Derby Pancreaticobiliary & Robotic AWR Unit

Pleased to share our latest publication in @JSHBPS Journal of HBP Sciences on the Safety and Outcomes of LCBDE in Elderly Patients. In 494 patients, outcomes in ≥70 vs <70 years were equivalent despite higher comorbidity, with ~100% duct clearance, no mortality, and similar morbidity. LOS was slightly longer in the elderly group. LCBDE remains a safe, definitive single-stage approach and age alone should not preclude LCBDE in specialist centres. Link to paper: onlinelibrary.wiley.com/share/author/J…

Principles of Szabo Knot 🔴Square knot - 2 throws 🔴Slip knot - unlock by pulling in opposite directions 🔴Slide - non-closed grasper 🔴Lock 🔴Final throw Useful in: 🟢Tissue approximatiob under slight tension 🟢Deep areas i.e. OG hiatus, pelvis #MedEd #SurgEd #surgery

𝗡𝗮𝗿𝗿𝗮𝘁𝗲𝗱 𝗩𝗶𝗱𝗲𝗼: 𝗥𝗼𝗯𝗼𝘁𝗶𝗰 𝗖𝗵𝗼𝗹𝗲𝗰𝘆𝘀𝘁𝗲𝗰𝘁𝗼𝗺𝘆 𝗮𝗻𝗱 𝗖𝗕𝗗 𝗘𝘅𝗽𝗹𝗼𝗿𝗮𝘁𝗶𝗼𝗻 See our paper in @IJSurgery at: journals.lww.com/international-…

Delighted to see @altaf_awan12 as an invited speaker at the 1st Libyan International Hernia & AWR Conference (LHS 2026) in Misrata, Libya hosted by the Libyan Hernia Society. Congratulations to the organising committee @hatem_elbernawi Fatim Elzowawi & Aiman Allawgali. It was a fantastic scientific programme focusing on advancing safety and training in Hernia & AWR surgery. We were pleased to give our talk on "Robotic Hernia & AWR Surgery" and the clinical benefits and excellence in patient care that can be achieved with the robotic platform. @altaf_awan12 was honoured to meet the Libyan Prime Minister His Excellency @AbdulH_Dbeibah. New friends were made and the Libyan hospitality was very enjoyable.

An excellent two days of proctoring Robotic UGI surgery at @SheffieldHosp by @altaf_awan12. We were delighted to proctor Martin Trotter as he embarked on his robotic programme. Cases performed included seven cholecystectomies of variable complexity. Special thanks to a welcoming theatre team. Thank you to Fiona Markland and Adam Clare of @IntuitiveSurg for their efforts and support to advance a safe robotic programme. #Robotics #Proctor #Training

𝗦𝘁𝗼𝗻𝗲 𝗥𝗲𝘁𝗿𝗶𝗲𝘃𝗮𝗹 𝗳𝗿𝗼𝗺 𝗡𝗮𝗿𝗿𝗼𝘄 𝗖𝗵𝗼𝗹𝗲𝗱𝗼𝗰𝗵𝗼𝘁𝗼𝗺𝘆 🔴Bring CBD stone trapped in basket to choledochotomy site 🔴Remove scope over wire 🔴Keep tension on basket wire with trapped CBD stone 🔴Introduce choledochotome (or laparoscopic scissors) and minimally extend choledochotomy over large CBD stone ➡️Prevents large choledochotomy #FOAMed #GITwitter #MedEd #SoMe4Surgery #Surgery

We were delighted to organise and host the 7th @ALRSGBandI Intermediate Skills in Robotic Surgery course at the @IntuitiveSurg Reading Lab. We thank @kotobuki_en for providing excellent models for robotic small bowel resection and TAPP hernia. Many thanks to all the faculty and for Navpreet Lakhan and @IntuitiveSurg for their invaluable contribution. #Robotics #Simulation #MedEd

Tips for Retrieval of CBD Stone during Transcholedochal LCBDE 🔴CBD >8mm 🔴Atraumatic graspers useful 🔴"Milking" CBDS 🔴5mm choledochoscope with 0-Tip basket ➡️Gentle "to-and-fro" motion ➡️Irrigation 🔴Withdraw choledochoscope over basket wire with trapped CBDS 🔴Extend choledochotomy #FOAMed #GITwitter #Surgery #SoMe4Surgery #HPB

Congratulations to @javlatif for this paper in @SLEPTonline. We were delighted to contribute with the excellent team at @HpbLeicester on this paper describing a structured training pathway to achieve @JAG_Endoscopy certification in ERCP during early higher surgical training. Link to paper: journals.lww.com/surgical-lapar…

An excellent two days of proctoring Robotic Hernia surgery at @CHRUStrasbourg by @altaf_awan12. We were delighted to proctor Prof. Benoit Romain and Dr. Aurelian Villeman as they embarked on their robotic hernia programme. Special thanks to a welcoming theatre team. Thank you to Henri Tranet and Jérôme Nourrisson of @IntuitiveSurg for their efforts and support to advance a safe robotic programme. #Robotics #Proctor #Training

Our Approach 🔴Dissection was kept close to gallbladder throughout 🔴Arterial rather than venous bleed 🔴Bleeding brisk ➡️Pressure did help but not successful 🔴Small arterial branch identified entering GB wall 🔴Suction/irrigation handy 🔴Careful evaluation of bleeding vessel 🔴After confirmation, clip applied to the vessel that was entering GB ➡️Likely a small branch off RHA 🔴Venous bleeds more common and can be a significant challenge intraoperatively Many thanks for all the engagement with the post 👏🏽

@drmohamedeb @Innov_Medicine @SAGES_Updates @BehindTheKnife @BrownJHM @IHPBA @imedverse @rbarbosa91 @altaf_awan12 @ib9994 @javlatif Thanks for your engagement. We will post a video showing our approach later this week.

