Dr. Christopher McCann and the da Vinci Robotic System
As amazing as the human body is, it does have its limitations. As our longevity continues to increase, we find ourselves in need of better ways to take care of ourselves, to repair the damages we endure along the way and maybe even replace defective or worn out parts when necessary.
Because of that, medical science continues to march forward in pursuit of improved products, procedures and techniques designed to make the human experience better. Researchers tirelessly seek to discover the modern miracles available to create new advancements or improve upon previous innovations. Here are a few of the medical achievements available today right here in Coastal Virginia:
MACI®
MACI® is the name given to matrix autologous cultured chondrocytes placed on porcine collagen membrane. In layman’s terms, it’s a way for doctors to harvest cartilage cells from a patient’s own knee, grow them on a special membrane, then implant the grown cells back into their knee to fix cartilage defects.
Dr. Steven J. Hospodar, an orthopedic surgeon with Riverside Health System, has been using the process for years with great success but admits it’s not an extensively known product/procedure. “It’s not a widely performed operation,” he says. “I’ve put in maybe a couple of dozen, but I’m fairly selective about candidates for it. However, I’ve had nothing but success with it.”
A veteran of the Air Force, Hospodar was intrigued by MACI’s ability to give people who want to stay active a second chance. “When I was in the Air Force prior to coming here, I was aware that everyone has to run, jump, fight,” he says. “It’s the same regardless of your age or what your job is. And if you can’t do those activities, then you can’t stay in the service. But I’ve had a number of patients who have had full thickness cartilage damage—area where the bone is completely exposed—and performed this technique to restore their cartilage. Those patients have all been able to go back to doing everything they could do before.”
The procedure starts with a biopsy of healthy knee cartilage. It is then shipped to a state-of-the-art, quality-controlled, FDA-licensed facility at Vericel in Cambridge, Mass., where it is processed and then cryogenically frozen. When the doctor decides the time is right for implantation, the cartilage cells are seeded on a special membrane where they will continue to grow. The membrane is then shipped back to the surgeon who will shape the implant to the size of the patient’s particular cartilage defect, then place it into their knee, affixing it to the damaged area.
The procedure might not be appropriate for everyone. From the time the biopsy is performed to the time of implantation takes about six weeks while the cells expand and are placed on the graft. But the cells can be stored until a patient is ready and at a time that is convenient. In most cases, patients are back to normal within about three months after the operation, although Hospodar suggests that his patients wait a full year before going back to activities like distance running.
“This procedure is specifically for cartilage damage,” says Hospodar. “When it comes to that, there is a full spectrum of options we can consider. If you have substantial arthritis, maybe you don’t have a ligament or haven’t had one for years, then this procedure isn’t going to work for you. But if you’re in the realm of ‘my cartilage is missing but I’m not so bad that I have arthritis and want to stay active and I don’t want a full knee replacement just to be a walking patient because I want to be active,’ that’s the whole point of this procedure. It’s a substantial technique available to treat cartilage loss. The procedure takes about two years to maximize its benefits, but if you do well in those first two years, you’ll never have a problem with it.”
ConforMIS Image-to-Implant® Customized Total Knee Replacements
For those patients who need a total knee replacement, Dr. Anthony Carter, an orthopedic surgeon in Newport News who is affiliated with Mary Immaculate Hospital (Bon Secours) and others, is using a technique that offers far greater customization than was previously available.
“Unfortunately, there is still about a 20 percent dissatisfaction rate with most total knee replacements because of pain or stiffness,” he says. “This is because everybody’s anatomy is different, so standardized replacement knees don’t always provide the best match. We’re trying to recreate normal knee kinematics (motion) with new technologies like 3D printing. With it, we can get an image of a patient’s knee, make a knee that clearly matches their anatomy bone-wise, then manufacture a 3D implant that totally matches our 3D model.”
In addition to providing a more natural, and thus more comfortable replacement knee, 3D printing eliminates the need for hospitals to keep a wide range of implants on inventory. It also cuts down on the instrumentation that is needed for the operation itself.
