The new and interesting experiences have only increased during this second week. For clinical research, I am working with a device developed in Dr. Lawrence Bonassar's lab back at Cornell University coined the "Smart Syringe." This is a real-time and in-line cell concentration and viability sensor that has previously been used to count chondrocytes. This Smart Syringe has the potential to be used to perform a real-time cell count for patient samples that have been collected. While at Weill Cornell Medicine, the idea is to collect any consenting patient's liquid samples that would otherwise be considered medical waste/extraneous and determine if the Smart Syringe can be used to quantify these materials. Dr. Spector's team consented a patient for a blood sample and, with the help of Dr. Xue Dong and India, we centrifuged the blood, aspirated the plasma layer, collected the "pancake" layer of PBMCs for Faith to use to isolate T-cells, and the RBCs resuspended in PBS. We were able to see a difference in impedance measurements on the Smart Syringe between PBS, a high concentration, and lower concentration of RBCs. This is very exciting to start with and I am hopeful to see where additional patient samples, maybe blood maybe other lipoaspirates or bone marrow aspirates, result in.
In regards to surgical observations, I observed surgeons in the OR. One surgery was that of the tail end of a melanoma removal from the chest by Dr. Adam Jacoby. Dr. Jacoby informed us that either an oncological surgeon or a plastic surgeon will perform this procedure depending on the depth of the melanoma. The other case was much more intensive, where the patient had a severe sacral pressure ulcer where an intensive V-Y flap down a large part of the hamstring was performed to close the open wound. During the operation, Dr. Jacoby used a Doppler device and a SPY instrument with injected contrast to find the location of the blood vessels and ensure that the flap maintained proper circulation.
Another very intense and interesting surgery was a double mastectomy with nipple nerve reinervation by Dr. Lisa Gfrerer. First, the nipple was removed and a medical student thinned the tissue for downstream reattachment. In the meantime, Dr. Gfrerer and her resident made two football shaped incisions on the breast and started cutting the fat away with a cauterizer and performing liposuction around the breast. This tedious process continued until both breasts were removed, and it was surprising how much tissue was underlying in the breast cavity. Once removed, very careful reconnection of pectoralis nerves was reconnected to reattach to the grafted nipple to try and maintain sensation. Another surgery was that of a double masectomy and robotic hysterectomy by Dr. Leslie Cohen in plastics and Dr. Lin in gynecology. We caught the tail end of the hysterectomy being performed by the DaVinci machine. I have seen a DaVinci machine before, but not in use, so that was cool to see. Also surprising was how the uterus, cervix, and ovaries were removed and the size of the organ outside of the body.
We also went to Dr. Spector's clinic hours where he sees patients in person. It was interesting to see the post-op checkin of the surgeries we had seen the previous week (facial lift with mesh attachment, scalp melanoma removal with Integra patch, and keloid removal), new patients looking for pre-surgical consultation (breast reconstruction following a single mastectomy from breast cancer), and in person visit to inject HA into the face to reconstruct the jaw. It was interesting to see how hectic going from patient to patient in and how much time each patient got.
On another side note, Dr. Spector's PA Dr. Ann Ni showed us how to perform sutures in the Surgical Skills Acquisition and Innovations Lab. It was fun learning what the different suture names mean, what material properties each have and how different instances call for different types.
Also interesting was in Lab meeting, Dr. Spector showed us expired products of a coronary shunt and an (expensive!) vascular graft. It was cool to see how these materials feel and look, and also how they are sterile packaged before being used inside the body.
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