Rho/SMAD/mTOR triple inhibition enables long-term expansion of human neonatal tracheal aspirate-derived airway basal cell-like cells.

BACKGROUND: Bronchopulmonary dysplasia remains one of the most common complications of prematurity, despite significant improvements in perinatal care. Functional modeling of human lung development and disease, like BPD, is limited by our ability to access the lung and to maintain relevant progenitor cell populations in culture. METHODS: We supplemented Rho/SMAD signaling inhibition with mTOR inhibition to generate epithelial basal cell-like cell lines from tracheal aspirates of neonates. RESULTS: Single-cell RNA-sequencing confirmed the presence of epithelial cells in tracheal aspirates obtained from intubated neonates. Using Rho/SMAD/mTOR triple signaling inhibition, neonatal tracheal aspirate-derived (nTAD) basal cell-like cells can be expanded long term and retain the ability to differentiate into pseudostratified airway epithelium. CONCLUSIONS: Our data demonstrate that neonatal tracheal aspirate-derived epithelial cells can provide a novel ex vivo human cellular model to study neonatal lung development and disease. IMPACT: Airway epithelial basal cell-like cell lines were derived from human neonatal tracheal aspirates. mTOR inhibition significantly extends in vitro proliferation of neonatal tracheal aspirate-derived basal cell-like cells (nTAD BCCs). nTAD BCCs can be differentiated into functional airway epithelium. nTAD BCCs provide a novel model to investigate perinatal lung development and diseases.

Comparative Study of the Biological Degradation of Poly(3-Hydroxybutyrate-co-3-Hydroxyhexanoate) Microbeads in Municipal Wastewater in Environmental and Controlled Laboratory Conditions.

From April to June 2019, poly(3-hydroxybutyrate-co-3-hydroxyhexanoate) (P3(HA)) microbead samples were exposed to an operational wastewater reclamation facility (WWRF) in an aerobic aeration basin in Athens, Georgia. Samples were withdrawn from the facility over a 13-week timeframe, and the particles were examined by Raman microscopy and thermogravimetric analysis/mass spectroscopy (TGA/MS) coupled with differential scanning calorimetry (DSC). The activated sludge from this facility was also used as an inoculum to examine carbon mineralization under controlled respirometry experiments to corroborate biological degradation rates determined from both the environmental and laboratory approach. Respirometry, Raman microscopy, and TGA/MS-DSC methods all measured similar biodegradation timelines for microbeads bound to an epoxy substrate, indicating that the three methods are temporally comparable and may be used to measure material biological degradation. Samples of epoxy-bound P3(HA) microbeads, free microbeads, the P3(HA) film, and poly(lactic acid) (PLA) film demonstrated carbon mineralization of 90.0, 89.4, 95.0, and 8.15%, respectively, relative to the cellulose positive control. Using a modified Gompertz growth model, the biological degradation rate coefficients (Rm) were determined for cellulose, P3(HA) film, epoxy-bound P3(HA) microbeads, and free P3(HA) microbeads and found to be 31.6, 30.2, 17.5, and 18.7 mL CO2·g-1·day-1, respectively. Moreover, P3(HA) microbeads can efficiently mineralize in WWRF infrastructure at a rate comparable to cellulose.

Ingested Micronizing Plastic Particle Compositions and Size Distributions within Stranded Post-Hatchling Sea Turtles.

From July 2015 to November 2016, 96 post-hatchling sea turtles were collected from 118 km of the Atlantic coastline in Florida, USA, including loggerhead, green, and hawksbill sea turtle species. Forty-five of the recovered turtles were rehabilitated and released, but the remaining 52 died and were frozen. At necropsy, the gastrointestinal tracts of most the turtles contained visible plastic, and collected particles of 27 individuals were chemically characterized by Raman microscopy as polyethylene, polypropylene, polyethylene terephthalate, and polystyrene. Mesoparticle plastic fragments 1.0-8.7 mm, microparticle fragments 20-1000 µm, and nanoparticles 5-169 nm were identified in the turtles. Polyethylene and polypropylene were the most common plastics ingested from specimens representing 54.1 and 23.7% of the total observed mesoparticles and 11.7 and 21.0% of the total observed microparticles, respectively. A plastic-to-body mass ratio of 2.07 mg/g was determined for this group. The authors suggest that ingestion of micronizing plastic by post-hatchling sea turtles is likely a substantial risk to survival of these endangered and threatened species. This study also provides some of the first evidence for the formation of nanoscopic plastic particles that we theorize forms in the post-hatchling and juvenile environment and are present post-ingestion.

