Raj Lahiri
@rajibaji1983
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Following
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1,776
Consultant HPB & robotic surgeon at Royal Surrey. Proud husband of a paediatric surgeon. Lucky dad of a football mad daughter who won’t sleep. Views are my own.
London, England
Joined March 2020
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Very proud to have been appointed as a consultant HPB surgeon
@RoyalSurrey
. A brilliant supportive department.
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Great work by our ST4 Tom Chase performing a robotic cholecystectomy that was abandoned elsewhere. Getting trainees on the console early will be key going forwards….
@RoyalSurrey
@GuildfordHpb
@DerbyPBunit
@Jawad004
#traineerobotics
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Our ST4 Irena Stefanova performing a robotic CBD clearance at the console. She did a fantastic job and the patient went home less the 24hrs after the procedure
@RoyalSurrey
@GuildfordHpb
@KSSSurgery
@whawkinssurgery
@Augishealth
@IHPBA
#hpbrobotics
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9
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We have celebrated completing our first 100 robotic HPB cases by perform our first 🤖 frey procedure & spleen preserving distal pancreatectomy. Great teamwork as always!
@GuildfordHpb
@Pritam__Singh
@nima_ghadi
@AndreaScalamed
@RoyalSurrey
#robotpancreas
#panGIrobotics
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5
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A pleasure to take our ST4
@Irena8181
& our CT2 Abby through a dedicated training day of 🤖 biliary cases. They planned the list, booked appropriate patients & were docking & undocking unsupervised by the end of the day!
@RoyalSurrey
@IntuitiveSurg
@IntuitiveBen
@roux_group
1/
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Proud to see our registrar Clare perform an excellent resection of an awkwardly placed segment 8 CRLM using the robotic/lap CUSA technique
@RoyalSurrey
. Great approach for precision & training
@GuildfordHpb
@IHPBA
@EAHPBA
@Augishealth
@GBIHPBAnews
@roux_group
#panGIrobotics
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Our post CCT fellowship is available from May 2022 - April 2023! High volume HPB cancer service (over 300 resections/year). Extensive complex biliary workload. Evolving robotic programme (100th case last week).
Advert live on Monday
@roux_group
@GuildfordHpb
@RoyalSurrey
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Our
@RoyalSurrey
HPB fellowship application is open! We are the highest volume 🤖 HPB centre in the UK. Fellows are trained in our high volume centre in open/lap/🤖 in complex benign/malignant HPB disease.
Please DM me for details.
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I was fortunate enough to assist our fellow Esther Platt during a 🤖 liver resection which was the first case on our new 4th Xi
@RoyalSurrey
🥳! We’ve also passed 500 🤖 HPB cases in the last few weeks
@GuildfordHpb
@IHPBA
@AHPBA
@EAHPBA
@roux_group
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Thankful to start my
@IntuitiveSurg
console journey today. Necrotic gallbladder in a morbidly obese patient. Thanks to my great colleague Tim Pencavel for his Co-console mentoring
@GuildfordHpb
@RoyalSurrey
#panGIrobotics
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Cases 293 & 294 were another step forward for our HPB programme
@RoyalSurrey
. Our first 2 🤖 PDs are in the bag! Thanks to
@Jawad004
for his time & excellent proctoring skills
@roux_group
@IHPBA
@EAHPBA
@GBIHPBAnews
1/
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60
A sad day as we wish a happy retirement to our HPB ward sister Izzy Kersley after 40 years of distinguished service
@RoyalSurrey
. She has looked after me as a registrar & consultant. We will all miss her
@GuildfordHpb
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2
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A fantastic day visiting
@CMRSurgical
in Cambridge. The versius robot platform is extremely impressive & it was great to discuss its potential use in HPB surgery
@GuildfordHpb
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A difficult open chole & transcystic CBD clearance. Patient underwent previous oesophagectomy & roux en-Y gastro-jej for poor conduit function. Presented to local hospital septic with a ruptured GB managed with drains.
