In the operating room with Dr. Wilfredy Castaño Ruiz


I am still working on several posts – but in the meantime, I wanted to post some photos from my visit to the operating room with Dr. Wilfredy Castaño Ruiz, one of the thoracic surgeons at Hospital General de Medellin.

Readers may notice that some of the content of my observations of the operating room have changed.. In reality, the reports haven’t changed – I have just chosen to share more of the information that I usually reserve for the books since I probably won’t get time for a “Medellin book”.  So, if you are squeamish, or if you don’t want to know – quit reading right about now…

It was a surprise to meet Dr. Wilfredy Castaño Ruiz because it turns out we’ve already met.  He was one of the fellows I encountered during one of my early interviews in Bogota, with Dr. Juan Carlos Garzon Ramirez at Fundacion Cardioinfantil.

Since then (which was actually back in the early spring of 2011), Dr. Castaño has completed his fellowship and come to Medellin.

Dr. Wilfredy Castaño Ruiz, thoracic surgeon at Hospital General de Medellin

Dr. Wilfredy Castaño Ruiz, thoracic surgeon at Hospital General de Medellin

Yesterday, I joined him in the operating room to observe a VATS decortication.  The case went beautifully.

Dra. Elaine Suarez Gomez, an anesthesiologist who specializes in cardiothoracic anesthesia managed the patient’s anesthesia during the case.  (This is important because anesthesia is more complicated in thoracic surgery because of such factors as double lumen intubation and selective uni-lung ventilation during surgery).

Anesthesia was well-managed during the case, with continuous hemodynamic monitoring.  There was no hypotension (low blood pressure) during the case, or hemodynamic instability.  Pulse oxymetry was maintained at 98% or above for the entire case.   Surgical Apgar: 8 (due to blood loss**)

Monitors at HGM are large and easily seen from all areas of the OR

Monitors at HGM are large and easily seen from all areas of the OR

Dr. Wilfredy Castaño Ruiz was assisted by Luz Marcela Echaverria Cifuentes, (RN, first assist*). The circulating nurse was a very nice fellow named Mauricio Lotero Lopez.

Enf. Luz Echaverria assists Dr. Wilfredy Castaño Ruiz during surgery.

Enf. Luz Echaverria assists Dr. Wilfredy Castaño Ruiz during surgery.

*”Registered nurse” is not terminology common to Colombia, but this is the equivalent position in Colombia, which requires about six years of training.)

** In this particular case, the surgical apgar of 8 is misleading.  The anesthesia was excellent, and the surgery proceeded very well.  However, due to the nature of surgical decortication (for a loculated pleural effusion/ empyema) there is always some bleeding as the thick, infected material is pulled from the lung’s surface.  This bleeding was not excessive for this type of surgery, nor was it life-threatening in nature.

Thoracic surgery and sympathectomy


Clinica Palermo,

Dr. Luis Torres, thoracic surgeon

I went back to see Dr. Luis Torres, thoracic surgeon and spent the day in the operating room with him for a couple of cases.   He is a very pleasant, and friendly surgeon that I interviewed last week.  Dr. Torres just recently returned to Bogotá after training in Rio de Janeiro for the last several years at the Universidade de Estado de Rio de Janeiro.  He completed both his general surgery residency and thoracic surgery residency in Rio after graduating from the University de la Sabana in Chia, Colombia.  (He is fluent in Spanish and Portuguese).

I spent some time out in Chia last year with the Dean of the medical school (and thoracic surgeon, Dr. Camilo Osorio).

The first case was a sympathectomy for hyperhidrosis.  I’ve written more about the surgical procedure over at Examiner.com, and I will be posting more information about the procedure – potential candidates and alternative treatments over at the sister site.

 

The second case was more traditional thoracic surgery – a wedge resection for lung biopsy in a patient with lung nodules.  **

In both instances, cases were reviewed prior to surgery, (films reviewed when applicable – ie. second case) and visibly posted in the operating room.  Patients were sterilely prepped, draped and positioned with surgeon present.  Anesthesia was in attendance for both procedures – and hemodynamic instability/ desaturations (if present) were rapidly attended/ addressed / corrected.

