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And okay, if people can sit down, we'd like to get started with the afternoon session. So this afternoon session, um it's always a pleasure to do this part of the Congress. We start with a guest lecture. Um We then follow that with the Dennis Brown Gold Award. And then in the end of that, we have a further award for outstanding trainee in their exam from a few years ago, but better late than never. So nothing more for me. I will ask Sean to introduce our guest lecture. It's a great honor and privilege to introduce uh Navid Alizai uh consultant, pediatric surgeon in Leeds since 2004. Um He graduated from Peshawar Pediatric Surgical Unit uh in 1986. If you don't know where that is, it's on the Great Silk Road. So he's come a long way. Um He's been through Dublin a port of entry to the British Isles for many. Um And then you've been in Leeds, Newcastle in Manchester, of course, along the way, you picked up a few other degrees uh diploma of law in 2002 from Exeter University. And then you became a barrister at law, which should be very fearful of you and all of you in 2003, you collected that one, from Bristol. Um, you have a special interest, uh, in, uh, sheep, which you're going to tell us about a healthy interest, I believe. Um, you're an hour adopted Yorkshireman and a farmer. Is there another slide of you? No. Okay. No. Okay. It's just that one. Okay. That, yeah, that, that one's been, uh, censored by the look of things. Yeah. Um, you're renowned hib Otto Hepatobiliary surgeon um, on these islands, not this island, uh, not this mainland but the British ours, but around the world as well. And, um, you've uh, been uh steadfastly building up your practice and expertise and you've built on the brilliant robotic work in leeds and been a world leader in robotic, minimal access surgery in the liver and pancreas and biliary system. And, uh that is a fantastic, uh, role model that you've become and any young people out there should be considering working with this guy because he ain't going to be around forever. Um, he's got vast experience and uh fellowship in leeds with this guy should be fought after I'm sure. But you're going to tell us about your journey, Navid. Thank you very much. Thank you, Sean. Hello. Good afternoon, everyone. Um, so I'm going to, uh, tell you a bit about what I do and how I got about to do those things. Uh and, and uh while doing that, I will show you a couple of things, we do a number of uh minimal access procedures, but just want to show you a couple as an example just to uh explain how it works and, and why, why it works and why we love it um are working leads as Sean mentioned. And we've got various subspecialists, interesting leads. We've got 15 consultants in leeds. Uh And almost everyone used some kind of laproscopic or thoracoscopic work. The one in red, the one who used the Davinci robot at the moment and the one in black hopefully will start using Davinci in the near future. So now I just want to mention a couple of conditions that I come across and, and uh I really enjoy doing them political cyst uh comes most of the time uh elective case for some time acute as well. They come in various sizes and shapes. Some are very small, some are big and some are huge. Uh What we need to do basically is to remove all the ex extra patrick ducts and create a rule loop of Jejunum and stitch it at uh hepatic level to the attic duct. We don't do hypothetical duty an ostomy. We don't think that's the right operation. Um The smallest child choledochal that I've done was 4.9 kg robotic Lee. The largest 11 35 kg was actually cholecystectomy and that was my very first reported case and I was prompted by this gentleman sitting over there and he was not happy uh for me to select that as first case, but went fine. So just to give an example that how things can work now as we go along, uh we're developing every everything has got some, you know, a few things are good if you're not bad and you need to make some changes for things to work. So for example, in robot uh in a small child, the external part of the instruments, they hit the table. So what we do, we in the in the new unit, we use the new one, it'll table for all the Children. We developed this mattress uh with the booster which is stuck to it. And as you can see, it's a bit on the left side, not in the middle that is to help assistant. So all these things uh they help when we operate. Uh Now, the good thing about minimal access surgery is that uh it doesn't matter about the size of the patient is as long as your reports are in right place, as long as your instruments are not hitting each other. Uh screen is the same size, they do exactly same operation in every case. Now, so we have developed this uh encyclopedia uh various positions for the robot. Uh and, and, and uh we make sure that we stress we and the surgeon himself or herself, make sure the table is in the right place. Robot is in the right place and instruments are placed in the right place. And after that, it makes everything easy. The benefit of robot uh that people haven't seen it or people who have seen it is a, is a beautiful three D view. Uh This is just a sketch of one of the patient's that we had and this is a view of the lower end of common channel. Uh And then I'll show you some video. And so I