Parenchymal sparing right anterior sectionectomy for 7cm HCC and left medial sectionectomy for 4cm colorectal liver metastasis.
Robotic surgery enabled widespread of technical complex hepatobiliary resection.
Optimal parenchymal preservation. Dark area on 2nd video is Fibrillar
In this operative video, Dr. Cohen demonstrates resection of a cavernous sinus meningioma through a frontotemporal approach.
The operation proceeds through the middle fossa, where the fibrous tumor is entered inferiorly and internally debulked to create working space. As the mass is reduced, the dissection follows the lateral wall of the cavernous sinus, with continued attention to the trigeminal nerve branches as they are identified and preserved.
Further opening of the lateral cavernous sinus wall allows additional tumor removal until cavernous sinus venous bleeding defines the limit of safe resection.
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𝙇𝙖𝙥𝙖𝙧𝙤𝙨𝙘𝙤𝙥𝙞𝙘 𝙍𝙚𝙥𝙖𝙞𝙧 𝙤𝙛 𝙋𝙚𝙧𝙛𝙤𝙧𝙖𝙩𝙚𝙙 𝘿𝙪𝙤𝙙𝙚𝙣𝙖𝙡 𝙐𝙡𝙘𝙚𝙧 𝙬𝙞𝙩𝙝 𝙋𝙧𝙞𝙢𝙖𝙧𝙮 𝘾𝙡𝙤𝙨𝙪𝙧𝙚 & 𝙊𝙢𝙚𝙣𝙩𝙖𝙡 𝙋𝙖𝙩𝙘𝙝
Presentation:
🔵1 day history of sever upper abdominal pain
🔵Smoker and excess ETOH
🔵CXR
➡️Pneumoperitoneum
🔵CT
➡️Perforated duodenal ulcer
🔵Time from ED➡️theatre 3 hours
Operative Approach:
🔴Thorough peritoneal lavage
➡️Lap washout allows for thorough removal of intra-abdominal contamination
➡️Modern OR table tilting can provide better view then open in select cases
🔴If fragile tissue then omental patch only
➡️This approach is a modified version of Grahams patch repair
➡️When suitable, we prefer primary closure with patch after
🔴For large perforations kocherisation of duodenum may be indicated
🔴Convert to open if:
➡️Large ulcer
➡️Associated ulcer bleed
🔴H. Pylori eradication therapy on discharge
🔴OGD in 6-8 weeks to confirm healing
Key Points:
🟢Timely intervention critical
🟢Lap approach in EGS should be encouraged
🟢Compared to open, advantages of lap are:
➡️Reduced pain
➡️Reduced LOS
➡️Reduced incisional hernia rate
🟢Trainees should be exposed to lap EGS early to develop skills and confidence
#FOAMed #GITwitter #MedEd #SurgEd #EGS #SoMe4Surgery
In this operative video, Dr. Cohen demonstrates staged retromastoid and pterional approaches for resection of a petroclival epidermoid tumor.
Careful attention is paid to the fourth cranial nerve as it enters the tentorium near the petrous apex. Tumor along the posterior basal temporal lobe is removed through the supratrochlear working corridor. The portion anterior to the midbrain is dissected while the contralateral oculomotor nerve is identified and protected, permitting maximal safe removal of tumor extending toward the medial temporal lobe.
Learn more here:
https://t.co/VzFC3VBQzh
#Neurosurgery #EpidermoidTumor #DrCohen #SurgicalExcellence
In laparoscopic surgery, precision is not just about where you dissect,it’s also about where you deliver energy.
GOOD
Adequate traction + subserosal dissection of the gallbladder bed + VCS doublet = 5 points.
BAD
Energy device delivering heat to the liver by continuity.
AWFUL
Using energy close to a metallic structure, with the risk of indirect thermal injury to the cystic duct.
🔹 Hiatal hernia repair + Roux-en-Y gastric bypass.
A 62-year-old patient with a history of sleeve gastrectomy 10 years ago underwent:
1.Operative time: <1 hour 30 minutes.
2.Endoscopy: Hiatal hernia + LA Grade C esophagitis.
3.ERAS/ERABS protocol + TAP block.
4.Walking just 5 hours post-op with minimal pain.
La paciente en piso de Ginecología por un “quiste anexial derecho”…
Los ginecos preguntándose por qué estará vomitando “fecaloide”🤔
La causa:
Trombosis segmentaria? Agente infeccioso? Isquemia mesentérica no oclusiva? Todas las anteriores?
This is how I undid an old Dor Fundoplication for a patient with Achalasia who had recurrent dysphagia and reflux , work up showed increased LES pressure but scope didn’t show tight junction rather than hiatal hernia and an odd wrap configuration, complete revision done and I converted Dor Fundo to Toupet Fundo after I did hiatal hernia repair with biomesh , intra op scope was reassuring.
Now it is two weeks post op and patient is doing very well with resolution of symptoms 🙏🏽
فيديو يوضح غياب الحويصلة المنوية الثانية أثناء استئصال البروستاتا عن طريق #الروبوت_الجراحي.
دائمًا راجع الأشعة بدقة قبل العملية لتوقع أي غياب أو تشوه تشريحي خلقي
لتتجنب البحث عن أنسجة غير موجودة.
وما هي التشوهات المصاحبة التي تحرص على الفحص عنها في مثل هذه الحالات؟
#دكتور_أحمد_الفرحان #سرطان_البروستاتا #RARP
surgical masterpiece in motion. 🫀 Witnessing open-heart surgery up close reveals the absolute precision and grit required in the operating room.
What's the most fascinating medical procedure you've ever learned about?
Invaginated “telescopic” pancreaticojejunostomy after Whipple pancreaticoduodenectomy. the more often I do this technique the more i like it! Excleeent results & safety (CT scan is 7th POD) especially useful & safe when pancreas is soft & MPP is small #2 VIDEOS