Week One: Eddie Wei

Over the first week of immersion, I had the opportunity to observe a couple standard urologic operating room procedures, each offering a different perspective on diagnosis, imaging, and operative care. On June 1, I observed two standard operating room procedures. The first involved the treatment of four urinary bladder stones using a cystoscope inserted through the male urethra. The cystoscope was first equipped with a specialized head capable of generating a stream of water to break down the stones. After fragmentation, the water head was replaced with a suction tube to remove the stone fragments and excessive water from the water jet. The procedure was performed under direct real time visualization with a  standard 3x magnification camera integrated into the cystoscope. This procedure lasted 2-3 hours, with 2 and a half hours allocated to breaking down these stones using the water jet. 

The second procedure involved a female patient undergoing blue-light cystoscopy to evaluate potential bladder cancer. Prior to the procedure, the patient received 50 mL of hexaminolevulinate, an agent used for showing fluorescence emission, approximately one hour before imaging using blue light fluorescence microscopy. Under blue light, suspicious cancerous or pre-cancerous tissue emit a bright pink fluorescence, while healthy cells remain blue, helping the physician identify areas that may require biopsy. This fluorescence-guided approach was very useful for improving visualization of abnormal tissue that might be more difficult to detect under standard white light camera. The results of the biopsy would help determine the patient’s next steps, including whether more aggressive treatment such as cystectomy might be necessary. In addition to observing these procedures, I also shadowed two patient questioning sessions, which gave me insight into how physicians gather clinical history, explain findings, and prepare patients for decision-making.

On June 2, I primarily shadowed patient interviews. One particularly striking case involved reviewing a Computed Tomography (CT) scan of a patient with a very large abdominal tumor measuring up to 29 cm. The tumor extended through much of the abdomen and appeared as a dark mass-like layer pushing against both kidneys. The CT image was based through the oral administration of contrast agents, which helped define the anatomy and distinguish the mass from surrounding structures. Seeing the scale of the tumor on imaging highlighted how radiologic evaluation is essential not only for diagnosis, but also for surgical planning and understanding the relationship between a tumor and nearby organs. 

The following day, June 3, I observed the operating case of the removal of the abdominal tumor, different from the case yesterday. While I only got to shadow only 2-3 hours of the operations where they were preparing to put the patient to sleep and first initial tasks, the operation took 6 hours, with them successfully removing abdominal tumors located behind the aorta and inside the vena cava. 

By the end of June 4th, my mentor and I identified a meaningful project idea to not only work on developing during my summer immersion term, but also potentially work on and commercialize, once I graduate from Ithaca. Overall, these first few days of immersion opened my eyes and gives me a better understanding of  how my research, which focuses developing imaging modalities to improve real time tumor diagnostics, could improve the lives of many clinically.