Surgery Email
An Email Describing My First Surgical Experience
We have been working/observing at a very new hospital here in Cusco, Peru. Yesterday at the hospital was kinda lame (I was in OB and no one wanted to deliver their baby) I decided to be a tad assertive today and try to get in on a round that might be a little more entertaining. I went to oncology and ended up assisting on a 6hour operation to remove half of this lady’s colon. It was amazing! This is how it went down.
The Dr asked if this other girl or I wanted to assist along with one of the 5th yrs from Peru. I said that I wanted to. He asked if my heart was ok and if I had any classes in anatomy. I told him that my heart was fine and I had taken some anatomy. I then went to scrub in. We entered the O.R. and the patient was already out. The nurse put a gown on me and helped me get into gloves.
The doc made the first incision down and around the umbilicus with a scalpel but not too deep and then did the rest of the procedure with a cortorizing tool that both cuts and cortorizes to prevent blood loss. First we separated the omentum (layer of fat that drapes over your stomach and down over your intestines) from the peritoneum (inside lining of your abdomen. And then we went around separating the large intestine from anything that it was touching. There were a lot of vessels going to and from that we had to clamp, cut, and then tie off. I did a lot of holding the clamps and removing them once the vessel was tied. I also spent a lot of time retracting back the incision with this big shoehorn so the Dr could work inside it. I even got to cut an artery, to which the Dr made fun on my shaky hands.
Quick review of the colon, it is horseshoe shaped starting on your right where the appendix is and where the sm intestine connects with it. It ascends to your ribs, crossing your body, and drops down on the left and then twists into your anus. This lady had a cancerous tumor at the right (hepatic) colic flexure which is where your colon makes a turn going from straight up on your right to horizontal across your body. They call it hepatic cause it is in the general area of your liver (no not at your neck Bevis, lower). This tumor had spread via the lymph to other parts of the colon outside the actual tube.
Our job was to cut the small intestine just before it meets the colon (aka. large intestine), then cut the large intestine at the transverse section (where it crosses horizontally across the body at about the level of the bottom of the ribs), remove what was in between which turns out to be all of the large intestine on the right side plus some small intestine, the appendix, and some of the transverse colon, and then attach what was left of her small intestine to what was left of her large intestine (colon).
Once the desired portion of the colon was free from the general surroundings, we began cutting off its arterial circulation and cutting the mesentery (this is the fan shaped part that connects all intestines to the back wall of your gut. Once the arterial circulation was cut the part of the colon that it fed began to die, turning pink. This pink indicated where we were going to cut the colon in half and where to cut at the end of the small intestine.
We clamped off the intestine itself and cut it removing a good 18inches of intestine and a lot of the associated omentum and appendix. We also removed some lymph that was cancerous. Once it was all out it was about the size of a medium pizza. They then closed off the two open ends of the small intestine and large intestine with a couple layers of stitches. The Dr then opposed these two ends, sutured them together, made a new slit in each and sewed the two ends of intestine together allowing the new slits to be their communication. This approach may have been taken because the two remaining intestine ends were of different diameter and thus could not be easily joined by their ends. Oh, and this was all in Spanish so as you can imagine there was a bit of a language barrier. It wasn’t too hard to follow the commands, “up” “pull” and “suave” though.
Once she was all back together the Dr and the nurses played the ´how many sponges did we start with and how many did we end up with´ game. They Spanished back and forth for a bit as the Dr dug around in the ladies abdomen. While the nurses weren’t looking he pulled out the last sponge (rag) while trying to tell them that they miscounted. It really is amazing how easily something can get lost within 30ft of guts when you are looking through a 5inch opening.
So then they sewed her back up starting first with the peritoneum and then a second layer and finally this other doc showed up and ran an internal stick that closed her belly. Oh and just before this they poked another hole in her side and inserted a tube to drain any excess fluid. Then the doc left, the anesthesiologist turned off the drugs, we moved her from the OR table to a bed to be transported to the post op room. Then I left. The whole procedure took 6hours and smelled of burnt hair the whole time thanks the cortorizing wand. Standing in one place for 6 straight hours was definitely the most strenuous task that I have ever accomplished. I really don’t know how these guys do it. I´m gonna go pass out now. hoping to follow up with the lady tomorrow to see how "my first" is doing.
[follow-up] I saw the lady the following day. She was awake, coherent, and even drinking water. It was quite amazing to see her somewhat back to normal seeing as how I just the day prior had my hands all over her intestines.
Ciao,
Todeo
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