Objectives: . This experimental study compared the precision and surgical outcomes of manual versus robotic electrode insertions in cochlear implantation. Methods: . The study was conducted on formalin-fixed cadaveric heads, with nine senior neurotologists performing both manual and robotic insertions. Results: . The results showed no statistically significant differences between the two methods in terms of insertion angle, cochlear coverage, or electrode coverage. However, the robotic method demonstrated a significantly slower and more controlled insertion speed (0.1 mm/sec) compared to manual insertion (0.66±0.31 mm/sec), which is crucial for minimizing intra-cochlear force and pressures. Although robotic insertions resulted in fewer complications such as tip fold-over or scala deviation, there were instances of incomplete insertion. Conclusion . The robotic system provided a consistent and controlled insertion process, potentially standardizing cochlear implant operations and reducing outcome variability. The study concludes that robotic-assisted insertion offers significant advantages in controlling insertion speed and consistency, supporting the continued development and clinical evaluation of robotic systems for cochlear implant surgery.

Objectives: . This experimental study compared the precision and surgical outcomes of manual versus robotic electrode insertions in cochlear implantation. Methods: . The study was conducted on formalin-fixed cadaveric heads, with nine senior neurotologists performing both manual and robotic insertions. Results: . The results showed no statistically significant differences between the two methods in terms of insertion angle, cochlear coverage, or electrode coverage. However, the robotic method demonstrated a significantly slower and more controlled insertion speed (0.1 mm/sec) compared to manual insertion (0.66±0.31 mm/sec), which is crucial for minimizing intra-cochlear force and pressures. Although robotic insertions resulted in fewer complications such as tip fold-over or scala deviation, there were instances of incomplete insertion. Conclusion . The robotic system provided a consistent and controlled insertion process, potentially standardizing cochlear implant operations and reducing outcome variability. The study concludes that robotic-assisted insertion offers significant advantages in controlling insertion speed and consistency, supporting the continued development and clinical evaluation of robotic systems for cochlear implant surgery.

Objectives: . This experimental study compared the precision and surgical outcomes of manual versus robotic electrode insertions in cochlear implantation. Methods: . The study was conducted on formalin-fixed cadaveric heads, with nine senior neurotologists performing both manual and robotic insertions. Results: . The results showed no statistically significant differences between the two methods in terms of insertion angle, cochlear coverage, or electrode coverage. However, the robotic method demonstrated a significantly slower and more controlled insertion speed (0.1 mm/sec) compared to manual insertion (0.66±0.31 mm/sec), which is crucial for minimizing intra-cochlear force and pressures. Although robotic insertions resulted in fewer complications such as tip fold-over or scala deviation, there were instances of incomplete insertion. Conclusion . The robotic system provided a consistent and controlled insertion process, potentially standardizing cochlear implant operations and reducing outcome variability. The study concludes that robotic-assisted insertion offers significant advantages in controlling insertion speed and consistency, supporting the continued development and clinical evaluation of robotic systems for cochlear implant surgery.

Background: Approximately 20% of patients with gallbladder stones (GS) also have common bile duct stones. This subgroup is susceptible to biliary complications, including obstructive jaundice, acute ascending cholangitis, and acute pancreatitis. Risk factors for these complications include older age, the presence of comorbidities, and the existence of multiple GS. This study was conducted to investigate whether the size of GS represents a risk factor for biliary complications. Methods: This retrospective cohort study compared two age- and sex-matched groups. The study group comprised patients who underwent endoscopic retrograde cholangiopancreatography for biliary complications, including obstructive jaundice, acute ascending cholangitis, and acute pancreatitis. The control group consisted of patients with GS who presented with non-specific symptoms and did not develop further biliary complications during long-term follow-up. Results: The study group (n = 57) exhibited smaller GS (3.93 ± 3.14 mm vs. 5.45 ± 3.64 mm, P < 0.01), a greater number of GS (8.30 ± 6.24 vs. 6.42 ± 5.63, P < 0.01), and a higher rate of gallbladder sludge (29.8% vs. 15.0%, P = 0.054) compared to the control group (n = 60). The three study subgroups—obstructive jaundice, acute ascending cholangitis, and acute pancreatitis—also displayed significantly smaller GS than the control group (4.6 ± 3.4 mm, 3.2 ± 2.9 mm, and 2.7 ± 1.1 mm vs. 5.45 ± 3.64 mm; P < 0.01, P < 0.006, and P < 0.036, respectively). Additionally, the obstructive jaundice and acute pancreatitis subgroups exhibited a higher number of GS compared to the control group (7.2 ± 6.8 and 7.4 ± 1.1 vs. 6.42 ± 5.63; P < 0.001 and P = 0.038, respectively). Conclusion Patients with biliary complications displayed smaller and more numerous GS compared to those without such complications. Given the uncertainty surrounding the referral of patients with non-specific symptoms for cholecystectomy, incorporating the size and number of GS into the decision-making process may be worthwhile. Further prospective studies are warranted in this area.

