Week 6: Three Surgeries, Two Patients, One Kidney

Who would you donate a kidney for?

Thankfully this was never a question that I had pondered before, until this week in my clinical immersion when I shadowed Dr. Joseph Del Pizzo in his urology clinic and during surgery. In his clinic, we saw several kidney donors – ranging from donating a kidney for a friend or to a friend’s grandparent – and met a patient who was about donate his kidney  the next day to his friend. On the following day I was able to see Dr. Del Pizzo perform his nephrectomy and follow the kidney into the transplant surgery with Dr. Sandip (see image below for kidney transplant diagram).

Image taken from:  https://www.drugs.com/mcp/living-donor-kidney-transplant

Historically, kidneys were removed through the patient’s side and back, which required an intense surgery with a large incision and breaking the patient’s ribs to have kidney access. As you can imagine, this gave little motivation to kidney donors and as a result it was much more difficult to get a transplant. A few decades ago, Dr. Del Pizzo’s mentor re-invented the nephrectomy by developing a technique in which the kidney is accessed through the patient’s stomach, making it a much easier and more attractive procedure for kidney donation. Then later, Dr. Del Pizzo improved this procedure by only requiring a small incision through the belly button to laproscopically remove the kidney. In this procedure, the surgeons guide a camera and surgical tools through the incision to cut the kidney out, scoop it up into a plastic baggie, then pull the kidney out through the incision. The kidney is brought to the other OR, where the transplant surgeon (Dr. Kapur) cleans the kidney and prepares the kidney and vasculature for the recipient. The kidney is cooled in an ice pack while it is attached to the patient’s vasculature and bladder, the kidney is re-perfused (turning purple as the blood re-enters), and then the incision is closed.

Later in the week, I was also able to observe Dr. Theodore Schwartz perform a right frontal lobectomy. The patient was having persistent seizures, and a partial frontal lobectomy can be performed to remove the part of the brain causing seizures without losing major cognitive or motor function. During the procedure, the surgeon cuts a long incision in the scalp from ear to ear, uses a drill to remove a piece of the skull above the frontal lobe to access the tissue, and carefully peels back the dura from the brain. They slowly remove the pieces of the brain until the frontal lobe is removed, stitch back the dura, add a skull plate back to close the hole, and stitches the scalp back together. During the procedure they even removed two large (1.5” diameter) masses to have sampled in pathology… it was crazy to see this large of pieces of the brain removed!

Post-brain surgery!

This week was really my first experience outside of cardiology during immersion, and I am thrilled that I was able to get this wider exposure to medicine. Although my understanding of these patients and procedures may not have been as deep as that in cardiology, I learned a lot and saw surgeries that I never imagined that I could see here.