What was the recommended sodium intake for an average healthy person in the United States? This was the last question I had to answer on my nutrition exam before I had to run to the ferry to begin my journey to the abdominal surgery conference in Tampa, Florida. I quickly circle 2300 mg and hand in my test to Doctor Mesumbe.
After several hours and multiple airports, my airplane lands at Tampa International Airport and my brief adventure begins. I iron my white coat and prepare myself for the early wakeup call. The 6:00 A.M. meeting at the conference was especially difficult as it was only 4:00 A.M. Belize time. We board the bus and are on route to Pepin Heart Institute as the sun rose.
Dr. Rosemurgy was the first speaker I had the opportunity of listening to. He dove right into the medicine of abdominal
surgery, highlighting one of the major complications: bile duct injuries. The bile duct is essential, as it carries bile from the gallbladder to the duodenum, aiding in the emulsification of fats. He demonstrated the concept of the “four clip rule”, stressing the importance of identifying every structure in order to avoid mistakes and complications. The videos demonstrated showed bile duct injuries and the immediate expulsion of bile from the cut duct. This allows the surgeon to immediately identify the problem and attempt to repair it. This presentation allowed Dr. Rosemurgy to segway into the malpractice lawsuits that are so prevalent with bile duct injuries.
Dr. Rosemurgy is one of the leading investigators in over 40 pancreatic cancer trials and has published more than 300 clinical trials. He specializes in treating gastroesophageal reflux, bile duct obstruction, achalasia, and many other conditions relating to the esophagus, pancreas, stomach, gallbladder, and liver. He has teamed up with Dr. Ross and Dr. Secundy who were also speakers at the conference.
As I was part of the group of medical students at the conference, we were given the opportunity to observe two surgeries being performed that day. As the video was being streamed to the conference room and the surgeon was explaining each step she was taking, we got a much more up close and personal view of the surgeries being done. The first surgery was a robotic surgery done using the DaVinci machine. It was absolutely mind blowing to see one surgeon at the table for precautionary measures in case there was a bleed, and another surgeon on the other side of the room, very far away from the patient. She was sitting at a machine with multiple pedals and handles. All of her fine intricate movements were instantly relayed through the robot, enabling her to perform the complex surgery in the most minimally invasive way possible. Three small incisions were made in the abdomen for ports for the robotic arms and one was made for the camera to go in. The surgery can even done through one small incision through the umbilicus which, not only is amazing from a cosmesis standpoint, but also for recovery time and risk of infection and complication.
Dr. Ross then proceeded to do a laparascopic cholecystectomy which took a mere 45 minutes. A challenge arose when Dr. Ross could not reach the gallbladder as the patient had an extra lobe on her liver. This truly gave perspective on how much it is not only important to know the anatomy and protocols well, but you need to be able to think on your feet and improvise with the unique situations in the safest and most efficient ways. It was also interesting to see that the patient was not put under general anesthetic. Given only an epidural, the patient is able to leave the hospital and drive home the same day as the procedure. After all of the lectures that day, we were all given the opportunity to try a simulation and dual console transoral incision-less fundoplication using the DaVinci machine.
The second day was conducted at the conference center. Doctor Secundy took over for Doctor Rosemurgy and gave us a thorough explanation of benign versus malignant liver masses, with the appropriate work ups and treatment modalities. He took us through the evolution of liver surgery, differentiating between the extended right subcostal incision and mercedes type incision. These older techniques had higher risks of herniations and other complications. The robotic surgery involves 6 ports in order to take an invasive surgery riddled with operations and make it as less invasive as possible.
Dr. Ross was next and brought forth her multidisciplinary team approach to hepato-pancreatic biliary tumors. Her team was so thorough with standardizing an entire process from initial patient contact to post-op appointments. What was most interesting was the incorporation of items that we may use in our daily life. The protocol included the use of gum and Gatorade G2 to speed up recovery time by promoting digestion and gut motility. This protocol ended up decreasing time spent in the hospital, complications and recovery time.
