Week 7

I spent some time this week observing different surgeries outside of HSS. After a failed attempt to watch an amputation last week I was able to see a below the knee amputation on Thursday with Jacob and Jason. The patient had a large sore on the back of his heel that resulted in exposure of the bone, and had no feeling in his lower leg. To perform the amputation, they mapped out the cut so that the soft tissue was cut more distally on the back of the calf, but the bones were cut near the more proximal anterior incision. This allowed the extra soft tissue to be folded over the exposed end of the limb and retain its vasculature. The major blood vessels and nerves were tied off and cauterized as they extended the incision around the limb. A bone saw was used for the tibia, but I was surprised that hand held bone cutters were used to cut the fibula. Since the fibula is much smaller than the tibia perhaps they were trying to protect the soft tissue from potential damage if a saw went through into the tissue behind it. Once everything was prepared, they slid a huge knife between the tibia/fibula and the soft tissue to fully separate the limb from the body. It was kind of strange to see somebody's lower leg just sitting on a table not attached to anything.

I was also able to join Lauren in observing a neurosurgery procedure. We saw an endoscopic endonasal pituitary adenoma removal. They accessed the tumor through the patient's nose, and since the procedure was video guided we could see everything on the screens in the room. They drilled through the sphenoid bone using a miniature version of the Midas bone mill the orthopaedic surgeons use to shape bone grafts. Once the tumor was exposed, they used an instrument that looked like a thin bubble wand to scrape the tumor off of the surrounding tissue and then used the suction to remove the pieces. It seemed like a very imprecise way to remove a tumor, with the potential to leave pieces behind or have pieces that were scraped off migrate somewhere else. That was one of the most surprising aspects of this whole experience. We like to think of surgery as this very precise, planned out procedure, but many times the plan is to go in and make a more complete plan once you get a better picture of what is happening.