Monday, June 28, 2010

Week 2 - Palacios

Last week ended with an extraction of a uterus which had such a big tumor that the woman seemed to have a 4 month old baby. The tumor was benign and this type of tumor in the uterus is called Uterine Fibroids. The procedure was the first that I have seen with the da Vinci robot, which is a very big and impressive machine. Amazingly, they did not begin to extract the uterus until four hours into the operation. This was because the woman had had all her kids by C-Section. As a consequence of all the C-sections, she had a lot of scar tissue that had glued together  parts of the uterus to the abdominal walls and the fact that she had not given birth to any of her kids the natural way also did not help when extracting the uterus through the vagina.
Surprisingly, as in most surgeries that I´ve seen, sometimes the surgeon was not completely sure of what he was seeing. This was shocking to me because I would expect that the surgeons would know where everything in the body is and how it looks. Also surprising to me was that the surgeons often don´t have a plan of what they are going to do, they just deal with things as they come along, and even the place of the initial cut into the skin is where ever the surgeon (or most often the resident student) decides at that moment. The extraction of the uterus was going to be done through the vagina and the surgeons were not sure if the uterus was going to fit through the vagina, but they tried to to it anyway.  Even after four hours of intense procedure the surgeons were able to make jokes all the time.
I learnt that we are not allowed to film inside the operating room, unless the patient has given her consent in a sheet of paper.
This is a picture of the actual machine being pushed into place. The robotic arms are covered in plastic to avoid possible contamination.

The rest of the week I spent in the lab of Dr. Suthanthiran, where I am learning about the diagnosis of acute rejection after kidney transplants, mainly by measuring the expression of appropriate messenger RNA in urine and blood samples of kidney transplant patients. I always wanted to learn about immunology and this is a great opportunity for me to do so, and for me it is a surprise that hospitals have such big laboratories where they do groundbreaking research.

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