Weekend 2

Blog Entry 12: 10/04/0 FORGIVE ME FOR GRAMMATICAL MISTAKES ILL GO BACK and correct it later.

This was probably the best day that I've had in Oaxaca so far. I observed a radical prostatectomy, which was the MOST invasive surgery I've ever seen. The only thing I could image to be more epic would be a open-heart surgery or a neurosurgery. I was there with my friend Yadira (or as Me and Nick call her Yadidaaaa!). She was a huge help because fluency in Spanish allowed me to understand what was going on in the surgery. This particular surgery was special because Hospital Carmen had to bring in this surgeon from Mexico City to teach the other surgeons at the hospital how to do this particular prostate removal. The teaching surgeon, Dr. Flores (A surgeon specialized in Oncology), did very beautiful work, and it was easy to see that he was an expert as well as a seasoned veteran. The other doctors were complimenting him on his work. Another reason the surgery was such an invaluable experience was due to the fact that the doctors in the room were so friendly, especially the head surgeon (Dr. Flores), and were willing to explain what was going even WHILE they were operating. They even let me take videos and pictures, which I'm definitely going to post. We were standing RIGHT next to the surgeons as they did the surgery, which made the observation an AMAZING learning experience; there was literally no way anyone could've gotten closer to observing than we did. To put it in perspective, I was as close as the surgeons were to the patient, but a little off to the side. In the U.S. they probably would've made us observe from behind glass in another room, which is also another reason why Oaxaca is such a priceless experience. I have trouble believing that any experience after this would be able to top the one I just had today...but maybe a neurosurgery or open heart might top it :P. Now I'll go to explain the specifics of the surgery.
We walked into the room with the patient already under the influence of anesthesia. His legs were wrapped and was given anticoagulants to prevent clotting anywhere in his body. Before the patient was operated on, doctors (I'm assuming his oncologist or primary care physician) already did a biopsy which revealed the presence of a very high antigen count, which usually indicates the presence of a tumor. Before any cutting, for about 5 minutes, the doctors would pinch the patient's abdomen to see if he would moan; moaning would indicate that he's still feeling pain and the painkillers still required more time to come into effect.
They started cutting his lower abdominal area, right above his penis, by using a very unique (at least it's unique to me) electrical burning tool. The first layer under the skin, was this thick layer of fat. It was REALLY weird that as the burning tool made its way through the layer of fat, it smelled like someone was frying something in cooking oil....very eerie. After the layer of fat, the surgeon stopped using the burning tool and instead started moving through the body by conventionally cutting connective tissue with different types of surgical tools. Throughout the surgery, the surgeons had tied off many parts of tissues with these interesting black ties (might be sutures), I need to find out what their function is, but I assumed it was seal bodily fluids from entering the cavity during surgery. As we made our way to the prostate gland, the surgeon was cutting out rectal lymphatic ganglion because these ganglion can serve as a pathway (which started in the iliac and ended in the prostate) for the malignant tumor to travel and spread to other areas of the body, such as in the case of metastasis. The lymphatic tissue was collected, and would later be sent to the pathologist for analysis to make sure that cancer didn't already spread along the lymphatic pathway; however, this was just a safety precaution, and Dr. Flores highly doubted that metastasis occurred.
Also, throughout the surgery, Dr. Flores put his hand fully into the cavity and felt around. He told me that a good surgeon must be able to visualize the cavity and viscera through tactile knowledge, surgical tools and visual knowledge were not enough. It looked SO CRAZY so someone put his whole hand and part of his arm into the gut of another man, but i thought it was cool.
Dr. Flores also said that this particular radical prostatectomy, saved 5-7 liters of blood over the older method; looking at how much blood came out, I would say this surgery MAYBE resulted in 1-2 liters of blood loss. There was bleeding when the surgeon cut into the pelvic fascia (visceral tissue), but the benefit of this was that we could see perfectly into the pelvic cavity, and therefore the bladder and prostate. What really blew my mind was when the surgeon cut the urethra, and separated it completely from the bladder and prostate gland (gland is located between the bladder and urethra), and we saw the catheter connecting the bladder to the separated urethra INSIDE cavity, I have pictures of this. Dr. Flores then identified the neck of the prostate gland, and started using the burning tool to separate it from the bladder. Once he separated the prostate gland from the bladder, he cut the catheter at both ends and used it to lift out the prostate gland.
Before reconnecting the bladder and urethra, Dr. Flores stitched the outer and inner membranes of both the bladder and urethra (my guess to promote membrane fusion). He reconnected the urethra to the bladder by passing a new catheter through the urinary pathway, and then stitching the bladder to the urethra, with only 4 stitches; his method of stitching was beautiful work, and all the other doctors were super-impressed. The cavity was resealed with stitches, by individually stitching together 3 layers of tissue. There was also a tube, that lead from inside of the cavity to outside of the body, into a bag that collected any extra bodily fluids that needed to be drained from the cavity. The surgery was over after that, and the patient was wheeled into recovery.
Some extra things I wanted to add about the surgery. The surgery was conducted in a way where the patient theoretically retained 100 percent of his voluntary bladder control, due to the fact that the surgeons where able to avoid damaging the neurovascular innervations that were located in the surrounding bladder control muscles. 15 percent of voluntary urinary control is located in the tissue surrounding bladder, and 85 percent was located around the urethra near the penis. The tissue was undamaged, and was joined together after the prostate gland was removed. Also, at points during the surgery, the patient was awake and making some jokes, even though there was a hole in his abdomen almost a foot deep, which was REALLY bizarre. If it wasn't for the visual divider, the patient would've FREAKED out seeing his own surgery, guaranteed. Dr. Flores let me feel the removed prostate, and we could see how enlarged it really was. The prostate weighted about 80 grams, while a normal prostate weights about 20 grams. Also, one side of the prostate was more enlarged than the other, indicating where the tumor was.
Now, I know this has probably been my longest post, but here are my reflections...
After watching this surgery, I am CERTAIN I want to be a surgeon. It was amazing in so many ways. It requires high levels of visual and physiological knowledge, and a level of intricacy and skill that can only be gained through lots of experience and talent. You have to be able to know the human body on an instinctive level, using intuitive knowledge to navigate the viscera as if it were the back of your hand. Surgery is an AMAZING art and it seems to require the usage of the left and right brain, which I think is the best way to stimulate the mind. I love it because it's a high level skill set, which makes the field really special, it's not something everyone can do. I think I fit into this field because I'm a very visual-spatial thinker and it's a field really based on using that sort of talent to develop it into an expertise. The surgery was 4.5 hours, which felt like 30 minutes; and I guarantee, I would've been glued even if it went on another 10 hours.