Guest Post: Skjalg and the Roux-en Y Procedure

November 4, 2013 § 1 Comment

Hi everyone! It’s Skjalg!

Bianca asked me to write a post about an experience I had a couple of weeks ago. I thought “here’s my shot at glory and fame”, so here it goes. I apologize for the length. Apparently I had more to say than I thought.  🙂

Every week we have a class called Introduction to Clinical Medicine, which entails that we go to a different department of the hospital to see how they work and learn about a case or two. Since we had a very similar class last semester, it has begun to feel a little repetitive. Not because they don’t want to teach us interesting things, but sadly at our current level of knowledge, there are very few cases that are simple enough for us to grasp. However, the experience I am going to share with you was a little different.

It is no secret that I would like to become a surgeon after completing my medical degree, so I was excited when I realized that we would be visiting the Department of Surgery. I admit that I didn’t expect that I would get to see much, but nevertheless there was a glimmer of hope.

We split into our usual groups and a nurse led us around. The first half hour of our tour was much of the same.  “Here is how an empty operating room looks like”, “here is the monitor for the ECG readouts” or “here is the machine that does this and that”. We were then asked to change into surgeon gear. This was first time we got to put it all on. We usually get a white or green coat, but this was the whole shebang. We were then led into a room were they were doing what appeared to be an appendectomy. It was a very dark room and the doctor did everything by looking a monitor. We were shown how the anesthesiologist had her equipment set up and after about 5 min we were led out again. It was fun but not overwhelmingly exciting.

Across the hall there was another operation going on and the nurse went in to see if we could pop our heads in there as well. After a minute or so, she had gotten the OK that a couple of us could come in and look for a short while. Two of my classmates quickly jumped at the chance and I was a bit bummed that I hadn’t acted more quickly. After they came out, she said two more could go in for a quick look. This time I didn’t politely wait – I jumped at the chance and got it. So did Chiara and Toni from my class.

The room was brightly lit and there were three doctors working on a patient. To each side and behind the chief surgeon were a couple of surgery interns looking over his shoulder. At first our view was mostly obstructed, but we could see that the abdominal cavity was opened from above the cloth separating the patients head from the operating area. Then one of the interns standing on a box behind the chief surgeon asked if I would like to take her place. It was perfect! I now had a full view of what the surgeon was doing.

The abdominal cavity was fully opened, the stomach had been removed and he was in the progress of removing large parts of the intestines. I was in awe. The surgeon moved so confidently, much faster than I would have expected. He burned his way through the tissues (as to diminish bleeding) and sliced off the part of the intestine that needed to be removed in a couple of minutes.

It was amazing to see how skillfully he sutured the parts together and checked every detail while doing so. He managed his assistants’ delegations with hardly any words and everything seemed like it had been done a thousand times before. By now, Chiara was standing on the box beside me and Toni, the taller one of us, was peeking over his shoulder. We all stood there mesmerized as the surgeon kept working. By now 20 minutes had passed; the others had long since left to switch places with the other group. I knew that if we left it would be a very long time until we had this chance again, so I told my “partners in crime” that we could sneak in with the next group as they came to the end of their tour. And so, we stayed for another twenty minutes. The surgeon was now past the hardest part and as he continued suturing, he explained what had been done and what kind of techniques he had used. We stood there like three groupies hanging on his every word. The remainder of the time flew by and before we knew it, the next group was there. We snuck out of the room and mingled in with the rest, although with conspicuously grins on our faces.

The surgery we saw was called a Roux-en Y. This form of surgery is sometimes used in gastric bypass operations, but in this case, cancer had started in the patient’s stomach and spread to the spleen and parts of the intestines. I was surprised enough to learn that we can live without our stomach and even more surprised to learn that it presents hardly any problem. If anyone wants to know more about the type of surgery, here is a short video with animations of the surgery and a longer video with actual video feed from a similar laparoscopic procedure.



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