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Congratulations to my colleague Tim Pencavel who performed the first robotic hemihepatectomy
@RoyalSurrey
. 125 robot cases & counting…
@GuildfordHpb
@RSCHAnaesthesia
#panGIrobotics
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Our Post CCT HPB fellowship post is available from April 2023! We perform over 300 HPB cancer resections/year & over 100 complex benign cases. Gain high volume experience in open/lap/robotic approaches 1/
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@GeeMcLachlan
The final ARCP should have 2 parts: 1. Has the trainee met requirements for CCT. 2. Has the training programme met the requirements of the trainee
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Shoutout to
@JHawksworthMD
! A pleasure to perform a 🤖/CUSA hybrid left hepatectomy with our fellow Esther Platt.
A great way to celebrate the arrival of our 4th Xi
@RoyalSurrey
today! Looking forward to more 🤖HPB cases next week!
@GuildfordHpb
@Augishealth
@roux_group
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Just fantastic advice. My wife’s a paeds surgeon, I’m a HPB surgeon. We have a very happy 6 year old daughter & make it work
Live your chosen life, and don’t ever tell someone else that their chosen life is wrong, inferior, or impossible. Just don’t do it. Try to understand that different people have different lives and that their skills and priorities may be different to yours.
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A great demonstration of the versius platform
@RoyalSurrey
by
@CMRSurgical
. Great to meet
@DrMarkSlack
& more of the team. Exciting days ahead…
#fleetofrobots
@GuildfordHpb
@AndreaScalamed
@nima_ghadi
@jameswread100
@Pritam__Singh
@roux_group
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Three 🤖 PDs and a 🤖 distal panc in the last 7 days by
@GuildfordHpb
@RoyalSurrey
as we move towards 500 🤖 cases by our HPB team!!
@IHPBA
@GBIHPBAnews
@roux_group
@Augishealth
@Declanfj
@Jawad004
@RyanDBaron
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Congrats to
@AndreaScalamed
on his robotic AR &
@nima_ghadi
,
@Pritam__Singh
on their robotic OG resection. Today, Tim Worthington & I join the party with a robotic distal panc & robotic left hepatectomy!!
#panGIrobotics
@RoyalSurrey
@GuildfordHpb
@RSCHAnaesthesia
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Thrilled to appoint
@tessalelarge
as our next HPB fellow
@GuildfordHpb
!! Tessa brings a fantastic clinical & academic background from
@amsterdamumc
. She will continue to develop her open/lap/🤖 HPB skills &
@GuildfordHpb
look forward to collaborating with
@MarcBesselink
!
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2/ an 89 year old lady with previous open chole & subsequent laparotomy for SBO. Transferred from another hospital with severe acute cholangitis
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@AnnalsofSurgery
Why did you publish this? It bears no relevance to worldwide HPB practice & will never be adopted widely.
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It was a pleasure to contribute to the newest addition of this fantastic book. I used it myself as a medical student and remains the standard for undergraduate surgical teaching.
@GuildfordHpb
@jamesgossage9
@MattBultitude
#MedEd
#medtwitter
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@langcatsteve
Absolutely stunning
@langcatsteve
!! My 8 year old daughter did this with her soft pastels & I had exactly the same feelings as you!
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A fantastic time in Ghent with
@Medtronic
using the HUGO robotic system which will be a fantastic platform for HPB surgery. Thank you to
@modarousta
for organising!
@RoyalSurrey
@IHPBA
@roux_group
#panGIrobotics
#multiplatform
🤖
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@freddomed
@ali1m
@viseshsankaran
Referring to a turning down a quick single, ‘You’d have taken than on in the private sector’
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I’m very proud of my fantastic colleagues & our trainees who have performed live laparoscopic & robotic surgery today for
@ALSGBandI
. Great work!
@GuildfordMattu
@GuildfordHpb
@RSCHAnaesthesia
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@KP24
Whilst fans make an enormous difference, your tweet disrespects the amazing efforts of these athletes. For many, this will be their only Olympics. If you don’t care, don’t watch & don’t tweet
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Fantastic HPB fellowship opportunity
@RoyalSurrey
. High volume (>300) annual major resections, advanced PB endoscopy exposure & a brilliant MDT to support you in a beautiful part of the UK.
