Derby Pancreaticobiliary & Robotic AWR Unit
@DerbyPBunit • 10,648 subscribers
Pancreaticobiliary, Adv Lap/Robotic & Robotic AWR Unit @UHDBTrust | Operative Videos & SurgEd | Department Leads @altaf_awan12 & @ib9994
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2:38
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𝗥𝗼𝗯𝗼𝘁𝗶𝗰 𝗖𝗼𝗺𝗺𝗼𝗻 𝗕𝗶𝗹𝗲 𝗗𝘂𝗰𝘁 𝗘𝘅𝗽𝗹𝗼𝗿𝗮𝘁𝗶𝗼𝗻 𝗣𝗼𝘀𝘁 𝗖𝗵𝗼𝗹𝗲𝗰𝘆𝘀𝘁𝗲𝗰𝘁𝗼𝗺𝘆 Patient Presentation: 🔵Previous cholecystectomy 🔵2 previous ERCPs 🔵Recurrent large stone ➡️1.7 x 1.1 cm ➡️Failed endoscopic clearance ➡️+/- requirement for EHL 🔵MDT decision to proceed to bile duct exploration Surgical Approach: 🔴Careful dissection of adhesions in the GB fossa to expose the CBD 🔴ICG injected immediately following induction of anaesthesia 🔴Firefly mode used to confirm the CBD 🔴Vertical choledochotomy made with robotic shears 🔴Large stone extracted by milking it gently through the choledochotomy 🔴Check choledochoscopy to confirm clearance of the CBD 🔴Closure of the CBD with 4/0 Vicryl Benefit of Robotic Platform: 🟢Wristed instruments which improves ergonomics for suturing 🟢May reduce the learning curve for transductal CBDE when compared with laparoscopy
Derby Pancreaticobiliary & Robotic AWR Unit11,471 görüntüleme • 10 gün önce
Principles of Szabo Knot 🔴Square knot - 2 throws 🔴Slip knot - unlock by pulling in opposite directions 🔴Slide - non-closed grasper 🔴Lock 🔴Final throw Useful in: 🟢Tissue approximatiob under slight tension 🟢Deep areas i.e. OG hiatus, pelvis #MedEd #SurgEd #surgery
Derby Pancreaticobiliary & Robotic AWR Unit45,288 görüntüleme • 2 ay önce
Tips & Tricks for Minimally Invasive Adhesiolysis 🔴Gentle counter traction on bowel whilst scissors dissects adhesion under tension 🔴Cold scissors 🔴Divide adhesion close to abdominal wall 🔴Include tissue from abdominal wall onto bowel ➡️Shown prior to division of adhesion
Derby Pancreaticobiliary & Robotic AWR Unit95,063 görüntüleme • 5 ay önce
𝗦𝘁𝗼𝗻𝗲 𝗥𝗲𝘁𝗿𝗶𝗲𝘃𝗮𝗹 𝗳𝗿𝗼𝗺 𝗡𝗮𝗿𝗿𝗼𝘄 𝗖𝗵𝗼𝗹𝗲𝗱𝗼𝗰𝗵𝗼𝘁𝗼𝗺𝘆 🔴Bring CBD stone trapped in basket to choledochotomy site 🔴Remove scope over wire 🔴Keep tension on basket wire with trapped CBD stone 🔴Introduce choledochotome (or laparoscopic scissors) and minimally extend choledochotomy over large CBD stone ➡️Prevents large choledochotomy #FOAMed #GITwitter #MedEd #SoMe4Surgery #Surgery
Derby Pancreaticobiliary & Robotic AWR Unit38,188 görüntüleme • 3 ay önce
Laparoscopic Ileocaecal Resection with Intracorporeal Anastomosis and ICG Patient Presentation: 🔴Sudden onset severe abdominal pain 🔴Tender abdomen 🔴No previous abdominal surgery 🔴High WCC 🔴Lactate ➡️5 on arrival down to 2 in 2 hours following fluid resuscitation 🔴CT abdomen/pelvis ➡️Red arrows show no small bowel perfusion with mural thickening ➡️Green arrows show perfused small and large bowel ➡️Mesenteric vessels patent Surgical Approach: 🔴Lap EGS approach ➡️Torsion of small bowel with Meckel's adhesion to abdominal wall acting as pivot point ➡️80cm ischaemic small bowel involving ileocaecal junction 🔴Specimen retrieved via extension of LUQ 12mm port
Derby Pancreaticobiliary & Robotic AWR Unit17,270 görüntüleme • 1 ay önce
0:30
