Week 5 - Mia Huang

 As the immersion term almost comes to the end, I tried to watch as many surgeries as possible when I am still here. On Monday, I shadowed a C4-7 ACDF, anterior cervical discectomy and fusion with Dr. Riew. I noticed that at the C4-5 level, Dr. Riew used a metal stand-alone cage with cadaver bone. At C5-6, he used a white PEAK cage with cadaver bone. At C6-7, he only used bone that was shaved to fit in between the vertebral bodies. The mental stand-alone cage has to be screwed in, while the peak cage doesn’t need to be screwed in, instead the levels connected by the peak cage has to be secured by a plate and screws along with the C6-7 bone. The stand-alone cage, as suggested by the name, can be implanted without additional plates. 


I also saw a Craniotomy with Dr. Knopman Monday afternoon, where he opened the patient’s skull and drained an abscess. He used the navigation system to find the precise location. Instead of taking a CT right before the surgery, the CT was taken ahead of time. There are pointers that look like blue stickers that were put at specific locations on the patient’s skull when they took the CT. During surgery, the pointers were out at the exact same place so that the computer knows where the patient is with regard to the CT taken pre-operatively. Later in the afternoon, I saw a lipoma excision with Dr. Tassler. The lipoma, a fat lump, was located at the right side of the patient’s nose. Dr. Tassler cut open the skin and used bovies to separate the lipoma.


I shadowed Dr. Riew with his clinics on Tuesday. Dr. Riew mentioned that PADI, posterior Atlantodental Interval was an extremely important criteria to determine if a patient needs surgery right away. The PADI measures the diameter of the spinal canal directly and from this parameter, you can tell how much of the spinal canal is narrowed. In healthy candidates, the PADI should be at least 14mm because you need at least 10mm for the spinal cord, 2mm for the dura matter, and 2mm for the cerebrospinal fluid. For patients with a PADI that is less or equal to 13mm, surgery is highly recommended regardless of neurological deficits. 


On Wednesday, I saw a total hip arthroplasty with Dr. Lane. The patient has their right side femur head cut out and had ceramic femur head implant and lines implanted. A Titanium acetabulum cup was pressed fit into the acetabulum. The implant stem was pressed fit into the femur. The surgery was longer than I expected because to ensure secure fit of the implants, the doctors has to spend a lot of time shaving the bone using drills and trying out different sizes of implants. The doctors were wearing special blue head pieces that are sterile and covers the entire head with plastic in the front. This is to avoid blood splashes onto the head.


Later on Wednesday, I watched a nephrectomy with Dr. Scherr. The patient had their left kidney taken out. In the evening, I saw a liver transplant surgery with Dr. Halazun. The surgery was very long. They started incision at around 8:30pm. By 1am, the donor liver finally got here, but they still had to take the diseased liver out and prep the donor liver. The patient had a very complicated condition and lost a lot of blood. We didn’t watch the whole surgery because it was too late. 


I saw an IORT, intraoperative radiology therapy, for breast cancer on Thursday with Dr. Ng who is a radiology oncologist. Dr. Alexander Swistel made the incision at the right breast and exposed the inside. Dr. Ng put in the radiation applicator that was connected to the source. The radiation was set to be 20 Gy, and the distance was 10mm. They put a small piece of lead against the rib and left the applicator inside the breast for 28 minutes. 


Thursday afternoon I went back to Dr. Riew’s clinics. I learned that a combination of one level of disc replacement and one level of fusion was not approved by the FDA because medical device company won’t spend money and time to do a study for this and apply for approval. 


I will be shadowing Dr. Ng’s clinics and see breast cancer patients on Friday. This week has been fantastic and very productive! I look forward to the last week of the immersion term!

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