Week 3: Nina

In the third week of immersion, I got to see my first robot-assisted surgery. I saw a living donor liver transplant surgery using the Da Vinci 5 surgical robot. It was really amazing seeing how the machine looks and operates in real life. While I have seen videos of the robot being used, I was shocked at how fine the resolution of the camera was and how precise each of the probes were in removing tissue. I also was surprised by the incorporation of multiple surgical tools into one robotic probe. The Da Vinci forceps attachment could cauterize and cut tissue, which decrease the amount of tool switching the surgeon had to do. It was really fascinating seeing how sealing tissue via stapling and suturing was done using the robotic arms. The vacuum pressure and gas exchange system incorporated into the machine, like the cauterizing and stapling tool, were also configured with audible cues to alert the surgeon to errors. I found that the auditory feedback helps the surgeon determine how long to use tools and allows them to monitor the success of failure of an intervention. One of the issues for this machine is that it the camera probe often had to be pulled out and cleaned manually. Stray tissue, bleeds, and system pressure/temperature can all contribute to build-up on the camera lens. Therefore, I think some optimization could be used clear the lens in-vivo and prevent time being spent on monitoring the state of the lens. Later this week, on Friday, I will see another liver resection. Together, experiencing clinic and surgeries has allowed me to see the importance of pre-transplant organ preservation and understand the value of surgical time when performing a transplant surgery. Up to this point, Dr. Samstein, my thesis advisor, Dr. Schwartz, and I have been finalizing the aims for the research collaboration that will ensue this summer. As liver transplantation involves human subjects, we have been careful to examine logistic hurdles to ensure the safety, de-identification, and consent of all involved parties before starting any research. My project will focus on examining the technique of normothermic machine perfusion used to preserve donor livers before transplant. More specifically, I will try to expand readouts for organs before transplant to better understand organ viability and predict graft success in patients.