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Our Approach 🔴Dissection was kept close to gallbladder throughout 🔴Arterial rather than venous bleed 🔴Bleeding brisk ➡️Pressure did help but not successful 🔴Small arterial branch identified entering GB wall 🔴Suction/irrigation handy 🔴Careful evaluation of bleeding vessel 🔴After confirmation, clip applied to the vessel that was entering GB ➡️Likely a small branch off RHA 🔴Venous bleeds more common and can be a significant challenge intraoperatively Many thanks for all the engagement with the post 👏🏽
Derby Pancreaticobiliary & Robotic AWR Unit32,536 görüntüleme • 4 ay önce
Tips for Retrieval of CBD Stone during Transcholedochal LCBDE 🔴CBD >8mm 🔴Atraumatic graspers useful 🔴"Milking" CBDS 🔴5mm choledochoscope with 0-Tip basket ➡️Gentle "to-and-fro" motion ➡️Irrigation 🔴Withdraw choledochoscope over basket wire with trapped CBDS 🔴Extend choledochotomy #FOAMed #GITwitter #Surgery #SoMe4Surgery #HPB
Derby Pancreaticobiliary & Robotic AWR Unit28,710 görüntüleme • 3 ay önce
2:06
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𝙀𝙢𝙚𝙧𝙜𝙚𝙣𝙘𝙮 𝙇𝙖𝙥𝙖𝙧𝙤𝙨𝙘𝙤𝙥𝙞𝙘 𝙍𝙚𝙥𝙖𝙞𝙧 𝙤𝙛 𝙎𝙩𝙧𝙖𝙣𝙜𝙪𝙡𝙖𝙩𝙚𝙙 𝙁𝙚𝙢𝙤𝙧𝙖𝙡 𝙃𝙚𝙧𝙣𝙞𝙖 𝙬𝙞𝙩𝙝 𝙎𝙢𝙖𝙡𝙡 𝘽𝙤𝙬𝙚𝙡 𝙍𝙚𝙨𝙚𝙘𝙩𝙞𝙤𝙣 𝙖𝙣𝙙 𝙄𝘾𝙂 Surgical Approach: 🔴Reduce small bowel first ➡️Gentle abdominal pressure and squeeze ➡️Atraumatic grasper to hold bowel and gently manipulate ➡️Stretch hernia ring if needed ➡️Gentle side-to-side traction without grasping useful when bowel is fragile 🔴Perform hernia repair ➡️Suture repair safe option in strangulated small bowel requiring resection ➡️On rare occasions a biologic mesh may be an option ➡️Synthetic mesh could be considered if no resection involved 🔴ICG to assess bowel perfusion and assist in delineating length of resection ➡️Improve trainee understanding of key concepts ➡️Reduce risk of leak or stricture ➡️"See the invisible" 🔴Advanced laparoscopic skills critical 🔴Training and development of laparoscopy in EGS should be encouraged #FOAMed #GITwitter #MedEd #Hernia #Surgery #SoMe4Surgery
Derby Pancreaticobiliary & Robotic AWR Unit173,989 görüntüleme • 3 yıl önce
2:05
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3:35
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Robotic TAPP (rTAPP) Repair of Left Inguinal Hernia with Imbrication of Transversalis Fascia Why imbricate: 🔵Direct defect/large hernia risk factors for postoperative seroma 🔵In open hernia repair, direct defect often closed ➡️Helps create a flat posterior wall and expedite mesh placement 🔵However it is not a routine practice during MIS Robotic Imbrication of Transversalis fascia: 🔴Possible advantages include: ➡️Reduce seroma risk formation ➡️Reduce risk of recurrence (mesh migration) 🔴Avoid deep bite ➡️Cord structures can be easily caught in sutures
Derby Pancreaticobiliary & Robotic AWR Unit16,444 görüntüleme • 4 ay önce
1:49
