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Hello. Good evening. Good day. Good morning. Good afternoon. Wherever you are in the world, we have 49 people with us this evening covering all the confidence. Thank you very much indeed. And thank you to the 3244 followers and Facebook. 477 on Instagram and 444 on Twitter. I'm extremely grateful. My name is David A Regan, Um, a cardiac surgeon in your chair, United Kingdom. I'm the past director of the Faculty of Surgical Pain is for the royal conversations better on Visiting Professor at Imperial College, London. My passion is teaching surgical skills, but in my journey through martial arts and I'm now reached it to do my fell down in Karachi on the 11th of September. I see a lot of parallels. And I want to share that philosophy with you on. Emphasize that you two can home your surgical skills and idea is to make it phone. Now we have a competition. I want to see a photograph on a short description off your surgical skill. You practicing on the model? And how you Whom on best three will receive a Black Belt Academy instrument pack that we'll forward to you. So you got no excuse to practice at home. I put out a former effort after the session that, please, do you think about models at the more exotic, more interesting, the better. And thank you. We talked last week off function and potential and this waas me, um, you to massage she undefeated summer. I worry of 16 43 in all parts, when concentration builds up and exercise is repeated, potential matures in great function imagines then that's what we're trying to do. For the Black Belt Academy, there is a scent saying the girls when great function appears, it does not keep the guidelines. This means that people were great potential and great function. I'm not at war, constrained by learning or rules in all fields of endeavor. There are things to learn, and there are rules. People who have attained supreme mastery are beyond them that freely and independently to act independently outside the rules is called personify fine, great potential in great function. Now, potential means to be thinking attentively off everything. Therefore, when that intently for potential becomes different, frozen and hard, then your entangled by potential and thus on or free. This is because potentials in mature and I'm right. If you build up effective exercise, potential will mature, expanding throughout the body, working freely and independently, and this is called great function. On this evening, we talking about snip that scissors. I would take them for granted. The count in all shapes and sizes and their function is really defined by the handles. You can see the kitchen scissors two fingers through to get cutting meat and joints says is for cutting material. Cloth three fingers through a swell a PSA thumb to improve the grip. Smaller kitchen scissors again, economically designed toe. Hold your finger and thumb. The regular scissors we use for cutting paper on the ubiquitous says, is for Ward on in theater. But make one important thing. Look how sharp those are. They're they're good at cutting suture material. Oh, removing says those 20 scissors have potential for citizens home. I was given the set of scissors by a Chinese student who is on my firm for a week before months on. This is by a company that was established in 16 43 and a specialized in ancient, out off paper cousin on these intrinsic, delicate designs have all been cut my hand using these rather mates scissors. But what's interesting? I marvel at how big these handles are. The first citizens actually were two blades put together with a strip of metal, that set of shears that described back in ancient Egypt and once the Romans that put two blades together and corden scissors after Cesari, Um, and hence the English name sisters. And they became popular in the 18 hundreds by Robert Hinchcliffe, who, because the ubiquitous nature off stainless steel and chef your mass produced the citizens that we know today. And, of course, the interesting thing about scissors is that it's a pleural pro taken. You see, a Paris is is reflecting the blades you drink or did a single scissor, probably if you nine months pregnant and put a set of Cicis under the pillow, it will induce labor and the healthy birth and keeping it sepsis is, is in the kitchen drawer, wards away evil spirits on what I should never give a friend a set of scissors because apparently it means that relationship is going to break up, which is interesting In theater we process is to each other regularly. These scissors are called back in doses. On your homework is to look out who McIndoe waas. So our church board, Hector McIndoe, was born and done eaten in New Zealand. And did this house jobs of my cater hospital, where he was ton spotted by and raw likely one in invited him to come over to the UK, not finding a job he actually worked in with his cousin. So how old killings? Who was in T Surgeon of Bites? He went off to America and got the American Fellowship came back, and it was appointed a plastic surgeon at the London Hygiene Hospital in 1938 on and as a plastic surgeon to the wrong airforce. Here's the father off plastic surgery on Founded All there's complex reconstruction operations in bank spent five pilots and World War Two. After his death. 