@SyedAAhmad5
And I still see people posting on SoMe that “elective” means cosmetic surgery, etc.
To be clear - this means patients with early cancers and other potentially life threatening surgical diseases are being delayed!!!
Residents:
I cannot stress this enough…
Your job is not to protect the attending
Your job is to protect the patient
Yes you should call the attending, yes you should wake them up.
(By the way - if you protect the patient ➡️ you are protecting the attending)
#MedTwitter
#MedEd
Just a reminder to my surgeon colleagues…data show patients prefer surgeons in scrubs as compared to other attire in both ambulatory & inpatient settings
So save your money on those fancy suits! 😁
#MedTwitter
#SoMe4Surgery
@SAGES_Updates
#surgery
A rarely discussed skill required to be a surgeon is the ability to ignore an itch on your face for an extended period of time…
#SoMe4Surgery
#medtwitter
A lung mass is >3cm
A lung mass is >3cm
A lung mass is >3cm
A lung mass is >3cm
A lung mass is >3cm
A lung mass is >3cm
<3cm = nodule
You now know one of my pet peeves (there may be many)
#tssmn
#MedTwitter
Craziest thing I’ve seen in chest
Patient transferred to us after chest tube placed at outside ED for spon pneumothorax 1 week prior
VATS for persistent air leak & found finger tip of glove embedded in lung
No prior chest procedures
ED procedure note - no issues noted
🤯
It’s a fine line between being a confident surgeon and being an arrogant surgeon.
You can be confident and still take advice
You can be confident and recognize your own fallibility
You can be confident and learn something new every single day.
#MedTwitter
#SoMe4Surgery
#tssmn
Major pet peeves is when a surgeon *blames* a resident/fellow for an OR complication. It may not be overt, but even mentioning "the fellow was doing it" during M&M is not relevant or appropriate. That's your case, the fellow is an extension of you.
#tssmn
#MedTwitter
#surgery
Surgery is tough
Surgery can be stressful
Surgery is a sacrifice
But I get to tell patients and their families “we got it all and your loved one is doing great”
Makes it all worth it and nothing will ever change my mind!
#tssmn
#surgery
#SoMe4Surgery
#MedTwitter
For many surgeons, the most malignant part of our lifelong training is not residency, but our own self-criticism, doubt, and unforgiving self-expectations.
If your patient asks whether they should consider a second opinion the answer should always be yes.
And you should help them get it.
#medtwitter
#SoMe4Surgery
Nice to see these guidelines.
Interesting that partial fundo is recommended over floppy Nissen.🤔
Likely because few *actually* do a true floppy Nissen.
Here’s the original concept…a bougie between the goose and the wrap. Raise your hand if you do that…exactly what I thought!
Highlighting features on DV5 that have impressed me so far during my early experience on the system:
1. 4K vision is awesome
2. Head-in menu control w/o taking head out of console
3. Force feedback - "haptics"!
4. Digital swap makes instrument swap seamless.
Highlighting features on DV5 that have impressed me so far during my early experience on the system:
1. 4K vision is awesome
2. Head-in menu control w/o taking head out of console
3. Force feedback - "haptics"!
4. Digital swap makes instrument swap seamless.
Men - read this.
Take aways:
1. Gender inequality hurts both women AND men
2. Breaking the cycle is our responsibility
3. Don't be a bystander - this requires active allyship, conscious effort.
#heforshe
#EqualityForAll
This direct condemnation of the Presidential Address
@STS_CTsurgery
#STS2023
is one small step. It is a sad and sobering reminder of how far we have yet to go.
Fluorescent imaging can be valuable during surgery to assess perfusion.
In this case of robotic esophagectomy, in a pt w/multiple redo hiatal hernia and fundoplication operations, indocyanine green w/infrared imaging helps confirm gastric conduit perfusion (time mark 3:42).
Where is the Twitter dislike button when I need it?!?
To be clear - surgeons are doctors first, who also know how to operate.
That surgeon was wrong , but please do not generalize this incorrect, polarizing statement (“surgeons only know to operate..”).
Today a stage 4 patients relatives asked me - “when there is a treatment option ,why did the surgeon say that there is none ?”
I said - Surgeons only know to operate.Since it is beyond their expertise,hence he said - nothing can be done .
No surgeon should use the term “surgery” as synonymous with “operation”.
You perform an operation; surgery is a medical specialty that includes performing operations, but encompasses much more.
