Ola

calm hands, chaotic plans | XXVIII

[The Bald Baddie @elash0222]

Got rejected after an interview but saw they reposted the same job so I applied again

[Donate4Dáithí @Donate4Daithi]

Dáithí has received the gift of a heart transplant.

Dáithí is at the beginning of his recovery. There have already been some big wins for him, but there is still a long road ahead, and we would ask you all to keep him in your thoughts and prayers. 1/3

[men HQ @themenHQ]

this remains one of the most attractive calvin klein campaigns ever

[M A T T 🎈 @UNAPIRIGUETE]

Rihanna gagging everyone with her catwalk at the Victoria Secrets fashion show

[DeAndre Brown @imdrebrown]

Thom Browne @ Capitol Hill

[Derby Pancreaticobiliary & Robotic AWR Unit @DerbyPBunit]

Trauma Laparoscopy and Primary Repair of Small Bowel Injury

Presentation:
🔵Presented 6 hours following football tackle with knee to abdomen
🔵Resulted in blunt trauma to anterior abdominal wall
🔵On examination
➡️tender abdomen with tachycardia but normotensive and HB stable
🔵CT in ED
➡️Small volume intraperitoneal free air anterior to liver
➡️Gas locules around transverse colon at the splenic flexure

Approach:
🔴Low threshold for laparoscopy +/- proceed
🔴Complete examination of small bowel on both anti mesenteric and mesenteric sides
🔴Two areas of injury near DJ flexure - one full thickness and one seromuscular
➡️Perforation immediately beyond DJ flexure
🔴Free intraperitoneal bile an irritant
🔴Primary repair with 2/0 vicryl
➡️If concern regarding ischaemic edges, consider freshening
🔴Thorough peritoneal lavage
🔴Feeding jejunostomy not indicated
➡️Oral intake resumed 24 hours post-op
🔴Advanced lap experience critical
🔴Pt. discharged POD3 with no readmissions to hospital

[Dylan Fabas @fabasaurusrex]

🌪️

[Ola @faladeola]

@fabasaurusrex Looking good Dylan! Can I ask where you got those pants from?

[Derby Pancreaticobiliary & Robotic AWR Unit @DerbyPBunit]

𝗡𝗮𝗿𝗿𝗮𝘁𝗲𝗱 𝗩𝗶𝗱𝗲𝗼: 𝗘𝗺𝗲𝗿𝗴𝗲𝗻𝗰𝘆 𝗟𝗮𝗽𝗮𝗿𝗼𝘀𝗰𝗼𝗽𝗶𝗰 𝗥𝗲𝗽𝗮𝗶𝗿 𝗼𝗳 𝗦𝘁𝗿𝗮𝗻𝗴𝘂𝗹𝗮𝘁𝗲𝗱 𝗙𝗲𝗺𝗼𝗿𝗮𝗹 𝗛𝗲𝗿𝗻𝗶𝗮 𝘄𝗶𝘁𝗵 𝗦𝗺𝗮𝗹𝗹 𝗕𝗼𝘄𝗲𝗹 𝗥𝗲𝘀𝗲𝗰𝘁𝗶𝗼𝗻 𝗮𝗻𝗱 𝗜𝗖𝗚

#FOAMed #GITwitter #MedEd #SurgEd #SoMe4Surgery #EGS #Hernia #ICG

[Ola @faladeola]

@earthcurated

[Derby Pancreaticobiliary & Robotic AWR Unit @DerbyPBunit]

DX: Obstructing Blood Clot at JJ Anastomosis
🔴Important to consider as DDx for patients who develop acute SBO post LRYGB
🔴High risk of gastric remnant blowout & mortality
➡️Prompt diagnosis and intervention critical
🔴Careful examination of staple line for bleeding prior to enterotomy closure during index LRYGB

See the full case in @JournalObesity at:
https://t.co/aM12ow4H1J

[Derby Pancreaticobiliary & Robotic AWR Unit @DerbyPBunit]

Laparoscopic Transgastric Necrosectomy with Cholecystectomy for Retrogastric Walled-off Necrosis (WON)

