USF Health and Tampa General Hospital are at the forefront of cutting-edge surgical techniques that reduce or eliminate the need for cutting patients open.
These minimally invasive procedures deliver life-changing treatments to patients who are too high risk for traditional surgery. They can turn major surgeries with extensive recovery times into outpatient procedures.
In the spring, interventional cardiologists at the USF Health/TGH Heart and Vascular Institute were the second surgeons in the country, and the first in Florida, to use a new heart implant device to replace the tricuspid valve, making the treatment available to patients too high risk for conventional surgery.
The innovation coming out of the collaboration of USF Health and Tampa General Hospital includes the use of focused ultrasound waves to treat essential tremor and some cases of Parkinson's disease.
In May, neurosurgeons with USF Health and TGH were the first in this region to use MRI-guided focused ultrasound waves to treat a neurological disorder, making care available to patients deemed too high risk for traditional brain surgery.the innovation that takes place at large academic medical centers like the one USF Health and TGH have developed here in Tampa Bay.
“Academics tend to focus more on the big picture of treatment, innovation advancing science,” says Dr. Oliver Flouty, an assistant professor in the USF Health Morsani College of Medicine Department of Neurosurgery and Brain Repair and a neurosurgeon at TGH. “A lot of the technologies that are emerging, early on they don’t have good reimbursements. So private groups often shy away from adopting it, where academic groups have a broader mission. The focus is advancing patient care through innovation and science.”
Building an international reputation
The pioneering work in minimally invasive surgeries is not limited to the collaboration between USF Health and TGH. The TGH Parathyroid and Thyroid Institute, which is not affiliated with USF Health, continues to establish a reputation as a world-class surgical center, bringing in patients from every state, Puerto Rico and foreign countries like Norway, England, Spain and Bahrain.
“Patients just find you,” says Dr. Douglas Politz, a parathyroid surgeon and co-founder of the TGH institute. “It’s not like I do interviews with TV stations in Paris. I guess the world has gotten to the point where they go online and do research and they find you.”
Dr. Douglas Politz and Dr. José Lopez of the TGH Parathyroid and Thyroid Institute are the two most experienced parathyroid surgeons operating in the world today.
Dee Lynch, of Largo, is one of the patients who found Politz. Lynch describes herself as a young 73. She works out regularly, takes care to look good and feels 40. But Lynch says she was not herself the last few years.
“I was totally exhausted,” Lynch recalls. “I had fatigue. I couldn’t do anything. I felt like I was 80. I stopped exercising, I was exhausted.”
The source of the health problems impacting her quality of life was a tumor enlarging one of the four tiny parathyroid glands in her neck. As a result, an overproduction of parathyroid hormone was pulling calcium out of Lynch’s bones and depositing it in her bloodstream. The condition can cause aches, depression, exhaustion, brain fog, osteoporosis, kidney stones, kidney failure and other serious health problems.
For Lynch, it was an agonizing journey to figure out exactly what she was facing.
“I was ill for a long time,” she recalls. “They sent me to all these different doctors. Some doctors didn’t think it was a big deal to have high calcium in your blood. My primary doctor said my blood work was off. She sent me to a cancer doctor. The cancer doctor could not find any cancer. He thought maybe it was the thyroid. So I went back and forth for a few years to doctors not knowing what to do. Finally, they sent me to an endocrinologist, he did a CAT scan and said that I had a ‘hot point.’ He thought I had a tumor on my parathyroid but would have to do exploratory surgery. Exploratory surgery! That really scared me. I thought my God. So I prayed, I really prayed.”
Lynch says she put trust in her faith and went online to research other treatment options besides major surgery. She discovered Politz, who, along with TGH Parathyroid and Thyroid Institute co-founder Dr. José Lopez, are the two most experienced parathyroid surgeons operating in the world today.
Instead of exploratory surgery, a diagnostic nuclear medicine test identified which parathyroid gland was enlarged by a tumor. Then, a small incision is made to target that specific gland instead of a six to eight-inch cut that leaves a large scar on the neck.
Patients previously faced a six to eight-hour surgery, a week’s recovery in the hospital and potential side effects such as damage to the nerves for the voice box, accidental destruction of the parathyroid glands functioning normally and the potential to develop involuntary muscle contractions. Now, Politz says an experienced surgeon can do a minimally invasive parathyroid surgery in 30 minutes as an outpatient procedure.
“When you think about the size of the tumor, we figured out in surgery the punishment was way worse than the crime, Politz says. “We should have the punishment fit the crime better, so to speak. If we’re going to take out something the size of a kidney bean, why are we making a giant incision across their neck and disturbing all this other stuff involved?”Dr. Douglas Politz, co-founder of the TGH Parathyroid and Thyroid Institute.
He says minimally invasive techniques started in the ‘90s and have evolved with better imaging technology and more experienced surgeons.
“It’s an outpatient procedure,” Politz says. “It’s not a week in the hospital, or even a night in the hospital, for most people. The cure rates are high, in the high 90 percent. The chance of death from this is essentially zero. The chance of someone dying from a parathyroid surgery like this is essentially zero. Complication rates are well under one percent. So you are doing a lot less surgery, a lot less of an insult to a patient's physiology. It’s a lot less for them to go through. The surgery is outside the body cavity. It’s just under the neck and about an inch and a half to two inches under the skin. That is how deep we have to go, not much at all. It’s much more tolerable for a patient, much less risky for a patient. They don't have to stay in the hospital. It’s a very small incision and very little pain after. High cure rates and very, very low complication rates.”
