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SANJAY GUPTA MD
Inside the OR; Soledad O'Brien's ACL Operation; Surgery Helps Haiti Earthquake Survivor
Aired January 22, 2011 - 07:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
DR. SANJAY GUPTA, HOST: Hey there. I'm Dr. Sanjay Gupta. Welcome to a very special SGMD.
Today, I'm going to take you inside a place that most people never get to see, at least while they are awake. It's a very special place to me. I'm going to give you an all access pass inside the operating room.
Have you ever wonder what all those people do inside there? I'm going to tell you person-by-person.
You are going to witness two of the most common orthopedic operations: a total knee replacement and an ACL repair.
And when you tear your ACL, you tear a ligament in your knee -- it's a fairly common sports injury. And today's patient is my good friend, my colleague as well, Soledad O'Brien. She tore hers, as you see her right there, she tore hers riding her horse.
She actually got a chance to watch her own operation as it was going on. And we're going to show you what happened there as well.
We're also going to introduce you to an incredible woman whose surgery helped her overcome a traumatic injury after the Haiti earthquakes. Take a look at those images.
Let's get started.
GUPTA: Now, the first patient is Robin Gray. She's 54 years old. After decades of sort of wear and tear on her knees, her right knee started causing her a tremendous amount of pain.
(BEGIN VIDEO CLIP)
ROBIN GRAY, KNEE SURGERY PATIENT: I go to work, but it's just getting -- it's hurting all the time.
OSKOUEI: You can see on the right knee, especially on the inside or the medial side, she has no space left between her femur and her tibia.
(END VIDEO CLIP) GUPTA: When he's talking about the femur and tibia, he's talking about the two bones surrounding the knee. You see Robin now here rolling into Dr. Shervin Oskouei, also known as Dr. O, operating room in Atlanta. That's in Emory University Hospital, midtown in Atlanta.
Now, before we get started with the operation, I want to give you a little bit of a tour of what happens inside the operating room, who all these people are.
So, for example, you look at an operating scene like this, the person standing over here, usually to the surgeon's right, is what we called a scrub nurse. This is the person who is essentially handing sterile instruments over to the surgeon. You see Dr. O standing right there, he's actually operating.
A physician's assistant usually stands over here.
At a teaching hospital like this, you're going to have a resident. That's this person over here. Dr. O is sort of taking this resident through the case, teaching him.
Usually, an anesthesiologist is behind this curtain, obviously, responsible for the patient being drifted off to sleep.
And there's usually a circulating nurse as well, someone who is not scrubbed that can go get things and hand them off on to the sterile table.
Now, I want to tell you, before Dr. O makes a first incision, I want to warn you, what you're seeing here is the real deal. You're going to hear and you're going to see what I see when I'm in the operating room. And if that sort of thing makes you squeamish at all, you may want to look away for a second.
Robin is prepped. She's ready for surgery. Let's take a look.
(BEGIN VIDEO CLIP)
UNIDENTIFIED MALE: Everybody ready? You're ready, too?
UNIDENTIFIED MALE: Yes.
(END VIDEO CLIP)
GUPTA: There it is. The first incision -- Dr. O placing a certain amount of force really on the scalpel, on the skin, getting through not only the skin and the fat layer under it, what is known as the fascia as well. You may have noticed or may have expected to see more blood.
Part of the reason you don't is because around Robin's leg is a tourniquet. That's a tourniquet that can be increased to a certain amount of pressure to try and decrease the blood flow that's going to her leg during this operation.
Again, Robin is not experiences anything right now. She's asleep. She's not feeling anything. But Dr. O has got a lot on his mind.
This is the first part of the operation, but how everything goes after this, how you visualize these things three-dimensionally, how you call for all these various instruments, such an important part of this entire orchestration of surgery like this. But let's quickly take a look inside at what Dr. O is about to see.
This is really very important. You have a lot of muscles. You have a lot of blood vessels. You have the nerves coming through. This is all very important when someone is thinking about surgery.
You see how the muscles and the bones all sort of interplay with one another. But what's so important is this area right in here -- is that arthritis, is that damage that is causing so many problems. This is what a bad knee sort of looks like. This is what's causing Robin so much pain.
