Correction to: Comparing benign laparoscopic and abdominal hysterectomy outcomes by time.

The original article was updated to correct the author listing: the last five author names were reversed.

Comparing benign laparoscopic and abdominal hysterectomy outcomes by time.

BACKGROUND: While laparoscopic hysterectomy has benefits compared to abdominal hysterectomy, the operative times are longer. Longer operative times have been associated with negative outcomes. This study's purpose was to elucidate if there is an operative time at which 30-day outcomes for laparoscopic hysterectomy become inferior to a more expeditiously completed abdominal hysterectomy. METHODS: This was a retrospective cohort study (Canadian Task Force classification II-2) using the American College of Surgeons National Surgical Quality Improvement Program database to identify women undergoing hysterectomy for benign indications from 2010 to 2016 by current procedural terminology code. Hysterectomy cases were stratified by approach and 60-min intervals. 30-day post-operative outcomes were analyzed by operative time and approach. RESULTS: 109,821 hysterectomies were included in our analysis, of which 66,560 (61%) were laparoscopic, and 43,261 (39%) were abdominal. In a multivariable logistic regression analysis comparing outcomes by surgical approach and operative time, there was no time combination in which patients who had a abdominal hysterectomy had significantly lower odds of the composite complications variable. This was true even in laparoscopic hysterectomies greater than 240 min compared to abdominal hysterectomies completed between 20 and 60 min. When compared to laparoscopic hysterectomies greater than 240 min, abdominal hysterectomies between 20 and 60 min had lower odds of sepsis and abdominal hysterectomies less than 180 min had lower odds of urinary tract infection. CONCLUSION: Given that benefits persist even in prolonged cases, a laparoscopic approach should be offered to most patients undergoing benign hysterectomy. Surgical efficiency should be prioritized for any surgical approach.

Transferability of Virtual Reality, Simulation-Based, Robotic Suturing Skills to a Live Porcine Model in Novice Surgeons: A Single-Blind Randomized Controlled Trial.

STUDY OBJECTIVE: To assess whether a robotic simulation curriculum for novice surgeons can improve performance of a suturing task in a live porcine model. DESIGN: Randomized controlled trial (Canadian Task Force classification I). SETTING: Academic medical center. PATIENTS: Thirty-five medical students without robotic surgical experience. INTERVENTIONS: Participants were enrolled in an online session of training modules followed by an in-person orientation. Baseline performance testing on the Mimic Technologies da Vinci Surgical Simulator (dVSS) was also performed. Participants were then randomly assigned to the completion of 4 dVSS training tasks (camera clutching 1, suture sponge 1 and 2, and tubes) versus no further training. The intervention group performed each dVSS task until proficiency or up to 10 times. A final suturing task was performed on a live porcine model, which was video recorded and blindly assessed by experienced surgeons. The primary outcomes were Global Evaluative Assessment of Robotic Skills (GEARS) scores and task time. The study had 90% power to detect a mean difference of 3 points on the GEARS scale, assuming a standard deviation (SD) of 2.65, and 80% power to detect a mean difference of 3 minutes, assuming an SD of 3 minutes. MEASUREMENTS AND MAIN RESULTS: There were no differences in demographics and baseline skills between the 2 groups. No significant differences in task time in minutes or GEARS scores were seen for the final suturing task between the intervention and control groups, respectively (9.2 [2.65] vs 9.9 [2.07] minutes, p = .406; and 15.37 [2.51] vs 15.25 [3.38], p = .603). The 95% confidence interval for the difference in mean task times was -2.36 to .96 minutes and for mean GEARS scores -1.91 to 2.15 points. CONCLUSIONS: Live suturing task performance was not improved with a proficiency-based virtual reality simulation suturing curriculum compared with standard orientation to the da Vinci robotic console in a group of novice surgeons.

Communication via Biotremors in the Veiled Chameleon (Chamaeleo calyptratus): Part II-Social Contexts.

