Short 🧵regarding the scissors with black handles:

Those who read my original 🧵on the meaning of gold handled surgical instruments may recall I mentioned scissors with black handles (if not, see link at the end).

I've now seen one in the wild and got the necessary photos.

Beautiful video of whipple anatomy that we usually can’t see as clearly. Plus nice example of external PJ stent via robot. Great work, Ahmad!

“Pucker sign” which is a depression in the liver at the region of the GB, is a predictive sign of op difficulties during a delayed chole after acute cholecystitis. It could be a halting sign to modify the procedure in order to increase its safety.

Rwhipple, my fav operation. I keep trying different approaches to learn the anatomy from diff angles. Here I tried the uncinate first approach and kept going until I saw the vein of Belcher & GDA from this side which was fascinating. Pancreatic transection became last step 😃

Congratulations to Jefferson Surgery team of Francesco Palazzo, MD, FACS and Sunjay S. Kumar, MD . Awesome work on a needed resource! SAGES is in Long Beach in 2025!

There is still a role for left thoraco-abdominal incisions in the management of gastro-esophageal junctional adenocarcinoma. We use this approach for bulky type 3 and some type 2 with retro-peritoneal nodes. MIE/RAMIE is not for all cases. academic.oup.com/dote/advance-a…

What a beautiful view!!! Congrats!!

Very well said!! 👇

A laparoscopic cholecystectomy is safe, not because it is easy, but 'because' it is performed by highly trained individuals.

LC has an enormous spectrum of difficulty and that is challenging to predict.

You need a quiver with a lot of different arrows to tackle these cases.

Direct gasless optical entry in Palmer’s point - one of the many ways to gain initial access in #MIS . What is your primary method and which area? What’s your back-up? Michael J. Pucci Omar M Ghanem Eric Knauer Ankit Patel Adnan Alseidi

Bleeding will happen in robot HPB. I have bleeding sutures ready so I don’t let go of the bleeder to tie a knot. Here’s how my scrub tech prepares them:

youtu.be/HZNJ0ec61RQ?si…

Once you have vascular control which is the hard part, vascular suturing on the robot is easier and more fun than open as you have 9x magnification, articulated instruments, no tremor, and you’re sitting comfortably 😅

#robot4HPB

I will repost this every time I see it.

May the 4th be with you

The inappropriately rough handling of tissues is a proximate cause of many complications and deaths, though it won’t be listed this way in any database.

It may get recorded as sepsis, or bleeding, or respiratory failure, but these are often secondary to the initial insult.

State-of-the-Art #Surgery

A few months ago, one of our residents sent me this picture; a postoperative wound from one of my patients (with permission to share)!

Can you imagine that this is the primary incision in men for an open-heart operation to repair the #mitralvalve ,…

Michael J. Pucci Ron Barbosa MD FACS Eric Knauer Sharmila Dissanaike Found it: Lancet 1954. I think it was because of this paper that Strasberg termed the “Shield of McElmoyle”. Mike, you probably know best.

Watch the full video. This is really impressive. Congratulations 🍾🎉 and thanks for sharing!!

Robotic whipple with vascular resection is feasible with experience and with complete vascular control. The actual vascular work is easier than open as you have 9x magnification, articulated instruments and no tremor..
Full videos on my YouTube channel

youtube.com/@ahmadabouabba…

1- IVC iliac bifurcation and right iliac artery sarcoma.
An illustrated technical note mini thread
#oncovascular #vascsurg