Medical procedures are constantly improving, as existing techniques are refined and new ones emerge. Some are true breakthroughs that can save or extend life. Others improve quality of life or are less invasive and easier to undergo than previous methods. Here are a few of the latest procedures some of South Florida’s top physicians are doing.
By Jana Soeldner Danger
Knee Replacement Pressure Balance
Doctors have been doing knee replacements for decades, using prosthetic parts to repair the damaged joints. One of the most challenging aspects has been consistently achieving optimal alignment to balance the pressure and loads among ligaments on the sides and back of the knee. Until recently, surgeons had to create this balance simply by visual examination and feeling with their hands as they tried to achieve the correct tension.
Now, the Verasense Knee System, a high-tech device developed by a company in Sunrise, provides data during surgery that allows the physician to create more natural alignment and pressure balance. “Knee kinematics, or movement, is a complex motion that involves knee flexion while the knee pivots,” says Dr. William Leone, head of the Leone Center for Orthopedic Care at Holy Cross Hospital in Fort Lauderdale. “The reason some people with knee replacements are not satisfied with their results is because knee balance and normal kinematics have not been perfectly restored. We can now do this much more accurately and predictably using this new technology.”
The Verasense device, which is implanted into the knee during the surgery and then removed, has sensors that measure the pressure on ligaments on the inside and outside compartments of the knee and also show the location of the load. To avoid any possibility of infection, the device is used only once. “It transmits the data to a computer screen during the surgery so we can quantify where in the arc of movement pressures are not balanced and make adjustments,” Dr. Leone says. “It takes away all the guesswork.”
The device allows very precise placement of the prosthetic knee parts, greatly reducing the possibility of misalignment and the need for additional surgery. Patients recover faster, he says. “It’s a remarkable improvement.”
Dr. William Leone, MD, is a graduate of Emory University School of Medicine. He completed his residency at the University of Miami and is certified by the American Board of Orthopedic Surgeons.
In many cases, minimally invasive laparoscopic surgery can be a better choice than an open procedure. With laparoscopy, the surgeon makes very small incisions and uses a tube to insert specialized instruments and a camera that transmits images to a video screen. Patients experience less pain, bleeding and scarring, and recovery times are shorter.
One of the challenges for surgeons, however, has been that the screen images were two-dimensional. Now, Olympus Medical Systems has developed a 3-dimensional laparoscope, the Endoeye Flex 3D Videoscope. Its camera has two separate lenses to produce left and right images, similar to a camera used to make 3D movies. The surgeon wears 3D glasses to bring the images together, providing a view similar to open surgery.
“One of the major shortcomings of laparoscopy has been the lack of depth of field,” says Dr. Brett Cohen, medical director of Memorial Healthcare System’s Laparoscopic and Bariatric Surgical Program. “With the new Olympus 3D equipment, we have very active, live 3D images, and we know exactly where we are. You get the feel of being right in there.”
The surgeon can be very precise with cutting and suturing, and the device even allows the doctor to see around corners. The laparoscopic operating room at Memorial Pembroke is fully integrated with 3D imaging, so the healthcare team can also do immediate consultations. “There’s no question that this is a huge advancement,” Dr. Cohen says. “It’s really the biggest advancement since the laparoscope itself.”
Dr. Brett Cohen earned his medical degree at the University of Miami School of Medicine. He completed residencies at Emory University Hospital and the University of Miami/Jackson Memorial Hospital, and a fellowship in advanced laparoscopic surgery at the University of Southern California.
Genetic Tumor Diagnosis
Not long ago, doctors treating cancer had to rely on pathology reports that were fairly general. “They could tell us the basic appearance of the cancer and its characteristics,” says Dr. Mohammad Jahanzeb, medical director at the University of Miami Sylvester Comprehensive Cancer Center in Deerfield Beach. “But not its genetic makeup.”
That has changed dramatically. “Now, we can send samples to companies that will look at all 236 genes known to be involved in human cancer,” Dr. Jahanzeb says. “And there are many designer drugs that can be matched to the patient’s specific tumor.”
