WILTIMS #451-3: Playing with toys

WednesdayIL: You can restart oral feeding on a patient recovering from esophageal surgery 7 days postoperatively, as long as there have been no complications.

ThursdayIL: A temporal artery biopsy is really not a big deal. We hear about this procedure all the time, because the disease it is diagnostic for, giant cell (or temporal) arteritis, is loved by test writers. And because a temporal artery biopsy sounds so serious, I always assumed it was a big difficult procedure. But after seeing a patient who had just had one of these biopsies, I now realize it's a super mild procedure. It required just local anesthetic and a tiny incision near the patient's temple. It takes all of 5 minutes and is basically an outpatient procedure.

FridayIL: I'm pretty good at playing with laparoscopic equipment. Today we met with our site director in the hospital's surgical skills lab to practice... surgical skills. We spent a good half hour just tying knots (it's harder than it sounds, ok?!). After that, we would normally have practiced suturing, but in a wonderful moment of irony, we couldn't find any suture needles in the surgery practice room. But as our preceptor is an accomplished laproscopic surgeon, we decided to fire up the laparoscopic trainer machines.

Laparoscopic surgery is when you use a camera and various small tools to do procedures through small incisions. The practice setups have all the same equipment, like a video monitor, camera, and two instruments that look a lot like those dinosaur head extended grabbers, only much much smaller and, ya know, no dinosaurs. And instead of a person's abdomen, there is a tarp with holes in it that you can place anything under. We were warned that most people find these instruments difficult to use at first because the screen makes you lose your depth perception. This is when I perked-up, since I have one bad eye and never had great depth perception!

Our first target was a set of blocks with holes in them that you could take on and off of plastic pegs. (see example on the right) The goal was to pick one up, transfer it to your other grasper, and then place it on another peg. Easy. Having mastered that, our preceptor set-up a new challenge: cutting a circle out of a piece of gauze. For this one, we replaced one grasper with a curved pair of scissors. Slightly more difficult, but we got the hang of it pretty quickly. (see my gauze and a bonus knot to the left) Lastly, we were set-up to tie some knots laparoscopically. Now this was tough. After a ton of awkward attempts, I managed to tie some sad looking knots.

Future challenges could include suturing a fake wound. Supposedly, many surgical residents can take ten minutes just to pick up the needle in the correct orientation. Challenge accepted... someday. I'm still generally turned off to surgery, but the laparoscopic stuff was pretty fun.