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My First Experience with Intramural Surgery

By Ashish Thakur, Guest reporter

Of all the things I did in Cleveland this weekend (including eating the world’s messiest meal at Seti’s Polish Boy), attending a course on insights and tricks of the trades at the Cleveland Clinic’s Endoscopic Intramural Surgery was really up there.   I had the chance to learn hands-on lab skills for emerging techniques in endoscopic surgery employing pigs’ gastrointestinal (GI) tract. Endoscopic surgery involves introducing a flexible camera or endoscope from the mouth or below into the GI tract. The scope has openings that permit one to cut and  cauterize to perform minor surgery.

Currently, management of achalasia, large polyp removal, pyloric stenosis, and Barrett’s esophagus, require a large open incision on the abdominal wall and lengthy complicated operations to address the problem. This course tackled the same problem using an endoscope, entering orally, which had the advantage of avoiding large incisions, no pain (there are no sensitive somatic nerve fibers in the gastrointestinal tract) and minimum recovery time.

Other attendees, who were trained physicians had hundreds, if not thousands of hours, of practice with the endoscopes. While they had mastered the building blocks of  cutting, injection, and manipulating the endoscope through narrow work spaces, this was my first experience  in handling one.

I found the course’s learning style highly collaborative. Four surgeons participated in small groups with their own subspecialty in the GI tracts and each had many new options and techniques to share. I also found it insightful that “thought leaders,” i.e., those considered the experts in the field, were open to ideas and suggestions from the attendees to see if these emerging technologies could be improved. The didactic/hands-on approach gave me the opportunity to physically manipulate the endoscopic camera and instrumentation.  I was shocked at how well I did with my eye-hand monitor coordination when using the camera—a skill doubtlessly developed from playing Fortnite with my mom almost every night after finishing my homework. I have a new respect for gastroenterologists and surgeons who spend 8-12 hours a day behind endoscopes, often working in spaces that are a mere 1-3 centimeters wide. I also now see that advances in medicine are often incremental versus the giant leaps I imagined and that practicing in an animal lab requires requisite evaluation with a proctor in a clinical setting.

Attendees at the lab indicated they need more training, coursework and practice with an established local practitioner and then a proctor to supervise and vouch for their safety when they finally perform endoscopies at their hospital. This ensures the absolute safety of the patient. Surgeons require many years of training and continuing education to identify when they are ready to perform these procedures.

Working with such adept surgeons taught me how much education, humility, and hard work is required to become a skilled surgeon. This experience was very satisfying as I learned from the most experienced global surgeons and was able to try out some cutting-edge techniques in endoscopic surgery.

The opportunity to participate in this course makes me feel that high school students with an interest in medicine or biology should consider similar experiences; the exposure would expand their awareness about how physicians learn and practice medicine. It is a great way to meet competent and thoughtful surgeons and understand how they approach complex problems. Courses like this expose students to medical advances while presenting their challenges. It also allows you to discuss challenges physicians face when applying skills they learn in real time. I think my greatest take away from this course was seeing that even surgeons, who we like to think of as infallible, get nervous when trying out a new skill.

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My First Experience with Intramural Surgery