Friday, June 18, 2010

Kidneys et al.

On Tuesday I first saw a tunneled dialysis catheter placement on an old woman. Interesting was to see the ultrasound machine used during the anesthesia and the real time x-ray machine used during the surgery. The second surgery that I saw was a fistula. The doctors wanted to put a vein closer to the skin and and sew it to an artery, thus creating a bridge between high and low pressure so that dialysis could be performed easier on this vein. Amazingly, the doctors were going to try a new method that they had never seen before! Instead of cutting 6 inches along the skin, they made two holes and cut and physically extracted the vein from the arm using a laparoscope!
On Wednesday I watched a kidney transplanted into an old woman. The kidney was cute according to the surgeon. Music was playing in the background. Two students were learning how to sew.. and hold the scissors right! Surprisingly to me, there was a second incision used for dialysis using the patients own tissue as membrane! Also surprising to me was that the intestines can be pushed around and pulled hard.. no problem! 
Very little bleeding. Suddenly a squirt of blood coming out, but quickly sewed.
Finding the bladder was difficult, finally a lot of urine came out, indicating that he had cut into the bladder. At the end I learnt that when sewing back the tummy you have to be careful to sew the muscle, otherwise hernia will develop!
On thursday I saw a living donor laparoscopic nephrectomy, though a lot of the work was done by two resident students. They spent 2 hours cutting things and eventually the kidney came out including the urether and a lot of fatty tissue which they wrap around the kidney for protection I assume.  Very interestingly, the patient had 2 arteries instead of just one that fed into the kidney, and these arteries were wrapped around each other making the cutting a bit difficult. Surprisingly, once the kidney was outside, they just stiched the two arteries together so that there was only one tube that could be connected to the artery of the recipient. This was done by Dr. Kapur in another room. To surgically join the two arteries into one took 40 minutes, time I used to look into the hole where the kidney was going to be placed and they told me where the bowel, veins, bladder, etc was located. Interestingly the bladder is small especially because these patients don't produce much urine,  so in order to find it and not poke into it by mistake they have to infuse liquid to expand it! The kidney is hold in place by 3 places (arteries and veins) but I thought that was not enough! especially after seeing so much cutting going on during the extraction of the kidney. According to the surgeons, kidney surgery is gratifying to the surgeons because blood is flown immediately through the veins after they have been sewn together and immediately you get urine filtered by the kidneys!! so you can tell if the surgery was done properly.
Surgery was a good experience for me but it was also very tiring to be standing there for so long without doing much. But from time to time things happened: They gave me instruments expecting me to know where to put them. Asked me which size of surgery gloves I used-  I said I didn't need them thank you. They asked me to page a doctor- I don't even know what a pager is. They asked me which side the kidney was- and I said I didn't know just in case!

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