For this last assignment I observed removal of the gallbladder. This was a robotic surgery performed with the DaVinci machine. Before going to surgery I was excited to view robotic surgery because this meant I would see more of the procedure ( since it is projected to a screen ). But when I was in the OR I was very intrigued with the machine, so much I almost forgot to watch the surgery.
While each of the three illustrations can seem separate I wanted to collage them together. I thought it was important to show the connection between the viewport, the surgeon and the robotic surgery machine.
The surgery I observed was to correct a type II fracture of the dens on the axis, a bone articulating with the atlas. The atlas and the axis are the first vertebrae of the spine. The atlas (C1) articulates with the base of the skull. This atlantooccipital joint helps create a head nod (‘yes’ motion). The atlantoaxial articulation rotates along a vertical axis, creating a head shake (‘no’ motion).
The patient had broken their dens, a process on the axis articulating with the atlas. Even though the neck had been braced for some time, the area would not heal. To correct this screws and rods were placed in the pedicle of the vertebra. Being that they are irregular vertebrae, it might be more correct to say the screws were under the articulating facets. This is lateral to the vertebral foramen and away from the vertebral arteries.
For my portfolio I plan to finish filling in the tone of the remaining drawings but for the assignment the first three illustrations were fully rendered in tone. I really like using the toned background. I think it was a good choice, especially since I had so much bone to render! The toned paper gave me more flexibility when rendering the light tones.
I can’t wait to fill in the bone chips and render the suture line!
While some people might find being in a surgical operating room uneasy and slightly awkward, I find it amazingly intriguing. First of all you get to wear and sweet get up:
Stylish… I know, but it’s all in the name of hygiene For our first surgical illustration assignment the goal was to view as many surgeries as possible and see different techniques. This exercise was to help build our surgical illustration visual library, a mental reference of as many tissue manipulations as possible.
Deep incision on the upper arm
Blunt dissection of superficial tissue
When you first go in the OR, anything can be happening. Sometimes no one is in the room, at others the surgery has already started. Everyone has a face mask on, so you can only see eyes. I found it took a little bit of re-learning body language without certain facial features to pick up on. But you quickly pick up on interpretations as well as etiquette.
Tissue manipulation and suture hemostasis; removal of fistula
Cauterization of skin tissue using hemostat
Some surgeries I couldn’t see anything, I would be on my tippy-toes, or crouching down just to get a glimpse of what was going on. If you have a more inviting OR team, they will help direct you to a place where you can see something, but still be out of the way. At other times the surgical field is so small, that regardless of how people move, you do not see anything. In instances like this I find it helpful to stay close ( but out of the sterile field) and listen to any discussion about the procedure.
Suturing skin to areola and staple retraction
Cauterizing skin tissue (hemostasis)
I am very thankful for this opportunity. It is amazing to be able to observe some of the complicated procedures surgeons are performing in real time. The chance to see teams of people work together for the health of one individual.
Recently returning from AMI Annual meeting, I immediately began the intense work load which the final Summer 2012 week has brought forth (or I saved for myself, tomato/tomato). I hope to show my piece from the workshop and discuss the AMI experience, but for now I want to display some work from this semester.
A recurring theme seemed to be The Eye
The first illustration displays a transverse cut through the eye. You are looking inferior half of the globe of the eye, with detail of structures within the eye. Adobe Illustrator was really helpful for this project. It helped keep lines clean and clear, facilitating depiction of the different layers making up the eye structure.
Cataract Surgery – Replacement of the Posterior Intraocular Lens
The steps I set out to depict are (a) cutting of the cornea, (b) capsulorhexis – circular cut to the lens envelop to gain access to the lens nucleus (pulp of the lens), (c) Phasoemulsification, (d) placement of the posterior chamber intraocular lens (IOL) into the lens envelope.
I really enjoyed rendering the phacoemulsification step of the procedure. I was excited about the texture of the lens pulp! I feel more comfortable rendering in Photoshop, now I just need to get that feeling when digitally painting too ( i.e. using color ).
Followed by some surgical instruments
Comments and critiques always welcome.
Or perhaps you have some surgical stories to share?!
Today our Surgical Orientation class took the much awaited visit to the OR at the University of Illinois Hospital & Health Sciences System. The surgical department was quite a fascinating environment. I wish I had pictures but alas I did not take my camera. However hopefully I can get a pretty nice visual worked up for you. The point of the trip was to orient everyone in the class to the OR. We needed to know where things are, who will be in the room, and what we can and cannot do.
First thing first, we learned about fashion in the OR. We borrowed scrubs -we got to use the scrub machine- as well as hairnets and…
The whole get-up looked something like this:
(fabulous, I know 😉 )
After we were properly dressed our tour guide gave us a nice introduction to the OR. I did not have anything to take notes with but I will give you the fragments of what I remember. There were 18 rooms, numbered 1-12 and 14-19 (13 is skipped for superstitious reasons). What struck me as interesting, made a lot of sense but I had not thought about, is each room was designated to certain types of surgeries. Up until now I just assumed that an operating room was an operating room, but after seeing the plethora of instruments the surgical field has, it just makes sense. One room would never hold all the instruments needed for every type of procedure.
When in the room there will be a handful of people with different responsibilities, alway at least two nurses and the surgeon as well as residents. Also, when in the room, always stay 12 inches or more away from the sterile field.
Another tid bit that I did not know was that about 80% of the surgeries are done either laparoscopic or roboticly, no longer are open procedures as common. At first this seems less ‘intriguing’ when viewing a surgery, but in reality it makes my job a lot easier. It places what I am looking at on a 2-dimensional field (making it easier to translate 2-dimensionally) as well as give me the opportunity to see everything more readily. When viewing an open procedure, given the amount of people in the room and the space you need to keep from the sterile field, you might not get to see all that much of the process.
The trip was was a little intimidating. The class as a whole did not have many questions. Everyone seemed in awe of this new environment. I am eager for my visits in the fall when I will visit the OR, take notes and produce sketches of surgical procedure. I hope I get a nice surgeon willing to give me a few good peeks!