Week 2

Prior to the start of our immersion term in New York City, I had only ever in the same room as 2 surgeries (both on myself). The past two weeks that number has increased ten-fold, as the majority of my time this week was spent in the operating rooms of interventional radiology.

Granted, these surgeries are generally quick and routine: biopsies among the most common of what I’ve now witnessed. As an observer of the technique required, I feel as though that routine seems mundane to me now; anesthetize, image, incise, insert probe, collect biopsy, deliver to in-room pathologist for confirmation as to correct samples collected (I’m sure the patients are thankful for this: I can’t imagine being called back to find out the initial biopsy was insufficient and needing to be called back for a second biopsy), and either collect more samples or close up. I’ve seen patients move in and out of the operating room in less than 30 minutes, and the numbers I’ve been told bear this out – apparently the department performs ~3 lung biopsies a day! In addition to these biopsies, I saw quite a few procedures adjusting inlet/outlets from specific organs: be it lines for bile removal or intake feeds for chemotherapeutics.

One of these procedures gave me the opportunity to learn about an interesting condition: a Morel-Lavallée lesion, wherein the skin and fascia covering the muscle separate, forming a gap susceptible to fluid accumulation and infection. In my head the layers are so compact, that frankly the idea that something like this could occur in response to physical trauma left me queasier than anything else I’ve seen so far.

By far the most notable procedure I was able to observe this week was a Transjugular Intrahepatic Portosystemic Shunt (TIPS). This procedure is done in response to hypertension in the portal vein, a frequent side effect of long term liver damage, which can lead to renormalization of blood flow through alternatives paths, and thus long term engorgement and possible hemorrhage of the alternative vessels not used to the additional flow demand. A shunt is placed between the portal vein and hepatic vein by piercing a path between the two with a wire, after which the shunt is inserted. This was the longest procedure I’ve had the chance to witness (all in all the preparation to completion time was six and a half hours), and I don’t know how the surgeons can remain so focused during that entire period as they guide the angioscope through the blood vessels.

All in all, this week represented the last bit of full time clinical exposure here at the hospital. I’ve now got a desk and a project started on some rather large-scale data analysis concerning lung biopsies (which, frankly, makes me happy that I got to see so many of them!), so I’m excited to see where that goes.