While most of the conference focused on organs such as the spleen, liver, gallbladder and colon, it was refreshing to have an OB/GYN come in to speak about surgeries related to the female reproductive system. Dr. Hart was very informative, especially tying together gynaecology with the ever growing problem of obesity in the United States. With bariatric patients, special care needs to be taken during surgeries. Dr. Hart went through all of the different nerve injuries that occur with overextension and overabduction of limbs which may result in compression of various nerves. Then Dr. Hart took an entire hour to describe the anatomy of the pelvis. I thought it was incredible that although I have only had about 6 months of experience in medical school, since I have taken the basic foundation of anatomy, histology and medical terminology I was able to engage and participate in the discussions and build on my previous knowledge. Dr. Hart discussed the histological aspects behind rectoceles, and when there is a prolapse of the wall between the rectum and the vagina, it was thought the wall was fascia, but now appears to be mostly adipose tissue. Concepts like vaginal reflexes which stop prolapses from occurring during sneezing and other regular bodily functions was very interesting to also hear about.
The day ended with Dr. Marcet who touched on Diverticulitis and small bowel obstruction. Focusing on the diverticulitis portion, it can either be acquired or congenital, complicated or uncomplicated. Dr. Marcet took us through the differential diagnosis , symptoms, and clinical investigation. We adjourned for the evening after this speaker and I went back to my hotel to do some more research on the topics, as they really resonated with me. What ended up being magnificent was the driver who took me from my hotel to the conference on the third day asked me: “So as a medical student, can you tell me if something is really bad?” I got a little bit nervous as my education is no where near complete and I am nowhere near as competent as the doctors he should be seeking advice from. I genuinely said I could try to answer, but even a benign tumor can pose problems and mess with the equilibrium within your body. To my surprise he asked me about diverticulosis and I was shocked! I asked him: is it aquired/ congenital? Simple/complex? Then I proceeded to share the little knowledge I had on the topic, and for the first time truly knew I was exactly in the right field and felt passionately enough to want to face each obstacle and test to ultimately become a physician and give people the medical attention and treatment they deserve.
The final day flew by as Dr. Cox and Dr. Gallagher spoke about diseases associated with the breast and bariatric surgery, respectively. It was so eye opening to see just how much of the body general surgeons get to deal with. Dr. Cox brought forth interesting facts, like caffeine should be limited in those with any type of cyst. Although caffeine does not directly cause the cysts, it may absorb the caffeine causing more discomfort in the patient. Primrose oil may be used as preventative measure and may even remove cysts. He then proceeded to discuss bloody versus non bloody nipple discharge and various conditions relating to the breast: such as papillomas, intraductal papillary cancer, perialveolar absesses. He also reiterated it is a P53 mutation associated with squamous metaplasia, which we learned in embryology. There were many visuals demonstrating the pathophysiology in nipple obstruction, showing how keratin plugs occasionally occur causing inflammation. Dr. Gallagher then followed, depicting all of the issues associated with the obesity epidemic our nation is facing. He went through all of the major comorbidities such as sleep apnea, hypertension, arthritis, GERD, diabetes, urinary incontinence, asthma and arthropathy. He then went though the various procedures that may be done, such as the gastric bypass, sleeve gastrectomy, and adjustable gastric band. It was riveting to see the numbers associated with costs for bariatric patients. It is in the hospital’s best interest to provide care in a form of a solution, with the goal of weight loss to ultimately reduce the other health issues associated with comorbidities. It was in Dr. Gallagher’s experience that bipolar bariatric patients are generally the most difficult ones to deal with as they often less compliant and refuse to take their medication, information which is usually only gathered by gaining experience.
I was very fortunate to have been able to be a part of the 55th clinical congress. I have acquired so much knowledge and have seen the light at the end of the tunnel. Being surrounded by intelligent, driven and successful surgeons was so inspiring and I plan to work as hard as I can to achieve my dream of becoming a physician, and maybe one day have the opportunity to speak to a room full of aspiring medical students and inspire them in a similar way.