Once that cartilage is gone, this bone, every time she bends her knee, it is bone on bone. And it hurts a lot.
The next step really is to measure and cut and try to find out exactly the best way this implant is going to fit in here. As you they say, you want to measure twice, you want to cut once. It's never more important than it is right now.
Let's listen in.
(VIDEO CLIP PLAYS)
GUPTA: The sound is the saw as you may have guessed here. Take a look here. This is a very important device, maybe something you have never seen before. It's a metal device that helps guide this operation. He is using that to help dictate exactly how that saw is going to work and how to remove some of the bone, some of the femur.
You see, he's actually cutting away the head of the femur bone or the thigh bone again. And once he's finished, he's going to moves to the tibia, again, the lower part of the leg. It takes a little bit of force to make that saw working. It can be a little bit disturbing if you've never seen this.
That sound as well. It's tough to hear, even for people who have done this for many, many years.
Let's take a look again at the graphics over. When this is all said and done, you look at those blue areas and look at what the saw has done, it's going to look something like this. All the bone that was diseased is gone. This is her bone, the bone that she had coming into this operation, sawed off and perfectly ready now for the implantation.
They are going to put a new knee here. It's precision operating. They only get one shot really at making this new knee fit.
(BEGIN VIDEO CLIP) DR. SHERVIN OSKOUEI, EMORY UNIVERSITY ORTHOPEDIC SURGEON: These are all trial implants. That's simulating the plastic or polyethylene insert. We've measured so far, 10 millimeters. We'll see if this is a good fit for her or not.
(END VIDEO CLIP)
GUPTA: Just listen in there. He literally said that he's testing it out, 10 millimeters. I mean, this -- it sounds like trial and error to some extent. It is. I mean, that's part of real-life surgery.
And I warn to you again that once the knee is in place, this implant is in place, he's going to be sort of testing the fit. That's probably the most difficult part I think for a lot of people to see because he's about to put this new knee to the test with the surgical sight still open.
We'll give you a viewer discretion once again. But here we go.
(BEGIN VIDEO CLIP)
OSKOUEI: So, her knee goes straight where it did not before. Her stability is perfect. She has no movement on either side. She gets very good flexion here. Her kneecap, patella is contracting perfectly right where it should without me even holding it.
(END VIDEO CLIP)
GUPTA: And the only thing left to do now, put the implant in place permanently and close up the incision that you see there.
I got a chance to talk with Dr. O shortly after he finished Robin's operation. Here's what he had to say.
GUPTA: Thanks for joining us.
OSKOUEI: My pleasure.
GUPTA: How did you look the cameras in there?
OSKOUEI: It was great.
GUPTA: All right. How is Robin doing?
OSKOUEI: She's doing very well. She's progressing very nicely.
GUPTA: I mean, weeks down the line, is she going to be able to get back to everything that she was doing and do more?
OSKOUEI: Absolutely. Back to everything she was doing and hopefully a lot more.
GUPTA: You take a look at something like this, we showed this a little bit earlier, Dr. Oskouei. This is the disease over here. Is this what's causing the problem?
OSKOUEI: That's correct. That's the loss of cartilage that's supposed at the ends of the bone.
GUPTA: Arthritis, that inflammation there is causing the pain?
GUPTA: We have a glimpse of this in the operation room. But this is a model obviously. But show us a little bit how this works.
OSKOUEI: Basically, we take the bones and we shape the ends of the bone. I want to take this implant off just to show you. Three- dimensional cuts.
GUPTA: Those are
OSKOUEI: Exactly, those are from the front and this is from the side. And the implant is basically replacing the bone that we take out.
GUPTA: How much does an implant like this cost, roughly?
OSKOUEI: It's generally somewhere in the $6,000 to $12,000 range.
GUPTA: This is a commonly done operation as well, right? I mean, how many roughly are being done in the country?
OSKOUEI: There are probably right around 300,000 a year.
GUPTA: Why, the numbers are going up. Why is that? Is it activity or age?
OSKOUEI: It's that, but it's the population is ageing. The baby boomers are getting to the age where they need joint replacements. So, there's going to be more and more of these done.
GUPTA: And as good as you are, a lot of people don't want to end up in your office. So, any advice on what they can do to avoid seeing you?