Dr. Torres utilized a dual-port technique for the sympathectomy, making 1 cm incisions, and using 5mm ports.  Each side (bilateral procedure) was treated rapidly – with the entire procedure from initial skin incision and application of final bandaids taking just 35 minutes.

Dr. Torres, performing VATS

The second case, proceeded equally smoothly, and without complications.  There was no significant bleeding, hypoxia or other problems in either case.  Surgical sterility was maintained.

** Both patients were exceedingly gracious and gave permission for me to present their cases, photographs etc.

Just as the second case ended – Dr. Ricardo Buitrago arrived – and performed a sympathectomy on one of his patients – using a single-port approach.  (I am currently working on a short YouTube film demonstrating both of these techniques.)

Robotic surgery at Clinica de Marly


I hope everyone is enjoying some of the changes in format – after all the wonderful experiences I had writing the Mexicali book, I thought I would start incorporating more local culture and content in the blog when I am in Bogotá.  (I have always enjoyed Bogotá – but my writing tended to be rather dry and uni-focal so from now on, I’ll try to include more local information about the city since I am in the midst of it all.)

Barbie display at Andino Mall, Carrera 11 No 82-01

It doesn’t mean that I am any less interested in crucial issues in medical tourism, quality measures or surgery – I just won’t focus on these topics exclusively.

I spent yesterday over at Clinica de Marly with Dr. Ricardo Buitrago to watch one of his robotic surgery cases.  They’ve been doing robotic surgery over at Marly for several years – but Dr. Buitrago just started the first robotic program in thoracic surgery in Colombia.  (Previously the robot was used exclusively for urology and gynecology surgery).

Robotic surgery with Dr. Ricardo Buitrago

Dr. Buitrago trained with the renown robotic (thoracic) surgeon, Dr. Mark Dylewski – and has been a thoracic surgeon for over 20 years so it is always interesting to watch one of his cases – robots or no robots..

Just published a new article about robotic-assisted thoracic surgery over at the Examiner.com along with photos and a short film clip that shows the robot in action.  I am working on a longer film that provides a better look at what robotic surgery really is/ what it entails.

 

Back in town..


Back in town just a few days, and already in the swing of things..

After arriving late last week, I was just in time to attend a conference on lung cancer and mesothelioma at the Hotel Tequendama.  There were some great presentations by several speakers on advances in the treatment of Lung cancer.  It was also an opportunity to catch of with several of the thoracic surgeons I’ve talked about here; including the always classy and amazing Dr. Stella Martinez, who was one of the surgeons giving a talk on surgery for mesothelioma.

Dr. Rafael Beltran and Dr. Ricardo Buitrago were moderating the event, which was put on by the National Cancer Institute.   Dr. Juan Carlos Garzon, Dr. Barrios, and Dr. Mauricio Palaez were also in attendance.

But the biggest and nicest surprise was seeing Dr. Edgard Gutierrez (Cartagena).  Those of you that are familiar with my Cartagena writings know that Dr. Gutierrez (unwittingly) took a large role in shaping my career.   It was great to sit down and catch up with him for a while.  But I’ll post more about my visit with him over at Cartagena Surgery so I don’t confuse my Bogotá readers..

(I’ve posted some photos from the event at my sister site, http://www.cirugiadetorax.org)

Radio Interview with Ilene Little


Interview with Ilene Little, “Know Before You Go”

Last month I completed a radio interview with Ilene Little, talking about Colombia, thoracic surgery, and issues in medical tourism.  I’ve been waiting for the archives to be published so I could provide a link here for interested readers.

Hope you enjoy. (You might recognize some of the names.)  For more print information on the interview – take a look at the article on my sister site.