@RouxGroup
@Adam_Frampton1
DM for details
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@hayleymagill
Well said
@hayleymagill
. We’re by no means perfect but I think the majority of surgeons have subverted this archaic narrative
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@hayleymagill
They work at least 80 hours a week. They’re also expected to do research/QIP/journal club on top of this. Their training system has many benefits, but it is incomparable to our system as our hours are so much less. Also, only training 1 way at 1 centre promotes IMO
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Delighted to contribute to this fantastic resource led by
@MaryHPBRD
. Fills a much needed gap & will hugely benefit surgeons/dietitians/gastroenterologists and more in postgrad exams!
@Augishealth
@roux_group
@IHPBA
@mj_pucci
@asgbi
It's here!! Thank you to everyone who worked so hard on this, 30% discount code NMSP on , valid until 20th October.
@GuildfordHpb
@rajibaji1983
@SaraSMI79748755
@DrSfpb
@UHB_HPB
@NEndoscopy
@neilbibby87
@helenmc68
@OonaghGriffinRD
@LindseyAllan6
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@mortensen_neil
@markataylor16
@RCSnews
This tweet is in awful taste. To write this & ignore the fact that junior doctors are excluded from this ‘pay rise’ is laughable. This reads like something written by a government lackey rather than someone who has trainee surgeons welfare at heart
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We’re extremely happy to restart our MATTU courses with our HPB department outlining modern management of gallstone disease. Including live operating of complex cases. A must for UGI trainees!
@roux_group
@CurrieSurgery
@GuildfordHpb
#livesurgery
#frcsprep
0
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Thank you to our registrars
@RoyalSurrey
who have been absolutely fantastic in the last 12 months
0
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Congratulations! Dr Nabeel Merali, a trainee surgeon
@RoyalSurrey
@GuildfordHpB
and studying for a PhD
@UniSurreyBioSci
@Adam_Frampton1
who has been awarded a Royal College of Surgeons Research Fellowship for his project investigating the microbial ecosystem in pancreatic cancer
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@SWexner
@ad_singh09
@NealPanse
@Vishnu__Prasath
@SimranArjani
@RaviChokshi1
@NJMSDeptSurgery
@RutgersU
I do lap, 🤖 & open choles. For the majority of cases, lap is an excellent technique & is more cost efficient than 🤖. However, the 🤖 confers benefits in complex biliary disease & we
@RoyalSurrey
have seen an improvement in our outcomes in these patients
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Another interesting biliary case! Csendes 3/4 mirizzi syndrome referred from another hospital for definitive management. Multiple episodes of biliary sepsis. Previous ERCP & abandoned cholecystectomy
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All HPB trainees should watch
@JHawksworthMD
videos! Fantastic approaches to 🤖 liver surgery & I use the hybrid 🤖/CUSA technique for major liver resections based on his videos. The wonders of Twitter
@IHPBA
@EAHPBA
@roux_group
@SAGES_Updates
0
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We are proud to offer our HPB, OG & CR patients open/lap/🤖 approaches to complex benign & malignant pathology
@RoyalSurrey
@nima_ghadi
@MadhavanAnantha
@Pritam__Singh
@jameswread100
@AndreaScalamed
@GuildfordHpb
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4
16
@Gio_Marchegiani
@LancetGastroHep
@villesallinen
@knutjla
@MarcBesselink
@ksoreide
@sparrelid
@HpbKarolinska
@juliomayol
@HalletJulie
@TheNotoriousHPB
@letswinpc
This ‘real world’ multi centre RCT is excellent work by all involved. It also sheds light on ‘agenda based surgery’ when the result doesn’t meet some expectations. This study has faced rigorous review across the 🌎 with some very forthright views 1/
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2
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@JazSeehra
Great points here. Just because surgeon x reaches ‘competency’ faster than surgeon y, it does not make them a better surgeon. You do not stop learning & improving when you’re a consultant, both in technical & non technical skills. It’s a marathon, not a sprint
0
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Huge thanks to
@Jawad004
for hosting us for a benign robotic HPB list today. Looking forward to welcoming you
@RoyalSurrey
next week for the advent of our robotic HPB programme
@GuildfordHpb
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2
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@RomiNavaratnam
@MISIRG1
@SurgicalClinics
@cutitoutPODCAS1
@EricKnauerMD
@ericpaulimd
@OscarGuevaraHPB
@rubenciria
@FlavioRochaMD
@mj_pucci
@FilippoLandi_
@mpalavecino_
I disagree
@RomiNavaratnam
. One stop lap chole & CBDE if necessary needs to be expanded in 🇬🇧. It should be in the armoury of all benign UGI surgeons
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These cases require exceptional teamwork & we are very fortunate
@RoyalSurrey
to have fantastic surgical, anaesthetic
@RSCHAnaesthesia
& experienced nursing teams that have allowed rapid development of our robot service 2/
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2/ dual console facilitates better training opportunities than open or lap IMO & regular simulation practice meant that all cases were performed beautifully
@IHPBA
@EAHPBA
@whawkinssurgery
@KSSSurgery
@Augishealth
0
0
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Another great session by
@T4UGIS
.
