James Lee

Endocrine Surgeon | Deputy Group Chief Technology Officer | Adjunct Associate Professor @NUSMedicine | National University Health System

[James Lee @drjameswklee]

Thyroid RFA doesn't change practice because it's new tech.

It changes practice when it's wired into a service — selection criteria, referral pathway, follow-up, outcomes tracking.

The procedure is the easy part. The pathway is the work.

[Clinical Thyroidology @clinicalthyroid]

Read now- Dr. Vaisman reviews new study in @AnnSurgOncol showing #calcitonin & #desmoplasia results that may help determine surgical extent for #MedullaryThyroidCancer

https://t.co/kioayFvl0I

#medtwitter #endotwitter #thyroid #thyroidcancer #MTC @ThyCaInc #thyroidectomy

[Keith Siau @drkeithsiau]

What we would like for Christmas 🎁🎄

[James Lee @drjameswklee]

Merry Christmas Everyone!!!

*Credit to Gen-AI

[NUS @NUSingapore]

NUS is 8th in the world and 1st in Asia! Holding 11th place for the past five years, NUS rose three places in the latest QS World University Rankings; and is now in the world’s top 10 universities for the first time. #NUSExcellence #ShapeTheFuture https://t.co/EeB4cC1bQz

[James Lee @drjameswklee]

@DrBenjaminTan Drinking in the knowledge!

[James Lee @drjameswklee]

Indeed a view we aim to see every day

[Philip Haigh, MD @pihaigh]

CVSTS ®
(critical view of safety in thyroid surgery! so many procedures have their CVS, thought it was time to coin the term here ha)

head left. left to right: superior parathyroid gland, recurrent laryngeal nerve, inferior parathyroid gland

image via microscope

[Derby Pancreaticobiliary & Robotic AWR Unit @DerbyPBunit]

𝙍𝙤𝙗𝙤𝙩𝙞𝙘 𝙏𝘼𝙍 𝙋𝙧𝙤𝙘𝙚𝙙𝙪𝙧𝙚

Patient Presentation:
🔵Incisional hernia post laparotomy for para-aortic LN biopsy 2011
🔵Dx. of lymphoma
➡️treated and in remission
🔵EHS classification M3W2
➡️Maximal defect size 9.8cm
🔵Second proctored case
➡️Telementoring @InanMD @IntuitiveSurg

Surgical Approach:
🔴Careful adhesiolysis
🔴Initial dissection of posterior rectus sheath to the NV bundle
🔴Bottoms up approach
➡️Bogros (retroinguinal) space
➡️Pretransversalis/preperitoneal plane
➡️Connect by dividing inferior lamella of internal oblique infront of NV bundle
🔴Top down approach
➡️Division of transversus abdominis muscle infront of NV bundle into pretransversalis plane
🔴Continue dissection into the pretransversalis/preperitoneal plane until the posterior layer can be brought comfortably to the midline
🔴Close the peritoneal openings with 4/0 vicryl
🔴Turn the patient around
➡️Place 3 ports in opposite flank
➡️Start dissection on contralateral side
➡️Meticulous closure of peritoneal openings with 4/0 vicryl
🔴Closure of posterior layer with 2/0 absorbable V-lock
🔴Closure of defect and reconstruction of midline with 0 absorbable V-lock
🔴Placement of mesh
➡️Versatex
➡️35cm x 25cm
🔴Use of ICG as an educational tool and guidance into correct layer

Training pathway to RoboTAR:
🟢15 month dedicated 🤖 hernia programme
🟢Stepwise approach
➡️R-TAPP groin hernia
➡️R-TAPP ventral hernia
➡️R-TARUP ventral hernia
➡️Robotic TAR procedure
🟢Live model course @eurohernias
@orsiacademy
🟢Experienced proctors @FilipMuysoms @InanMD

@NovitskyYuri @HerniaResearch @MaaikeVierstr @hgok @HerniaGirl @ericpaulimd @VNikolian

#FOAMed #SoMe4Surgery #Robotics #Surgery #Hernia

[James Lee @drjameswklee]

Interesting study for a challenging topic in endocrine surgery.

[World Journal of Surgery @WorldJSurg]

#VisualAbstract

Original Report ➡️Parathyroidectomy for Normocalcemic Primary Hyperparathyroidism is Associated with Improved Bone Mineral Density Regardless of Postoperative Parathyroid Hormone Levels

🆓🔗https://t.co/tS68a3AAfU

@iss_sic @Jasosamd @alison_baskin #SoMe4Surgery

[James Lee @drjameswklee]

Neuromonitoring in Thyroid Surgery. To use or not to use?

