Hello,
On Wednesday of this past week, I got to observe my first surgery! It was a laparoscopic nephrectomy. A woman was donating one of her kidneys to her brother. Unfortunately, one of my mentors who was taking me only had time for the surgery where the kidney was being taken out. So, I couldn't see the transplant.
Obviously, one of the first things you'll notice in an operation room are the surgeons, the anesthesiologists, and the various doctors with their scrubs. It was very interesting to see how they get prepped for surgery, and how there is one person sanitizing all tools and handing it to the surgeon.
A laparoscopic surgery is very intriguing since the whole thing is done with only 3 small incisions (about 1 cm each) in the abdomen. A telescope and small instruments are inserted into the abdomen through these incisions, which allow the surgeon to slowly cut away the surrounding tissue and dissect the kidney without having to place his hands into the abdomen. One of the tubes put into the abdomen has a camera; this is how the surgeon sees and controls the instruments. Additionally, monitors are everywhere throughout the surgery room, so everyone can see what is going on.
One neat thing I noticed when the surgeon was cutting through the tissue, was that the places being cut were also cauterized immediately with the same tool. This would stop the bleeding and help heal the tissue faster. While this was happening, you could actually see some smoke forming inside the body (through the monitors).
After the kidney is cut out, it is placed inside a plastic sack and removed intact through an extension of one of the existing incisions. I was really surprised when I saw the size of the kidney. It's only about the size of your fist!
Once the kidney is out of the donor's body, another surgeon (the transplant surgeon) carefully placed it in a plastic box and cleaned it with saline, so it could be put into another body. This was amazing because the surgeon even allowed me to take a closer look, showing me parts such as the ureter, and the renal artery and the vein.
One question I had was how the surgeons decide which kidney to remove. Anatomically, it is easier to remove the left kidney rather than the right kidney. The large artery in the body (the aorta) lies on the left side of the abdomen. The large vein (the vena cava) lies on the right side of the abdomen. This arrangement of blood vessels makes the vein to the left kidney longer than the vein to the right kidney. A longer vein is usually easier to sew into a kidney transplant recipient than a short vein (Loyola University Chicago). However, it was different for this patient. To determine which kidney to take out, they had a kidney test done. The results showed that the left kidney had 60% function rate while the right only had 40%. So, they decided to keep the kidney which is the better functioning and remove the one which has lesser performance.
Although looking at human flesh and blood was quite unsettling at first, I was a little used to it over the two hours I spent watching the surgery. I hope to see more fascinating surgeries in the future!
