Week 4 Rotation - Surgery

This week Jodi, Lukas (some days) and I had our surgery rotation with Dr. Galindo (General Surgeon), Dr. Alarcón (General Surgeon), and Dr. Rivera (anesthesiologist).  

Me, Lukas, and Jodi in the Operating Room (yes, I know, it's not grammatically correct)

I've only seen adult surgeries in the US, so seeing surgery done on a pediatric patient was very interesting, with some patients who were only 12 days old!  It's amazing what can be done on such a small small person.  Please enjoy the pics and descriptions I've provided below.  Also note, with all surgeries, patients are put under general anesthesia.


Also note that for all surgeries that I was observing, I found myself a stool and hovered over the residents like so:

CAUTION:  The pictures in this post are not for all.  The photos are graphic (not gore-graphic), but there are photos of children being intubated, of their innards, genital areas and there is definitely blood in most.  For those in medicine, you will definitely enjoy!

Day 1

Surgery 1 - Angelatola, 2 years old, down syndrome, 3rd procedure to rectify her digestive system.  Angelatola was not born with an anus, so the first procedure was a colostomy, the second, to give her an anus; and now the third, to close her colostomy (Colorectal Anastomosis). Total approximate procedure time was 2 hours.

Intubating the patient after putting her under general anesthesia.

Not the best pic, but patient's colostomy has been sterilized.

Suturing her intestines back together after removing the colostomy.

Surgery 2 - Rogher, 2 months 21 days, cyst - left eyebrow.  Surgery to remove the cyst.  Total approximate procedure time was 15 minutes.

Patient is under general anesthesia and has been intubated.

Removing the cyst.

The cyst after it's been removed.

Day 2

Surgery 1 - Emergency Surgery.  Valentina, 19 days old, came into the emergency room because her intestines 'popped out' from her abdominal sutures.  When the patient was 10 days old, she had corrective surgery on her digestive system because her internal intestines were reversed.  This day she had cried so hard that her sutures popped open and her intestines came out.  Procedure took about 3 hours to clean, and resture the patient back up.

Dr. Alarcón holding Valentina's intestines in place as the OR is being prepped for the procedure.

Valentina's intestines as she came in to the emergency room.

Cauterizing to help control the bleeding.

 

Putting her intestines back in.

Suturing her back up, this time, they put extra strong and many sutures to keep the intestines inside.

Day 3

Surgery 1 - Reicel, 8 years old, removal of her preauricular fistula because it kept filling with fluid and secretion.

Incision into the right preauricular area.

Bit by bit removing the fistula that was in Reicel.

The fistula removed.

Surgery 2 - Dayana, 9 months, bronchoscopy (biopsy of fluid in the lungs).

The doctor performing the brochoscopy.

The fluid removed from the patient's lungs.

Surgery 3 - Patient has no name, 12 days old, blockage of the intestine.  Procedure to remove part of the intestine with fluid to pathology and reuniting the intestine.  Procedure took about 3 hours...my legs almost gave out on me.

X-ray of the impaction in the patient's intestine.

Dr. Rivera intubating the 12 year old.

Dr. Galindo feeling the impaction of fluid/pre-fecal matter.

Making the incision of the part of the intestine to send to pathology.

The portion of intestine that will be sent to pathology.

Removal of the rest of the pre-fecal matter that was in the intestine.

Cutting the intestine so that it will match up with the other side.

Suturing the lateral incision that was made so the 2 intestine parts that are to be reunited will match.  To test that the sutures were secure and that the intestine was still patent, saline was pushed into the intestine on both sides.

Placing a J-tube in the patient's intestine for feeding.

Final product.

Securing the J-Tube outside the patient and placing all intestine in the patient and ready for the final suture to close the patient.

Day 4

Surgery 1 - Luis, 12 years old, fosita pilonida (patient's testes did not descend, bilateral; procedure will rectify this issue).

Prepping the patient.

Finding the left testicle.

Left testicle has been found.

Elongating the left testicle so that it will reach the scrotum.

Making a pathway for the left testicle.

Pulling the left testicle down to the scrotum.

Stitching left testicle into place within the scrotum.

Then the same was done for the right testicle.  It was a long surgery and Jodi, Lukas and I were only able to see the left side because we had to go to the auditorium for a lecture on body temperature and surgery.

In the auditorium at Hospital del Niño for lecture.

Day 5 - BEST LAST DAY IN THE HOSPITAL AND IN LA PAZ


Patient 1 - Briefly saw a young boy being casted (plater of paris)

Waiting for the next patient in the doctor's lounge.
 

Discussing the fact that Hospital del Niño is a 3rd level hospital (highest) but doesn't have the equipment to be a 3rd level hospital.  From the left, Jodi, Dr. Galindo (our preceptor), ..., and Dr. Rivera.

For Patient 2, we (Jodi and I) GET TO...SCRUB IN!!!!!!
Patient 2 -Sarely, 9 months, diagnosed with fistula rectobulbar y espino bifida.  Procedure - to correct her ano anterior.
 

Prepping the patient and putting her under general anesthesia.

Jodi and waiting for our sterile gowns.

** Special thanks to Lukas for taking pics during this procedure.

Patient's anus before surgery.

Me looking at the procedure...I'm not gonna lie, it was a bit uncomfortable.

During this procedure I got to hand the docs the sterilized tools and Jodi got to scrub into the procedure itself!

Patient's anus after surgery.

My preceptor, Giovanna.  I learned a couple of spanish medical tools - gasas, mosquitos, pinces, tijeras, and portaguhas (spelling might be a little or a lot off).

In the doctor's lounge between patients.
 

Dr. Agurduy (Orthopedic surgeon) entertaining us on his guitar and with his singing...it was AWESOME!

Patient 3 - Orlando, 1 year, 9 months, malformacion del ano.  Procedure was to close his colostomy.
 

Since I already have pics of this procedure in the Day 1 section, I thought I would take a pic of the operating room itself.

This was an amazing week!  I will post one more when I get back to the States -- top 10 things I will miss and top things I will not miss :)  Goodbye La Paz!!