Des Winter

Pain intensity and prognosis of acute pancreatitis in an international, prospective study ➡️ doi.org/10.1093/bjs/zn… 🔥 Severe abdominal pain at admission linked to worse outcomes in acute pancreatitis (organ failure & necrosis). ⚖️ Moderate pain tied mainly to pancreatic necrosis, but not consistently to other complications. 📉 Pain severity alone was a poor predictor of disease course (low accuracy for risk stratification). ✅ Absence of severe pain may help reassure clinicians and support safe outpatient management in low-risk patients. Work by Cecilie S Knoph, PAINAP Collaborative, Sanjay Pandanaboyana #SoMe4Surgery #MedTwitter #SurgEd #Surgery @RCPSGTrainees @aecirujanos @SEIQuirurgica @iss_sic #MedicalTechniques @BJSAcademy @young_bjs @BJSOpen @des_winter @evanscolorectal @robhinchliffe1 @bplwijn @MalinASund @nfmkok @TejedorPat @paulo_sutt @PVaughanShaw @JJEarnshaw @juliomayol @ksoreide #some4hpb #some4tpl @DPCG_official @pancreatitis_nl @PancreasClub #PancreasClub2023 #PancreaticCancer #Pancreatitis #HCC @PanCAN #PanCANawareness @EurPancClub @P_C_E_ @dice_europe #PancreaticCancer #cholangiocarcinoma

🆕Read our new @young_bjs article! High-output stoma management: an overview ➡️doi.org/10.1093/bjs/zn… 1⃣High-output stoma is common, especially in those with an ileostomy 2⃣Exclude obstruction, infection, or IBD flare as a cause 3⃣Initial resuscitation focuses on replacement of electrolytes as well as fluids 4⃣Further management aims to reduce gut transit and gastrointestinal secretions 5⃣Patients with proximal stomas may require parenteral fluid or nutritional support 6⃣Reverse the stoma if it is feasible and sensible Work by Rachel S M Heard, Dominic S Thompson, Martyn D Evans #SoMe4Surgery #MedTwitter #SurgEd #Surgery @RCPSGTrainees @aecirujanos @SEIQuirurgica @iss_sic #MedicalTechniques @BJSAcademy @young_bjs @BJSOpen @des_winter @evanscolorectal @robhinchliffe1 @bplwijn @MalinASund @nfmkok @TejedorPat @paulo_sutt @PVaughanShaw @JJEarnshaw @juliomayol @ksoreide #colorectalsurgery #StepUp4CRC @FightCRC @ACPGBI #ERAS @dice_europe #Crohn #proctology @Dukes_Club @ACPGBI_EduTrain @AECP_FAECP @PelvExGroup @escp_tweets @YouESCP #TeachMeColoproctology #Some4COLoprocto

Recurrence rate and mesh bulging are reduced with primary fascial closure in ventral hernia repair: the PROSECO randomized clinical trial ➡️doi.org/10.1093/bjs/zn… 🔍 RCT in midline hernia repair: Fascial closure vs bridging during laparoscopic IPOM 📊 No overall difference in hernia site complications, but fascial closure cut recurrence (4% vs 20%) & mesh bulging, and reduced pain at 12 months 👉 Supports fascial closure as standard with IPOM Work by Mikael Lindmark, Jael Tall, Bahman Darkahi, Johanna Österberg, Karin Strigård, Anders Thorell, Ulf Gunnarsson #SoMe4Surgery #MedTwitter #SurgEd #Surgery @RCPSGTrainees @aecirujanos @SEIQuirurgica @iss_sic #MedicalTechniques @BJSAcademy @young_bjs @BJSOpen @des_winter @evanscolorectal @robhinchliffe1 @bplwijn @MalinASund @nfmkok @TejedorPat @paulo_sutt @PVaughanShaw @JJEarnshaw @juliomayol @ksoreide #some4hpb #some4tpl @DPCG_official @pancreatitis_nl @PancreasClub #PancreasClub2023 #PancreaticCancer #Pancreatitis #HCC @PanCAN #PanCANawareness @EurPancClub @P_C_E_ @dice_europe #PancreaticCancer #cholangiocarcinoma #colorectalsurgery #StepUp4CRC @FightCRC @ACPGBI #ERAS @dice_europe #Crohn #proctology @Dukes_Club @ACPGBI_EduTrain @AECP_FAECP @PelvExGroup @escp_tweets @YouESCP #TeachMeColoproctology #Some4COLoprocto #some4UGI #uppergi #esophagealcancer #gastriccancer #reflux @ISDE_net @Augishealth @roux_group @T4UGIS @SARONG_Trial

