From a Stage III-IV Cancer to Recovery

In September 2011, I was brought to the operating room for surgery to remove the tumor. I was intubated under anesthesia before the operation. An arterial line was first placed in the right wrist after which I was placed in lithotomy with right arm tucked to the side, the left extended, the TED stockings of elastic fibers placed on legs to promote blood flow and prevent blood clots. The loop colostomy was then sutured and its appliance removed. They washed the abdomen and prepped and draped me for an adequate surgical exposure. A catheter was placed under complete sterile conditions and intravenous antibiotics administered prior to skin incision and then regularly re-dosed at 4-hour intervals. Using a skin knife, an incision was made from the midline cartilaginous joint between the superior rami of the left and right pubic bones anterior to the urinary bladder to just above the umbilicus and a Cautery was used to incise through the subcutaneous tissue to open up the fascia midline. They took down the distal end of the colostomy to create a window between the bowel and the mesentery which they divided down towards the apex between the two bowel limbs. The colon was mobilized to enter behind the abdominal cavity. As they enter this plane, they placed a vessel loop around the ureter to visualize the testicular artery and the common iliac artery in the pelvis. They preserved the ureter but removed the whole tissue between two common iliac arteries together with the tumor specimen. They went up and made a window above the superior mesenteric artery pedicle which they divided with scissors. They also divided the remainder of the mesentery at the colon and tied it leaving the end-loop colostomy inside. They continued excising the bowel around the tumor and realized unfortunately my pelvis was narrow for the dissection. They could not also have a good exposure because of tumor proximal, its bulky nature and the presence of fibrous tissues. They went down to the posterior plane to reach the large triangular bone curve at the base of the spine and at the upper and back part of the pelvic cavity. They succeeded dissecting around on the left-hand side as this was relatively free of the tumor. Because seminal vesicles were near the tumor, they proceeded from the right side along the external iliac artery taking out all the tissue with the tumor including the ureter onto the tumor surface. They mobilized the bladder on both sides to identify the internal iliac vein and vas deferens which carry sperm to ejaculatory ducts. The urologist intervened with the dissection and took vas deferens on the right-hand side leaving the undivided superior vesical artery inside. The external iliac became clearly exposed although at least neurologically affected by the tumor. Fortunately, this was not the case but the ureter short segment at entrance into the bladder appeared to be fixed to the tumor. The segment at the involvement point with the tumor was excised. Its distal end was tied and gently packed up into the abdomen. They continued dissecting it around the right-hand side between seminal vesicles and the bladder. The dissection continued down, keeping seminal vesicles with the tumor on the right-hand side but taking them down on the left-hand side where they were not involved, but took them out anyway. Because of the rectum thickening on the right-hand side, they used the ligature to come through the prostate posterior right and below the tumor. The rectum was itself very stuck to the anterior aspect of the sacrum. They got it off the pelvic floor using tissue heating with electrical current and went around the right-hand side below the tumor to re-enter the normal mesorectal plane leading to the sidewall away. Again they realized the pelvis was narrow making the dissection challenging. Fortunately, there was an adequate free margin below the tumor facilitating the rectum incision together with the tumor. I lost approximately 1 L of blood on the course of the dissection. The pelvis was packed after which they created a colon joint or anastomosis. The colostomy was taken down using a knife for an incision around its loop opening and Cautesy to free it circumferentially. It was brought into the abdominal cavity and the splenic flexure mobilized. The distal small end-loop segment was divided off and a pursestring applier and its needle used to clamp the tissue and penetrate the tissue through the stainless-steal instrument holes across the distal end of the left colon. A suture was placed through the pursestring applier and the end of colon was removed using heavy curved scissors. The staple anvil was placed in the lumen, the suture tightly tied and the anastomosis line inspected to ensure no major blood vessels are incorporated into the staple line. A 28 mm staple handle was then placed through the anus up to the staple line after which the spike was opened and exited posterior to the line. The staple was placed together, closed and fired. They performed an air test with water in the pelvis to ascertain there was no air leak. Since there was no problem with hemostasis, a skin Vitene rejuvenation product was placed down in the pelvis. They then decided for a diversion using this opening to create a loop ileostomy although this has not been a standard surgical procedure. A single suture was placed in the superior opening aspect to make it smaller. The small bowel was brought through the opening by creating a window between the small-bowel mesentery using a red rubber catheter to bring it up without any tension. The ileostomy was finally opened in its inferior aspect ensuring it was correctly orientated. Then, they grafted its superior aspect with three brooking sutures. The remainder of the left-sided and diverted ileostomy was sutured to the skin and a rod placed at the site of the red rubber catheter. The surgery took 9 hours instead of the 6 hours initially suggested by the surgeon. Though in stable conditions in the post-anesthetic care unit for reanimation after surgery, I failed to wake up as monitoring machines for life signs were not responding meaning I was dead. The Lord in heaven heard prayers from my family, various pastors and friends in Canada, Côte d’Ivoire, France, Germany, Italy, United States, Democratic Republic of Congo, Zambia, Malawi, Angola, Nigeria, Benin, United Kingdom and South Africa pleading to the LORD for my healing and recovery. Nurses realized they started to respond slowly and then stabilized. My spouse was called in to stand by the bed side and asked to speak to me to test whether I could recognized the person talking. She asked how I was feeling. Following my answer that I was fine, a nurse asked who was the person standing here. I said my spouse since I could clearly identify her voice despite my eyes were still not open. My face was puffy and eyes swollen due to overdose of the anaesthetic drug. She was told to return home and that I will be kept overnight in the unit for a close monitoring of my health. She left.