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𝗘𝗺𝗲𝗿𝗎𝗲𝗻𝗰𝘆 𝗥𝗌𝗯𝗌𝘁𝗶𝗰 𝗥𝗲𝗜𝗮𝗶𝗿 𝗌𝗳 𝗟𝗲𝗳𝘁 𝗜𝗻𝗎𝘂𝗶𝗻𝗮𝗹 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...

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Derby Pancreaticobiliary & Robotic AWR Unit

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22,834 次观看 • 21 倩前 •via X (Twitter)

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Altaf K Awan 的倎像
Altaf K Awan21 倩前

@Innov_Medicine @SAGES_Updates @BehindTheKnife @eurohernias @BritishHernia @MedicalAdv @rbarbosa91 @ib9994 @javlatif @bipin_dr2009

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Emergency Laparoscopic Repair of Strangulated Femoral Hernia with Small Bowel Resection & ICG 🔎Reduction of small bowel ➡Await perfusion recovery ➡Allows for demarcation of ischaemic segment 🔎Undertake hernia repair ➡TAPP approach ➡Opted for suture repair for this case ➡Biologic mesh alternative option ➡Synthetic mesh can be considered if no bowel resection 🔎ICG to assess bowel perfusion and delineate length of resection ➡Given intraop at time of assessment ➡Immediate assessment within 30 seconds key ➡Excellent tool for teaching trainees 🔎Advanced lap skills crucial 🔎Lap EGS recommended ➡Underutilisation in the UK
2:06

Emergency Laparoscopic Repair of Strangulated Femoral Hernia with Small Bowel Resection & ICG 🔎Reduction of small bowel ➡Await perfusion recovery ➡Allows for demarcation of ischaemic segment 🔎Undertake hernia repair ➡TAPP approach ➡Opted for suture repair for this case ➡Biologic mesh alternative option ➡Synthetic mesh can be considered if no bowel resection 🔎ICG to assess bowel perfusion and delineate length of resection ➡Given intraop at time of assessment ➡Immediate assessment within 30 seconds key ➡Excellent tool for teaching trainees 🔎Advanced lap skills crucial 🔎Lap EGS recommended ➡Underutilisation in the UK

Derby Pancreaticobiliary & Robotic AWR Unit

115,420 次观看 • 29 倩前

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
3:48

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

17,955 次观看 • 3 䞪月前

𝙇𝙖𝙥𝙖𝙧𝙀𝙚𝙘𝙀𝙥𝙞𝙘 𝙍𝙚𝙥𝙖𝙞𝙧 𝙀𝙛 𝙋𝙚𝙧𝙛𝙀𝙧𝙖𝙩𝙚𝙙 𝘿𝙪𝙀𝙙𝙚𝙣𝙖𝙡 𝙐𝙡𝙘𝙚𝙧 𝙬𝙞𝙩𝙝 𝙋𝙧𝙞𝙢𝙖𝙧𝙮 𝘟𝙡𝙀𝙚𝙪𝙧𝙚 & 𝙊𝙢𝙚𝙣𝙩𝙖𝙡 𝙋𝙖𝙩𝙘𝙝 Presentation: 🔵1 day history of sever upper abdominal pain 🔵Smoker and excess ETOH 🔵CXR ➡Pneumoperitoneum 🔵CT ➡Perforated duodenal ulcer 🔵Time from ED➡theatre 3 hours Operative Approach: 🔎Thorough peritoneal lavage ➡Lap washout allows for thorough removal of intra-abdominal contamination ➡Modern OR table tilting can provide better view then open in select cases 🔎If fragile tissue then omental patch only ➡This approach is a modified version of Grahams patch repair ➡When suitable, we prefer primary closure with patch after 🔎For large perforations kocherisation of duodenum may be indicated 🔎Convert to open if: ➡Large ulcer ➡Associated ulcer bleed 🔎H. Pylori eradication therapy on discharge 🔎OGD in 6-8 weeks to confirm healing Key Points: 🟢Timely intervention critical 🟢Lap approach in EGS should be encouraged 🟢Compared to open, advantages of lap are: ➡Reduced pain ➡Reduced LOS ➡Reduced incisional hernia rate 🟢Trainees should be exposed to lap EGS early to develop skills and confidence #FOAMed #GITwitter #MedEd #SurgEd #EGS #SoMe4Surgery
2:01