BJS commission on the surgical management of the axilla in breast cancer ➡️doi.org/10.1093/bjs/zn… - The operating room has long been the main place where surgeons in training develop their skills. But in breast cancer surgery, the complexity of modern procedures means this may no longer be enough. - With techniques like ALND, axillary management, nipple-sparing mastectomy, and oncoplastic surgery, the need for highly specialized breast surgeons is greater than ever. - Future training must go beyond the OR: simulators, cadaver labs, hands-on courses, VR/AR, and even AI tools will play a key role in standardizing procedures. - This evolution is not a setback for surgical education — it’s an opportunity to reshape how we train the next generation of breast surgeons. Ultimately, better training means not only improved oncological outcomes but also a better quality of life for breast cancer patients. Work by Michael R Boland, Oreste D Gentilini, G Bruce Mann, Jana de Boniface, Elena Leinert, Christine Obondo, Thorsten Kühn, Anna Weiss, Judy C Boughey, Paul T R Thiruchelvam, Anna Duncan, Meera Joshi, Maria Mani, Isabel T Rubio, Pedro F Gouveia, Malin Sundon behalf of @BJSurgery Editors #SoMe4Surgery #MedTwitter #SurgEd #Surgery @RCPSGTrainees @aecirujanos @SEIQuirurgica @iss_sic #MedicalTechniques @BJSAcademy @young_bjs @BJSOpen @des_winter @evanscolorectal @robhinchliffe1 @bplwijn @MalinASund @nfmkok @TejedorPat @paulo_sutt @PVaughanShaw @JJEarnshaw @juliomayol @ksoreide #breastcancer @YoungIFSO #BreastCancerAwareness #BreastSurgery

Predictors of maintained remission at one year following appendicectomy in ulcerative colitis: post-hoc analysis of the ACCURE trial ➡️ doi.org/10.1093/bjs/zn… This analysis identifies younger age and former smoker status, both acknowledged as risk factors for relapse, as predictors of greater benefit from appendicectomy in UC patients in remission without advanced medical therapy These results provide a potential basis for refining patient selection criteria for appendicectomy in UC management, although further biological research is warranted to clarify underlying mechanisms Work by Eva Visser , Thomas D Pinkney , Lianne Heuthorst , Geert R D’Haens , Willem A Bemelman , Christianne J Buskens #SoMe4Surgery #MedTwitter #SurgEd #Surgery @RCPSGTrainees @aecirujanos @SEIQuirurgica @iss_sic #MedicalTechniques @BJSAcademy @young_bjs @BJSOpen @des_winter @evanscolorectal @robhinchliffe1 @bplwijn @MalinASund @nfmkok @TejedorPat @paulo_sutt @PVaughanShaw @JJEarnshaw @juliomayol @ksoreide #colorectalsurgery #StepUp4CRC @FightCRC @ACPGBI #ERAS @dice_europe #Crohn #proctology @Dukes_Club @ACPGBI_EduTrain @AECP_FAECP @PelvExGroup @escp_tweets @YouESCP #TeachMeColoproctology #Some4COLoprocto

