Derby Pancreaticobiliary & Robotic AWR Unit
@DerbyPBunit • 10,613 subscribers
Pancreaticobiliary, Adv Lap/Robotic & Robotic AWR Unit @UHDBTrust | Operative Videos & SurgEd | Department Leads @altaf_awan12 & @ib9994
Shorts
Videos
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 Unit44,549 просмотров • 16 дней назад
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 Unit94,663 просмотров • 3 месяцев назад
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 Unit38,089 просмотров • 1 месяц назад
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 Unit28,577 просмотров • 2 месяцев назад
0:30
Sensitive content
This media may contain sensitive content.
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 Unit32,481 просмотров • 2 месяцев назад
2:06
Sensitive content
This media may contain sensitive content.
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 Unit173,980 просмотров • 3 лет назад
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 Unit16,378 просмотров • 2 месяцев назад
3:35
Sensitive content
This media may contain sensitive content.
2:05
Sensitive content
This media may contain sensitive content.
1:49
Sensitive content
This media may contain sensitive content.
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 просмотров • 5 месяцев назад
3:29
Sensitive content
This media may contain sensitive content.
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 Unit12,292 просмотров • 3 месяцев назад
2:04
Sensitive content
This media may contain sensitive content.
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 просмотров • 2 лет назад
1:49
Sensitive content
This media may contain sensitive content.
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 просмотров • 3 лет назад
1:58
Sensitive content
This media may contain sensitive content.
"Hot" Laproscopic Cholecystectomy 🔴Principles remain the same 🔴Know bailout options ➡️Subtotal 🔴Gallbladder decompression 🔴Identification of Rouviere's sulcus if present 🔴Endo pledget very useful in these cases 🔴Suction/irrigation ➡️blunt dissection 🔴Demonstrate CVS
Derby Pancreaticobiliary & Robotic AWR Unit11,323 просмотров • 3 месяцев назад
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 Unit17,208 просмотров • 7 месяцев назад
1:56
Sensitive content
This media may contain sensitive content.
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 просмотров • 1 год назад
1:40
Sensitive content
This media may contain sensitive content.
𝙇𝙖𝙥𝙖𝙧𝙤𝙨𝙘𝙤𝙥𝙞𝙘 𝙎𝙢𝙖𝙡𝙡 𝘽𝙤𝙬𝙚𝙡 𝙍𝙚𝙨𝙚𝙘𝙩𝙞𝙤𝙣 & 𝙋𝙧𝙞𝙢𝙖𝙧𝙮 𝘼𝙣𝙖𝙨𝙩𝙤𝙢𝙤𝙨𝙞𝙨 𝙛𝙤𝙧 𝙄𝙨𝙘𝙝𝙖𝙚𝙢𝙞𝙘 𝙎𝙢𝙖𝙡𝙡 𝘽𝙤𝙬𝙚𝙡 𝙬𝙞𝙩𝙝 𝙐𝙨𝙚 𝙤𝙛 𝙄𝘾𝙂 𝙛𝙤𝙧 𝙑𝙞𝙨𝙘𝙚𝙧𝙖𝙡 𝙋𝙚𝙧𝙛𝙪𝙨𝙞𝙤𝙣 𝘼𝙨𝙨𝙚𝙨𝙨𝙢𝙚𝙣𝙩 Patient Presentation: 🔵Presented with severe abdominal pain 🔵No previous abdominal surgery 🔵Cross-sectional imaging: ➡️Omental band adhesion ➡️Twisting of small bowel segment causing closed loop ➡️Main visceral vessels patent Surgical Approach: 🔴Overlay and monochromatic modes useful for perfusion assessment 🔴ICG will help decide demarcation level for small bowel resection ➡️Important if extensive small bowel ischaemia 🔴Most important factor contributing to healing in anastomosis is good blood supply ➡️Facilitated by undertaking qualitative assessment of perfusion with ICG ICG Tips: 🟢0° or 30° scope with technology to detect ICG 🟢Immediate assessment of bowel perfusion following ICG administration key ➡️ICG can diffuse across non-viable bowel 🟢Monochromatic mode provides additional information regarding perfusion #FOAMed #GITwitter #surgery #SoMe4Surgery #MedEd #SurgEd #ICG #EGS
Derby Pancreaticobiliary & Robotic AWR Unit50,750 просмотров • 3 лет назад
0:51
Sensitive content
This media may contain sensitive content.
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 Unit17,689 просмотров • 8 месяцев назад
1:34
Sensitive content
This media may contain sensitive content.
𝙋𝙤𝙨𝙩 𝘾𝙝𝙤𝙡𝙚𝙘𝙮𝙨𝙩𝙚𝙘𝙩𝙤𝙢𝙮 𝙇𝙖𝙥𝙖𝙧𝙤𝙨𝙘𝙤𝙥𝙞𝙘 𝘾𝘽𝘿 𝙀𝙭𝙥𝙡𝙤𝙧𝙖𝙩𝙞𝙤𝙣 𝙬𝙞𝙩𝙝 𝙄𝘾𝙂 & 𝙇𝙖𝙨𝙚𝙧 𝙇𝙞𝙩𝙝𝙤𝙩𝙧𝙞𝙥𝙨𝙮 Patient Presentation: 🔵Previous lap cholecystectomy 🔵Presents with cholangitis 🔵Spinal deformity 🔵Ampullary diverticulum with anatomical distortion of ampulla precluded ERCP 🔵Large CBD stone >15mm 🔵Emergency PTC to treat biliary sepsis 🔵Referred to our unit for definitive intervention 🔵Undertook LCBDE 4 weeks post PTC Surgical Approach: 🔴ICG administered via PTC tube ➡️Key to identify CBD ➡️Invaluable in post cholecystectomy LCBDE ➡️Limitations are dissection of adipose tissue anterior to CBD required for ICG scope to detect fluoresence from CBD 🔴Vertical choledochotomy ➡️Preserves "3" and "9" O'clock axial vessels 🔴Choledochoscopy and laser lithotripsy to break down large and impacted CBDS ➡️Alternative is EHL 🔴PTC tube removed 8 weeks post-op #FOAMed #GITwitter #surgery #SoMe4Surgery #MedEd #SurgEd #SoMe4HPB #HPB
Derby Pancreaticobiliary & Robotic AWR Unit48,591 просмотров • 3 лет назад