General Surgery Rotation Day 2 14-June-2011

In the morning I attended the general surgery meeting with Bor-Han, Amanda and Sandy, where a medical equipment company introduced the new ultrasound machine that was just purchased. Bor-Han and I ended up using the practice laparoscopy machine for a bit after the meeting as there was some free time. Pictures below:

Bor-Han on the practice machine:

Me on the practice machine:

A success:

After words I ended up following Bor-Han’s preceptor Dr. Kou, Chin-Chang (Dr. 郭錦璋) as my preceptor Dr. Fan requested. Bor-Han and I ended up going to the OR where Dr. Kou showed us how to properly prepare ourselves before surgery including how to watch our hands and put on gloves. Putting on the gloves in the way we were taught proved to be a challenge and we both decided to repackage our gloves so we could practice on our own time. We then caught the end of the biopsy procedure that Dr. Kou did where he explained that it is important to take the periphery of the suspected lesion to get the most accurate results as usually is the periphery is usually the portion that is still proliferating and most active.

In the afternoon I meet up with Dr. Fan where we discussed about breast cancer which is one of his specialties. Apparently for general surgery in Taiwan there has been a shift from doing cases like ulcer removals, liver abcess to more cancer management and trauma in recent years. Starting form the beginning Dr. Fran talked about the screening and diagnostic procedures used (Physical Examination, Mammography, Sonography and MRI). Reporting is done using the BI-RADS (Breast Imaging-Reporting and Data System) which utilize 6 categories to describe findings. BI-RADS assessment categories

0: Incomplete

1: Negative

2: Benign finding(s)

3: Probably benign

4: Suspicious abnormality

5: Highly suggestive of malignancy

6: Known biopsy – proven malignancy

Dr. Fan also brought up special issues including the controversy of using self-breast examinations citing the paper sponsored by the Fred Hutchinson Cancer Research Center which concluded that intensive instruction in BSE did not reduce mortality from breast cancer, hence why self-breast examinations are deemed optional in some countries however in Taiwan it is still used part of the screen. Other differences include that it is recommended that women 45 and older receive a mammogram every 2 years and that sonography is routinely used in Taiwan because the cost is relatively low. Another interesting thing he brought up regarding diagnostic imaging is that CT is not very useful for primary screening and diagnosis of breast cancer due to the fact that having things cut in planes means lesions could be missed. However Dr. Fan did say that it was great to use CT to check for the spread of the cancerous lesion as CT is good for accessing depth.

Later at 4:00pm Bor-Han and I attended the surgery pathology meeting which was jointly held by the surgery, pathology and oncology department. Several cases were presented including a rare case of primary diffuse B-cell lymphoma in the GI tract. Overall it was an interesting day and I am looking forward to tomorrow where I will be able to see Dr. Fan perform some operations in the OR.