Perioperative and functional outcomes following robot-assisted partial nephrectomy: Descriptive analysis of Indian study group on partial nephrectomy database.

Introduction: There is an unmet need for high-quality data for Robot-assisted partial nephrectomy (RAPN) in the Indian population. Indian study group on partial nephrectomy (ISGPN) is a consortium of Indian centers contributing to the partial nephrectomy (PN) database. The current study is a descriptive analysis of perioperative and functional outcomes following RAPN. Methods: For this study, the retrospective ISGPN database was reviewed, which included patients who underwent RAPN for renal masses at 14 centers across India from September 2010 to September 2022. Demographic, clinical, radiological, perioperative, and functional data were collected and analyzed. Ethics approval was obtained from each of the participating centers. Results: In this study, 782 patients were included, and 69.7% were male. The median age was 53 years (interquartile range [IQR 44-62]), median operative time was 180 min (IQR 133-240), median estimated blood loss was 100 mL (IQR 50-200), mean warm ischemia time was 22.7 min and positive surgical margin rates were 2.5%. The complication rate was 16.2%, and most of them were of minor grade. Trifecta and pentafecta outcomes were attained in 61.4% and 60% of patients, respectively. Conclusions: This is the largest Indian multi-centric study using the Indian Robotic PN Collaborative database to evaluate the outcomes of robot-assisted PN, and has proven its safety and efficacy in the management of renal masses.

Surface plasmon-enhanced solution-processed phosphorescent organic light-emitting diodes by incorporating gold nanoparticles.

Organic light-emitting diodes (OLEDs) have attracted increasing attention due to their superiority as high quality displays and energy-saving lighting. However, improving the efficiency of solution-processed devices especially based on blue emitter remains a challenge. Excitation of surface plasmons on metallic nanoparticles has potential for increasing the absorption and emission from optoelectronic devices. We demonstrate here that the incorporation of gold nano particles (GNPs) in the hole injection layer of poly(3,4-ethylene dioxythiophene):polystyrene sulfonic acid with an appropriate size and doping concentration can greatly enhance the efficiency OLED device especially at higher voltage. Apparently, the spectral of the multiple plasmon resonances of the GNPs and the luminescence of the emitting materials significantly overlap with each other. At 1000 cd m-2 for example, the power efficiency of a studied green device is increased from 29.0 to 36.2 lm W-1, an increment of 24.8%, and the maximum brightness improved from 21 550 to 27 810  cd m-2, an increment of 29.1%, as 2 wt% of a 12 nm GNP is incorporated. Remarkably, designed blue OLED also exhibited an increment of 50% and 35% in power efficacy at 100 and 1000 cd m-2, respectively, for same device structure. The reason why the enhancement is marked may be attributed to a strong absorption of the short-wavelength emission from the device by the gold nano particles, which in turn initiates a strong surface plasmon resonance effect, leading to a high device efficiency.

Superselective vesical artery embolization in the management of intractable hematuria secondary to hemorrhagic cystitis.

PURPOSE: To evaluate the efficacy and outcome of superselective vesical arterial embolization in the management of severe intractable hematuria secondary to hemorrhagic cystitis. MATERIALS AND METHODS: We retrospectively reviewed the medical records of nine patients with severe intractable hematuria treated with superselective vesical artery embolization at our institution between March 2003 and February 2015. There were six males and three females with a mean age of 56.1 years. Seven patients had transitional cell carcinoma (TCC) of urinary bladder and had undergone transurethral resection of bladder tumor and pelvic radiotherapy. One patient had synchronous renal pelvis and bladder TCC. One patient had aortoarteritis and was receiving cyclophosphamide therapy and another patient had carcinoma cervix post-pelvic radiotherapy. Following the failure of conservative management, superselective vesical artery catheterization and embolization was performed with 300-500-µ PVA particles in all patients. Coil embolization of inferior gluteal artery followed by particle embolization of vesical arteries was done in one patient in whom superior, inferior vesical and inferior gluteal arteries were arising as a trifurcation. RESULTS: The technical success rate was 100% with complete cessation of hematuria within 48 h in all patients. No significant complications were noted, except for post-embolization syndrome in one patient, which improved on symptomatic treatment. During a mean follow-up period of 14.45 months (ranging from 3-28 months), one patient had mild recurrent hematuria (at 2 months) which resolved spontaneously. CONCLUSIONS: Superselective vesical artery embolization is a safe and effective procedure in controlling intractable life-threatening hematuria in a select group of patients who have failed conventional treatment protocols. This procedure may be considered as the treatment of choice since it usually obviates the need for emergency surgery in these severely ill patients.

