Low-volume combined aerobic and resistance high-intensity interval training in type 2 diabetes: a randomised controlled trial.

Objective: The objective of this study was to compare the effects of novel, time-efficient, low-volume combined aerobic and resistance high-intensity interval training (C-HIIT), and current exercise guidelines (210 min/week of combined moderate-intensity continuous training (C-MICT)), with waitlist control (CON) on glycaemic control in people with type 2 diabetes mellitus (T2D). Methods: Sixty-nine low-active people with T2D were randomised to 8 weeks of supervised C-HIIT (78 min/week), supervised C-MICT (210 min/week), or waitlist CON. Those in waitlist CON were re-randomised to supervised C-HIIT/C-MICT at week 8. Following 8 weeks of supervised training, participants completed 10 months of self-directed exercise. Outcomes were assessed at baseline, week 8 and month 12. Participants in waitlist CON were only included in the exercise groups for the month 12 analysis. Analyses were completed using intention-to-treat analysis of covariance (n=69; week 8) and linear mixed modelling (n=63; month 12). Results: Compared with CON, at week 8, HbA1c decreased in C-HIIT (adjusted mean difference: -0.7% (95% CI -1.3, -0.2%)) and C-MICT (-1.2% (-1.9, -0.6%)). There were also improvements in C-HIIT and C-MICT versus CON at week 8 for fat mass (-1.9 (-3.1, -0.6) and -1.5 (-2.6, -0.4) kg, respectively), lean mass (1.5 (0.8, 2.3) and 0.9 (0.1, 1.7) kg), and exercise capacity (124 (77, 171) and 49 (5, 93) s). At month 12, adherence was low, and most measures returned to baseline. Conclusions: Low-volume C-HIIT (78 min/week) and C-MICT (210 min/week) improved glycaemic control, body composition and exercise capacity similarly over 8 weeks in people with T2D. However, at month 12, improvements were not maintained following self-directed exercise. Regardless, these data suggest that supervised low-volume C-HIIT is a time-efficient and effective strategy for improving outcomes in T2D.

Scientific Evidence for the Updated Guidelines on Indications for Metabolic and Bariatric Surgery (IFSO/ASMBS).

The 2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) updated the indications for Metabolic and Bariatric Surgery (MBS), replacing the previous guidelines established by the NIH over 30 years ago. The evidence supporting these updated guidelines has been strengthened to assist metabolic and bariatric surgeons, nutritionists, and other members of multidisciplinary teams, as well as patients. This study aims to assess the level of evidence and the strength of recommendations compared to the previously published criteria.

Annual and Seasonal Patterns of Dietary Intake in Australian Adults: A Prospective Cohort Study.

Poor diet is a major risk factor for non-communicable disease. The aims of this study were to describe temporal patterns and seasonal changes in diet across the year in Australian adults. A total of 375 adults from a prospective cohort study conducted between 1 December 2019 and 31 December 2021 in Adelaide, Australia, were asked to complete the Dietary Questionnaire for Epidemiological Studies at eight timepoints over a year. Average intakes over the previous month of total energy, macronutrients, healthy food groups, and discretionary foods and beverages were derived. Temporal patterns in diet were analysed descriptively. Multilevel linear regression modelling was used to assess seasonal differences in diet. Of the 375 participants recruited, 358 provided sufficient data for analysis. Intake of total energy, all macronutrients, and most discretionary foods and beverages peaked in December. Total energy intake was higher in summer than in autumn, winter, and spring. Fruit intake was higher in summer than in winter. Consumption of alcoholic beverages was higher in summer than in autumn, winter, and spring. Consumption of non-alcoholic beverages was higher in summer than in autumn and winter. This study identified temporal differences in dietary intake among Australian adults. Seasonal effects appear to be driven largely by increases in consumption of foods and beverages over the December (summer) holiday period. These findings can inform the design and timing of dietary interventions.

Analysis of bariatric surgical complications requiring interhospital transfers using a modified Victorian Audit of Surgical Mortality framework.

