Week 6 - Justin Levine

 For week 6 of the immersion program (which, although sad to consider, has us at the 75% mark for this summer experience), I had a lighter week of research, instead spending more time in the OR to shadow some unique and challenging cases.


Dr. Spector’s work as a plastic surgeon lets him work on tissues all over the body and perform operations in collaboration with a wide range of specialists, giving us a uniquely wide range of access to see different diseases and body areas worked on in the OR. However, one of the few areas Dr. Spector does not typically work with is the inside of the abdomen, and all of the important organs contained within. Dr. Spector talked with Pooja and I to determine what type of procedures outside his area of expertise we would like to shadow, and after we expressed our interest in any abdominal operation that would allow us to see internal organs, he asked his colleagues if any could accommodate us. Dr. Cheguevara Afaneh, a bariatric surgeon, was kind enough to invite us to the OR for a paraesophageal hernia repair surgery. 


Dr. Afaneh is a specialist in minimally invasive surgeries, and we were able to watch him use robotic microsurgery to repair the hernia. After making 4 small incisions in the patient’s abdomen to serve as ports for the robotic arms and moving the robot into position, Dr. Afaneh assumed his position at the control console. The robotic attachments were outfitted with cameras providing a high definition view of the patient’s insides, visible both to Dr. Afaneh at his control station and to us spectators (and the surgical team) via large screens in the OR. We watched as Dr. Afaneh controlled the robotic attachments to move through the patient’s abdomen, often needing to utilize the probes’ cauterizing cutting mechanisms to make its way through fascia, eventually arriving at the base of the esophagus, where the stomach had pushed up through the diaphragm into the chest cavity. Dr. Afaneh used the robotic arms to move the stomach back down, wrapping it around the esophagus to keep it in place, before suturing the opening shut. All of this was done expertly and stunningly quickly, and all with just four small incisions into the patient. I was very appreciative to have been able to see a new side of the body in the OR, but even more so to have seen robotic surgery at work. Minimally invasive surgery is a complete game changer for patient experience, and we are very grateful to Dr. Afaneh for allowing us to watch him work.


I will note one other case, a patient we saw with Dr. Spector in the clinic on Monday and in the OR on Wednesday, but only as an introduction (I will expand on this next week). This patient had extensive damage on the right half of their face from complications associated with head and neck cancer and associated radiation therapy, leaving much of the skin dead and very eroded, in some areas down to the bone. In the OR, extensive debridement was undertaken to remove necrotic tissue before Dr. Spector’s team came in to attempt repairs with a skin flap and multiple layers of DermiSphere, as well as some work on the eyelid (which had gained some deformities from the damage) to enable it to fully shut. We will see how the patient is doing next week, and I hope that this will prove to be yet another case of DermiSphere’s incredible success.


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