Excited to announce the first
@T4UGIS
HPB webinar. A monthly series focussing on clinical HPB surgery
Kicking off on Wed 10 Nov. with pre-op imaging in liver surgery. Two great speakers
@SharanWad
& Shelley Chapmam
#some4hpb
@IHPBA
@GBIHPBAnews
@EAHPBA
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RIP Prof Blumgart. A titan of HPB Surgery who taught & influenced many.
0
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I can’t make it to
@IHPBA
this year & I hope everyone has a great time! I wanted to share this interesting case I had recently.
Young female pt with recurrent attacks of acute pancreatitis for 4 months. Unable to eat & started on NJ feeding. Repeat admissions….1/
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@NEndoscopy
I know this is rhetorical but I’ll bite. It’s 2 all day long. I was a registrar in 2016 when we took IA & fully support the juniors now I’m on the other side
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@mj_pucci
@cutitoutPODCAS1
@laarhoven_stijn
@GuildfordHpb
@Adam_Frampton1
@MStott88
Exactly this!! ‘Just a gallbladder’ is one of the most dangerous terms in abdominal surgery. The pancreatectomy I did the week before was far more straightforward
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@RoyalSurrey
we performed (we believe) led by Tim Pencavel & Tim Worthington, the first 🤖 PD with an Archimedes biodegradable stent. Great support by
@martynrichards1
& Q3 medical. We have used these stents in open & robot PD & I firmly believe they can benefit patients 1/
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13
@TarakChouari
@RoyalSurrey
@GuildfordHpb
@KSSSurgery
@whawkinssurgery
@Augishealth
@IHPBA
Irena does not work at ST4 level. Train the trainee, not their badge number
0
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@JJcolemanMD
1 GSW treated in Melbourne. 0 in 15 years of NHS practice. The UK has many faults, gun control is not one of them
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Probably the best benign HPB video atlas ever made. Fantastic job
@DerbyPBunit
🧵 of our laparoscopic pancreatic videos on complex benign pathology
@MISIRG1
@IHPBA
@EAHPBA
@SAGES_Updates
@Cirbosque
@me4_so
@TeamSurgery247
@T4UGIS
@ANZHPBAinc
@hpb_so
#FOAMed
#GITwitter
#MedEd
#SurgEd
#SoMe4Surgery
#surgery
#laparoscopic
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4
12
@robhinchliffe1
@BJSurgery
@ESVSmembership
@karimbrohi
@ASiTofficial
@TobyRichardsUWA
@yeung_joyce
@rmoonesinghe
@bhwords
@CTU_LSHTM
@RouleauxClub
We give a dose at induction for all our hpb resections
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Following removal of fistulating gallstones through old midline wound, distorted CBD found as expected from CT. Transcystic CBD clearance performed.
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@timdudderidge
We & our oesophagogastric colleagues
@RoyalSurrey
offer 24/7 subspecialty on call & consultant led wards rounds on both Saturday & Sunday. Completely agree with you
@timdudderidge
0
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@CurrieSurgery
@EmilyJBritton
@Bhaskar23859803
@roux_group
@T4UGIS
@hpb_so
@IHPBA
@GBIHPBAnews
@EAHPBA
@JAG_Endoscopy
@GuildfordHpb
@CurrieSurgery
couldn’t agree more. Having HPB surgeons who perform ERCP & interventional PB EUS is fantastic. However, not all HPB surgeons should train in it IMO. Getting competent at complex resection & complex endoscopy is incredibly challenging
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A fantastic achievement for our colleagues from Derby to contribute to IMO, the best HPB learning resource ever created
@TVASurg
We are delighted to contribute to
@TVASurg
which is a resource we used throughout our training. We hope this will be an excellent video for anyone interested in LCBDE. Special thanks to Albert Fung for his enthuaism and support throughout.
