Blog 20

Blog entry 15: 10/14/08

I couldn't have started off the week in a better way than by watching a surgery. At 8:30pm in Hospital Carmen, I watched a radical hysterectomy, and it was EPIC. It's very invasive and it takes about 2.5-3 hours to complete. It's analogous to a radical prostectomy, however, instead of removing the prostate of a man, we remove the uterus of a woman. The surgeon this time around was Dr. Banos, who was really friendly and let me watch the surgery right at the surgical table. I had the same viewing angle as I did in the radical prostectomy, so I could see pretty much everything that was going on inside the body, and this made the experience AMAZING.
Oh, and as a side note, I watched a cesarian a few days ago, but didn't have time to write about it. iA I'll try to make a post for it this week. Midterms are killer.
I'm really getting used to surgeries now. As the surgeon enters the body, I'm starting to identify and differentiate between tissues. For example, today I was able to identify lymphatic ganglion, the iliac arteries and veins, mucles, fascia, and fat. Also, I pretty much know most, if not all, of the functions of the techniques the surgeon uses in surgery. Considering the amount I'm learning by watching these surgeries, as well as the having the ability to talk to surgeons on a regular basis, this program is priceless. I'm able to go into the O.R. so much, that the surgical nursing staff knows who I am! There are no programs that offer such a comprehensive medical experience, especially for undergrads, and I'm experiencing medicine in a way I know most people won't even be able to imagine. I don't think I realize the extent of how lucky I am. Now, I'll go into the specifics of this surgery. I'll also contrast the radical prostectomy to the hysterectomy, as a way to compare the individual operative styles between surgeons.
The surgeon operating was Dr. Banos, he wanted to be more fast-paced in comparison to the last surgeon we had, mainly because it was a night surgery, and he wanted to get done before it became late. However, 5 min into it, he changed his mind and decided to spend more time teaching Me and Yadira about the procedures and process... We got really lucky.
The patient was a 64 year old woman. She had cervical cancer, which is generally detected through a papsmear(if the lesion is not visible), or a biopsy (if the lesion is visible). In this case, I think it was a papsmear because the surgeon told us we wouldn't be able to see the lesion. Dr. Banos preferred that the patient was fully anesthatized and intibitated to prevent her from moving around. I noticed that Dr. Flores from the radical prostectomy preferred his patient to be half-awake. The surgeon entered the body with a cauderizing tool. This woman was extremely skinny, and to get to the abdominal rectus we didn't cut through much fat at all. It was interesting when the surgeon stitched edges of the first 2-3 tissue layers in the incision to these large towels so that we would have better access to the cavity. The towels held the cavity open in a way which we could only see the innermost tissue layers. Then he checked the abdominal cavity with his hand for cancerous tissue. Inside the cavity, he cauderized blood vessels to prevent bleeding, as well as tying off certain tissues. As we went in, he showed me her large intestines. It was CRAZY when he pulled some of it out of her abdominal cavity to show us how it looks. Analogous to the prostectomy, the surgeon pulled off the lymphatic ganglion that runs next to the iliac vein/artery bundle and inferior to the obdurator nerve. He pulled off the tissue carefully so as not to tear into the artery or vein; if he did tear into the artery or vein, there would've been a lot of bleeding, mainly because they're HUGE. He also pinched the obdurator nerve, and we saw a leg twitch in response, which was really cool. The surgeon also repeated the procedure on the other side of the body, where he showed us the nerve that innervates the genitalia.
Then, he cut down 1/3 of the way into the vagina region to make sure there was no cancerous tissue left. Thereafter he cut the ligaments that hold up the infundibulum part of the uterus. To remove the uterus he cauterized all the way through the neck of the cervix.
After he removed the uterus along with the ovaries and uterus associated lymphatic tissue, he stitched the inner end of the vagina in order to seal it. In the pelvic cavity, he reconnected the ligaments that hold up the vagina. Before the entire cavity was closed, he inserted 2 "sondas", which are tubes that run from the inside of the cavity to a drainage pouch. The sondas are used to drain out residual bodily fluids. However, in the prostectomy, there was only 1 "sondas."
Reflecting back, the surgery was very similar to the radical prostectomy, but it was interesting to note the anatomical differences between men and women, as well as differences in surgical styles; even the stitching styles were different. This particular surgeon also felt around much less with his hands. It was way easier to see her iliac vascular bundle than it was for the man. I was able to really identify tissue differences, which was really a big deal for me. Last time it all just looked the same. Again, we were lucky because the doctors were all really nice. When I first pointed the vagina out, I didn't know what it was because of how it looked inside the pelvic cavity, and the entire surgical staff laughed for about 4 min.s straight. They called me chicitito, which is an endearing term for innocent little kids, and said I would find out what it was soon enough...LOL. I think I lightened the mood, which was good.