This has probably been the busiest week of the Senior Research Project so far, which is why the blog post is so late in the week. I’ve spent a lot of time in the OR and in the office, gathering data, so here’s what I’ve been doing:

On Thursday, I had the opportunity to watch a neurosurgery case! But in order to explain what the case was about, I need to give a little background. When humans are developing, the spinal cord forms all the way into the tail bone, and as the fetus develops more, the spinal cord shortens, so it ends before it reaches the sacrum. In some babies, however, the spinal cord does not shorten, so it extends into the tail bone even after birth. In some cases, babies are born with tails that they can move, since the spinal cord extends into the tail. The baby being operated on did not have a tail, but did have a spinal cord that extended into her tail bone. So the surgeon, Dr. Ruzicka, made an opening in the baby’s back, exposing the spinal cord, which looked like a silvery, translucent cord. He then used a microscope to cut the spinal cord, and only the spinal cord, where it should have ended. He then used the smallest needle the scrub tech could find to stitch the dura mater (the outermost layer of the sheath covering the spinal cord) back together. By watching this case, I also learned that it is imperative that the surgeon has the tools he originally asked for.

While I was in the office, I had the surgeons start doing time trials with the smooth and barbed sutures. Here is a comparison of the two different suture designs:

Both of these sutures are monofilament sutures, so they are made up of only one strand of material (as opposed to multifilament sutures, which are braided). 

Hey followers! This is a fairly unrelated topic of discussion, but some of you may have heard about a shooter in the Phoenix area. It turns out the shootings were really close to Cardon Children’s Medical Center, my research site, so the hospital is on lockdown as I’m writing this post. Believe it or not, we didn’t turn the lights off and sit under our desks. All but 3 of the hospital’s entrances and exits are locked, while the 3 unlocked doors are accompanied by security guards. On the inside, however, everything and everyone is working as if nothing had changed, which makes sense, because there are still patients that need medical attention.

Update:  The shooter was caught just down the street, and he was actually taken to the emergency room at the same hospital.

In other news, at the beginning of this week, my advisor gave me a small cactus and told me that it is my responsibility to maintain and water the plant every week. Here’s what it looks like:

I came in during spring break to watch one of Dr. Vegunta’s laparoscopic surgeries. This particular surgery was a nissen fundoplication, in order to correct a hiatal hernia. A hiatal hernia is the protrusion of the upper part of the stomach into the thorax, which is the area between the neck and the abdomen, in which the thoracic cavity is located. The stomach enters the thoracic cavity through the hole between the two cavities, which the esophagus goes through. Dr. Vegunta and his colleague, Dr. Truong, created several openings in the patient’s abdomen for the camera and the rest of the laparoscopic tools. During the surgery, which lasted 7 hours, Dr. Vegunta pulled the stomach back into the abdominal cavity, then stitched part of it around the esophagus, so the same movement doesn’t happen again. Here’s a cartoon of what the surgery looks like:

Before I go, here’s some trivia for you:

What’s the difference between pain and tenderness?

What’s the difference between a symptom and a sign?

Write your answers in the comments, and I’ll give you the answers in my next post.

Hey followers! The research part of my SRP has started to become more concrete, as we’ve obtained all the materials we need to start running trials. We were able to buy pig uteri from a local supermarket. I was really surprised (and a little grossed out) that they were selling pig tongues and even pig hearts in the meat section. Thankfully, I didn’t have any need for those.

My research is dealing with laparoscopic anastomosis, which is the joining of two tubes by stitching their openings together. This will be done in laparoscopic simulators with the pig uteri, which will be pinned down so the material does not move around as much when being handled. As I mentioned earlier, I’ve been learning how to use sutures when I’m not in the OR, and now I’ve started practicing anastomoses on the pig uteri outside the simulators. But it’s extremely important that anything the pig meat touches is sanitized, because raw meat has a significant chance of carrying salmonella. I’m not supposed to let the cleaning wipes touch my skin, because their chemicals are harmful to it.

As one may imagine, laparoscopic tasks are much more difficult than regular tasks, and here are some of the reasons:

1.      The tools are extended, so the user must be very steady with his or her movements

2.      The tools must be placed through small openings that restrict their movement, so they cannot approach the material from the opposite side of the user

3.      The 3-dimensional material is being displayed on a 2-dimensional screen, so it is more difficult to determine depth

4.      The user cannot use his or her hands to tie knots or correct the suturing needle

These restrictions can make for a very long, very tiresome laparoscopic anastomosis. But that’s what practice is for.