Top Three Surgeries

Since I am now done with third year, woohoo, I am ready to come out with my top three surgeries list. One is from Ob/Gyn and the other two are from Surgery. So here it goes. Do not get too excited though, after all there are no pictures so you do not get to see them.

Coming in at number three is the abdominal myomectomy from Ob/Gyn. The myomectomy is done to remove leiomyomas also know as fibroids and as fireballs by some. The fibroids are most commonly located in the wall of the uterus, although they can also grow into the uterus or grow off of the uterus like a polyp. In order to do the surgery, a tourniquet was tied around the uterus to cut off the blood supply since fibroids tend to be pretty bloody. Then the uterus was palpated to locate the fibroids and we sliced open the uterus layer by layer. The fibroid then kind of popped out after some adhesions were removed. After all of the fibroids were removed, the uterus was then sewn up with three layers of sutures. The last one was a baseball stitch. I wanted to tell the lady that she had baseball stitches on her uterus, because I would want to know that, but I figured it was not really my place. After that, the tourniquet was released and we watched the uterus to make sure there was not any bleeding. Then she was sewn back up and she should be able to have a child.

At number two is the coronary artery bypass grafting (CABG pronounced cabbage like the stuff in sauerkraut). This could easily be substituted with a valve replacement or pacemaker placement. The coolest part is that they use little sutures and sew on to the heart. So why do a CABG? A CABG is done when the arteries on the outside of your heart are not so good. They are filled with plaques and no longer have blood flowing through them and the heart can no longer get the nutrients it needs to keep pumping, which is kind of important. When three or more of these arteries are clogged or your left main one is, a CABG is in order. There are some other reasons also. Because the current arteries are bad, replacement ones need to be found and these are called grafts. One can use internal mammary artery which is conveniently located in the chest or the saphenous vein from the leg which has to have the valves removed with a cool little instrument (a rod with a hook). Prior to the suturing, the patient goes on a cardiopulmonary bypass machine where the blood shockingly enough bypasses the heart and lungs and circulation is maintained throughout the body. At this time the grafts are sewn on the heart downstream of the clogs in the bad arteries. The cardiopulmonary bypass machine is turned off blood goes back through the heart and it begins pumping. Then the other end of the grafts are sewn into the aorta while the heart is beating, too cool. By the way if you ever have a chance to see one, the best place to stand is at the head of the bed with the anesthesiologist. If you are a giant like me, then a step stool or two might be needed.

So what could possibly top the CABG and come in first place on my list??? Well, I have to say this one has some favoritism involved because I actually got to do a lot during this surgery, woohoo. This one was also on cardiothoracic surgery. So coming in at number one is the thoracotomy(chest incision) with decortication and wedge resection. Decortication is the removal of an infected fibrous rind from around the lung. This was the part I got to help with. I am trying to think of something that would be similar. Well, something that is close but not quite would be if you were peeling an orange and wanting to do it very gently so as to not tear any part of the orange while taking of the peel. You would always want to maintain that thin membrane that keeps the orange juice inside. With the lung that membrane would be the pleura. It was a slow process, but one worthwhile since it helps preserve lung function. We used retractors and a little cotton thing which I cannot remember the name of to gently separate the pleura from the rind. We also did a wedge resection which is the removal of a part of the lung which was too infected to keep by using a staple gun. The staple gun works by putting the area that you want stapled into it and then it releases about 45 staples all at once and the wedge comes off. I think there is something more to it, but I cannot remember because the stapler works so quickly.

So that is it the top three surgeries according to me. I considered doing the top smells of third year, but there were some pretty bad ones and I did not really want to reminisce about them.