Week 2 - Differences in the OR

I began this week with an experience quite different than the reconstructive surgery cases I saw last week—neurosurgery. On Monday, my mentor was unable to meet with me due to some other obligations so I went to see neurosurgical cases with David. Since the day was so different from my experiences last week, I've decided to focus on it for this week's blog. It was nice to stay at Cornell for a day (Dr. Grant works from Columbia most days) and see some new cases. I was surprised at the stark contrast of the operating room, with the large Zeiss microscope that was used to aid in precisely removing tumors, to the more ‘standard’ operating rooms that I had been in with the plastic surgery cases. Dr. Schwartz was already well into surgery, excision of a meningioma (a typically benign tumor that occurs due to growth of the meninges into the brain), and it was really interesting to watch him use various tools to remove the tumor. Although the surgery was going well, I couldn’t help but notice the tense atmosphere in the room and it reminded me how serious one mistake could be for rest of the patient’s life.

Next, we entered an operating room where Ear, Nose, and Throat specialists were working with neurosurgeons to remove a pituitary tumor intranasally. The patient had markers that were glued to their head and the precise location of the probe that was being used could be determined by correlating the relationship between the markers and the probe to a MRI was done that morning. It was really interesting to watch the surgeons ‘remove’ the tumor—it really seemed as though they were fishing with a probe to take out as much of the abnormal tissue as possible. They were able to identify the pituitary gland with the MRI and leave it unharmed. To close the area (they had to break bone to access the pituitary gland), they excised some adipose tissue from the abdomen to use as a cushion, placed a piece of cartilage they had removed from the nasal passage, and then sutured Alloderm to the outside to hold everything in place. It was amazing to see how much can be done due to endoscopic technology.

The last surgery of the day included Dr. Schwartz removing a subdural hematoma using two burr holes. Although it was a simple procedure that has been done for many years, the patient would have likely had major complications or even died without it. The surgeon drilled two holes in the cranium using a special drill that stops cutting just before it reaches that brain tissue and irrigated the area using saline to remove the hematoma. The whole procedure was completed within 15 minutes.

I feel that this week has shown me how important biomedical engineering is to physicians as well as how specialized the equipment needs to be for the different specialties. Without specialized equipment such as operating microscopes, edoscopic probes, and precise drills, neurosurgeions would not be able to operate as efficiently and accurately as they currently due. For example, before endoscopy became common, pituitary tumors had to be removed by doing a craniotomy and likely harming tissue in the path of the surgery. This week has also made me realize how important it is to communicate with physicians and even observe their procedures before designing products so that we can effectively meet their needs. As Dr. Grant told me last week, “A device or new technique must save the physician at least 15 minutes to make it worth their time to try it.”