Chapters Transcript Video NOTES: Cholecystectomy or Subserosal peritoneal SET resection Pinghong Zhou, MD, PhD performs a live cholecystectomy over Zoom. So it's a great honor to have you here. So we can, we will alternate between your college is said to me and to additionally sc by Professor jehadi. Okay, maybe we can start with you showing us the gold bladder and what you plan to do? Very mature. Uh It was a dog. Remember Uh huh. The first reported a page in history. This is the uh male patient presented two episodes of the acute typically package and we have already entered to the prosecutorial cavity. This is the bladder here. This is the entrance of the star mark with the and Syria. Uh wait, where do you go through the stomach to have the best position? We normally to the anterior world of the gastric enter the patient. Noise owner supplying position was the tube with intubation. So you got one until you're an through. Yes. This is as the entrance is here you the excess. Our notes basically. Where that where we put plans, right? That's where we put maybe a little more approximate position. So the scope I used today is a PCF clone scott from Olympus. Here is the liver. The right liver is a core bladder for this patient is just the property of the war is very, very second. Yeah. Here you here you see a girl blood at your angle. No. Well, yes, technique I want from bisected probably the first from the probably the bad from the funding towards the triangle. Right? Yeah, we uh, we resected the gold bladder from the founders side to the next side. So we are taking down we are taking off the gold bladder from the gall bladder. If OSHA you already dissected the sandwich from the liver? We are still in the process. Okay go blood. If OSHA uh Professor joe is using the urban knife to injector, they're sailing to their gold bladder. Um the connective tissue between gold bladder and the labor. So we know this this space is route so we can resect the gall bladder from this space. But is the endoscope read reflect? Yes. Okay. And there's no no traction on the gold bladder. Right? There's no no not at all. So I I used a special cup from the pushy germ to uh to explode as a uh the field section, feared a cup the car. Yeah. So we don't use any assistance from the lateral scope. We only use one scope which is the one we are using. Now I perform such procedures. Our endoscope room. Uh huh. But what happens if you have to convert too often for a blade? Um What what happens if you need to convert because of bleeding lydia Sir, you will use the cargo grass but to stop it in the conduct of the room. Never think of the reverse reversing to the operation. But if you never if you need to do a conversion you never do a conversion. Do you know how to cases of reversing to talk. Is this not not because of the bleeding. Only because of the severe at the Hanjin severe inflammation in the career ladder. So we cannot dissect the on a carpet. And how many cases have you done in the endoscopy room? Uh Huh. We almost did it. 50 cases this year. Yeah. Today I will have three cases and the closest economic three. Three. Yes. Three. This is sir. I worked from the four oclock morning in shanghai in the morning. Oh my God, you're you're you already did this one for warm up. Right. So you show us the second was a young warmed up. Yes. Yes. Yes. Yes. Yes, yes. So we go to that hardly now. He's waiting. Uh huh. Doctor for like 10 minutes. Okay, come back. I guess it will be really interesting when you get to the to the hypothesis triangle. So then we want to see how you how you sure? Looking forward to see you again? Thank you a letter. Yeah. Okay. Okay, Professor Shaul. Uh in fact, we're happy to be back. Can you explain what has happened? We are still in the process of separating the gold bladder from the cold blooded forsa. And due to the patient inflammation, therefore, vessels in the gold blood forces. So we are cape like uh separated the vessel and calculating. And there are a lot of bleeding. So because this car bladder is very fat. Many, many vessels within the go to church to tissue. So I use the cocoa user called europe chances to use the core grasshopper to manage such. Yeah bigger vessels. No, I know I change to use that's enough to bisect in just your bladder. I don't want to ask a stupid question. But uh do you have to be careful not to injure the bio doctor? Do identify the bile duct first when you're doing extensive Kateri. Not as a stupid question, I think is a very collateral questions. Father Collins is technology. We must always be careful for the uh for your doctor. So one complication for such procedures is uh injury to the bio doctor to the C. B. D. I think away even for the laparoscopy procedures. Yes. So one must be we must be very very careful to my thanks to the by a doctor from the from the CBD. From the uh from the artery. Okay, go back here is a big vessel. And