Jada Saunders

@BehindTheKnife you guys have a pelvic floor dedicated episode?!?

@thrdcultortho Great deanery congrats 😎

Alhamdulilah Alhamdulilah Alhamdulilah Alhamdulilah - it’s been rough but I’m officially an orthopaedic surgeon under construction. Also so glad I don’t ever have to log into Oriel ever again 🤲🏽🙏🏽😭🚧🦴🦴🦴

The UK is rapidly losing medical academics and we need urgent action to reverse the decline. The Government needs to deliver a fair offer for medical academics training in England. We stand in solidarity with the UK resident doctors committee who have voted to reject the Government’s offer, which falls short in addressing the pay loss built into academic training. Read our full letter from Medical Academics to the Secretary of State here.

😂😂😂

@gibb_jonathan This looks very interesting I would like to read it but don’t have access, do you have a pdf version?

Resident doctors in England lose up to £81,000 in average lifetime earnings for every year out of programme undertaking research. The current academic flexible pay premia isn't fit for purpose and inaction is driving the decline in medical academics.

Dont hate the player hate the game.

A lot of people in academic medicine explain things in an overcomplicated fashion, in part to create a certain mystique around themselves and give others the impression that they understand things at some higher level than the average practitioner is able to. It works especially well if the person sounds confident when they speak, because the listener will usually not have enough mastery of the subject to question them on it. People think that when they can’t understand what’s being said, that the problem is with themselves. Entire careers are built on this dynamic. As learners, you have to recognize that this behavior is often false. True geniuses do exist, but are rare. The prevalence of individuals that truly understand things that no one else can is definitely much less than 1 per department. The 2 take-home messages from this are: 1) In general you want your teachers to spend most of the time making things reductive; in other words, making them seem simpler, not more complex. 2) the confidence with which someone says a thing has little correlation to whether it is true or not. Being a good salesperson helps one’s career in medicine as much as it does in other fields, and you have to recognize when the person talking to you is bluffing.

The mornings are brighter earlier, the evening are brighter longer. Life is worth living!!!!!!!

Silver linings

Earbuds to Operating Rooms: 10 Years of Behind the Knife. Thank you 🙏🏼 @AnnalsofSurgery for sharing our story. 🔗journals.lww.com/annalsofsurger…🔗 "We believe the fundamentally human aspects of surgery will remain just that—human. And to create meaningful surgical education content, we will use AI as another helpful tool. As we continue to evolve, our mission will stay the same: to provide practical, accessible, high-quality surgical education that reflects the realities of modern training and practice." @georgoff @ScottRSteeleMD @BinghamMd @Kniery_Bird @mcclellanjm @Cody_Mullens @clarkninam

Percutaneous cholecystostomy should serve as a bridge to interval cholecystectomy in patients with contraindications to immediate surgery, specifically those with sepsis and acute cholecystitis, with IC ideally performed 8-13 weeks post-PC. ja.ma/45zCzoK

I translated this into English for everyone to read. This is written by an orthopedic surgeon colleague in Spain, but I know my American colleagues will appreciate the text an similarities to challenges we face here 1/ The Asymmetry in Medicine in Spain: Responsibility Without Authority (I) Opinion Francisco J. Guitián Lema The Asymmetry in Medicine in Spain: Responsibility Without Authority (I) “There is irrefutable empirical proof of this asymmetry: the doctor can replace anyone; no one can replace the doctor,” states Francisco J. Guitián Lema, a Vigo-based traumatologist specializing in orthopedic surgery There is a truth so elementary that it feels uncomfortable to state it: a hospital exists solely and exclusively to cure the sick. It is not there to provide jobs or to justify organizational charts. Nor to feed bureaucracies or to experiment with organizational theories. It exists so that a sick human being leaves it less sick or, at the very least, having received the best possible treatment. From this premise follows a logical consequence that the Spanish healthcare system seems determined to ignore: in that healing process, there are only two absolutely indispensable figures. The patient, who is the reason for the entire structure’s existence, and the doctor, who possesses the knowledge to guide that process. Everything else — and this is not disdain, but taxonomy — is support structure. Necessary, valuable, often heroic, but auxiliary. The doctor is the only professional capable of performing the core act that justifies the hospital’s existence: diagnosing the disease and establishing the treatment. Without a diagnosis, there is no possible direction. Without a therapeutic indication, there is no meaningful action. An orderly transports the patient, but it is the doctor who determines where and why. A nurse administers medication, but it is the doctor who decides which, how much, and when. A technician performs a test, but it is the doctor who orders it and interprets its result. This functional hierarchy is not a social convention or an inherited privilege: it is a direct consequence of training. Six years of medical school plus four or five years of MIR specialization produce a professional capable of integrating knowledge of anatomy, physiology, pathology, pharmacology, and a thousand other disciplines into a diagnostic synthesis that no other healthcare professional is trained to perform. There is irrefutable empirical proof of this asymmetry: interchangeability. A doctor can, in case of need, perform the functions of any other hospital professional. They can push a stretcher, insert an IV line, draw blood, take vital signs — in Germany, doctors routinely perform these functions. The reverse is not true. An orderly cannot diagnose pneumonia. A nurse cannot order a surgical intervention. The doctor can replace anyone; no one can replace the doctor. Recognizing this reality does not imply disdain toward anyone. Nursing care is essential. The orderly’s work ensures that hospital flow does not stop. Everyone deserves respect and fair compensation. But respect for personal dignity cannot be confused with functional equivalence. In an operating room, the surgeon is not worth more as a human being than the assistant; but their function is irreplaceable in a way that the assistant’s is not. This distinction, obvious in any other field, has become taboo in Spanish healthcare. The prevailing egalitarianism has managed to make an evident functional truth be perceived as a moral offense.

