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𝙏𝙧𝙖𝙪𝙢𝙖 𝙇𝙖𝙥𝙖𝙧𝙀𝙚𝙘𝙀𝙥𝙮 & 𝙋𝙧𝙞𝙢𝙖𝙧𝙮 𝙍𝙚𝙥𝙖𝙞𝙧 𝙀𝙛 𝙎𝙢𝙖𝙡𝙡 𝘜𝙀𝙬𝙚𝙡 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...

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Derby Pancreaticobiliary & Robotic AWR Unit

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64,501 görÃŒntÃŒleme • 3 yıl önce •via X (Twitter)

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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
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

16,523 görÃŒntÃŒleme • 1 ay önce

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

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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

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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

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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
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 görÃŒntÃŒleme • 9 ay önce

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

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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
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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

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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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