ß2-Adrenergic receptor agonist ameliorates phenotypes and corrects microRNA-mediated IGF1 deficits in a mouse model of Rett syndrome.

Rett syndrome is a severe childhood onset neurodevelopmental disorder caused by mutations in methyl-CpG-binding protein 2 (MECP2), with known disturbances in catecholamine synthesis. Here, we show that treatment with the ß2-adrenergic receptor agonist clenbuterol increases survival, rescues abnormalities in respiratory function and social recognition, and improves motor coordination in young male Mecp2-null (Mecp2(-/y)) mice. Importantly, we demonstrate that short-term treatment with clenbuterol in older symptomatic female heterozygous (Mecp2(-/+)) mice rescues respiratory, cognitive, and motor coordination deficits, and induces an anxiolytic effect. In addition, we reveal abnormalities in a microRNA-mediated pathway, downstream of brain-derived neurotrophic factor that affects insulin-like growth factor 1 (IGF1) expression in Mecp2(-/y) mice, and show that treatment with clenbuterol restores the observed molecular alterations. Finally, cotreatment with clenbuterol and recombinant human IGF1 results in additional increases in survival in male null mice. Collectively, our data support a role for IGF1 and other growth factor deficits as an underlying mechanism of Rett syndrome and introduce ß2-adrenergic receptor agonists as potential therapeutic agents for the treatment of the disorder.

Risk Factors for Revision of External Fixation of Unstable Ankle Injuries.

INTRODUCTION: External fixation of unstable ankle injuries is commonly done by orthopaedic surgeons. An improper technique can negate the benefits of the procedure and necessitate revision. This study sought to determine the risk factors for revision of external fixation of unstable ankle injuries. METHODS: Retrospective cohort at a level I academic trauma center of 120 consecutive patients underwent external fixation of an unstable ankle injury. Exclusion criteria included external fixation for reason other than fracture, inadequate intraoperative imaging, skeletal immaturity, and follow-up less than 30 days. Primary outcome measurement was revision of external fixation within 30 days. RESULTS: Ninety-seven patients met inclusion criteria. Eighteen (18.6%) underwent revision within 30 days of whom 5 (28%, P < 0.001) had a poor reduction intraoperatively. No patients with a good reduction required revision. Revised patients had a significantly higher talar tilt (P < 0.001) and were more likely to lack a first metatarsal pin (P = 0.018). Multivariate analysis revealed talar tilt >0.5° (odds ratio, 22.62; 95% confidence interval, 6.52 to 50.63) as an independent risk factor for revision. DISCUSSION: For external fixation of unstable ankle injuries, poor reduction quality is a risk factor for need for revision surgery. Orthopaedic surgeons should be critical of their final intraoperative assessment to prevent revision.

SNAPSHOT USA 2021: A third coordinated national camera trap survey of the United States.

SNAPSHOT USA is a multicontributor, long-term camera trap survey designed to survey mammals across the United States. Participants are recruited through community networks and directly through a website application (https://www.snapshot-usa.org/). The growing Snapshot dataset is useful, for example, for tracking wildlife population responses to land use, land cover, and climate changes across spatial and temporal scales. Here we present the SNAPSHOT USA 2021 dataset, the third national camera trap survey across the US. Data were collected across 109 camera trap arrays and included 1711 camera sites. The total effort equaled 71,519 camera trap nights and resulted in 172,507 sequences of animal observations. Sampling effort varied among camera trap arrays, with a minimum of 126 camera trap nights, a maximum of 3355 nights, a median 546 nights, and a mean 656 ± 431 nights. This third dataset comprises 51 camera trap arrays that were surveyed during 2019, 2020, and 2021, along with 71 camera trap arrays that were surveyed in 2020 and 2021. All raw data and accompanying metadata are stored on Wildlife Insights (https://www.wildlifeinsights.org/), and are publicly available upon acceptance of the data papers. SNAPSHOT USA aims to sample multiple ecoregions in the United States with adequate representation of each ecoregion according to its relative size. Currently, the relative density of camera trap arrays varies by an order of magnitude for the various ecoregions (0.22-5.9 arrays per 100,000 km2), emphasizing the need to increase sampling effort by further recruiting and retaining contributors. There are no copyright restrictions on these data. We request that authors cite this paper when using these data, or a subset of these data, for publication. Any use of trade, firm, or product names is for descriptive purposes only and does not imply endorsement by the US Government.