the coagulation is with foreign population. Yeah. That further. Chocolate carried. Yeah. And again it's uh 0.3.5. used the viral three sound shriek. Well, what uh excuse me? With the question. Again, what strength of force coagulation? Oh yeah yeah. For me the poem and SD procedures are always used. Force the calculation and Tom in interview was three 3324, wow. For some some sometimes for the actual abilities I changed to use is about soft soft calculation. Yes. So I used this SD SDI in a hot so a as a traction. So I use it tip of the capital excludes you dissected the field. Yes. So this is much of smoke in a phenomenal capital. Just because of the phet in a global leader. So there were after the dissecting such tissues. Earl was much uh smoke within the abdominal cavity. So no, I want to clean the lens. So, okay, do you control the CO. Two in the peritoneal cavity with a catheter through the abdominal wall with constant pressure. So, so, so yeah. Yeah, experts for during such procedures are always put a needle in the economic uh phenomenal war. The chinese, the air chinese smoke. You can get attention. Okay. So I will assure you Janish in economical war. Um, we are showing the journey the journey of the air from the cavity. Can you say? No. Yes, we can. Yeah. The powers. Yeah. Because we don't measure the pleasure. But we we join the carbon oxygen to from the cavity. Yeah. Okay. Uh huh. So you see here, uh Yeah. Another bleeding. Okay. So our first uses could operate the linear point. Yes. Yeah. With the water flush. Oh, we'll find we check the exact linear points. Okay. Open please. Okay. So well tied real flash. Not cut. Yeah. Back. Okay. Yeah, I see it as the artery. So somehow used. So. Okay. Nothing. Okay. About. Okay. Here is another picture vessel. Okay. Blues. First call village. Yeah, I got it. Uh huh. Okay. Close. Yes. Okay. Yes. Okay. Yeah. Okay. Hyper knife. So uh call girl Roosevelt for like the more. I think this is a difficult case. Where are you now? Are you near the which part of the letter? Here? You nearly according to assist. Here we are near the system. Uh So you're aware uh this take that. Okay. Uh The cold blooded founders and the body is almost free. And we are towards to the neck now. Okay, Natalie. Oh, I see. Right. No, just the field. A little bit of clean. Yeah. For the come on, proud to Dushanbe. Is it easy to distinguish statistic artery from the cystic duct? Are they close to each other? Uh Excuse me. Can you say it again? The cystic artery and assisting dr they run the yellow. Yes. for 6 3 were always use the coca growth about to manage that directly. But for the. Did you get that? We must be used. And the look so like it like it is. Okay here. We must be very very careful careful for what? Talk an artery. Okay. Uh huh. Good. So review to the injection is very very useful. Domenico trying down so you're isolating the cystic artery. Uh Maybe this is a branch of the this is a branch. Maybe this is one of the branch of the cystic artery. Have some more branch? I'm already frightened. I don't want to see me. I don't want to see the main artery. Let me assure you for this case. The many many bigger vessels time can So we must manage such vessels close to the global order. Okay. This wasn't the number in the world. What does she want? Continental control? No, the minimal settlement of center, lot of like. Yeah. Yeah. How's it going? All right. Shit. Has it done something? Okay. Stop. Yes. Okay. Shake My 300 and many many others. Yeah. prof Joe. Uh and we leave you for about 10 or 15 minutes now and come back. Sure. Sure. Sure. Sure. Okay, but you promise not to finish before we come back. Okay? We promise. We promise. Okay. Thank you. So just in the moment I have many bleeding. I cannot find the beginning point and now. Okay. Yeah, I think you can you can move to another room now. All right. Uh So, we'll come back to you. I will give you some time to look after that. Yes, it was a good one. Right cut. So the gun that triggered the sugar. Mhm. Right. Yeah. Yeah. Uh huh. You didn't put out that mania. Oh right. Yeah, petition. Mhm. Going to have a talk. Here's your coma. Yeah. Yeah. Just so much. Uh What is that? Okay. Two to visit the grand wash. No, Professor joe. We've joined you again. No, it's OK. So you see I I spent much time or not. Human spaces. Many many vessels now. Many many abilities from the global Oda. It's extremely difficult because of the believing in the field was not so clear where the bleeding? Yeah. Yeah. Sometimes it is difficult to find the bill. Indian point where to come home? Okay. Okay. Something. Yeah. Yeah I see that. It's difficult to control scope now. Yeah. Okay. Maybe it was rebuilding point again. Close. So that's a very deft maneuver because Professor joe is using the cap to include the bleeder and as he moves slowly off of the inclusion. Of course the bleeding starts again. It has to be