𝙇𝙖𝙥𝙖𝙧𝙀𝙚𝙘𝙀𝙥𝙞𝙘 𝙍𝙚𝙥𝙖𝙞𝙧 𝙀𝙛 𝙋𝙚𝙧𝙛𝙀𝙧𝙖𝙩𝙚𝙙 𝘿𝙪𝙀𝙙𝙚𝙣𝙖𝙡 𝙐𝙡𝙘𝙚𝙧 𝙬𝙞𝙩𝙝 𝙋𝙧𝙞𝙢𝙖𝙧𝙮 𝘟𝙡𝙀𝙚𝙪𝙧𝙚 & 𝙊𝙢𝙚𝙣𝙩𝙖𝙡 𝙋𝙖𝙩𝙘𝙝 Presentation: 🔵1 day history of sever upper abdominal pain 🔵Smoker and excess ETOH 🔵CXR ➡Pneumoperitoneum 🔵CT ➡Perforated duodenal ulcer 🔵Time from ED➡theatre 3 hours Operative Approach: 🔎Thorough peritoneal lavage ➡Lap washout allows for thorough removal of intra-abdominal contamination ➡Modern OR table tilting can provide better view then open in select cases 🔎If fragile tissue then omental patch only ➡This approach is a modified version of Grahams patch repair ➡When suitable, we prefer primary closure with patch after 🔎For large perforations kocherisation of duodenum may be indicated 🔎Convert to open if: ➡Large ulcer ➡Associated ulcer bleed 🔎H. Pylori eradication therapy on discharge 🔎OGD in 6-8 weeks to confirm healing Key Points: 🟢Timely intervention critical 🟢Lap approach in EGS should be encouraged 🟢Compared to open, advantages of lap are: ➡Reduced pain ➡Reduced LOS ➡Reduced incisional hernia rate 🟢Trainees should be exposed to lap EGS early to develop skills and confidence #FOAMed #GITwitter #MedEd #SurgEd #EGS #SoMe4Surgery

Derby Pancreaticobiliary & Robotic AWR Unit

388,248 次观看 • 10 倩前

𝗥𝗌𝗯𝗌𝘁𝗶𝗰 𝗧𝗔𝗥𝗚𝗣 𝘃𝘀. 𝗟𝗮𝗜𝗮𝗿𝗌𝘀𝗰𝗌𝗜𝗶𝗰 𝗜𝗣𝗢𝗠 𝗥𝗲𝗜𝗮𝗶𝗿 𝗌𝗳 𝗩𝗲𝗻𝘁𝗿𝗮𝗹 𝗛𝗲𝗿𝗻𝗶𝗮 Defect closure: 🔵Standard of care in both approaches 🔵Robot facilitates closure of larger defect up to a maximum size of 5cm for TARUP repair Comparison: 🔎Retromuscular (rTARUP) vs. Intraperitoneal (IPOM) mesh placement 🔎No tacks (rTARUP) vs. Use of tacks (IPOM) 🔎Minimal risk of bowel adhesions (rTARUP) vs. Possibility of bowel adhesions (IPOM) 🔎Extensive dissection (rTARUP) vs. Minimal dissection (IPOM) 🔎LOS and analgesic requirements less for rTARUP Less pain in rTARUP due to: 🟢Better and precise haemostasis in dissection plane facilitated by robotic platform 🟢No use of tacks 🟢Robotic port remote centre technology with less muscle trauma at port sites #FOAMed #SoMe4Surgery #hernia #surgery #robotics
2:12

𝗥𝗌𝗯𝗌𝘁𝗶𝗰 𝗧𝗔𝗥𝗚𝗣 𝘃𝘀. 𝗟𝗮𝗜𝗮𝗿𝗌𝘀𝗰𝗌𝗜𝗶𝗰 𝗜𝗣𝗢𝗠 𝗥𝗲𝗜𝗮𝗶𝗿 𝗌𝗳 𝗩𝗲𝗻𝘁𝗿𝗮𝗹 𝗛𝗲𝗿𝗻𝗶𝗮 Defect closure: 🔵Standard of care in both approaches 🔵Robot facilitates closure of larger defect up to a maximum size of 5cm for TARUP repair Comparison: 🔎Retromuscular (rTARUP) vs. Intraperitoneal (IPOM) mesh placement 🔎No tacks (rTARUP) vs. Use of tacks (IPOM) 🔎Minimal risk of bowel adhesions (rTARUP) vs. Possibility of bowel adhesions (IPOM) 🔎Extensive dissection (rTARUP) vs. Minimal dissection (IPOM) 🔎LOS and analgesic requirements less for rTARUP Less pain in rTARUP due to: 🟢Better and precise haemostasis in dissection plane facilitated by robotic platform 🟢No use of tacks 🟢Robotic port remote centre technology with less muscle trauma at port sites #FOAMed #SoMe4Surgery #hernia #surgery #robotics

