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The advancement in material platforms exhibiting strong and robust electro-optic effects is crucial for further progress in developing highly efficient and miniaturized optoelectronic components with low power consumption for modern optical communication systems. In this work, we investigate thin-film lead zirconate titanate (PZT) substrates grown by a chemical solution deposition technique as a potential platform for on-chip plasmonic electro-optic modulators. A high modulation depth (>40 %) is achieved with 15 μm-long electro-optic directional coupler modulators. An unusual cutoff in the modulation frequency response at ∼200 kHz is observed and further studied with respect to possible reorientation effects. Second-harmonic generation signals are found influenced by the externally applied electric field, indicating that the domain reorientation effect can be responsible for the unusual frequency response observed.

The demand on broadband near-infrared photodetections with high responsivity is becoming increasingly eminent; however its realization remains a significant technological challenge. Here we design, fabricate, and characterize a broadband Ge photodetector (1000–1600 nm), composed of densely packed 230-nm-thick Ge disks of different diameters (255 nm, 320 nm, and 500 nm), placed on top of a 105-nm-thin Ge layer. Using experimentally measured and calculated transmission and absorption spectra, we demonstrate that the absorption and detector responsivity are increased by nearly 2 orders of magnitude, compared to the unstructured Ge photodetector, due to the excitation of magnetic dipole resonances in Ge disks, while preserving a relatively low dark current. Our approach is simple and can be easily adapted to other semiconductor material platforms and operation wavelengths to enable performance improvements of broadband photodetector devices.

Background: Increasing familiarity and practice might free up mental resources during laparoscopic surgical skills training. The aim of the study was to track changes in mental resource allocation during acquisition of laparoscopic surgical skills. Methods: Medical students with no previous experience in laparoscopic surgery took part in a 5-week laparoscopic training curriculum. At the beginning and end of the training period, one of the training tasks was combined with a secondary auditory detection task that required pressing a foot switch for defined target tones, creating a dual-task situation. During execution of the two concurrent tasks, continuous electroencephalographic measurements were made, with special attention to the P300 component, an index of mental resources. Accuracy and reaction times of the secondary task were determined. Results: All 14 participants successfully completed the training curriculum. Target times for successful completion of individual tasks decreased significantly during training sessions (P <0.001 for all tasks). Comparing results before and after training showed a significant decrease in event-related brain potential amplitude at the parietal electrode cluster (P300 component, W = 67, P = 0.026), but there were no differences in accuracy (percentage correct responses: W = 48, P = 0.518) or reaction times (W = 42, P = 0.850) in the auditory detection task. Conclusion: The P300 decrease in the secondary task over training demonstrated a shift of mental resources to the primary task: the surgical exercise. This indicates that, with more practice, mental resources are freed up for additional tasks. [ABSTRACT FROM AUTHOR]

Topological insulators have shown great potential for future optoelectronic technology due to their extraordinary optical and electrical properties. Photodetectors, as one of the most widely used optoelectronic devices, are crucial for sensing, imaging, communication, and optical computing systems to convert optical signals to electrical signals. Here we experimentally show a novel combination of topological insulators (TIs) and transition metal chalcogenides (TMDs) based self-powered photodetectors with ultra-low dark current and high sensitivity. The photodetector formed by a MoS2/Sb2Te3 heterogeneous junction exhibits a low dark current of 2.4 pA at zero bias and 1.2 nA at 1V. It shows a high photoresponsivity of >150 mA W−1 at zero bias and rectification of 3 times at an externally applied bias voltage of 1V. The excellent performance of the proposed photodetector with its innovative material combination of TMDs and TIs paves the way for the development of novel high-performance optoelectronic devices. The TIs/TMDs transfer used to form the heterojunction is simple to incorporate into on-chip waveguide systems, enabling future applications on highly integrated photonic circuits.

Competing Interests: Tobias Keck war als Berater für Medtronic und Olympus tätig und hat Vorträge für Intuitive, Medtronic, Olympus und Astra Zeneca gehalten. Die übrigen Autoren geben keine Interessenkonflikte an.

