Robotic Major Hepatectomy: Influence of Age on Clinical Outcomes.

BACKGROUND: This study was undertaken to determine if age influences postoperative outcomes for patients undergoing robotic major hepatectomy. METHODS: Ninety-four patients undergoing robotic major hepatectomy were prospectively followed. With regression analysis, demographic data and postoperative outcomes were compared to age. Data are presented as median (mean ± SD). RESULTS: Overall, the patients were of age 62 (61 ± 13) years, body mass index (BMI) of 29 (29 ± 5.9) kg/m2, and American Society of Anesthesiologists (ASA) class of 3 (3 ± 0.5). The mass size was 5 (5 ± 3.0) cm. The operative duration was 252 (276 ± 106) minutes with an estimated blood loss (EBL) of 175 (249 ± 275.9) mL. One operation was converted to "open" due to bleeding, accounting for the only intraoperative complication. Nine patients required intensive care unit (ICU) admission. Postoperatively, 7 patients had complications with no in-hospital mortalities, and a length of stay (LOS) of 4 (5 ± 2.6) days. Thirteen patients were readmitted within 30 days with 0 deaths within 30 days.A significant relationship was found between age and ASA class (P = .001) and LOS (P = .03). No correlation was found when comparing age to operative duration, EBL, ICU admission, ICU duration, complications, and readmission within 30 days. CONCLUSION: For patients undergoing robotic major hepatectomy, there was no significant correlation between age and perioperative outcomes, with the exception of LOS. Increasing age is not associated with increased morbidity or perioperative mortality. With the application of innovative technology, that is, the robotic approach, surgeons should be encouraged to undertake major hepatectomy in elderly patients deemed candidates for surgery.

100 Robotic Distal Pancreatectomies: The Future at Hand.

INTRODUCTION: This study was undertaken to examine 100 consecutive robotic distal pancreatectomies with splenectomies, and to compare our outcomes to predicted outcomes as calculated using the American college of surgeons national surgical quality improvement program (ACS NSQIP) Surgical Risk Calculator and to the outcomes contained within NSQIP. METHODS: Outcomes were compared with predicted outcomes, calculated using the ACS NSQIP Surgical Risk Calculator, and with outcomes documented in NSQIP for distal pancreatectomy. For illustrative purposes, data are presented as median (mean ± SD). RESULTS: Patients who underwent robotic distal pancreatectomy were of age 67 (63 ± 13.4) years with a BMI of 29 (29 ± 6.3) kg/m2, with 49% being women. Operative duration was 242 (265 ± 112.2) minutes and estimated blood loss was 110 (211 ± 233.9) mL. Predicted outcomes were similar to those reported in NSQIP. Our actual outcomes were significantly superior to the predicted outcomes for serious complication, any complication, surgical site infection, sepsis, and length of stay. Compared to NSQIP outcomes, our actual outcomes for serious complication, any complication, surgical site infection, sepsis, and delayed gastric emptying were significantly superior. Twelve percent of operations were converted to "open." There were 3 deaths within 30 days, similar to predicted outcomes. Deaths were due to sepsis (2) and respiratory failure (1). CONCLUSION: Our patients' predicted outcomes were the same as national outcomes; our patients were not a select group. However, their actual outcomes were like or significantly superior than those predicted by NSQIP or reported in NSQIP. We believe that the robot has the future of distal pancreatectomy with or without splenectomy.

A Multi-Method Simulation Toolbox to Study Performance and Variability of Nanowire FETs.

An in-house-built three-dimensional multi-method semi-classical/classical toolbox has been developed to characterise the performance, scalability, and variability of state-of-the-art semiconductor devices. To demonstrate capabilities of the toolbox, a 10 nm gate length Si gate-all-around field-effect transistor is selected as a benchmark device. The device exhibits an off-current (I OFF) of 0 . 03 µA/µm, and an on-current (I ON) of 1770 µA/µm, with the I ON / I OFF ratio 6 . 63 × 10 4, a value 27 % larger than that of a 10 . 7 nm gate length Si FinFET. The device SS is 71 mV/dec, no far from the ideal limit of 60 mV/dec. The threshold voltage standard deviation due to statistical combination of four sources of variability (line- and gate-edge roughness, metal grain granularity, and random dopants) is 55 . 5 mV, a value noticeably larger than that of the equivalent FinFET (30 mV). Finally, using a fluctuation sensitivity map, we establish which regions of the device are the most sensitive to the line-edge roughness and the metal grain granularity variability effects. The on-current of the device is strongly affected by any line-edge roughness taking place near the source-gate junction or by metal grains localised between the middle of the gate and the proximity of the gate-source junction.