Week 2 -- Bunyarit

For second week, I reobserve Dr. Tewari's surgeries and saw the da Vinci Surgical System in action. Dr. Tewari employed this system to perform robotic-assisted prostatectomies. For this week, I had a chance to explore robotic-assisted prostatectomies closer than previous week. I saw the surgeries from the beginning till the conclusion of the surgery. Before the surgery began, the patient was anesthesized. Thereafter physician assistants marked about 5 small incision points on the patient's stomach, and the robotic arms and endoscope were then inserted into the body. The physician assistants emptied the patient’s bladder by inserting a small tube to drain urine out of the body. After that, three assistants stood by the patient to guide, move the robotic arms, and prepare necessary elements for the robot, whereas Dr. Tewari sat at a console and remotely controlled the movement of robotic arms like playing video game but it is the game of life. Amazingly, the endoscope view provided clearer three-dimensional picture than human eyes did; consequently, the robotic surgery made him to pay close attention to details that open surgery cannot offer. For this surgery, Dr. Tewari would like to remove the patient’s prostate gland, but spared the nerves around the prostate gland in order to maintain bladder and sexual function of the patient, and the crystal-clear picture provided by the enndoscope is an important element for nerve sparing technique. At the conclusion of the process, the holes used for inserting robotic arms were repaired and anastomosed, and the patient stayed in hospital for 2-3 days.

I attended the weekly meeting of Dr. Tewari’s group, and there my project started to be defined. My research project is to investigate the effect of suprapubic tube on continence of patients after robotic-assisted prostatectomy. The motivation of this project predicates on the fact that after the surgery, patients are incontinence, which is the inability to control their urination. For this reason, the patients have to be inserted by small tube in order to empty their bladder. The tube will be inside the patients about 1-2 weeks, and then removed out. After the tubes are removed, the patients have to use pads. The number of pads employed by the patients will be representing their continence or incontinence. The further detail of the project will be discussed in the third week.