There is a lack of training curricula and educational concepts for robotic-assisted surgery (RAS). It remains unclear how surgical residents can be trained in this new technology and how robotics can be integrated into surgical residency training. The conception of a training curriculum for RAS addressing surgical residents resulted in a three-step training curriculum including multimodal learning contents: basics and simulation training of RAS (step 1), laboratory training on the institutional robotic system (step 2) and structured on-patient training in the operating room (step 3). For all three steps, learning content and video tutorials are provided via cloud-based access to allow self-contained training of the trainees. A prospective multicentric validation study was conducted including seven surgical residents. Transferability of acquired skills to a RAS procedure were analyzed using the GEARS score. All participants successfully completed RoSTraC within 1 year. Transferability of acquired RAS skills could be demonstrated using a RAS gastroenterostomy on a synthetic biological organ model. GEARS scores concerning this procedure improved significantly after completion of RoSTraC (17.1 (±5.8) vs. 23.1 (±4.9), p < 0.001). In step 3 of RoSTraC, all participants performed a median of 12 (range 5-21) RAS procedures on the console in the operation room. RoSTraC provides a highly standardized and comprehensive training curriculum for RAS for surgical residents. We could demonstrate that participating surgical residents acquired fundamental and advanced RAS skills. Finally, we could confirm that all surgical residents were successfully and safely embedded into the local RAS team., (© 2024. The Author(s).)

The photonic spin Hall effect, referring to the spatial separation of photons with opposite spins due to spin-orbit interactions, has enabled potential for various spin-sensitive applications and devices. Here, using scattering-type near-field scanning optical microscopy, we observe spin-orbit interactions introduced by a subwavelength semiring antenna integrated in a plasmonic circuit. Clear evidence of unidirectional excitation of surface plasmon polaritons is obtained by direct comparison of the amplitude- and phase-resolved near-field maps of the plasmonic nanocircuit under excitation with photons of opposite spin states coupled to a plasmonic nanoantenna. We present details of the antenna design and experimental methods to investigate the spatial variation of complex electromagnetic fields in a spin-sensitive plasmonic circuit. The reported findings offer valuable insights into the generation, characterization, and application of the photonic spin Hall effect in photonic integrated circuits for future and emerging spin-selective nanophotonic systems.

Introduction: Intraoperative accurate localization of tumors in the lower gastrointestinal tract is essential to ensure oncologic radicality. In minimally invasive colon surgery, tactile identification of tumors is challenging due to diminished or absent haptics. In clinical practice, preoperative endoscopic application of a blue dye (ink) to the tumor site has become the standard for marking and identification of tumors in the colon. However, this method has the major limitation that accidental intraperitoneal spillage of the dye can significantly complicate the identification of anatomical structures and surgical planes. In this work, we describe a new approach of NIR fluorescent tattooing using a near-infrared (NIR) fluorescent marker instead of a blue dye (ink) for endoscopic tattooing., Methods: AFS81x is a newly developed NIR fluorescent marker. In an experimental study with four domestic pigs, the newly developed NIR fluorescent marker (AFS81x) was used for endoscopic tattooing of the colon. 7-12 endoscopic submucosal injections of AFS81x were placed per animal in the colon. On day 0, day 1, and day 10 after endoscopic tattooing with AFS81x, the visualization of the fluorescent markings in the colon was evaluated during laparoscopic surgery by two surgeons and photographically documented., Results: The detection rate of the NIR fluorescent tattoos at day 0, day 1, and day 10 after endoscopic tattooing was 100%. Recognizability of anatomical structures during laparoscopy was not affected in any of the markings, as the markings were not visible in the white light channel of the laparoscope, but only in the NIR channel or in the overlay of the white light and the NIR channel of the laparoscope. The brightness, the sharpness, and size of the endoscopic tattoos did not change significantly on day 1 and day 10, but remained almost identical compared to day 0., Conclusion: The new approach of endoscopic NIR fluorescence tattooing using the newly developed NIR fluorescence marker AFS81x enables stable marking of colonic sites over a long period of at least 10 days without compromising the recognizability of anatomical structures and surgical planes in any way., (© 2023. The Author(s).)