Synthesis of Solution-Processable Donor-Acceptor Pyranone Dyads for White Organic Light-Emitting Devices.

A series of donor-acceptor pyranones (3a-m, 4a-h) were synthesized using α-oxo-ketene- S, S-acetal as the synthon for their application as emissive materials for energy-saving organic light-emitting devices (OLEDs). Among them, five pyranones 3f, 3g, 3h, 3m, and 4e exhibited highly bright fluorescence in the solid state and weak or no emission in the solution state. Photophysical analysis of these dyes revealed that only 3f and 3m showed aggregation-induced emission behavior in a THF/water mixture (0-99%) with varying water fractions ( fw) leading to bright fluorescence covering the entire visible region, while other derivatives 3g, 3h, and 4e did not show any fluorescence signal. The computational studies of the compounds revealed that the longer wavelength absorption originates from HOMO to LUMO electronic excitation. These dyes exhibited good thermal stability with 5% weight loss temperature in the range of 218-347 °C. The potential application of the donor-acceptor pyranone dyads was demonstrated by fabrication of solution-processed OLEDs. Remarkably, OLED devices prepared using highly emissive compounds 6-(anthracen-9-yl)-4-(methylthio)-2-oxo-2 H-pyran-3-carbonitrile (3m) and 6-(4-methoxyphenyl)-4-(methylthio)-2-oxo-2 H-pyran-3-carbonitrile (3f) displayed pure white emission with CIE coordinates of (0.29, 0.31) and (0.32, 0.32), respectively. Additionally, the resultant devices exhibited external quantum efficiencies of 1.9 and 1.2% at 100 cd m-2, respectively.

Impact of learning curve on the perioperative outcomes following robot-assisted partial nephrectomy for renal tumors.

INTRODUCTION: Robot-assisted partial nephrectomy (RAPN) is an established, minimally invasive technique to treat patients with renal masses. The aim of this study was to assess the learning curve (LC) of RAPN, evaluate its impact on perioperative outcomes following RAPN and to study the role of surgeon experience in achieving "trifecta" outcomes following RAPN. METHODS: We prospectively analyzed the clinical and pathological outcomes of 108 consecutive patients who underwent RAPN for renal tumors from January 2012 to December 2016 by a laparoscopy trained surgeon with no prior robotic experience. We used warm ischemia time (WIT) <20 min, operative time <120 min, and blood loss <100 ml as endpoints for plotting the LCs. Trifecta was analyzed in relation to our LC. RESULTS: Surgeon experience was found to correlate with WIT, operative time, and blood loss. Overall 18.5% of patients developed complications. Complication rate reduced with increasing surgeon experience. LC was 44 cases for WIT ≤20 min, 44 cases for operative time <120 min, and 54 cases for blood loss <100 ml. Trifecta outcome was achieved in 67.6% patients overall and was found to correlate with increasing surgeon experience. Improvement in trifecta outcomes continued to occur beyond the LC. CONCLUSIONS: RAPN is a viable option for nephron-sparing surgery in patients with renal carcinoma. For a surgeon trained in laparoscopy, acceptable perioperative outcomes following RAPN can be achieved after an LC of about 44 cases. Increasing surgeon experience was associated with improved "trifecta" achievement following RAPN.

Transperitoneal laparoscopic left versus right live donor nephrectomy: Comparison of outcomes.

INTRODUCTION: Although laparoscopic donor nephrectomy (LDN) is being performed at many centers, there are reservations on the routine use of laparoscopy for harvesting the right kidney due to a perception of technical complexity and increased incidence of allograft failure, renal vein thrombosis and the need for more back-table reconstruction along with increased operative time. MATERIALS AND METHODS: We performed a prospective non-randomized comparison of transperitoneal laparoscopic left donor nephrectomy (LLDN) with laparoscopic right donor nephrectomy (RLDN) from August 2008 to May 2013. The operative time, warm ischemia time, intraoperative events, blood loss and post-operative parameters were recorded. The renal recipient parameters, including post-operative creatinine, episodes of acute tubular necrosis (ATN)  and delayed graft function were also recorded. RESULTS: A total of 188 LDN were performed between August 2008 and May 2013, including 164 LLDN and 24 RLDN. The demographic characteristics between the two groups were comparable. The operative duration was in favor of the right donor group, while warm ischemia time, estimated blood loss and mean length of hospital stay were similar between the two groups. Overall renal functional outcomes were comparable between the two donor groups, while the recipient outcomes including creatinine at discharge were also comparable. CONCLUSIONS: RLDN has a safety profile comparable with LLDN, even in those with complex vascular anatomy, and can be successfully performed by the transperitoneal route with no added morbidity. RLDN requires lesser operative time with comparable morbidity.