Background: Functional bowel disorders (FBDs), including irritable bowel syndrome (IBS), are common worldwide. Recently, increasingly many bariatric surgical procedures have been performed in response to rising obesity rates. However, data on the association between FBDs and bariatric surgery are scarce. We examined the prevalence of FBDs among candidates for bariatric surgery and prospectively investigated the association between FBDs and bariatric surgery. Methods: This prospective cohort study included 112 bariatric surgery candidates at the Tel Aviv Medical Center from 2019 to 2020. Before and after surgery, patients completed the Rome III questionnaire. Data regarding demographics, socioeconomic status, and gastrointestinal symptoms were recorded. The rates of FBDs—IBS, functional constipation (FC), functional diarrhea (FDi), and unspecified functional bowel disorder (UFBD)—were then compared from before surgery to 6 months after the procedure. Results: Of 112 candidates with obesity at baseline, 68 underwent surgery and completed the postoperative questionnaire. Overall, the respective prevalence rates of FBDs, IBS, FC, FDi, and UFBD were 37.5%, 2.7%, 17.9%, 5.4%, and 11.6%. Female sex and single status were particularly common among patients with FBDs, whereas divorced status was more frequent in the group without FBDs. However, these factors were not independently associated with FBD presence upon multivariable analysis. IBS was more prevalent after surgery than before (8.8% vs. 1.5%, P = 0.06), but FBDs in general did not share this trend (44.1% vs. 36.8%, P = 0.44). Conclusion Bariatric surgery appears to increase the risk of developing IBS, while not impacting the overall risk of FBDs.

Background: Approximately 20% of patients with gallbladder stones (GS) also have common bile duct stones. This subgroup is susceptible to biliary complications, including obstructive jaundice, acute ascending cholangitis, and acute pancreatitis. Risk factors for these complications include older age, the presence of comorbidities, and the existence of multiple GS. This study was conducted to investigate whether the size of GS represents a risk factor for biliary complications. Methods: This retrospective cohort study compared two age- and sex-matched groups. The study group comprised patients who underwent endoscopic retrograde cholangiopancreatography for biliary complications, including obstructive jaundice, acute ascending cholangitis, and acute pancreatitis. The control group consisted of patients with GS who presented with non-specific symptoms and did not develop further biliary complications during long-term follow-up. Results: The study group (n = 57) exhibited smaller GS (3.93 ± 3.14 mm vs. 5.45 ± 3.64 mm, P < 0.01), a greater number of GS (8.30 ± 6.24 vs. 6.42 ± 5.63, P < 0.01), and a higher rate of gallbladder sludge (29.8% vs. 15.0%, P = 0.054) compared to the control group (n = 60). The three study subgroups—obstructive jaundice, acute ascending cholangitis, and acute pancreatitis—also displayed significantly smaller GS than the control group (4.6 ± 3.4 mm, 3.2 ± 2.9 mm, and 2.7 ± 1.1 mm vs. 5.45 ± 3.64 mm; P < 0.01, P < 0.006, and P < 0.036, respectively). Additionally, the obstructive jaundice and acute pancreatitis subgroups exhibited a higher number of GS compared to the control group (7.2 ± 6.8 and 7.4 ± 1.1 vs. 6.42 ± 5.63; P < 0.001 and P = 0.038, respectively). Conclusion Patients with biliary complications displayed smaller and more numerous GS compared to those without such complications. Given the uncertainty surrounding the referral of patients with non-specific symptoms for cholecystectomy, incorporating the size and number of GS into the decision-making process may be worthwhile. Further prospective studies are warranted in this area.

Background: Functional bowel disorders (FBDs), including irritable bowel syndrome (IBS), are common worldwide. Recently, increasingly many bariatric surgical procedures have been performed in response to rising obesity rates. However, data on the association between FBDs and bariatric surgery are scarce. We examined the prevalence of FBDs among candidates for bariatric surgery and prospectively investigated the association between FBDs and bariatric surgery. Methods: This prospective cohort study included 112 bariatric surgery candidates at the Tel Aviv Medical Center from 2019 to 2020. Before and after surgery, patients completed the Rome III questionnaire. Data regarding demographics, socioeconomic status, and gastrointestinal symptoms were recorded. The rates of FBDs—IBS, functional constipation (FC), functional diarrhea (FDi), and unspecified functional bowel disorder (UFBD)—were then compared from before surgery to 6 months after the procedure. Results: Of 112 candidates with obesity at baseline, 68 underwent surgery and completed the postoperative questionnaire. Overall, the respective prevalence rates of FBDs, IBS, FC, FDi, and UFBD were 37.5%, 2.7%, 17.9%, 5.4%, and 11.6%. Female sex and single status were particularly common among patients with FBDs, whereas divorced status was more frequent in the group without FBDs. However, these factors were not independently associated with FBD presence upon multivariable analysis. IBS was more prevalent after surgery than before (8.8% vs. 1.5%, P = 0.06), but FBDs in general did not share this trend (44.1% vs. 36.8%, P = 0.44). Conclusion Bariatric surgery appears to increase the risk of developing IBS, while not impacting the overall risk of FBDs.