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Something interesting I learnt in the operating room…the miracle of organ reperfusion.

Authors: Nikolaos-Andreas Anastasopoulos; SpR in General and Vascular Surgery; Croydon University Hospital; Croydon Health Services NHS Trust; London; United Kingdom; LinkedIn: Nikolaos-Andreas Anastasopoulos.

I have spent many nights in a busy operating theatre in my brief career, but the first one would shape the doctor I would become for the rest of my career.

It was March 2013, and I was a third year medical student in the University of Ioannina, Northwest Greece. Despite the hardships of the economic crisis, this small medical school was fighting to expand its newly established kidney transplant programme, that started in late 2012 and was solely driven by the enthusiasm of the medical and nursing teams.

That year, I was invited to make a presentation at the National Medical Students’ Conference, explaining what a transplant surgeon contributes to the process of kidney transplantation, and I was lucky enough that the Head of the Transplant Service would help me structure it. Not only that, but a few days later, he invited me to scrub in to my first kidney transplant. My excitement was naturally through the roof, as it would be my first night shift as a medical student, my first time in an operating theatre, and I would witness a complex surgical operation.

The night shift started, and the retrieval team arrived with the kidney, which they immediately started benching. I distinctly remember how I was surprised by how small but perfectly shaped it looked. I also thought that operating in the ice (benching) was quite surreal and was impressed by how delicate and well-co-ordinated the surgeon and his assistant were.

The implantation operation started, and it was running quite smoothly. The first thing I remember from that night was how different the external iliac vessels looked from the cadaveric ones I had dissected last year in my anatomy modules. And then the vascular anastomoses took place, with the thinnest suture I had ever seen (and could barely see).

I was blissfully ignorant at that point, that the most important moment in my life was about to take place. And then it happened. And it lasted only a few seconds. The surgeons released the clamps in a carefully choreographed manner, and then blood rushed in through the fresh arterial anastomosis to the dead, cold, purple kidney .. It transformed immediately. It grew in size, turned pink and alive. It was the first time I could see something seemingly lifeless returning to life. Today, I still cannot explain the feeling I was overwhelmed with.

By that time, I vaguely knew I wanted to become a surgeon but was unsure of my preferred speciality. That was the very moment I decided I would become a transplant surgeon. As a third-year student, I was completely unaware of the challenges that this decision came with. The sleepless nights, the hard work and the sacrifices that come with the gift of reperfusion. Years later, when I scrub in a kidney transplant, my heart skips a beat every time a kidney reperfuses, and I can still have that feeling I cannot name.


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