The University of Texas Medical Branch at Galveston (UTMB) is in the top tier when it comes to robotic surgeries. But when UTMB’s doctors training to be surgeons performed robotic simulations side by side with video game-playing high school and college students, the young gamers actually beat them out. The results were presented at a conference on minimally invasive gynecology [pdf] in November.
The synthetic trachea, just before implantation
What’s the News: An African man’s new trachea is the world’s first synthetic organ to be transplanted. Made from a polymer scaffold coated with the patient’s own cells, the windpipe seems to be working out well, more than a month after the surgery.
The birth defect spina bifida is a devastating condition, often leading to a life of cognitive disability and even paralysis. But for a new study in the New England Journal of Medicine, doctors have shown that fetal surgery conducted in utero, though tricky and carrying some risk, can help to fight the ravages of this affliction.
The study focused on women carrying fetuses diagnosed with myelomeningocele, the most common and most severe form of spina bifida, in which the spinal cord bulges outside the spinal column. The condition can result in lifelong cognitive disabilities, fluid on the brain, bowel problems and paralysis. Typically surgeons operate on such babies within a few days of birth. [Science News]
The option of performing surgery before birth—sealing the opening in the spinal column while the fetus is in the womb—has actually been around for more than a decade.
But no one knew if operating before birth was preferable to operating after. What they did know was that fetal surgery had a number of complications, including causing premature birth, which in some cases killed babies who would otherwise have survived. [ScienceNOW]
A hospital in Barcelona has announced that it has successfully carried out the world’s first full face transplant.
A team of 30 doctors conducted a 24-hour surgery on the patient who had lost most of his face in an accident; in the end the surgeons gave him new jaws, cheekbones, nose, teeth, skin, and other features.
The patient now has a completely new face from his hairline down and only one visible scar, which looks like a wrinkle running across his neck, said Dr. Joan Pere Barret, the surgeon who led the team [Associated Press]. She added that if you ran into the patient at the hospital now, you would not notice anything unusual.
This is the first time that doctors have performed a total facial transplant. Over the past few years, partial facial reconstructions have been performed on ten patients, including on an American woman who suffered an unspecified trauma and a Chinese farmer whose face was mauled by a bear. All the patients were put on a strict regime of immunosuppressant drugs after surgery to ensure that their bodies didn’t reject the transplanted bones, muscles, and skin, and were also given psychiatric counseling.
The current Spanish patient is reportedly a farmer in his 30s who accidentally shot himself in the face in 2005. Prior to the face transplant, he had to breathe and be fed through tubes. After looking at himself in the mirror, post-surgery, he is said to be happy with his new visage.
80beats:First American Face Transplant Is Successful (So Far)
80beats: Bear Attack Victim Gets Successful Face Transplant
80beats: Woman Gets Transplanted Windpipe That Was Grown in Her Arm
Discoblog: Organ Transplants Gone Horribly Awry
DISCOVER: How Do Transplant Patients Wind Up With Killer Organs?
Image: Valle d’hebron Hospital
Former President Bill Clinton is out of the hospital today after seeing a doctor in New York about chest pains this week. Clinton showed no evidence of a heart attack and his prognosis is excellent after a procedure Thursday to insert two stents in a coronary artery that had become blocked, said his cardiologist Dr. Alan Schwartz [Los Angeles Times].
Clinton’s rush to the hospital brought new attention to the common medical practice of using stents in heart patients. A stent is a small wire mesh tube that is inserted into an artery in order to prop it open, like a miniature scaffold. Surgeons use stents to improve blood flow to the heart muscle and relieve symptoms such as the chest pain that Clinton experienced [ABC News]. Most people who undergo coronary angioplasty procedures receive stents. Once the tube is in the artery, the artery grows over it and it becomes a permanent part.
An increasingly common surgical procedure for repairing spinal fractures might not be all it’s cracked up to be–in fact, the surgery had the same effect on patient’s pain as a placebo, two studies report in the New England Journal of Medicine.
The technique, called vertebroplasty, involves injecting medical cement into a fractured spine bone to strengthen it. More than 38,000 such procedures are done in the United States every year and the number has been [increasing] rapidly, nearly doubling from 2001 to 2005 [Reuters]. But the new studies showed that the procedure alleviated pain about the same amount as a placebo “surgery,” in which the physicians tapped on the spine and piped in the smell of cement to make groggy volunteer subjects believe they were receiving the real thing.