BACKGROUND: Surgical audit is key in upholding the standards of surgical care but may be inadequate in capturing morbidity experienced by patients being transferred across different health systems. The aim of this study was to assess the utility of an objective framework in the evaluation of clinical issues surrounding interhospital transfers (IHTs). METHODS: A retrospective cohort study was conducted at a Victorian state bariatric hospital. Patients transferred with bariatric surgery related complications between 2014 and 2021 were included. Each case was reviewed by two surgeons using an objective framework developed via a modified Delphi-process. Key issues and preventability surrounding each transfer were evaluated. Inter-observer agreement was assessed using weighted Cohen's Kappa coefficient. RESULTS: Seventy-three patients were included. The most common indication for transfer was proximal staple line leak post sleeve gastrectomy (34/73, 46.6%). Length of stay was 38.3 ± 58.8 days. Cost of care amounted to AUD $110 666.18 per patient. Delay in transfer and complication recognition were present in 20% of cases (Cohen's Kappa 0.51;0.61). Human factors and patient related factors were the most common principal underlying causes (Cohen's Kappa 0.59). A third of the complications (n = 25/73, 34.2%), were potentially preventable (Cohen's Kappa 0.58) and more than half (39/73, 53.4%) did not have documented objective feedback to referring clinicians. CONCLUSION: IHTs associated with bariatric surgery complications have significant morbidity and costs. A structured framework in reviewing IHT can consistently identify potentially modifiable factors that improve clinical outcomes, and constructive feedback to the referring clinician should be actively facilitated and documented.

miR-33 deletion in hepatocytes attenuates MASLD-MASH-HCC progression.

The complexity of the mechanisms underlying metabolic dysfunction-associated steatotic liver disease (MASLD) progression remains a significant challenge for the development of effective therapeutics. miRNAs have shown great promise as regulators of biological processes and as therapeutic targets for complex diseases. Here, we study the role of hepatic miR-33, an important regulator of lipid metabolism, during the progression of MASLD and the development of hepatocellular carcinoma (HCC). We report that miR-33 was elevated in the livers of humans and mice with MASLD and that its deletion in hepatocytes (miR-33 HKO) improved multiple aspects of the disease, including steatosis and inflammation, limiting the progression to metabolic dysfunction-associated steatotic hepatitis (MASH), fibrosis, and HCC. Mechanistically, hepatic miR-33 deletion reduced lipid synthesis and promoted mitochondrial fatty acid oxidation, reducing lipid burden. Additionally, absence of miR-33 altered the expression of several known miR-33 target genes involved in metabolism and resulted in improved mitochondrial function and reduced oxidative stress. The reduction in lipid accumulation and liver injury resulted in decreased YAP/TAZ pathway activation, which may be involved in the reduced HCC progression in HKO livers. Together, these results suggest suppressing hepatic miR-33 may be an effective therapeutic approach to temper the development of MASLD, MASH, and HCC in obesity.

Patient and healthcare practitioner evaluation of patient-reported outcomes in bariatric surgery - a modified Delphi study.

BACKGROUND: Patient-reported outcomes are an important emerging metric increasingly utilised in clinical, research and registry settings. These outcomes, while vital, are underutilised and require refinement for the specific patient population of those undergoing bariatric surgery. This study aimed to investigate and compare how pre-surgical patients, post-surgical patients, and healthcare practitioners evaluate patient-reported outcomes of bariatric surgery to identify outcomes that are considered most important. METHODS: A modified Delphi survey was distributed to patients pre- and post-surgery, and to a variety of healthcare practitioners involved in bariatric care. Across two rounds, participants were asked to rate a variety of physical and psychosocial outcomes of bariatric surgery from 0 (Not Important) to 10 (Extremely Important). Outcomes rated 8-10 by at least 70% of participants were considered highly important (prioritised). The highest-rated outcomes were compared between the three groups as well as between medical and allied health practitioner subgroups. RESULTS: 20 pre-surgical patients, 95 post-surgical patients, and 28 healthcare practitioners completed both rounds of the questionnaire. There were 58 outcomes prioritised, with 21 outcomes (out of 90, 23.3%) prioritised by all three groups, 13 (14.4%) by two groups, and 24 (26.7%) prioritised by a single group or subgroup. Unanimously prioritised outcomes included 'Co-morbidities', 'General Physical Health', 'Overall Quality of Life' and 'Overall Mental Health'. Discordant outcomes included 'Fear of Weight Regain', 'Suicidal Thoughts', 'Addictive Behaviours', and 'Experience of Stigma or Discrimination'. CONCLUSION: While there was considerable agreement between stakeholder groups on many outcomes, there remain several outcomes with discordant importance valuations that must be considered. In particular, healthcare practitioners prioritised 20 outcomes that were not prioritised by patients, emphasising the range of priorities across stakeholder groups. Future work will consider these priorities to ensure resulting measures encompass all important outcomes and are beneficial and valid for end users.

