OB/GYN: robot surgery

I'm now on ob/gyn surgery... which actually means just GYN stuff not any babies, which is a little bit of a change of pace.  (although i do note that i've seen so many c-sections that i'm 100% convinced that I could do one on my own.  I'm even willing to bet my grade on it... which is saying a lot from a med student's position. now if only the residents would let me..)

GYN surg seems to be primarily hysterectomies (removal of the uterus) 'hyst' for short. There are so many ways you can do it: abdominal (cut a pfannenstiel incision then remove the uterus out thru the hole), laproscopic (like a lap chole, make 3 tiny holes called 'ports' to stick our tools then watch the monitors to cut it up and take it out), vaginal (you take it out only thru the vagina, cut by cut, which is super neat and my favorite), or finally the DiVinci...

The DiVinci is this new fancy robotic way where the doctor sits at this console and watches the surgery from inside his little cubicle while the robot looks like a spider overtop the patient, the uterus does come out the vagina still.  Hence my cheesy picture... thanks google images!

 Its like playing a video game only way way more tedious and in 3D. The reason we do this is because it helps the patient heal faster, but its a bigger pain in the ass for the surgeon.  As a nurse or resident, it sucks because all you do is change the tools for the doctor. As a medical student, it sucks because you sit between the woman's legs and after inserting a fluid filled balloon-stick (yes that's a fancy surgeon term) into the uterus thru the vagina and you move the stick around to help out the surgeon.

A normal hyst takes say max 2 hrs ... a DiVinci takes 3 or 4 because you are working with such small instruments.  Have i also mentioned that it takes doctor 2 years of EXTRA training before they can operate these?  yeah...

Anyhow, my first DiVinci gave me a migraine... quite literally.  It was a 7.5 hour surgery and stare at this tiny little screen for hours... I can't get up, pee or eat. And i have to move the uterus around but i can't wiggle it wrong or the doc will have to start over.  Not to mention the controls are inverted! (right means left, up meand down, etc). GAH!  So this doc accidentally 'forgot' to cut the uterus totally free (its a circle, you have to cut the cervix out of the vagina in a circle) but he thought he cut it but he didn't. So he's telling me to pull out her cervix and shouting all these mean things at me, when i'm like.... uh, dude its still attached. The resident decides i'm incompetent and comes down out of the sterile zone (vagina and bowel are two areas that are known as 'dirty sterile') to assess me and realizes the uterus is still attached like i SAID.  And so the surgeon gets all in a huff and accidentally breaks one of the DiVinci robot instruments, called the 'Grabber' which no longer shuts. So we have to get it out thru this tiny port hole without closing it, which is hard. And somehow a piece of bowel gets stuck on the grabber when it got pulled out, so its half in and half out of the abdomen and the doc starts using the robot arms to try and pull the bowel out and it RIPS. He's officially cut open the BOWEL!! (the biggest no-no in surgery is cutting the pancreas. the second biggest is cutting the bowel). So we have to call in the general surgeons because the bowel is open and leaking contents everywhere. In the meantime the uterus is bleeding and leaking into the vagina. So we are trying to get the uterus out before the general surgeon gets there which of course we don't get done.  Anyhow this is why the surgery took 7.5 hours.  It was a painfully agonizingly long time trying to fix mistakes that the THIRD YEAR MEDICAL STUDENT could point out.

I get that surgery is harder than it looks, but SERIOUSLY.  Anyhow, patient came out fine, no bowel problems thanks to the general surgeon who took an hour to suture up those holes. Not to mention, I actually left the surgery thinking i might pass out at any minute because my head was killing me, i hadn't eaten all day, i needed to pee and my vision was actually wavy...  I had to pull over twice before i was able to drive home. So i am a huge non-fan.  If surgery is headed in that direction... count me out.