used to dissect with bipolar, but now I just set with monopolar scissors uh because you can see everything so clearly. So you can be very precise. The problem with bipolar is that they charge the tissues and then you can't see where you just sit next. I'm going to forward these videos a bit to show you. So now, uh the other thing I just want to show you here that in some cases of uh choledochal, uh the right hepatic artery travels in front of the hepatic duct, just the left, right hepatic artery which I'm lifting with my left hand, have dissected using monopolise is is so you can do even arterial dissection using monopolise is with the robot. Um uh And uh so then you cut the duct, you have a look inside and then after that, you trim it. Uh And in all cases where the hepatic hepatic artery is traveling in front, you put it behind and you do the anastomosis in front because if you do the anastomosis uh behind the artery, there's a higher risk of an estimated stricture. And this is just to show that how it is easy. And you can look at this video. This is just a cholecystectomy. The thing about uh this machine is that you control the camera yourself, all the instruments are in your hand. We have got forearm robot, but we just use three arms. Uh So there's no shake, there's no sudden movement, no unintentional movement. If you lift your head off, it stops and everything so precise and clean. Now, I'll show you just forward slightly just to show the dissection that we use businesses as an example. There was a third year trainee and she's sitting here, she is a consultant or she, I won't take the name. Uh She said not to uh uh she, I made her sit, I made her put the port in for Cholecystectomy. I made her sit on the console. She did the cholecystectomy and then she closed the ports. I did not even scrub. She was third year trainee and she had never done Cholecystectomy in the past and she did it beautifully with no, no problems at all. Uh That is because of the view and the precision and the control that you have. So you can, you know, you can see it just cut uh visible pleural layer, you clear and then you can see everything so clearly, this is very different to the laproscopic work and that we do, I'm not against laproscopy, but if you can afford to have this machine, it does help. So I'm going to go to the next slide. Okay, I think click here. Okay. So I need to go back to the previous like, can you go with the previous light, please? It wasn't moving. Okay. If anyone asked me that if I, if I select one procedure that I wanted to robotically, it will be this, this is a non political uh hep a Texas. Uh Most of them is missing camera, hematomas or isolated, forget cysts or sometimes sympathies which have certainly enlarged in size or they bled into it or they got infected. And it just because uh it gives you such a nice way to dissect. And this patient, this patient went home the next day, this patient and this was his cyst. Uh because normally if you have to operate on these Children, you have to make a right subcostal muscle, cutting incision and they have pain. Uh they are analgesia for many days. Uh And then in the long run, they have, you know, Kozmus and all that. But this went home next day. What I do normally is we I aspirate, assist uh I take the floor off and then addasect the rest of the cyst from the parenchyma using the monopolise scissors. So you've seen the scans in the past, you know, where the major blood vessels are and you can very easily dissect the cyst off sometime. It just feels off beautifully. And then at the end, I usually fill it up with the Sealer Floseal. Even if it's not bleeding, you sleep better that night. This, this uh missing karma hematoma was just behind the middle part of the girl better. Uh And I was using my bipolar for this because it's very close to major vessels and billary structures. And uh with monopolar, there is some spread of uh current when you uh when you don't know exactly where the issues are. So it's safer and also you can spread issues as well. Uh And again, if I was doing this laparoscopically or open, I would have had to remove the gallbladder as well and we didn't need to this one. Uh And, and this patient again did well. Uh this last one was on the inferior surface of the uh segment five and I would have had to avert the liver if I was doing open. And again, this was almost a day case procedure. It was small, missing calm hematoma, but because of robot bodegas procedure, so it doesn't move to the next slide. Uh Okay. Now, just one more uh with you about this, sometimes the cysts are quite intrahepatic and you can see here is attached to the uh middle hepatic wane and a branch of the right hepatic vein. And uh, what I've done, the mend a section you can pull yourself in, into the liver. Uh, that's what I've done. And you can see this last part of the sister attached to the middle hepatic vein, which is huge. And if it bleeds it can cause serious problems. This is an unedited with you. I'm showing you and I'll just forward this and in fact, what I'll do, I'll go to the next. Uh, So in this one again, I'm using bipolar because I'm worried that if I burn the way and it can bleed suddenly, I've got to swab there in case it, please, then I can put some pressure on it. So, uh this is the same one and I'm going a bit further. Uh And all