So this week, I got to see some surgeries. Dr. Nanus managed to set me up with urologists and they have kindly agreed to let me see their surgeries. On Monday, after a pain-staking hunt for scrubs and the schedule of my surgeon, I finally entered the OR for the first time of my life. Dr. Scherr had an emergency surgery. A tumor mass was found in the kidney of the female patient during a free screening. The tumor has grown into the vein and the heart. In the ultrasound in the OR, the tumor can be seen just entering the heart (which was amazing, but horrible at the same time). To remove the kidney, a cardiac-bypass is necessary to prevent the patient from bleeding to death after opening the vein. It was fascinating to see such a big surgery for my first surgery. The patient was literally open from the chest to the torso. The intestines were taken out for access to the kidney and renal vein. The chest was open for cardiac-bypass. I got to see the heart beating and how they did the stitches and attached the tubes to the pump. They also had to cool down the patient to stop metabolism since blood would only be circulating to the brain during the surgery. I saw the removed kidney with a tumor mass sticking out in the shape of the vein. I was told later that this was a very rare surgery and one of the most complicated surgeries in urology since it involves an urologist and cardiac surgeon. I must have been quite lucky to be able to watch this one.
On Wednesday, I got to watch two robotic prostectomy using da Vinci. This is as technologically-advanced as a surgery can get. A camera and various tools are inserted into the stomach of the patient via small openings for a minimally-invasive surgery, which allowed for better perservation of the blood vessels and nerves. The camera can zoom in 12x to improve the resolution and various tools are used to remove the prostate and to reattach the bladder to the uretery tract. The prostate, when removed, is actually placed in a bag, which is then sealed and removed from the body. The surgery was also shown on a 3D TV! This allows for the depth perception of the surgery, which definitely enhanced the experience.
On Friday, I went to a surgery with Brandon. It was interesting to go to surgeries in another department since most of the things I have done so far was in urology. It was definitely a worthwhile experience, and I will definitely branch out to other departments as well later in the immersion. Dr. Haytl, a neurological surgeon, was removing a tumor from C1 and C2 spine. The entire surgery required a lot of patience, experience and skill. The C1 and part of C2 were removed to access the tumor. It was very important not to cut the nerves, and to not damage the brain stem. The surgeons also only had a very small window from which they can remove and excise the tumor. An ultrasonic tool was also used to dissolve the tumor and aspirate it out. I was amazed at the patience of Dr. Haytl since the tumor was very persistent and difficult to be removed.
Tuesday and Thursdays are clinic days for Dr. Nanus and I followed him in his office. Surprisingly I am understanding more and can appreciate the cases a lot more. The days were also much less hectic that those in the first week, so Dr. Nanus has more time to explain the situation to me and I could ask more questions. Some very interesting cases came along. Dr. Nanus had a few new patients this week. One patient had found blood in her urine and her results were positive for cancer. It was heart-wrecking and difficult to watch as Dr. Nanus explained to her and her husband that she may or may not have cancer (more tests are required), but the chances are very high given her family history and her medical record (she had cancer previously). It was difficult to see how the patients are trying to minimize their emotions after receiving the news and approach the matter logically. I am amazed that doctors can do this regularly in their job as it was so painful for me to just stand there and listen to the conversation.
Another interesting case is that another patient has come in with a tumor mass in the kidney growing into the renal vein. He was referred to Dr. Scherr for surgery, which I hopefully will be able to observe. But, first, he must get an MRI in the brain to make sure he does not have metastases there, or else the surgery cannot take place.
As for the project, I am in the process of ordering antibodies and obtaining cell lines. Hopefully I can be trained on a flow cytometer soon, and get started!
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