Elbow Ulnar Collateral Ligament (UCL) Repair Using Suture Augmentation, Anchors, and Bone Tunnels.

Ulnar collateral ligament (UCL) repair with suture augmentation has been increasingly used to treat UCL pathology in overhead athletes. For the appropriately indicated patient, UCL repair with suture augmentation without reconstruction has promising results. Advantages of repair with suture augmentation include earlier return to sport, low complication rate, and decreased operative time since there is no need for graft harvest. Previously reported techniques use suture anchors with high-tensile and collagen-coated nonabsorbable sutures. This article provides an alternative augmentation method using a combination of anchors and bone tunnels to obtain an isometric repair.

Direct Anterior Versus Posterior Approach for Total Hip Arthroplasty Performed for Displaced Femoral Neck Fractures.

OBJECTIVES: To compare perioperative, 90-day, and 1-year postoperative complications and outcomes between the direct anterior approach (DAA) and the posterior approach for total hip arthroplasty in geriatric patients with displaced femoral neck fractures (FNFs). DESIGN: Retrospective cohort study. SETTING: Multicenter Health care Consortium. PATIENTS: Seven-hundred and nine patients 60 years or older with acute displaced FNFs between 2009 and 2021. INTERVENTION: Total hip arthroplasty using either DAA or posterior approach. MAIN OUTCOME MEASUREMENTS: Rates of postoperative complications including dislocations, reoperations, and mortality at 90 days and 1 year postoperatively. Secondary outcome measures included ambulation capacity at discharge, ambulation distance with inpatient physical therapy, discharge disposition, and narcotic prescription quantities (morphine milligram equivalents). RESULTS: Through a multivariable regression analysis, DAA was associated with significantly shorter operative time ( B = -6.89 minutes; 95% confidence interval [CI] -12.84 to -0.93; P = 0.024), lower likelihood of blood transfusion during the index hospital stay (adjusted odds ratios = 0.54; 95% CI 0.27 to 0.96; P = 0.045), and decreased average narcotic prescription amounts at 90 days (B = -230.45 morphine milligram equivalents; 95% CI -440.24 to -78.66; P = 0.035) postoperatively. There were no significant differences in medical complications, dislocations, reoperations, and mortality at 90 days and 1 year postoperatively. CONCLUSION: When comparing the DAA versus posterior approach for total hip arthroplasty performed for displaced FNF, DAA was associated with shorter operative time, lower likelihood of blood transfusion, and lower 90-day postoperative narcotic prescription amounts. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Transpedicular Screw Placement Accuracy Using the O-Arm Versus Freehand Technique at a Single Institution.

STUDY DESIGN: Retrospective cohort. OBJECTIVE: The objective of this study was to assess the effectiveness of the O-arm as an intraoperative imaging tool by comparing accuracy of pedicle screw placement to freehand technique. METHODS: The study comprised a total of 1161 screws placed within the cervical (n = 187) thoracic (n = 657), or lumbar (n = 317) spinal level. A pedicle breach was determined by any measurable displacement of the screw outside of the pedicle cortex in any plane on postoperative images. Each pedicle screw was subsequently classified by its placement relative to the targeted pedicle. Statistical analysis was then performed to determine the frequency and type of pedicle screw mispositioning that occurred using the O-arm versus freehand technique. RESULTS: A total of 155 cases (O-arm 84, freehand 71) involved the placement of 454 pedicle screws in the O-arm group and 707 pedicle screws in the freehand group. A pedicle breach occurred in 89 (12.6%) screws in the freehand group and 55 (12.1%) in the O-arm group (P = .811). Spinal level operated upon did not influence pedicle screw accuracy between groups (P > .05). Three screws required revision surgery between the 2 groups (O-arm 1, freehand 2, P > .05). The most frequent breach type was a lateral pedicle breach (O-arm 22/454, 4.8%; freehand 54/707, 7.6%), without a significant difference between groups (P > .05). CONCLUSIONS: The use of the O-arm coupled with navigation does not assure improved transpedicular screw placement accuracy when compared with the freehand technique.

Patterns of ecstasy use amongst live music event attendees and their opinions on pill testing: a cross sectional study.

