Transvaginal MA-NOS radical sigmoidectomy is a feasible and oncologically safe procedure. MA-NOS is a realistic option for avoiding the need of assisting incisions and related morbidity in the laparoscopic resection of large intra-abdominal lesions. Combined hybrid laparoscopic NOS in humans (MA-NOS) currently provides a safe and reliable way of defining future clinical applications and advantages of NOS and NOTES. Additionally, it stimulates the active development and evaluation of the underpinning technologies and instrumentation.

Transvaginal hybrid MA-NOS sleeve gastrectomy is both feasible and safe. The hybrid technique ensured safety during the performance of the procedure. MA-NOS is a potential option to avoid abdominal incisions and related complications for the laparoscopic resection of large intra-abdominal organs. Combined hybrid laparoscopic NOS for humans is currently a safe and reliable approach for major surgery through the NOS approach in female patients. Hybrid surgery allows controlled implementation of NOS techniques in clinical practice, providing a stepwise progression to the pure NOS approach once the appropriate technology has been developed. Additionally, it is the best way to stimulate the active development and evaluation of the underpinning technologies and instruments for these novel endoscopic surgical approaches. Appropriate clinical indications for these new procedures are yet to be defined. LSG is associated with short-term excess weight loss and resolution of comorbidities comparable to those obtained with other restrictive procedures. The performance of sleeve gastrectomy is an option in selected patients undergoing bariatric surgical treatment, particularly in the super obese and those who are considered high risk because of comorbid disease.

Purpose – The purpose of this paper is to provide new evidence about the technical efficiency and its determinants in Spanish textile sector during the period 2002-2009. The empirical results suggest that the effects of trade liberalization have led to higher levels of inefficiency in the Spanish sector, due to the lack of flexibility of firms to adjust to the environment, and perhaps to aggressive competition with fuzzy rules of the game. Controlling for specific factor like age, intensity of capital, salary by worker, regions and market share, the authors have obtained that the interaction between market share and size indicates that as firms have more size are also more inefficient. Design/methodology/approach – In this paper, the stochastic frontier production function is considered, specifically, a panel data version of Battese and Coelli (1995), in which the technical inefficiency is estimated from the stochastic frontier and simultaneously explained by a set of variables. This approach avoids the inconsistency problems of the two-stage approach used in other empirical works when analyzing the inefficiency determinants. Findings – This work provides new evidence about the technical efficiency and its determinants can be due to environmental or firm-specific factors in Spanish textile sector during the period 2002-2009. The authors have estimated the Cobb-Douglass stochastic production frontier following Battese and Coelli (1995) model to analyze an unbalanced panel. Originality/value – The empirical results suggest that the trend of the inefficiency shows a curvilinear behavior in the form of U (turning point third-quarter of 2004). This result is related to the efficiency analysis through Kernel distributions (in static and dynamic form) confirmed a clear process of divergence. In the period 2002-2005 the efficiency of the firms analyzed maintained higher levels than the 2005-2009 period where there is deterioration. This may be related to the increased competition due to the end of the Multi-Fiber Arrangement in January 2005 and the entry of Chinese products in 2004.