“I performed a surgery today” denigrates the specialty.
#MedTwitter
#SoMe4Surgery
People often say “surgery...wow...that must be stressful”
With all the craziness in the world, the OR is my happy place. That’s where I’m zen. Protected from the outside, free.
Good luck to
#SurgeryMatch2021
.
You have chosen wisely.
#surgery
#surgeonlife
#happyplace
#MedTwitter
@drkeithsiau
@Karimep94
Nah.
@drkeithsiau
is tricking you all.
You don’t aspirate a chylothorax from the lung. Chylothorax occurs in the pleural space.
If this was aspirated from the lung it could be an abscess or maybe the patient aspirated eggnog 😉
Today I finished OR early…instead of burying myself in manuscript reviews and chart completions, I left to pick up my daughter from school and brought her to an arcade she loves
I still have not completed my mandatory annual education and wellness modules…sorry, not sorry!!
Check out this
@ctsnetorg
video “how I do it” on robotic paraesophageal hernia repair.
Identifying the proper plane between the sac and peritoneum on the hiatus are critical.
Video also shows our Dor and Nissen technique
Dear Surgery Residents,
When you ask for instrument A, and the experienced scrub tech/nurse looks you in the eyes and hands you instrument B...take instrument B.
Thank me later.
#MedTwitter
#Surgery
#SoMe4Surgery
Special delivery today
@LaheyHospital
@bethisraellahey
!
Excited & honored to be one of first sites in the world with the new
@IntuitiveSurg
robot - DV5
A testament to Lahey’s commitment to patient care, innovation, & surgical excellence!
Looking forward to 1st case tomorrow!
Postoperative incentive spirometry is a scam
(Hospitals should take all the money they spend on those little spirometers and spend it on early ambulation resources instead!)
My biggest advice to thoracic surg residents & fellows is to learn thoracic anatomy.
I mean really learn it. Know it backwards, forwards, upside down.
I mean - walk in the room & know what they’re dissecting in a millisecond glance type know it.
@ThoracicStudent
@TSRA_official
My biggest advice to anesthesia residents and CCM fellows is to learn physiology. Once you learn how to apply/optimize physiology, you can take care of any patient
Stay tuned for the 2022
@STS_CTsurgery
General Thoracic Surgery Database (GTSD) update in press
@annalsthorsurg
We see the continued trend towards minimally invasive surgery and, importantly, low mortality and overall morbidity in the world’s largest thoracic surgery database.
1of4/
Lots of talk about ergonomics, which are definitely improved, but frankly very low on my list of benefits having had the privilege of doing a case on DV5 yesterday (the first thoracic case post-FDA approval!)
Too much to list here, but the safety features are remarkable.
One issue I see in academic medicine is that the endpoint for investigators is often the publication of a manuscript rather than the actual clinical implementation/translation of the findings.
#medtwitter
#SoMe4Surgery
My older brother and I. From building LEGO planes, forts and cars to becoming surgeons. He’s a robotic thoracic surgeon at Loyola now and I’m about to finish surgical training and move to sub-specialise in breast surgical oncology
#ILookLikeASurgeon
#MedTwitter
Interesting paper
@NEJM
very thought-provoking. Many questions come to mind. Also, you can clearly tell that a surgeon did not read this before submission or during peer-review.
#thoracic
#surgery
#thymectomy
#thymoma
Lung cancer kills more women than breast, ovarian, and cervical cancer - combined!
Anyone with lungs can get lung cancer
The time for lung cancer research and advocacy is now!
@WomenInThoracic
@LungRescue
@AmLungCSI
November is Lung Cancer Awareness Month. Women are affected with lung cancer as much as men but often don’t have the same support to seek care. WTS cares about you and your loved ones!
#WTSwearswhiteforLC
We currently screen <10% of eligible people for Lung Cancer (generous estimate).
With cancer detection rate ~2.3% (
@LaheyHospital
published data) & est 15mil eligible people in the USA…
There’s opportunity to diagnose additional 310,000 lung cancers w/lung cancer screening!
@rbarbosa91
Tissue handling is critical & a refined skill, but can be taught to non-surgeons
The differentiator is intraoperative decision-making, complication management, & pivoting with aberrant anatomy/findings.
This is what “doctoring in the OR” means and separates pure technicians.
