Sunday, June 21, 2015

Week 2: Engineering at play/more of the same...

So in addition to the various cases we get to see in Dr. Spector’s clinic hours and operations in the OR, this week we (Aaron, Zhexun and I) got the chance to see “engineering at play”. Especially in something like reconstructive surgery where the end 3D topology is such an important aspect, technologies such as CAD modeling is increasingly being implemented in their pre-operative planning.

Our week started off with attending the reconstructive surgery department’s weekly conference/didactic lecture series early Monday morning. The format of these talks is (usually) a more senior physician presenting a case study or on a specific topic relevant to their field to other attending physicians, residents, med students, etc. (us). I wasn’t aware that the subject of the talk would be a heavy discussion on patient pre/post-operative imaging (e.g. lighting, aperture, etc.). I was glad we stuck around, as one of the topics of discussion was regarding the utilization of a CAD modeling program (Crisalix) in 3D planning for operations. The reconstruction is carried out using a series of patient profile images and body measurements, and the resultant model can be manipulated to get a better idea of the end result of the procedure. While the service/program is expensive, surgeons (at least those in attendance) are hesitant in widely implementing the technology due to the potential for litigation issues. Not only did they view showing patients these 3D models as potentially misleading, but can leave them vulnerable to lawsuits/can be subpoenaed by an unsatisfied patient.
Wednesday gave us the opportunity to observe their planning of a mandible reconstruction with a fibula flap, the same type of 12+ hour procedure we saw in our first day in the OR. Via video conference, we listened in as Dr. Spector, in addition to the oral surgeon and the head & neck surgeon who will also be involved in the operation, consulted with the engineer actively modeling the phases of the operation (cutting of the mandible/fibula and positioning for fixation to ensure recapitulation of the original geometry). It was a lengthy process as they looked over the CT imaging of the patient’s jaw with a massive, but benign, tumor and simulated the bone resectioning/titanium implant positioning, accounting for even the most minute details. The Colorado based company would then fabricate the titanium mounts and 3D print the cutting guides for the procedure, which was pre-emptively planned for the last week of July. Hoping we will get the chance to see the procedure around then.

During the group meeting Friday morning, I was glad Dr. Min had brought up IDEAL (Imaging Data and Analytics Lab) within the Department of Radiology, and how they actively perform this type of 3D reconstruction/modeling to assist in the planning of various other types of surgeries. Hoping we can coordinate a visit to the lab and see some of the work they do.

Beyond that, more of the same from the previous week, as in ping-ponging between clinic/rounds/OR:
Tuesday: spinal wound debridement/closure, reverse-flap procedure to cover an exposed ankle implant
Wednesday: breast reduction, revision to a facial ALT flap reconstruction
Friday: rhinoplasty, and a nose/upper lip reconstruction
Additionally, Dr. Spector and his team performed a series of wound closures and debridements/skin grafts (split-thickness skin grafting from patients own skin or using Integra ECM composite) for patients for whom they are on consultation.

Overall, the more you immerse yourself into this experience, the more you get out of it. Side by side with the surgical team, we build a rapport and in showing our interests/enthusiasm, we come across unanticipated experiences and/or find them presented to us. Looking forward to what other experiences these next weeks will bring…

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