OSKOUEI: Healthy eating, healthy activities, weight loss, keeping your weight down would certainly improve your risk of not getting (INAUDIBLE).
GUPTA: This is mechanics, wear and tear on the knee.
GUPTA: Thanks for joining us. Good stuff. Thank you for joining us.
OSKOUEI: A pleasure. (END VIDEOTAPE)
GUPTA: Now, if you want to get some more tips on how to avoid ever having a knee operation like that, you can go to our Web site. We got a lot of information there, CNNHealth.com.
You know, our own Soledad O'Brien is heading into the operating room as well for a different type of knee operation. You're going to see it. We're going to be talking to her and hear what it was like. That's ahead.
And next, an operation that had a great outcome. It really highlights the idea of going from tragedy to triumph. This woman was stuck in Haiti's quake rubble for five days. And now, she's overcoming tragedy by sharing her strength with all of us.
Stay with SGMD.
GUPTA: Every week, we introduce you to some ordinary people who are doing extraordinary things. Imagine this, you are going to surgery and they're going to remove your hand and part of your arm, you don't even know about it. We met one brave woman who found herself in this exact position, because she was trapped in for five days in rubble from that earthquake in Haiti one year ago.
GUPTA (voice-over): As the walls disintegrated, as the ceilings crumble, Darline Bertil first thoughts was the world is ending.
DARLINE BERTIL, HAITI EARTHQUAKE SURVIVOR (through translator): I didn't realize that it was an earthquake.
GUPTA: When the earthquake hit Haiti, Bertil was at work.
BERTIL: The mirror broke. And the glasses and bottles blocked the way. You couldn't even run. And then the ceiling fell on us.
GUPTA: Within seconds, Bertil was entombed, pinned beneath a co- worker in a mound of rubble for five days.
BERTIL: After a while, I felt like I was in a dream. After that, I didn't know anything.
GUPTA: Bertil awoke after a three-week coma aboard the USS Comfort. She had no idea what happened to her or her country.
BERTIL: I opened my eyes. There were a lot of bright lights. I spoke to someone and I said to him, what happened to me? Up until now, I didn't know that I had lost my two hands.
GUPTA: The gravity of her situation sank in. Without hands, she could no longer support her family.
BERTIL: In my country, they shun handicapped people like me.
GUPTA: But Bertil soon recovered the strength that characterized her before the quake. She's decided that overcoming her own tragedy could only happen by sharing her strength.
BERTIL: My big dream is to help others who have been injured like me.
GUPTA: Inspired by her, Bertil's doctor decided to help. He contacted a state senator in New York for Darline and her family, who arranged a visa, transportation and medical care, including prosthetics for Darline.
DANIEL SQUADRON, ARRANGED VISA, MEDICAL CARE FOR BERTIL: It's an extraordinary thing to have gone through what Darline has gone through -- and instead of curling up inside yourself to expand your dreams and expand your goal.
GUPTA: While Bertil recovers, her spirit, she says, is already in Haiti.
BERTIL: I have thought why? Why me? Perhaps it's to help me realize all is not lost even though I'm handicapped, all is not lost.
GUPTA: Well, as you see there, she lost both of her hands. But she hasn't lost her hope. I mean, she's improving physically and mentally as well. She realizes it could have been a lot worse. You know, she wants to get a degree in psychology now so she can help others that have lost limbs as well. She's a remarkable woman and a real inspiration to all of us.
Next, getting ready to head into the operating room with our pal, Soledad O'Brien.
(BEGIN VIDEO CLIP)
SOLEDAD O'BRIEN, CNN CORRESPONDENT: I'm excited to have the surgery done so I can, you know, start like actually getting better for a final result. So, I'm really looking forward to it.
(END VIDEO CLIP)
GUPTA: And we are, too, Soledad.
Stay with SGMD.
GUPTA: And we are back with SGMD.
You know, one of the most common sports injuries in the United States is when you tear your anterior cruciate ligament. A lot of people know this as the ACL. Now, the ACL, you can take a look on this visible body here, is right over here behind the knee. Sort of take this and sort of zoom in a little bit on what the knee looks like. It's usually the ligament that's sort of right behind the patella. You can injure this -- when soccer players, football players, runners sort of land improperly. The knees twist, that ligament can tear. That can cause tremendous pain and swelling. Swelling is usually the first thing you note.