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𝗧𝗿𝗮𝘂𝗺𝗮 𝗟𝗮𝗽𝗮𝗿𝗼𝘀𝗰𝗼𝗽𝘆 𝗮𝗻𝗱 𝗣𝗿𝗶𝗺𝗮𝗿𝘆 𝗥𝗲𝗽𝗮𝗶𝗿 𝗼𝗳 𝗦𝗺𝗮𝗹𝗹 𝗕𝗼𝘄𝗲𝗹 𝗜𝗻𝗷𝘂𝗿𝘆 Presentation: 🔵Presented 6 hours following football tackle with knee to abdomen 🔵Resulted in blunt trauma to anterior abdominal wall 🔵On examination ➡️tender abdomen with tachycardia but normotensive and HB stable 🔵CT in ED ➡️Small volume intraperitoneal free air anterior to liver ➡️Gas locules around transverse colon at the splenic flexure 🔵Direct transfer from ED to OR Approach: 🔴Low threshold for laparoscopy +/- proceed 🔴Complete examination of small bowel on both anti mesenteric and mesenteric sides 🔴Two areas of injury immediately beyond DJ flexure ➡️One full thickness ➡️One seromuscular 🔴Free intraperitoneal bile an irritant 🔴Primary repair with 2/0 vicryl ➡️If concern regarding ischaemic edges option to freshen prior to closure 🔴Thorough peritoneal lavage 🔴Advanced lap experience critical #FOAMed #GITwitter #trauma #SoMe4Surgery #surgery #MedEd
Derby Pancreaticobiliary & Robotic AWR Unit64,317 görüntüleme • 2 yıl önce
2:14
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𝗟𝗮𝗽𝗮𝗿𝗼𝘀𝗰𝗼𝗽𝗶𝗰 𝗖𝗵𝗼𝗹𝗲𝗱𝗼𝗰𝗵𝗼𝗱𝘂𝗼𝗱𝗲𝗻𝗼𝘀𝘁𝗼𝗺𝘆 𝗮𝗻𝗱 𝗖𝗼𝗺𝗽𝗹𝗲𝘁𝗶𝗼𝗻 𝗖𝗵𝗼𝗹𝗲𝗰𝘆𝘀𝘁𝗲𝗰𝘁𝗼𝗺𝘆 Patient Presentation: 🔵Previous Lap RYGB 🔵Index lap chole and CBDE 🔵Distal CBD stricture at site of retrieved impacted stone 🔵Discussion in HPB MDT ➡️Dilated intra and extra hepatic ducts on imaging ➡️Decision to proceed to PTC 🔵PTC x 2 ➡️Brushings confirmed benign stricture 🔵CT imaging showed no mass lesion causing extrinsic compression Surgical Approach: 🔴Careful adhesiolysis 🔴Mobilisation of gallbladder stump ➡️Blunt dissection with endopledget 🔴Clipping of cystic artery and cystic duct 🔴Vertical choledochotomy ➡️Choledochotome loaded with size 11 blade 🔴Choledochoscopy with 5mm KARL STORZ - UK scope 🔴Duodenotomy 🔴Creation of choledochoduodenostomy 🔴Placement of drains Post-op: 🔵LFTs normal at 2 years follow-up 🔵Reduced risk of bile reflux in this case #FOAMed #GITwitter #HPB #Surgery #SoMe4Surgery
Derby Pancreaticobiliary & Robotic AWR Unit60,364 görüntüleme • 3 yıl önce
2:04
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𝗦𝘂𝗿𝗴𝗶𝗰𝗮𝗹 𝗔𝗽𝗽𝗿𝗼𝗮𝗰𝗵 𝘁𝗼 "𝗛𝗼𝘁" 𝗚𝗮𝗹𝗹𝗯𝗹𝗮𝗱𝗱𝗲𝗿 🔵Preoperative review of CT imaging essential for operative planning 🔵This case was performed within 36 hours of acute episode 🔴Divide immediately above Hartmann's pouch once safe point confirmed 🔴Remove gallbladder above that point first 🔴Assessment of hepatocystic triangle ➡️Careful assessment of CVS and posterior wall attachment of gallbladder to liver ➡️2nd opinion very useful ➡️Know bailout options and exit strategies i.e. subtotal ➡️Consider adjuncts such as IOC, IOUS and ICG 🔴Safe completion cholecystectomy 🔴Drains optional #FOAMed #GITwitter #MedEd #SoMe4Surgery #SurgEd
Derby Pancreaticobiliary & Robotic AWR Unit56,588 görüntüleme • 2 yıl önce
1:49
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𝙏𝙧𝙖𝙪𝙢𝙖 𝙇𝙖𝙥𝙖𝙧𝙤𝙨𝙘𝙤𝙥𝙮 & 𝙋𝙧𝙞𝙢𝙖𝙧𝙮 𝙍𝙚𝙥𝙖𝙞𝙧 𝙤𝙛 𝙎𝙢𝙖𝙡𝙡 𝘽𝙤𝙬𝙚𝙡 𝙄𝙣𝙟𝙪𝙧𝙮 Presentation: 🔵Presented following football tackle with knee to abdomen 🔵Resulted in blunt trauma to anterior abdominal wall 🔵On examination ➡️tender abdomen with tachycardia but normotensive and HB stable 🔵CT in ED ➡️Small volume intraperitoneal free air anterior to liver ➡️Gas locules around transverse colon at the splenic flexure Approach: 🔴Low threshold for laparoscopy +/- proceed 🔴Complete examination of small bowel on both anti mesenteric and mesenteric sides 🔴Two areas of injury near DJ flexure - one full thickness and one seromuscular 🔴Free intraperitoneal bile an irritant 🔴Primary repair with 2/0 vicryl 🔴Thorough peritoneal lavage 🔴Advanced lap experience critical #FOAMed #GITwitter #trauma #SoMe4Surgery #surgery #MedEd