@DerbyPBunit @Innov_Medicine @SAGES_Updates @BehindTheKnife @BrownJHM @IHPBA @imedverse @rbarbosa91 @altaf_awan12 @ib9994 @javlatif Looks like an arterial bleed from a branch of the RHA. Clip or suture. How did you manage it ?

What Would You Do? During an emergency cholecystectomy and CBD exploration, you encounter the below during dissection of the gallbladder off the cystic plate. What would be your approach in managing this? Any tips or tricks?

Robotic TAPP (rTAPP) Repair of Left Inguinal Hernia with Imbrication of Transversalis Fascia Why imbricate: 🔵Direct defect/large hernia risk factors for postoperative seroma 🔵In open hernia repair, direct defect often closed ➡️Helps create a flat posterior wall and expedite mesh placement 🔵However it is not a routine practice during MIS Robotic Imbrication of Transversalis fascia: 🔴Possible advantages include: ➡️Reduce seroma risk formation ➡️Reduce risk of recurrence (mesh migration) 🔴Avoid deep bite ➡️Cord structures can be easily caught in sutures

𝗥𝗼𝗯𝗼𝘁𝗶𝗰 𝗧𝗿𝗮𝗻𝘀𝗮𝗯𝗱𝗼𝗺𝗶𝗻𝗮𝗹 𝗥𝗲𝘁𝗿𝗼𝗺𝘂𝘀𝗰𝘂𝗹𝗮𝗿 𝗨𝗺𝗯𝗶𝗹𝗶𝗰𝗮𝗹 𝗣𝗿𝗼𝘀𝘁𝗵𝗲𝘁𝗶𝗰 𝗥𝗲𝗽𝗮𝗶𝗿 (𝗿𝗧𝗔𝗥𝗨𝗣): 𝗕𝗼𝘁𝘁𝗼𝗺𝘀 𝗨𝗽 𝗔𝗽𝗽𝗿𝗼𝗮𝗰𝗵 Advantages of Approach: 🔴Overcomes limitations of lateral docking to achieve adequate cephalad dissection beyond defect 🔴Option to extend dissection into TAR plane ➡️Indicated in cases where approximation of defect becomes difficult 🔴Allows good mesh overlap 🔴rTAPP approach can be difficult ➡️Thin peritoneum laterally ➡️May not allow defect approximation in absence of posterior rectus sheath release for defect >4cm See our paper on outcomes during the learning curve and implementation of the @eurohernias guidelines for RAWS in the UK: frontierspartnerships.org/journals/journ…

𝗙𝗲𝗹𝗹𝗼𝘄𝘀𝗵𝗶𝗽 𝗔𝗱𝘃𝗲𝗿𝘁 Our Post CCT/Senior Complex Benign PB & Robotic Fellowship at @UHDBTrust is now open for applicants to start from Aug 2026. Gain experience in advanced laparoscopic and robotic benign PB surgery. In addition, fellows will develop skills in laparoscopic and robotic hernia surgery including complex abdominal wall hernias as well as training in ERCP. Advert below or DM for more details: nhsjobs.com/job/UK/Derbysh…

𝗔𝗻𝘁𝗲𝗿𝗶𝗼𝗿 𝗚𝗮𝘀𝘁𝗿𝗼𝘀𝘁𝗼𝗺𝘆 𝗮𝗻𝗱 𝗥𝗲𝘁𝗿𝗶𝗲𝘃𝗮𝗹 𝗼𝗳 𝗜𝗺𝗽𝗮𝗰𝘁𝗲𝗱 𝗛𝗼𝘁 𝗔𝘅𝗶𝗼𝘀 𝗦𝘁𝗲𝗻𝘁 🔴Anterior gastrostomy just at level of palpable bulge and proximal to pylorus ➡️Correlated with Hot Axios position on CT 🔴3/0 PDS used as stay sutures to improve visibility ➡️Just anterior leaf of gastrostomy ➡️To falciform using slip knot 🔴Despite manoeuvres described difficult to visualise Hot Axios stent 🔴Ligaclips applied to mucosa where stent could be palpated 🔴Intraoperative XR screening used to orientate the stent in relation to ligaclips 🔴Hook diathermy used to divide stomach mucosa to the right of the ligaclips to identify the stent which proved to be unsuccesful 🔴Real time IOUS utilised ➡️Critical step ➡️Key in identifying location of Hot Axios stent 🔴Once identified the stent which buried beneath the mucosa was removed with careful traction 🔴Bleeding encountered upon stent retrieval ➡️Controlled with pressure, judicious use of diathermy and placement of Veriset 🔴Anterior gastrostomy sutured close in 2 layers with 3/0 PDS 🔴Postoperatively patient started on IV PPI and initiated on oral fluids and diet in stepwise manner #FOAMed #GITwitter #EUS #HPB #SoMe4Surgery #surgery

"Hot" Laproscopic Cholecystectomy 🔴Principles remain the same 🔴Know bailout options ➡️Subtotal 🔴Gallbladder decompression 🔴Identification of Rouviere's sulcus if present 🔴Endo pledget very useful in these cases 🔴Suction/irrigation ➡️blunt dissection 🔴Demonstrate CVS

Tips & Tricks for Minimally Invasive Adhesiolysis 🔴Controlled but purposeful traction and counter traction to divide adhesion ➡️See image below with arrows 🔴Blunt instruments i.e. Johann 🔴Useful for adhesions between bowel loops