November 11, 2014
Written by Martin Susskind (class of 2014-2015)
Wow what a fine day to be an OREXer! I was early to rise in order to make it to Grand Rounds where I was learned up real good (insert cowboy accent) on the correlations between patient lung capacity and surgical success. I also got to load up on muffins, fruit, oatmeal and cups o’ joe… breakfast of champions… or surgeons…or both…
The conference ended at 8:30 so I squeezed in a quick sit with the cat at home before heading off to Highland for surgery at 11:30. Then I was told to wait until general surgeries started at 12:30. Anti-climax. But not really because when I came back I was blown away! Resident MD Robert Tessler took me right under his wing and prepped me on everything I could ever want to know about gallbladders with his tablet and then he invited me into his Laparoscopic cholecystectomy. I learned way more than I will write here but the general procedural steps are as follows…
- “Fish around” in the patients mouth and intubate the throat
- Iodine wash the exposed abdominal region for surgery. Never before had I seen a human so reduced to just an abdomen.
- Used the “Hasan Technique” (1st incision into the abdomen through the mid line right at the naval. 4 incisions total)
- Stick space shuttle-like “ports” into each incision for the scopes and tools to enter.
- Inflate the abdomen like a balloon with CO2.
- Using scopes and scalpels pull all fat and extra tissue off of the gall bladder.
- Cut/laser burn the tissue joining the gallbladder and the liver.
- Clip/tie off the 2 arteries connected to the gallbladder before cutting them.
- Use teamwork to excise the freed gall bladder.
After the surgery Dr. Tessler invited me to shadow him around for a bit as he checked in with post-op patients and prepared for his next surgery. I finally ended up going into one more surgery and it was probably the most ridiculous thing I have ever seen! Shotgun bullet right to a grown man’s tibia… this was some real ol’ fashioned slice and pull surgery here. Dr Allen and Swanson invited me over their shoulders to see literally everything. They excised a huge chunk of muscle as well as about 25 shards of loose bone. Metal scaffolding that was bolted into the bone surrounded the entire leg and the doctors used it as a handle when they moved the leg around. And now I’m just ranting but this leg was entirely open and ENTRIRLY excavated. It was truly incredible. The last step was to slice a foot long strip of skin off of the patient’s quadricep to use for a skin graft on the tibia. The surgeons fed the skin strip through a flattening device and poked holes through it like an aerator so that the skin graft resembled a strip of jersey mesh. They then stapled and sewed the skin graft onto the lower leg and dressed the wound. That is one more incredible instance of human ingenuity in the books folks! What a day! Cant wait for next month.