“There are cutting guides that come with the 3D implant,” Carter says. “So instead of using traditional instruments that include a long cutting guide with a rod that goes inside the bone, there are cutting guides that will pin onto the bone—to the femur and tibia—that have been customized and manufactured for each patient. So, this produces less of a strain on hospitals in regard to processing equipment, turning equipment over, etc.”
One more benefit with a customized, 3D implant is that total knee replacement is now moving to more of an out-patient procedure, meaning patients don’t have to spend time in the hospital recovering.
“ConforMIS implants are now covered under the same insurance reimbursement codes as ‘off-the-shelf’ knee implants, so they are more readily available to patients who want them,” Carter says. “The idea is to get away from a hospital-centric, sick-patient model, to one where patients are healthy and well, so we can get them out of the hospital and onto the road to recovery. This is so much better for patients as far as recovery time, and it saves costs for everyone.”
SpaceOAR® Hydrogel Protection During Prostate Cancer Treatment
Prostate cancer is the most common cancer among men, excluding skin cancer. One of the most effective weapons available against prostate cancer right now is radiation therapy. The objective is to radiate the prostate to destroy cancer cells, stopping their growth and potentially eliminating the disease altogether. Unfortunately, in many cases this also means that other organs near the prostate are also getting hit with unwanted radiation.
Enter SpaceOAR (Organs At Risk) Hydrogel. A simple injection prior to radiation treatment, SpaceOAR is a temporary soft gel that acts as a shield to prevent unintended radiation. It is injected between the prostate and the rectum to gently move the rectum out of harm’s way when irradiating the prostate. It remains stable in the human body for about 12 weeks, then gradually dissolves and is naturally eliminated by the body.
“Usually radiation for prostate cancer lasts about nine weeks,” says Dr. Geoffrey B. Kostiner of Tidewater Physicians Multispecialty Group in Williamsburg. “SpaceOAR reduces the radiation dose to the rectum, which is one of the complications from radiation therapy, down to about zero.”
Without this technology, there are many problems that can arise including rectal bleeding, urges to have bowel movements, incontinence and chronic diarrhea.
Although the procedure has been available for over three years and has been performed on over 25,000 patients worldwide, many oncologists and urologists are not yet offering SpaceOAR technology. “Sentara Williamsburg was the first hospital system in this area to perform this procedure,” Kostiner says. “My partner, Dr. Joseph R. Habibi, and I have probably performed the most procedures in the state, so we’re getting a lot of people from Northern Virginia, Richmond and even as far away as Maryland coming to us for help. The procedure has a very high success rate, especially with proton radiation therapy, and most people don’t even notice the product once it’s implanted. We give them a little sedation, perform the procedure, then they wake up and say, ‘Did you do anything yet?’
“We feel that any benefit a patient can gain by reducing complications from radiation therapy will obviously be better for them in the long run” says Kostiner. “It helps the patient choose a form of therapy without fear of complications. When you have a product available like SpaceOAR that has had no complications involved with its use, we think that’s just one more tool to use in making the overall treatment plan that much better.”
Dr. Christopher McCann and the da Vinci Robotic System
da Vinci® Surgical System
Used in several hospitals in Coastal Virginia, across the country and around the world, the da Vinci Surgical System enables surgeons to perform minimally invasive operations—even for procedures that might normally be open surgery operations—by utilizing specialized robotic technology. Approved by the Food and Drug Administration (FDA) in 2000, it is revolutionizing complex surgeries for all specialties, including cardiology, colorectal, thoracic, gynecology, oncology, general surgery, urology and more.
“For my specialty in particular, it allows us to handle more difficult cases where we would typically have had to use a larger abdominal incision,” says Dr. Christopher McCann, gynecologic oncologist with Bon Secours Gynecologic Oncology Specialists. “Now we are able to take on these cases with smaller incisions and a minimally invasive approach, which provides the patients with faster recovery times, less pain, less scarring, less blood loss, shorter hospital stays and fewer wound complication risks.”