🔵 Surgery for chronic pancreatitis across Europe 🇪🇺 22 centres in 13 countries 🪡 200 surgeries 💊 50% did opiod before 🤒 14% major morbidity / 1.4% mortality 👍 Pain relieved 72% 😎 Reported good pain relief and improvements in quality-of-life #google_vignette" target="_blank" rel="nofollow noopener">academic.oup.com/bjs/article/11…

Birth rates after laparoscopic and open ileal pouch–anal anastomosis for ulcerative colitis: a nationwide population-based cohort study ➡️ doi.org/10.1093/bjs/zn… - Women with ulcerative colitis (UC) undergoing open IPAA face significantly reduced fertility - Laparoscopic IPAA may be less detrimental, possibly due to fewer pelvic adhesions, but current evidence is limited and biased - This Danish nationwide cohort (2000–2022) investigates fertility outcomes in women of childbearing age after laparoscopic vs open IPAA Work by Anders Mark-Christensen , Anthony Charles Ebert , Kirstine Kirkegaard , Søren Laurberg , Gry Poulsen , Tine Jess , Mette Julsgaard #SoMe4Surgery #MedTwitter #SurgEd #Surgery @RCPSGTrainees @aecirujanos @SEIQuirurgica @iss_sic #MedicalTechniques @BJSAcademy @young_bjs @BJSOpen @des_winter @evanscolorectal @robhinchliffe1 @bplwijn @MalinASund @nfmkok @TejedorPat @paulo_sutt @PVaughanShaw @JJEarnshaw @juliomayol @ksoreide #colorectalsurgery #StepUp4CRC @FightCRC @ACPGBI #ERAS @dice_europe #Crohn #proctology @Dukes_Club @ACPGBI_EduTrain @AECP_FAECP @PelvExGroup @escp_tweets @YouESCP #TeachMeColoproctology #Some4COLoprocto

International BEST-CLI Collaborative: next steps to create a coordinated global initiative to improve awareness and access while reducing mortality and amputation for patients with chronic limb-threatening ischaemia ➡️ doi.org/10.1093/bjs/zn… The International BEST-CLI Collaborative is taking a long view of PAD and CLTI The goal is not just to ‘bend the curve’ of morbidity and mortality but to aim towards a ‘cure’ for CLTI This is an ambitious and multidecade goal but is essential to improve health and decrease amputations for these patients As a next step, the Collaborative aims to gather resources and create a durable vehicle to develop new and amplify existing science on CLTI and PAD, and to advance the awareness, access to treatment, detection, diagnosis, and prevention of CLTI There is a growing awareness of the unmet need for improvement in treatments of PAD patients that makes this an ideal moment for a thoughtful global approach to mitigating this disease process Work by Michael B Strong , Alik Farber , David G Armstrong , Nobuyoshi Azuma , Joshua A Beckman , Marc P Bonaca , Andrew Bradbury , Michael S Conte , Foluso Fakorede , Philip P Goodney , Prem C Gupta , Christian S Hansen , Robert J Hinchliffe , Kim C Houlind , Jakob Kjellberg , Philippe Kolh , Steven W C Kum , Joakim Nordanstig , Sahil Parikh , Manesh R Patel , Lorenzo Patrone , Richard J Powell , Kenneth Rosenfield , Birgitta Sigvant , Peter A Schneider , Ramon L Varcoe , Melina Vega de Ceniga , Maarit A Venermo , Matthew T Menard #SoMe4Surgery #MedTwitter #SurgEd #Surgery @RCPSGTrainees @aecirujanos @SEIQuirurgica @iss_sic #MedicalTechniques @BJSAcademy @young_bjs @BJSOpen @des_winter @evanscolorectal @robhinchliffe1 @bplwijn @MalinASund @nfmkok @TejedorPat @paulo_sutt @PVaughanShaw @JJEarnshaw @juliomayol @ksoreide #vascularsurgery #vascular #Ischemia @vascularsurger @VascularSVS @FutureVascSurgn @SVM_tweets

