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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...

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Derby Pancreaticobiliary & Robotic AWR Unit

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60,367 views • 3 years 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
3:55

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

17,864 views • 2 years ago

𝗘𝘅𝘁𝗲𝗻𝘀𝗶𝗼𝗻 𝗼𝗳 𝗖𝗵𝗼𝗹𝗲𝗱𝗼𝗰𝗵𝗼𝘁𝗼𝗺𝘆 𝗳𝗼𝗿 𝗟𝗮𝗿𝗴𝗲 𝗖𝗕𝗗 𝗦𝘁𝗼𝗻𝗲 🔴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
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𝗘𝘅𝘁𝗲𝗻𝘀𝗶𝗼𝗻 𝗼𝗳 𝗖𝗵𝗼𝗹𝗲𝗱𝗼𝗰𝗵𝗼𝘁𝗼𝗺𝘆 𝗳𝗼𝗿 𝗟𝗮𝗿𝗴𝗲 𝗖𝗕𝗗 𝗦𝘁𝗼𝗻𝗲 🔴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 views • 2 years ago

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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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 views • 5 months ago

𝙇𝙖𝙥𝙖𝙧𝙤𝙨𝙘𝙤𝙥𝙞𝙘 𝙍𝙚𝙥𝙖𝙞𝙧 𝙤𝙛 𝙋𝙚𝙧𝙛𝙤𝙧𝙖𝙩𝙚𝙙 𝘿𝙪𝙤𝙙𝙚𝙣𝙖𝙡 𝙐𝙡𝙘𝙚𝙧 𝙬𝙞𝙩𝙝 𝙋𝙧𝙞𝙢𝙖𝙧𝙮 𝘾𝙡𝙤𝙨𝙪𝙧𝙚 & 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

𝙇𝙖𝙥𝙖𝙧𝙤𝙨𝙘𝙤𝙥𝙞𝙘 𝙍𝙚𝙥𝙖𝙞𝙧 𝙤𝙛 𝙋𝙚𝙧𝙛𝙤𝙧𝙖𝙩𝙚𝙙 𝘿𝙪𝙤𝙙𝙚𝙣𝙖𝙡 𝙐𝙡𝙘𝙚𝙧 𝙬𝙞𝙩𝙝 𝙋𝙧𝙞𝙢𝙖𝙧𝙮 𝘾𝙡𝙤𝙨𝙪𝙧𝙚 & 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 views • 9 days ago

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
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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 Unit

38,341 views • 5 months ago

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 views • 3 months ago

And here's part 2 of our tour. Wishlist Big Walk on Steam at More at 🔴🟡🔵 🔴🟡🔵
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And here's part 2 of our tour. Wishlist Big Walk on Steam at More at 🔴🟡🔵 🔴🟡🔵

House House

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🔴🔵🔴🔵🔴🔵🔴 ミャクミャク…！ 🔵🔴🔵🔴🔵🔴🔵 #EXPO2025 #大阪・関西万博
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🔴🔵🔴🔵🔴🔵🔴 ミャクミャク…！ 🔵🔴🔵🔴🔵🔴🔵 #EXPO2025 #大阪・関西万博

せきぐちあいみᯅAimi أيمي

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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
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Derby Pancreaticobiliary & Robotic AWR Unit

10,114 views • 7 months ago

Prolongation ➡️ Tunnel 😂🔴🔵
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Olympique Lyonnais

42,380 views • 2 months ago

𝗥𝗼𝗯𝗼𝘁𝗶𝗰 𝗧𝗔𝗥𝗨𝗣 𝘃𝘀. 𝗟𝗮𝗽𝗮𝗿𝗼𝘀𝗰𝗼𝗽𝗶𝗰 𝗜𝗣𝗢𝗠 𝗥𝗲𝗽𝗮𝗶𝗿 𝗼𝗳 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
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𝗥𝗼𝗯𝗼𝘁𝗶𝗰 𝗧𝗔𝗥𝗨𝗣 𝘃𝘀. 𝗟𝗮𝗽𝗮𝗿𝗼𝘀𝗰𝗼𝗽𝗶𝗰 𝗜𝗣𝗢𝗠 𝗥𝗲𝗽𝗮𝗶𝗿 𝗼𝗳 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

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11,606 views • 2 years ago

Chelsea 5-4 Man Utd 🔴22’ Giggs 🔵31’ Luiz 🔴43’ Hernandez 🔵52’ Cahill 🔴59’ Nani 🔵94’ Hazard 🔵97’ Sturridge 🔵116’ Ramires 🔴120’ Giggs Definition of “Mentality”
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CFCDigest

385,383 views • 2 years ago

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
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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 views • 10 months ago

🔴🔵 PSG ➡️ CRF 🔴⚫️ É O BRUXO Ronaldinho! 🧙‍♂️
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🔴🔵 PSG ➡️ CRF 🔴⚫️ É O BRUXO Ronaldinho! 🧙‍♂️

Paris Saint-Germain

109,398 views • 9 months ago

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
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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

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16,736 views • 6 months ago

🌈 Rainbow Waterfall 🌈 🔴 🟠 🟡 🟢 🔵 🟣 🔴 🟠 🟡 🟢 🔵 🟣 🔴 🟠 🟡 🟢 🔵 🟣 🔴 🟠 🟡 🟢 🔵 🟣 🔴 🟠 🟡 🟢 🔵 🟣 🔴 🟠 🟡 🟢 🔵 🟣 🔴 🟠 🟡 🟢 🔵 🟣 🔴 🟠
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🌈 Rainbow Waterfall 🌈 🔴 🟠 🟡 🟢 🔵 🟣 🔴 🟠 🟡 🟢 🔵 🟣 🔴 🟠 🟡 🟢 🔵 🟣 🔴 🟠 🟡 🟢 🔵 🟣 🔴 🟠 🟡 🟢 🔵 🟣 🔴 🟠 🟡 🟢 🔵 🟣 🔴 🟠 🟡 🟢 🔵 🟣 🔴 🟠

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36,301 views • 8 months ago

On this day in 2017: Arsenal came from behind to beat Leicester 4-3 on a dramatic opening night of the Premier League season. 🤯🔊 🔴 Lacazette (2’) 🔵 Okazaki (5’) 🔵 Vardy (29’) 🔴 Welbeck (45+2’) 🔵 Vardy (56’) 🔴 Ramsey (83’) 🔴 Giroud (85’)
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On this day in 2017: Arsenal came from behind to beat Leicester 4-3 on a dramatic opening night of the Premier League season. 🤯🔊 🔴 Lacazette (2’) 🔵 Okazaki (5’) 🔵 Vardy (29’) 🔴 Welbeck (45+2’) 🔵 Vardy (56’) 🔴 Ramsey (83’) 🔴 Giroud (85’)

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112,029 views • 1 month ago

🔵🔴Atte.Aquiles23🔵🔴 Y el Gran y 👊🏻Mbarete👊🏻 🔵🔴👊🏻Pueblx Azulgrana👊🏻🔵🔴 ‼️
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🔵🔴Atte.Aquiles23🔵🔴 Y el Gran y 👊🏻Mbarete👊🏻 🔵🔴👊🏻Pueblx Azulgrana👊🏻🔵🔴 ‼️

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