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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...

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Derby Pancreaticobiliary & Robotic AWR Unit

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32,944 views • 7 months ago •via X (Twitter)

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𝗟𝗮𝗽𝗮𝗿𝗼𝘀𝗰𝗼𝗽𝗶𝗰 𝗙𝗲𝗻𝗲𝘀𝘁𝗿𝗮𝘁𝗲𝗱 𝗦𝘂𝗯𝘁𝗼𝘁𝗮𝗹 𝗖𝗵𝗼𝗹𝗲𝗰𝘆𝘀𝘁𝗲𝗰𝘁𝗼𝗺𝘆 Patient Presentation: 🔵History of severe cholecystitis 🔵CT on index admission showed: ➡️Cholecysto-colic fistula ➡️Air locules on GB ➡️Figure 1 below 🔵Follow up CT (~4 months later): ➡️Good improvement with apparent resolution of fistula as absence of air in GB ➡️Figure 2 below 🔵Symptomatic gallstones 🔵Listed for planned biliary surgery Operative Approach: 🔴Colonic adhesion to GB fundus 🔴Fused hepatocystic triangle ➡️Decision to perform subtotal cholecystectomy 🔴Dissection plane (window) identified between GB and colon 🔴Presumed area of fistula tract detached with cuff of GB wall 🔴Stone retrieved and GB opened to identify cystic duct ostium on opening GB ➡️Closed with 2/0 Vicryl 🔴Gallbladder dissected off as far as safe to do so 🔴Detached colonic attachment with GB cuff ➡️No obvious fistula tract ➡️The area was under run to achieve haemostasis 🔴Cystic artery transfixed with figure of 8 suture 🔴Drain x 1 ➡️Removed after 24 hours 🔴Uneventful postop course #FOAMed #MedTwitter #GITwitter #SoMe4Surgery #HPB
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𝗟𝗮𝗽𝗮𝗿𝗼𝘀𝗰𝗼𝗽𝗶𝗰 𝗙𝗲𝗻𝗲𝘀𝘁𝗿𝗮𝘁𝗲𝗱 𝗦𝘂𝗯𝘁𝗼𝘁𝗮𝗹 𝗖𝗵𝗼𝗹𝗲𝗰𝘆𝘀𝘁𝗲𝗰𝘁𝗼𝗺𝘆 Patient Presentation: 🔵History of severe cholecystitis 🔵CT on index admission showed: ➡️Cholecysto-colic fistula ➡️Air locules on GB ➡️Figure 1 below 🔵Follow up CT (~4 months later): ➡️Good improvement with apparent resolution of fistula as absence of air in GB ➡️Figure 2 below 🔵Symptomatic gallstones 🔵Listed for planned biliary surgery Operative Approach: 🔴Colonic adhesion to GB fundus 🔴Fused hepatocystic triangle ➡️Decision to perform subtotal cholecystectomy 🔴Dissection plane (window) identified between GB and colon 🔴Presumed area of fistula tract detached with cuff of GB wall 🔴Stone retrieved and GB opened to identify cystic duct ostium on opening GB ➡️Closed with 2/0 Vicryl 🔴Gallbladder dissected off as far as safe to do so 🔴Detached colonic attachment with GB cuff ➡️No obvious fistula tract ➡️The area was under run to achieve haemostasis 🔴Cystic artery transfixed with figure of 8 suture 🔴Drain x 1 ➡️Removed after 24 hours 🔴Uneventful postop course #FOAMed #MedTwitter #GITwitter #SoMe4Surgery #HPB

Derby Pancreaticobiliary & Robotic AWR Unit

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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
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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 Unit