🔴Benign MDT approach
➡️"One size does not fit all"
🔴Dominant WON/solid necrosis
➡️Pseudocyst/liquid collection ideal for EUS
🔴Adv of MIS > EUS
➡️Single stage clearance of necrosis
➡️Better visualisation
➡️Sturdy instruments for necrosectomy
➡️Concomitant cholecystectomy if gallstone aetiology
🔴IOUS an important adjunct and critical in delineating anatomical configuration of WON

🔵Prospective study by @NZyromski et al
➡️Largest series of published transgastric necrosectomy
➡️Surgical approach offers single stage clearance of WON
➡️EUS requires multiple sessions with recurrent hits of sepsis in-between
➡️Link to paper: https://t.co/Szuw8DIsWu

See our ongoing collaboration with @BehindTheKnife on MIS management of complicated SAP:
https://t.co/Ihu684TBjg

#HPB #Surgery #Pancreatitis

[Sam Ghali, M.D. @EM_RESUS]

When an ER patient says “Sorry to bother you guys I’m sure it’s probably nothing”, something is really fucking wrong until proven otherwise. Trust me on this one.

[Derby Pancreaticobiliary & Robotic AWR Unit @DerbyPBunit]

Emergency Robotic Chole and CBD Exploration in a Pregnant Patient

Presentation:
🔵23 year old 20/52 pregnant presents with obstructive jaundice
➡️Uterus at the level of umbilicus
🔵MRCP demonstrated GB and CBD stones
➡️A single 8mm stone impacted in the distal CBD
➡️CBD >8mm in diameter.
🔵Benign MDT decision that lap chole and CBDE was the best approach to manage her condition
🔵Proceeded to Robotic Assisted Chole and CBDE

Surgical Approach:
🔴4 robotic arms and 1 assistant port
🔴Careful open cut down just below umbilicus taking care to access the peritoneal cavity taking particular attention to avoid injury to the uterus
🔴Early positioning of patient in reverse trendelenburg with right side tilt to take pressure off IVC
🔴Cystic artery dissected and ligated
🔴Choledocotomy
➡️Clear bile indicative of obstructed CBD
➡️Open jaw technique
➡️Extension of choledochotomy over the captured stone in the basket pulled to the entry of the choledochotomy
🔴Choledochoscope through cystic duct and irrigated to flush out smaller stones via choledochotomy
🔴Wide cystic duct dissected
🔴Proximal extent of the duct suture ligated
🔴Cystic duct divided to release cystic duct stones
🔴Stones flushed through the cystic duct during transcystic choledochoscopy
🔴Cystic duct sutured closed with 2/0 Vicryl.

Benefits of Robotic Platform:
🔴Low pressure pneumoperitoneum at 8mmHg feasible with precision wristed robotic instruments and magnified 3D enhanced vision
🔴Improved ergonomics for closure of choledochotomy

@SAGES_Updates Guidelines for Laparoscopy during Pregnancy:
https://t.co/nuz984O2IT

[Awesome Videos ❤️ @Awesomevideos07]

Your Honor my client is innocent 🤓

[Sryan Bruen Photography @sryanbruenphoto]

Moonset above the Samuel Beckett Bridge this morning aligned from the Great South Wall. #dublin #moon #ireland

[Derby Pancreaticobiliary & Robotic AWR Unit @DerbyPBunit]

Robotic Cholecystectomy and Transductal CBD Exploration

Patient Presentation:
🔵38-year-old female
🔵RUQ pain with jaundice
🔵MRCP performed (below)
➡️Stone at cystic duct/CBD junction
➡️Multiple CBD stones
🔵Decision to perform single stage robotic intervention

Surgical Approach:
🔴IOUS useful adjunct due to dynamic process of gallstone disease
🔴ICG helpful to delineate critical structures
🔴Cystic duct too wide to apply locking clips so suture closure of cystic duct stump undertaken
🔴Pt discharged 48 hours post-op

[Sam Ghali, M.D. @EM_RESUS]

Here's a video I made breaking down this impressive case of a man in his 50's who presented to the ER with cough and shortness of breath for 1 week

#FOAMed