Background: Gastrointestinal stromal tumors (GIST) are rare mesenchymal tumors. They are most frequently located in the stomach but are also found in the esophagus and the gastroesophageal junction (GEJ). Information regarding the prognostic factors associated with upper gastrointestinal GIST is still scarse., Methods: In this study, datasets provided by the German Clinical Cancer Registry Group, including a total of 93,069 patients with malignant tumors in the upper GI tract (C15, C16) between 2000 and 2016 were analyzed to investigate clinical outcomes of GIST in the entire upper GI tract., Results: We identified 1361 patients with GIST of the upper GI tract. Tumors were located in the esophagus in 37(2.7%) patients, at the GEJ in 70 (5.1%) patients, and in the stomach in 1254 (91.2%) patients. The incidence of GIST increased over time, reaching 5% of all UGI tumors in 2015. The median age was 69 years. The incidence of GIST was similar between males and females (53% vs 47%, respectively). However, the proportion of GIST in female patients increased continuously with advancing age, ranging from 34.7% (41-50 years) to 71.4% (91-100 years). Male patients were twice as likely to develop tumors in the esophagus and GEJ compared to females (3.4% vs. 1.9% and 6.7% vs. 3.4%, respectively). The median overall survival of upper gastrointestinal GIST was 129 months. The 1-year, 5-year, and 10-year OS was 93%, 79%, and 52% respectively. Nevertheless, tumors located in the esophagus and GEJ were associated with shorter OS compared to gastric GIST (130 vs. 111 months, p = 0.001). The incidence of documented distant metastasis increased with more proximal location of GIST (gastric vs. GEJ vs. esophagus: 13% vs. 16% vs. 27%) at presentation., Conclusion: GIST of the esophagus and GEJ are rare soft tissue sarcomas with increasing incidence in Germany. They are characterized by worse survival outcomes and increased risk of metastasis compared to gastric GIST., (© 2023. The Author(s).)

Van der Waals (vdWs) heterostructures, assembled by stacking of two-dimensional (2D) crystal layers, have emerged as a promising new material system for high-performance optoelectronic applications, such as thin film transistors, photodetectors, and light-emitters. In this study, we showcase an innovative device that leverages strain-tuning capabilities, utilizing a MoS 2 /Sb 2 Te 3 vdWs p-n heterojunction architecture designed explicitly for photodetection across the visible to near-infrared spectrum. These heterojunction devices provide ultra-low dark currents as small as 4.3 pA, a robust photoresponsivity of 0.12 A W -1 , and reasonable response times characterized by rising and falling durations of 0.197 s and 0.138 s, respectively. These novel devices exhibit remarkable tunability under the application of compressive strain up to 0.3%. The introduction of strain at the heterojunction interface influences the bandgap of the materials, resulting in a significant alteration of the heterojunction's band structure. This subsequently shifts the detector's optical absorption properties. The proposed strategy of strain-induced engineering of the stacked 2D crystal materials allows the tuning of the electronic and optical properties of the device. Such a technique enables fine-tuning of the optoelectronic performance of vdWs devices, paving the way for tunable high-performance, low-power consumption applications. This development also holds significant potential for applications in wearable sensor technology and flexible electro-optic circuits.

Purpose: Sigmoid resection for diverticular disease is a frequent surgical procedure in the Western world. However, long-term bowel function after sigmoid resection has been poorly described in the literature. This study aims to assess the long-term bowel function after tubular sigmoid resection with preservation of inferior mesenteric artery (IMA) for diverticular disease., Methods: We retrospectively identified patients who underwent sigmoid resection for diverticular disease between 2002 and 2012 at a tertiary referral center in northern Germany. Using well-validated questionnaires, bowel function was assessed for fecal urgency, incontinence, and obstructed defecation. The presence of bowel dysfunction was compared to baseline characteristics and perioperative outcome., Results: Two hundred and thirty-eight patients with a mean age of 59.2 ± 10 years responded to our survey. The follow-up was conducted 117 ± 32 months after surgery. At follow-up, 44 patients (18.5%) had minor LARS (LARS 21-29) and 35 (15.1%) major LARS (LARS ≥ 30-42), 35 patients had moderate-severe incontinence (CCIS ≥ 7), and 2 patients (1%) had overt obstipation (CCOS ≥ 15). The multivariate analysis showed that female gender was the only prognostic factor for long-term incontinence (CCIS ≥ 7), and ASA score was the only preoperative prognostic factor for the presence of major LARS at follow-up., Conclusion: Sigmoid resection for diverticular disease can be associated with long-term bowel dysfunction, even with tubular dissection and preservation of IMA. These findings suggest intercolonic mechanisms of developing symptoms of bowel dysfunction after disruption of the colorectal continuity that are so far summarized as "sigmoidectomy syndrome.", (© 2023. The Author(s).)

