Assistant Professor of Surgery-Emory University. General Surgeon, educator. My tweets are my own. How I do anything is how I do everything. PGY25+
@emorysurgery
“At the end of my intern year, I was very fortunate to be given the opportunity to go to a new program where I still worked very long hours but was treated like a surgery resident should be treated.” Eric Knauer, MD.
@EricKnauerMD
@EmorySurgery
Trocar trajectory is critical. They may be 8cm apart on the skin,but if your angles are not right they will be too close on the inside and “hand cuff” you. Torquing to the target also results in hernias and pain. For Robo cases I’ve started saying PPP (parallel port placement).
“Internal hernia of gallbladder”. I’ve seen this before where the cystic artery courses over the lower body of the gb. Made infundibulum look like a node or mass that was stuck to duo.
@ISorianoMD
@DissanaikeMD
@thefighter_sm
When you do a small bowel resection and anastomosis always check the small bowel orientation to try to reduce kinking. Sometimes it kinks anyway. Not a debate on stapled, hand-sewn, iso, anti, etc..
More trocar trajectories:
When lysing adhesions from the ab wall they need to be lateral and directed up towards the ab wall. If they are too medial, too close to the adhesions, and pointed down its difficult to get the angle you need
@FilipinoSurgeon
@rbarbosa91
@VNikolian
Trocar trajectory is critical. They may be 8cm apart on the skin,but if your angles are not right they will be too close on the inside and “hand cuff” you. Torquing to the target also results in hernias and pain. For Robo cases I’ve started saying PPP (parallel port placement).
Critical View of Safety
1.Hepatocystic triangle cleared of fat and fibrous tissue
2.Lower 1/3 of gb dissected from cystic plate
3.Two structures entering the gb
Frequently in cases of BDI the op note says CVS achieved.
#safechole
@mj_pucci
@cutitoutPODCAS1
@FilipinoSurgeon
Thanks
@HPB_Surgeon
for this reminder of what the Critical View of Safety in lap chole actually is.
Often see the term used inappropriately, when only the first criterion has been met
Looking for 4 things on GB US
1. Are there stones
2. Gallbladder wall thickness measurement
3. Is there pericholecystic fluid
4. What is the CBD diameter?
Another other info needed?
@mj_pucci
@CPark_MD
@DissanaikeMD
@ISorianoMD
Classic posterior acoustic shadowing here.
Defining Biliary Hyperkinesia and the Role of Cholecystectomy
Kartik, Akash MBBS; Jorge, Irving A MD, MBA, FACS; Webb, Christopher MD; Lim, Elisabeth S MPH; Chang, Yu-Hui MS, PhD; Madura, James MD, FACS
@SAGES_Updates
@ChaseSurgical
@Sharpknife_Aziz
Surgeon’s knot, overrated or essential for surgery? I rarely ever throw one, it’s granny style for me usually. Apparently important in the fishing community according to The Google.
4 years ago I left one work family and joined another. Thank you Dr Sweeney for bringing me to
@EmorySurgery
. Here’s a little chapter we wrote when I was his MIS fellow.
Thanks
@EdLinEmory
#midcareerchange
A school in Atlanta requires masks and has eligible students and teachers that get vaccinated. They tested all students and teachers pre-k thru 6th for COVID. Zero positive tests. Zero.
Masks work, vaccines work.
#WearAMask
#GetVaccinated
@CarlosdelRio7
A dedicated OR for emergency cases improved quality of care by decreasing cancellations and overruns in elective rooms and increasing the proportion of priority 3 patients who accessed care within the targeted time
@EdLinEmory
@jpsteinberg
Experience counts. When I was a resident, an attending at a small hospital we rotated thru liked to bend the needle when injecting local. the needle broke off in the deep sq on a large pt and we had a difficult time finding it. Don’t bend the needle, it works fine as is.
@samsfeelinggood
Besides paging
@ericpaulimd
my only contribution here is that everyone calls a tube that goes into the GI tract a PEG tube. Even if this is a surgically placed gastrostomy or jejunostomy tube or a tube placed in IR.
Routine IOC helps with image interpretation. What I look for:
-Normal opacification of the biliary tree
-Normal contrast run off into duo
-Filling defects
-Normal taper of CBD
-Contrast extrav
-Aberrant anatomy
What else?
@FilipinoSurgeon
@mj_pucci
@cutitoutPODCAS1
@Cirbosque
@SPerdawood
Doesn’t matter, unless you are going to be placing a stoma. However, I prefer a more gradual incision around the umbilicus, rather than sharp corners.
@MISIRG1
@Cirbosque
@cutitoutPODCAS1
@ChaseSurgical
The question of duration of antibiotics for intra-abdominal infection comes up frequently. The STOP-IT trial is a must read.
Link:
Credit to Mathieu Larouche for the first pic.
Started in practice 20 years ago today. Was a Friday and I was on call for the weekend. I took off the entire month of July after finishing fellowship, a great choice if you can do that.