Traditional chemotherapy drugs were successful in just 15 to 20 percent of cases, and doctors had to keep experimenting to find the one that was most effective for a specific patient. But because the new drugs are closely matched to the genetic makeup of the tumor, the results now are much better. “We can make them work in 60 to 80 percent of cases,” Dr. Jahanzeb says.
Also, the new drugs don’t cause debilitating side effects like severe nausea, hair loss and drops in blood count. Skin rashes, diarrhea and some other side effects may occur, but they are easier to handle. “It’s a major change,” Dr. Jahanzeb says.
Dr. Mohammad Jahanzeb received his medical degree at King Edward Medical College, University of Punjab, Pakistan. He did his residency at New Britain General Hospital at the University of Connecticut and a fellowship in oncology at Washington University in St. Louis.
Diet and exercise often aren’t enough to shape up problem spots like thighs, arms and abdomen. In the past, doctors have treated stubborn fat in these areas with liposuction, a procedure in which fat cells are removed with a high-pressure vacuum through a hollow tube inserted under the skin. Anesthesia is usually required, and the procedure leaves scars.
Today, physicians can remove fat cells by freezing them. The FDA-approved nonsurgical, noninvasive procedure, called CoolSculpting, leaves no scars and requires no down time.
Harvard researchers developed the method after discovering fat cells freeze at a higher temperature than surrounding tissue, says Dr. Jordana Herschthal, a dermatologist with offices in Fort Lauderdale and Boca Raton. “The procedure doesn’t damage skin or muscle. It takes about an hour and afterwards, patients can go right back to work,” she says, adding that with two of the devices, she can cut treatment time in half.
The physician attaches a suction applicator with two cooling plates that surround fat and skin. The fat cells freeze, leading to a controlled cell death. “This sends a signal for the body to clear them out, so over the course of about three months, they’re naturally eliminated from the body,” Dr. Herschthal says. “And once fat cells are gone, they’re gone.”
Jordana Herschthal, MD, is certified by the American Board of Dermatology. She earned her medical degree from the University of Miami Miller School of Medicine and completed a residency in dermatology at the University of Miami Jackson Memorial Hospital.
Treating Abdominal Cancers
Until recently, the only way to administer chemotherapy to abdominal cancers was intravenously, sending it through the entire body. This traditional method usually needs to be done repeatedly for weeks or months and causes unpleasant side effects like severe nausea and hair loss.
Now, doctors at Cleveland Clinic are using Hyperthermic (heated) Intraoperative Peritoneal Chemotherapy (HIPEC), an innovative alternative that delivers drugs directly into the abdomen to treat Stage 4 cancers. Many patients seeking an option to traditional chemotherapy or radiation, which often offer limited success in treating advanced abdominal cancers, may benefit from HIPEC, says Dr. Conrad Simpfendorfer, a surgeon in the hepato-pancreato-biliary and transplant department at Cleveland Clinic Florida.
The process goes like this: The physician first removes any visible tumors. Then two catheters are inserted into the abdomen, one to carry in the sterile fluid containing the medication and another to carry it back out again. “It’s heated for better penetration, and it bathes the entire surface of the abdominal cavity,” Dr. Simpfendorfer says. “It cycles for 90 minutes to two hours to destroy any remaining cancer cells.”
Because there is minimal exposure to the rest of the body, side effects are reduced. “We can also give higher doses, because it’s not going through all the patient’s veins,” Dr. Simpfendorfer says. HIPEC can be far more convenient than traditional chemotherapy or radiation because it doesn’t have to be repeated over and over again. “It’s usually just a single treatment,” he says.
HIPEC was first used about 15 years ago at the National Institutes of Health for patients with inoperable abdominal cancers. Cleveland Clinic in Ohio began performing it about five years ago, and physicians at Cleveland Clinic Florida have been doing it for about a year and a half. “It’s no longer experimental,” Dr. Simpfendorfer says. “It’s very effective, and it can offer hope for patients who have no hope with any other method. There’s a strong chance of treating the cancer and even curing it.”