Derby Pancreaticobiliary & Robotic AWR Unit

11,606 次观看 • 2 幎前

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
3:08

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 Unit

16,736 次观看 • 6 䞪月前

𝗘𝘅𝘁𝗲𝗻𝘀𝗶𝗌𝗻 𝗌𝗳 𝗖𝗵𝗌𝗹𝗲𝗱𝗌𝗰𝗵𝗌𝘁𝗌𝗺𝘆 𝗳𝗌𝗿 𝗟𝗮𝗿𝗎𝗲 𝗖𝗕𝗗 𝗊𝘁𝗌𝗻𝗲 🔎CBD diameter key 🔎Extend choledochotomy with choledochotome 🔎CBD stone trapped in basket under slight tension and brought to choledochotomy 🔵Other options ➡EHL ➡Laser Lithotripsy 🔵Caution when extending choledochotomy ➡Experience and training critical #FOAMed #GITwitter #MedEd #Surgery #SoMe4Surgery
0:27

𝗘𝘅𝘁𝗲𝗻𝘀𝗶𝗌𝗻 𝗌𝗳 𝗖𝗵𝗌𝗹𝗲𝗱𝗌𝗰𝗵𝗌𝘁𝗌𝗺𝘆 𝗳𝗌𝗿 𝗟𝗮𝗿𝗎𝗲 𝗖𝗕𝗗 𝗊𝘁𝗌𝗻𝗲 🔎CBD diameter key 🔎Extend choledochotomy with choledochotome 🔎CBD stone trapped in basket under slight tension and brought to choledochotomy 🔵Other options ➡EHL ➡Laser Lithotripsy 🔵Caution when extending choledochotomy ➡Experience and training critical #FOAMed #GITwitter #MedEd #Surgery #SoMe4Surgery

Derby Pancreaticobiliary & Robotic AWR Unit

32,821 次观看 • 2 幎前

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
0:51

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 Unit

95,384 次观看 • 7 䞪月前

𝗟𝗮𝗜𝗮𝗿𝗌𝘀𝗰𝗌𝗜𝗶𝗰 𝗙𝗲𝗻𝗲𝘀𝘁𝗿𝗮𝘁𝗲𝗱 𝗊𝘂𝗯𝘁𝗌𝘁𝗮𝗹 𝗖𝗵𝗌𝗹𝗲𝗰𝘆𝘀𝘁𝗲𝗰𝘁𝗌𝗺𝘆 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
3:55

𝗟𝗮𝗜𝗮𝗿𝗌𝘀𝗰𝗌𝗜𝗶𝗰 𝗙𝗲𝗻𝗲𝘀𝘁𝗿𝗮𝘁𝗲𝗱 𝗊𝘂𝗯𝘁𝗌𝘁𝗮𝗹 𝗖𝗵𝗌𝗹𝗲𝗰𝘆𝘀𝘁𝗲𝗰𝘁𝗌𝗺𝘆 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

17,864 次观看 • 2 幎前

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
1:24

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

29,010 次观看 • 5 䞪月前

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
0:53

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

14,575 次观看 • 11 䞪月前

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 Journal of Gastrointestinal Surgery (JoGS): #Surgery #HPB #Pancreatitis
2:20

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 Journal of Gastrointestinal Surgery (JoGS): #Surgery #HPB #Pancreatitis

Derby Pancreaticobiliary & Robotic AWR Unit

10,114 次观看 • 7 䞪月前

𝗊𝘁𝗌𝗻𝗲 𝗥𝗲𝘁𝗿𝗶𝗲𝘃𝗮𝗹 𝗳𝗿𝗌𝗺 𝗡𝗮𝗿𝗿𝗌𝘄 𝗖𝗵𝗌𝗹𝗲𝗱𝗌𝗰𝗵𝗌𝘁𝗌𝗺𝘆 🔎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
0:31

