March 4, 2018
Written by Sydney Palagonia (class of 2017-2018)
This was my first Friday when observing a surgery so like normal I make my way to the conference. I see one other resident in one of the rooms, so I take a seat. 7 o’clock rolls around and it’s just me a couple other residents and Dr. Victorino. Some small talk happened till the remaining residents joined in. The conference topic was about trauma departments and how they rank compared to any other trauma departments. Highland was more in the top percent when it came down to treating theses patients that come through the emergency department. There were a few things that left highland in a grey area, meaning not in the green nor the red markers. Dr. Victorino discussed this is due to the types of tests and diagnosis that some of the residents/ doctors give the patient. These residents were taught that certain things need to be done depending on if this is happening or that’s happening. As time goes on we discover new techniques and requirements to treat patients. From this the residents/ doctors have been treating patients based on old treatments and routine tests causing highland to slip into some grey areas in treatment plans. Overall Highland Hospital is in the top percentile in the rankings of trauma departments.
I usually have stuck to operating room one and get an ortho surgery. When I went up to look at the board I decided to choose a non ortho surgery as well as a different operating room. This time I went with operating room four. The procedure was a left thyroid lobectomy. As usual I get to the room and they are putting the patient to sleep and securing him to the table. The procedure started off with a four-inch incision mid neck using a scalpel. They then proceeded using a light scalpel to open each individual layer of tissue and muscle in order to expose the thyroid. Part of the process is to detach the thyroid using a peanut forceps (which hold a small sponge at the tip), fingers, and a ligaSure jaw instrument (helps fuse vessels together).
It was a little hard to see the entire procedure since there were three residents and one attending working on a four by four area on the patients body. From what I could hear and see they had started using the peanut to go in and detach the tissues and muscle that connected the thyroid trachea. This would create extra space between the skin and thyroid. They would do little sections at a time. First using a peanut than go back over that same area using the ligasure jaw tool to fuse blood vessels so no unnecessary bleeding would occur. This process was repeated as they moved their way around the left lobe of the Thyroid. When enough of the lobe was able to come out of the initial incision, a little bit of trouble came. This is where the fingers came into use. The attending would use his finger to swipe all around the left lobe of the thyroid to feel and possibly detach what was missed in the first place. The left lobe of this man’s thyroid was roughly the size of a tennis ball which was another reason why it was a little hard to detach. They were finally able to get the thyroid lobe to protrude out of the incision. From this they were able to continue a similar process to detach the part of the thyroid attaching directly to the trachea. To do this part no peanut or fingers were used. Instead a simple action of forceps and a curved hemostat were used. The surgeon would use forceps to pick up a small section of tissue and poke the closed curved hemostat through the tissue and open them to create a hole. This would detach the tissue from the lobe of the thyroid. This was done around larger blood vessels so that way they could use the ligasure jaw to cut off the blood flow. Roughly another hour went by and they were finally able to take the left lobe of the thyroid of this patient completely.