Category Archives: rt knee ligament debridement

January 24, 2015

Written by Stephanie Nguyen (class of 2014-2015)

Yet again, Dr. Harken strutted (more like, I imagine he did because he’s awesome) into the meeting room dressed again in a suit. He jumped very quickly into the topic of scientific data—something I wouldn’t think would be discussed as a complete topic in and of itself. He focused very specifically on data gathered on patients with sepsis, describing the rating system for research and the reasons for why it is actually very difficult to collect complete data based on this system. It was an interesting lecture, to say the least. Something notable that Dr. Harken said was that he was “startled yesterday about how little [the students] knew about ebola”. That didn’t sound too good…

I had no guidance whatsoever in the OR this time, which made me feel a little more lost than I have been since starting with OREX. However, I figured that wherever Dr. Krosin was, I would be in good shape because of how outgoing and receptive he is toward his students. I ended up in a Right Knee Ligament Debridement with the resident Dr. Dickinson. There was a shuffle of attendings because of Dr. Billing’s sickness, and I did not end up seeing Dr. Krosin at all. The nurses reported that Dr. Billings was actually incredibly sick and needed to go home, but that he was still around trying to tend to one last surgery—I guess there are no sick days for surgeons.

Getting right to the surgery was a very quick intubation, because of the anesthesiologist’s technique that she claimed was “new” and more effective. They set up the patient’s legs, one off to the side and the other held up by the patient’s big toe and bound by a tourniquet. A computer screen was set at the end of the bed and shocked me when it very clearly said “SDC vein, visual capture initializing”. I didn’t realize this surgery was going to be laparoscopic and it was the first time I was seeing it. The surgeons did not immediately place the camera into the patient’s knee and instead spent a long time discussing the case. There was a definite need for meniscal debridement, which is more or less clearing out tissue at the meniscus, but there was also a possibility of an ACL repair that was difficult to actually diagnose because of contradictions in different tests and an MRI. What was a 1-hour surgery could become a 3-hour one with the addition of an ACL repair. It was decided that 5 minutes into the surgery, they would determine if it was necessary.

(Side note: this surgery is so much more relevant to me now that my sister recently twisted her knee in a lacrosse match. Her primary care doctor said that she may have a tear in her meniscus, just the way this patient did. It made so much more sense now to understand her condition and the necessary steps to fix this problem. I love when things like this become so applicable to my own life!)

Dr. Dickinson drew a star at the point of incision at the patient’s kneecap and stuck in a rod deep into her leg. The screen registered a lot of white and fibrous structures, with some yellow and red things floating around. I wasn’t able to grab anyone at the table to explain to me what everything was, but I watched as Dr. Dickinson moved the camera around to expose a great variety of images on the computer screen. Occasionally, Dr. Dickinson would pull the camera rod out of the knee to readjust, and fluid would pour out of the point of incision. I later pieced together that this camera rod has the function of ejecting fluid, possibly to flush things when needed. At the 5-10 minute mark, Dr. Dickinson announces to the team that the ACL is intact, although it is not in great shape. He informs Dr. Shah that he will not operate on the ACL, but will notify the patient and discuss with her the possibility of returning and performing surgery if she deemed it necessary.

Once the camera was finally set up in a way that Dr. Dickinson thought appropriate, he handed off the camera to another resident, Dr. Jackie. She took the camera in her left hand and inserted a pincer-like rod into the other side of the patient’s knee. The pincer came into view once she aligned the two rods together in the knee. The next hour or so involved the pincer rotating and trimming down the white meniscus particles, while another probe was used to pull out these fibers. Dr. Dickinson takes over at some point and he very obviously has more experience, trimming faster and more steadily. It all looks fairly easy, if not also reasonably tedious, but it is clear that it is extremely precise work—they do say that surgeons need to have steady hands. When the surgery is finally over in about an hour and a half, the patient’s knee is sewed up at the small holes where the rods went in and wrapped up at those same spots. Everything was so small and precise, it was amazing!

My next surgery was a left inaugural hernia repair with resident Dr. Arturo Garcia. As I pass a surgeon to go into the room, he informs me that Dr. Garcia is the “chief”, as they call him. I have observed a surgery with him before, but I never knew that he was so high-ranking and important (if not humorously so). Dr. Garcia creates an incision from the groin up and uses clamps to hold his incision open. It is rather small although the nurse positions me at the head of the patient and with a step-stool so I am able to see at least the movement of the tools and whatever is pulled up from the site. At this point, I wrote down in my notebook, “How can you tell?! Everything looks red and orange and squishy and lumpy”, which represents my awe about what I didn’t know and what these doctors clearly knew very well.  Dr. Garcia and the other resident surgeon stick their fingers inside their incision, feeling for the hernia and pulling out more structures. Occasionally, the medical student dabs and rinses the area. The most interesting part of this surgery is when the surgeons insert an A-shaped mesh that is sutured in. It looked so foreign in a body full of tissue. And then went the numerous sutures and ties that seem inevitable in a hernia repair. Toward the end, there is light-hearted conversation about Dr. Garcia’s new baby girl and the funny events of his wife’s pregnancy and delivery. Who would have known this tall, outgoing doctor is considered the head honcho of the OR?

That ended my 4-hour shift with OREX for January. Until next time!