As my twitter followers know, today I assisted in a surgery. I thought I would elaborate a bit more about that on here, share my experience and thoughts on the subject.
I now do my summer practicals at the surgical ward of the hospital, having done already 3 weeks at the nephrology ward. Yesterday I got to witness a couple of quite invasive surgeries, and I was asked if I wanted to assist in one today. To be honest, at first I was a little unsure, I mean, I had no idea what to do. I predicted that my assist competence would be about as good as that of Stewart Downing, in other words, not very competent at all. However, the junior surgeon who was explaining the procedure to me said I needed not to worry since I was doing it with the Chief of Surgery. I should just study up a bit on the surgery once I got home. Yeah, no pressure there.
We were performing an aortic bifemoral bypass surgery on an elderly patient who needed the surgery due to occluded arteries. In other words, the blood in the vessels had the fluidity of the traffic in Nairobi, and an alternative road was needed to avoid getting stuck. We were quite a team in the operation theater. There was the Chief of Surgery, another experienced surgeon and also a junior surgeon. Then there was an anesthesiologist, and a couple of scrub nurses as well.
Before we got started we "scrubbed in" as it is called. We washed our hands and arms in the surgical way, which takes as long as 5 minutes, and then we stood there T-rexing our arms in that boss surgical way waiting for our surgical gowns. When I had my gown on, and had put my squeaky clean hands in a pair of sterile surgical gloves we were ready to go. The chief and I on one side of the patient, and the other two surgeons on the opposite side. I'll now try to explain what the surgery was like, but if you don't feel like reading a bunch of medical terms, I'll include a short video at the bottom of the post of a surgery of the same type.
Firstly, an incision was made on each thigh, and the femoral artery was exposed at the location of the bifurcation of the profunda femoris artery. I held open the incision as the chief initially cut deeper to locate the artery. Then all the small blood vessels around the incisions were tied to prevent bleeding. Here I got to clamp the vessels, as the chief tied a suture around them. When the arteries had been exposed and the bleeding had been controlled, it was time for the big kahuna.
A long incision was made along the mid line of the patients abdomen. When the incision was deep enough to penetrate the peritoneum, I and the junior surgeon stretched open the abdomen using a pair of retractors. The chief examined the intestines to see that everything was ok, and enjoyed quizzing me on various anatomical structures in situ. That's right, not even I could escape having an oral quiz.
After confirming that everything was in order, the chief partly pulled out the intestines and put them on the patients belly in order to get to the aorta. Another incision was performed, now on the posterior side of the peritoneum, close to where the duodenum pierces it. And there, in all its glory, was the aorta. The aorta was cut open at the level which the inferior mesenteric artery branches off, and, obviously, there was a lot of blood splashing about. The chief commenced to pull out loads of old clots inside the aorta, part of which was causing the patient their problems. The aorta was then clamped, and the graft was prepared. The long part of the Y-shaped graft was implanted on the aorta, and using other tools, the two other short parts of the graft were pulled from the place where the incision had been made for the femoral arteries. It was quite intense throughout, as the surgeons were elbow deep in the patient pulling the graft along the original arterial course. The two short ends of the graft where then implanted on each of the femoral arteries. Thus, the bypass had been performed.
It was quite a gory procedure, with intestines and blood everywhere. The aorta was unclamped from time to time to test the sutures holding the graft in place, and whenever there was a small leakage the blood spewed out on everybody. The aorta was then clamped again, the leakages were fixed, and the aorta was again unclamped. This was continued until there was no leakage and the graft was firmly attached to the arteries.The main part of the surgery was now done, the two experienced surgeons left for lunch, and I helped the junior surgeon stitch the patient back up along all incisions, and bandage accordingly.
The surgery took 3 hours, and it was really tiring having to stand for all that time in a small space around the patient. However, for what I got to see and do, it was totally worth it. Even though what I did were things that could have been performed by anyone, I still felt very much part of the medical team. Tomorrow is my last day of summer clerkship, so to have got the opportunity to do this was really something fantastic. Hopefully this will be the first of many major surgeries I can assist in.
