Sam Douglas, MD FACS

FACS AHPBA/Board Certified HPB/General Surgeon with interests in: Liver, Pancreas, Biliary, GI Oncology, and Robotics. Proud husband, dad, and Christian.

[Sam Douglas, MD FACS @Robo_HPB]

https://t.co/PmAGABtVdw

[Sam Douglas, MD FACS @Robo_HPB]

EHL lithotripsy is extremely helpful to breakup stones which can then be easily pushed through to the duodenum. I like having a wire across ampulla and having dilated it first then flush/push through/pull back/flush to clear debris. Pushing Antegrade balloon might also work?

[Sam Douglas, MD FACS @Robo_HPB]

@ziadtawad @DoctorBenChan So far so good

[Sam Douglas, MD FACS @Robo_HPB]

Surgical ligation of right hepatic artery for actively hemorrhaging massive ruptured HCC after ICG verifying adequate left sided arterial perfusion (IR not available anywhere inside a 100 mile radius). What would you have done?

[Sam Douglas, MD FACS @Robo_HPB]

@ziadtawad @DoctorBenChan Honestly, the Synchroseal I think is a better energy device than anything I've got open. Since he was hemodynamically stable, I think he'll make it through this episode. My biggest regret, though, is that with the artery formally ligated TACE/TARE is going to be very limited.

[Sam Douglas, MD FACS @Robo_HPB]

@ziadtawad @DoctorBenChan Definitely not easy though. All of the varices makes the dissection very treacherous.

[Sam Douglas, MD FACS @Robo_HPB]

@ziadtawad @DoctorBenChan And if it's not available?

[Sam Douglas, MD FACS @Robo_HPB]

Openings at Alabama Oncology https://t.co/xpw1JjOIv9

[Sam Douglas, MD FACS @Robo_HPB]

This particular (35yo) patient had 3 lesions ranging from 1cm to 2.5cm - all ablated. he got his LAR and liver directed therapy all in one session.

[Sam Douglas, MD FACS @Robo_HPB]

Microwave Ablation of 1.7cm CRLM during robo LAR. Joint cases (although a hassle for surgeons at times) save patients extra procedures, time, money. Safety is priority but wherever possible, with together! #teamsport

[Sam Douglas, MD FACS @Robo_HPB]

@rbarbosa91 The percentage of modifier -22 cases that actually pay:

[Sam Douglas, MD FACS @Robo_HPB]

@JeyarajahRohan I agree. If I'm instrumenting the CBD I almost always either do sphinteroplasty (I've not found a safe way to do a true sphincterotomy from above) or I leave a stent and have GI come back in 6 weeks or so.

[Sam Douglas, MD FACS @Robo_HPB]

PGY1 - Spyglass CBDE during robot chole. Usually can just push these through but some times they float and spin, so snare is nice. I try to dilate the ampulla with 13Fr sheath first (just advance over wire all the way down through ampulla).

[Sam Douglas, MD FACS @Robo_HPB]

@UroDonMD Haha, I usually go raid their stuff anyway. It would always be good to get more touches though

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[Sam Douglas, MD FACS @Robo_HPB]

@altaf_awan12 @DerbyPBunit @ib9994 Interestingly the only clinically relevant pancreatitis I've seen was when I used a balloon to dilate the ampulla.

[Sam Douglas, MD FACS @Robo_HPB]

Robot resection of segment 7 locally recurrent colorectal liver met (previous ablation 1 year ago). Ultrasound to verify margin during resection

[Sam Douglas, MD FACS @Robo_HPB]

Robotic Segment 5/6 partial resection for 7cm metastatic sbNET +chole + SBRsxn. Looping a sponge around transection line gives nice control.

[Sam Douglas, MD FACS @Robo_HPB]

@aabutaka Yeah my preferred method is to advance this through the ampulla (dilates to 13Fr) then fragment the stones up with EHL. Put wire through the scope through the ampulla then flush and push all the fragments into duo.

[Sam Douglas, MD FACS @Robo_HPB]

Robotic chole with common bile duct exploration with spyglass and intraop ultrasound (as sensitive as IOC and more specific). Single strange duct clearance with chole saves patients LOS and extra procedures.

[Sam Douglas, MD FACS @Robo_HPB]

@rajibaji1983 Transcystic 99% of the time (unless have other reason to go transductal). With glide wire and uropass sheath and EHL lithotripsy machine can almost always clear stones.