Ary Rodríguez

Cirugía General y Laparoscopia

[Derby Pancreaticobiliary & Robotic AWR Unit @DerbyPBunit]

𝙀𝙢𝙚𝙧𝙜𝙚𝙣𝙩 𝙇𝙖𝙥𝙖𝙧𝙤𝙨𝙘𝙤𝙥𝙞𝙘 𝙄𝙣𝙛𝙧𝙖𝙘𝙤𝙡𝙞𝙘 𝙉𝙚𝙘𝙧𝙤𝙨𝙚𝙘𝙩𝙤𝙢𝙮

Patient Selection:
🔵Central, infracolic collections that are dominantly solid (WON) often not amenable to perc. drainage and/or narrow window of access for transgastric approach
🔵Too unwell for concomitant cystjejunostomy
🔵Septic
🔵3-4 weeks into acute attack of SAP

Approach:
🔴Initial identification of bulge in transverse mesocolon
🔴Location confirmed with IOUS
🔴Window created into infracolic compartment
🔴Necrosectomy and washout performed
🔴2 x 18F Robinsons drains placed adjacent to cyst

Key Points:
🟢Timing of intervention critical
🟢Surgical approach allows 𝘀𝗶𝗻𝗴𝗹𝗲 𝘀𝘁𝗮𝗴𝗲 𝗰𝗹𝗲𝗮𝗿𝗮𝗻𝗰𝗲 of WON which avoids multiple hits of sepsis
🟢Concomitant cholecystectomy can be undertaken in select cases
🟢Patient selection and discussion in benign specialist MDT key

Link to our paper in @JournalofGISurg below:
https://t.co/kcdwWFwSjz

#FOAMed #GITwitter #surgery #SoMe4Surgery #MedEd #hpb

[Salomone Di Saverio MD PhD FACS FRCS (Eng) @salo75]

Technically challenging Whipple for Distal Biliary carcinoma arising on a previous choledoco-duodenal anastomosis done 30 years ago for a biliary iatrogenic lesion

[Sociedad Española de Patología Digestiva (SEPD) @sepdigestiva]

🔎 Caso de #colonoscopia

👤 Varón de 21 años.
Indicación: colonoscopia diagnóstica por diarrea.
📍 Localización: colon sigmoide y recto.
Hallazgos endoscópicos compatibles con colitis ulcerosa (#CU).
📊 Clasificación endoscópica de la EII:
• Índice de Mayo: 2
• UCEIS – Patrón vascular (V): 1
• UCEIS – Sangrado (B): 1
• UCEIS – Erosiones y úlceras (E): 1
• UCEIS total: 3 (leve)

Por cortesía de @Serhii_endo108

[Dr. Johnny Stewart. MD , FRCSC / RMC, CAF @DrJStewart_GS]

🔑 Retraction is dissection

✅ Correct (a): Fundus up ⬆️ + infundibulum lateral ➡️ Opens Calot's triangle and gives you a real Critical View of Safety

❌ Wrong (b): Pulling the infundibulum up ⬆️ Tents the CBD right into line with the cystic duct → classic bile duct injury

[Sociedad Española de Patología Digestiva (SEPD) @sepdigestiva]

#QuizSEPD Una erupción cutánea llamativa observada en un paciente con dolor abdominal de larga evolución. ¿Cuál es el diagnóstico? By @drkeithsiau

[Dr Abo Omar @dromr__]

أمس رأيت أشعة لشاب تظهر كيس الصفن (Scrotum) متمدد بشكل مخيف مثل ما ترون.

هذا الشاب رياضي٫ ياكل كل شي صحي٫ ليس عنده أي مرض أدى لها أو ورم.

لكنه كان يفعل عادة واحدة خبيثة أدت إلى نزول الخصيتين وتمددهم بهذا الحجم٫ العادة كانت:

[WebSurg @websurg]

Monthly focus on HPB & pancreatic surgery

🔗 Check it out here: https://t.co/1F1sHEZ86l

#surgery #minimallyinvasive #roboticsurgery #laparoscopy #HPBsurgery #liver #pancreas

[Vigen Malkhasyan @drvigen]

Comma-tail tumor.