I now do my summer practicals at the surgical ward of the hospital, having done already 3 weeks at the nephrology ward. Yesterday I got to witness a couple of quite invasive surgeries, and I was asked if I wanted to assist in one today. To be honest, at first I was a little unsure, I mean, I had no idea what to do. I predicted that my assist competence would be about as good as that of Stewart Downing, in other words, not very competent at all. However, the junior surgeon who was explaining the procedure to me said I needed not to worry since I was doing it with the Chief of Surgery. I should just study up a bit on the surgery once I got home. Yeah, no pressure there.
We were performing an aortic bifemoral bypass surgery on an elderly patient who needed the surgery due to occluded arteries. In other words, the blood in the vessels had the fluidity of the traffic in Nairobi, and an alternative road was needed to avoid getting stuck. We were quite a team in the operation theater. There was the Chief of Surgery, another experienced surgeon and also a junior surgeon. Then there was an anesthesiologist, and a couple of scrub nurses as well.
Before we got started we "scrubbed in" as it is called. We washed our hands and arms in the surgical way, which takes as long as 5 minutes, and then we stood there T-rexing our arms in that boss surgical way waiting for our surgical gowns. When I had my gown on, and had put my squeaky clean hands in a pair of sterile surgical gloves we were ready to go. The chief and I on one side of the patient, and the other two surgeons on the opposite side. I'll now try to explain what the surgery was like, but if you don't feel like reading a bunch of medical terms, I'll include a short video at the bottom of the post of a surgery of the same type.
Firstly, an incision was made on each thigh, and the femoral artery was exposed at the location of the bifurcation of the profunda femoris artery. I held open the incision as the chief initially cut deeper to locate the artery. Then all the small blood vessels around the incisions were tied to prevent bleeding. Here I got to clamp the vessels, as the chief tied a suture around them. When the arteries had been exposed and the bleeding had been controlled, it was time for the big kahuna.
A long incision was made along the mid line of the patients abdomen. When the incision was deep enough to penetrate the peritoneum, I and the junior surgeon stretched open the abdomen using a pair of retractors. The chief examined the intestines to see that everything was ok, and enjoyed quizzing me on various anatomical structures in situ. That's right, not even I could escape having an oral quiz.
After confirming that everything was in order, the chief partly pulled out the intestines and put them on the patients belly in order to get to the aorta. Another incision was performed, now on the posterior side of the peritoneum, close to where the duodenum pierces it. And there, in all its glory, was the aorta. The aorta was cut open at the level which the inferior mesenteric artery branches off, and, obviously, there was a lot of blood splashing about. The chief commenced to pull out loads of old clots inside the aorta, part of which was causing the patient their problems. The aorta was then clamped, and the graft was prepared. The long part of the Y-shaped graft was implanted on the aorta, and using other tools, the two other short parts of the graft were pulled from the place where the incision had been made for the femoral arteries. It was quite intense throughout, as the surgeons were elbow deep in the patient pulling the graft along the original arterial course. The two short ends of the graft where then implanted on each of the femoral arteries. Thus, the bypass had been performed.
It was quite a gory procedure, with intestines and blood everywhere. The aorta was unclamped from time to time to test the sutures holding the graft in place, and whenever there was a small leakage the blood spewed out on everybody. The aorta was then clamped again, the leakages were fixed, and the aorta was again unclamped. This was continued until there was no leakage and the graft was firmly attached to the arteries.The main part of the surgery was now done, the two experienced surgeons left for lunch, and I helped the junior surgeon stitch the patient back up along all incisions, and bandage accordingly.
The surgery took 3 hours, and it was really tiring having to stand for all that time in a small space around the patient. However, for what I got to see and do, it was totally worth it. Even though what I did were things that could have been performed by anyone, I still felt very much part of the medical team. Tomorrow is my last day of summer clerkship, so to have got the opportunity to do this was really something fantastic. Hopefully this will be the first of many major surgeries I can assist in.