Corrigendum to "RPN (Radius, Position of tumour, iNvasion of renal sinus) Classification and Nephrometry Scoring System: An Internationally Developed Clinical Classification To Describe the Surgical Difficulty for Renal Masses for Which Robotic Partial Nephrectomy Is Planned" [Eur. Urol. Open Sci. 54 (2023) 33-42].

[This corrects the article DOI: 10.1016/j.euros.2023.05.007.].

Single incision laparoscopic distal pancreatectomy with splenectomy for neuroendocrine tumor of the tail of pancreas.

Laparoscopic resection is becoming the standard of care for tumors located in the body and tail of pancreas. We herein report a patient with neuroendocrine tumor in the tail of pancreas who underwent single incision laparoscopic distal pancreatectomy with splenectomy without the use of a commercial port device.

Cyanoacrylate Glue Masquerading as an Obstructive Calculus: Rare Sequelae of Angioembolization for Renal Pseudoaneurysm.

Renal pseudoaneurysm is a well-known albeit rare vascular complication following renal trauma, percutaneous interventions, renal biopsy, and partial nephrectomy. Angioembolization has become an effective treatment option for pseudoaneurysm using Cyanoacrylate glue, Gel-foams, Micro-coils, polyvinyl alcohol, etc. We herein present a 20-year-old gentleman with infected left hydroureteronephrosis secondary to an impacted foreign body in a ureter, specifically, down-migrated cyanoacrylate glue. This is two weeks following glue angioembolization for a left upper polar segmental renal artery pseudoaneurysm secondary to stab injury. He underwent a successful left-side ureteroscopic extraction of this polymerized glue, following which his symptoms subsided. These complications of glue migration following angioembolization are infrequent, and reports of it are scarce in the literature. Stringent follow-up and timely intervention are essential to mitigate disastrous outcomes.

High-Throughput Virtual Screening of Host Materials and Rational Device Engineering for Highly Efficient Solution-Processed Organic Light-Emitting Diodes.

The appropriate choice of host and electron-transporting material (ETM) plays a very crucial role in the generation and collection of radiative excitons in the desired recombination zone of organic light-emitting diodes (OLEDs). Due to the sustainable development of material organic chemistry, there is a big library of functional materials that leads to uncountable combinations of device structures, which might achieve a desirable high device performance. However, there is no appropriate methodology available for the fast virtual screening of organic materials and designing a suitable device structure. Here, we have used the electrical software package SETFOS 4.5 for high-throughput virtual screening of host materials and developed a highly efficient multistack OLED device structure. To further enhance the device performance, a co-host approach has been used, and the final device structure has also been optimized with two different ETMs. The best-optimized Ir(ppy)3-based solution-processed green OLED device exhibited a maximum power efficiency (PE) of 83.20 lm/W and brightness of 61,362 cd/m2 with a driving voltage of 2.1 V without using any light extraction outcoupling techniques, which is the best among the OLEDs in its own category. The developed device structure has also been utilized to fabricate highly efficient blue hazard-free low-color temperature OLEDs for a physiologically friendly light at night. The resultant 2083 K OLED device displayed a maximum PE of 51.4 lm/W and luminance of 44,548 cd/m2 with a turn-on voltage of 2.1 V that is also 42 and 104 times safer in terms of retinal protection and ∼4 and ∼11 times safer in terms of melatonin generation when compared with those of a real candle and incandescent bulb, respectively. The observed excellent device performance may be attributed to the balanced charge carrier in the recombination zone, broader emissive layer due to a mixed-host system, less accumulation of charges at the injecting surfaces, well-aligned triplet energy and molecular orbital energy level of the host and guest, and high electron mobility and enhanced hole blocking ability of the employed ETM in the designed OLED device structure.