@hpb_so
#FOAMed
#SoMe4Surgery
#hpb
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3
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@hayleymagill
I am sorry you feel this way
@hayleymagill
. I disagree wholeheartedly with you on this. I love my job, work with fantastic colleagues & take great pride in working with our patients.
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@jameshallesmith
@hpbjournal
@sanjay_HPB
@Drsampathak
@UHB_HPB
@DrSfpb
@rupaly_pande
All our patients have a whipples drug chart with our ERAS protocol built in. No NGT, NJ placed in all. Free fluids from day 1. Start NJ feed on day 3 if not progressing oral intake as per ERAS. Our fantastic dietitians are involved in the whole peri-op period
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@AnnalsofSurgery
I cannot believe this was published in one of the premier surgical journals. Many excellent manuscripts are rejected & this was accepted?!
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Pt at home & doing well. Histology showed pancreatic inflammatory myofibroblastic tumour!! My first experience with one of these!
@GuildfordHpb
@roux_group
@EAHPBA
@Augishealth
@cutitoutPODCAS1
@SyedAAhmad5
@Declanfj
@hpbsurgeon1
@TheNotoriousHPB
@SAGES_Updates
@IswantoSucandy
2
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Exciting times & will allow us to continue to treat more cancer patients
@RoyalSurrey
Do you want to see what our new Cancer and Surgical Innovation Centre will look like?
Here’s a sneak peek. You can find out more about the centre and see the full virtual tour at our online event on June 24.
Find out how to attend:
#RoyalSurrey
#NHS
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I am fortunate to work with Artem who is a fantastic colleague. Please read his message & help in anyway you can
@RoyalSurrey
@RSCHAnaesthesia
@GuildfordHpb
#StandWithUkraine
If you work with me, you will also know one of the best colleagues I have. This is his Facebook message. Please come find me or him in PACU and do what you can, please retweet, share or donate.
@RoyalSurrey
@RSCHAnaesthesia
thank you
0
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@kmahawar
@T4UGIS
@bbugssuk
@asgbi
@Augishealth
@SAGES_Updates
We do almost all lap choles that present as hot choles. Abandoned choles from other hospitals are discussed at our referral meeting (cons & CNS’s present) to decide on robot/lap/open approach. Gallbladders with concerning features go through mdt
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@SyedAAhmad5
@SurgJournal
@SWexner
I didn’t realise that people staple the GJ during open cases 🤣🤦♂️! It’s a great training opportunity so the trainee always does a hand sewn in our unit
0
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@Adam_Frampton1
@T4UGIS
@laarhoven_stijn
@EAHPBA
@MarcBesselink
@gall_tamara
@Jawad004
@doctor_felix
@Ch_Oberkofler
Another fantastic webinar organised by
@laarhoven_stijn
& my brilliant colleague
@Adam_Frampton1
! An interesting & very current topic
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@ElliotServaisMD
Best decision ever
@ElliotServaisMD
. Wednesday is generally my half day after ward round & a busy clinic. I always get my daughter from school. It’s a highlight of my week
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@LukeEvans_EGS
@dr_shai
I was an SHO many years ago at the N&N and lived just around the corner from this very picture! A great opportunity in a brilliant city
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Join us this Wednesday 8/2 at 7pm 🇬🇧 for the latest instalment of the
@T4UGIS
HPB webinar;
Interventions in severe pancreatitis.