Would a root diving into the parenchyma stop you from trying to spare the kidney?

Laparoscopic enucleation.
Followed the tail. Coagulated the bed.

[Dr Ihab Suliman @IhabFathiSulima]

A 28-year-old man is taken to surgery after four days of worsening right lower abdominal pain and fever. During laparoscopy, the surgeon finds the appendix buried in a dense mass of inflamed omentum and adherent bowel loops.

The surgeon pauses before attempting to separate them.

What is this inflammatory mass called?

[Dr CHIRAG 🩺 @Chiragrx07]

🔺 HEPATOCYSTIC TRIANGLE (CALOT’S TRIANGLE)

Boundaries:-

• Medial - Common hepatic duct.
• Inferior/Lateral - Cystic duct.
• Superior - Inferior surface of liver.

Contents:-

• Cystic artery
• Cystic lymph node (Lund’s node)
• Lymphatics & connective tissue

EXAM TRAP:-
Calot’s original triangle (1891) was bounded by the cystic duct, common hepatic duct and cystic artery.

Modern hepatocystic triangle uses the inferior surface of the liver as its superior boundary.

SURGICAL Importance is 👇

Critical View of Safety (CVS) during laparoscopic cholecystectomy requires:-

1. Clearance of the hepatocystic triangle
2. Separation of the lower ⅓ of gallbladder from liver bed
3. Confirmation that ONLY TWO structures enter the gallbladder i.e cystic duct & cystic artery.

🎯 Remember:- CVS helps prevent bile duct injury.

[EndoCollab™ | GI Endoscopy Community @EndoCollabcom]

Endoscopic GERD therapy, by mechanism:

Radiofrequency: Stretta

Plication: TIF (EsophyX, MUSE), GERDx

Resection: ARMS, ESD-G

Constriction: CLEAR band ligation

Ablation: ARMA

None is as established as laparoscopic fundoplication, and most have not been evaluated extensively.

[AJG - The American Journal of Gastroenterology @AmJGastro]

ACG Clinical Guideline: Diagnosis and Management of Adenomatous Colorectal Polyposis Syndromes

📕 https://t.co/dBrT23qLFf
🎙️ https://t.co/HZtFj3Vh8u
📄 https://t.co/NU08hNHQHY

@GMankaney @burkegastrodoc @CarlKayMD @AndrewMMoon

[Dan Souza @danatsouza]

This is not an osseous metastasis!

Iliac bone graft harvesting! Most frequent autograft donor site: superficial, accessible, provides abundant bone...

@MGBRadEdu @FOAMrad @SAR_RFS @futureradres @ARRS_Radiology @Abdominal_Rad @CBRadiologia @DanaFarber #MedEd

[Mukesh Harisinghani @mharisinghani]

Gastric intussusception secondary to GIST; rare

[Mukesh Harisinghani @mharisinghani]

Scirrhous adenocarcinoma against background of Ulcerative Colitis can be difficult to detect

[American College of Surgeons @AmCollSurgeons]

One Skill, Two Platforms: Mastering Difficult Suturing in Open and Laparoscopic Surgery

#ACSCC26

[Marion ✙ @Fleshtoplay]

Medical illustrations by Max Bröden

[Douglas G. Adler MD, FASGE, FACG, AGAF @DouglasAdlerMD]

Colonic stent for a low lying rectal cancer. Extremely effective ! #gitwitter #surgery #colonoscopy

[河野健一 Kenichi Kono ｜ 脳外科医 CEO｜AI 医療 MBA｜脳血管内手術支援AI @CeoImed]

作ってみました

｢ダビンチ･シミュレーター！｣

専門外なのでどのくらいリアルなのかは分かりませんが、イメージを掴むのには良さそうです

[Osgenic @osgenic]

A quick look at the two-incision technique used in lower leg fasciotomy to release pressure in the four compartments of the leg.

To access full video, start your free trial at https://t.co/yZdFnplAid

#orthopaedics #trauma #Fasciotomy #leg #orthotwitter #orthoX