Special Section: Health Matters – Next-Level Care

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HEALTH MATTERS:

Next-Level Care Medical innovations are making Central Ohio patients healthier, faster.

By Peter Tonguette FOR MOST OF US, the word “trending�

photo: istock.com/ BlackJack3d

suggests the latest topic of conversation or controversy on Twitter, Facebook or other social media channels. Yet the word has realworld applications in health care.

In Central Ohio, physicians and their teams point to high-tech trends ranging from the use of robotics in surgery to new medicines designed to target cancer cells. With such innovations at their fingertips, area providers are poised to remain at the cutting edge of their professions.

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At Ohio State University’s Comprehensive Cancer Center–James Cancer Hospital and Solove Research Institute, one breakthrough begins as early as the time of diagnosis.

When a patient is thought to have cancer, tissue is extracted with a needle biopsy.

In traditional pathology, the tissue is then submitted to the pathology lab, where it is examined on a glass slide.

“Subsequently, there is some additional testing done on the tissue biomarker,” says Dr. Anil Parwani, a professor of pathology at OSU. “The whole process will probably take about two days, maybe three days.”

Today, OSU pathologists still make slides, but they are digitized, permitting physicians to scrutinize the tissue in much greater detail. “It enables us to do things which we cannot do on a glass slide,” Parwani says. “There [could be] a combination of cancer cells and inflammatory cells or immune cells present there, and there is a pattern which is not easily recognizable by the human eye.”

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Digital slides, he adds, allow doctors to “use computers to create artificial intelligence algorithms to quantitate the cancer cells.”

Digital pathology also allows a greater number of physicians to have fast access to a slide. “Let’s say this was an unusual, very rare tumor and you wanted to seek a second opinion,” Parwani says. “We could press a button and instantaneously have it reviewed by an expert anywhere in the world.”

Also trending are less-invasive measures for procedures that once required major operations. For pancreatic cancer patients, a Whipple procedure—during which the surgeon removes the gallbladder, as well as portions of the pancreas and the small intestine—can be deemed necessary.

Traditionally, the procedure is performed during an open operation that takes three to six hours to complete, with an additional recovery period of about six weeks.

Since late 2017, however, The James has been performing the Whipple procedure with the use of a robot. Small incisions—most no larger than 8 millimeters—provide access for

the robot, which is controlled by the primary surgeon at a console. (This differs from a laparoscopic procedure, in which the surgeon controls tools manually at the patient’s bedside.) The reduced size of the incisions means that many patients make strides in their recovery within two or three weeks.

“Typically, a Whipple would give you an incision from your breastbone to below your bellybutton,” says Dr. Mary Dillhoff, a surgical oncologist at The James. The robotic approach, she explains, creates incisions so small that, once healed, may be difficult to even locate.

Dillhoff also points to the agility of the robot, which has a 270-degree articulation to perform the intricate reconstructive work called for in the procedure. “Once you’re really facile with robots, you can sew nearly as well as I could with my hand—and, I would argue, sometimes better,” she says.

Robots joining surgeons in operating rooms is nothing new, but the latest generation helps speed up recovery time. Previous generations of surgical robots required indi-

photo: courtesy ohiohealth

OhioHealth’s surgical robot allows surgeons to perform less-invasive procedures.

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vidual incisions for each of the robot’s arms.

“Most of the surgeries that we were doing would have four or five incisions around the belly or chest,” says Dr. Ronney Abaza of OhioHealth.

Yet the latest surgical robot, which has been in use since earlier this year at OhioHealth Dublin Methodist Hospital, necessitates only a single port of entry. “You still have the same number of robotic arms—four robotic arms, a camera and three instruments—but all four of those go through one single incision,” Abaza says. Once inside the patient, the arms fan out. “They have elbows on them in addition to wrists,” Abaza says, but the biggest difference surely is felt by the patient.

“When they wake up from the surgery, they literally have just one incision that’s about an inch,” he says.

Less-invasive procedures also are popular in treating epilepsy, which 1 in 26 people can develop during their lifetime, according to OhioHealth neurologist Dr. Emily Klatte. “Of that number, 30 percent of people, in general, will not respond to medical therapy in terms of becoming seizurefree,” Klatte says.