ready to grab that vessel. We'll see coagulation force. That smoke was very important to tamponade with the cap to stop the bleeding and then gradually move until you see the bleeding vessel. Yeah. So to sum up with geranium. Self regulation. Yeah. Yeah. This. Uh huh. S. S. S. S. Yes a bit. Hello. Event. Yeah. Mhm. I've been close heard that close about Susanna. So close. Yeah. Ma right back. Okay so Suzanne craig so and we change use another coaxial grasp. Yes. Is there ever an advantage to injecting diluted epinephrine or adrenaline? Yes. Oh wait additional. Yeah. Yeah. Mhm. Not yet. Uh huh. Yeah. Nothing uh covering that you were show to make your way that urgent? Mm you get to it. Oh ready there now I want to change the position. Yeah. Oh bye Halama he uh Oh true. Uh huh. How are you going to go to kind of a tragedy? Not true, doesn't she just say it Is it the nama. Yeah tell you what. Uh huh. So Mhm. Through enema. Okay you're still doing this cordon are you going values? Yeah so mama about an expected so that Mhm. The Madonna check the connection does it? The normal just to africa thinking I did a good families. No she's a non trying to ensure. Uh huh regularly. Okay getting uh there's going to remember childhood which is it earlier Latina. Uh huh. Yeah shit I think I just you know shit she president I don't know what you're doing. Uh Yes yes yes yes So this was at 11:00 The Bleeder. Yeah maybe blood. So I found I find a point at 10 o'clock. Yeah more we just saluted. Thank you. Things like that humor. Uh wow maybe here and then I'll stop. Okay. Uh dollars. Uh huh. Time changes. My god. Uh huh. Louis. Uh huh. What? Right. For help. Yeah bravo bravo. Yeah that's a summary enema. Funny. Okay Canada. Uh huh. Mhm. Sure. Yeah. Okay. Mhm Sure. Quick mm. Yeah. Okay okay but uh uh change the normal position here is the beginning cloth cloth. That's palladium stopped. Yes. Amazing. Just amazing work. Now you change the position from supine to left lateral. No no from the left us side to the supplying and now you're going that point Yes leading with the bleeding? You turn the patient left lateral. Yes yes yes just so shoot the look to keep the bladder and the fear Bolivia point apart. Yes. Yeah the whole procedure seems to how to manage the bleeding? Very difficult as you do it. Okay he'll show them the final like yeah like a great either video or discrete pictures of like the uh now okay Back in one minute. Yeah. Okay. Yeah cover that. So your bladder is very big. Me long. Well you don't adult content. Mhm. Yes. Uh huh. Why in the commodore? Right twitter. Can I ring a bell? Canada shot? Well she s touch us how she is. Uh huh. Uh huh. And I'm trying to watch general time. Uh You know your grandma and what part you know your lyrical cognac? Mhm. Body and soul please. Uh She knew what she wanna ma. Uh huh. Because they really are. Thanks. How is enough better? Uh huh huh. Just wait. Okay. Uh huh. Enough right camera mm. Villa julie english dance. Uh huh. Who uh How much is your shot? one doors. Huh. Mhm. Right. Can be shipped the Colombian cinema? Uh huh. Sorry I had to leave you. Oh. Mhm. And now no tradition I was just. Yeah. Yeah. Sorry could you tell us your strategy now what are you doing now? Uh Here is a bleeding point so I just bisected the T shirt close to that your bladder but here's the injury straight up play the war. So I use a clip first louis so ah yes okay listen okay here is an injury to the another war. Yes. Okay but why does it matter if the gallbladder is being removed that just to prevent bile leakage? Yeah. Yes. Yeah. Okay. Does it an mp talking to charlotte? And um what structures are you watching out for? What are you being careful about right now? What? Thank you. Thank you. Hear some mom. Right. A lot of what me worry about is bleeding I think. But okay to the hopeful I think I said Mhm. Mhm. Yeah. Tasha. And for the bleeder you're using spray coagulation soft. The coagulation soft just soft. Okay here is a car bladder. Yeah. So you're still working at the neck of the gall bladder? Yes. Yes. Yes. Yes. Yeah. Done with the party? Not your students. Mhm. Yeah. It's about energy from a what about just Mhm. Uh huh. Okay. Well but you know you're sitting, are you santa Sheila? Does it look awful? Mhm. Uh huh. So actually. Mhm. Okay. Uh huh. And focus and I wanted me to tell you that question. Yeah. So Professor Zhao um when you have a moment, one of our audience would like to know if you could point out the cystic duct. The empathic artery and the bile duct. So and are not affected concerned her in there. Uh We're still dissecting the um the hip, hip polycystic triangle. Now we try to show and identify the cystic dutch and uh hepatic artery and the common bile duct. Okay so so far you have not identified those structures. Not yet. Okay. I would professor said he will show they're all three these doctors later we are still um still working