Week 4: Urodynamics and first OR experience

This week I continued my shadowing experience with Dr. Chughtai in the urology clinic, and for the first time observed a couple of surgeries, taking advantage of my classmate who shadowed a plastic surgeon. Those were enlightening experiences as they were novel experiences for the most part.

The procedure I was able to watch was Urodynamics. Here, physicians access how well the bladder as a whole and how well the different muscles work together. The urodynamic test setup consists of an X-ray device to look at the different structures of interest, a couple of EMG electrodes and instruments to measure muscle electrical activity. The electrodes are placed on the subjects legs, close to the perineal area. Some sensors are also placed in the colon, vaginal canal and labia where applicable, as well as through the urethra and in the bladder. Aside from the sensor, in the bladder is a device that allows some fluid input (the procedure starts with an empty bladder and is with local anesthesia). After placing all devices where  they need to be, the bladder is gradually filled. The patient is then instructed to report any discomfort as well as when they feel the urge (light, medium and severe) to empty their bladder. This allows the physician to measure the bladder capacity as well as measure how well the bladder sphincters work in retaining fluid. Following the severe urge, the physician instructs the patient to hold the urine the release. Upon release, the activity measured by different electrodes placed on the lower abdomen, colon or vaginal canal inform us if the patient is forcing the urine out or letting it flow with little to no stain on the bladder. Failure to void often means the patient needs assistance to empty their bladder. With no alarming signs on the x-ray, EMG output, if the patient is able to void on their own, there isn't much to be concerned about when the bladder fills as it is supposed to with no leakage. 

Aside from the urodynamic procedure, I was lucky enough to witness a complete mandible resection and right neck dissection tracheostomy with a reconstruction of the head and neck with pectoralis major myocutaneous flap and tissue rearrangement. For this procedure, I observed the careful removal of a previously placed orthopedic mandible implant with a reconstruction of the jaw and cheek using breast muscle tissue. It was an interesting procedure as I expected the muscle tissue to be completely detached from the chest before being used to reconstruct the head and neck. Instead, the surgeons carefully measured and cut the area of interest into a "flap"; while connected to the chest still, the surgeons maneuvered the tissue to the head by slipping it under the chest and neck connective/muscle layer. From an external point of view, after closure of the chest opening, it did not seem as if much tissue had been taken out. On the contrary, it seemed as a regular excision. Another aspect of the experience was to witness how incredibly efficient the team of surgeons was. In fact, there were at all times at least 4 medical professionals directly working close to the excision site. As well as anesthesiologists monitoring the patients vitals. Their work was vital as they controlled the blood pressure and other metrics while the surgeons made the cuts, ensuring little blood would be lost. Despite the crowded surgery table surgeons communicated efficiently and while working at different sites, it seemed as if it was only one surgeon was working. To me they formed an ideal team. 

This week was novel in consideration to what I did in the past weeks. Although I made little progress on my data analysis, all was compensated by the shadowing experience in clinic and in the operation room/OR.