By Molly Dannenmaier | UTMB at Galveston
MINIMUM INTRUSION, MAXIMUM RESULTS—
Jennifer Thomas, a mammographer at The
University of Texas Medical Branch at Galveston,
shows the needle used to extract breast tissue in
minimally invasive breast biopsies.
Roughly a third of Texas women with a breast lump end up having an old-fashioned surgical biopsy to determine whether the lump is cancerous.
Yet since 2001, the American Society of Breast Surgeons, the American College of Radiology, and the National Cancer Center Network have recommended nonsurgical, minimally invasive biopsies as the first course of action for women with breast lumps or masses. These less invasive methods of sampling breast tissue provide results that are as accurate as surgical biopsies, the organizations say.
“We need to get the word out to women across the state that surgery is not the procedure of choice for definitive diagnosis of a breast mass,” said Taylor Riall, M.D., associate professor of surgery at the University of Texas Medical Branch at Galveston.
Riall is a lead investigator of new research performed by UTMB researchers and published in the Journal of the American College of Surgeons, which reveals that despite national recommendations, invasive and expensive surgical breast biopsies were the first diagnostic step for 35 percent of Texas women diagnosed with a breast mass between 2000 and 2008. The findings were based on an exhaustive analysis of Texas Medicare data during that six-year period which gleaned information on a total of 87,000 breast biopsies. Continue reading
KTRK-TV Reporter Christi Myers reported recently on a procedure being performed by UTMB’s Dr. Eric Walser. “There may soon be a new option for men suffering from prostate cancer. The treatment involves a laser and has already shown promising results in studies overseas. This laser procedure is something in between watchful waiting and the radical prostate surgery. And right now they’re testing it with men who have early cancer.”
One of the biggest problems with kidney cancer (also known as renal cell carcinoma or RCC) is removing it. Obvious, you say.
However, the reason is not what you might think.
The surgical options for resecting (cutting-out) kidney cancer are well-developed and usually pretty straightforward. The kidney containing the tumor is removed (nephrectomy) or just a part of the kidney might be removed if the tumor is small (partial nephrectomy). All of this is just fine– as long as you have a second kidney that is normal and can pull duty for the one you are about to lose. But some people don’t have this option due to chronic kidney disease from diabetes or high blood pressure.
Two cancers in the right kidney (arrows)– oh my. You are looking at a CT “slice” (cut section of the human body) from the patient’s feet looking toward the head.
Years of these conditions can lead to so much kidney damage that these patients cannot afford to lose even a part of one kidney– They risk permanent renal failure and may need kidney dialysis treatment for the rest of their lives.
The patient in this picture has 2 kidney cancers in his right kidney (arrows) and has no options for surgery due to long-standing kidney disease and poor function. What are his options?
Several “cryoprobes” inserted through the back. The tips are guided into the tumors using guidance from CT scanner images
- Remove the kidney and probably start dialysis treatments three times per week for the rest of his life. This is very difficult for families’ finances/schedule and for the patient’s sense of well-being
- Do nothing and hope the cancers grow slowly and don’t spread. This is unlikely to happen.
- Perform regional tumor therapy consisting of needle-puncture and ablation (destruction) of the tumors only, while preserving as much of the kidney as possible. This option was chosen for this patient to treat his cancer in a way that maximized tumor destruction but minimized risk of permanent renal failure.
- Grey fuzzy blobs (“iceballs”–white arrows) surround the bright needles that are embedded into the kidney cancers
Figures 3 (right) and 4 (below) show the “Cryoprobes” inserted into the tumors with guidance by a CT (computed tomography) scanner. “Ice-balls” (white arrows) form as the freezing process envelopes the tumors. This treatment takes about 2 hours and involves admission overnight. Post procedure pain is minor and goes away in less than a week with pain medications or just Advil/Tylenol.
By the way, the patient’s renal function dropped slightly after the procedure but returned to baseline about a week later and he requires no dialysis. To monitor how successfully we killed these tumors, we repeat a CT or MRI scan in about 3 months. If some tumor remains alive, further treatment is considered and is generally easier and safer than the first procedure.