on that. Sure. Yes but painful. Mm CIA families initiative. I understand john you don't want to die. Mhm. Yeah. No to donna. The Uh huh. So deliver yeah. Mhm. To the horror of war. Huh. Yeah. Um ahmad. Mhm. I mean someone not to right. Alhamdulillah and relax. Yeah. Right. Uh huh. Certainly each of thanks julie. Yes. You're sure shipping mm jbl and transparent project. Why this is Yeah. Russia. Uh huh. Uh huh. Twitter. Ah Kind of mm. Uh huh. Ma from the chicana. Uh huh. Mm. Hey. Mhm. I never even told my two. So my mom to prevent mom. Mhm. Yeah. Mhm. Yeah. Yeah. Has a conundrum. Uh huh. Position. Okay. For the opposition money. Uh huh. Cinema. So hey, how did you get to know you got to work? Uh huh conditions in the indian Tommy moe shop. Yeah. Stephanie miller. Mm So european. Mhm european. Huh european the european. The european. Okay so that Honey I'm not the one. Shit. Mhm. Yeah. Uh huh. Sure. Yeah I cannot. Uh huh. Is that? Yeah. Yeah. You can appreciate your movie kind of a. Uh huh. Yes. Well we can see how extremely difficult this is a little bit a little bit of bleeding in that area obscures the entire field. Yeah it's very very challenging. And the question arose as well with a different scope with a double channel scope, health I think that I don't think it would be much of an advantage here. Yeah. Yeah. Okay. Mhm. Right. You work hard come back. Mhm. Mhm. Between the patient doctor left lateral uh another minor not supporting bleeding I think. Sure. So I so I change change the position. Yes. Uh Michael. Yeah, never have such a situation. That's crazy. Electronic. Uh huh I mean All right. Mhm. Uh huh. Sure I mean or not so I cannot see where the blood. So President must just your gun. Mhm. Yeah, in the evidential. Yes he had mm. Mhm. That's it. Yeah. Were you treated you doctor mm some resident now does it now? Okay to go home about that. Now the non quasi Uh huh. Now the church is down 19. Yeah, I got the end. Uh She's got very well has been tremendous amount of bleeding is very difficult to control. Please the mics are alive. Uh huh. Oh yet okay, intelligent. What we do, what do we do? Aren't you gonna go 13 nothing. Mhm mm let's go talking. Yeah sure. Uh huh. Uh huh. They may have why tariffs? Yeah, those are the pictures, what you're doing people. The email Yeah. Here go and put them all on downloads. five picture descent More. There's another one but I can share this and go like this. Right? Uh for your computer. And if you're ready, be good to go now. If we could switch over the case equivalent unit. Yes, a little bit forever now. Mhm. Exactly. Okay. What or football downwards Like how was Yeah. Yes, I'm ready. I can show them with preview. Probably like this. Now I'm gonna live one on. Mhm. I wanted to show the video. So that time out. This is more than enough. This is the final strand, right? This is a the reception of reparations. Nothing. This is the beginning of this return, the military the final final journey. This is uh you know, pink thing is the bullet. I've got close only in one area. I don't remember which one but they are zero. What's the speed working on video? Just have the video. Just skip around video video for the live course videos membership played from the, from the from this. And those are you guys moved from? So let's see this one. Find her window and Yeah. Right. And again, british fashion you're justifying in this one. Uh huh. The the really you know that the final yet happened like activity mary takes forever cut. Okay, but there is a there's a defect stands where. Okay, so the second video, the Children molly mm mm mama mama show it in high spain. Not so high. Okay, so this is the future. 5-7 minutes. I would have just, what is it, banana? A piece? I can put everything on downloads. Mm How much hit them, but and not go. So this specimen, this specimen can be in vegetative. Okay. So how we doing, you can show them you have everything you do. You just make sure that your queued up with everything and this. How do you have a seven point the pictures also out of their folder downloads? Just like I'm so the India is wanting to, what, what do you want to run and why? Yeah. Right. That's nice. Just keep around. They're hiding. Uh huh. Uh And with that. No, not that right? Oh yeah, they were Okay. Okay. Asia # two. And like thank you. I think that's too fast now and go to the middle of the medium. He's very to sleep like that. Yes. You know where you're going? Probably uh, you know, Michael has the slack. I'm removing the segment. So where does this situation here? Huh? Season 1533. Okay. And 33 Boom Christine. I mean. Uh huh computers have oh my God. Uh, you do that by solid state drive. Yeah. It's a fortune. Does that feel the way it normally does for you? Sure. Thank you. We're going to leave you again for a little while. We'll let you can continue to work with all that bleeding Published August 5, 2021 Created by
