Week 7: Peter

 Lab work was pretty slow this week but with the assistance of Dr. Min, I should have a lead on a pathologist to look over my results. I was able to watch some interesting surgeries this week. Wednesday morning, Dr. Chandwani was doing a robotic surgery to resect the tail of the pancreas where a tumor was present. Something I found interesting with this procedure was that he used the robot to clear a path to the pancreas and position it well but then he left the console and inserted a laparoscopic stapler through the umbilical port to actually make the cut. The intermixing of old and new technology seems to demonstrate that the robotic surgery still has room for improvement. Following this case, Dr. Chandwani was following up on an endoscopic ampullectomy case performed by another doctor. The patient's blood pressure had dropped severely so there was fear of sepsis with concerns of a perforation in the duodenum. Dr. Chandwani opened the patients abdomen and aspirated out nearly a liter of murky biliary fluid. However, upon a wash out of the cavity no leak could be detected. They then administered about 250 mL of diluted methylene blue through the NG tube to see if the leak could be detected. No blue was found to be leaking out so they called in the endoscopy doctor from before to discuss the results before closing the patient up. The doctor decided that he wanted throw the endoscope in to see if he could find anything internally. The duodenum was full of blood to the point that the scope couldn't effectively visualize the walls to find the source. Dr. Chandwani decided to cut into the duodenum to see what he could see. He was greeted by a stream of blood and promptly plugged the hole with his finger. After holding pressure for several minutes, the blood stream began to slow but the stomach was so distended with blood and air that it impeded his ability to stitch the duodenum closed. Suction from both the NG and the endoscope failed to clear out the stomach so Dr. Chandwani ended up making an incision to relieve the pressure in the stomach. This then allowed him to close to duodenum, but he was still left with an issue; he had no idea where the bleed was coming from. Short of removing the entire duodenum, he was out of options so he sent the patient to interventional radiology. However, to transport the patient, the abdomen needed to be temporarily closed using an Abthera, which is like a vacuum sealer for large wounds. IR was able to successfully embolize the bleed and the patient didn't require any further transfusions and got closed up on Friday.