Introduction: 2−8% of all gastric cancer occurs at a younger age, also known as early-onset gastric cancer (EOGC). The aim of the present work was to use clinical registry data to classify and characterize the young cohort of patients with gastric cancer more precisely. Methods: German Cancer Registry Group of the Society of German Tumor Centers—Network for Care, Quality and Research in Oncology (ADT)was queried for patients with gastric cancer from 2000−2016. An approach that stratified relative distributions of histological subtypes of gastric adenocarcinoma according to age percentiles was used to define and characterize EOGC. Demographics, tumor characteristics, treatment and survival were analyzed. Results: A total of 46,110 patients were included. Comparison of different groups of age with incidences of histological subtypes showed that incidence of signet ring cell carcinoma (SRCC) increased with decreasing age and exceeded pooled incidences of diffuse and intestinal type tumors in the youngest 20% of patients. We selected this group with median age of 53 as EOGC. The proportion of female patients was lower in EOGC than that of elderly patients (43% versus 45%; p < 0.001). EOGC presented more advanced and undifferentiated tumors with G3/4 stages in 77% versus 62%, T3/4 stages in 51% versus 48%, nodal positive tumors in 57% versus 53% and metastasis in 35% versus 30% (p < 0.001) and received less curative treatment (42% versus 52%; p < 0.001). Survival of EOGC was significantly better (five-years survival: 44% versus 31% (p < 0.0001), with age as independent predictor of better survival (HR 0.61; p < 0.0001). Conclusion: With this population-based registry study we were able to objectively define a cohort of patients referred to as EOGC. Despite more aggressive/advanced tumors and less curative treatment, survival was significantly better compared to elderly patients, and age was identified as an independent predictor for better survival.

Lithium niobate Mach-Zehnder modulators (MZMs) are present in a wide range of technologies and though fulfilling the performance and reliability requirements of present applications, they are becoming progressively too bulky, power inefficient, and slow in switching to keep pace with future technological demands. Here, we utilize plasmonics to demonstrate the most efficient (V π L = 0.23 Vcm) lithium niobate MZM to date, consisting of gold nanostripes on lithium niobate that guide both plasmonic modes and electrical signals that control their relative optical phase delay, thereby enabling efficient electro-optic modulation. For high linearity (modulation depth of >2 dB), the proposed MZM inherently operates near its quadrature point by shifting the relative phase of the signal in the interferometric arms. The demonstrated lithium niobate MZM manifests the benefits of employing plasmonics for applications that demand compact (<1 mm 2 ) and fast (>10 GHz) photonic components operating reliably at ambient temperatures.

Research in optical metasurfaces has explosively grown in recent years, primarily due to their ability of exercising complete control over the transmitted and reflected fields. Application prospects in many emerging technologies require this control to become dynamic, so that the metasurface response could be tuned with external stimuli. In this work, electrically tunable optical metasurfaces operating in reflection as optical free-space modulators are demonstrated. The intensity modulation is achieved by exploiting the electro-optic Pockels effect and tuning the Fabry-Perot resonance in a 320 nm-thick lithium niobate (LN) film sandwiched between a continuous thick gold film and an array of gold nanostripes, serving also as control electrodes. The proposed compact (<1000 μm 2 ) modulators operate in the wavelength range of 900-1000 nm, featuring a maximum intensity modulation depth of ∼20% at the driving voltage of ± 10 V within the bandwidth of 8.0 MHz (with the potential bandwidth of ∼25 GHz). By arranging a 2 × 2 array of individually addressable modulators, space-variant control of light reflection is demonstrated, therefore opening a way towards the realization of inertia-free, ultrafast, and robust spatial light modulators based on tunable LN flat optics components.