Validation of the Swiss-Finnish Bariatric Metabolic Outcome Scorewithin a large prospective registry cohort ➡️ doi.org/10.1093/bjs/zn… 🌟 The SF-BARI Score helps measure success after bariatric surgery — and it just got validated in a huge real-world study. 📈 Most patients land in the “good” category, showing surgery works well across different groups. 🔬 Results were consistent even with very different patient profiles, proving the score works for everyone. - Gastric bypass patients scored higher than sleeve gastrectomy at 5 years, confirming the score’s value for tracking outcomes. Work by Floris F E Bruinsma , Saija Hurme , Ralph Peterli , Erik Stenberg , Simon W Nienhuijs , Sofia Grönroos , Villy Våge , Marco Bueter , Johan Ottosson , Ronald S L Liem , @PaulinaSalminen #SoMe4Surgery #MedTwitter #SurgEd #Surgery @RCPSGTrainees @aecirujanos @SEIQuirurgica @iss_sic #MedicalTechniques @BJSAcademy @young_bjs @BJSOpen @des_winter @evanscolorectal @robhinchliffe1 @bplwijn @MalinASund @nfmkok @TejedorPat @paulo_sutt @PVaughanShaw @JJEarnshaw @juliomayol @ksoreide #some4UGI #uppergi #esophagealcancer #gastriccancer #reflux @ISDE_net @Augishealth @roux_group @T4UGIS @SARONG_Trial

Ultra-low dose superparamagnetic iron oxide nanoparticle injection for sentinel lymph node detection in breast cancer: prospective cohort study ➡️doi.org/10.1093/bjs/zn… 🔬 A new magnetic liquid with tiny iron particles helps identify the first lymph node draining a breast cancer. It’s injected into the breast, and the node can be found with a magnetometer, usually in the armpit. 🧪 In this study, an ultra-low dose of this liquid was tested against today’s standard radioactive liquid. Patients received both before surgery. ✅ The very low dose of magnetic liquid worked just as well as the standard. Advantages? No radioactivity, and it can be injected weeks before surgery. Work by Lovisa Sundh , Marya Alzoubi , Nizar Abu-Oddos , Sarah Båtelsson , Per Nyman , Andreas Karakatsanis , Staffan Eriksson , Mookaiah Ravichandran , Kian Chin , Roger Olofsson Bagge , Nushin Mirzaei , Fredrik Wärnberg #SoMe4Surgery #MedTwitter #SurgEd #Surgery @RCPSGTrainees @aecirujanos @SEIQuirurgica @iss_sic #MedicalTechniques @BJSAcademy @young_bjs @BJSOpen @des_winter @evanscolorectal @robhinchliffe1 @bplwijn @MalinASund @nfmkok @TejedorPat @paulo_sutt @PVaughanShaw @JJEarnshaw @juliomayol @ksoreide #BreastCancerAwareness #BreastSurgery

Read our @young_bjs article! Perineal reconstruction for advanced pelvic malignancies ➡️ doi.org/10.1093/bjs/zn… Key points: 1⃣Perineal reconstruction aims to mitigate the complications of radical pelvic cancer resection by filling pelvic dead space, restoring perineal skin continuity, and reconstructing the pelvic floor and vagina 2⃣The reconstructive strategy can be influenced by factors relating to the patient, the defect, previous treatment, and surgeon experience 3⃣There is no consensus on optimal reconstructive technique, which can be broadly categorized into direct closure, mesh repair, and tissue flaps 4⃣Flaps have different advantages and complication profiles. It remains crucial to tailor reconstruction according to the specific needs and wishes of each patient Work by Zoe Li , Alethea Tang , Peter Drew #SoMe4Surgery #MedTwitter #SurgEd #Surgery @RCPSGTrainees @aecirujanos @SEIQuirurgica @iss_sic #MedicalTechniques @BJSAcademy @BjsOpen @des_winter @evanscolorectal @robhinchliffe1 @bplwijn @MalinASund @nfmkok @TejedorPat @paulo_sutt @PVaughanShaw @JJEarnshaw @juliomayol @ksoreide #colorectalsurgery #StepUp4CRC @FightCRC @ACPGBI #ERAS @dice_europe #Crohn #proctology @Dukes_Club @ACPGBI_EduTrain @AECP_FAECP @PelvExGroup @escp_tweets @YouESCP #TeachMeColoproctology #Some4COLoprocto