1961 they plastic surgical unit that East Grinstead was named after him, but what I like about him is a surgeon. He thought off his patients in the more realistic sense. He didn't put them on their recovery uniforms. Encouragement to get dressed. He courage the local community to invite them out and apparently only appointed. Good looking mass is because he is acutely aware that these young men who have disfigured and that where perhaps not worthy it's pretty girls eyes not being true. A lot off. Those young men actually apparently married the nurses and some hanky panky read on the couples. But these are beautiful scissors and the chunky equivalent other medicine bombs. And I'm extremely grateful to Braun Escalera for giving me these instruments. The longer version Nelson obviously is for region down. Now there's a simple physics involved with, from fingers to the pivot and from the pivot to the the force Times distance. It was the fourth times distance, so you don't need much in the way off force. Tachy exact a cutting or dissect from movement because of the way they're built up. I'm taking over to the top and explain how we need to hold these diseases. Your note that this is have a curve and it's important that you hold the citizens such the curve is with the curve of the wrist. There, hold it this way up. I can see the tip, but I can't see the belly on. I have seen the poor me actually cracked. People focus on the tip on about the belly, so therefore one should always hold with the curve of the wrist. Now the scissors have multiple functions Cutting, scraping, separating, even used for blood dissection on the important thing to realize that full function of this is is is to hold them properly. No, I know my hands are bigger then many. But even so, I do not advocate putting your fingers through the rings. Indeed, I hold this is on the helps off my fingers and you will note that my ring finger is actually there with my middle finger stabilizing on my index finger extended down the shaft of this is is to give me that direction. Prep reception. Now my coloring pointed out that recorded on my ring finger. And I suppose that is a habit for my general surgical days. When I was dissecting, I could move, my sister's up on that. Then three my fingers up to do a note I and flip misses out like a switchblade and cut the note. One of our colleagues pointed out one should not be cutting suture material with the max dose is is as we're blunt but American surgeon Wrong Barbara's. It was actually tweeting at the present moment. Pick this up into the study and looked at the sharpness of this is is I agree with Jim, not disrespect the instrument by cutting fake material, and indeed, you should never use. This is to cut skin, but for cutting suitors, it is absolutely fine. Why these are better than using the sharp scissors. Is one there longer it can reach into the cavity and to one should always remember not to open this. Is this any further than necessary to do the job? So, just like that, a good trick is How much do you leave when you cut suture on? I don't see five millimeters, so we surgeon is holding up both suitors. Is UTI indicating either to cut or put it? Clip on it, but it's the same afford to comes, and your brain nurses in places where you need to be on your cut five millimeters is you do not come in from behind the legs since is wide open. Pour it for for a sweet truth and cuts. It's a deliberate movement. Precious is in the operative field and count procedure. What's quite base about this exercise, and I've got a lot of cotton time to Kotani. Here is where you're cutting discipline yourself. To think that was five millimeters can cut it essentially to and come back up two centimeters on the simple exercise off. Disciplining yourself and thing king about the function of the scissors and realizing this potential and thinking about what you're doing certainly can accessory. It has been useful for me of the years to say five millimeters five millimeters, 10 millimeters 20 millimeters Because when I had doing a arterial to be, I know exactly what to do. So the other important aspect on the scissors is for separating tissue, and you're well aware that I like organic material and the organic material here is in the dream on I'm going to use this is is to separate the skin from this naturally and as I'm doing it acutely aware that underneath I've got very soft tissue. Now, this is not unlike the thick cortex over a chronically inflamed lung, all the thick pericardium and pericarditis. What is doing is giving you an opportunity to feel your way around on. Do you want to see the scissors are placed in opened, taken out in closed, never opened closures is underneath. On the curve of this is is very useful for gently developing planes. Beware if you have resistance and dissect out the resistance because it could be and you're a muscular right, your vascular bundles. The other useful thing about the cysts. They may be used as a blunt dissection. Two, as you see here, but simple. Removing the skin is perhaps easy pen you use. This is to separate out different segments off time. Dream remembering that pushing your scissors into the tangerine you're obviously damaged the flesh. So this is again and simple exercise that you can do at home to try and feel your way through the dissection and two separate tissues. You'll know if you're successful when the segment comes out and you have left the Jason segments correct, intact and teaching feel. I hope you can see there that this segment is dissected out super exercise for feeling the bases is I like because the rounds ends of a round and they're not sharp. This is still sharp and compare it to a tissue. If you're not careful, I like this for that section off poorer or dissection off the pericardium. Writers and Flynn on a great food turns out to be not too dissimilar to that thick cortex that you see on these organs with chronic information in the same principle of plays. This can be separate all the tissues off without damaging underlying flesh of the great food of a curve. Actually, of these scissors. If it's nicely with the curve off the tangerine, we're grateful you can see how you use fel. This is is a tool for separated tissues, much thicker, obviously. But you still have to exercise care, because on this side it is rather soft. This is is I used for cutting, and I have demonstrated to you those beautiful examples off paper cutting as an ancient Chinese aren't your scissors for cutting needs to be only open as much is necessary to do the job. I knew it may scoff a cat in bits of paper as something that you did in kindergarten, but what we want you to be able to do the Black Cloud