Watch out our #reeltime 📽️ Advancing surgical techniques: three-port robotic cholecystectomy ➡️ Robotic cholecystectomy has gained popularity over the past few years since the introduction of robotic surgery in general surgery units worldwide However, most surgeons have used a four-port approach Here, the authors describe the procedure using a... three-port approach Great video by Fanourios Georgiades and Kanapathi Rajaratnam #SoMe4Surgery #MedTwitter #SurgEd #Surgery @RCPSGTrainees aecirujanos SEIQ International Society of Surgery (ISS/SIC) #MedicalTechniques BJS Academy Young BJS BJS Open Des Winter Martyn Evans Robert Hinchliffe Bas Wijnhoven Malin Sund Niels Kok Pat Tejedor Paul Sutton Peter Vaughan-Shaw Jonothan Earnshaw Julio Mayol #some4hpb #some4tpl DPCG DutchPancreatitisSG The Pancreas Club #PancreasClub2023 #PancreaticCancer #Pancreatitis #HCC PanCAN #PanCANawareness EPC-Europ Pancr Club Pancreatic Cancer Europe (PCE) Digestive Cancers Europe #PancreaticCancer #cholangiocarcinomashow more

What's your preference for MIS elective cholecystectomy? #SoMe4Surgery #MedTwitter #SurgEd #Surgery @RCPSGTrainees @aecirujanos @SEIQuirurgica @iss_sic #MedicalTechniques @BJSAcademy @young_bjs @BjsOpen #some4hpb #some4tpl @DPCG_official @pancreatitis_nl @PancreasClub #PancreaticCancer #Pancreatitis #HCC @PanCAN @EurPancClub @P_C_E_ @dice_europe #PancreaticCancer #cholangiocarcinoma

Abandoning established safety principles for what? One less 8mm port? The guidance is there for a reason, this is how mistakes happen.

This not advancing technique , this is retrograde …. Please follow all principles of Safe cholecystectomy as per SAGES guidelines ….the video not even demonstrated critical view of safety on two sides …..either robotic/laparoscopic/open cholecystectomy must follow safety principles @SAGES_Updates @IHPBA @tdyadav @Journal_AHBPS

As someone who does alot of 🤖 HPB surgery, I cannot understand this. The case shown is extremely straightforward & could be done 3 port lap. The catastrophic CBDI shown @SAGES_Updates earlier this year was 3 port. This is innovation for the surgeon, not the patient

For residents watching this, there is a difference between a procedure that went well and a procedure that was safe. This technique abandons several of the key principles put in place to avoid catastrophic injury. For what, a 5ml port? People who do a lot of these would not recommend doing like this. @Augishealth

Have the authors abandoned the CVS / safe cholecystectomy principals when it's robotic? or do they not do this either with their lap technique? Maybe it's just the edit and it wasn't shown but I felt quite uncomfortable watching that.

All I see is how to make what should be an easy gallbladder dangerous (technique problem, not a robot problem). I’ll give authors benefit of doubt and assume it was editing that that resulted in bad exposure and lack of CVS but don’t recommend this as a teaching video!

@BJSurgery are you playing 4-D chess here with the next #reeltime being a video of a Roux-en-Y hepaticojejunostomy for bile duct injury after 3-port chole that abandoned widely accepted and standardized principles of safe cholecystectomy?

Also if I’m not mistaken, they are using the ‘blunt’ obturator (normally meant for Hasson access) to place the other trocar here which means they have to push hard. Instead, it’s better to use the ‘pointy’ obturator and use a twisting motion (?) @EricKnauerMD @ericpaulimd

Hard to watch this one….the port your saving provided all the retraction and exposure missing in the vid. Extremely lucky on what looks like conventional anatomy and very little intra-abd fat but high risk low reward on saving a single port…..ill take and extra port over an HJ