Urethrocutaneous fistula after hypospadias repair: outcome of three types of closure techniques.

OBJECTIVE: To evaluate the outcomes of three surgical techniques for the closure of urethrocutaneous fistula (UCF) after hypospadias repair. MATERIALS AND METHODS: Fifty-one patients (mean age 6.5 years) who underwent UCF closure between June 1998 and February 2008 were divided in to three groups depending on fistula size; group I had <2 mm and (n = 17, 33.4%), group II had 2-4 mm (n = 21, 41.2%) and group III had >4 mm or multiple fistulas (n = 13, 25.4%). Group I patients were treated by excision and simple closure. Patients in group II and III were treated with flip flap technique along with the wrapping of repaired area with scrotal dartos flap and tunneled tunica vaginalis flap (TVF), respectively. RESULTS: Mean surgical time was 45 min (range 30-55), 60 min (range 50-75) and 80 min (range 60-100) in three techniques, respectively. The mean follow-up was 3.5 years (range 6 months-10 years). No patient had recurrence of fistula in group III, while 2 (9.5%) and 4 (25.4%) patients in groups II and I, respectively, had recurrent UCF. No postoperative complications were encountered in the testis or the scrotum. No patient had torsion or deviation of penis. CONCLUSION: Simple fistula closure carries a higher risk of recurrence even in small sized fistulas. The application of scrotal dartos or TVF for wrapping the repaired area gives excellent results and they are easy to harvest with no harmful effects on the scrotum or testis.

Approaches for Long Lifetime Organic Light Emitting Diodes.

Organic light emitting diodes (OLEDs) have been well known for their potential usage in the lighting and display industry. The device efficiency and lifetime have improved considerably in the last three decades. However, for commercial applications, operational lifetime still lies as one of the looming challenges. In this review paper, an in-depth description of the various factors which affect OLED lifetime, and the related solutions is attempted to be consolidated. Notably, all the known intrinsic and extrinsic degradation phenomena and failure mechanisms, which include the presence of dark spot, high heat during device operation, substrate fracture, downgrading luminance, moisture attack, oxidation, corrosion, electron induced migrations, photochemical degradation, electrochemical degradation, electric breakdown, thermomechanical failures, thermal breakdown/degradation, and presence of impurities within the materials and evaporator chamber are reviewed. Light is also shed on the materials and device structures which are developed in order to obtain along with developed materials and device structures to obtain stable devices. It is believed that the theme of this report, summarizing the knowledge of mechanisms allied with OLED degradation, would be contributory in developing better-quality OLED materials and, accordingly, longer lifespan devices.

Role of Molecular Orbital Energy Levels in OLED Performance.

Abundant molecules enable countless combinations of device architecture that might achieve the desirable high efficiency from organic light-emitting diodes (OLEDs). Due to the relatively high cost of OLED materials and facilities, simulation approaches have become a must in further advancing the field faster and saver. We have demonstrated here the use of state-of-art simulation approaches to investigate the effect of molecular orbital energy levels on the recombination of excitons in OLED devices. The devices studied are composed of 1,1-bis[(di-4-tolylamino)phenyl]cyclohexane (TAPC) as hole transporting material (HTM), 4,4'-Bis(9-carbazolyl)-1,1'-biphenyl (CBP) as host, 2,2',2"-(1,3,5-benzinetriyl)-tris(1-phenyl-1-H-benzimidazole) (TPBi) or bathophenanthroline (Bphen) as electron transporting materials. The outcomes reveal that exciton recombination highly sensitive to the energy-level alignment, injection barriers, and charge mobilities. A low energy-barrier (<0.4 eV) between the layers is the key to yield high recombination. The lowest unoccupied molecular orbital (LUMO) levels of the organic layers have played a more pivotal role in governing the recombination dynamics than the highest occupied molecular orbital (HOMO) level do. Furthermore, the Bphen based device shows high exciton recombination across the emissive layer, which is >106 times greater than that in the TPBi based device. The high carrier mobility of Bphen whose electron mobility is 5.2 × 10-4 cm2 V-1 s-1 may lead to low charge accumulation and hence high exciton dynamics. The current study has successfully projected an in-depth analysis on the suitable energy-level alignments, which would further help to streamline future endeavours in developing efficient organic compounds and designing devices with superior performance.