Early-onset gastrointestinal cancers: comprehensive review and future directions ➡️doi.org/10.1093/bjs/zn… ⏰Early-onset GI cancers represent clinically distinct disease entities that are associated with unique challenges in screening, management, and survivorship 🚨A better understanding of underlying aetiologies, optimized screening strategies, and improved survivorship support are necessary 🧑‍🤝‍🧑Meeting the needs of this growing patient population will require a multidisciplinary, equity- based approach in both clinical care and research Work by @SaraKCharMD, @CatherineaOC and @KimmieNgMD #SoMe4Surgery #MedTwitter #SurgEd #Surgery @RCPSGTrainees @aecirujanos @SEIQuirurgica @iss_sic #MedicalTechniques @des_winter @evanscolorectal @robhinchliffe1 @bplwijn @MalinASund @nfmkok @TejedorPat @paulo_sutt @PVaughanShaw @JJEarnshaw @juliomayol @ksoreide @BJSAcademy @young_bjs @BJSOpen #colorectalsurgery #StepUp4CRC @FightCRC @ACPGBI #ERAS @dice_europe #Crohn #proctology @Dukes_Club @ACPGBI_EduTrain @AECP_FAECP @PelvExGroup @escp_tweets @YouESCP #TeachMeColoproctology #Some4COLoprocto @PSOGI_EC #GICancer #EarlyOnset #OncologyCare @CatherineaOC

Surgeon factors and their association with operating room turnover time ➡️ doi.org/10.1093/bjs/zn… - Surgeons in leadership roles and with ≥10 years of experience have significantly shorter OR turnover times, enhancing efficiency - Leadership and experience likely streamline turnover through better logistics, team coordination, and policy implementation - Even small reductions in turnover time (6–8 minutes) can lead to substantial cumulative time savings across cases Work by Kshitij Pandit, Luke Wang, Joel Rosenberg, Nicole Goldhaber, Jill C Buckley, Sonia Ramamoorthy, Kristin L Mekeel, Aditya Bagrodia #SoMe4Surgery #MedTwitter #SurgEd #Surgery @RCPSGTrainees @aecirujanos @SEIQuirurgica @iss_sic #MedicalTechniques @BJSAcademy @young_bjs @BJSOpen @des_winter @evanscolorectal @robhinchliffe1 @bplwijn @MalinASund @nfmkok @TejedorPat @paulo_sutt @PVaughanShaw @JJEarnshaw @juliomayol @ksoreide #colorectalsurgery #StepUp4CRC @FightCRC @ACPGBI #ERAS @dice_europe #Crohn #proctology @Dukes_Club @ACPGBI_EduTrain @AECP_FAECP @PelvExGroup @escp_tweets @YouESCP #TeachMeColoproctology #Some4COLoprocto #some4UGI #uppergi #esophagealcancer #gastriccancer #reflux @ISDE_net @Augishealth @roux_group @T4UGIS @SARONG_Trial #some4hpb #some4tpl @DPCG_official @pancreatitis_nl @PancreasClub #PancreasClub2023 #PancreaticCancer #Pancreatitis #HCC @PanCAN #PanCANawareness @EurPancClub @P_C_E_ @dice_europe #PancreaticCancer #cholangiocarcinoma