Researchers found that 36 volunteers who received sham surgery did just as well as 35 who got the real operation. A separate test, of 131 people at 11 medical centers, … also found that sham surgery produced a comparable degree of pain reduction and movement [Reuters].
The first U.S. patient to receive a face transplant came forward yesterday to show off the results and to praise the doctors and the unnamed donor who made it possible. The 46-year-old Connie Culp underwent a 22-hour surgery in December to receive her new face. Her expressions are still a bit wooden, but she can talk, smile, smell and taste her food again. Her speech is at times a little tough to understand. Her face is bloated and squarish. Her skin droops in big folds that doctors plan to pare away as her circulation improves and her nerves grow, animating her new muscles. But Culp had nothing but praise for those who made her new face possible [AP].
Culp was severely disfigured by a shotgun blast to the face that left only her upper eyelids, forehead, lower lip, and chin intact. News reports prior to her surgery say she was shot by her husband in an apparent murder-suicide attempt in 2004. He also survived and is serving a seven-year prison sentence. In the years before the transplant, Ms. Culp had 30 different reconstructive surgeries, but none effectively restored the lost functionality [The Wall Street Journal]. She was unable to breathe unaided, eat solid food, smell, or smile.
Within a few decades, a surgeon may be able to make a tiny incision in a patient’s artery and insert a miniature robot that would scoot along through the blood vessel to the area of concern. The microbot could remove blockages, scrape plaque off of artery walls, remove a few cells from an organ to test for cancer, or could even, eventually, carry a tiny camera to show doctors exactly what’s going on inside the body. In a major step towards that science fiction-tinged surgical scenario, researchers have built and demonstrated a motor about twice the width of a human hair that could power such a microbot.
Researcher James Friend says that miniature mechanics have been a long time coming. “If you pick up an electronics catalogue, you’ll find all sorts of sensors, LEDs, memory chips etc that represent the latest in technology and miniaturisation,” he says. “Take a look however at the motors, and there are few changes from the motors available in the 1950s” [BBC News].
Doctors already snake catheters through blood vessels in many procedures to reduce the impact of surgery, but some blood vessels, like the labyrinthine network in the brain, are too narrow and delicate to reach with current technology. But a microbot might be able to reach even these most sensitive areas, and could one day be used to remove clots from stroke patients’ brains in the emergency room. The researchers have tested their motor in human blood and artificial arteries and later this year it will begin experiments in pigs, whose arteries and brains are similar to humans, before proceeding to full-scale human trials [Telegraph].
The next big break through in surgery might not be a sophisticated new tool or imaging device; instead, it may be a simple checklist that the surgical team has to run through before making the first incision. In a pilot study, researchers found that using the checklist cut the death rate following surgery by 47 percent, while the complication rate decreased by 36 percent. The procedure is simple: Surgeons and nurses run through a series of basic safety checks before each operation, similar to those made by pilots before take-off. The checks include asking: Is this the right patient? Is this the right limb? Has the patient had the right drugs? [The Independent]
The checklist is composed of 19 fairly obvious items, but lead researcher Atul Gawande says that even a small change, like having surgical team members take a moment to say who they are and what they do before scalpel touches skin, can have important consequences later on should one of them develop a concern during the operation. Earlier studies have shown that communication problems are fairly common in operating rooms, with junior members of the team sometimes hesitant to speak up. “Giving them a chance to say their names allows them to speak up later,” Dr. Gawande said [The New York Times].
The first face transplant operation in the United States has been completed and initial results are positive, reports the medical team at the Cleveland Clinic. The patient, who had suffered severe facial disfigurement from trauma, had 80 percent of her face replaced with one taken from a cadaver, leaving only her own upper eyelids, forehead, lower lip, and chin. After the transplant, “I must tell you how happy she was when with both her hands she could go over her face and feel that she has a nose, feel that she has a jaw,” said the lead surgeon, Dr. Maria Siemionow [AP].
Although the woman’s identity and the nature of her trauma has not been revealed, doctors say her injuries were so severe that she lacked a nose and palate, and could not eat or breathe on her own without a special opening into her windpipe [AP]. The 22-hour-long surgery took place sometime in the last two weeks and is the most radical facial transplant ever attempted. Along with about 500 square centimeters of skin, the transplant also included bones, muscles, blood vessels, nerves, a nose, sinuses, the upper jaw, and even some teeth. The doctors hoped the operation would allow her to regain her sense of smell and ability to smile [AFP].