Jonathan Go Week 3 General Surgery Day 1

     Today was the first day of surgery rotation!  Director Ou was not here, so instead we observed Dr. Fan and other physicians.   Our first surgery was on a middle aged male with a foreign body inside his right arm.  It was not visible by eye but was palpable.  We didn’t know if it was possibly iatrogenic or if it was a parasite or something else.  Dr. Fan could not fully resect it so he cut it out and sent it to the pathology lab.  Initial speculation is that it was just an enlarged blood vessel.

     The second surgery we observed was performed on an overweight female with 2 fractures in her ankle.  The first extended from her lateral malleoli up her fibula approximately 5 inches.  The second was only about an inch and centered around her medial malleoli.  There was some trouble getting the first (longer) fracture to sit right; however, after the correct positioning was accomplished, a clamp was used to hold the two pieces in place.  Following, a plate with 8 holes was placed across the fracture.  Each hole had to be drilled, measured, and screwed in with the proper gauge screw.  A temporary rod was used to hold the other fracture in correct position, followed by the insertion of two screws.

     The last surgery for the day was an emergency laparoscopic appendectomy.  The first step was to create a pneumoperitoneum using CO2, which is the classical way to perform the operation.  This created a space that allowed us to work in.  Three incisions were made, with the largest below the umbilicus.  The laproscope was inserted in this incision for most of the procedure.  Various electrosurgical instruments were inserted through the other two incisions to dissect out the appendix.  The instruments used electrical current and resistance to generate heat that both destroys/cuts and cauterizes the tissue simultaneously, thus controlling the bleeding.  Following, the appendix was resected using a staple tool that was referred to as a GIA: http://surgical.covidien.com/products/stapling/endo-gia-reinforced-reload.  There were complications in that the appendix had contents; however, the resection and stapling were ultimately successful.  Lastly, the appendix was put in a bag before being pulled out of the peritoneum, as to prevent the spilling of appendix contents in the event of it rupturing.

     So far surgery has been fascinating and I am excited to see more surgeries.  It is quite amazing how much stress we put the body through while under general anesthesia.  Observing the use of power tools in Orthopedics was definitely a stark juxtaposition of man and machine.  Lastly, I just wanted to note that Dr. Fan explained that doctors in our hospital somewhat have a more difficult job than that of a physician in another, bigger hospital because if anything goes wrong, we have no one for backup and must be self-reliant.