you do is you generally uh burn the tissue on the cyst as far away from the vein as possible and you peel it off and I'm just going to forward it. Uh, this last leashes always the uh one that can cause problems. So you have to be careful even up to the last bit of the dissection. And this patient home, went home in two days. This was a quite large intrahepatic segment forces attached to the hepatic way. So that's where uh the benefit of the report is. Now, we didn't get there very easily. Uh There were issues people were complaining that it's too expensive, but just to give an example, uh for, for the cyst excision. Uh I use these instruments. It's cost about 500 to 600 lbs, but they go home within 123 days instead of 5 to 7 days, they're very low and religiously requirement. Uh Cause Mrs is excellent, less risk to tissue damage and editions. In the long run, we've done some comparative studies using, looking at various procedures, choledochal Nissen's and Splenectomy and combined procedures, robotic and laproscopic. When we found that the difference in price in these two procedures of about about 400 lbs difference. And in these procedures, they're roughly similar. Uh And once you have the machine which is usually paid by the charity, then after that, the running costs are not that high. Now, we didn't reach their that quickly. How did we, how did I start in 2001? I got my CC ST in those, there's used to be known as CC ST. Uh I was an open surgeon. I had worked in leeds for one year, but I didn't do any laproscopy. I was trained as an open surgeon. Uh I started working as a consultant, local consultant in a hospital. It was summer time. Uh uh two weeks into the job, I had a phone call from okay personal health that I have to stop. I can't work as a surgeon anymore because uh I was a carrier for Hepatitis B and my titers had gone up. And according to rules, I was not allowed to work. So at the age of 39 I stopped working at the surgeon uh after being trained and I had various meetings with occupational health and it was clearly suggested that there's no way you can get a substantive post in NHS. Uh That's the reason why I didn't go for certain jobs and some people who are in the audience, they will today find out why I didn't go for the jobs. Um, so I had to do something. I had to think, uh I didn't want to waste whatever I'd learned. I learned by then. So I decided to, uh consider law, uh steady law and see what I can do. Uh It was summer time. I, my family was in exeter, I spoke to university but obviously there were no places. So I was planning to do the degree apply for the next year just at that time. Uh They told me that, uh, there was someone who had dropped out from a conversion course, which is one year conversion course because I done degree in the past. So they said they can offer that to me. The course had already started. So I got my, uh certification from a law society within a week and I started, uh studying law. Remember it was a Tuesday when I studied, started in September, it was a sad day. Uh, uh, my world had changed that day. So in the afternoon I went to the security to get an ID badge. There was no one at the security desk, uh, waited and then I looked in the room at the back. They were all in there. All the security people, they were watching TV, they were watching a movie on TV. And I could see the TV. And there was a plane that hit at all. Building the day, it was 9 11, 2001 that day. And it was a sad day. It changed the world. So I studied law. I did uh my diploma and then I did my Parker's from Bristol uh was quite happy. This is just a report after the bar course. And then in 2004, just before 2004, I was working as an adviser, medical legal advisor for a firm. Uh and then I was applying for uh my uh people ages because you have to do kind of house job known as people age and had some interviews lined up, went for those interviews. And at that time, I was also keeping my options open. So I thought maybe I'll consider general practice as well. So I did a six months as standalone job at a palliative care megacurie center. Just at that time, I was still in contact with particularly Protyne Ery and, and uh really score in leeds. He said that there's a job six month job as a registrar in leeds if I'm interested. So I was living close to leeds at that time. Uh So when the occupational health, the checked March charters were fine and I was allowed to work. So I started as a registrar. Uh Then they said there's a possibility of a compatibility concertante are interested. But the Decker was hanging because anytime that artists can go up, uh and what we'll do then if I go that direction again. So then I did, I was doing some research at that time and I found out that uh uh the Department Health allows you to do non exposure prone procedures. Uh If uh if uh your titers are up, so you can continue to work non exposure prone procedures, use scopes like upper larger endoscopy, cystoscopies and minimal access procedures. So I thought, okay, maybe I will try and do some minimal access procedures. So I looked around, asked around, I found out this person Li Long in China, Beijing, he was doing a lot of uh irritability laproscopic procedures. So I went to China stayed a few months over there, learned from him, came back and we started laproscopic choledochal sees. Uh We