In brain surgery, a mistake can mean a disability or death. So how do you teach a neurosurgeon without mistakes? In this recent newscast by the Houston ABC affiliate KTRK, Christi Myers shows how Dr. Jaime Gasco uses a 3-D brain simulator. UTMB has one of only five simulators in the United States. In the first two UTMB studies, they found that medical students who were going into neurosurgery were 30 percent to 50 percent more accurate if they trained on the computer brain simulator.
This is a high-resolution high-strength magnetic resonance (MRI) image of the prostate gland below the bladder. Notice the 6 mm dark spot to your left (white arrow on the right side of the prostate). This represents an early prostate cancer confined to the gland. Often, these small cancers can be treated with lasers and no surgery.
Cross sectional MRI view of prostate gland with needle guide in the rectum preparing for biopsy
UTMB is proud to introduce a complete MRI solution for analysis, planning, biopsy and possible non-surgical ablative treatment of prostate cancer. The advanced imaging capabilities and biopsy tools allow state-of-art imaging and intervention for men experiencing persistently elevated PSA (prostate specific antigen) levels suspicious for prostate cancer.
This new paradigm for evaluating and treating men with prostate cancer is a cooperative effort of the UTMB radiology and urology departments. The diagnostic MRI requires no special preparation and no rectal instruments and is highly sensitive and specific for focal cancers in the prostate gland. The prostate biopsy, done at a different setting, involves MRI-guidance and tissue sampling of areas of the prostate gland considered suspicious by the previous diagnostic MRI. Continue reading
Dr. Dan Beckles
A recent article published by CNN/Fortune does a great job explaining the “rise of machines” in the nation’s operating suites. Here at UTMB , our surgeons have been performing robotic assisted surgeries since 2000 (and other minimally invasive procedures such as laparoscopic surgery for much longer). During the past decade, the scope and number of surgical procedures that can be addressed using the robotic platform has increased dramatically.
UTMB features a state-of-the-art da Vinci Si Surgical System, not unlike the unit featured in the article. This new robotic surgery system has allowed us to expand the scope of our robotic surgeries and expertise even further. Enhancements such as high definition 3D video, fluorescence imaging for vascular structures, and enhanced safety features allow us to perform advanced procedures while maximizing patient safety and decreasing recovery time. However, as evidenced in the story, this great technology and everything it enables, only extends the capabilities of the surgeon and the OR Team. There is no replacement for skill and experience, and the dynamic nature of the OR requires that your health care team be nimble and prepared to offer whatever therapy or approach best fits your condition. It’s with this philosophy that we approach robotic surgery, all in order to offer our patients the best possible outcome.
Advances in surgery usually attempt to ameliorate surgery’s essential nature: cutting someone to cure him. The less severe the tissue damage, the faster the patient heals — less time in recovery, less money spent recovering from the wounds. In health care this is known as “lowering the downstream costs,” and it is what is driving hospitals to invest $2 million a pop for surgical machines.
Read full article: http://tech.fortune.cnn.com/2013/01/15/robotic-surgeons/
Dr. Andrew Zhang
Our hands are extensions of our brain. We use them to sense and change the world around us.
Every day each of us uses our hands to navigate through our private obstacle course; there are knobs and wheels to be turned buttons to be pushed wrappers to be unwrapped strings to be tied heavy things to be lifted. Most of the time we accomplish this so effortlessly we hardly give any thought to our amazing hands. They just work. It’s only when our hands are injured that we become painfully aware of our dependence on these finely tuned instruments.
Specialized training in hand surgery has greatly improved the outcome of hand injuries. Minimally invasive techniques use much smaller incisions sometimes with the aid of a camera. By avoiding a larger incision the patient recovers faster has less scarring and fewer potential complications.
One of the most well-known and popular minimally invasive techniques used in hand surgery today is for the treatment of carpal tunnel syndrome. Traditionally the surgery is performed with an incision on the palm one to two inches long.
Many patients don’t realize there is also an endoscopic technique invented by a physician born and raised right here in Texas City, Dr. John Agee. His system which I use in my practice reduces the incision to less than half an inch. I find that patients recover faster and have less pain after this endoscopic release. Continue reading