Now, today, we're going to go back inside the operating room to see what an ACL reconstruction really looks like. Dr. Laith Jazrawi, he's going to use a small scope and a piece of ligament that comes from a cadaver to repair the torn ACL.
The patient is our own Soledad O'Brien. She tore her ligament falling off a horse.
Now, again, before we get started, I want to warn you, this is real surgery. If you're a little bit squeamish, you might want to look away.
DR. LAITH JAZRAWI, ORTHOPEDIC SURGEON, NYU LANGONE: So, you are going to have a medial portal, a lateral portal, the incision on the tibia will be somewhere based here. And then you'll have an incision here.
We are going to perform an anterior cruciate ligament reconstruction for, basically, a tear that she sustained while falling off a horse. There should be a nice band going from here to here. That's completely blocked. And in this case, you see it's filled with fluid and it's torn to its mid-substance.
We're doing a left anterior cruciate ligament reconstruction with (INAUDIBLE) allograft any indicative procedure, possible meniscular repair on Soledad O'Brien. I agree that it's the left knee and we ask the rest of the staff.
UNIDENTIFIED MALE: We all agree.
JAZRAWI: Anesthesia, we all agree, Rob. OK. And then we're ready to go. OK.
OK. The incision is starting. You can put those away. So, this is (INAUDIBLE), this is the scope (ph) that everyone talks about. This is part of routine procedure. If you get a look at that, that is all the fluid left in her knee.
Now, you are getting a look at her knee. So, she's got some damage to her kneecap. There is her ACL. As you come over here, reviewing her ACL. You can see that.
I'll look up there. You can see that this is the detached area. And it's torn. And it's completely detached, torn PCL. So, that's where we're going to put the new graft in, right over here. We're about ready to start preparation of the graft and just doing up few more minutes of work here on the notch.
OK. Now, we're going to take the instruments out of the knee and we're going to start the graft preparation now. Here's the graft for it and there's a couple things on it. We're going to size the graft.
And here's our graft. OK? It's a tibialis anterior allograft.
The wire is brought through the knee right there.
OK. Now I take the graft. Prepared it nicely before.
OK. Let me get the snap when you're ready. The graph comes across through here.
Now, the graft is making a pass. You're going to see it (INAUDIBLE) up through the knee.
You can see there's the new ACL. OK.
UNIDENTIFIED FEMALE: What was it like seeing the inside of the knee?
O'BRIEN: It was awesome. I like my new ACL. I'm hoping to be able to get off crutches as soon as possible. I'm tired of being on crushed (ph). And then get back on my horse as soon as possible.
JAZRAWI: I was pleased with the entire surgery. Her -- you know, her allograft was excellent. Everything was as expected.
GUPTA: So, you watch that and you probably wonder how is she doing now? Well, guess what? You get to hear from her. That's next.
Stay with SGMD.
GUPTA: And we're back with SGMD.
Before the break, we took you inside the operating room for Soledad O'Brien's knee operation. It's been three months now since that surgery and she is recovering well. I got a chance to check in with her and see how she's doing.
GUPTA: You look great, Soledad. Good to see you. It's been three months since your operation.
O'BRIEN: Thank you, feeling well.
GUPTA: Good. I mean, that's what I was going to ask. Three months, are you feeling pretty much back to what you were doing before?
O'BRIEN: I'm limping a little bit. My knee is definitely bothering me. It's not 100 percent at all. But I feel much better. Yes, it's just nice to be off crutches and off the cane and be able to walk and get around on my own steam, for sure.
GUPTA: It was about three weeks, I think, roughly, since the time your injury before you had surgery. And I knew you were busy then, even flying around, doing events for a big documentary you were promoting. What was it like then? I mean, were you in a lot of pain? What were you experiencing?
O'BRIEN: I was never in any pain except the day after surgery. But, really, even when I heard my -- all my ligaments pop and I could sort of feel it through my body like pop, pop, pop, it never hurt. I was never in any pain. I didn't take any pain medication practically, except for a day or two after surgery. So, that was good.