We report thorough measurements of surface plasmon polaritons (SPPs) running along nearly perfect air-gold interfaces formed by atomically flat surfaces of chemically synthesized gold monocrystals. By means of amplitude- and phase-resolved near-field microscopy, we obtain their propagation length and effective mode index at visible wavelengths (532, 594, 632.8, 729, and 800 nm). The measured values are compared with the values obtained from the dielectric functions of gold that are reported in literature. Importantly, a reported dielectric function of monocrystalline gold implies ∼1.5 times shorter propagation lengths than those observed in our experiments, whereas a dielectric function reported for properly fabricated polycrystalline gold leads to SPP propagation lengths matching our results. We argue that the SPP propagation lengths measured in our experiments signify the ultimate limit of optical losses in gold, encouraging further comprehensive characterization of optical material properties of pure gold as well as other plasmonic materials.

According to current revised Fukuoka guidelines, there is an indication for resection of BD-IPMN of the pancreas with "worrisome features", as there is a risk of malignant degeneration of up to 30%. This can be performed as a non-anatomical local excision in the absence of clinical, radiological and laboratory signs of malignancy.Robotic enucleation for benign tumours of the pancreas is a very good alternative to resecting procedures, especially those using open techniques. This surgical treatment option is recommended by the "International consensus statement on robotic pancreatic surgery" in a case of a minimum distance to the main pancreatic duct of at least 2 mm.In addition to the known advantages of minimally invasive surgery, this parenchyma-sparing approach results in preservation of endo- and exocrine function (ca. 90%) and 10-year progression-free survival of ca. 75% with slightly increased morbidity (ca. 60%) compared with resecting procedures.The following video article presents the surgical video of a robotic cyst enucleation (for suspected BD-IPMN with "worrisome features") in the pancreatic head and uncinate process in a 62-year-old female patient with special emphasis on the most important vascular landmarks, special features of the approach and advantages of the robotic technique., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

A relevant number of patients with locally advanced esophageal squamous cell carcinoma and adenocarcinoma show a locoregional complete response of the tumor in the resected material after neoadjuvant therapy with modern chemotherapy and chemoradiation protocols. Due to a high rate of perioperative morbidity and decreased long-term quality of life following esophagectomy, the current treatment algorithm with neoadjuvant therapy and post-neoadjuvant esophagectomy on principle is critically questioned. An individualized treatment algorithm with extended clinical evaluation of post-neoadjuvant remission status and esophagectomy as needed is discussed. Patients with complete remission after neoadjuvant therapy are identified in an extended restaging protocol. Cases of clinical complete remission are treated with an active surveillance concept with esophagectomy as needed, i.e. surgery only when a local tumor recurrence is detected. Retrospective cohort studies have suggested that the active surveillance concept with esophagectomy as needed does not lead to a deterioration of overall survival rates in the patient collective. European prospective randomized, controlled, noninferiority studies with an oncological endpoint are currently evaluating the possibilities of organ-preserving concepts for clinical complete remission of esophageal cancer., (© 2021. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Pancreatic carcinoma in the body and on the left side of the mesentericoportal axis is often only detected in late stages owing to unspecific or even missing clinical symptoms. In approximately 20% of the cases, there is already infiltration of the tumour into the surrounding arteries or veins. Despite locally advanced growth, 30% of patients do not have distant metastases and would potentially qualify for local resection. Arterial resections and vascular reconstruction are associated with an almost 9-fold increase in postoperative mortality compared with resections without vascular reconstruction. The Appleby procedure is a complex surgical technique originally developed for advanced gastric cancer. The technique has been further developed for patients with advanced pancreatic body and tail tumours with infiltration of the coeliac trunk (modified Appleby procedure). The advantage of the procedure is that technically, no reconstruction of the resected arteries is required. This is because a natural internal anastomosis in the pancreatic head between the A. mesenterica superior and the A. hepatica via branches of the A. gastroduodenalis is used to maintain liver perfusion and gastric blood flow. However, the surgical procedure is also associated with high morbidity and mortality, with comparably poor oncological results (R0 rates of approximately 60%). Therefore, the procedure was not recommended until a few years ago, and patients were considered inoperable. With developments in neoadjuvant therapy for pancreatic carcinoma, the Appleby procedure is being performed more frequently, with the goal of improving oncological outcomes in the context of multimodal treatment. With developments in robotics in visceral surgery, the previous limitations of minimally invasive pancreatic surgery can be overcome, and significantly more patients may benefit from the advantages of this minimally invasive surgery, such as faster convalescence. The use of robotic surgical techniques allows the extension of minimally invasive techniques into the field of complex vessel resection and reconstruction. In this video contribution, we describe a robot-assisted modified Appleby procedure using the Da Vinci Xi Surgical System in a patient with advanced pancreatic carcinoma of the pancreatic body, after neoadjuvant therapy., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background . In minimally invasive surgery (MIS), the loss of stereoscopic depth perception in a two-dimensional (2D) representation is most challenging. Recently introduced 4K ultrahigh definition (UHD) 2D optical systems could potentially facilitate the learning and use of compensation mechanisms for the loss of depth perception. However, the role of the new 4K technology against three dimensional (3D) in learning and implementation of MIS remains unknown. The aim of this trial was to determine the influence of 4K UHD 2D vs 3D HD representation on the acquisition of MIS skills. Methods. This was a prospective randomized study involving 62 MIS-inexperienced study participants. We compared a laparoscopic 4K UHD 2D (system A) vs a laparoscopic 3D HD system (system B) for differences in learning MIS skills using the Lübeck Toolbox (LTB) video box trainer. We evaluated participants' performance regarding the repetitions required to reach the goal of each LTB task. Results. Comparing systems A and B, participants using the laparoscopic 3D system required fewer repetitions to achieve goals of LTB tasks No. 1 ( P = .0048) and No. 3 ( P = .0014). In contrast, for LTB tasks No. 2 and No. 4, no significant difference could be determined between both groups. Conclusion. Our results indicated that MIS basic skills can be learned quicker using a 3D HD system vs a 4K UHD 2D system. However, for MIS tasks in confined spaces, the learning speed with 4K UHD 2D imaging seems to be comparable to a 3D HD system.

