12 hours of Surgery

Today was unbelievable. I left home at about 4:30 am and got to the hospital at 6:00 am. I got there a little early so that I could prepare / study for the scheduled surgery. I brought my anatomy book and reviewed all of the anatomy of the neck. It is much easier now to review the anatomy because I have had to study / memorize it for many previous tests. Like anything else it starts to become second nature after a while. 

I reported to OR 10 to get ready for the surgery. Here is some back ground information on the surgery. We removed a Paraganglioma. This is a rare tumor that usually presents in the abdomen, thorax and only 3% of the time in the head / neck. In some rare cases the tumor actually secretes neurosecretory granules like epinephrine and norfiepinepherine which are substances your body normally releases in fight or flight responses. For example the surge of adrenaline you feel when you are scared or angry results for the release of these substances. Your body responds with an increase in heart rate and by sweating, and a myriad of other responses that help you better handle certain situations. This is maintained by your autonomic nervous system. The problem with secreting paragangliomas is that there release extra neurosecretory granules at random times under no modulation. The patient will just be relaxing and all of the sudden breakout in sweat and have a racing heart rate. These random sympathetic nervous responses are the symptoms that usually bring the patient into the doctors office. 

The surgery took 12 hours total with no breaks. We were scrubbed in and working the entire time. Most of the surgery is spent dissecting the neck to get to the tumor which was posterior to the carotid artery. The tumor was golfball size and had its own blood supply and had enveloped much of the normal anatomy. There were many nerves and vessels that we had to be care to not damage. The work is very detailed and meticulous. 

The chief resident and attending physician were both very nice and let me do quite a bit. I went into the surgery knowing that there was a possibility that I would only be allowed to watch. However I was allowed to work the retractors, suture and even do some of the cutting. I certainly got to help out and felt like a member of the team. Of course they were coaching and on guard for any mistakes. It was such a rush to be doing surgery. Particularly such a rare surgery. Most ENT surgeons will only see a couple of these there whole career. Some have never had the opportunity to perform this particular surgery. 

The body is so amazing. The surgery went well and we were able to get the entire tumor out. The chief resident and I went to talk with the family following the surgery. That was cool and I was allowed to explain to the family how it went. The family was so grateful and kept saying thank you. It felt great to be able to help and see the impact of the work. I left the hospital at 7:00 pm on a total high. I had completely forgotten that I had not eat or gone to the bathroom all day. I guess that my own neurosecretory granules / neurotransmitters  kept me going all day.