Expansion of the phenotypic spectrum of KARS1-related disorders to include arthrogryposis multiplex congenita and summary of experiences with lysine supplementation.

There are currently multiple disorders of aminoacyl-tRNA synthetases described, including KARS1-related disorder resulting from dysfunctional lysyl-tRNA synthetases. In this report, we describe four novel KARS1 variants in three affected individuals, two of whom displayed arthrogryposis-like phenotypes, suggestive of phenotypic expansion. We also highlight subjective clinical improvement in one subject following lysine supplementation in conjunction with a protein-fortified diet, suggesting its potential as a novel treatment modality for KARS1-related disorders. This report offers additional insight into the etiology and management of KARS1-related disorders and expands our ability to provide guidance to affected individuals and their families.

Metabolic and Bariatric Surgeon Criteria-An International Experts' Consensus.

PURPOSE: With the global epidemic of obesity, the importance of metabolic and bariatric surgery (MBS) is greater than ever before. Performing these surgeries requires academic training and the completion of a dedicated fellowship training program. This study aimed to develop guidelines based on expert consensus using a modified Delphi method to create the criteria for metabolic and bariatric surgeons that must be mastered before obtaining privileges to perform MBS. METHODS: Eighty-nine recognized MBS surgeons from 42 countries participated in the Modified Delphi consensus to vote on 30 statements in two rounds. An agreement/disagreement among ≥ 70.0% of the experts was regarded to indicate a consensus. RESULTS: Consensus was reached on 29 out of 30 statements. Most experts agreed that before getting privileges to perform MBS, surgeons must hold a general surgery degree and complete or have completed a dedicated fellowship training program. The experts agreed that the learning curves for the various operative procedures are approximately 25-50 operations for the LSG, 50-75 for the OAGB, and 75-100 for the RYGB. 93.1% of experts agreed that MBS surgeons should diligently record patients' data in their National or Global database. CONCLUSION: MBS surgeons should have a degree in general surgery and have been enrolled in a dedicated fellowship training program with a structured curriculum. The learning curve of MBS procedures is procedure dependent. MBS surgeons must demonstrate proficiency in managing postoperative complications, collaborate within a multidisciplinary team, commit to a minimum 2-year patient follow-up, and actively engage in national and international MBS societies.

Participation in Sports/Recreational Activities and the Occurrence of Psychological Distress in Mid-Aged Adults: Findings From the HABITAT Cohort Study.