Derby Pancreaticobiliary & Robotic AWR Unit64,501 görüntüleme • 3 yıl önce
1:49
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Trauma Laparoscopy and Primary Repair of Small Bowel Injury Presentation: 🔵Presented 6 hours following football tackle with knee to abdomen 🔵Resulted in blunt trauma to anterior abdominal wall 🔵On examination ➡️tender abdomen with tachycardia but normotensive and HB stable 🔵CT in ED ➡️Small volume intraperitoneal free air anterior to liver ➡️Gas locules around transverse colon at the splenic flexure Approach: 🔴Low threshold for laparoscopy +/- proceed 🔴Complete examination of small bowel on both anti mesenteric and mesenteric sides 🔴Two areas of injury near DJ flexure - one full thickness and one seromuscular ➡️Perforation immediately beyond DJ flexure 🔴Free intraperitoneal bile an irritant 🔴Primary repair with 2/0 vicryl ➡️If concern regarding ischaemic edges, consider freshening 🔴Thorough peritoneal lavage 🔴Feeding jejunostomy not indicated ➡️Oral intake resumed 24 hours post-op 🔴Advanced lap experience critical 🔴Pt. discharged POD3 with no readmissions to hospital
Derby Pancreaticobiliary & Robotic AWR Unit18,125 görüntüleme • 7 ay önce
3:29
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𝗙𝗲𝗹𝗹𝗼𝘄𝘀𝗵𝗶𝗽 𝗔𝗱𝘃𝗲𝗿𝘁 Our Post CCT/Senior Complex Benign PB & Robotic Fellowship at University Hospitals of Derby and Burton NHS FT is now open for applicants to start from Aug 2026. Gain experience in advanced laparoscopic and robotic benign PB surgery. In addition, fellows will develop skills in laparoscopic and robotic hernia surgery including complex abdominal wall hernias as well as training in ERCP. Advert below or DM for more details:
Derby Pancreaticobiliary & Robotic AWR Unit12,323 görüntüleme • 4 ay önce
1:56
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𝗘𝗺𝗲𝗿𝗴𝗲𝗻𝘁 𝗟𝗮𝗽𝗮𝗿𝗼𝘀𝗰𝗼𝗽𝗶𝗰 𝗖𝗵𝗼𝗹𝗲𝗰𝘆𝘀𝘁𝗲𝗰𝘁𝗼𝗺𝘆 𝗮𝗻𝗱 𝗧𝗿𝗮𝗻𝘀𝗰𝘆𝘀𝘁𝗶𝗰 𝗟𝗖𝗕𝗗𝗘 Patient Presentation: 🟢Acute cholecystitis with deranged LFTs 🟢Surgery performed <24 hours from admission Surgical Approach: 🔴Timing critical in acute cases 🔴Retraction of duodenum improves view 🔴Cystic artery clipped prior to IOC in this case due to confidence in anatomy 🔴3mm choledochoscope for stone retrieval ➡️Remove scope over wire if CBD stone is larger than cystic duct 🔴Check choledochoscopy #FOAMed #MedEd #Surgery #SoMe4Surgery #gallstones
Derby Pancreaticobiliary & Robotic AWR Unit36,769 görüntüleme • 1 yıl önce
Laparoscopic Infracolic Necrosectomy and Drainage of RIF Abscess 🔴Septic patient but no organ failure 🔴Narrow window of access for EUS or IR drainage 🔴Single stage clearance of WON and drainage of RIF abscess ➡️Prevents hits of sepsis between multiple procedures ➡️Address both collections at once ➡️Select cases ➡️Benign PB MDT ➡️"One size does not fit all" Our paper on infracolic approach in JOGS: Our collaboration with BehindTheKnife on MIS for complicated SAP: #Surgery #HPB #Pancreatitis
Derby Pancreaticobiliary & Robotic AWR Unit17,219 görüntüleme • 8 ay önce