The daVinci and Thoracic Surgery


Clinica Marly, Bogota – Colombia

 

Dr. Ricardo Buitrago, Thoracic Surgeon

Dr. Ricardo Buitrago, Thoracic Surgeon is now performing robot-assisted thoracic surgery with the daVinci robot at Clinica de Marly.  He began performing cases with the robot in Bogotá early this month.  The daVinci robot has been heralded for enabling surgeons to perform more precise procedures through smaller incisions.  While I’ve interviewed several surgeons over at Cirugiadetorax.org about use of the daVinci for thoracic procedures (aka RATS), I’ve yet to see it in action.

In related news – I am planning to return to Colombia for a few months this Fall, and hope to bring you more first-hand information about Dr. Buitrago and his robot!

Dr. Palaez, same surgeon, new role


Attended the monthly thoracic surgery meeting this morning to discuss cases.

The rest of the morning was spent with Dr. Palaez, rounding and seeing patients.  It was an interesting contrast – at Cardioinfantil, we saw consults and patients in his role as Vascular Surgery fellow before proceeding to Clinica del Country to see patients in his role as the attending Thoracic Surgeon.  It was a different perspective for me and I asked Dr. Palaez about it.

He explained that while many of his colleagues thought it was interesting that he would return to training at this stage in his life (he is 49 and has been a practicing thoracic surgeon for many years), that he was really enjoying his training.  He believes strongly in lifelong learning but is very pleased to be close to the completion of his vascular surgery training.  He has enjoyed the experience but is looking forwards to being a practicing vascular surgeon.  (He is currently training with Dr. Jaime Camacho, who is himself, a hybrid surgeon with training in both vascular and cardiac surgery.

During rounds, we saw several post-operative patients as well as consultations in the emergency room with a wide variety of vascular disease.

In the operating room with Dr. Mauricio Palaez, thoracic surgeon


Clinica del Country,

Caught up with Dr. Palaez one evening to accompany him to the operating room. As we previously mentioned, he is completing his vascular surgery fellowship this fall, and is a busy fellow indeed.  He has an upcoming trip to Barcelona, Spain for two months training in endovascular surgery prior to completing his fellowship this Nov/Dec.

When I caught up to him, Dr. Palaez was seeing consulting in the emergency room prior to heading to the operating room for a bilateral sympathectomy.

In the operating room,  all standard time out, and pre-operative protocols were followed.  Anesthesia in attendance with good heart rate control – and appropriate hemodynamics, no hypoxia.

Case completed quickly, surgical sterility maintained. No intra-operative issues.

Surgical apgar score 10 at completion of case.

In the operating room with Dr. Rafael Beltran, Thoracic Surgeon


Dr. Rafael Beltran, Thoracic Surgeon

Spent the morning at the National Cancer Institute, which really is a pretty amazing place, with a pretty amazing guy – Dr. Rafael Beltran. He’s one of the many incredible people I’ve met here – that truly make the world a better place through their work. I could have spent all day with him, seeing patients, surgery, discussing his cases and research – (Heck – I’d love to work with him!) but unfortunately, I had to race across town after several hours for another interview..

Dr. Beltran (tall gentleman on the left) and his surgical team

I really like this picture here, I think it highlights one of the important aspects of surgery – the surgical team.. As you can see above, Dr. Beltran (left) certainly doesn’t work in isolation – and that’s his philosophy about cancer care – the surgeons from different specialties work together closely, along with oncologists, radiologists, hematologists, therapists and other specialties to give well-coordinated, and well-rounded care. While I was the operating room, I stood next to a shy young woman.. After I badgered her for a little bit – she told me her story. She’s a respiratory therapist – and she was watching the surgery, so she would better understand how to take care of her lung surgery patients – and to understand exactly what they had been through. Not often do surgeons find room in their ORs for respiratory therapists – but Dr. Beltran understands that by having this young woman here observing – she learned more today than she could ever glean from books.. By doing so – he’s integrated her into the surgical team, and that’s important when often today’s medicine is an exercise in fractured and fragmented care.