OBJECTIVES: The aim of this study was to investigate prospective associations between participation in sports/recreational activities and the occurrence of moderate-to-severe psychological distress over 2 years in a sample of mid-aged Australians. METHODS: This prospective study used data from 6699 adults aged 40+ years, living in Brisbane in 2007, and surveyed in 2009, 2011 and 2013. Participants provided self-reported data on frequency of participation in each of 11 sports/recreational activities in past 12 months and completed the Kessler Psychological Distress 6-item Scale (K6). Generalized estimating equation (GEE) models with a 2-year lag were used to assess the associations of participation in sports/recreational activities in 2009 and 2011 with new cases of moderate-to-severe psychological distress (K6 score ≥ 5) in 2011 and 2013. RESULTS: From 2009 to 2013, 22.4% of participants without moderate-to-severe psychological distress at baseline (N = 4943) developed this outcome in at least one survey. Overall, there were no clear patterns of association between frequency of participation in sports and recreational activities and occurrence of moderate-to-severe psychological distress. In unadjusted models, weekly participation in some activities (e.g., tennis, golf, and exercise classes) was associated with reduced odds of moderate-to-severe psychological distress over the next 2 years, but these associations were attenuated in most adjusted models with sociodemographic, lifestyle, and health covariates. Participation in home-based exercise and running/jogging were associated with higher odds of psychological distress. CONCLUSION: Our findings do not provide strong evidence of beneficial associations of frequency of sport/recreational activities with psychological distress but show surprising negative associations of home-based exercise and running/jogging with occurrence of moderate-to-severe psychological distress over 2 years.

Core Set of Patient-Reported Outcome Measures for Measuring Quality of Life in Clinical Obesity Care.

PURPOSE: The focus of measuring success in obesity treatment is shifting from weight loss to patients' health and quality of life. The objective of this study was to select a core set of patient-reported outcomes and patient-reported outcome measures to be used in clinical obesity care. MATERIALS AND METHODS: The Standardizing Quality of Life in Obesity Treatment III, face-to-face hybrid consensus meeting, including people living with obesity as well as healthcare providers, was held in Maastricht, the Netherlands, in 2022. It was preceded by two prior multinational consensus meetings and a systematic review. RESULTS: The meeting was attended by 27 participants, representing twelve countries from five continents. The participants included healthcare providers, such as surgeons, endocrinologists, dietitians, psychologists, researchers, and people living with obesity, most of whom were involved in patient representative networks. Three patient-reported outcome measures (patient-reported outcomes) were selected: the Impact of Weight on Quality of Life-Lite (self-esteem) measure, the BODY-Q (physical function, physical symptoms, psychological function, social function, eating behavior, and body image), and the Quality of Life for Obesity Surgery questionnaire (excess skin). No patient-reported outcome measure was selected for stigma. CONCLUSION: A core set of patient-reported outcomes and patient-reported outcome measures for measuring quality of life in clinical obesity care is established incorporating patients' and experts' opinions. This set should be used as a minimum for measuring quality of life in routine clinical practice. It is essential that individual patient-reported outcome measure scores are shared with people living with obesity in order to enhance patient engagement and shared decision-making.

Modified One Anastomosis Gastric Bypass Following Sleeve Gastrectomy for Severe Reflux and Delayed Gastric Emptying: A Prospective Trial with Clinical and Physiological Outcome Measures.

BACKGROUND: Gastro-esophageal reflux (GORD) following sleeve gastrectomy (SG) is a central challenge, and precise indications for revisional surgery or the physiology have not been precisely defined. We aimed to determine whether OAGB performed for reflux post-SG (1) accelerates gastric emptying half-time, (2) reduces the frequency and severity of reflux events, and (3) improves reflux symptoms. METHODS: We undertook a prospective trial (ACTRN12616001089426). There were 22 participants who underwent measurement before and after revisional surgery with 29 optimal SG (patients with optimal outcome from their primary surgery) as controls. All participants underwent a protocolized nuclear scintigraphy, 24-h pH monitoring, and gastroscopy and completed objective questionnaires. RESULTS: Trial patients were 90.9% female, age 44.4 years. Conversion from SG to OAGB was at a median of 45.2 ± 19.6 months. Scintigraphy showed an increased rate of gastric emptying post-OAGB 34 (IQR 14) vs 24 (IQR 10.3) min, p-value 0.008, with decreased number of reflux events post-prandially (39 (IQR 13) vs 26 (IQR 7), p-value 0.001). This data correlated with the pH analysis; total acid events substantially reduced post-OAGB 58.5 (IQR 88) vs 12 (IQR 9.4) events, p-value 0.017. Endoscopic findings indicated a reduction in incidence of bile stasis 72.7% vs 40.9% post-OAGB, p-value < 0.00010. Post-OAGB, patients experienced less frequent regurgitation (12 ± 4.1 vs. 5.5 ± 3, p-value 0.012) and reflux (37.1 ± 15.7 vs. 16.8 ± 12.6, p-value 0.003). CONCLUSIONS: We found OAGB is an effective treatment for reflux associated with delayed gastric emptying post-SG. The likely mechanisms is by, an increase in the rate of gastric clearance and reduced reflux events and overall esophageal acid exposure. This suggests that some forms of post-SG reflux are driven by slower emptying of the residual stomach and are amenable to treatment with drainage above the incisura.

