Week 6 - Pooja Nair

Name: Pooja Nair

Clinical Mentor: Dr. Jason Spector

This week, I want to highlight two different procedures.

The first case involved reconstruction of defects on a patient's leg and finger following Mohs surgery for skin cancer removal. Instead of performing a skin graft or flap reconstruction, Dr. Spector and his team used DermiSphere, a dermal regeneration template that promotes tissue regeneration without requiring a donor site. Unlike many of the previous procedures I had observed, this surgery was performed under local anesthesia, allowing the patient to remain awake throughout the operation.

The second case was a minimally invasive robotic paraesophageal hernia repair performed by Dr. Cheguevara Afaneh and the GI metabolic and bariatric surgery team using the da Vinci robotic surgical system. A paraesophageal (hiatal) hernia occurs when part of the stomach and sometimes other abdominal organs pushes through the hiatus, an opening in the diaphragm through which the esophagus normally passes, into the chest. This displacement can lead to symptoms such as acid reflux, heartburn, difficulty swallowing, and chest discomfort.

After the robotic trocars were inserted, the robotic instruments were docked, allowing the surgeon to operate from the console. The high-definition robotic camera provided an incredible view of the abdominal anatomy. To expose the surgical field, the liver was retracted, allowing access to the stomach and esophagus. The herniated stomach was then reduced back into the abdominal cavity, and the enlarged hiatus in the diaphragm was repaired with sutures. The surgeon then performed a fundoplication, in which the fundus or upper portion of the stomach, was wrapped around the lower esophagus to reinforce the lower esophageal sphincter. This helps prevent stomach acid from refluxing into the esophagus while still allowing food to pass normally into the stomach.1,2

 

References

1.      Baiu, I. & Lau, J. What Is a Paraesophageal Hernia? JAMA 322, 2146–2146 (2019).

2.      Baiu, I. & Lau, J. Paraesophageal Hernia Repair and Fundoplication. JAMA 322, 2450–2450 (2019).

 

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