Sasindran Ramar

Consultant Robotic Upper GI & Bariatric Surgeon | King’s College Hospital. Single-port & multiport robotic surgery.

[Sasindran Ramar @SasindranR]

@Rainmaker1973 !

[Sasindran Ramar @SasindranR]

@AhmadAbouAbbas8 @rvyapMD Beautiful dissection like always. What suture did you use? PTFE?

[Sasindran Ramar @SasindranR]

@DrDhirajkachare @AhmadAbouAbbas8 Beautiful dissection like always. What suture did you use? PTFE?

[Ahmad Abou Abbass @AhmadAbouAbbas8]

The capabilities of the single port platform continue to impress me. Can't wait to explore what's possible!
But technology is only as good as the practice behind it. Every stitch and every repetition matters.

Didn't find grapes in the cafeteria but lots of other fruits 😅
Suturing delicate tomato skin without tearing it is a great exercise before moving on to something as precise as maybe a PJ? 😬
#roboticsurgery
@IntuitiveSurg

[Neil Floch MD @NeilFlochMD]

I posted this in 2006 when people believed that diet nd exercise were an effective treatment for #obesity. Despite life-changing Bariatric Surgery results it took the acceptance of GLP-1 medications to convince the public otherwise.

[Ahmad Abou Abbass @AhmadAbouAbbas8]

The future of surgery is single...port 🤖
Exciting times ahead for robotic surgery.
I’m incredibly impressed by the capabilities and versatility of this machine. Just imagine the possibilities!

[Intuitive @IntuitiveSurg]

Our innovative single-port platform: da Vinci SP Surgical System received new @US_FDA clearance for urological surgical procedures. Learn more about the latest in our integrated product family: https://t.co/njtV9vfkye #urology

[Sasindran Ramar @SasindranR]

#NewProfilePic

[Julie Hallet @HalletJulie]

Team ergonomics - 🤖 ergonomics not just about the console surgeon
👥92 procedures
💪Back pain ↓4.3 points robotic vs lap
✅Assistants benefited too: ↓shoulder pain, ↓fatigue

🤔Should we evaluate OR ergonomics team-wide by default?

https://t.co/x4luKYImlm

[Neil Floch MD @NeilFlochMD]

Metabolic Bariatric Surgery remains the most durable and effective treatment for obesity

[Steven D Wexner MD, PhD @SWexner]

Robotic Cholecystectomy May Reduce Bile Duct Injury in Complex Cases https://t.co/nyPUmfe40C @AmCollSurgeons

[Jose M. Balibrea MD, PhD, FACS @BalibreaJose]

The question isn’t whether robotic surgery is expensive. It’s when.
This @AnnalsofSurgery study shows that during implementation, robotic pancreaticoduodenectomy costs more—but after the learning curve, costs become comparable to open surgery thanks to shorter OR times, fewer complications, and shorter hospital stays. Volume and experience change the equation.

@aecirujanos #roboticsurgery

[JAMA Surgery @JAMASurgery]

In youths after sleeve gastrectomy, early reinitiation of obesity medication was associated with greater 12-month weight loss vs surgery alone, without higher postoperative morbidity. https://t.co/LPtNdCIwai

[Keith Siau @drkeithsiau]

A patient on longstanding omeprazole was admitted with severe fatigue. What do you think we found?

[Neil Floch MD @NeilFlochMD]

Patients and physicians are excited about the results of these pharmaceutical sponsored studies with incredible results. Those of us who treat patients with medications and surgery - see the real world results and they are significantly lower. Although 50% achieve success on medications, the other half fail to achieve meaningful weight loss that alters their health and quality of life. Why? Because they don’t have access to medications, they can’t afford to pay, the medications don’t work for them or they cannot tolerate them. Many patients “just stop” and regain. Bariatric Surgery at its height only was performed on 1% of patients who needed it, despite the entry of GLP-1 medications, there remain many patients who would greatly benefit from surgery but avoid it now because of the stigma-I see patients talked out of surgery by family and friends who then fail medications and remain with obesity.

[Neil Floch MD @NeilFlochMD]

A new study from @nyulangone compared #Semaglutude to bariatric surgery: People in the surgery group shed an average of 25.7 percent of their total body weight over two years, while those in the medication group lost only 5.3 percent because the GLP-1 group stopped the medication.

[Vahagn C. Nikolian, MD @VNikolian]

Post-sternotomy ventral hernias can be deceptively nuanced to treat. This video demonstrates how to do a robotic reinforced tension line, expose the central tendon of diaphragm, and perform TAPPRA.
https://t.co/bwATbmOhFv #HerniaGeeks #NYUHernia

[Juan Luis Calisto M.D. @doctorcalisto]

@JAMASurgery Would say that does not make sense at all.

Robotic surgery esentially is the same as laparoscopic surgery. Maybe there is a difference in operators perhaps more experienced laparoscopists?.

[Jose M. Balibrea MD, PhD, FACS @BalibreaJose]

The study focuses solely on recurrence (which was virtually the same across all three groups). This is legitimate. However, there is a lack of very relevant data regarding the type of repair, mesh fixation, complications…

However, robotics cannot (yet) demonstrate a lower recurrence rate. Thanks to the robot, we perform better surgeries on more complex patients (recurrences, high BMI…), visualize the structures much better, and cause significantly less pain (with all that entails). Those are the interesting results IMHO.

@JordiTarasco @EgarsotElisenda @aecirujanos @jorgebravolo @FilipMuysoms @CarlosFerrigni @santiazagra

[Sean Langenfeld @SeanLangenfeld]

"8.6 fold increase" was 0.3%-->2.6%.

"Higher operative recurrence" was 3.78% for robot vs 3.21% for lap.

This was Medicare-only so everyone above age 65, and much of the meaningful variables (pain, return to work, etc) were not measured.

This obviously doesn't control for so many things on the patient and surgeon end, so such modest differences don't seem meaningful to a non-hernia surgeon such as myself.

One thing to consider, as well, is robot acting as a bridge and allowing surgeons to tackle more difficult hernias MIS that they would have done open (and thus a higher recurrence would be expected, no?)

Also, table 1 shows modest-but-likely-statistically-significant differences between lap and robot patients in several important patient characteristics with robots having higher rates of diabetes, COPD, PVD, CKD, liver disease, etc.

If this study proves anything to you, it's likely confirmation bias.