SPARC - A multi-disciplinary team program for retroperitoneal sarcoma: the Royal Prince Alfred Hospital and Chris O'Brien Lifehouse Collaboration.

BACKGROUND: The Royal Prince Alfred Hospital (RPAH) and Chris O'Brien Lifehouse (COBLH) established a formal Sarcoma of the Pelvic and Abdominal Retroperitoneum Collaboration (SPARC) in November 2020. An established multidisciplinary team (MDT) with the aims to centralise patient referrals and treatment, establish database and research, coordinate surgical resections is critical in improving patient outcomes and quality of life. METHODS: A prospective database was established in October 2021. Clinical, pathological and radiological data points were recorded for all patients since the inception of SPARC. Quality of Life questionnaires were included and follow-up planned regularly for 5 years. RESULTS: From November 2020 to Feb 2024, 294 new referrals were discussed at the MDT meeting. Majority were from the metropolitan area (182) followed by regional NSW (87), interstate (20) and five internationals. 141 operations were performed during this period compared to 119 operations from 2010 to November 2020 in RPAH. The inception of the SPARC program has resulted in exponential growth in operations, improving from the previous rate of 15 cases annually to 35. Liposarcomas followed by leiomyosarcomas are the most common types of sarcomas resected. The majority were extended resections (81.6%) and 22% were pelvic exenterations. Overall R0 rate is 54.6%, R1 38.3% and R2 1.4% (131 (92.9%) had R0/R1 resections. Overall complication rate is 35.5% with one in-hospital mortality. CONCLUSION: Success and expansion of a robust retroperitoneal sarcoma program requires a collaborative surgical approach, an MDT meeting, centralized referral process, and a research team in specialized tertiary institutions.

Trajectories of Physical Activity and Chronic Conditions Among Mid-Aged Women.

INTRODUCTION: Women's physical activity levels vary throughout adulthood. However, the associations between trajectories of physical activity and health outcomes have been little studied. The aim of this study was to examine the associations of physical activity trajectories with incident diabetes, hypertension, obesity, depression, and physical disability in mid-aged women. METHODS: Data were from the 1946-51 cohort of the Australian Longitudinal Study on Women's Health (n=11,611). Mailed surveys at 3-year intervals from 1998 (age 47-52) to 2019 (age 68-73) were used to collect data on physical activity and each outcome. The analyses were conducted in 2023/24. Physical activity trajectories from age 47-61 (2-4 time-points) were identified using group-based trajectory modeling. Cox regression models with time-varying covariates were used to examine the associations of physical activity trajectories with adverse health outcomes onset from ages 56-73 (2-5 time-points). RESULTS: Trajectories of physical activity were labeled as Low (59.7% of participants), Declining (5.9%), Increasing (26.3%), and High (8.1%). The median of 9-year overall physical activity (MET.minutes/week) was 450 in the Low, 1324 in the Declining, 1399 in the Increasing, and 2323 in the High group. Compared with the Low group, the risks of diabetes, obesity and physical disability were lower in the Increasing and High groups, and the risk of depression was lower in the High group. Conversely, the risk of obesity was higher in the Declining group. CONCLUSIONS: Targeting mid-aged women with declining physical activity for prevention programs could enhance health in later life.

