Week 3 - Ben Grodner

Another week gone by, and summer is really starting to come into full swing. As the temperatures rise, it's been important to get outside early and avoid the muggy afternoon heat. Work has also started to heat up as things start to fall into rhythm. This week I had my first experience in the operating room! I got to scrub in for the first time and shadowed Dr. Rodeo through three arthroscopic joint surgeries. The first surgery was a set of meniscus sutures to decrease the mobility of a torn section of the cartilage. The second brought a torn rotator cuff back into place against the joint. The third surgery was an anterior cruciate ligament (ACL) replacement by transplant with a hamstring tendon.

One of the first things I noticed about surgery was how coordinated the actions of each person were. It was like a finely choreographed dance where each person has an essential role as supporting member to the lead (Dr. Rodeo). It was impressive to see how finely tuned everything was. Largely, the preparation including incisions, and setup of arthroscopy was not done by Dr. Rodeo, but rather by other staff, the PA, or the resident. Dr. Rodeo would sweep into the room at exactly the moment when the dangerous or difficult step was to be taken. Again, as in the clinic, Dr. Rodeo's exhaustive knowledge and experience showed through everything as he calmly dealt with small missteps or unexpected events all while educating the resident thoroughly and giving over key actions for their learning benefit. I was also impressed by the general atmosphere of calm combined and alternated with intense focus.

The precision of the suturing techniques was impressive especially in the meniscus tear. Six stitches were placed in a precise pattern at short intervals in the torn section and secured to an anchor in the bone. The precision was especially impressive because of the confusing logistics involved. Every step had to be performed in a precise order with the right tool, or none of it would have worked. This was largely due to the use of arthroscopy where only three generally small incisions were made. In the rotator cuff surgery, I was struck by how much the techniques resembled carpentry and sewing. There were four anchors bored into the humerus using a hammer and awl and the suturing was performed in a clever pattern to pull evenly on the torn tendon and suck it back to its correct position on the bone. The most exciting surgery was the ACL replacement, which had the most steps and was therefore logistically challenging. The removal of a hamstring tendon happened so quickly, I almost missed it. The tendon was prepared by folding over several times and wrapping it with suture material. There were sutures attached to each end of the now ligament. A hole was drilled through the femur again with surprising quickness, and measurements were made on the depth of the hole. Then a button was attached to the end of the constructed  ligament at the correct length and the whole system was slid through the hole until the button just passed the end of the hole. Then the button was rotated to secure the built ligament. A second hole had been bored through the humerus and the tendon was secured at the correct tension using a plug in the hole and an anchor in the bone. All in all, an incredible procedure to witness. Again, it was all performed in such a state of calm, I hardly realized when something dramatic was happening (like removing a hamstring or boring a hole in the femur).

Watching the "dance" in the OR I realized that if I were to design any system for OR use, I would have to take into account the logistical nightmares I witnessed. Research has moved forward this week as I got trained on the local fluorescent microscope and have begun to stain samples and prepare slides for my bacterial assay. I am looking to start building a list of possible taxa in joint infections to build a generalized probe set for FISH.