@ib9994

Consultant PB and Hernia Surgeon. Robotic Surgery. ERCP. @UHDB @DerbyPBunit

 Derby, England
Joined May 2012
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𝙀𝙢𝙚𝙧𝙜𝙚𝙣𝙩 𝙇𝙖𝙥𝙖𝙧𝙤𝙨𝙘𝙤𝙥𝙞𝙘 𝙄𝙣𝙛𝙧𝙖𝙘𝙤𝙡𝙞𝙘 𝙉𝙚𝙘𝙧𝙤𝙨𝙚𝙘𝙩𝙤𝙢𝙮 Patient Selection: 🔵Central, infracolic collections that are dominantly solid (WON) often not amenable to perc. drainage and/or narrow window of access for transgastric approach 🔵Too unwell for concomitant cystjejunostomy 🔵Septic 🔵3-4 weeks into acute attack of SAP Approach: 🔴Initial identification of bulge in transverse mesocolon 🔴Location confirmed with IOUS 🔴Window created into infracolic compartment 🔴Necrosectomy and washout performed 🔴2 x 18F Robinsons drains placed adjacent to cyst Key Points: 🟢Timing of intervention critical 🟢Surgical approach allows 𝘀𝗶𝗻𝗴𝗹𝗲 𝘀𝘁𝗮𝗴𝗲 𝗰𝗹𝗲𝗮𝗿𝗮𝗻𝗰𝗲 of WON which avoids multiple hits of sepsis 🟢Concomitant cholecystectomy can be undertaken in select cases 🟢Patient selection and discussion in benign specialist MDT key Link to our paper in @JournalofGISurg below: pubmed.ncbi.nlm.nih.gov/3558… #FOAMed #GITwitter #surgery #SoMe4Surgery #MedEd #hpb
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Replying to @420HassanXO @Innov_Medicine @SAGES_Updates @BehindTheKnife @BrownJHM @imedverse @roux_group @rbarbosa91 @altaf_awan12 @ib9994 @javlatif
Thanks for your comment. We used: ➡️10mm suprapumbilical camera port ➡️10mm and 5mm LUQ ports ➡️5mm RUQ port The two 5mm ports were used for placement of drains.
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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
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Imran Bhatti retweeted
Altaf K Awan@altaf_awan12
Aug 31
Replying to @Robo_HPB
Thanks for sharing. Pushing stone thru (unless prev sphincterotomy) or dilating the ampulla is fraught with risk of pancreatitis; a manoeuvre that I would strongly discourage. Unintended stone impaction at ampulla can complicate the situation. @DerbyPBunit @ib9994
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𝗘𝗺𝗲𝗿𝗴𝗲𝗻𝗰𝘆 𝗥𝗼𝗯𝗼𝘁𝗶𝗰 𝗥𝗲𝗽𝗮𝗶𝗿 𝗼𝗳 𝗟𝗲𝗳𝘁 𝗜𝗻𝗴𝘂𝗶𝗻𝗮𝗹 𝗛𝗲𝗿𝗻𝗶𝗮 𝘄𝗶𝘁𝗵 𝗜𝗖𝗚 Surgical Approach: 🔴Initial assessment of small bowel with ICG 🔴Small bowel placed in pelvis with warm wet swabs overlying 🔴TAPP approach to hernia repair ➡️Critical view of MPO ➡️ICG to help delineate key structures ➡️Progrip mesh ➡️3-0 absorbable V-lock to close peritoneum 🔴Reassessment of small bowel after hernia repair ➡️ICG present in bruised area demonstrating viability ➡️Aided decision making to not resect or oversew Robotics in EGS: 🟢Case selection key 🟢MDT approach with anaesthetic and scrub teams to coordinate 🟢Minimally invasive approaches in EGS should be encouraged #FOAMed #GITwitter #MedEd #Surgery #Hernia #EGS
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Emergency Laparoscopic Repair of Strangulated Femoral Hernia with Small Bowel Resection & ICG 🔴Reduction of small bowel ➡️Await perfusion recovery ➡️Allows for demarcation of ischaemic segment 🔴Undertake hernia repair ➡️TAPP approach ➡️Opted for suture repair for this case ➡️Biologic mesh alternative option ➡️Synthetic mesh can be considered if no bowel resection 🔴ICG to assess bowel perfusion and delineate length of resection ➡️Given intraop at time of assessment ➡️Immediate assessment within 30 seconds key ➡️Excellent tool for teaching trainees 🔴Advanced lap skills crucial 🔴Lap EGS recommended ➡️Underutilisation in the UK
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Imran Bhatti retweeted
Dr Zubir Ahmed MP
@zubirahmed
Aug 21
Fantastic to see the Labour govt funding for cutting edge technology now saving lives and the impossible possible. 👇
Sky News
@SkyNews
Aug 21
The first lung transplant has been successfully completed through the UK's new Assessment and Recovery Centres (ARCs) pilot programme