Physical activity volume, frequency, and intensity: Associations with hypertension and obesity over 21 years in Australian women.

BACKGROUND: Optimal patterns of accrual of recommended levels of physical activity (PA) for prevention of hypertension and obesity are not known. The overall aim of this study was to investigate whether different patterns of accumulation of PA are differentially associated with hypertension and obesity in Australian women over 21 years. Specifically, we investigated whether, for the same weekly volume of PA, the number of sessions (frequency) and vigorousness of PA (intensity) were associated with a reduction in the occurrence of hypertension and obesity in women. METHODS: Data from the 1973-1978 and 1946-1951 cohorts of the Australian Longitudinal Study on Women's Health were analyzed (n = 20,588; 12%-16% with a Bachelor's or higher degree). Self-reported PA, hypertension, height, and weight were collected using mail surveys every 3 years from 1998/2000 to 2019/2021. Generalized Estimating Equation models with a 3-year lag model were used to investigate the association of PA volume (metabolic equivalent min/week) (none; 33-499; 500-999; ≥1000, weekly frequency (none; 1-2 times; 3-4 times; 5-7 times; ≥8 times), and the proportion of vigorous PA to total volume of PA (none; 0%; 1%-33%; 34%-66%; 67%-100%) with odds of hypertension and obesity from 2000 to 2021. RESULTS: The cumulative incidence of hypertension was 6% in the 1973-1978 and 23% in the 1946-1951 cohort; 27% of women in the 1973-1978; and 15% in the 1946-1951 cohort developed obesity over the period. Overall, a higher volume of PA was associated with reduced odds of hypertension and obesity. When the volume of PA was considered, the odds of hypertension did not vary according to the frequency or intensity of PA. However, increased proportion of vigorous PA to the total volume of PA was associated with a small additional reduction in the risk of obesity. CONCLUSION: PA volume appears to be more important than the pattern of accumulation for the prevention of hypertension and obesity. Incorporating more sessions, particularly of vigorous-intensity PA, may provide extra benefits for the prevention of obesity.

Physical activity across midlife and health-related quality of life in Australian women: A target trial emulation using a longitudinal cohort.

BACKGROUND: There is little long-term causal evidence on the effect of physical activity on health-related quality of life. This study aimed to examine the associations between longitudinal patterns of physical activity over 15 years and health-related quality of life in both the physical and mental health domains, in a cohort of middle-aged Australian women. METHODS AND FINDINGS: We used data collected at 3-year intervals (1998 to 2019) from 11,336 participants in the Australian Longitudinal Study on Women's Health (ALSWH) (1946 to 1951 birth cohort). Primary outcomes were the physical (PCS) and mental health component summary (MCS) scores (range from 0 to 100; higher scores indicate higher perceived physical/mental health) from the SF-36 in 2019 (when women aged 68 to 73 years). Using target trial emulation to imitate a randomized controlled trial (RCT), we tested 2 interventions: (1) meeting the World Health Organization (WHO) physical activity guidelines consistently throughout the 15-year "exposure period" (2001 to 2016; when women aged 50-55 to 65-70 years; physical activity assessed every 3 years); and (2) not meeting the guidelines at the beginning of the exposure period but starting to first meet the guidelines at age 55, 60, or 65; against the control of not meeting the guidelines throughout the exposure period. Analysis controlled for confounding using marginal structural models which were adjusted for sociodemographic and health variables and conditions. Consistent adherence to guidelines during the exposure period (PCS: 46.93 [99.5% confidence interval [CI]: 46.32, 47.54]) and first starting to meet the guidelines at age 55 (PCS: 46.96 [99.5% CI: 45.53, 48.40]) were associated with three-point higher PCS (mean score difference: 3.0 [99.5% CI: 1.8, 4.1] and 3.0 [99.5% CI:1.2, 4.8]) than consistent non-adherence (PCS: 43.90 [99.5% CI: 42.79, 45.01]). We found a similar pattern for most SF-36 subscales but no significant effects of the interventions on MCS. The main limitations of the study were that it may not account for all underlying health conditions and/or other unmeasured or insufficiently measured confounders, the use of self-reported physical activity and that findings may not be generalizable to all mid-age women. CONCLUSIONS: Results from the emulated RCT suggest women should be active throughout mid-age, ideally increasing activity levels to meet the guidelines by age 55, to gain the most benefits for physical health in later life.