Why “da Vinci?” The technology is named after 15th century inventor, painter, philosopher and Renaissance man, Leonardo da Vinci, who is widely known for advancing the study of human anatomy. He participated in autopsies, produced many extremely detailed anatomical drawings and planned a comprehensive work of human and comparative anatomy. This study of human anatomy eventually led to the design of the first known robot, probably around 1495.
According to McCann, the da Vinci system is superior to traditional open surgeries as well as laparoscopy procedures, where a fiber-optic instrument is inserted through the abdominal wall to view the organs in the abdomen or to permit a surgical procedure. Offering a 3D, high definition view inside the patient with up to 10 times magnification and an immersive view of the operating field, it allows for greater precision during surgeries. It offers dual consoles, so the surgeon can collaborate with another surgeon within the operating suite, and the operation of the instruments is “wristed,” so it’s more like using the hands to make precision movements of tiny instruments, as opposed to only two dimensions of movement available in laparoscopy surgeries.
“It also allows for a lot of independence,” says McCann, who has been using the system for more than 10 years. “What I mean by that is you can control everything that is going on. There is a surgical assistant that helps to facilitate the procedure, but the da Vinci system provides much more control to the surgeon, versus standing across the operating table from a surgical assistant where they would have to do a lot more.”
Another major benefit, in McCann’s opinion, is that, while performing surgeries, doctors using the da Vinci Surgical System are seated at a console, rather than standing at a table, which is traditionally the way surgeries have been performed previously. “I think in the long-term, physicians are going to be able to do more difficult procedures over longer periods of time because they aren’t standing,” he says. “As far as body mechanics are concerned, it’s much easier on the body to sit at a console as opposed to standing at the bed side.”
AeroForm®
A tissue expander that is used primarily for breast cancer patients seeking breast reconstruction after a mastectomy has been performed, AeroForm is an alternative to traditional tissue expanders that use saline injections to prepare post-operative breasts for implants.
Successfully implanted hundreds of times in other countries around the world before it came to the United States, AeroForm was approved by the FDA in late 2016. Utilizing a CO2 cartridge to remotely inflate the device, AeroForm, the first and only device of its kind, eliminates the inconveniences of fluid-based tissue expanders in a number of ways. Both are inserted by way of surgery, but with a traditional device, a patient would have to make several follow-up visits to her doctor, linger in a waiting room, get undressed, have the injection site numbed by the doctor or nurse, get a supplemental boost of fluid, etc., until the level of expansion recommended by the doctor had been achieved.
With the AeroForm expander, a patient’s doctor can show her how to remotely inflate the breast using a small hand-held unit that’s about half the size of your average smartphone. It can then be used two to three times a day to speed up the overall process, and the patient can be in total control of the expansion process over time—in the privacy of her home, at work or even while driving—until they reach the results they want.
“With a saline expander, a patient may come to see me two to 10 times after the expander is inserted to get to the size they like,” says Dr. Michael Denk, plastic surgeon with Associates in Plastic Surgery in Virginia Beach. “With the AeroForm expander, they only have to come see me once post-operatively to learn how to use the unit. Then they can use it for two to three months, try on different clothes during the process and decide when they have reached the level they want. It puts all the control back in their hands, keeps them out of the doctor’s office and provides them with autonomy and dignity without needles or inconvenience.”
Denk was the first doctor in the United States to use the AeroForm expander on a patient after it was FDA-approved and is still one of the few plastic surgeons in the U.S. who will provide it as an option, even though it is widely available to patients who request it. In fact, he admits that he probably never would have used it had it not been for a patient who was originally from South Africa, had heard about the technology and insisted on having it. Denk and his partner, Dr. John Alspaugh, were willing to shift the paradigm of their plastic surgery practice to provide it as an option.
“It’s all about a patient being educated about their choices,” he says. “I think that’s truly where medicine is and should be. In other words, a patient shouldn’t get procedure ‘x, y and z’ because that’s what the doctor said you should get. You should get ‘x, y and z’ because you’ve been presented with ‘a, b and c’ and ‘j, f and k’ and you can make an informed decision based on the information you have.”
