General Surgery Rotation Day 5 17-June-2011 and Community Service 18-June-2011

The last and final day of general surgery rotation, time flies by too fast. I started the day along with Bor-Han with the book reading meeting in the meeting room on the 7th floor. Today the topic presented was splenectomy. The most interesting thing about the presentation was the discussion about laparoscopic splenectomy being the gold standard for splenectomy for elective spleen removal without splenomegaly. Apparently most of the splenectomy procedures done in the hospital have not been elective cases as after a brief recount by the recount by the physicians at the meeting they could only recall about one video of a laparoscopic splenectomy being done in the hospitals in the records. It seems that in most cases at least in this hospital splenectomy is an emergency procedure and laparoscopic removal would be too slow.

After the meeting at 10:30 I met with Dr. Fan and we continued to discuss about breast cancer management. Dr. Fan gave a brief introduction of the ranking of risk factors for breast cancer in Taiwan and commented about some problems including insurance payouts depending on breast cancer classification. Interestingly Dr. Fan is interested in seeing more studies and research done for breast cancer in the Han Chinese population as he feels eventually specific protocols should be developed as more target therapies are being made available. He also gave a introduction about the different types of surgical procedures for breast cancer starting from the historical perspective of the radical mastectomy, where entire breast, the axillary lymph nodes, and the pectoralis major and minor muscles behind the breast are removed and the serratus anterior and latissimus dorsi are resection to prevent skin necrosis to the move to breast conservation surgery (BCS). Of special interest apparently preserving the shape of the breast after BCS is an ever improving field for plastic surgeons given that they never really know what they are going to get as selective portions of the breast tissue is removed based on what is cancerous. Overall given the short time in the surgery department I am glad that I was given the opportunity to see so much from my preceptor Dr. Fan on the rest of the surgical department.

On Saturday we all got up bright on early to get on the bus at 6:30am to go help out for the integrated community health screening that the Taipei Hospital sponsoring. Bor-Han and I ended up in the oral exam unit where we observed Dr. Li, a dentist examine the local community for various oral problems. For the epidemiologists everyone Dr. Li saw had gingivitis. I am not sure how helpful we were, but I am glad that we had a chance to interact with the community.