The optimum approach for pre-transplant bilateral nephrectomy in small kidneys: dorsal lumbotomy vs laparoscopy.

OBJECTIVE: To evaluate the outcomes of bilateral pretransplant nephrectomy (BPN) for small kidneys, using a bilateral dorsal lumbotomy (BDL) or transperitoneal laparoscopy (TL) approach. PATIENTS AND METHODS: Fifty-eight patients with end-stage renal disease and small kidneys underwent BPN for various indications, most commonly uncontrolled hypertension. There were 38 patients in the BDL group (group 1) and 20 in the TL group (group 2). The variables before and during surgery, and the outcomes afterward, were compared between the groups. RESULTS: The mean age of the patients and male/female ratio were comparable in both groups. The mean size of the kidneys removed were 7.4 and 8.2 cm, respectively, in groups 1 and 2. The mean (range) operative duration was longer in group 2, at 210 (160-240) min, than in group 1, at 112 (90-150) min (P < 0.001). The postoperative analgesic requirement for pain, blood transfusion rate, wound and pulmonary complications were similar between the groups. Bowel function recovered earlier in group 1 than group 2 (19 vs 37 h, P < 0.001). The total cost for the nephrectomy in group 2 was 3.5 times that of group 1. The mean interval between nephrectomy and transplantation was similar in both groups. CONCLUSION: BDL appears to be better than TL for BPN in small kidneys because the surgery is quicker, and there is earlier bowel recovery and lower costs.

Laparoscopic radical nephrectomy: a journey from T1 to very large T2 tumors.

OBJECTIVES: To evaluate the feasibility, efficacy and safety of laparoscopic radical nephrectomy (LRN) in T1 and T2 renal tumors. PATIENTS AND METHODS: From December 1999 to March 2007, a retrospective analysis of 102 patients was done. A thorough preoperative workup was done in all patients. Postoperatively the patients were followed up every 3 months for the first year, 6-monthly for the next 2 years and yearly thereafter. RESULTS: Transperitoneal radical nephrectomy was done in 85 patients, whereas 7 patients had a retroperitoneal surgery. A combined approach of retroperitoneal renal artery clipping followed by transperitoneal nephrectomy was done in 10 patients. 72 patients had clinically T1 tumors and 30 patients were T2 tumors. Mean tumor size was 6.97 cm, mean operative time was 174 min, mean blood loss was 230 ml, mean hospital stay was 4.6 days, and mean incision length was 8 cm. 19 patients had conversion to open surgery. Mean follow-up was 22.6 (range 4-56) months. Overall recurrence-free survival was 88.1%. CONCLUSIONS: LRN is a safe and effective treatment for renal tumors with a steep learning curve. Large right-sided T2 tumors can be safely treated with the combined approach. Disease control rates with LRN are satisfactory.

Laparoscopic pyeloplasty: a versatile alternative to open pyeloplasty.

OBJECTIVE: To report the safety, efficacy and versatility of laparoscopic pyeloplasty (LPP) in treatment of pelviureteric junction obstruction (PUJO). PATIENTS AND METHODS: From January 2002 to November 2006, 185 patients (186 units; 182 with primary and 4 with secondary PUJO) underwent LPP (transperitoneal approach in 184; retroperitoneal approach in 2). A double J stent was placed antegradely in 121 (68.4%) units, cystoscopically in 50 units (28.2%), and 6 units (3.4%) were stentless. Patients were followed up clinically, with additional diuretic renogram. RESULTS: Surgery was completed laparoscopically in 177 units, and conversion was required in 9 (4.8%) units. Pyeloplasty was dismembered in 143 units, Foley YV plasty in 26 units, and Fenger pyeloplasty in 8 units. The median estimated blood loss, operative time and hospital stay were 50 ml, 180 min and 4 days, respectively. Overall, 18 (9.6%) patients had complications. Improvements in drainage patterns of 167 out of 177 units (94.3%) were shown on a renal scan at a median follow-up of 39 months (range: 3-63 months). CONCLUSION: LPP is a safe, effective and versatile method for treatment of PUJO, which is applicable to all age groups, even in the presence of secondary stones, crossing vessels and secondary PUJO.

The routine use of prostate-specific antigen for early detection of cancer prostate in India: Is it justified?

