Good for the "Goose"

Yesterday I scrubbed-in on my first "marathon" surgery. It was by far, the most interesting thing I have seen. It was an Ivor-Lewis Esophagectomy***, and required two surgeons to work in concert- one in the chest and one in the abdomen.

This procedure is done to remove a diseased portion of the esophagus (the tube that connects your mouth with your stomach. The disease is usually Esophageal Carcinoma). It is fairly complicated and done in several steps- that on their own, could be considered a surgery unto itself; but I will attempt to simplify:

Typically, a large incision is made in the abdomen and the goal here is to "free-up" the stomach. This means separating the blood vessels, and connective tissue attchments. Then through a thoracotomy incision, the stomach is pulled up into the chest cavity. The diseased portion of esophagus is cut out. After some creative work by the surgeon trimming the stomach down to become a "replacement esophagus" crudely speaking, the cut ends are sewn back together.

Several factors made this particular patient's surgery more complicated. For starters, the abdominal portion of the surgery was done via laparoscopy- No small feat considering all the work that needed to be done. Secondly, a series of equipment problems seemed to plague the surgery to such an extent, that toward the end of the surgery, it looked like the scrub nurse had some sick type of Noah's Ark fetish, since there were 2 of everything crowding the room : video monitors, laparoscopes, harmonic scalpels, electro-cauteries, et cetera, et cetera, et cetera.

The surgery began at 10:20am and lasted just shy of 12 hours! I would love to tell you I hung in there for the entire thing, but I would be lying. There were 2 medical students scrubbed-in on the case and we were offered after about 5-6 hours a "break" to scrub-out, grab a drink or use the bathroom. We both refused since the case was very interesting. (and we are both closet masochists) However at hour 10 1/2 my bladder had ideas of its own and I gracefully bowed-out.

Standing for 10 1/2 hours in an OR, gowned and gloved, is no small task- I assure you. I now have an even greater appreciation for those surgeons engaged in these sorts of procedures.

I still think I am destined to beocme an Emergency Room physician, but if it were not for my age, family status, and presence of emotions, I could certainly see myself becoming an entirely adequate surgeon.

Oh, I almost forgot, the title of this installment of inanity.

It took me several times before I finally caught on, but the surgeons kept referring to the "goose", as in "this is goose", or "the goose should be free now". Aparrently, in surgeon-speak the "goose" is esophagus; as in, "esopha-goose".

It seems the cyborgs possess a sense of humor....hhmmm.

I spoke to a fellow student who is working in the Surgical Intensive Care Unit and I was pleasnatly surprised to learn that this patient is off the ventilator,awake, and is doing reasonably well for being a hexagenarian who underwent 12 hours of general anesthesia. Godspeed sir, godspeed.



*** For the geeky among you, this is a cool link that chronicles the whole procedure with a series of pictures. (although they did an open abdomen)