Hector Blaz

[Hector Blaz @hblazg]

@RicardoRGlz Sí.

[PleuralPOCUS | Dr. Jaime Sánchez @PleuralPOCUS]

En 1949 un médico inglés publicó 700 palabras en The Lancet que deberían leerse en voz alta cada vez que entra una generación nueva a un hospital.

Casi nadie las lee.

Los siete pecados de la medicina. 🧵

[Vanessa Teresa🍒 @CoralTeresa]

🚨🇳🇴 ÚLTIMA HORA: Debido al fuerte RECHAZO María Corina Machado no recibirá el 'Premio Nobel de la Paz' ni estará presente en la ceremonia.

[Japan Society for Endoscopic Surgery (JSES) @jses_eng]

JSES IllustCon 46
📌Surgical approach in robotic distal pancreatectomy for pancreatic ductal adenocarcinoma - Caudo-dorsal view approach behind the body and tail of pancreas ?
📝RDP for PDAC employs a caudo-dorsal view approach with “no-touch” technique, ensuring adequate lymphadenectomy and negative margins, emphasizing the technical precision and oncological safety essential for radical resection.
🖊Nakagawa Naoya
#JSESイラストコンテスト　#JSES_illustration_contest

[La Catrina Norteña @catrina_nortena]

🚨 INDIGNANTE como el Alcalde Panista de Querétaro, @FeliFerMacias volvió a mandar a sus Inspectores a GOLPEAR VIOLENTAMENTE y a quitarle sus productos a Artesanos Indígenas que honestamente se estaban ganando la vida en el Centro Histórico

Por favor compartamos para que las autoridades puedan hacer algo al respecto...

📽 @AvseFernando

[Susana Cueto @SusanaCueto7]

Pregunta seria. ¿Esto los representa?

[Terror Restaurantes MX 🔻 @TerrorRestMX]

@Javier_Alatorre Esta es la buena.

[Mara @Maramensaje]

No se arriesguen, saquen absolutamente todo lo que tengan en banco azteca, no dejen 1 centavo.
¡Pero de ya!🏃🏽‍♀️

[Hector Blaz @hblazg]

@RicardoRGlz E-TEP
Empezamos con las inguinales bilaterales y al terminar colocamos trocar óptico supra púbico para trabajar con las hernias para y supraumbilicales.

[Hector Blaz @hblazg]

Una foto bonita.

[Derby Pancreaticobiliary & Robotic AWR Unit @DerbyPBunit]

Robotic Cholecystectomy and CBD Exploration

Choledocotomy:
🔴In lap cases - Berci knife standard
🔴Robotic cases - robotic scissors ➡️Open jaw technique
🔴Extension of choledochotomy over the captured stone in the basket pulled to the entry of the choledochotomy

Robotic Maryland:
🔴Appropriate training a must
🔴Judicious use during procedure
🔴Dissect with direct visualisation of tissue
➡️Intelligent use of instrument articulation as seen whilst exposing bile duct and during cystic artery dissection

Fundus down:
🔴Extreme degree of caution required during dissection 🔴Dissection was carefully advanced in this case by staying flush on GB, and stopped once wide & thickened CD visualised
🔴Good understanding of changes at Hartmann’s pouch with impacted stone(s) key to complete dissection safely

#Robotics #Gallstones #MedEd #SoMe4Surgery #HPB

[Derby Pancreaticobiliary & Robotic AWR Unit @DerbyPBunit]

𝗧𝗲𝗰𝗵𝗻𝗶𝗾𝘂𝗲 𝗳𝗼𝗿 𝗥𝗼𝗯𝗼𝘁𝗶𝗰 𝗣𝗮𝗻𝗰𝗿𝗲𝗮𝘁𝗶𝗰 𝗖𝘆𝘀𝘁𝗷𝗲𝗷𝘂𝗻𝗼𝘀𝘁𝗼𝗺𝘆

Indication:
🔵Large 10 by 16cm collection in the body of pancreas post severe acute pancreatitis with DPDS
🔵Link to our 📝
➡️https://t.co/jRmchjOlRI