Dr. Conrad Simpfendorfer, MD, graduated from Jefferson Medical College at Thomas Jefferson University in Philadelphia. He completed his residency at Cleveland Clinic Ohio.
Just about everyone over the age of 40 wants to look younger. In the past, however, facelifts too often resulted in a taut, “windblown” appearance. Today, several newer techniques offer alternatives that provide more natural looking results and quicker recovery times.
For those who want a more youthful appearance but prefer to avoid surgery, Ultherapy may be the answer. The FDA-approved nonsurgical, noninvasive procedure uses ultrasound and the body’s own healing process to lift and tighten skin on the face and neck. “It targets the muscle layer under the subcutaneous skin,” says Dr. David Herschthal, a dermatologist with offices in Fort Lauderdale and Boca Raton. “We project the area visually onto the computer screen and deliver ultrasonic energy directly to the site, which results in both lifting and tightening. It’s very effective for light to moderately loose skin, and the earlier you do it, the better.”
While some improvement may be visible in about two weeks, maximum results take three to six months. “At the same time the muscles tighten, the production of new collagen begins,” Dr. Herschthal says.
Ultherapy typically requires no anesthesia, although a patient may receive something to relax. “There’s no bruising and minimal swelling, and it’s considered a no-downtime procedure,” he says, adding that the degree of success depends on the skill and experience of the physician performing the procedure, which needs to be repeated every few years to maintain results.
The procedure, which costs about $3,000 for the face and neck, is one of four key components in nonsurgical facial rejuvenation, Dr. Herschthal says. “The others are revolumizing with fillers, resurfacing with lasers and relaxing muscles with Botox,” he adds. “Ultherapy is safe and effective. And for people who’ve already had a facelift, it’s a great way to maintain it.”
Dr. David Herschthal, MD, is certified by the American Board of Dermatology and is a professor of dermatology at the University of Miami Miller School of Medicine. He graduated from New York Medical College and did his residency at Mount Sinai Medical Center.
Deep Plane Facelift
Many people undergo full facelifts with the goal of looking younger. The deep-plane facelift, developed from understanding of facial anatomy that has occurred over the past decade, releases and repositions facial ligaments to restore them to their original position, instead of only tightening skin or muscle. “This is not your mother’s facelift,” says Dr. Jacob Steiger, a facial plastic surgeon with offices in Boca Raton and Delray Beach. “Today, our understanding of sagging ligaments is better than it used to be. As we age, the ligaments in the cheeks, jaw line and jowls start to fall. With the deep-plane facelift, we lift vertically rather than just pulling back. It provides a more natural look, and it’s longer lasting than traditional facelifts.”
The result is a defined, sculpted appearance. “The goal of a facial rejuvenation is to make a person look like a younger version of himself or herself,” Dr. Steiger says. “We want to turn back the hands of time without making the person look like someone else.”
Dr. Jacob Steiger, MD, earned his medical degree at the University of Miami Miller School of Medicine and did his residency at the University of Pennsylvania. He is certified by the American Board of Facial Plastic and Reconstructive Surgery and the American Board of Otolaryngolgy.
An S-lift is a kind of mini-facelift, a surgical procedure done under local anesthetic in about 90 minutes. “It’s an opportunity for people who don’t want to undergo general anesthesia and a traditional facelift,” says Dr. David Globerman, a plastic surgeon in Hollywood. “It also takes less time, is less expensive, and recovery time is usually less.”
The physician makes incisions behind and in front of the ears, then lifts and tightens the skin of the face and neck. Results are best for those who have minimally loose skin, so the sooner a patient does it, the better, Dr. Globerman says. It costs about $3,800, far less than the typical traditional facelift.
Effects usually last from three to five years, not as long as a traditional facelift, but the procedure can be redone when the skin sags again, he says, adding, “The results are great.”
Dr. David Globerman, MD, is certified by the American Board of Plastic Surgery. He received his medical degree from the University of Manitoba, Canada and did his residency at the Health Science Center in Winnipeg.