Week 7 | Harry Peng | Dr. Rohit Chandwani

 This week I have seen another Whipple procedure and pancreatectomy. An advanced medical device, Argon Bovie, which was new to me was used this time. It can destroy tissue with an electrical current passed through a stream of argon gas to the tissue. Argon gas is emitted then ionized by an electrical current that results in the coagulation of the lesion or tumor, which stops the bleeding. The procedure started with a laparoscopic probing because the patient has a very complicated internal body condition. Although the tumor was benign at the pancreatic head, it was really close to the hepatic artery. Much liver bleeding was expected during the procedure.

The patient had a severe complication one day after the surgery and was taken back to the OR to have the colon taken out. Part of the cecum, and the whole ascending and descending colon were all taken out due to necrosis at the part where the arteries go through. This is very uncommon because normally it is the part lack of blood vessels getting necrosis. It was suspected that embolism from the heart or other parts of the body went right into the artery wall and blocked the blood flow through the big intestine. 

Other than the surgery, I have seen 5 more new patients and 4 follow-up cases, which brings my total patient count to 24. Among the new patients, I learned how to distinguish normal blood vessels from tumor mass since they both show brightly on the CT scans. By scrolling down and checking different layers of scans, the bright parts will all connect together if they are blood vessels; on the other hand, the tumor would just be a stand-alone bright sphere.

One follow-up patient was not cleared for surgery because the patient had a really low platelet count and previous cirrhosis. Upon evaluation by the hepatologist through a method called "risk of decompensation," the patient was suggested to have the blood test done again before the laparoscopic procedure to remove the GIST.

I was also working on my research project last week to study the Rac1 depleted PDAC cells as well as doing some simple migration studies and coculture experiments to see how they interact with the lymphatic endothelial cells.

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