Academy of Surgical Skills is accurately cut out circles of paper showing control without see there. No dog is without dog is like that. It is actually difficult to cut out strips. This is a felt A pen, and you're aiming. This exercise is to gently cut out a strep without leaving any ink on the other side. It is insurance that your control and precision off this beautiful instrument is is best it can be. And these simple exercises are not only giving the feel, but this is helping you with the accuracy. What my favorite exercises is a combination of cutting and the combination off opening this is, is up. Scraping them along for separating as you were due to the Paris is is to cut the length or wrapping paper. You know, when you've done that, get this isn't open ups lately, and you can cut without using this mechanism. What I have here, a couple of chip a lot of sausage is I like the chip a lot of sausage because it is actually very, very friable on the skin is very friable to, and the idea behind this exercise is to get your senses underneath that skin without damaging the flesh Getting started is probably the most difficult time and and see their I've not got the right plane and I'm actually in to the flesh off the sausage. We try this from The thing about these models is that you can't have models that it easy. You need to have a model that is difficult. That challenge is yours. Your skills and pushes the limits of function potential of the instrument said a year now, um, in the right thing. Now this plane is not too dissimilar to the adventitia plane that you'll see over vessels on. Of course, that claim is a beautiful plane to be in when you dissecting solid organs like kidneys like the liver where you're following the anatomy, Vascular now, to me, to the lobes and segments are the respected organs. Certainly when doing vein harvesting this fascial layer of the vein is the layer that have caught up in the suitors causes constriction off the vessel, so clean dissection off the side branch is requires that you practiced giving into this layer. You can see there's no water thin, some reason my forces of picking up the edge. But like a typical surgeon blaming instruments. But it's not working out. It's one's bigger or this is an exercise that's not to be heard. It's an exercise that requires delicacy and patients dish issues with forceps. A swelling this is, is so I would like to see examples from your country's off through materials that you can use on practice at home. Remember that I am stood up. I'm at an ironing board, adjusted to the right height so I can actually use the function on my colon. They was coming off. Sometimes decisions take a little bit longer, and that's the whole thing about surgery. There's no speed at all. Sometimes it takes longer, sometimes quicker, with the important thing is accuracy. I have also He's a chicken one I wanted. The piece of chicken here for is to one show. You do not cut skin with the scissors. It may be easy. It may be quick, but two blades come together, actually crush the skin. So my plea is do not use scissors to cut skin, but as of this here, they're very useful for developing planes. Is she coming around? Put your sister's behind. Same resistance. That's a small vein. You see there. Well, talk about that section. More detail on the outside dissection in next week's less In jihad. You would join me. They get your vascular bundle, and if there's any resistance to you're separating, there usually is in your vascular bundle. And it was a small vessel. There, I sincerely hope, is make sense. I hope that is it inspiring you to practice at home? These morals are deliberately difficult. Uh, you can go from simple, too complex, but they they're too challenging. My last says a skill is using your sister's down a deep, dark hole, and I call this my inverted or ent grip. In this occasion again, I got my thumb and index finger blinky should really reins on my ring finger, stabilizing it. I've now gone my little finger extended down the scissors on what this means is that I can get down into very difficult places and I can maneuver. We've used the pepper before for force it preface, and you can see now I can get my scissors into this very narrow space and dissect off and pimps I do not. I have my hand obstructing my view because I'm holding this is is upside down. But employing all my fingers is giving me the same feel appreciation off this wonderful instrument called McIndoe senses Metzenbaum produce the slightly chip trunk your version, and he, too, is a wonderful surgeon. But I do find about the models that offer you. I end up getting so engrossed in them. I forget you're there and our time is up. I hope it's killing your flavor off how you can practice at home using simple, more pills. I am very happy to take questions from any of you on extremely grateful that you joined us this evening. I'm going to continue next week exploring life and the scissors and have to practice dissection at home with more foodstuffs, an organic materials fill. Do we have any questions? Thanks, David, the moment we don't have any questions, but we do have some comments. Juice Soup has said Hello, just Stevens on. Do If he ana has says, has said, thank you so much for the teaching. This is actually my pleasure. Pleasure on good evening. Any other questions? Ladies and gentleman, I do appreciate your feedback as a said, Well advertised the competition. I want to see a picture of your home moral whether it was the life of scissors. Forceps, not time. It doesn't matter on a short description. And if you put that on Twitter house tag, Black Belt Academy, surgical skills on metal, the winner will get there and set of enjoyments as one second and third. Please do not hesitate if you enjoyed it. Also spread the word and encourage others to join in. It's really fun. Began to interact with you and to take your questions. I wish you well. You have a good evening. A good night. And so thank you again for hosting you bet.