Development and validation of a novel tool for identification and categorization of non-technical errors associated with surgical mortality ➡️doi.org/10.1093/bjs/zn… Many errors in surgery occur because of poor non-technical skills The aim of this study was to create a tool to identify this type of error using patient data so future errors may be prevented 🔧The tool was designed through expert opinion and literature review. It was tested using surgical patient death data from Australia and New Zealand The final tool was able to identify and group non- technical errors reliably. This tool makes it possible to identify non-technical errors so future errors may be reduced Work by Jesse D Ey, Victoria Kollias, Matheesha B Herath, Octavia Lee, Martin H Bruening, Adam J Wells, Guy J Maddern #SoMe4Surgery #MedTwitter #SurgEd #Surgery @RCPSGTrainees @aecirujanos @SEIQuirurgica @iss_sic #MedicalTechniques @BJSAcademy @young_bjs @BJSOpen @des_winter @evanscolorectal @robhinchliffe1 @bplwijn @MalinASund @nfmkok @TejedorPat @paulo_sutt @PVaughanShaw @JJEarnshaw @juliomayol @ksoreide #some4hpb #some4tpl @DPCG_official @pancreatitis_nl @PancreasClub #PancreasClub2023 #PancreaticCancer #Pancreatitis #HCC @PanCAN #PanCANawareness @EurPancClub @P_C_E_ @dice_europe #PancreaticCancer #cholangiocarcinoma #colorectalsurgery #StepUp4CRC @FightCRC @ACPGBI #ERAS @dice_europe #Crohn #proctology @Dukes_Club @ACPGBI_EduTrain @AECP_FAECP @PelvExGroup @escp_tweets @YouESCP #TeachMeColoproctology #Some4COLoprocto #some4UGI #uppergi #esophagealcancer #gastriccancer #reflux @ISDE_net @Augishealth @roux_group @T4UGIS @SARONG_Trial

🏥Toxic megacolon ➡️buff.ly/4fgEUrv A part of the acute threat to life @young_bjs article series recently published in @BJSurgery: "Toxic megacolon is a potentially lethal condition characterized by total or segmental non-obstructive colonic dilatation." 💬 Resuscitate and medical management, with prompt surgery for high risk or complicated disease. - @jjearnshaw #LeadingSurgicalEducation #trauma #youngbjs #colon

Pathological response to neoadjuvant chemoradiotherapy for #oesophageal squamous cell carcinoma in Eastern versus Western countries: #metaanalysis ➡️ doi.org/10.1093/bjs/zn… This study suggests that the pathological response to nCRT is less favourable in patients treated in Eastern countries compared with Western countries Despite attempts to investigate possible accounting factors in subgroup and meta-regression analyses, the discrepancy in pCR rate cannot be entirely explained by differences in patient, tumour, or treatment characteristics Work by Xing Gao, Hidde C G Overtoom, Ben M Eyck, Shi-Han Huang, Daan Nieboer, Pieter C van der Sluis, Sjoerd M Lagarde, Bas P L Wijnhoven, Yin-Kai Chao, Jan J B van Lanschot #SoMe4Surgery #MedTwitter #SurgEd #Surgery @RCPSGTrainees @aecirujanos @SEIQuirurgica @iss_sic #MedicalTechniques @BJSAcademy @young_bjs @BJSOpen @des_winter @evanscolorectal @robhinchliffe1 @bplwijn @MalinASund @nfmkok @TejedorPat @paulo_sutt @PVaughanShaw @JJEarnshaw @juliomayol @ksoreide #some4UGI #uppergi #esophagealcancer #gastriccancer #reflux @ISDE_net @Augishealth @roux_group @T4UGIS @SARONG_Trial

