HPB_GI surgical oncology

Robotic HPB is the future

[HPB_GI surgical oncology @MHAl_Temimi]

@Robo_HPB Proximal gastrectomy is a good operation for proximal gastric tumors. Despite the negative reputation, I see the quality of life is better than total gastrectomy.

[Sean Langenfeld @SeanLangenfeld]

With #ACSCC26 fast approaching, it's a good time to share the new @ASCRS_1 2026 #CPG on #Diverticulitis

This group effort, hot off the press in the October @DCRjournal issue, was expertly led by @alexhawkinsmd

Don't forget to catch us in DC as well at PS102 (This Sunday at 1245, Ballroom C. Hottest ticket in town!)

Yes, the CPG discusses omission of antibiotics for uncomplicated disease, but there are so many other great topics:

Emergency surgery:
-Which patients should receive a protected anastomosis during emergency surgery for peritonitis.
-Colectomy preferred over lap lavage for most patients

Elective surgery:
-Selective approach to elective surgery for pelvic abscesses as well as immunocompromised patients
-Avoidance of colo-colonic anastomoses, as this is associated with high rates of recurrence.
-The threshold for elective surgery is not based on an arbitrary number of attacks, but instead individualized based on QUALITY OF LIFE!
-One third of patients have chronic symptoms after an episode of diverticulitis, and surgery is effective at improving their QOL.

Link to the CPG:
https://t.co/GBGIvp0TBV

@AmCollSurgeons @BoutrosMarylise @a_bham18 @Thomascurran27 @ianmpaquette @tlhedr0 @GaertnerWB

[HPB_GI surgical oncology @MHAl_Temimi]

@SocSurgOnc @AnnSurgOncol @laleh_melstrom @SyedAAhmad5 Early adopters need more than “competency-based training”. You need help from mentors, very competent MIS assistant and careful patient selection. you also cannot jump from robotic chole to RPD! You could do so many other robotic cases leading to RPD.

[JAMA Surgery @JAMASurgery]

Single-stage laparoscopic common bile duct exploration (#LCBDE) reduced costs and length of stay vs ERCP plus cholecystectomy, with improved net margin in #choledocholithiasis care. https://t.co/HWXYn7Yz0P

[HPB_GI surgical oncology @MHAl_Temimi]

@SurgOnc_Sam The tethering to the diaphragm helps in this case! It suspends the intended area of resection. Great work!

[HPB_GI surgical oncology @MHAl_Temimi]

@SWexner @AmCollSurgeons @acsJACS @YouTube MIS Completion cholecystectomy is feasible and safe robotically in experienced hands. It is unfortunate to see such high number of open operations

[HPB_GI surgical oncology @MHAl_Temimi]

@SWexner @AmCollSurgeons @acsJACS @YouTube @JeyarajahRohan
Billing for the “complex” completion cholecystectomy is a challenge as there is no CPT code and the patient already had “cholecystectomy”!

[HPB_GI surgical oncology @MHAl_Temimi]

@SWexner @AmCollSurgeons @acsJACS @YouTube Thanks for sharing. This is a real issue as some surgeons still perform “subtotal cholecystectomy” without cleaning the pouch of the GB, thus leaving residual untreated Gallstone disease.

[HPB_GI surgical oncology @MHAl_Temimi]

@ZhiVenFongMD Hot topic. Bring it for discussion at the SRS!
The medical staff office provide privileges for performing surgery.
Training institutions and intuitive could provide certificates of training.
Another question: who can do which robotic operation?

[HPB_GI surgical oncology @MHAl_Temimi]

@ZhiVenFongMD @SSATNews @IHPBA @SAGES_Updates @AHPBA @EAHPBA Congrats! The main PD is abutting this tumor. She did not leak, but definitely not a guaranteed outcome with such location!
What was your intraop marker to decide whether to convert to central pancreatectomy or not? Post-resection US?

[Haitham in Gaza 🇵🇸🍉 @HaithamElmasri1]

One of the most brutal crimes committed against us by Israel…

After starving us for more than two years — until our children began dying from hunger — Israel, under American leadership, established camps in areas that had turned into barren deserts, claiming they were for distributing aid.

And when we arrived at those places, the Israeli–American army forced us into tightly packed lines; families standing one behind another, barbed wire fencing on both sides, and in front of us masked soldiers heavily armed with deadly weapons and military gear.

There, we were forced to chant for them… not out of love or respect, but out of fear that they would kill us all, and in desperate hope of obtaining a little food to ease our children’s hunger.

We were subjected to the cruelest and filthiest humiliation at the hands of Israel — a humiliation unlike anything humanity has ever witnessed throughout its history.

[Syed A. Ahmad @SyedAAhmad5]

Sobering graph. 👇🏼👇🏼

[HPB_GI surgical oncology @MHAl_Temimi]

@SyedAAhmad5 That is how they killed private practice and physicians lost their autonomy

[HPB_GI surgical oncology @MHAl_Temimi]

@HalletJulie @SocSurgErgo @Hamid_Norasi @GeetaLalMD @jennyshaomd @Dr_A_Wooldridge @AnnalsofSurgery Use the Robot more often, particularly DV5

[HPB_GI surgical oncology @MHAl_Temimi]

@drkeithsiau The failure rate does not sound like success to me at all.

[HPB_GI surgical oncology @MHAl_Temimi]

@ShaykhSulaiman “Historic humanitarian aid” 😮 😳

[HPB_GI surgical oncology @MHAl_Temimi]

@IswantoSucandy Amazing work! Congrats. Did you split S4/S5? Or this is a central hepatectomy+ S1 (S4, S5, S8 and caudate)?

[Sen. Bernie Sanders @SenSanders]

Larry Ellison, the world’s 2nd-richest man, predicts an AI surveillance state where “we’re constantly recording & reporting everything.”

Are we headed toward a future where every call, text, email & search is tracked by billionaires? That's not democracy. It's authoritarianism.

[HPB_GI surgical oncology @MHAl_Temimi]

@ZhiVenFongMD @HalletJulie @MarcBesselink @DrJashDatta @SyedAAhmad5 @NEJM Outcome (not necessarily volume) should be the dictating who can do a procedure.
1. Why are we training so many HPB surgeons?
2. Why some patients need to travel 5 hours for care?
3. Junior faculty in high volume centers mostly have low volume practice. Is the outcome inferior?

[Dutch Rojas @DutchRojas]

If you want to fix medical bankruptcy, you’d have to do three things simultaneously:

Enforce real-time price transparency.

Ban secret negotiated rates.

Make insurance catastrophic only,
not first-dollar prepayment.