First lung transplant completed through new NHS programme

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Robotic enucleation of a pancreatic solid pseudopapillary epithelial neoplasm that’s abutting the splenic artery & vein in a young 20 year old. Fall back plan was a central pancreatectomy but was fortunate that it wasn’t needed. Full vid: youtu.be/AEhS1EY3NT8
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Replying to @DerbyPBunit @Innov_Medicine @SAGES_Updates @BehindTheKnife @MedicalAdv @BrownJHM @EricKnauerMD @altaf_awan12 @ib9994
It’s surprising how often there isn’t really much of a Rouviere sulcus, unfortunately.
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Imran Bhatti retweeted
Eric Knauer
@EricKnauerMD
Aug 9
Replying to @DerbyPBunit @Innov_Medicine @SAGES_Updates @BehindTheKnife @MedicalAdv @BrownJHM @rbarbosa91 @altaf_awan12 @ib9994
Nice work. Would add ioc of course.
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"Hot" Laparoscopic Cholecystectomy: 🔴Principles remain the same 🔴Know bailout options ➡️Subtotal 🔴Gallbladder decompression 🔴Rouviere's important landmark 🔴Endo pledget very useful in these cases 🔴Suction/irrigation ➡️Blunt dissection 🔴Demonstrate CVS #FOAMed #GITwitter #surgery #SoMe4Surgery #MedEd #chole
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Altaf K Awan@altaf_awan12
Aug 4
Replying to @DouglasAdlerMD @bsc_endoscopy @Stentingwoman @NEndoscopy
Thanks for sharing. Was there a pre procedure CT angio? @DerbyPBunit @ib9994
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The BMA
@TheBMA
Aug 3
We are calling for doctors’ titles to be protected in law. We must see an end to doctor replacement by physician assistants and advanced practitioners too. bma.org.uk/our-campaigns/all…
The BMA
@TheBMA
Jul 31
Patients should never be left unclear about whether they have seen a doctor, nurse or another member of staff. The Government is consulting on protecting the title “nurse”, which is a welcome step towards clearer roles, professional standards and patient safety. But protecting titles alone is not enough. The Government must also act to stop doctors and nurses being substituted by less qualified staff. Have your say by making a submission to the Government consultation and call for clear, safe and properly protected professional roles across the NHS.
Blue BMA graphic with large white text reading: “Doctors support nurses against frauds and against substitution in the NHS.” The BMA logo appears in the bottom left corner and a white arrow icon appears in the bottom right. The background is a blue gradient.

ALT Blue BMA graphic with large white text reading: “Doctors support nurses against frauds and against substitution in the NHS.” The BMA logo appears in the bottom left corner and a white arrow icon appears in the bottom right. The background is a blue gradient.

BMA graphic with the headline: “The Government is consulting on protecting the title ‘nurse’.” Below is a photo of a healthcare professional with a stethoscope, holding a tablet in a hospital setting. Further text reads: “The Government wants to stop unqualified people using nursing titles and misleading patients. We support action that helps patients know they’re being treated by the right professional.” The graphic has a blue background with a white arrow icon in the bottom right corner.

ALT BMA graphic with the headline: “The Government is consulting on protecting the title ‘nurse’.” Below is a photo of a healthcare professional with a stethoscope, holding a tablet in a hospital setting. Further text reads: “The Government wants to stop unqualified people using nursing titles and misleading patients. We support action that helps patients know they’re being treated by the right professional.” The graphic has a blue background with a white arrow icon in the bottom right corner.

BMA graphic with the headline: “Protecting titles matters”. Below is a photograph of a healthcare professional in blue scrubs checking a patient’s blood pressure at a hospital bedside. Text beneath the image reads: “Patients need to know: who is treating them; what training they have; what their role is.” The graphic has a blue background with a white arrow icon in the bottom right corner.

ALT BMA graphic with the headline: “Protecting titles matters”. Below is a photograph of a healthcare professional in blue scrubs checking a patient’s blood pressure at a hospital bedside. Text beneath the image reads: “Patients need to know: who is treating them; what training they have; what their role is.” The graphic has a blue background with a white arrow icon in the bottom right corner.

