Adult mice communicate by emitting ultrasonic vocalizations (USVs) during the appetitive phases of sexual behavior. However, little is known about the genes important in controlling call production. Here, we study the induction and regulation of USVs in muscarinic and dopaminergic receptor knockout (KO) mice as well as wild-type controls during sexual behavior. Female mouse urine, but not female rat or human urine, induced USVs in male mice, whereas male urine did not induce USVs in females. Direct contact of males with females is required for eliciting high level of USVs in males. USVs (25 to120 kHz) were emitted only by males, suggesting positive state; however human-audible squeaks were produced only by females, implying negative state during male-female pairing. USVs were divided into flat and frequency-modulated calls. Male USVs often changed from continuous to broken frequency-modulated calls after initiation of mounting. In M2 KO mice, USVs were lost in about 70–80% of the mice, correlating with a loss of sexual interaction. In M5 KO mice, mean USVs were reduced by almost 80% even though sexual interaction was vigorous. In D2 KOs, the duration of USVs was extended by 20%. In M4 KOs, no significant differences were observed. Amphetamine dose-dependently induced USVs in wild-type males (most at 0.5 mg/kg i.p.), but did not elicit USVs in M5 KO or female mice. These studies suggest that M2 and M5 muscarinic receptors are needed for male USV production during male-female interactions, likely via their roles in dopamine activation. These findings are important for the understanding of the neural substrates for positive affect.

PAAL leads to longer hospital stays, and approximately 4.8% of patients undergoing pulmonary resection experience PAAL that necessitates placement of additional chest drains, bronchoscopy, reoperation, or life support. Further study is required to assess the cost-effectiveness of measures to reduce PAAL.

Functional outcomes are inconsistently assessed and reported and require common definitions, and the more regular use of validated assessment tools, as well. Preoperative radiation and, in particular, short-course radiation may be a strong risk factor for incontinence; however, further studies are needed.

The application of minimally invasive approaches to pancreatic resection for benign and malignant diseases has been growing in the last two decades. Studies have demonstrated that laparoscopic distal pancreatectomy (LDP) is feasible and safe, and many of them show that compared to open distal pancreatectomy, LDP has decreased blood loss and length of hospital stay, and equivalent post-operative complication rates and shortterm oncologic outcomes. LDP is becoming the procedure of choice for benign or small low-grade malignant lesions in the distal pancreas. Minimally invasive pancreaticoduodenectomy (MIPD) has not yet been widely adopted. There is no clear evidence in favor of MIPD over open pancreaticoduodenectomy in operative time, blood loss, length of stay or rate of complications. Robotic surgery has recently been applied to pancreatectomy, and many of the advantages of laparoscopy over open surgery have been observed in robotic surgery. Laparoscopic enucleation is considered safe for patients with small, benign or low-grade malignant lesions of the pancreas that is amenable to parenchyma-preserving procedure. As surgeons' experience with advanced laparoscopic and robotic skills has been growing around the world, new innovations and breakthrough in minimally invasive pancreatic procedures will evolve. Key words: Laparoscopy; Distal pancreatectomy; Pancreaticoduodenectomy; Robotic pancreatectomy; Enucleation Core tip: This review discusses recent advances in laparoscopic distal pancreatectomy (LDP), minimally invasive pancreaticoduodenectomy (MIPD), and enucleation. Recent studies show that LDP have improved perioperative recovery and equivalent oncologic outcomes. Studies on MIPD demonstrate that it is safe in terms of intra-operative outcomes, post-operative recovery and early oncologic outcomes; however, it requires advanced laparoscopic skills. Laparoscopic enucleation has become the operation of choice for small benign tumours that are away from the main pancreatic duct, especially insulinomas. We also summarize key results in pre-operative, perioperative and post-operative outcomes from contemporary series comparing open and laparoscopic pancreatic resections in the tables.

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MIPD and OPD had similar safety and cost in this introductory series. However, a trend toward a higher rate of re-operation for pancreatic leak suggests the need for caution in introducing this novel technique.

LLDP is a feasible and safe approach for distal lesions of the pancreatic tail, associated with shorter operative time and decreased blood loss compared to traditional MLDP. Potential of decreased conversion rate and length of stay exists. These hypotheses need to be confirmed in larger prospective studies.

The Society of Thoracic Surgeons General Thoracic Surgery Database (STS GTSD) Task Force has proposed a composite performance measure to evaluate quality of care delivered to patients undergoing esophagectomy for esophageal cancer (1). The Task Force summarized c l i n i c a l d a t a f r o m G T S D v e r s i o n 2. 2 b e t w e e n January 01, 2012 to December 31, 2014 for the participating programs, and compared them to the National Inpatient Sample (NIS). The methodology parallels that of the previous STS composite measures for lobectomy for lung cancer (2) and aortic valve replacement (3). In contrast to composite measures derived from administrative data, such as the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP), the STS GTSD uses prospectively collected, externally audited clinical data from voluntary participants. It captures non-fatal complications and risk-adjusted outcomes, which are important for low-volume complex operations like esophagectomy, where comparisons are adjusted for comorbidities. The authors have proposed using the composite score to assign a program quality rating based on a 3-tiered "star" rating system. In calculating the composite score, operative mortality is defined in the GTSD as death occurring at discharge or within 30 days of operation. It is weighted four times greater than complications, such as unexpected return to operating room, anastomosis requiring medical or surgical treatment, reintubation, initial ventilator support >48 hours, pneumonia, renal failure and recurrent