technique are necessary to better define the role of RPD.

Background: Bleeding lesions of the small bowel are often difficult to identify due to the obscure symptomatology. Localizing these lesions requires specific techniques. The Double-balloon enteroscopy (DBE) could be used to precisely localize and mark lesions, so that a minimally invasive surgical treatment could be performed., Methods: Twenty robot-assisted small bowel procedures are presented using a combination of DBE for localization and robotic resection., Results: There were 10 jejunal resections and 10 ileal resections. Mean age was 58.7 years. Mean operative time was 153.4 minutes, mean blood loss of 46 mL. No conversion-to-open and there were 4 post-operative complications. The 90-day mortality was nil and the median length of stay was 4.1 days. Final pathology was consistent with malignancy in 10 cases., Conclusions: The combination of double-balloon enteroscopy and robotic technology allows accurate identification and selective treatment of lesions that could be otherwise difficult to treat in a minimally invasive fashion.