This week was very exciting surgically: I was able to watch cardiothoracic surgery on Monday and gynecologic oncology surgery on Thursday. It's hard to believe these seven weeks are over, but I'm excited by everything I've seen and learned and have renewed motivation for my work in Ithaca.
Each of us had the opportunity to watch cardiothoracic surgery this week with Dr. Girardi. While this was the first "major" surgery I watch, I found it remarkably calm and uneventful. I saw a 70-year old man undergo a triple bypass, with veins for grafts taken from his upper right leg and mammary vein. It was difficult to see the procedure, as the opening is not that large and many people are actively working at the same time. However, for a portion of the surgery I was able to stand at the head of the patient (where the anesthesia team is) and from there I was able to see the last graft attached and the heart restarted. It was definitely one of the more inspiring things I saw this summer.
This week I again watched gynecologic oncology surgeries with Dr. Gupta. On Thursday I saw two surgeries for pelvic masses of unknown origins. The first patient, a woman in her 50s, was a patient I had previously seen in the office for her initial visit. This was great for me, as I was familiar with her history and the motivation behind her surgery. She was on hormone replacement therapy, and as a precaution, her general physician ordered a sonogram, which showed an ovarian/abdominal mass. As a result, she had an MRI which confirmed those findings, and was referred to Dr. Gupta. Her surgery began laparoscopically to remove the mass/her ovaries and fallopian tubes, determine whether it was malignant, and remove any other necessary tissues (uterus, appendix, colon, etc.) Inter-operative pathology confirmed that the mass was benign; however, her internal organs had a lot of adhesions, making it impossible for the surgery to continue laparoscopically. Consequently, she was opened up, which allowed the full abdominal cavity to be visualized.
The second pelvic mass removal surgery I saw was an older woman with a large (bocce ball-sized) mass, which was removed via laparotomy. Inter-operative pathology was performed on the frozen mass, which revealed that the mass was benign. I went with the sample up to pathology, which was interesting to see how a more "scientific" technique (pathology) affects active clinical/surgical practice. As the mass was benign, she did not need to have anything else removed, and was subsequently closed up.
Both of these patients were very fortunate to not have ovarian cancer, as it has very poor outcomes (5-year survival of <50%). It was very illuminating for me to realize that both of these women only learned of large abdominal masses through incidental imaging--underscoring the lack of early detection modalities for ovarian cancer. I'm looking forward to working with Dr. Gupta developing new ways of detecting ovarian cancer earlier, and as a result of this immersion term I have a much better understanding of the challenges associated with that goal.
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