Chemotherapy switch for localized #PancreaticCancer: a systematic review and meta-analysis ➡️ doi.org/10.1093/bjs/zn… This #systematicreview and #metaanalysis of five studies identified that one in five patients with localized pancreatic ductal adenocarcinoma underwent chemotherapy switch after an inadequate response or toxicity to first-line chemotherapy The pooled resection rate after chemotherapy switch was 42% Postoperative survival of patients who underwent chemotherapy switch was similar to that of patients treated without a switch in systemic therapy The findings suggest that chemotherapy switch may improve biochemical and radiological response, increase the chance of surgical resection, and improve survival Work by Esther N Dekker, Raja R Narayan, Mohamed A Ahmami, Anis Meddouch, Eva M M Verkolf, Anne M Gehrels, Marc G H Besselink, Casper H J van Eijck, Marjolein Y V Homs, Bianca Mostert, Grainne M O’Kane, Roeland F de Wilde, Johanna W Wilmink, Eileen M O’Reilly, Motaz Qadan, Bas Groot Koerkamp #SoMe4Surgery #MedTwitter #SurgEd #Surgery @RCPSGTrainees @aecirujanos @SEIQuirurgica @iss_sic #MedicalTechniques @BJSAcademy @young_bjs @BJSOpen @des_winter @evanscolorectal @robhinchliffe1 @bplwijn @MalinASund @nfmkok @TejedorPat @paulo_sutt @PVaughanShaw @JJEarnshaw @juliomayol @ksoreide #some4hpb #some4tpl @DPCG_official @pancreatitis_nl @PancreasClub #PancreasClub2023 #PancreaticCancer #Pancreatitis #HCC @PanCAN #PanCANawareness @EurPancClub @P_C_E_ @dice_europe #PancreaticCancer #cholangiocarcinoma

#ArtificialIntelligence -based anatomy recognition in laparoscopic hepatectomy: multicentre study ➡️doi.org/10.1093/bjs/zn… Because of the complex anatomical structure of the liver, accurate identification of key landmarks is crucial for safe implementation of LH Next-generation computer vision approaches based on AI technology can perform pixel-level semantic segmentation of medical images, achieving a human-like image recognition ability, and have the potential to provide real-time guidance during complex operations However, few studies have constructed AI models that can recognize anatomical structures and landmarks during LH The aim of this study was to train AI models for the real-time automatic recognition of critical anatomical landmarks during LH and to assess their performance Work by Haisu Tao, Baihong Li, Xiaojun Zeng, Xuanshuang Tang, Erlei Zhang, Jiang Li, Wei Cai, Yinling Qian, Jian Yang #SoMe4Surgery #MedTwitter #SurgEd #Surgery @RCPSGTrainees @aecirujanos @SEIQuirurgica @iss_sic #MedicalTechniques @BJSAcademy @young_bjs @BJSOpen @des_winter @evanscolorectal @robhinchliffe1 @bplwijn @MalinASund @nfmkok @TejedorPat @paulo_sutt @PVaughanShaw @JJEarnshaw @juliomayol @ksoreide

Watch #reeltime 📽️ Laparoscopic Pancreatoduodenectomy: The Intermediate Approach ➡️doi.org/10.1093/bjs/zn… The authors introduce the intermediate approach to LPD, optimizing the conventional superior mesenteric artery (SMA) method This technique focuses on the critical area between the superior mesenteric vein (SMV) and portal vein, and the SMA and coeliac trunk By strategically mobilizing this space, the pancreatic uncinate process is excised before venous system management, streamlining subsequent steps. Work by Kui Long, Dingwei Xu, Jie Huang #SoMe4Surgery #MedTwitter #SurgEd #Surgery @RCPSGTrainees @aecirujanos @SEIQuirurgica @iss_sic #MedicalTechniques @BJSAcademy @young_bjs @BJSOpen @des_winter @evanscolorectal @robhinchliffe1 @bplwijn @MalinASund @nfmkok @TejedorPat @paulo_sutt @PVaughanShaw @JJEarnshaw @juliomayol @ksoreide #some4hpb #some4tpl @DPCG_official @pancreatitis_nl @PancreasClub #PancreasClub2023 #PancreaticCancer #Pancreatitis #HCC @PanCAN #PanCANawareness @EurPancClub @P_C_E_ @dice_europe #PancreaticCancer #cholangiocarcinoma

Agree. When things get rocky it gets very quiet. Pin drop quiet. When emergency and out of control it can get noisy but the sound level falls with the heart rate and inotrope requirements. Well functioning teams have a level of background noise far below ambient urban or jungle