Speakers
@IRHorton
&
@drnataliegastro
#some4surgery
@EAHPBA
@BASO_ACS
@IHPBA
@GBIHPBAnews
@pancreatitis_nl
@PainapStudy
@Panc_Study
@PancSocGBI
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@Schoolofsurg
@ASiTofficial
@bota_uk
It may vary significantly by deanery but certainly IMO, almost all foregut cancer surgeons require (but more importantly) benefit from post CCT fellowships
0
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@GracePhysio
@StGeorgesUni
Enjoy it! Be social as your friends get you through the tougher times. I started as a student
@StGeorgesUni
21 years ago… I feel old now
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This cannot come to
@RCSnews
soon enough!
RACS is phasing out the use of gendered titles for surgeons, which can create power and status differences between surgeons and other medical professionals, male and female surgeons, and women who are married and women who are not. Find out more:
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@ZhiVenFongMD
@fdahdaleh
@DenboJw
Patients need a safe PD by a high volume HPB surgeon. MIS vs open will likely never show any significant differences. Whatever technique that leads to minimal POPF is best IMO. Possible to get open PD home within 7 days with good ERAS. Keen to see where MIS benefit is
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@mstotty88
@roux_group
We do a significant amount of emergency abdominal surgery Martyn. Many enjoy it & are really good at it too! Another question is why so many sub specialists feel that they are above it?
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@EricKnauerMD
@mj_pucci
@EzraTeitelbaum
@ericpaulimd
@SAGES_Updates
@drkeithsiau
@andrewswright
@cutitoutPODCAS1
@DissanaikeMD
@Cirbosque
@T4UGIS
@laarhoven_stijn
Triple phase liver CT will answer most questions. If in doubt, laparoscopy ‘look & see, don’t wait & see’
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An important paper highlighting the safety of 🤖 chole in 🇬🇧 HPB centres. Congratulations
@Irena8181
!
Our new article on ‘Safety of 🤖 chole - the UK experience’ is out in
#SurgicalEndoscopy
! Have a look! Huge thanks to all collaborators!
@rajibaji1983
@Adam_Frampton1
@Declanfj
@RyanDBaron
@Jawad004
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@mstotty88
@LucyLucyHuppler
@bariatricBOMSS
Surgeon speed is a taboo in 🇬🇧 but must be addressed. The variation is massive & slow surgery is expensive & a waste of valuable resources
3
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A fantastic team that have helped to facilitate complex cancer surgery throughout the pandemic.
This week, we highlight the incredible work of the Post-Operative Care Unit (PACU) as March’s first Team of the Week.
PACU is based in Theatres and looks after the patients following surgery and brachytherapy.
Read more:
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@SyedAAhmad5
@AmJSurgery
@UCincySurg
@SocSurgOnc
@SSATNews
@juliomayol
@TomVargheseJr
@SAGES_Updates
@TsengJennifer
How much of those 5 whipples will the resident ‘perform’? Is that skin to skin as first surgeon? Assisting the fellow? Performing parts of the procedure?
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Beautiful demonstration of options in SMV/PV reconstruction. All HPB trainees should follow
@Manishbhandare4
Type II PVR - Part of the wall is excised but primary closure (type I) is not feasible. The patch recon is more tedious than end to end recon. Hence most suitable cases are lateral/posterior wall involvements at the level of S-P confluence as splenic vein can be preserved.
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Post clearance cholangiogram. Haemolocks to cystic duct. Patient managed with wound catheters & home day 4 post op.
@cutitoutPODCAS1
@laarhoven_stijn
@GuildfordHpb
@Adam_Frampton1
@mj_pucci
@MStott88
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@SWexner
@CleveClinicFL
We have done this. Our week on/week off rota has merged the HPB/OG/Colorectal services at registrar (resident) level. Double consultant operating for ongoing cancer cases. Working well this far.
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@MarkarSheraz
Not just ethnic minorities in my opinion Sheraz. Female colleagues & those from working class backgrounds (regardless of colour) face similar discrimination
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@Gio_Marchegiani
@LancetGastroHep
@villesallinen
@knutjla
@MarcBesselink
@ksoreide
@sparrelid
@HpbKarolinska
@juliomayol
@HalletJulie
@TheNotoriousHPB
@letswinpc
Yet some retrospective case series with nowhere near the same scientific validity are lauded 🤔🤷♂️. What is clear is that we have a long way to go, and a blunder bus ‘1 size fits all’ will not significantly improve outcomes
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