Metal-semiconductor-metal plasmonic nanostructures enable both on-chip efficient manipulation and ultrafast photodetection of strongly confined modes by enhancing local electrostatic and optical fields. The latter is achieved by making use of nanostructured thin-film germanium (Ge) plasmonic-waveguide photodetectors. While their sizes and locations can be accurately controlled during the nanofabrication, the detector efficiencies are significantly reduced due to deposited Ge amorphous nature. We demonstrate that the efficiency of waveguide-integrated Ge plasmonic photodetectors can be increased significantly (more than 2 orders of magnitude) by spatially controlled laser-induced Ge crystallization. We investigate both free-space and waveguide-integrated Ge photodetectors subjected to 800 nm laser treatment, monitoring the degree of crystallization with Raman spectroscopy, and demonstrate the efficiency enhancement by detecting the telecom radiation. The demonstrated local postprocessing technique can be utilized in various nanophotonic devices for efficient and ultrafast on-chip radiation monitoring and detection, offering significantly improved detector characteristics without jeopardizing the performance of other components.

Background: Postoperative pancreatic fistula (POPF) after pancreatoduodenectomy (PD) can be associated with severe postoperative morbidity. This study aims to develop a preoperative POPF risk calculator that can be easily implemented in clinical routine., Methods: Patients undergoing PD were identified from a prospectively-maintained database. A total of 11 preoperative baseline and CT-based radiological parameters were used in a binominal logistic regression model. Parameters remaining predictive for grade B/C POPF were entered into the risk calculator and diagnostic accuracy measures and ROC curves were calculated for a training and a test patient cohort. The risk calculator was transformed into a simple nomogram., Results: A total of 242 patients undergoing PD in the period from 2012 to 2018 were included. CT-imaging-based maximum main pancreatic duct (MPD) diameter (p = 0.047), CT-imaging-based pancreatic gland diameter at the anticipated resection margin (p = 0.002) and gender (p = 0.058) were the parameters most predictive for grade B/C POPF. Based on these parameters, a risk calculator was developed to identify patients at high risk of developing grade B/C POPF. In a training cohort of PD patients this risk calculator was associated with an AUC of 0.808 (95%CI 0.726-0.874) and an AUC of 0.756 (95%CI 0.669-0-830) in the independent test cohort. A nomogram applicable as a visual risk scale for quick assessment of POPF grade B/C risk was developed., Conclusion: The preoperative POPF risk calculator provides a simple tool to stratify patients planned for PD according to the risk of developing postoperative grade B/C POPF. The nomogram visual risk scale can be easily integrated into clinical routine and may be a valuable model to select patients for POPF-preventive therapy or as a stratification tool for clinical trials., Competing Interests: Declaration of competing interest The authors declare to have no conflict of interest., (Copyright © 2021 IAP and EPC. Published by Elsevier B.V. All rights reserved.)

