Monthly Archives: March 2009

February 2009

By Kevin Lee, OREXer ’08-09

Today’s OREX was slightly different from the past in that I was able to observe to new surgeries, particular one that I had not ever seen or heard about. The first procedure of the day was a laparoscopic cholecystectomy, which I’ve seen three times at this point. Although I’m pretty familiar with the procedure, it’s still kind of interesting to see how each resident performs the surgery, which is slightly telling of how they are as surgeons. I remember the last time I watched the same surgery, the careless resident seemed to be doing everything wrong – severing arteries and causing unnecessarily excessive bleeding, not stapling the gallbladder properly causing bile and gall stones to leak out into the abdominal cavity, etc – which made me skeptical of not only her as surgeon, but also of the power that doctors have over their unconscious and unknowing patients. This time, the cholecystectomy went much more smooth as the resident was able to complete the procedure in a delicate and skilled, yet efficient manner. My confidence in physicians once again became restored, with the exception of that other resident whose name I wouldn’t be able to name anyway since I don’t recall what it was. Despite the fact I had seen this procedure already a couple other times, it was much more comforting to be in the room because of the resident’s natural friendliness as he explained to me different things he was doing and ensuring that I was able to see what was going on. After the surgery was over, he even clued me in on the fact that I should return to OR 4 for the next procedure, which although I was not clear on what it is, presumed it must have been interesting.

The next surgery of the day that I watched was a bit difficult to see, but was interesting nonetheless. This one was a mandible reconstruction with a hip graft. I wasn’t clear on what had happened to the patient, but what I did see from the x-ray was that a large portion of his mandible was missing, replaced by a metal plate. The procedure was to take a piece of bone from his hip and implant it into his chin, which never occurred to me as a possibility. What I wonder now, and should have asked when I had the chance was why do a hip graft? Why not extract from elsewhere from the body? Perhaps the hip has an excess of bone, or bone that if taken, won’t result in adverse problems. In any case, there were two sets of surgeons working on this procedure – two on the mandible and two on the hip. It was quite interesting to see the mandible, or lack thereof. I wasn’t exactly sure what the surgeons were looking for, I believe the joints, but it appeared to be a huge gash that extended from one side of the jaw to the other, located under the chin where the neck was. I surprised that this opening didn’t affect any of the major arteries that are located in the neck area. While those two doctors were working on the mandible, the other two were working on the hip where it appeared as if they were doing some kind of drilling. This wasn’t as exciting simply because I wasn’t able to see what was happening, but it did sound like drilling was occurring, probably to remove some of the hip bone.

The final procedure that I observed for the day was definitely the most unfamiliar to me. This was a video assisted thoracic surgery (VATS), specifically an open apical blebectomy. The patient, according to the resident, was someone who smoked and injected drugs. I believe because of these activities, he had endured pneumothorax a number of times, which was treated or worked on. However, despite the treatment that was provided, the pneumothorax ensued. Upon doing CT scans, it was discovered that this patient had blebs that had developed on his lungs. These blebs are apparently air bubbles where air becomes trapped within very thin tissue along the lungs. Somehow, the blebs were believed to be responsible for the continuous pneumothorax, probably the thinness of the tissue being more prone to rupture. So this blebectomy was to remove the blebs from the lungs. Now, up to this point, I had seen laparoscopic procedures a number of times, but I had not seen anything else other than gall bladder removal. This surgery also used cameras to perform the surgery, but was instead called VATS for some reason, and was obviously performed elsewhere in the body. It was similar to a cholecystectomy in that three incisions were made in a triangular fashion to place the ports into on the right lateral thoracic area. Upon entering the thoracic cavity, it was slightly difficult to understand what was on the screen. the lung seemed to be completely deflated, which makes sense considering the pneumothorax, but was also gray and black which also makes sense because the patient smoked. After examining the deflated lung briefly, the residents came across the bleb, which just looked like bubbles conflated bubbles growing on top of the lung. The procedure was similar to a cholecystectomy in that they had to apply the stapler-like tool where the bleb in order to remove the bleb. Following the removal of the blebs, they used a scratch sponge which like the name implies, is a coarse sponge, to wipe around the walls of the thoracic cavity. Although the blebs were removed, which decreased the chances of a pneumothorax, it didn’t completely eliminate the possibility of it occurring again. By scratching the cavity walls, it induced a natural inflammatory response that would somehow cause the lungs or holes in the lungs to stick to the wall in order to provide more support. Although the VATS apical blebectomy was somewhat similar to a laparoscopic cholecystectomy, it was still very interesting to see how this practice can be applied to different kinds of surgery and different organs.