Safety and outcomes of performing laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy at an ambulatory site of a tertiary care hospital in Ontario.

BACKGROUND: In Ontario, bariatric surgery is publicly funded and is performed only in accredited tertiary care hospitals. The purpose of our study was to report on the safety and outcomes of performing bariatric surgery at an ambulatory site of a tertiary care hospital in southern Ontario. METHODS: We conducted a retrospective cohort study of all adult (age ≥ 18 yr) patients who underwent primary laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) at the ambulatory site of our tertiary care hospital between September 2016 and August 2018. The 2 sites are 1.4 km apart. Patient demographic characteristics, duration of surgery, intraoperative and 90-day postoperative complications, number of transfers and readmission to the tertiary care hospital, and emergency department visits were collected. RESULTS: A total of 314 patients (285 women [90.8%] and 29 men [9.2%] with a mean age of 41.8 yr [standard deviation (SD) 8.9 yr]) underwent surgery: LRYGB in 295 cases (93.9%) and LSG in 19 (6.0%). The mean body mass index was 45.3 (SD 5.1), the median American Society of Anesthesiologists score was 3 (range 2-4), and the median Edmonton Obesity Staging System score was 2 (range 0-4). The mean operative time was 119.8 (SD 23.1) minutes for LRYGB and 96.2 (SD 22.0) minutes for LSG, and the mean length of stay was 2.1 (SD 0.6) days and 2.1 (SD 0.2) days, respectively. Thirteen patients (4.1%) required transfer to the tertiary care hospital for a postoperative complication. Of 312 patients, 29 (9.3%) presented to emergency department within 90 days after surgery, and 8 (2.6%) required readmission to hospital; no deaths were reported. CONCLUSION: The findings suggest that LRYGB and LSG can be performed safely at an ambulatory site of a tertiary care hospital. However, caution should be exercised in performing these procedures at an ambulatory site without a tertiary care hospital affiliation, as patients may require urgent transfer for a serious postoperative complication.

Digital approach to informed consent in bariatric surgery: a randomized controlled trial.

BACKGROUND: Informed consent is of paramount importance in surgery. Digital media can be used to enhance patient's comprehension of the proposed operation. The objective of this study was to examine the effects of adding a digital educational platform (DEP) to a standard verbal consent (SVC) for a laparoscopic Roux-en-Y gastric bypass (LRYGB) on patient's knowledge of the procedure, satisfaction with the clinical encounter and duration of the consent appointment. METHODS: This prospective non-blinded randomized controlled trial allocated 51 patients, who were candidates for a LRYGB, into DEP+SVC (intervention, n = 26) or SVC (control, n = 25) groups. Data were collected at one Bariatric Centre of Excellence (Ontario, Canada) between December 2018 and December 2019. DEP consisted of a 29-slide video-supplemented module detailing the risks, benefits, expectations and outcomes for the LRYGB. Primary outcome was knowledge about the LRYGB operation following the consent discussion. Secondary outcomes were knowledge retention, patient satisfaction, and duration of time required to obtain an informed consent. RESULTS: Baseline demographic data were equivalent between groups except for a greater proportion of male patients in the DEP+SVC group (7/19 vs 0/25; p < 0.01). Baseline procedure-specific knowledge was equivalent between the groups (72.3 ± 11.3% vs 74.7 ± 9.6%; p = 0.41). Post-consent knowledge was significantly higher in the DEP + SVC vs SVC group (85.0 ± 8.8% vs 78.7 ± 8.7%; p = 0.01; ES = 0.72). The duration of time to obtain informed consent was significantly shorter for the DEP + SVC vs SVC group (358 ± 198 sec vs 751 ± 212 sec; p < 0.01; ES = 1.92). There was no difference in knowledge retention at 4-6 weeks (84.4 ± 10.2% vs 82.9 ± 6.8%; p = 0.55) and in patient satisfaction (31.5 ± 1.1 vs 31 ± 2.7; p = 0.10). CONCLUSION: The addition of a DEP online module to a standard verbal consent for LRYGB resulted in improved patient's understanding of the procedure-specific risks and benefits, high patient satisfaction, and over 50% time savings for the bariatric surgeon conducting the consent discussion.

