February 20, 2015
Written by Xiteng Yan (Class of 2014-2015)
When I arrived in the surgery wing last Friday for the 7AM lecture, I saw only the residents sitting at the table. They mentioned how Dr. Harken would not be in this morning, so after signing in, I went straight to the 5th floor. I was able to get some homework done before the first surgery, which was a tonsillectomy. The surgeon for this case was Dr. McDonald. The patient was in his late twenties or early thirties. The procedure began with a student inserting a ventilator tube into the patient under the guidance of a senior doctor. They used a laparoscopic camera in order to ensure the proper positioning of the tube. After this, the staff did a few more preparatory procedures (e.g. repositioning the patient) before the operation began. First, the tonsils appeared to be clipped in place before being removed by a pair of surgical scissors. A sickle-shaped instrument was also inserted into the patient’s mouth and may have been used to excise the tonsils. Finally, after the left and right tonsils were removed, the surgeon inserted a heating tool into the patient’s mouth, possibly to seal the cut blood vessels. Overall, the procedure was difficult to observe because it was entirely in the patient’s mouth and was not projected onto any screen like a laparoscopic operation. The operation was also brief, lasting only an hour. After it was completed, I went to the break room for a few minutes before heading to my next surgery.
The next operation I watched was on a left tibia plateau fracture. The surgeon on this case was Dr. Robert Hoffman. The operation was well underway when I entered the OR, but the staff brought me up to speed. The circulating nurse, Wendy, told me that the patient had been in a “pedestrian versus automobile” incident. The patient had his left leg propped up; there was a rectangular opening that started on the left side of his knee and went down to his upper shin. The team had already inserted several K-wires into the patient’s knee, which was visualized via X-ray. The K-wires were adjusted until they crossed in the left side of the left knee. A perforated, rectangular metal plate was then inserted into the leg, covering the left side of the knee down to the upper part of the shin. According to the circulator, the cartilage was damaged and the goal of the operation was to bring the upper and lower parts of the leg back together. The metal plate was needed to set the tibia back in place since it had been shattered into many small pieces by the incident. To conclude the operation, multiple screws were inserted into the knee (there were four horizontally placed screws and two that formed a cross at the knee). The placement of the screws were then checked with X-ray. Dr. Hoffman rinsed the opening with saline before asking the residents to close the wound. As I watched them suture the wound shut, another doctor came up from behind me and took my notebook. I was caught by surprise as he read through my notes out loud and slightly embarrassed by my simplistic observations. However, I quickly realized that the doctor was being tongue-in-cheek, but he nevertheless quizzed me on what had happened during the operation. After failing to give a satisfactory answer to a question on cartilage, the doctor invited me over to the OR next door, where a total knee replacement surgery was about to begin.
I found out that the doctor who invited me into his OR was Dr. Krosin. He was personable, had a good sense of humor and he was very inclusive during the operation. He told me that the patient coming in had arthritis in her left knee, which damaged the cartilage to point where she needed a total knee replacement. As a result of the operation being a total joint replacement, a sign saying “total joint no entry” was placed on the OR doors. Dr. Krosin explained this as an extra precaution; while all operations needed to be safeguarded against possible infection, the consequences of a joint being infected were considerably more dire than other cases. Nevertheless, Dr. Krosin said that I was free to leave whenever I needed to. The operation itself was incredibly dramatic. The speed and forcefulness with which the surgeons operated (e.g. their use of the power saw) was slightly terrifying but all the more admirable for it (I was asking myself how much training one had to go through in order to saw off slabs of bone with such speed and confidence). First, a slice of bone from the left side of the femur was sawed off and replaced with a metal disk. After this, portions of the cartilage connecting the femur to the tibia were systemically sawed away. Throughout all of this, the surgeons continuously checked the alignment of the knee to the rest of the leg. Finally, after the damaged cartilage was removed, metal replacements for the femur and tibia’s cartilage were inserted (the doctors went through several different sizes before finding the proper ones) and held in place with bone cement. The opening was then washed with a dark fluid (I forgot to ask for its name). Overall, the procedure was surprisingly quick, lasting no more than three hours. I thanked Dr. Krosin for inviting me to watch and left the OR.