BACKGROUND: Pill testing services could potentially be used to reduce drug-related harm. This study aims to identify patterns of ecstasy use among live music event attendees; explore the opinions and potential usage of illicit pill testing programs and examine factors associated with the likelihood of still taking a pill containing a potential harmful substance. METHODS: A cross-sectional survey was completed by 760 people attending a major Australian live music event in 2017. RESULTS: The most commonly used drug in the last 12 months was ecstasy (73.9%). About 5% of people who use drugs had sought medical attention due to consumption of ecstasy. People who use drugs agreed "a lot" that pill testing should be provided for free at live music events (82.2%) and that it should be combined with harm reduction advice (62.9%). Additionally, 32% of all participants agreed 'a lot' that they would be more likely to take illicit drugs at a music festival if pill-testing services were present. However, if people perceived that a harmful substance was detected in their drugs after using a pill testing service, 52.3% of people who have used illicit drugs reported that they would 'not at all' be likely to still consume the drug. They also reported that they would still take a pill if testing demonstrated the presence of unintended MDMA-type substances (70.3%), amphetamines (31.2%) or ketamine (27.8%). Multivariate analyses demonstrated that only increased frequency of ecstasy use was significantly associated with taking a pill despite pill testing services detecting a harmful substance. Gender, age, alcohol and previously seeking ecstasy-related medical attention were not associated in the multivariate analyses. CONCLUSIONS: A high proportion of live music attendees consume alcohol and ecstasy. Both people who have and who have not used illicit drugs support the implementation of pill testing services. People reported they would change their consumption patterns according to the results given by pill testing services. The findings may be used to stimulate public debate, and assist drug and alcohol policy makers in the implementation of harm minimisation strategies such as combining pill testing services with harm reduction advice.

Author Correction: Task-dependent representations of stimulus and choice in mouse parietal cortex.

In the original version of this Article, the Acknowledgements section was inadvertently omitted. This has now been corrected in both the PDF and HTML versions of the Article.

Task-dependent representations of stimulus and choice in mouse parietal cortex.

The posterior parietal cortex (PPC) has been implicated in perceptual decisions, but whether its role is specific to sensory processing or sensorimotor transformation is not well understood. Here, we trained mice to perform a go/no-go visual discrimination task and imaged the activity of neurons in primary visual cortex (V1) and PPC during engaged behavior and passive viewing. Unlike V1 neurons, which respond robustly to stimuli in both conditions, most PPC neurons respond exclusively during task engagement. To test whether signals in PPC primarily encoded the stimulus or the animal's impending choice, we image the same neurons before and after re-training mice with a reversed sensorimotor contingency. Unlike V1 neurons, most PPC neurons reflect the animal's choice of the new target stimulus after re-training. Mouse PPC is therefore strongly task-dependent, reflects choice more than stimulus, and may play a role in the transformation of visual inputs into motor commands.

Uterine weight as a predictor of morbidity after a benign abdominal and total laparoscopic hysterectomy.

OBJECTIVE: To determine if an enlarged uterus is associated with an increased rate of intraoperative and postoperative complications and prolonged hospital length of stay (LOS) after benign total abdominal hysterectomy (TAH) or total laparoscopic hysterectomy (TLH). STUDY DESIGN: Women who underwent TAH or TLH were stratified, according to uterine weight, into 3 groups: group 1, uterine weight < 200 g; group 2, 201-500 g; and group 3, > 500 g. Indications included uterine leiomyomas, chronic pelvic pain, prolapsed uterus, endometriosis and adenomyosis, dysfunctional uterine bleeding; all had benign final pathology. Statistical analysis compared risks of intraoperative and postoperative morbidity and prolonged hospital stay. RESULTS: Prolonged hospital stay risk increased for uterine weight > 500 g (p < or = 0.001). There was a significant association between postoperative complications and uterine size (p < or = 0.001). Mean estimated blood loss (EBL) also increased with uterine weight > 500 g (p < or = 0.001). TLH was associated with fewer postoperative complications, shorter LOS and reduced EBL (p < or = 0.001). CONCLUSION: Average LOS and risk of blood loss, blood transfusion and other postoperative complications after hysterectomy for benign disease increased with increasing uterine weight. TLH is an excellent alternative for enlarged uteri; it was strongly associated with decreased morbidity, shorter LOS, and reduced EBL and blood transfusion rate in all uterine weight groups when adjusted for other variables.