@EzraTeitelbaum Thank you.

@JadaS95 Yes, I do the same for acute and chronic cholecystitis. With chronic itis, if I can’t separate GB body from cystic plate/liver then I do a subtotal cholecystectomy. Especially helpful in avoiding dissection in proximity to CBD in chronically inflamed/contracted gallbladders…

Terrible complication for patient and surgeon. Looks like a straight forward blue gallbladder with a surgeon in a hurry. Need proper “critical view of safety” #safechole sages.org/safe-cholecyst… @SAGES_Updates

@EzraTeitelbaum Great video. I liked your “medialisation” of the cystic artery. Out of curiosity,in a hot GB do you have the same approach?

@EricKnauerMD @SAGES_Updates Everyone talks about CVS, but not strategy to get there. Video shows danger of “infundibulum first” approach, you can end up dissecting medial to the CBD. CVS per se does not prevent this. Here’s the “body first” approach I use to prevent this error: youtu.be/SzKvgE8YyE0?si…

🧐

@SurgeryBro Definitely

@JadaS95 I didn’t know it played by hydra rules😅

@Gio_Marchegiani Hi there. Do you have an open pdf link to this paper please?

Save 🐼 laparoscopy! 🤖 Are we allowing robotic surgery to diminish laparoscopic skills that transformed surgical care a generation ago? ⏰ A wake up call for surgical education 💤 jamanetwork.com/journals/jamas…

@Ryanair Lolllllll

and the gap in your trophy room

@DerbyPBunit Thank you!

Thanks for your comment Jada. We have done narrated videos in the past (see below) but will release some new content in the future. Stay tuned! Links to narrated videos: x.com/DerbyPBunit/st… x.com/DerbyPBunit/st… x.com/DerbyPBunit/st… x.com/DerbyPBunit/st… x.com/DerbyPBunit/st…

Procedure: Laparoscopic Infracolic Necrosectomy with Roux-en-Y Cystjejunostomy and Drainage of LIF Abscess Surgical Approach 🔴Good nutritional status and no organ failure ➡️Suitable for minimally invasive surgery 🔴MRCP showed DPDS ➡️Intraoperative fluid amylase from collection 2529 iU/L ➡️Roux-en-Y Cystjejunostomy for dependent drainage 🔴Single staged clearance of large WON and LIF abscess ➡️Debridement performed using lap instruments ➡️Flexible scope used to guide debridement to ensure it was done under vision 🔴Drain placed in left retrocolic collection ➡️Allow drainage of left flank and pelvic component of collection 🔴No further radiological, endoscopic or surgical intervention was needed ➡️Drain flushing ➡️Antibiotics as per cultures Post-op 🔴Discharged post-op day 10 ➡️Longer stay due to pancreatic bed infection ➡️E. Coli from necrosis MCS 🔴Roux limb drains removed day 3 ➡️Drain amylase normal 🔴Left retrocolic drain remained in-situ on discharge ➡️Used as closed drain with regular flushes 🔴4 week post-op CT (see below #1) shows resolution of infracolic collection and near resolution of left flank collection ➡️Drain kept in to allow for flushing and closed drainage 🔴Drain removed at 3 months follow-up ➡️Interval CT showed resolution of collection (#2) ➡️Minimal output ➡️Drain amylase normal 🔴3 year follow-up showed no recurrence of collection See our paper in @JournalofGISurg on infracolic necrosectomy with or without Roux-en-Y cystjejunostomy: sciencedirect.com/science/articl…