Tuesday, July 30, 2013

"Turn your head and cough, please!" Day 10

My poor back. I think once I am in any position to say something and make decisions, especially in my OR, it will be that things are done more back friendly.

There were only two procedures today but the first was 4 hours long and spectacular (except for the at times extreme back pain from standing).

Today I witnessed the first ever DaVinci operation in the Medical School Hospital of Göttingen. My chief was operating. He had apparently gotten a lot of hours of training in a different hospital and conferences because he performed the operation without any major problems. So what exactly is DaVinci? It's this beast:

How does it work?

-Five people are essential for the operation to work.
  • Operating surgeon
  • assisting  surgeon
  • OR nurse
  • OR runner (get supplies for the OR nurse who is sterile and can't touch unsterile things)
  • and the anethesiologist
-The patient is prepped as though he was having a laproscopic operation done. So instead of cutting the patient open, five holes are made where various instruments are inserted and the inside is made visible with a camera.

-The difference in the DaVinci procedure is that the operating surgeon isn't standing by the patient with his two instruments inserted in two of the holes but rather the DaVinci device is attached to two of the holes while the surgeon sits in a sort of console and operates the DaVinci machine from there.

-So the assistant is still standing at the table and inserting various instruments to essentially help the robot arms (inserting needles, removing tissue, sucking away the blood).

Why my back killed.

Most of the operation, this chair was right next to me:

My back was killing me from the standing so I tried all different kinds of subtle stretches to ease the pain and even thought about inventing OR-Yoga to help others. I was happy to see one of the assistant doctors (not operating but observing like me) was also stretching his back or had his thigh on the above pictured chair but he also never sat down.

At some point the older nurse (the oldest person in the room) momentarily sat down on the chair. I feel that was legit.

But why didn't Dr.M or I ever sit down in those 4 hours? I thinks its a hierarchy thing. Every one in that room knows that standing around for 4 hours in one spot will hurt your back. The chief was the only one (except for the anesthesiologist) sitting during the procedure. The assistant surgeon (who happened to be the attending) had to stand.

So if he had to stand the 4 hours and not move, what gave us the right as merely observers to be more comfortable than him? It would have looked really bad had I, as the little medical student, made myself comfortable on the chair while everyone else got to stand in pain. So it's a combination of hierarchy and solidarity I guess. Or at least it is in my head. So there I stood thinking up the next big fitness wave called OR-Yoga while watching the operation.

So what was done?
The patient's prostate was removed. It was crazy how the surgeon at the console was controlling the machine to actually sew things and cut and navigate through the set holes and the filled-with-gas stomach of the patient. Check out the doctor at work:

Luckily for me a representative of the DaVinici system was there to help. This was only practical for me because reps are known to bring food along for the OR-team and that is exactly what he had done. I was starving, cold and aching by the end of the operation so the three brötchen (German bread with something on it) and candy where a life saver (and I didn't have to buy food...I'm on a low student budget after all).

The other operation was an open kidney biopsy. Dr.H, Dr.M and I where done with that in less than an hour. Go team!

I debated going to the lab after all the work was done but then decided to enjoy the good weather a bit and hit up the basketball court with a good friend. Sometimes you just gotta live a bit...

Baci, V

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