Automated precision alignment of optical components for hydroxide catalysis bonding.

We describe an interferometric system that can measure the alignment and separation of a polished face of a optical component and an adjacent polished surface. Accuracies achieved are ∼ 1µrad for the relative angles in two orthogonal directions and ∼ 30µm in separation. We describe the use of this readout system to automate the process of hydroxide catalysis bonding of a fused-silica component to a fused-silica baseplate. The complete alignment and bonding sequence was typically achieved in a timescale of a few minutes, followed by an initial cure of 10 minutes. A series of bonds were performed using two fluids - a simple sodium hydroxide solution and a sodium hydroxide solution with some sodium silicate solution added. In each case we achieved final bonded component angular alignment within 10 µrad and position in the critical direction within 4 µm of the planned targets. The small movements of the component during the initial bonding and curing phases were monitored. The bonds made using the sodium silicate mixture achieved their final bonded alignment over a period of ∼ 15 hours. Bonds using the simple sodium hydroxide solution achieved their final alignment in a much shorter time of a few minutes. The automated system promises to speed the manufacture of precision-aligned assemblies using hydroxide catalysis bonding by more than an order of magnitude over the more manual approach used to build the optical interferometer at the heart of the recent ESA LISA Pathfinder technology demonstrator mission. This novel approach will be key to the time-efficient and low-risk manufacture of the complex optical systems needed for the forthcoming ESA spaceborne gravitational waves observatory mission, provisionally named LISA.

Optical fiber couplers for precision spaceborne metrology.

We describe the optical and mechanical design, construction philosophy, and testing of a pair of matched, spaceflight-qualified fiber couplers. The couplers were developed for the LISA Pathfinder mission but are relevant for other applications-both on ground and in space-where a robust fiber coupler with well-controlled beam parameters and stable beam pointing is required. This particular implementation of the design called for two couplers providing collimated beams with individual waist sizes and positions. The target values were a 522 µm waist 145 mm after the collimating lens for one coupler and a virtual 520 µm waist 194 mm before the collimating lens for the second coupler. Values of (542±4) µm at (142±19) mm and (500±8) µm at (-275±8) mm were achieved, fully meeting the mission requirements. To control spurious noise effects in the interferometer, the optical system design also specified tight limits on relative beam curvature at an intended interference point. With nominal curvatures at this location of ∼2.35 m, the matching between the outputs of the two fiber couplers was measured to be λ/33 peak-valley over the central 1 mm of the beams. Results showing pointing stability of 3 µrad/°C over a 50°C range are presented. The vibration, shock, and thermal vacuum environmental testing conditions to which a pair of qualification fiber couplers were subjected-without change in performance-are listed.

Precision absolute positional measurement of laser beams.

We describe an instrument which, coupled with a suitable coordinate measuring machine, facilitates the absolute measurement within the machine frame of the propagation direction of a millimeter-scale laser beam to an accuracy of around ±4 µm in position and ±20 µrad in angle.

Construction of rugged, ultrastable optical assemblies with optical component alignment at the few microradian level.

A method for constructing quasimonolithic, precision-aligned optical assemblies is presented. Hydroxide-catalysis bonding is used, adapted to allow optimization of component fine alignment prior to the bond setting. We demonstrate the technique by bonding a fused silica mirror substrate to a fused silica baseplate. In-plane component placement at the submicrometer level is achieved, resulting in angular control of a reflected laser beam at the sub-10-µrad level. Within the context of the LISA Pathfinder mission, the technique has been demonstrated as suitable for use in space-flight applications. It is expected that there will also be applications in a wide range of areas where accuracy, stability, and strength of optical assemblies are important.

Isolated intrapetrous carotid canal atraumatic internal carotid artery dissection: MRI and digital subtraction angiography findings.

A case of spontaneous internal carotid artery (ICA) dissection confined to the intrapetrous carotid canal that was confirmed by angiography and magnetic resonance imaging is presented. Isolated dissection involving the intrapetrous ICA is rare; however, whenever arterial dissection is a consideration, specific review of imaging in this region is warranted.