This study extends recent research demonstrating that the veiled chameleon (Chamaeleo calyptratus) can produce and detect biotremors. Chameleons were paired in various social contexts: dominance (male-male; female-female C. calyptratus); courtship (male-female C. calyptratus); heterospecific (C. calyptratus + C. gracilis); and inter-size class dominance (adult + juvenile C. calyptratus). Simultaneous video and accelerometer recordings were used to monitor their behavior and record a total of 398 biotremors. Chamaeleo calyptratus produced biotremors primarily in conspecific dominance and courtship contexts, accounting for 84.7% of the total biotremors recorded, with biotremor production varying greatly between individuals. Biotremors were elicited by visual contact with another conspecific or heterospecific, and trials in which chameleons exhibited visual displays and aggressive behaviors were more likely to record biotremors. Three classes of biotremor were identified-hoots, mini-hoots, and rumbles, which differed significantly in fundamental frequency, duration, and relative intensity. Biotremor frequency decreased with increasing signal duration, and frequency modulation was evident, especially in hoots. Overall, the data show that C. calyptratus utilizes substrate-borne vibrational communication during conspecific and possibly heterospecific interactions.

Communication via Biotremors in the Veiled Chameleon (Chamaeleo calyptratus): Part I- Biotremor Production and Response to Substrate-Borne Vibrations.

Biotremors are vibrations, usually surface waves along the boundary of a medium, produced by an organism. While substrate-borne vibrations are utilized by different reptile species, true conspecific communication via biotremors has not yet been demonstrated in lizards. Recent research revealed that the veiled chameleon (Chamaeleo calyptratus) produces biotremors. The prerequisites for any communication system are the ability of an organism to produce and detect a signal. We tested C. calyptratus behavioral responses to vibrations by placing them on a dowel attached to a shaker, emitting vibrations of 25, 50, 150, 300, and 600 Hz and compared their locomotory velocity before and after the stimulus. Adult chameleons exhibited a freeze response to 50 and 150 Hz, while juveniles exhibited a similar response to frequencies between 50 and 300 Hz. In a second experiment, chameleons were induced to produce biotremors via experimenter contact. These biotremors ranged in mean fundamental frequency from 106.4 to 170.3 Hz and in duration from 0.06 to 0.29 s. Overall, two classes of biotremors were identified, "hoots" and "mini-hoots," which differed significantly in mean relative signal intensity (-7.5 and -32.5 dB, respectively). Juvenile chameleons 2 months of age were able to produce biotremors, suggesting this behavior may serve a wide range of ecological functions throughout ontogeny. Overall, the data demonstrate that C. calyptratus can both produce and detect biotremors that could be used for intraspecific communication.

Outcomes of women age 40 or more undergoing repeat cesarean or trial of labor after cesarean.

AIM: Despite the increasing trend in delayed childbirth and the known associated complications in advancing maternal age, limited information exists regarding outcomes in very advanced maternal age by delivery type. This study aims to evaluate maternal and neonatal outcomes in women age 40 or more undergoing cesarean delivery or trial of labor after cesarean delivery. MATERIALS AND METHODS: We performed a secondary analysis of the Cesarean Section Registry Maternal-Fetal Medicine Units (MFMU) Network data, which was a prospective study of women undergoing repeat cesarean delivery or trial of labor after cesarean delivery from 1 January 1999 to 31 December 2002. Women age 40 years or more at the time of delivery were compared to the control group of women less than 40 years of age. RESULTS: There were 67,389 cases identified that met inclusion criteria. 2,436 (3.6%) were age ≥40 years old, and 65,403 (97.05%) were <40 at delivery. The >40 group had a higher rate of PRBC transfusion (aRR 1.75; 95% CI 1.20-2.56), maternal ICU admission (aRR 2.02; 1.41-2.89), bowel injury (aRR 3.65; 1.43-9.31), placenta accreta (aRR 1.92; 1.09-3.38) and classical uterine incision (aRR 1.59; 1.43-9.31) compared to the control group. Maternal death rates were similar in both groups (p = .30). CONCLUSION: Women aged 40 or more undergoing repeat cesarean delivery or trial of labor after cesarean delivery are more likely to have maternal complications including intraoperative transfusion, maternal ICU admission, abnormal placentation and surgical complications in comparison to women under age 40.