General Surgery W2D1 (w/ Dr. Ou)

I started the day going on rounds with Dr. Ou to check up on a few inpatients. The evaluation/interaction with each patient was very brief, so I was not able to absorb much information. Furthermore, I personally did not find what I was able to observe very intriguing.

The highlight of my first day in surgery came when I was able to observe pleurodesis by VATS procedure (video-assisted thoracoscopic surgery) for a patient who presented with a left-sided pneumothorax. The surgeons used only one surgical hole to perform the entire operation, which is normally done with three holes. This made the surgery much more technically difficult because all the tools were inserted from the same area. The head surgeon explained to me the only benefit of this technique is less pain and scarring. Throughout the entire operation, I was able to view the surgery with my own eyes, the thoracoscope, and also a general view camera. Thus, I had a pretty good view of everything that was going on at the table even though I was standing much further away.

First, the surgeons tried to rescue an area of chronic inflammation by compression of the surrounding area and forcing air into the afflicted portion. They were able to successfully force inflation of certain collapsed areas. However, a portion of the lung was still collapsed, so they clamped and cauterized it off. I was surprised to see how pliable the lungs were in a live individual. The only comparison I could draw was to cadaver lungs we have felt in anatomy. The difference of appearance and pliability was pretty drastic, the anesthesiologist was even able to safely completely collapse one lung if needed.

After rescuing part of the lung, they performed pleurodesis, which is intentionally destroying the parietal pleura layer by burning it off. The cauterizing tool made it look like the pleural membrane was disintegrating. By damaging the pleural lining, the healing and adhesion that ensues effectively attaches the lung to the chest wall and eliminates the pleural space. The purpose of this operation is to prevent the recurrence of a pneumothorax.

This is the first ever operation I have observed that used an internal video device. The prospect of this type of procedure really sparked my interest in surgery and I really look forward to what the rest of the week has in store.