Week 8 - Our final week and an ending with watching a major surgery.

 Week 8!

This week was our final week of immersion and it was bitter sweat. Looking back, I have learned so many different things and it saddens me to leave the OR and clinic behind. However, I have made new connections with the thoracic surgeon teams. I may even decide to integrate lung cancer into my Ph.D. and expand off of the summer project.

This week in the OR was extremely exciting. I saw Dr. Alorki do an Esophagectomy - a major surgery which removes the esophagus. The esophagus runs from the throat, though the chest and into the abdominal cavity, and thus the surgery has three parts to it. The surgery took the entire day and in all probably about 6 hours. First Dr. Altorki made incisions on the chest and used a laparoscopic and minimally invasive approach. The esophagus is located in the mediastinum, this means that he had to first peel off the layers of the mediastinum to get to the esophagus. He detached the esophagus from the surrounding tissue and made sure that there were no blood vessels going into the esophagus. I noticed that it was very critical how a tissue was held, in terms of the direction and how much tension was placed. 

After this part was complete the patient had to be turned around onto the back and the surgery began in the stomach, this section was open. I asked why it was opened and Dr. Goudie said it was because the tissue in the stomach was much more fragile and better handled when the surgery was done open. Once again the vessels leading to the esophagus had to be removed and the esophagus had to be detached from any tissue. They ended up also cutting part of the esophagus, although I was unsure why. This section was extremely challenging. The doctors had to use a lot of strength to keep certain organs in a specific position, in addition to having to focus on have precise cutting in the correct area. They had to look for specific vessels as well, this part took a very long time, partially because every body is different but also because they had to search through the intestine and stomach for a small vessel. Although I really enjoyed the opportunities of watching surgeries laparoscopically, I really loved watch the surgery live in front of me, and watching the surgeons cut the tissue right in front of me. 

Once the stomach portion was complete, the surgeons had to open the throat. Dr. Altorki cut the esophagus in two in the throat, and pulled the bottom piece out of the stomach (which was still open). He then cut the part of the esophagus that connected to the stomach. They then used a specific technique where they put the stomach into a long tubed-shaped bag and pulled it up to the throat using a string. The throat was then stitched to the stomach. A feeding tube was also placed into the intestine, which is left there while the body heals. Eventually the patient will learned how to eat again.

Over all summer immersion was an incredible experience and I want to thank everyone involved.