In the past, the next step—surgery—could be complex and potentially destructive. “The traditional operation was to make a big incision on the scalp, make a big window in the bone of the skull and remove the temporal lobe almost completely, and then resect that deep part of the temporal lobe,” says Dr. Girish Hiremath, also of OhioHealth.

That procedure had significant drawbacks.

“That’s an operation that has a lot of collateral damage,” he says. “We’re resecting a lot of normal temporal lobe to get to that diseased area.”

By contrast, stereotactic laser ablation allows surgeons to access the brain by snaking a catheter through a 2 or 3 millimeter incision. “We close it with one or two staples,” Hiremath says. To ensure that the catheter is precisely positioned, the procedure is done in an MRI machine.

A laser is deployed to treat the regions from which the seizures spring, leaving as much surrounding tissue as possible undisturbed. “The trick in using a laser is to keep that heat energy focused in the abnormal area and away from the normal areas of the brain that provide functioning,” Hiremath says. “Usually, we’re on the order of 0.5 millimeters off-target, which is an acceptable accuracy.”

Drug therapies may not sound as hightech as robots or lasers, but Dr. Shabana

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through the insertion of dissolvable cones around the cheeks that aid in collagen production. “It is able to provide immediate mechanical suspension,” says Dr. Mary Beth Mudd of New You Center, which offers the procedure. “It’s got these little cones that literally will grip the tissues and lift them up.”

The Silhouette often appeals to patients who don’t feel ready for plastic surgery. “The ideal candidate for this is somebody who is starting to notice that their face is falling, their face is sagging, but maybe isn’t sagging enough yet that it’s time for them to go to surgery,” Mudd says.

Breast cancer patients often need to have their skin expanded following a mastectomy and in anticipation of reconstruction. Traditionally, a tissue expander similar to an inflatable water balloon was used to loosen the skin ahead of the implant placement; every few weeks, a physician would inject saline to increase the expander’s size. For the past year, Central Ohio Plastic Surgery has been offering an alternative: the AeroForm Tissue Expander, which stretches the skin with carbon dioxide—and can be done at home.

“The woman will then be able to … go home with a remote control,” says Dr. Jason Lichten of Central Ohio Plastic Surgery.

“They can push the button, and it causes the carbon dioxide disc to release.” The skin is

expanded gradually each day rather than in intermittent bursts over the course of weeks.

“It’s a less painful option, potentially,” Lichten says. “We’re to full expansion quicker, and therefore can get to the second operation to put the permanent implant in quicker.”

Technology can even help with pain relief, as demonstrated with a spinal-cord stimulator. The device, which quells nerve pain through electrical stimulation, has been in use for decades, but is proving popular with an increasing number of patients suffering from chronic neuropathic pain caused by spine issues.

In the procedure, two wires bearing eight electrodes are inserted. “They actually stick outside of the body for a few days and the patient can test it and see if it’s covering their pain,” says Dr. Chris Karas of OhioHealth. “We can flood a nerve in many ways: We can use a vibration sensation, a pulsing sensation, a massage sensation.”

Once pain has been satisfactorily diminished, a physician will cover the wires and battery. “That battery lasts 10 to 15 years,” Karas says. “Like a cellphone, it has to be recharged periodically.” The procedure helps prevent reliance on opioids. “Those medications are prone to tolerance,” he says. “They also have a considerable amount of side effects at higher doses.”

photo: istock.com/ gorodenkoff

Dewani of Columbus Oncology and Hematology Associates says that new cancer drugs are being approved on an almost weekly basis in her field. “The biggest thing right now that is at the forefront of oncology is immune therapy and targeted treatments,” says Dewani, who contrasts such treatments with chemotherapy.

“Immunotherapy is more specifically targeted toward the tumor cells,” she says, resulting in treatments without the side effects—including hair loss and susceptibility to infections—of chemotherapy. Immunotherapy can be used to treat cancers of the lung, kidney and bladder, among other categories.

The results of immunotherapy, Dewani says, can surpass those of chemotherapy.

“We haven’t seen such a long survival with chemotherapy that we are seeing with immunotherapy,” she notes, adding that for some advanced patients, chemotherapy works initially but comes with the risk that the disease eventually could again rear its head.

“With immunotherapy, we know that once they respond, they will have more sustained response,” she says.

Cosmetic medicine, too, reaps the rewards of technological innovations, including the Silhouette InstaLift. The procedure, which was introduced in 2010 but has since been refined, remedies facial skin that sags

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