Week 7 - Alessandra

 Alessandra Coogan | Clinical Mentor: Dr. Scott Rodeo

    This week consisted primarily of data analysis and presenting a brief four-minute overview of my Clinical Immersion project to my peers and Dr. Robert Min. It was a great opportunity to summarize the progress I've made over the past several weeks and receive feedback before continuing with the project. The highlight of the week, however, was shadowing Dr. Rodeo during a total knee arthroplasty (TKA).

    After spending several weeks observing arthroscopic procedures such as ACL reconstructions and meniscus repairs, it was almost surreal to watch an open knee replacement. Seeing the joint fully exposed and the bone being precisely resected gave me an entirely new appreciation for the scale of the operation and the engineering behind joint replacement.

    One aspect that stood out was Dr. Rodeo's surgical technique. Unlike many surgeons who use computer-assisted navigation or robotic systems, he performs the procedure using traditional mechanical alignment guides. The operating room staff jokingly referred to it as the "old-school" approach, but it was clear that experience plays a tremendous role both on the surgeon's side and the technicians. Throughout the procedure, Dr. Rodeo continually verified his bone cuts and implant fit, making small adjustments as needed to ensure proper alignment and stability (Figure 1).

 

Figure 1. Femoral and tibial implant components (right) and a selection of tools (left) used during total knee arthroplasty. Implant sizes are selected preoperatively based on radiographic measurements and confirmed intraoperatively for optimal fit.

   I also had an interesting conversation with one of the surgical technicians about revision knee replacements. I had assumed that primary TKAs involved removing large amounts of bone, but they explained that relatively little bone is actually resected during an initial replacement. Revision procedures, on the other hand, are much more demanding because the original implants (often cemented into place) must first be removed, followed by additional bone removal before new implants can be inserted.

    Another concept that surprised me was the surgical tech's explanation that the tendons around the knee will need to stretch. Implants are intentionally fitted on the tighter side because the surrounding ligaments and soft tissues will gradually stretch as the patient recovers. Although patients often experience significant pain early after surgery, achieving the correct balance between stability and mobility is critical for long-term function. I just cannot imagine the pain without medication.

    One unexpectedly memorable moment came while the bone cement was being prepared. I had the opportunity to hold a ball of the curing cement and was shocked by how warm it became. Since the polymerization reaction is highly exothermic, the cement generated a substantial amount of heat. It was a funny contrast to the frigid operating room and I held onto it for a while until it no longer kept me warm.


Comments

Post a Comment

Popular posts from this blog

Week 3: Eddie Wei - Multimodal Endoscope

Image
Figure 1: Multimodal OCT and Confocal Setup Housed in moving cart connected to Endoscope for operations Endoscope Design           This week, I finalized the optical setup and handheld endoscopic probe design in SolidWorks CAD for multimodal imaging with Optical Coherence Tomography (OCT) and Confocal Microscopy in both 360° side-view scanning and forward-view orientations, as shown in the setup and endoscope CAD figures above. Figure 2: Current OCT-Red ( Freund et al.)  and Confocal Fluorescence Microscopy-Green ( Wang et al. ) images in comparison to Histology.           As a brief review of their demonstrated applications in urology, OCT uses backscattered near-infrared light to generate depth-resolved structural images and can delineate bladder layers up to the muscularis with limited cellular information [1], while confocal fluorescence endoscopy uses fluorescein-induced emission and optical sectioning to distinguish...
Read more

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 evalua...
Read more

Week 1- iqra

This week started off pretty slow since I didn’t meet with my clinician until Wednesday, but things picked up quick ly after that. One thing that has made a big difference is that Dr. Cheung sent an email out to the department about me shadowing, which has allowed me to move around and observe a variety of electrophysiology procedures rather than being limited to a single physician or case type. This has given me exposure to many different aspects of the field and has helped me gain a broader understanding of cardiac electrophysiology. In addition to clinical observations, I also met with one of the medical students working on my research project. During our meeting, we discussed some of the technical details and logistics of the project and worked through a few questions regarding the overall direction of the research. We are still in the early stages of planning, so there are additional details that need to be worked out, and we plan to continue those discussions next week. On Wednes...
Read more