7/28/16

Today was my first day back in the OR, and I picked a good morning to come. All the while, I had company in some interns from UT, and got to chat with Dr. Nguyen for a bit before he scrubbed in. It's interesting to see how calm and collected these surgeons can be before cutting someone open, but I suppose a lot of the pre-op excitement dies down when you're performing multiple operations each day. One great thing about today was that one of the performing doctors decided to use a headcam, which is perfect for giving us lowly students some insight into the surgery; a fiberoptic cable links whatever they're seeing to suspended TV screens around the room, displaying footage in real time. Otherwise, the only good view in the house is from the anesthesiologist's corner of the room, which can get a bit crowded. Today's case was a double bypass, and was pretty standard fare- sternotomy, saphenous vein harvest from the left leg, interior mammary harvest from the left breast, etc. At this point, unless I see a new procedure or surgical method, I can sit back and enjoy the surgeons' work instead of tapping away at my phone taking notes. But, I did find out about one thing: why the saphenous vein harvests are done endoscopically (within the leg), instead of making an incision along the length of the leg and opening it up completely. When I wrote about the first surgery in which I saw a vein harvest, I didnt know what it was (formally) called, and looked it up to find out. Most of the picture results displayed a long incision spanning the length of the leg, which seemed ridiculously excessive. Turns out that the latter method is is much more traumatic, and takes much longer to recover from. Here's a picture of endoscopic vs. standard vein harvest techniques below, to give an idea of what I'm talking about:

  I also watched one of the doctors prep the saphenous vein for the graft, which is something I've never really paid attention to. The vein gets flushed of blood, the leads going to the venules (smaller vessels along the vein) are sutured shut, and the vein segment is dyed purple to distinguish it as foreign tissue when the time comes to graft it onto the myocardium.