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Minimally Invasive Procedures

The Incredible Shrinking Man may be the makings of science fiction, but incredible shrinking medical tools? Those are the result of scientific progress — the progress that makes minimally invasive medical procedures possible.

Technological advances have resulted in tiny medical tools, such as miniature cameras, minuscule guide wires, microcatheters and instruments that can be collapsed to move through small incisions and then expanded to do their work inside the patient. These microscopic medical devices make possible a myriad of minimally invasive procedures that treat health problems with as little disruption to the body as possible.

"We are trying to develop techniques across all health care areas that are less invasive and therefore less traumatic to the body," says Clifford Kavinsky, MD, PhD, interventional cardiologist at Rush University Medical Center.

Because of these advances, minimally invasive procedures typically result in reduced surgical time, less discomfort, smaller incisions, reduced blood loss, shorter hospital stays, quicker recovery and fewer after-procedure complications.

Cardiovascular procedures: More options
Brain solutions: A good use of space
Complex surgeries, tiny incisions
Spine surgery: Protect and preserve
 

Cardiovascular procedures: More options

Imagine an artificial heart valve — the size of an egg roll that is built to collapse to the size of a bean sprout — gets threaded through a catheter the diameter of a chopstick. Once in place, it expands to replace an existing heart valve that is not opening and closing properly.

This describes a new minimally invasive heart valve replacement procedure that physicians at the Rush Center for Congenital and Structural Heart Disease helped to develop while researching an alternative for elderly patients who are too ill or too frail to undergo a traditional valve replacement.

Other new minimally invasive procedures are also in the works and are in the process of being refined.

Currently, the most commonly performed minimally invasive cardiovascular procedure is angioplasty. In this procedure, a catheter with a balloon attached is threaded through the femoral artery in the leg and up into a blocked artery within the heart. The balloon is then inflated to open the artery and restore normal blood flow. The balloon is removed, and a stent may be placed to hold the artery open.

"Minimally invasive techniques do not replace traditional surgery," Kavinsky says. "They add to the choices we can consider when creating a treatment plan that will be most beneficial for a patient."

To make an appointment with a cardiologist at Rush, call (888) 352-RUSH (7874).

Clifford Kavinsky, MD, PhD, serves as director of interventional therapy for structural heart disease at the Rush Center for Congenital and Structural Heart Disease.

Brain solutions: A good use of space

Minimally invasive procedures may use small tools, but the idea behind them is big.

"The concept of minimally invasive procedures is to work within the body's existing spaces, as opposed to creating new ones," says Michael Chen, MD, a neurointerventionalist at Rush.

For example, an endovascular alternative for treating a brain aneurysm not only preserves bone tissue, but safeguards skin and muscle as well. Advances in catheter technology — including the creation of smaller, more flexible catheters — have made it possible for doctors to treat a brain aneurysm without cutting the brain or the skull. This means less blood loss, no scarring and less brain injury.

This procedure, called endovascular embolization, requires an incision at the crease in the groin about the length of a penny that allows access to the femoral artery.

"With new catheters providing the flexibility to move through ever smaller and more twisted arteries, we have direct access from the leg into the brain," Chen says. The microcatheter is about half as thin as a piece of angel hair pasta and as flexible as angel hair cooked al dente. It slides along an even smaller guide wire through a sheath resembling a small coffee stirrer to place tiny coils into the brain to block the aneurysm.

Chen cautions that this technique is not for every patient, and it depends on the size and location of the aneurysm as well as the overall health of the patient. "At Rush, we have many options readily available, so a patient and his or her doctor can choose the one that is in the patient's best interest," he says.

Michael Chen, MD, performs endovascular embolization procedures for brain and spine malformations, as well as tumors of the brain, head, neck and spine.

Complex surgeries, tiny incisions

Many minimally invasive hysterectomies and myomectomies (a procedure to remove fibroids) are performed at Rush with the aid of the da Vinci Surgical System. In fact, Joseph Maurice, MD, a specialist in robotic surgery at Rush, considers minimally invasive surgery using the da Vinci system to be the standard of care in his practice because it results in less blood loss, smaller scars and faster recovery times.

Use of this system is known as robotic surgery. The robot has four arms, which are guided by the surgeon, with instruments that are about the length of long-grain rice and have complete 360-degree range of movement.

With traditional hysterectomy or myomectomy, there is a large incision — approximately the length of a piece of licorice — across the abdomen. Robotic surgery can be done with five eight-millimeter incisions, each about the size of an M&M. The da Vinci system also provides a 3-D view of the anatomy being operated on. This 3-D image appears on a screen with the internal organs magnified 10 times to give the doctor a more detailed view.

"The tools used by the da Vinci system allow the surgeon to be incredibly precise," Maurice says.

To learn more about how minimally invasive options at Rush can benefit patients, visit www.rushstories.org.

Joseph Maurice, MD, has specialized training in laparoscopic and robotically assisted surgery.

Spine surgery: Protect and preserve

The goal of most surgery is to remove disease or repair damage, but minimally invasive surgery also emphasizes preservation.

"With minimally invasive spinal surgery, we focus on preserving muscle and soft tissue, which can mean fewer infections and quicker healing time," says Kern Singh, MD, orthopedic surgeon at Rush. "What we have learned is that the less you disrupt the natural system, the quicker and better the recovery, and the better function a patient will have after six months or a year."

Spinal surgeons at Rush employ minimally invasive techniques in nearly every type of spinal surgery, including fusion procedures and lumbar laminectomy (the removal of bone, spurs or ligaments). They use incisions about the size of two Tic Tacs placed end to end rather than incisions the length of a banana, which are used in traditional spine surgeries. They also use small spinal implants that expand from the size of a raisin to the size of a grape to replace discs and pieces of bone that have been removed from the spine.

These implants may be the latest in spine surgery, but that does not mean minimally invasive surgery is the right choice for everyone. You have to look at each patient individually to see what is right for him or her, Singh says.

Singh and his fellow orthopedic surgeons will be seeing patients in the new orthopedic building located on the Rush campus.

Read about this new building and other projects that are part of the Rush Transformation.

Kern Singh, MD, performs minimally invasive spinal surgery for patients with neck and low back problems, scoliosis, spinal cord tumors, and failed back surgeries.

Keith Bruninga, MD, is board certified in internal medicine and gastroenterology. His areas of interest include colonic motility and functional gastro-intestinal disorders.


 

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