げか 2 - Surgery II

I went back into surgery on Wednesday. It was only the third time I have been in there but it felt like the hundredth. I feel like I have been watching surgeries all my life, but each one is still just as amazing as the first one I saw.

I watched two operations on this visit: a Cholecystectomy (removal of the gallbladder) and a skin graft.

Cholecystectomy:
This was an endoscopic (or laparoscopic) procedure. Several small incisions are made at strategic points on the patient's abdomen and then the surgeon detaches the gallbladder and pulls it out through one of the holes. This particular patient had a rather bad case of gallstones, so his gallbladder was very enlarged. It was about the size of a pear, and the incisions are roughly the size of grapes, so there was quite a bit of tugging and twisting when it came to pulling it out. It reminded me of birth, only the result isn't a cute baby but a diseased sac of bile. Oh, speaking of bile, the surgeons accidentally punctured the gallbladder while they were detaching it from the liver, and this caused some of the bile contained within to gush out into the patients abdominal cavity. It was quite a sight!

This procedure was particularly impressive because the surgeons can't see anything they are doing directly. They have various long instruments stuck into their patient, which they are enthusiastically moving around, thrusting them into the far corners of this poor man's stomach, all time while looking at a TV screen. It must take a lot of practice. Obviously.

Skin Graft
Now this one was very interesting indeed. Whereas all the other procedures I have observed have been fairly routine, a skin graft can never really be routine, can it? I mean, if you need some of your skin replacing... how often does that happen?

The patient had had a malignant melanoma on her foot. The cancer was very aggressive so the dermatologist had to remove a lot of skin from the foot around the tumour to ensure there wasn't a single cell of it left that would spread. That happened several weeks ago. Now, the patient was well enough to undergo a second surgery to repair some of the damage sustained to her foot as a result of the first surgery. A large section of skin was removed from the patient's abdomen – about the size of a mango, to continue the fruit sizing system – and while an intern and resident took to sewing up this huge hole, the chief of dermatology started preparing the skin for grafting. This involved carefully cutting off the inch of fat – which is a delicious, bright yellow colour by the way – that was present and then smoothing the underside of the skin by cutting away any imperfections. When she was finished, the skin looked so thin and shrivelled I was just hoping that it was stretchy, otherwise it would never cover the wound. It turned out to be remarkably stretchy; The skin really is an amazing organ, you know.

Once the skin was loosely attached with just enough stitches to hold it in place, a blue dye was injected into the tissue around the would, presumably to track the blood flow to the new skin over the next few hours/days. That's when it happened.... the foot moved!!! Ha! The surgeon stopped what he was doing and gave a rather amused look to the anaesthesiologist, who quickly made a few adjustments to the station at his end of the table. Aw man, the foot moved.... awesome :-)