𝗊𝘁𝗌𝗻𝗲 𝗥𝗲𝘁𝗿𝗶𝗲𝘃𝗮𝗹 𝗳𝗿𝗌𝗺 𝗡𝗮𝗿𝗿𝗌𝘄 𝗖𝗵𝗌𝗹𝗲𝗱𝗌𝗰𝗵𝗌𝘁𝗌𝗺𝘆 🔎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 Unit

38,341 次观看 • 5 䞪月前

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
2:20

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 Unit

17,219 次观看 • 10 䞪月前

𝗡𝗮𝗿𝗿𝗮𝘁𝗲𝗱 𝗩𝗶𝗱𝗲𝗌: 𝗘𝗺𝗲𝗿𝗎𝗲𝗻𝗰𝘆 𝗟𝗮𝗜𝗮𝗿𝗌𝘀𝗰𝗌𝗜𝗶𝗰 𝗥𝗲𝗜𝗮𝗶𝗿 𝗌𝗳 𝗊𝘁𝗿𝗮𝗻𝗎𝘂𝗹𝗮𝘁𝗲𝗱 𝗢𝗯𝘁𝘂𝗿𝗮𝘁𝗌𝗿 𝗛𝗲𝗿𝗻𝗶𝗮 #FOAMed #GITwitter #MedEd #SurgEd #SoMe4Surgery
3:27

𝗡𝗮𝗿𝗿𝗮𝘁𝗲𝗱 𝗩𝗶𝗱𝗲𝗌: 𝗘𝗺𝗲𝗿𝗎𝗲𝗻𝗰𝘆 𝗟𝗮𝗜𝗮𝗿𝗌𝘀𝗰𝗌𝗜𝗶𝗰 𝗥𝗲𝗜𝗮𝗶𝗿 𝗌𝗳 𝗊𝘁𝗿𝗮𝗻𝗎𝘂𝗹𝗮𝘁𝗲𝗱 𝗢𝗯𝘁𝘂𝗿𝗮𝘁𝗌𝗿 𝗛𝗲𝗿𝗻𝗶𝗮 #FOAMed #GITwitter #MedEd #SurgEd #SoMe4Surgery

Derby Pancreaticobiliary & Robotic AWR Unit

55,164 次观看 • 2 幎前

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
0:57

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 Unit

46,019 次观看 • 4 䞪月前

🔎⏳ BREAKING Miguel Timm ➡ CT City SmashSports 🟢
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🔎⏳ BREAKING Miguel Timm ➡ CT City SmashSports 🟢

Mazola J. Molefe

28,677 次观看 • 8 䞪月前

Here’s how the 🇺🇞 stock market performed today 🔎➡🟢
0:48

Here’s how the 🇺🇞 stock market performed today 🔎➡🟢

Evan

83,294 次观看 • 6 䞪月前

AO infrastructure update with 🐘🔗 sam.arweave.net Where we are: 🟢 HyperBEAM migration well underway 🟢 Massive reduction in legacynet compute 🟢 Performance improvements already live What's next: ➡ Completing the migration to HyperBEAM ➡ **Staking is coming** - decentralized scheduler network with node operators ➡ Significant performance multipliers ahead ➡ New token distribution mechanisms in development The compute layer is maturing fast. Via Drew
8:27

AO infrastructure update with 🐘🔗 sam.arweave.net Where we are: 🟢 HyperBEAM migration well underway 🟢 Massive reduction in legacynet compute 🟢 Performance improvements already live What's next: ➡ Completing the migration to HyperBEAM ➡ **Staking is coming** - decentralized scheduler network with node operators ➡ Significant performance multipliers ahead ➡ New token distribution mechanisms in development The compute layer is maturing fast. Via Drew

ao

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🚚The Political Agenda of Cockroach Party ! ➡ To defeat Yogi Adityanath in UP ! ➡ To help AAP winning Punjab ! 🔎 CJP is a Non-Conventional Proxy Movement ! 🔎 It’s not a youth Movement for the betterment of the country ! 🚚Started by AAP and supported by Samajwadi Party to help these Parties to win Elections !
5:01

🚚The Political Agenda of Cockroach Party ! ➡ To defeat Yogi Adityanath in UP ! ➡ To help AAP winning Punjab ! 🔎 CJP is a Non-Conventional Proxy Movement ! 🔎 It’s not a youth Movement for the betterment of the country ! 🚚Started by AAP and supported by Samajwadi Party to help these Parties to win Elections !

Mona Patel 🇮🇳🐅🌳

17,550 次观看 • 3 䞪月前