Dear anesthesia resident, Thank you for all you do. You are wonderful
Now…when I tell you, I see the diaphragm contracting, I do not care if “there are no twitches”
😂🤦🏼♂️
@rbarbosa91
One of the senior surgeons where I trained would take the needle driver from your hand if he saw you palming it, hold it up, and ask if you thought the holes or for hanging the instrument on the wall 😂
Why robotics for lung CA? 1. See better (no more asking "Fred" q2sec!), 2. wristed instrumentation = precise dissection, 3 autonomous operation & 4. future of computer interface!
Here's an example in a left level 7 dissection.
#tssmn
#lcsm
@MISIRG1
@STS_CTsurgery
@TSRA_official
You’re not officially a thoracic surgeon until you are consulted to manage a chest tube that you had recommended not placing in the first place.
#thoracic
#tssmn
You're not officially a radiation oncologist until you are consulted to manage radiation side effects for a patient who never received radiation.
#radonc
When your hospital President & CEO (and colleague and friend) shows up for your
@AATSHQ
induction ceremony
This is what sponsorship looks like!
Thank you
@smoffattbruce1
🙏🏻
Robotic esophagectomy is a complex operation with a steep learning curve.
Engaging in a well-planned training pathway is critical. This involves video review, case obs, and proctoring.
Was a pleasure and honor to host
@abribriesco43
for RAMIE obs.
"Women screened for breast cancer are dying from lung cancer."
Important article from Vanderbilt regarding the huge missed LCS opportunity in the mammography population.
So I paid for Twitter blue. I now have the blue checkmark.
It’s truly life-changing
I feel smarter, stronger, my blood pressure this morning has improved, I can run faster, go longer on Peloton, my kids manners have improved, I’ve stopped losing my hair
Thank you
@elonmusk
This next generation robotic system is the real deal!
Super excited about “force feedback” allowing surgeons to sense forces during robotic operations and the digital surgery suite.
Ergonomics feel noticeably better operating on the system as well.
Today, we’re proud to announce the U.S. Food and Drug Administration (FDA) provided 510(k) clearance for da Vinci 5, our next-generation multiport robotic system.
Talking to a couple students about
#surgerymatch2024
10 years as an attending, ~10 years training prior to that…
And I still think the ability and privilege to operate on someone is the coolest thing in the world.
The OR remains one of my happy places.
Congrats to Lahey Hepatobiliary & Transplant team for 100th robotic liver resection!
This team embodies excellence performing 60% liver rsxn robotically including living DONOR hepatectomy.
Congrats!
#MedTwitter
#DonateLife
@SAGES_Updates
#SoMe4Surgery
@DrClaudiusMahr
This💯
It also disincentives non-RVU producing activities, potentially creates competition rather than collaboration within divisions/departments, and rewards quantity over quality!
Points for those considering surgical residency:
1. Research is not mandatory, expected in some programs, but not in many
2. Research during residency has started many a surgeon-scientist career
3. My research years were some of the most formative in my entire training and
I am strongly opposed to mandatory research in residency training-it contributes zero to a surgeon’s clinical acumen or maturity. I am also blessed to work in an open minded academic environment where my “heretic” opinion on this subject is respected and not used against me.
A new Focus details how a drone successfully brought a donated lung to a 63-year-old patient for ensuing organ transplant surgery.
@AndrewTSage
@SKeshavjee
@UHN
Extremely proud to celebrate with the
@LaheyHospital
lung cancer screening program another milestone this week:
300 lung cancers diagnosed (of 22,250 scans performed)!!
With >80% of these cancers early stage that’s many lives saved!
#LungCancerScreening
#tssmn
@lung_ca_screen
When I was looking for my first job out of training, someone told me not to worry about salary, that salary will come with time…
How’s 4 yrs of college, 4 yrs med school, 5 yrs residency, 2 yrs research, 2 yrs fellowship… like that kind of time?
This is an underappreciated, critical operative pearl!
Relevant to any approach - open, MIS, robotic
Surgeon’s tunnel vision to tip of the instrument can fail to appreciate trauma from proximal part of instrument.
In robotics, the gears out of view for example
Always maintain
The most common question I get regarding our RAMIE approach is how we do the anastomosis
This video shows our preferred approach, which has been refined over >100 RAMIEs (and still learning!)
Confession as a cardiology fellow 8 weeks from graduating: I low key miss pontificating on rounds about the differential of eosinophilia and hyponatremia. Once an internist, always an internist haha