I was -- it was very uncomfortable to lie down. Hard to sleep, all of that. But I was never in raging pain.
So -- and that's been consistent. Once I got through the surgery, the same thing. I felt pretty good. It aches. It feels crampy. It's uncomfortable. But it doesn't really hurt.
GUPTA: I know you -- I think you e-mailed me soon after your injury. I'm not sure if it was right at the time or not.
O'BRIEN: For free medical advice. Yes.
GUPTA: Because I think that's why I was hired, frankly. But were you a good patient? I mean, how quickly did you go and see your doctor after that?
O'BRIEN: Oh, I was a great patient actually. I think that's been highly correlated to how well I have done. I felt like I make a really good progress.
I'm a very good patient. I went to see my doctor immediately. We did the MRI right after I damage my knee, saw the doctor the next morning.
Three weeks he told me I could have surgery. We scheduled the surgery pretty quickly. And then right after that, I started doing physical therapy even before the surgery and I kept up with the physical therapy after the surgery. So, I think I've just been very aggressive about trying to bring myself back.
I think for knee surgeries, it's all in how much you push yourself and make yourself get to these milestones that you need to hit. My goal is to be able to run. They tell me, in a couple weeks, I'll be able to start running. And, then, hopefully, in the spring, I should be able to go horseback riding again.
GUPTA: And I think -- I don't know -- I don't know if this is public, but you talk about doing a triathlon, a sprint distance triathlon in a few months from now, in June.
O'BRIEN: Yes. In June. You know, it's like a 5K and I've run a bunch of 5ks and it's a quarter mile swim. You know -- so it's not horribly difficult. I think playing them (ph) altogether will be hard. So, I think I can do it. I think my knee will hold up and I think it will give me something to aim for in physical therapy because that's the hardest part to sort of want to stick to it and make yourself, you know, do it very aggressively. So, that's my plan.
GUPTA: You actually -- you got a chance to watch the operation. I guess you were awake during surgery. You watched it over, I guess, a feed -- video feed.
GUPTA: What was it like for you to watch your own knee being operated?
O'BRIEN: You know, it was weird. It was really weird. I wanted to see it. I was really fascinated. It was pre-med a million years ago. So, I love all that, you know, medical stuff, especially if it's your own knee. I'm dying to see what's in your own knee.
I was on a lot of sedation, so I kept sort of dozing off and the doctor would poke me and say, no, this is important, take a look. But it was fascinating. I mean, it was amazing.
And I've learned a lot about sort of how my knee is put together and then also when they were able to put a new cadaver ligament in.
O'BRIEN: You know, just -- you know, sort of that you can grab somebody else's ligaments and then, you know, connect it to your own body. And now, I literally wasn't able to walk and now, I can walk really, really well.
GUPTA: And you're going to go back to ride Charlotte, you said, right? I think you're getting close to doing that.
O'BRIEN: Yes, you know, I'm not bitter that she chucked me. She got spooked and I got ditched.
So, you know, I will go back. I'm told in April I should be able to go back to riding, which is great because by then, the snow is melting. It's become nice again. It's exactly the perfect time of year to start riding.
So, I'm hopeful that I won't be too anxious getting back on. And I'll be able to start riding again. I can't wait.
GUPTA: Well, good luck, Soledad. Hey, you know what? I'm doing a triathlon as well in August. Maybe we can train together sometime.
O'BRIEN: Are you? I would love that. GUPTA: Yes. Yes. Maybe in New York.
O'BRIEN: That would be great.
GUPTA: We get to see each other at least for a bit.
O'BRIEN: Yes, yes, I would love that. That would be fun.
GUPTA: Always a pleasure. I'm so glad you're doing better, Soledad. Great to see you.
GUPTA: That's what they tell you to do, Soledad, get right back up on that horse. Good for you.
And I'm also so glad I got to show all of you at home the other part of my job, to take you inside my world, inside the operating room, a place that is so important to me.
And if you missed any part of today's show, be sure to check out my podcast, CNN.com/podcasting. Also, set your DVR, 7:30 a.m. Eastern.
And remember, this is the place for the answers to all of your medical questions. Thanks for watching.
I'm Dr. Sanjay Gupta. More news on CNN starts right now.