DB Week 7

Cystectomy

This week I saw a bladder and prostate removal via the da Vinci robot followed by the construction of a new bladder from the patient's colon. 

In the robotic part of the procedure, fat and connective tissue was removed to gain access to the ureters, bladder and prostate. There are 3 monitors to watch the robot camera. While this is great, it was very hard to make out what was going on during the start of the procedure. Clamping of the ureters and the sealing of the urethra were noticeable. The actual removal of the bladder and prostate was unclear, just a bunch of cutting and cauterizing. Once removal was complete, the bladder and prostate were bagged inside of the patient by the robot.  

The second part of the procedure was extremely interesting to watch. The patient was cut open and a ton of fat and intestines was moved out of the way. The bagged materials were removed and saved for pathology. A section of the colon was exposed. At this point, I was able to stand on stool right next to Dr. Scherr, getting a surgeon-eye view. About a 10cm length of colon was partially detached such that the blood supply remained intact. A strip of colon was cut and opened flat. Then, two holes were cauterized in the strip. The ureters were inserted through the holes and catheterized to drain urine while the bladder was non-functional. The ureters were dissected on one edge to create flat flaps of tissue that could easily be sown into the colon stratum. Next, the doctor and fellow assembled  the bladder by creating three suture lines, working effortlessly as if sowing the seams of a quilt, constantly asking for more thread. At some point during this process, Dr. Scherr started a conversation where we discussed the procedure and the potential for engineering new bladders from scratch. It was motivating that the surgeon is trying to move beyond this procedure, which seems so ingenious that you'd think no alternative would be in demand. I found it very interesting that this bladder provides continence which is engineered by crimping the exit  to the new bladder with sutures. Dr. Scherr passed a catheter through the opening to test its resistance. Too stiff and the bladder won't empty, too weak and the bladder will always be ready to empty. Since the urethra is shut, a new conduit must be used. Dr. Scherr removed the patient's belly button and promptly threw it on the table. This next part I found really weird and interesting. The colon piece is sowed directly onto the outside of the patient's abdomen. Part of the body that was inside is now outside. A catheter tube was place through the hole for permanent use. Controlled urination from the belly button is now a reality. 

Dr. Scherr is awesome and this was definitely my best OR experience of the summer. 

The rest of the week

Saw some cool things in the MICU and SICU, and downloaded the echos for our research.
Zhe and Alexey were also able to give me an MRI.

Summer Immersion

This was a transformative experience that has given us a perspective into healthcare that we could not achieve in any other way. While I would not consider my experience immersive, as it should have been, hence the title, it was still fulfilling and completely worth it for the best moments.