did a few laprascopically. Uh I used to travel to China quite regularly. I became um honorable professor over there. And so, so university and I used to operate there as well. They were always very helpful. So over the following few years in 2005, then uh I was at National Dean, uh arrange for least to have a robot. Uh, and then, uh, we thought, why not? We try robotic. And so we started to develop robotic choledochal sees and that's how it started. Uh, at that time, I was still kept, uh, department health and occupational health. And my hepatologist, we're keeping an eye on me. And, and 2012, suddenly my blood results were not right. And, and they thought maybe some complication has happened, uh, because happy can cause problems with the liver. So I had some investigations done. Uh, it was quite surprising the result. Normally, if you have happy, uh, if you have it for six months, you become a career for life. Uh, uh, the test showed that I had cleared my happy. Uh, they couldn't believe it tested again. And then for the foreign two years, they kept on testing and the immune system had cleared the lab. So I was one in many millions who can sometimes clear hepatitis B carrier stage. So after that, I've been clear. Uh, so I bought a lottery ticket. I thought I felt quite, quite lucky. So that did the jackpot was 9.1 million. These were the numbers and my numbers were these literally to zero, but I did get paid 1363 lbs. So I had no choice but to come back to surgery. So, uh, and since then we've developed it, we've done many different procedures. We have one of the largest in the world. Largest in the western world. We've done over 1000 cases uh to practice for Europe. One is me and one is uh another colleague for uh for urology. We published papers, chapters, teach, run courses in order to procedures. I do choledochal says liver says clinic me from the application Haller's to make me which did together with them uh and construct mean Baldick exploration, duplications. And our urology colleagues are doing quite a lot of procedures as well. So there are 54 or five of us who are using robot in, in, in a trust. And I'm teaching some of the other colleagues, I'm prompting to at the moment and hopefully, oncology, colorectal will come on board. And there are other people who have shown interest for bariatric surgery from other centers. Uh This is a neuro and cardiac are interested as well. This is a patient. She is a three year old who has bilateral SPC and she's blue all the time. And the cardiac surgeons have asked me if I can put because she will require uh to record me. So they've asked me if I could put a ban on this. So I'm doing this next month, robotically will put a ban on the left, left SBC uh and hopefully uh it will change your life. So, and without requiring a major uh thoracotomy, now we get visitors from other places. Uh There are uh I've because I'm parked also, I've uh helped uh uh develop a robotic centers in France, Netherlands and Finland. Uh There are five centers in UK. Uh They've contacted us to have visited us. They want to get a robot so we'll proctor them. Polish team is coming next week to stay a few days with us. Uh They're getting a robot. Brazilian team has already been and they want to develop that as well. We cover because there are three liver centers. We cover one third of the UK Civic it referrals from all those centers but also get non regional referrals from UK because people, doctors and other it, people who Google and they find out someone is doing it robotically, they bring the patient's to me. Uh and we get patient's from Europe and from Middle East as well. They come on private basis who are trust hospital is quite happy because they make good money with them. So we are developing now. I didn't. Uh yeah, I did uh study law. I didn't give it up completely. So I do got a lot of medical legal work which helps. And as Sean mentioned, I am because when I have a lot of free time, uh look after my animals and I do that myself. Now as you go along in your life, you know, uh sometimes uh you can't, you need help, you need some people to hold your hand. Uh And I've had help for many people. Professor Gerald is sitting there, he was in Dublin. He helped me and professor, I didn't tell you I did take some flying lessons as well, but I didn't get people. So I will probably do that at some stage. Uh And I would like to mention a few uh Caroline Dyche who unfortunately is not with us anymore. She helped me to get on the ladder. She was a great help. Uh Edin Bianchi showed me how to hold a knife and how to think about uh patient uh as, as a person and how to think about the future of that patient, this gentleman as announcement in just sitting over there. Uh He taught me minimal access surgery if it wasn't for him, I wouldn't be standing here talking to you. Thank you. Last thanks. That was thank you to Assad only, sorry. So last but not least my wife who has helped me because I went through many years of quite dark ages. Uh and I needed support and she helped me and she's still um right or wrong. She's always there. I'm quite a strong believer in, in, in this statement. Uh And, and I think uh for me, uh it just says it all and it's not just for people as for anyone, patient's doctors, anyone. And I think for me, I probably have reached the end and thank you.