Optical metasurfaces (OMSs) have shown unprecedented capabilities for versatile wavefront manipulations at the subwavelength scale. However, most well-established OMSs are static, featuring well-defined optical responses determined by OMS configurations set during their fabrication, whereas dynamic OMS configurations investigated so far often exhibit specific limitations and reduced reconfigurability. Here, by combining a thin-film piezoelectric microelectromechanical system (MEMS) with a gap-surface plasmon-based OMS, we develop an electrically driven dynamic MEMS-OMS platform that offers controllable phase and amplitude modulation of the reflected light by finely actuating the MEMS mirror. Using this platform, we demonstrate MEMS-OMS components for polarization-independent beam steering and two-dimensional (2D) focusing with high modulation efficiencies (~50%), broadband operation (~20% near the operating wavelength of 800 nanometers), and fast responses (<0.4 milliseconds). The developed MEMS-OMS platform offers flexible solutions for realizing complex dynamic 2D wavefront manipulations that could be used in reconfigurable and adaptive optical networks and systems., (Copyright © 2021 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works. Distributed under a Creative Commons Attribution NonCommercial License 4.0 (CC BY-NC).)

Highly integrated active nanophotonics addressing both device footprint and operation speed demands is a key enabling technology for the next generation optical networks. Plasmonic systems have proven to be a serious contender to alleviate current performance limitations in electro-optic devices. Here, we demonstrate a plasmonic optical phased array (OPA) consisting of two 10 μm long plasmonic phase shifters, utilized to control the far-field radiation pattern of two subwavelength-separated emitters for aliasing-free beam steering with an angular range of ±5° and flat frequency response up to 18 GHz (with the potential bandwidth of 1.2 THz). Extreme optical and electrostatic field confinement with great spatial overlap results in high phase modulation efficiency ( V π L = 0.24 Vcm). The demonstrated approach of using plasmonic lithium niobate technology for optical beam manipulation offers inertia-free, robust, ultracompact, and high-speed beam steering.

Introduction: The use of robots in minimally invasive surgery has become increasingly common in recent years. Robot-assisted pancreatoduodenectomy is more frequent than the laparoscopic procedure especially due to the greater flexibility of instruments and therefore better handling and better angulation. Furthermore, there are benefits from enhanced 3D visibility, software-based tremor control and reduction in the physical exertion of the surgeon., Methods and Results: This review delivers a point-by-point approach to the setup of a robotic pancreatic programme and a detailed approach to robot-assisted pancreatoduodenectomy., Results: In our standardised SOP approach, we use 5 trocars, 4 robotic trocars and one assist trocar. We prefer the position of the robot ports to be in a straight horizontal line with a distance of 20 cm away from the operational field. The operation is dissected in 11 standardised procedural steps, namely 1. Access to the pancreas and visualisation, 2. extended Kocher manoeuvre, 3. lower rim and mesenterico-portal axis, 4. upper rim and hepato-duodenal ligament, 5. dissection of the pancreatic neck, 6. mesenteric root and pars IV duodeni, 7. mesopancreas, 8. pancreatic anastomosis reconstruction, 9. bilio-enteric anastomosis, 10. dudenojejunal anastomosis, 11. drainage and closure. The set up of the pancreas program and the structured approach to complex pancreatic resections are elucidated., Summary: In summary, this review describes the approach to robotic pancreatic surgery in a high-volume pancreas centre at a structural and procedural level, in order to support establishment of such programs at other locations., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Georg Thieme Verlag KG Stuttgart · New York.)