Surgical Technique:
🔴Roux limb created 60cm from DJ flexure and used to perform robotic pancreatic cystjejunostomy
🔴Two 8 inch 3/0 PDS sutures
➡️One for posterior layer and another for anterior layer
🔴Posterior suture placed in the anatomical left corner of cyst opening - knot on the outside
➡️before suturing posterior wall, needle taken inside through small bowel at the left corner
🔴Anterior suture placed in the anatomical left corner of cyst - knot on the outside
🔴 Suturing should be performed sequentially to get the best views alternating from posterior to anterior wall
🔴Posterior wall sutured in a continuous fashion to midpoint of cyst wall opening
➡️Bites taken to involve all layers of the bowel and cyst wall
➡️Importance given to follow the curve of the needle
🔴Anterior wall sutured in a continuous fashion to midpoint of the cyst wall opening
🔴Posterior wall sutured to the anatomical right corner of the cyst wall opening and around the corner
🔴Anterior wall continued to meet the posterior suture
🔴Tie both the anterior and posterior suture

Robotic Advantage vs Laparoscopic:
🟢Ergonomics for suturing
🟢Camera stability
🟢Stable third arm
🟢3D enhanced vision
🟢Improved surgeon comfort

#FOAMed #GITwitter #MedEd #SurgEd #SoMe4Surgery #HPB

[Derby Pancreaticobiliary & Robotic AWR Unit @DerbyPBunit]

Tips for Accurate Needle Mounting during Laparoscopic Suturing
🔴Load suture needle perpendicular to jaw of grasper
🔴Use suture thread to adjust needle into correct orientation
🔴Gentle pressure downwards on tissue can manipulate suture needle to correct orientation
🔴Close needle holder 2/3 along curve of suture needle for optimal ergonomics
#FOAMed #SurgEd #MedEd #SoMe4Surgery #suturing

[Derby Pancreaticobiliary & Robotic AWR Unit @DerbyPBunit]

Minimally Invasive Adhesiolysis
🔴Gentle counter traction on bowel whilst scissors dissects adhesion under tension
🔴Cold scissors
🔴Divide adhesion close to abdominal wall
🔴Include tissue from abdominal wall onto bowel
➡️Shown prior to division of adhesion

[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

[Hector Blaz @hblazg]

Mi forma de ser congruente es: ofrecer cirugía laparoscópica como primera opción SIEMPRE tanto en la priva como en la institución.

[Hector Blaz @hblazg]

@RicardoRGlz 1. Malla de polipropileno
2. Tacker de titanio en IMSS, absorbatack cuando hay
3. Prolene o vycril 2-0 depende lo que haya
4. Anestesio es el mejor DJ
5. R4 que ya sabe hacerlo les coucheo el procedimiento, r1 piel y a veces un punto del flap
6. Amo tocar guitarra
7. Michas

[Miguel Peralta | 𝕏 @miguelrperaltaf]

LA ESTACIÓN ESPACIAL INTERNACIONAL (ISS) ORBITA LA TIERRA 16 VECES AL DÍA, GRABANDO IMPRESIONANTES IMÁGENES ALREDEDOR DEL MUNDO

Sigue 🧵 para descubrir 20 de las mejores jamás tomadas

1 - Brasilia

[Hector Blaz @hblazg]

De la misma manera deben brindar y exigir el entrenamiento a sus médicos quirúrgicos.
La mínima invasión siempre debe ser la primera elección.

[Hector Blaz @hblazg]

La cirugía de mínima invasión es casi siempre, por mucho, la mejor opción para todos los pacientes. Las instituciones públicas deben seguir invirtiendo más en este tipo de cirugía para el beneficio de los pacientes y la optimización de los recursos.