Surgery through the eyes of a teenager - Day 6

Day six, simply awesome! We spent all day in the intervention I was telling you about in the last post, with Dr. Halpern and three colleagues of him trying to fix the aortic aneurysm rupture in the patient. In the evening we were exhausted from staying on two feet for about eleven hours, but we were all happy that the intervention seemed to be a success.

When we got into the operation room, the patient was already laying on the table, prepared for the anesthesia. He received both spinal block and general anesthesia, the general one being for not feeling anything during the intervention and the spinal one for relieving the possible postoperative pains. The patient was quite cooperative and the anesthetist put him to sleep in almost no time, thus allowing Dr. Halpern to place the patient in a comfortable position for the surgeons to operate properly.

After having this done, Dr. Halpern, assisted by another colleague, started performing the whole procedure. Firstly, an incision would be done somewhere near the patient's shoulder so as to expose the axillary artery.

He had to cut through a superficial layer of subcutaneous fat and after that, through the proximal end of the pectoralis minor muscle so as to reach the artery. Once the artery reached, the team anastomosed (attached) a polytetrafluoroethylene (PTFE) prosthetic graft to the artery. This was done with the use of a very thin thread of polypropylene wire, similar to the one we had used for performing the fistula intervention in the first day.

The surgeons consequently attached to the graft a device called visceral perfusion system (octopus), basically a device which split the blood supply into four, one for each of the four major abdominal arteries that would have been left short of blood supply when they clamped the aorta so as to remove the aneurysm. The device was composed of different cannulae, all plugged one to another in a tree-like configuration.

Here was the first cannula inserted into the PTFE graft

Then, the surgeons opened the patient's thorax between two ribs, by cutting through intercostal muscles. Using a special device, they enlarged the space between the ribs. At that stage we could clearly see the lungs with some pretty black odd spots covering them (maybe due to smoking?). We could even make out the heart beating at pretty high rates and the anesthetist could even read on the ECG scan some abnormal extrasystoles when touching the heart with the hands or with surgical instruments.

You can clearly see the left lung of our patient in this picture

In this 5 seconds video that I've made, you can distinguish the beating heart in the open thorax of the patient

After this, Dr. Halpern cut the patient's abdomen and one rib into half so that he could have easier acces to the aorta, introduced the octopus into its place in the four major arteries, one branch of the device per artery and finally clamped the aorta at the thorax level. Thus, the blood could pass from the heart to the viscera through this external "piping system" and not suffer from no blood supply while the aorta was clamped.

Here, the four plastic tubes are the branches of the visceral perfusion

Consequently, the team put another synthetic tube so as to replace the aorta, united the celiac artery, and the renal arteries were anastomosed together at the distal end of the prosthetic graft, while the superior mesenteric artery was attached to a smaller graft anastomosed at its turn, right into the middle of the prosthesis, used to replace the piece of aorta suffering from aneurysm.

Immediately after that, the surgeons started putting back in place the lungs, sewing back the ribs and suturing the wounds.

You can see the rib and the doctors' hands sewing it together

Finally, blood draining tubes were inserted into the patient's leg so as to collect any possible blood from postoperative hemorrhages. The axillary prosthesis was removed and the artery closed, in this way finishing the operation.

Nevertheless, the most amazing thing I noticed, what not on the 6th day I'm talking about in this post, but this morning (the 7th day), when Dr. Halpern came in and told me that last night he had an emergency, and had to operate from midnight until 7 AM another aneurysm, infrarenal this time, which is an operation as big as the one described here. So more than 20 hours of almost continuous work requires a lot of resilience from the surgeon and an ability to focus day and night without break.

This was the last day of "Surgery through the eyes of a teenager" series and I hope you enjoyed this fantastic opportunity of peeking through into the surgical world.

To sum up, it was an incredible experience and I believe it strengthened my resolve to follow the path of medicine. I would also like to thank Dr. Halpern once again for taking the responsibility of my being there and I also invite you to say your opinion regarding this 6 days experience of mine. See you soon!