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Imran Bhatti retweeted
Robert Smithers@Rob_Smithers
Aug 3
Replying to @DerbyPBunit @Innov_Medicine @SAGES_Updates @EAHPBA @IHPBA @MKeremDr @roux_group @MedicalAdv @altaf_awan12 @ib9994 @javlatif
Refreshing to see surgeons who take sepsis source control seriously, the constant “we’ll operate *on his source of sepsis* once he’s not so septic anymore” we get from our surgical colleagues is soul destroying 🤦🏻
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Laparoscopic Infracolic Necrosectomy and Drainage of RIF Abscess 🔴Septic patient but no organ failure 🔴Narrow window of access for EUS or IR drainage 🔴Single stage clearance of WON and drainage of RIF abscess ➡️Prevents hits of sepsis between multiple procedures ➡️Address both collections at once ➡️Select cases ➡️Benign PB MDT ➡️"One size does not fit all" Our paper on infracolic approach in @JournalofGISurg: pubmed.ncbi.nlm.nih.gov/3558… Our collaboration with @BehindTheKnife on MIS for complicated SAP: behindtheknife.org/video-pla… #Surgery #HPB #Pancreatitis
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𝗥𝗼𝗯𝗼𝘁𝗶𝗰 𝗧𝗔𝗣𝗣 𝗥𝗲𝗽𝗮𝗶𝗿 𝗼𝗳 𝗥𝗲𝗰𝘂𝗿𝗿𝗲𝗻𝘁 𝗥𝗶𝗴𝗵𝘁 𝗜𝗻𝗴𝘂𝗶𝗻𝗮𝗹 𝗛𝗲𝗿𝗻𝗶𝗮 Patient Presentation: 🔵Previous open repair 🔵Mesh in preperitoneal plane 🔵Referred with painful recurrence Surgical Approach: 🔴Medial recurrence 🔴Near complete mesh excision ➡️Small disc on abdominal wall side left to avoid nerve injury 🔴Transversalis fascia approximated with V-loc ➡️Imbrication of transversalis fascia ➡️Thin bites only ➡️Movement facilitated by 🤖 🔴Mesh ➡️Good medial coverage #FOAMed #GITwitter #Hernia #Robotics #MedEd #SurgEd
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We're pleased to share our latest publication in @SurgEndosc on 𝘙𝘰𝘣𝘰𝘵𝘪𝘤 𝘷𝘦𝘳𝘴𝘶𝘴 𝘓𝘢𝘱𝘢𝘳𝘰𝘴𝘤𝘰𝘱𝘪𝘤 𝘊𝘉𝘋 𝘌𝘹𝘱𝘭𝘰𝘳𝘢𝘵𝘪𝘰𝘯: 𝘖𝘶𝘵𝘤𝘰𝘮𝘦𝘴 𝘧𝘳𝘰𝘮 𝘢 𝘏𝘪𝘨𝘩-𝘝𝘰𝘭𝘶𝘮𝘦 𝘚𝘱𝘦𝘤𝘪𝘢𝘭𝘪𝘴𝘵 𝘗𝘢𝘯𝘤𝘳𝘦𝘢𝘵𝘪𝘤𝘰𝘣𝘪𝘭𝘪𝘢𝘳𝘺 𝘜𝘯𝘪𝘵. This study reports our experience of 547 consecutive MIS CBDE, demonstrating that RCBDE achieves comporable outcomes to LCBDE, despite preferential use in technically demanding cases. Following propensity-adjusted analysis, the only significant difference was a modest increase in operative duration with the robotic approach. Our findings support the integration of robotic surgery within a structured minimally invasive biliary pathway in dedicated specialist centres. Link to paper: link.springer.com/article/10…
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𝗥𝗼𝗯𝗼𝘁𝗶𝗰 𝗖𝗼𝗺𝗺𝗼𝗻 𝗕𝗶𝗹𝗲 𝗗𝘂𝗰𝘁 𝗘𝘅𝗽𝗹𝗼𝗿𝗮𝘁𝗶𝗼𝗻 𝗣𝗼𝘀𝘁 𝗖𝗵𝗼𝗹𝗲𝗰𝘆𝘀𝘁𝗲𝗰𝘁𝗼𝗺𝘆 Patient Presentation: 🔵Previous cholecystectomy 🔵2 previous ERCPs 🔵Recurrent large stone ➡️1.7 x 1.1 cm ➡️Failed endoscopic clearance ➡️+/- requirement for EHL 🔵MDT decision to proceed to bile duct exploration Surgical Approach: 🔴Careful dissection of adhesions in the GB fossa to expose the CBD 🔴ICG injected immediately following induction of anaesthesia 🔴Firefly mode used to confirm the CBD 🔴Vertical choledochotomy made with robotic shears 🔴Large stone extracted by milking it gently through the choledochotomy 🔴Check choledochoscopy to confirm clearance of the CBD 🔴Closure of the CBD with 4/0 Vicryl Benefit of Robotic Platform: 🟢Wristed instruments which improves ergonomics for suturing 🟢May reduce the learning curve for transductal CBDE when compared with laparoscopy
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We are balloting for a clear journey to restore lost pay and pension value. Our average pay is still 26% lower in real terms than it was 17 years ago. Vote YES and make your voice heard. The ballot will run until 6 July.
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Laparoscopic Ileocaecal Resection with Intracorporeal Anastomosis and ICG Patient Presentation: 🔴Sudden onset severe abdominal pain 🔴Tender abdomen 🔴No previous abdominal surgery 🔴High WCC 🔴Lactate ➡️5 on arrival down to 2 in 2 hours following fluid resuscitation 🔴CT abdomen/pelvis ➡️Red arrows show no small bowel perfusion with mural thickening ➡️Green arrows show perfused small and large bowel ➡️Mesenteric vessels patent Surgical Approach: 🔴Lap EGS approach ➡️Torsion of small bowel with Meckel's adhesion to abdominal wall acting as pivot point ➡️80cm ischaemic small bowel involving ileocaecal junction 🔴Specimen retrieved via extension of LUQ 12mm port
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