It’s been a while since my last post, but things are starting to wrap up at the hospital. Well, for my SRP, but not for anyone else. One of the pediatric neurosurgeons, Dr. Ruzicka, has performed multiple brain surgeries in the past week, all tumor resections, and he’s been kind enough to let me watch some of them. Brain tumor resections are very long cases, as they can last for more than 8 hours. Even the set-up is much longer than most of the surgeries I’ve observed. While watching these surgeries, I was particularly fascinated by two pieces of equipment:

            The first is a technology called Stealth. To use Stealth, doctors must take an MRI of the patient pre-operatively. Then, in the operating room, the equipment technicians place a sensor next to the patient, and connect it to the Stealth machine. The surgeon can then use a tracing needle and place it in the patient, and the sensor will pick up the tracer’s position, relative to the patient’s anatomy. The screen on the Stealth machine will show where the tip of the tracing needle is with multiple angles of the MRI that was taken earlier. So during surgery, a surgeon can figure out what exactly he or she is looking at by using the Stealth technology.

            The second is the microscope that Dr. Ruzicka used during the tumor resections. It was an incredibly complicated device mounted on a 7-foot tall arm. There were 4 different pairs of eyepieces and buttons on every side of it. Before the surgeon could use it, the entire arm had to be wrapped in a sterile covering, so he would remain sterile while working with it. The equipment technicians connected it to a 3D screen, so everyone in the room could wear 3D glasses and see the surgeon’s work more clearly.

            In other news, we had a fire drill in the clinic building today. With only a couple days left of my SRP, the problem at hand is trying to fit the whole experience into a relatively short presentation.

Two Surgeries I Didn't Know Were Surgeries

This week was a pretty short one for me, as I was only at the hospital on Monday and Tuesday. I was out of town for the rest of the week, so I wasn’t able to do as much as in previous weeks. I spent most of my time in the OR during those two days, but I did reach my goal of having at least 6 participants do timed anastomoses.

On the other hand, I watched some surgeries that I didn’t even know existed before Tuesday. The first case was on a person whose costal cartilage was protruding on the right side of his sternum. This excess cartilage was causing his chest to have an abnormal ridge to the left of his midline, since his left ribs were normal. To correct the problem, the surgeon, Dr. Greenfeld, had to cut through the patient’s chest until his costal cartilage was exposed. He pointed out to the rest of us in the room that the cartilage from separate ribs was overlapping and building up, only making the problem worse. Dr. Greenfeld pulled the cartilage out of the kid’s chest from about 4 different ribs and kept the pieces to the side. This left a gap in the patient’s chest, which the surgeon closed with some of the pieces of cartilage, so the cartilage would heal without the prominent ridge. The patient was in his late teens, so his ribs and his cartilage were very mature, making it much harder to pull the cartilage out. Another effect of the age is the amount of pain that the patient would have during the healing process of a few months. Any excision of the actual ribs would be more effective in removing the ridge, but would be more painful during recovery, so Dr. Greenfeld only took cartilage. Before completely closing the wound, the surgeon placed a drain in the kid’s chest to address any internal bleeding.

Another surgery (that some people may react more sensitively to) that I watched was on a baby that had just been born 2 hours earlier. The baby was tiny, and weighed less than 2 kilograms! His limbs had about the same girth as my thumb. In order to explain why he was in the operating room so early, here’s some background:

While in the womb, a human’s intestines are developed outside the fetus’s body, and when the fetus is big enough, the bowels fold into the abdominal cavity, following a specific pattern. In some cases, including this one, the bowels do not enter the abdominal cavity, and the baby is born with its bowels outside its body (not a pretty sight), although the ends are still connected to the stomach and the abdominal wall. However, this baby was too small to fit the bowels back in immediately, as most babies with this condition are. So the surgeon, Dr. Cox, placed the bowels in a special bag, in which the opening enters directly into the baby’s abdomen. Every day, the bag will be taped, and the bowels will slowly enter the baby’s abdominal cavity, until the opening can be closed surgically.

Things are starting to wrap up at the hospital, now that there are only three weeks left in my project. I’ve had almost everyone in the office, surgeons and their assistants alike, come in to do at least one pair of anastomoses to compare to each other. As a reminder, each participant is doing one anastomosis with smooth sutures, and one with barbed sutures. One external variable that could possibly affect the results is the fact that a task or procedure will almost always be easier the second time a person does it. Since the participants cannot do both anastomoses at the same time, we had to find a way to minimize this effect. So everyone completed a practice session to get the first simulated anastomosis out of the way, while getting used to the tools. This way, the participants would have started moving along the learning curve before they were timed. To further minimize the effect of the learning curve on the data, some of the surgeons have thankfully been able to set aside enough time to do a second round of time trials. So far, both surgeons and physicians’ assistants have been suturing more quickly with the barbed sutures.

However, the material and length of the barbed sutures have been a bit cumbersome for some of the surgeons. For example, some suture material has more “memory” than other material, which means it maintains its shape if it is bent, similar to how a piece of paper will remain bent if it is folded in half. This can cause annoyances while using the suture, because it will bounce back to its previous position if one lets go of it. The length of the suture can also be an issue when using it laparoscopically, since one always wants to keep the material and tools within the camera’s field of view.

In other news, I was able to watch Dr. Workman, the pediatric plastic surgeon, during some of her cases this week. On Friday, she had a surgery on an infant who had been born with radial deficiency. Radial deficiency is a congenital condition in which there is a lack of length in the radius, one of the bones in the forearm. The shortened radius causes radial club hand, in which the wrist is angled toward the radius, usually accompanied by a deformed or missing thumb. In order to straighten this baby’s wrist, Dr. Workman first opened up the wrist and moved all the tendons and ligaments out of the way. She then drilled a rod all the way through one of the metacarpals, entering the bone in the wrist and exiting it near the fingers. She then switched to the other side of the rod and drilled it into the radius. To finish, Dr. Workman cut off the extra part of the rod and closed the muscle and skin. Now, the rod is acting as a longer radius, effectively keeping the baby’s wrist straight. She also said that, in 6 months, she would be able to make a new thumb for the infant from its index finger.