Changes in neighbourhood walkability and body mass index: An analysis of residential mobility from a longitudinal multilevel study in Brisbane, Australia.

This study examined associations between changes in neighbourhood walkability and body mass index (BMI) among 1041 residents who relocated within Brisbane, Australia between 2007 and 2016 over five waves of the HABITAT study. Measures included spatially-derived neighbourhood walkability (dwelling density, street connectivity, and land use mix) and self-reported height and weight. No associations were found between any neighbourhood walkability characteristics and BMI. Examining these associations over the life course, and the impact of residential relocation in the younger years, remains a priority for future research.

Metabolic Bariatric Surgery Across the IFSO Chapters: Key Insights on the Baseline Patient Demographics, Procedure Types, and Mortality from the Eighth IFSO Global Registry Report.

INTRODUCTION: The International Federation for Surgery for Obesity and Metabolic Disorders (IFSO) Global Registry aims to provide descriptive data about the caseload and penetrance of surgery for metabolic disease and obesity in member countries. The data presented in this report represent the key findings of the eighth report of the IFSO Global Registry. METHODS: All existing Metabolic and Bariatric Surgery (MBS) registries known to IFSO were invited to contribute to the eighth report. Aggregated data was provided by each MBS registry to the team at the Australia and New Zealand Bariatric Surgery Registry (ANZBSR) and was securely stored on a Redcap™ database housed at Monash University, Melbourne, Australia. Data was checked for completeness and analyzed by the IFSO Global Registry Committee. Prior to the finalization of the report, all graphs were circulated to contributors and to the global registry committee of IFSO to ensure data accuracy. RESULTS: Data was received from 24 national and 2 regional registries, providing information on 502,150 procedures. The most performed primary MBS procedure was sleeve gastrectomy, whereas the most performed revisional MBS procedure was Roux-en-Y gastric bypass. Asian countries reported people with lower BMI undergoing MBS along with higher rates of diabetes. Mortality was a rare event. CONCLUSION: Registries enable meaningful comparisons between countries on the demographics, characteristics, operation types and approaches, and trends in MBS procedures. Reported outcomes can be seen as flags of potential issues or relationships that could be studied in more detail in specific research studies.

Emerging multi-port soft tissue robotic systems: a systematic review of clinical outcomes.

Multiple novel multi-port robotic surgical systems have been introduced into clinical practice. This systematic review aims to evaluate the clinical outcomes of these novel robotic systems to conventional laparoscopic technique and established da Vinci robotic surgical platforms. A literature search of Embase, Medline, Pubmed, Cochrane library, and Google Scholar was performed according to the PRISMA guidelines from 2012 to May 2023. Studies comparing clinical outcomes of novel multi-port robotic surgical systems with laparoscopic or the da Vinci platforms were included. Case series with no comparison groups were excluded. Descriptive statistics were used to report patient and outcome data. A systematic narrative review was provided for each outcome. Twelve studies comprised of 1142 patients were included. A total of 6 novel multi-port robotic systems: Micro Hand S, Senhance, Revo-i MSR-5000, KangDuo, Versius, and Hugo™ RAS were compared against the laparoscopic or the da Vinci robotic platforms. Clinical outcomes of these novel robotic platforms were comparable to the established da Vinci platforms. When compared against conventional laparoscopic approaches, the robotic platforms demonstrated lower volume of blood loss, shorter length of stay but longer operative time. This systematic review highlighted the safe implementation and efficacy of 6 new robotic systems. The clinical outcomes achieved by these new robotic systems are comparable to the established da Vinci robotic system in simple to moderate case complexities. There is emerging evidence that these new robotic systems provide a viable alternative to currently available robotic platforms.