Background: Laparoscopic distal pancreatectomy (LDP) is increasingly being performed as an alternative to open surgery. Whether the implementation and corresponding learning curve of LDP have an impact on patient outcome is unknown. The aim was to investigate the temporal trends in practice across UK centres. Methods: This was a retrospective multicentre observational cohort study of LDP in 11 tertiary referral centres in the UK between 2006 and 2016. The learning curve was analysed by pooling data for the first 15 consecutive patients who had LDP and examining trends in surgical outcomes in subsequent patients. Results: In total, 570 patients underwent LDP, whereas 888 underwent open resection. For LDP the median duration of operation was 240 min, with 200 ml blood loss. The conversion rate was 12⋅1 per cent. Neuroendocrine tumours (26⋅7 per cent) and mucinous cystic neoplasms (19⋅7 per cent) were commonest indications. The proportion of LDPs increased from 24⋅4 per cent in 2006-2009 (P1) to 46⋅0 per cent in 2014-2016 (P3) (P < 0⋅001). LDP was increasingly performed for patients aged 70 years or more (16 per cent in P1 versus 34⋅4 per cent in P3; P = 0⋅002), pancreatic ductal adenocarcinoma (6 versus 19⋅1 per cent; P = 0⋅005) and advanced malignant tumours (27 versus 52 per cent; P = 0⋅016). With increasing experience, there was a trend for a decrease in blood transfusion rate (14⋅1 per cent for procedures 1-15 to 3⋅5 per cent for procedures 46-75; P = 0⋅008), ICU admissions (32⋅7 to 19⋅2 per cent; P = 0⋅021) and median duration of hospital stay (7 (i.q.r. 5-9) to 6 (4-7) days; P = 0⋅002). After 30 procedures, a decrease was noted in rates of both overall morbidity (57⋅7 versus 42⋅2 per cent for procedures 16-30 versus 46-75 respectively; P = 0⋅009) and severe morbidity (18⋅8 versus 9⋅7 per cent; P = 0⋅031).Conclusion: LDP has increased as a treatment option for lesions of the distal pancreas as indications for the procedure have expanded. Perioperative outcomes improved with the number of procedures performed. * Other members of the Minimally Invasive Liver and Pancreatic Surgery Study Group -UK are co-authors of this study and can be found under the heading Collaborators

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<span>The world community relied heavily on fossils energies but just after the big oil crisis the use of renewable energy has greatly increased and has become the main interest of many countries for its many advantages such as: minimal impact on the environment, renewable generators requiring less maintenance than traditional ones and it has also a great impact on economy. It is easy to get charmed by the advantages of using the renewable resources but we must also be aware of their disadvantages. One of the major disadvantages is that the renewable energy resources are intermittent and thus they have led scientists to develop new semiconductor power converters among which are the multilevel inverter. In this paper a new smart multi-level inverter is proposed so as to increase its levels according to the user’s needs and also to avoid the impact of shades and the intermittence on photovoltaic panels. We also propose a modification on the multicarrier aiming to reduce the harmonics. This modification introduces a sinusoidal wave compared with trapezoidal multi-carrier to generate the pulses. In order to obtain the line voltages and the total harmonic distortions (THD) MATLAB/SIMULINK is used.</span>