18,311 views • 5 months ago

𝗘𝗺𝗲𝗿𝗴𝗲𝗻𝗰𝘆 𝗥𝗼𝗯𝗼𝘁𝗶𝗰 𝗥𝗲𝗽𝗮𝗶𝗿 𝗼𝗳 𝗟𝗲𝗳𝘁 𝗜𝗻𝗴𝘂𝗶𝗻𝗮𝗹 𝗛𝗲𝗿𝗻𝗶𝗮 𝘄𝗶𝘁𝗵 𝗜𝗖𝗚 Surgical Approach: 🔴Initial assessment of small bowel with ICG 🔴Small bowel placed in pelvis with warm wet swabs overlying 🔴TAPP approach to hernia repair ➡️Critical view of MPO ➡️ICG to help delineate key structures ➡️Progrip mesh ➡️3-0 absorbable V-lock to close peritoneum 🔴Reassessment of small bowel after hernia repair ➡️ICG present in bruised area demonstrating viability ➡️Aided decision making to not resect or oversew Robotics in EGS: 🟢Case selection key 🟢MDT approach with anaesthetic and scrub teams to coordinate 🟢Minimally invasive approaches in EGS should be encouraged #FOAMed #GITwitter #MedEd #Surgery #Hernia #EGS
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𝗘𝗺𝗲𝗿𝗴𝗲𝗻𝗰𝘆 𝗥𝗼𝗯𝗼𝘁𝗶𝗰 𝗥𝗲𝗽𝗮𝗶𝗿 𝗼𝗳 𝗟𝗲𝗳𝘁 𝗜𝗻𝗴𝘂𝗶𝗻𝗮𝗹 𝗛𝗲𝗿𝗻𝗶𝗮 𝘄𝗶𝘁𝗵 𝗜𝗖𝗚 Surgical Approach: 🔴Initial assessment of small bowel with ICG 🔴Small bowel placed in pelvis with warm wet swabs overlying 🔴TAPP approach to hernia repair ➡️Critical view of MPO ➡️ICG to help delineate key structures ➡️Progrip mesh ➡️3-0 absorbable V-lock to close peritoneum 🔴Reassessment of small bowel after hernia repair ➡️ICG present in bruised area demonstrating viability ➡️Aided decision making to not resect or oversew Robotics in EGS: 🟢Case selection key 🟢MDT approach with anaesthetic and scrub teams to coordinate 🟢Minimally invasive approaches in EGS should be encouraged #FOAMed #GITwitter #MedEd #Surgery #Hernia #EGS

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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 Unit

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Derby Pancreaticobiliary & Robotic AWR Unit

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Tips for Transcystic Laparoscopic CBD Exploration 🔴3mm choledochoscope ➡️Direct visualisation of duct 🔴Cephalad retraction 🔴Incise cystic duct parallel to CBD stone 🔴If large CBD stone ➡️withdraw scope over wire and provide gentle traction 🔴Milk backwards 🔴Keep CBD in view 🔴Reduce speed of irrigation to trap CBDS What are your tips and tricks for transcystic LCBDE? #FOAMed #GITwitter #surgery #hpb #MedEd #SoMe4Surgery
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Tips for Transcystic Laparoscopic CBD Exploration 🔴3mm choledochoscope ➡️Direct visualisation of duct 🔴Cephalad retraction 🔴Incise cystic duct parallel to CBD stone 🔴If large CBD stone ➡️withdraw scope over wire and provide gentle traction 🔴Milk backwards 🔴Keep CBD in view 🔴Reduce speed of irrigation to trap CBDS What are your tips and tricks for transcystic LCBDE? #FOAMed #GITwitter #surgery #hpb #MedEd #SoMe4Surgery

Derby Pancreaticobiliary & Robotic AWR Unit

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Derby Pancreaticobiliary & Robotic AWR Unit

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🚨🇬🇧 KEIR STARMER’S GROWING LIST OF LIES – AND THE GASLIGHTING THAT FOLLOWS Keir Starmer has lied about: 🔴 Farming 🔴 Fishing 🔴 Small boats 🔴 The £22bn “black hole” 🔴 Tuition fees 🔴 Winter fuel allowance 🔴 Council tax 🔴 Energy bills 🔴 Taxation 🔴 Food prices And that’s before the rest: 🔴 Net migration and border control 🔴 EU alignment and “no return to EU control” 🔴 Free speech and policing of opinion 🔴 Early prisoner releases and law-and-order promises 🔴 Nationalisation pledges quietly dropped 🔴 Protecting pensioners and low-income households 🔴 Honesty and “restoring trust in politics” Every failure is followed by denial. Every broken promise is blamed on someone else. Every challenge is met with gaslighting. This is pure incompetence – and the public are not stupid. Starmer must resign and we must have a general election NOW.
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🚨🇬🇧 KEIR STARMER’S GROWING LIST OF LIES – AND THE GASLIGHTING THAT FOLLOWS Keir Starmer has lied about: 🔴 Farming 🔴 Fishing 🔴 Small boats 🔴 The £22bn “black hole” 🔴 Tuition fees 🔴 Winter fuel allowance 🔴 Council tax 🔴 Energy bills 🔴 Taxation 🔴 Food prices And that’s before the rest: 🔴 Net migration and border control 🔴 EU alignment and “no return to EU control” 🔴 Free speech and policing of opinion 🔴 Early prisoner releases and law-and-order promises 🔴 Nationalisation pledges quietly dropped 🔴 Protecting pensioners and low-income households 🔴 Honesty and “restoring trust in politics” Every failure is followed by denial. Every broken promise is blamed on someone else. Every challenge is met with gaslighting. This is pure incompetence – and the public are not stupid. Starmer must resign and we must have a general election NOW.