Performance of a plastic-wrapped composting system for biosecure emergency disposal of disease-related swine mortalities.

A passively-ventilated plastic-wrapped composting system initially developed for biosecure disposal of poultry mortalities caused by avian influenza was adapted and tested to assess its potential as an emergency disposal option for disease-related swine mortalities. Fresh air was supplied through perforated plastic tubing routed through the base of the compost pile. The combined air inlet and top vent area is ⩽∼1% of the gas exchange surface of a conventional uncovered windrow. Parameters evaluated included: (1) spatial and temporal variations in matrix moisture content (m.c.), leachate production, and matrix O2 concentrations; (2) extent of soft tissue decomposition; and (3) internal temperature and the success rate in achieving USEPA time/temperature (T) criteria for pathogen reduction. Six envelope materials (wood shavings, corn silage, ground cornstalks, ground oat straw, ground soybean straw, or ground alfalfa hay) and two initial m.c.'s (15-30% w.b. for materials stored indoors, and 45-65% w.b. to simulate materials exposed to precipitation) were tested to determine their effect on performance parameters (1-3). Results of triple-replicated field trials showed that the composting system did not accumulate moisture despite the 150kg carcass water load (65% of 225kg total carcass mass) released during decomposition. Mean compost m.c. in the carcass layer declined by ∼7 percentage points during 8-week trials, and a leachate accumulation was rare. Matrix O2 concentrations for all materials other than silage were ⩾10% using the equivalent of 2m inlet/vent spacing. In silage O2 dropped below 5% in some cases even when 0.5m inlet/vent spacing was used. Eight week soft tissue decomposition ranged from 87% in cornstalks to 72% in silage. Success rates for achievement of USEPA Class B time/temperature criteria ranged from 91% for silage to 33-57% for other materials. Companion laboratory biodegradation studies suggest that Class B success rates can be improved by slightly increasing envelope material m.c. Moistening initially dry (15% m.c.) envelope materials to 35% m.c. nearly doubled their heat production potential, boosting it to levels ⩾silage. The 'contradictory' silage test results showing high temperatures paired with slow soft tissue degradation are likely due to this material's high density, low gas permeability and low water vapor loss. While slow decomposition typically suggests low microbial activity and heat production, it does not rule out high internal temperatures if the heat produced is conserved. Occasional short-term odor releases during the first 2weeks of composting were associated with top-to-bottom gas flow which is contrary to the typical bottom-to-top flow typically observed in conventional compost piles. In cases where biosecurity concerns are paramount, results of this study show the plastic-wrapped passively-ventilated composting method to have good potential for above-ground swine mortality disposal.

Total laparoscopic hysterectomy in obese versus nonobese patients.

OBJECTIVE: To estimate the risk of operative and postoperative complications for obese patients undergoing total laparoscopic hysterectomy compared with nonobese patients. METHODS: A retrospective cohort study was performed for patients undergoing total laparoscopic hysterectomy at Ochsner Clinic Foundation in New Orleans, Louisiana, for a period of 4.3 years. Rates of complications, successful laparoscopic completion, readmission, and reoperation were compared for those patients having a body mass index (BMI) of 30 kg/m(2) or greater with those whose BMI was less than 30 kg/m(2). RESULTS: Of 270 patients who met inclusion criteria, 106 (39.3%) women had a BMI of 30 kg/m(2) or greater. Procedures were completed by using endoscopic technique in 253 cases (93.7%), by using a combined vaginal approach (laparoscopically assisted vaginal hysterectomy) in 7 cases (2.6%), and via laparotomy (total abdominal hysterectomy) in 10 cases (3.7%). Neither the 2-fold risk of conversion to laparoscopically assisted vaginal hysterectomy (relative risk [RR] 2.2; 95% confidence interval [CI] 0.5, 10.1) nor the 4-fold risk of conversion to laparotomy (RR 3.9, 95% CI 1.0, 15.4) associated with obesity was statistically significant. Total laparoscopic hysterectomy for obese patients was 60% more likely to require at least 2 hours to complete (RR 1.6, 95% CI 1.2, 2.0) and was associated with a 3-fold risk of blood loss exceeding 500 mL compared with nonobese patients. Risks of major and minor complications, hospital readmission, and reoperation were similar for both groups. CONCLUSION: Total laparoscopic hysterectomy can be performed successfully in most obese patients, with complication rates similar to those for nonobese patients. LEVEL OF EVIDENCE: II-2

White matter neuron alterations in schizophrenia and related disorders.