BACKGROUND: The use of prostate-specific antigen (PSA) for early detection of prostate cancer is a widely debated issue. The average Indian urologist is faced with the dilemma of whether PSA testing should be routinely offered to men over 50 years of age. The Urological Society of India is yet to issue any guidelines on PSA testing. This article attempts to explore scientific evidence dealing with this controversial subject. MATERIALS AND METHODS: A MEDLINE search was performed using the words 'PSA screening', 'prostate cancer statistics', and 'PSA screening guidelines'. The relevant articles were then analysed for evidence regarding the utility of PSA screening. RESULTS: Prostate cancer does not qualify to be categorized as a major health problem in India. The natural history of screen-detected cancer is not known. Prostate-specific antigen testing for early detection of prostate cancer has questionable benefits and has a potential to cause harm to asymptomatic individuals. There is no consensus amongst learned medical societies as to what should be the best approach for PSA testing. Most organizations caution against widespread PSA screening and emphasize on informed consent and patient counseling with regard to PSA testing. Randomized prospective trials are ongoing to assess to the true impact of screening on prostate cancer mortality. CONCLUSIONS: There is no scientific rationale to advocate routine use of PSA for early detection of prostate cancer in Indian males. Results of randomized screening trials are awaited to clarify on this issue.

Minimal invasive treatment of ureteropelvic junction obstruction in low volume pelvis: A comparative study of endopyelotomy and laparoscopic nondismembered pyeloplasty.

OBJECTIVE: To evaluate the role of nondismembered laparoscopic pyeloplasty and percutaneous endopyelotomy for ureteropelvic junction obstruction (UPJO) with low volume renal pelvis. MATERIAL AND METHODS: Retrospective acquired data of 34 patients of laparoscopic nondismembered pyeloplasty was compared with 26 patients of UPJO with pelvic volume less than 50 ml undergoing antegrade endopyelotomy and analyzed for clinical parameters, operative outcomes and success of procedures. All patients were followed up clinically and with diuretic renogram at regular intervals. RESULTS: Mean age, renal pelvic volume and preoperative glomerular filtration rate (GFR) was 25 years, 43.6 ml and 42.5 ml/min, respectively in endopyelotomy group and 21 years, 34.4 ml and 39.9 ml/min, respectively in laparoscopic pyeloplasty group. Mean operative time, postoperative analgesic requirement and mean hospital stay was 100min, 250 mg and 4 days, respectively in endopyelotomy group and 210 min, 300 mg and 4 days, respectively in laparoscopic pyeloplasty group. Only operative time was significantly different between two groups (P < 0.05). Mean follow-up was 36 and 39 months and success rates were 91.2% and 88.8% in laparoscopy and endopyelotomy group, respectively (P < 0.05). No significant complication was seen in endopyelotomy group while two patients had hematuria (one requiring blood transfusion) and three had increased drain output for more than 3 days in laparoscopy group. CONCLUSION: Percutaneous endopyelotomy is associated with significantly less operative time and postoperative complication rate and provides equivalent success in comparison to nondismembered laparoscopic pyeloplasty in patients with UPJO and low volume pelvis. It can be a preferred minimally invasive treatment modality for such patients.

Closure versus nonclosure of buccal mucosal graft harvest site: A prospective randomized study on post operative morbidity.

OBJECTIVE: To prospectively compare the postoperative morbidity of closure versus non closure of the buccal mucosal graft (BMG) harvest site. METHODS: Patients who underwent BMG harvest for urethroplasty were randomized into 2 groups; in group 1 donor site was closed and in group 2 it was left open. Self made questionnaires were used to assess post-operative pain, limitation to mouth opening, loss of sensation at graft site. The time to resumption of liquid and solid diet were also noted. RESULTS: Fifty patients were studied, 25 in each group from July 2003 to July 2005. BMG was harvested from single cheek in most of the patients. Mean post operative pain score was 4.20 and 3.08 at day 1 in group 1 and group 2, respectively (P < 0.05). Return to oral intake in terms of liquid and solid diet was comparable between the groups. Difficulty with mouth opening was maximal during the first week with no difference among the two groups. Two patients in group 1 and one in group 2 had persistent peri-oral numbness at 6 months. None of the patients in both the groups had changes in salivation or retention cysts. CONCLUSION: Pain appears to be worse in the immediate post operative period with suturing of the harvest site. There is no difference in long term morbidity whether the graft site is closed or left open. It may be best to leave buccal mucosa harvest sites unsutured.