[BJS Open @BjsOpen]

📜assessing safety of cont. intraop N. vagus neuromonitoring during thyroidectomy shows mild electrophysiological impact of electrode placement➡️however, diff negligible & not assoc with clinical symptoms➡️safe to use during🔪#SoMe4Surgery @samira_sadowski
https://t.co/5B3JFxSguB

[The Lancet Diabetes & Endocrinology @TheLancetEndo]

Management of thyroid nodules https://t.co/ozJtXLZ0AZ
#thyroid #thyroidnodule #thyroidcancer

[DR AFTAB AHMED @DRAFTABAHMED7]

𝗦𝗲𝘃𝗲𝗻 𝗶𝗺𝗽𝗼𝗿𝘁𝗮𝗻𝘁 𝗧𝗿𝗶𝗮𝗻𝗴𝗹𝗲𝘀 𝗶𝗻 𝗧𝗵𝘆𝗿𝗼𝗶𝗱 𝗦𝘂𝗿𝗴𝗲𝗿𝘆:
Ⓐ︎ Beahrs triangle or Riddle’s triangle
Ⓑ︎ Simon's triangle
Ⓒ︎ Lore’s triangle
Ⓒ︎ RLN triangle
Ⓓ︎ Joll's triangle
Ⓔ︎ Cricothyroid space of reeves
Ⓕ︎ Triangle of concern

[GrepMed @grepmeded]

C. difficile Infection (CDI) - Diagnosis and Management Summary Sheet

[BJS Academy @BJSAcademy]

🆕Part 4 of the AI series is available!

"The development of medical AI systems must continue to be driven by economic benefits and meaningful healthcare outcomes..."

📖Read in full:
https://t.co/B3TEUPGy0P

#ArtificialIntelligence
@JJEarnshaw

[James Lee @drjameswklee]

Countless possible applications in surgery and medical education. Looking forward to real world reviews!

[Apple @Apple]

The era of spatial computing is here. Where digital content blends seamlessly with your physical space. So you can do the things you love in ways never before possible. This is Apple Vision Pro.

[Amy Faith Ho, MD MPH @amyfaithho]

How to be hyper-efficient in #Epic #EHR — from a physician #informaticist who loves to flyyy on shift🧵

1️⃣ Smartphrases are the #1 documentation efficiency. Use a standard naming convention so you can find it quickly. I use:

.dc*** for discharge instructions (ie .dcviral, .dcchestpain)
.proc*** for procedures that aren’t smart blocks (.proccpr, .proctriggerpoint, etc.)
.hpi*** for standard history where I mark *** to cue the parts to fill out (.hpimvc, .hpitransfer, .hpistd)
.mdm*** for risk calculators that aren’t in Scoring Tools (.mdmPerc, .mdmCanada, .mdmHasbled, etc.)

2️⃣ Macros: same concept as smartphrases, but used for smart blocks (the click-buttons in Notewriter for Exam, ROS, Procedures, etc.)

3️⃣ Ctrl-space bar opens up a search function where you can search the entire chart. I.e. I’ll search “creatinine” to see if careeverywhere (OSH) has a creatinine documented outside my system to compare a baseline, or search “cancer” if a patient says they had cancer and I can’t figure out what type

4️⃣Epic has a whole free training series called “Power User” geared at clinicians of small 1-hour asynchronous topics of how to maximize efficiency. Pick and choose what’s relevant to your context/specialty. Check it out! https://t.co/NWYGiHfMeD

5️⃣Talk to your local Epic builders (called application analysts) or your Epic trainers/educators. There are a TON of customizations the system can do. Automated-drop-in’s (called CER rules, but basically like IF a patient has a systolic BP>140, THEN drop in a phrase mentioning you acknowledge and address it by ***), customizing your trackboard/patient lists, building data elements behind drop-downs (smartlists) so you can report on it, and overall helping you decrease clicks!
Epic is highly customizable, just need a clinical champion to work with analysts to understand where builds can help clinical workflow!

There are many more “hacks”, these are just some of my favorite!
(And, no conflicts with Epic, it’s just my favorite EHR out of Cerner, Meditech, Medhost, etc…)

Interested? Think about #informatics as a field OR talk to your local friendly physician informaticist (often CMIO at a hospital system!)
@AMIAinformatics @HIMSS #medtwitter

[The Lancet Diabetes & Endocrinology @TheLancetEndo]

#Hyperthyroidism: aetiology, pathogenesis, diagnosis, management, complications, and prognosis https://t.co/YyILhYb7mu #thyroid

[TODAY Sports @tdysports]

Boxing: @MannyPacquiao wins fight against @Brandon_Rios1 http://t.co/SUOu1jKEFZ #pacmanwins

[James Lee @drjameswklee]

@RaviCuttilan depends on the load that day haha

[James Lee @drjameswklee]

@muffinatic cheer up!