Increased density and altered spatial distribution of subcortical white matter neurons (WMNs) represents one of the more well replicated cellular alterations found in schizophrenia and related disease. In many of the affected cases, the underlying genetic risk architecture for these WMN abnormalities remains unknown. Increased density of neurons immunoreactive for Microtubule-Associated Protein 2 (MAP2) and Neuronal Nuclear Antigen (NeuN) have been reported by independent studies, though there are negative reports as well; additionally, group differences in some of the studies appear to be driven by a small subset of cases. Alterations in markers for inhibitory (GABAergic) neurons have also been described. For example, downregulation of neuropeptide Y (NPY) and nitric oxide synthase (NOS1) in inhibitory WMN positioned at the gray/white matter border, as well as altered spatial distribution, have been reported. While increased density of WMN has been suggested to reflect disturbance of neurodevelopmental processes, including neuronal migration, neurogenesis, and cell death, alternative hypotheses--such as an adaptive response to microglial activation in mature CNS, as has been described in multiple sclerosis--should also be considered. We argue that larger scale studies involving hundreds of postmortem specimens will be necessary in order to clearly establish the subset of subjects affected. Additionally, these larger cohorts could make it feasible to connect the cellular pathology to environmental and genetic factors implicated in schizophrenia, bipolar disorder, and autism. These could include the 22q11 deletion (Velocardiofacial/DiGeorge) syndrome, which in some cases is associated with neuronal ectopias in white matter.

Air sampling methods for VOCs related to field-scale biosecure swine mortality composting.

Monitoring specific volatile organic compounds (VOCs) as markers of biosecure carcass degradation is a promising method to test progress and completion of the composting process. The objective of this study was to test the feasibility of using existing aeration ducts in composting units as practical sampling locations. The secondary objective was to test the feasibility of using marker VOC concentrations in aeration ducts to elucidate information about airflow patterns inside composting units. Marker VOC concentrations were significantly higher in the upper aeration duct and this duct can typically be used to collect air samples instead of placing special air sampling probes inside the composting units. Occasionally, the airflow direction inside composting units can change. Marker VOC concentrations can be used to decide the airflow direction inside the composting units. In this study, higher VOC concentrations were measured from the upper aeration duct, and this duct was shown to be an outlet.

miR-132, an experience-dependent microRNA, is essential for visual cortex plasticity.

Using quantitative analyses, we identified microRNAs (miRNAs) that were abundantly expressed in visual cortex and that responded to dark rearing and/or monocular deprivation. The most substantially altered miRNA, miR-132, was rapidly upregulated after eye opening and was delayed by dark rearing. In vivo inhibition of miR-132 in mice prevented ocular dominance plasticity in identified neurons following monocular deprivation and affected the maturation of dendritic spines, demonstrating its critical role in the plasticity of visual cortex circuits.

Total laparoscopic hysterectomy: our 5-year experience (1998-2002).

PURPOSE: To review our experience performing total laparoscopic hysterectomy since we first introduced this procedure in 1998. METHODS: A retrospective cohort study was performed for patients undergoing total laparoscopic hysterectomy at Ochsner Clinic Foundation from February 1998 through December 2002. Rates of complications, successful completion, length of hospital stay, readmission, and reoperation were determined for this period. RESULTS: Among 511 patients who underwent attempted total laparoscopic hysterectomy, 487 procedures (95.3%) were completed by laparoscopy. The major intraoperative complication rate was 3.9%, and the major postoperative complication rate was 4.7%. No significant differences were seen in the intraoperative and postoperative complication rates of patients who were morbidly obese (body mass index ≥30 kg/m(2)), patients with enlarged uteri (≥300 g), or patients who underwent concomitant procedures (unilateral or bilateral salpingo-oophorectomy and lysis of adhesions). The readmission rate was 4.1%, and the reoperation rate was 2%. None of the variables studied, including age, medical problems, morbid obesity, concomitant procedures, or enlarged uterus, were found to have an association with readmission or reoperation rates. CONCLUSIONS: Total laparoscopic hysterectomy can be performed successfully in most patients with benign indications. Morbidity is comparable to that of other types of hysterectomies, and this technique may be a more reasonable approach under some circumstances.