In the operating rooms all around us – the same thing was occurring, with orthopedics, plastic surgery, neurosurgery.. As you can tell – on all my visits to the National Cancer Center, I’ve been very impressed with the physician commitment and the level of care.

As I raced off – I received a text that the doctor I was next scheduled to meet had to go to another hospital – he offered to meet me there, but he had an emergency, so I thought it best to reschedule for when he had more time.  I’m really looking forward to talking to him – so I didn’t want him to be too distracted.. I get the best interviews when we can just sit down and talk..

Then – a thoracic surgeon we’ve talked about before – texted me that he had 2 interesting cases – did I want to go? So I spent he remainder of the afternoon talking with Dr. Juan Carlos Garzon, thoracic surgeon. I’m glad I did – because I had lots of questions from our previous interviews, and between cases, he spent the time to answer my lingering questions; about his practice, about thoracic surgery in general, and about Colombian medicine so it was definitely a worthwhile trip..

  Dr. Juan Carlos Garzon, Thoracic Surgeon..

The Future of Thoracic Surgery


Dr. Juan Carlos Varon in the bronchoscopy suite


Actually, this title sounds way too dire for the pleasant and relaxed day I spent over at Hospital Santa Clara, interviewing Dr. Barrios, Thoracic Surgeon and two Thoracic residents, Dr. Juan Carlos Veron and Dr. Carlos Carvajal.. But it’s essentially true as I talked to the up and coming Dr. Barrios, and the future thoracic surgeons… Dr. Barrios is currently involved in some very interesting treatments for metastatic cancer.

Dr. Juan Carlos Varon, unmasked

Dr. Carlos Carvajal

I also interviewed Dr. Juan Manuel Troncoso and his partner, Dr. Elena Facundo, two general surgeons who are currently involved in some interesting projects..

New short on YouTube : The Thoracic Surgeons


New short film on YouTube featuring many of the thoracic surgeons you’ve seen profiled here on BogotaSurgery.org – Dr. Nelson Renteria, Dr. Stella Martinez, Dr. Andres Jimenez, Dr. Mario Lopez, Dr. Juan Carlos Garzon, and Dr. Ricardo Buitrago.

Hoping the next film is ‘live action’.

Dr. Beltran and Dr. Renteria, Thoracic Surgeons


Spent a fascinating morning over at the National Cancer Insitute with Dr. Rafael Beltran, the Chief of Thoracic Surgery.  Since the cancer institute is the biggest hospital specializing in cancer treatment – Dr. Beltran sees most of the rare and unusual cancers affecting the chest.  He also have a keen interest in tracheal surgery, and has published (in collaboration with Dr. Barrios) several articles on the topic recently.  (Guess we’ll have to tap into his expertise for a guest publication over at CirugiadeTorax.org)

Hoping to follow him to the OR next week.

Then I spent the afternoon over at Hospital de Kennedy with Dr. Nelson Renteria.

Dr. Nelson Renteria, Thoracic & Vascular Surgeon

Today he performed a VATs decortication for a stage III empyema (which is one of my favorite cases – but that’s another discussion entirely.)  Going back tomorrow to see some of his vascular cases.

Dr. Renteria in the operating room

Meeting of the minds – thoracic surgery


Attended the monthly thoracic surgery meeting led by Dr. Juan Carlos Garzon yesterday for case discussions.. Several interesting cases presented.  More importantly, I met and set up interviews with the last few thoracic surgeons; Dr. Beltran and Dr. Rodolfo Barrios (that I hadn’t met previously).  Should be an interesting week in the south end of the city..

On the topic of thoracic surgery – I am soliciting articles from thoracic surgeons, and other practitioners on the site – not just here in Bogota, but from around the world as part of the mission of the site.  I’ve already had some great feedback from some American surgeons.

Over at cartagena surgery we are talking about the recent announcement by the International Diabetes Federation on treatment recommendations for diabetes including the endorsement of Bariatric Surgery.