Week 7 - Amanda

This last week was bitter-sweet. Even though I'm excited to leave the city (so many people, everywhere, all the time!) and get back to my normal research, it's a little sad leaving this opportunity behind. I made the most of it this last week, trying to work surgeries into my research. On Tuesday I went to a cardiothoracic surgery where the patient needed a mitral valve repair. Open heart surgery was particularly interesting to me, and I had been hoping to see the procedure this summer. In high school, my biology teacher had his class watch a recorded video on open heart surgery. Back then, I was afraid of blood and had to tell the teacher to keep an eye on my to make sure I didn't pass out. I managed to watch half of it (with frequent looking-away), but I didn't pass out. Seven years later, I was curious to see if this particular surgery bothered me. I can happily report that I was fine. In fact, I put on a face mask and stood next to the anesthesiologist by the patient's head, discussing and pointing out heart anatomy on the exposed heart while we waited for the surgeon to come from another surgery. The procedure itself was very fast. Once the surgeon appeared, he had the heart stopped with the patient on cardiopulmonary bypass and the heart opened within minutes of entering the room. He quickly assessed the mitral valve damage, and decided it could be repaired instead of replaced (which is ideal for the patient). In this case, the valve was prolapsed and ruptured, which means the main leaflet went past the normal stopping point, allowing blood from the left ventricle to shoot back into the left atrium. The surgeon sewed a biocompatible metal ring around the valve annulus, mechanically prohibiting the leaflet from going past the optimum stopping point. The surgeon sewed the heart back up, shocked it to get it beating again, and then made sure the valve was working (via doppler ultrasound) and the patient off bypass before leaving the room.

Although I thought watching open heart surgery, practically looking over the surgeon's shoulder, was great, I got an even better opportunity a few days later. I had set up a meeting with Dr. Scherr, a urologist that I'll be collaborating with for a new research project in my lab. I will be working with rat models of prostate cancer, developing instrumentation to optically detect nerves during a prostatectomy to aid the surgeon in avoiding nerve damage. However, I'm new to the field, so I asked him if he was doing any procedures that day that might help me understand the prostatectomy surgery. That afternoon he was performing one of these surgeries, so he invited me along. Dr. Scherr was one of the first surgeons to use the daVinci surgical system for minimally invasive procedures, which is ideal for a prostatectomy. All of the operating room staff were more than happy to explain the whole procedure as it progressed. They began by putting the patient under anesthesia, strapping him down, and tipping the bed so his head is much lower than the rest of his body, allowing the intestines and other organs to slide closer to the diaphragm and leaving room in the pelvic area for the surgery. They cut several small holes in the lower abdomen, placed about 5" apart, and slid cannulas in that served as ports for the daVinci instruments. They then wheeled the multi-armed robot over to the patient, and placed the tools on the arms, and guided the arms into the cannulas. This operating room had two control consoles for student teaching. The first part of the surgery consisted of clearing away the fat and tissue to expose the prostate, which was apparently easy enough for one of the newer residents to perform on his own. I sat in the other console, and had an opportunity to see the 3D display that allows the surgeon to gauge depth. It was incredible seeing exactly what the surgeon sees. I was surprised by the textures of the tissue, and noticed that some tissue could be cleared by "scooping" or swiping with a scalpel rather than direct cutting (mostly fat). I was very unfamiliar with the anatomy, as they kept on referring to small muscle groups in the pelvis and other landmarks that were relatively obscure/specialized, but I was able to understand most of the procedure. I'm excited to relate this surgery to the surgeries I'll be performing in rat models. Hopefully this will ground my research in an actual clinical basis.