Week 6: Peter

 I finally made it into some surgeries this week with Tuesday being super busy. I got in a little after 7 and watched a simultaneous liver and kidney transplant with Dr. Samstein. It was surprising how mobile and stretchy all the components of the abdomen were. The tissue retractors were also pretty cool. I am curious how the anesthesiologist's dosing changes when they are temporarily missing some of these organs as kidneys and the liver play large roles in drug filtration and metabolism. I dipped out of this surgery so that I could watch some of Dr. Chandwani's case. His case had been bumped to about 5 pm due to some more pressing transplant cases in the OR. He was going to be removing some of the patients duodenum and possibly performing a whipple depending on the size and spread of the tumor. They quickly performed a diagnostic laparoscopy before opening up her abdomen. Due to a prior gallbladder removal, some of the organs were scarred and fused to one another making it much more difficult to access the duodenum. On Wednesday, I joined one of Dr. Chandawani's PAs on a case with Dr. Rocca. They were using the Da Vinci surgical robot to remove a liver cyst. Dr. Rocca was incredibly good at navigating the environment and almost had a proprioceptive understanding of where the arms were. He was using the shaft of tools to hold tissue back as he made cuts with the other tools. I also got to see one of his residents run the machine and see how they differed in techniques. The PA acted almost like a fifth arm to the machine and would provide suction where needed while also changing tools or dropping in new supplies like absorbent 'cigars'. On Friday I got to scrub in at another Dr. Rocca procedure. They were respecting a large portion of the liver due to cancer. They used this cool ultrasonic ablation tool to do most of the cutting and then would come in with the LigaSure to cut and seal the blood vessels that remained. It was a delicate operation working in such close proximity to the hepatic artery, vein, and the vena cava.