Week 2 - Anne

My clinical mentor, Dr. Prince, was away this week, so I observed a number of surgeries in other departments.

On Monday, I went with Pao to a robotic prostatectomy performed by Dr. Tewari. The patient was a middle-aged man with prostate cancer, and we arrived just as he was being put under anesthesia. The da Vinci robot for the surgery was really cool - it was over 6 feet tall and had four arms that entered the patient through small incisions on his abdomen. Dr. Tewari sat in an alcove of the OR, and his hand movements were mimicked by the robotic hands. He wears 3D glasses and his . We wore 3D glasses and were able to observe the entire surgery on a large TV in the OR. The prostate was removed whole and the urethra was reconnected to the bladder. Then the robotic arms were removed from the patient and the incisions were sewn back up. It was a relatively quick surgery, about 4.5 hours from start to finish.

I went with Chelsea and Peter to see a reconstructive surgery performed by plastic surgeon Dr. Spector. The patient was a middle-aged woman with Type II diabetes, and she had lost her eyesight in both eyes and had a large foot ulcer on her right foot. It had literally eaten away about 1/3 of her foot. The surgery involved taking a piece of healthy tissue from her thigh, including the blood vessels and muscle, and using it to cover the ulcer and encourage rejuvenation of the remaining foot tissue. One team worked on recovering the piece of tissue from her leg while Dr. Spector located the veins and artery near the woman's ankle to which the healthy tissue would be sutured and the ulcer area was prepped. Using a microscope, he sutured the veins and arteries of the healthy tissue. The thigh incision was sewed up, and the tissue transplant was trimmed to fit the woman's foot and sewed into place. It was an all-day surgery that hopefully saved the woman from having her foot amputated.

Yesterday I went with Sidd and Fredrik to observe two urology surgeries. The first was an elderly man who had come in for a prostatectomy for prostate cancer. Unfortunately the cancer had spread to his bladder, so the surgeon was going to use part of the right colon to make a new bladder. When they opened him up (it was a very invasive surgery), they discovered that the radiation treatment had left a quarter-sized hole in his rectum, so they had to remove that as well. I certainly hope all of the cancer was removed so he doesn't have to have more surgery.

The second patient was a younger man (early 40s) with a golf-ball-sized tumor on one kidney and a number of large kidney stones. The surgery involved dumping two buckets of ice into the patient's side to give the surgeon more time (about an hour) to operate while keeping the kidney's function intact. The surgeon removed only part of the kidney as the patient was unable to live with just the second kidney, and spent a good 20 minutes picking out several dozen kidney stones, one as large as a peanut.

Being in the OR has been an amazing experience and I am really glad I have been able to see up close what it is like to undergo a surgery for a life-threatening disease. I would really like to see the follow-up for these patients. Next week I will return to the MRI reading room on Monday with Dr. Prince and learn more about my research project!