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39,362 views • 10 months ago

🔴 NAZOOOOOOOOOOOO!!!! 🔴 And that is a wrap!!🎬🎬 THANK YOU TO ALL THE #MSW SHAREHOLDERS who kept us at No.1 in 2024!! Too many highlights, too many memories!! Thanks to all our guests for their time!! What was YOUR highlight?? Blessed 2025!! 🫱🏾‍🫲🏽🥂📻
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🔴 NAZOOOOOOOOOOOO!!!! 🔴 And that is a wrap!!🎬🎬 THANK YOU TO ALL THE #MSW SHAREHOLDERS who kept us at No.1 in 2024!! Too many highlights, too many memories!! Thanks to all our guests for their time!! What was YOUR highlight?? Blessed 2025!! 🫱🏾‍🫲🏽🥂📻

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Imagine Neville spent all these years talking the most sh*t about Arsenal only for Don Arteta & Capo of all capos Don Kronke Rock up to your skysports show to hand you this “L” MY CLUB ARE NOT TAKING NO PRISONERS. MERCY IS FOR THE WEAK. 🥷🏽🔴☠️🪦😭 THE NORTH ABSOLUTELY REMEMBERED! 🔴🔴🔴🔴🔴🔴😂😂😂😂😂👏🏽

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53,398 views • 5 months ago

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Pleasure to be on Pre Match Warm Up on The Anfield Wrap for Arsenal vs Liverpool with Ian Ryan hosting John Gibbons, Kev & me 🔴 Clip ⬇️ 🔴How does Arne Slot set Liverpool up for this one? 🔴 The challenge of trying to beat Arsenal press 🔴 Saliba & Gabriel 🔴 How Liverpool might play out 🔴 Wirtz & Szoboszlai roles? I’d like them in double 10….. ⬇️ 🔴 Frimpong & Gakpo

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136,040 views • 1 year ago

the sky cam could barely keep up with how far Josh Allen kept running backwards orbs all popping presnap 🔴🔴🔴🔴
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the sky cam could barely keep up with how far Josh Allen kept running backwards orbs all popping presnap 🔴🔴🔴🔴

Warren Sharp

203,075 views • 11 months ago

Ah honest to God the small GAA clubs need to be kept going 🔵🔴
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Ah honest to God the small GAA clubs need to be kept going 🔵🔴

Joe Troy

74,244 views • 1 year ago

Critical BC Ostrich Farm Update: The cull appears imminent and will probably start early in the morning. Key developments: 🔴 Katie and Kathy from the farm were arrested and then released after being tricked and lied to that they could feed the birds. 🔴 Authorities have closed the pens to everyone but CFIA / police. 🔴 CFIA agents / contractors are going around wearing Hazmat costumes after smugly interacting with the grounds, animals and people there for more than a day and waving the warrants in their faces with no PPE. 🔴 The CFIA / RCMP have built a hay wall to presumably shoot the ostriches like fish in a barrel. 🔴 The Conservative party remains almost entirely silent on this horrific infringement of our rights and basic human decency. 🔴 The ostriches have not been tested for a long time, potentially since December 2024. 🔴 The CFIA is threatening anyone who tries to test the ostriches with massive fines and jail time for every single bird.
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Critical BC Ostrich Farm Update: The cull appears imminent and will probably start early in the morning. Key developments: 🔴 Katie and Kathy from the farm were arrested and then released after being tricked and lied to that they could feed the birds. 🔴 Authorities have closed the pens to everyone but CFIA / police. 🔴 CFIA agents / contractors are going around wearing Hazmat costumes after smugly interacting with the grounds, animals and people there for more than a day and waving the warrants in their faces with no PPE. 🔴 The CFIA / RCMP have built a hay wall to presumably shoot the ostriches like fish in a barrel. 🔴 The Conservative party remains almost entirely silent on this horrific infringement of our rights and basic human decency. 🔴 The ostriches have not been tested for a long time, potentially since December 2024. 🔴 The CFIA is threatening anyone who tries to test the ostriches with massive fines and jail time for every single bird.

Jon Villeneuve

91,968 views • 1 year ago

The 179th Brigade, the Yahalom Unit and the Israeli Navy's Flotilla 13 completed a targeted activity at a Hamas compound in central Gaza, where they identified several tunnel shafts leading to a network of hundreds of meters of Hamas tunnels—where they found: 🔴Mortars 🔴Grenades 🔴RPG missiles 🔴A weapons manufacturing site with machinery 🔴Explosives and materials used to extend the range of Hamas' rockets. The tunnel network was destroyed by the engineering forces of the 99th Division and the Yahalom Unit.
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Israel Defense Forces

577,442 views • 2 years ago

🚨Did you know 👉 “ Chanakya Series ” TV serial Stopped from DD during Congress Era !! 🔴 “ Chanakya Series ” was Prematurely ended because of intense Pressure on DD from Marxist "Academics" who accused it of promoting Saffron Nationalism !! 🔴And asked Chanakya Series Producer to Remove the “ Bhagwa Flag ”from the Series 🔴 And additionally asked him not to Proceed with the Series as No Knowledge/Education was needed !! He was told to 👉 Make Entertainment !!! 🔴 Make sure that More ppl watch the Series. Its Powerful Message Needs to Reach More ppl !!
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