Lynch had her surgery in early July and immediately regained her energy and health.
“I want other people to know there is a way to go to fix this and it’s with an experienced doctor who knows what he’s doing,” she says. “I was out in 20 minutes. You can go in, have this done, be out of there in half an hour and go back to a normal life.”
At the forefront
The USF Health/TGH Heart and Vascular Institute is at the forefront of newly developed surgical techniques for heart valve implants that do not require open heart surgery. This year, surgeons there were second only to the Cleveland Clinic for implanting a newly developed device, the TricValve, to replace the tricuspid valve of the heart. The new implant consists of two self-expanding valves that sit adjacent to the tricuspid valve.The USF Health//TGH Heart and Vascular Institute was the second medical center in the U.S. to use a newly developed heart implant to replace the tricuspid valve.
Dr. Hiram Bezerra, the section chief of interventional cardiology at the Morsani College of Medicine and director of the Interventional Cardiology Center of Excellence at the TGH Heart and Vascular Institute, says they have now done four procedures, making them the most experienced team in the developing area of surgery.
Bezerra says the newly developed implant is the latest innovation in transcatheter therapies for heart valve disease. Instead of cracking open the sternum, transcatheter procedures replace the cardiac valves through catheters inserted in the artery or, more often, the vein, in the groin area. Through that technique, a major surgery that meant breaking open the chest bones now requires no cut and is done with the patient under mild sedation.
“Equally or more important is they feel good,” Bezerra says. “There is no recovery time because they are not recovering from a big operation that needs to heal and wait for the bones of the chest to recover. They can literally have a better life the next day.”
Transcatheter surgery has already supplanted open-heart surgery as the standard of care for aortic valve replacement. Now, USF Health and TGH are leading the way in using transcatheter surgery and the new TricValve device to replace the tricuspid valve.Dr. Hiram Bezerra, the section chief of interventional cardiology at the USF Health Morsani College of Medicine and director of the Interventional Cardiology Center of Excellence at the TGH Heart and Vascular Institute.
“The new kid on the block is the tricuspid valve,” Bezerra says. “Right now, the tricuspid valve is a new option that is going to serve patients at high risk for conventional surgery because it is still a new device that is not even FDA approved. It is limited to what we call compassionate use. If the patients have no other options because they are deemed high risk for conventional surgery, and it is approved by the FDA on a case-by-case basis, we can proceed.”
Bezerra says USF Health and TGH will be part of clinical trials starting late this year to expand the use of the TricValve device.
A new option for essential tremor and Parkinson’s
The focused ultrasound procedure that Morsani College of Medicine neurosurgeons at TGH started using in May provides hope for patients with essential tremor or Parkinson’s disease who are too high risk to go through conventional brain surgery that involves implanting hardware in the brain to manage symptoms. At this early stage in its development as a treatment, the FDA has approved focused ultrasound for disabling tremor and select Parkinson’s patients.
“It is select patients, especially patients who are old, who have other illnesses or comorbidities or cannot tolerate surgery for a specific reason,” says Flouty, the neurosurgeon at TGH and assistant professor of neurosurgery at the Morsani College of Medicine. “The surgery provides a less invasive option for them. Patients are coming out of the woodwork asking about this technology. Prior patients who were deemed surgically unfit are now potential candidates. I have a patient who is 90 years old. In the past, we didn’t think about treating patients above 80 or 85. Now with this technology, we were able to offer that gentleman surgery at the age of 90.” Dr. Oliver Flouty, assistant professor in the USF Health Morsani College of Medicine Department of Neurosurgery and Brain Repair and a neurosurgeon at Tampa General.
Flouty compares focused ultrasound treatment to using a lens to magnify the sun’s rays.
“When you were a kid and you would use a lens to burn a leaf, you would focus the sun’s rays on a single point to heat it up,” he says. “Even though individual sun rays are harmless, when you converge them onto one point, it can heat up the leaf and burn it. It’s the same with ultrasound. A single ultrasound beam is harmless but when you converge a thousand onto a surface that is millimetric in size, you can heat it up. If you converge enough of them you can create an effect. By creating a small lesion you can disrupt abnormal networks that are causing symptoms such as tremor.”
Magnetic resonance imaging (MRI) technology and computer software monitor and guide the ultrasound beams. It is typically an outpatient procedure and the patient remains awake during the treatment.
This compares to the traditional method, which involves cutting through the skull to implant hardware, significant recovery time, waiting for the skin to heal, removal of sutures, activation of the hardware implanted to manage symptoms and living with that implant.
“With ultrasound, it provides immediate benefit,” Flouty says. “No need for the long-term wait. No need for the incision. And it obviates the need for hardware or permanent implants.”
He says the process is ongoing to get FDA approval for wider use of focused ultrasound, including for more Parkinson’s patients.
“We don’t have a cure for Parkinson’s,” Flouty says. “It’s similar to diabetes. We can’t cure diabetes, but we can control the sugar levels in the blood. We can’t cure Parkinson’s but we can mitigate the symptoms. At this stage in medicine the symptoms that are most amenable to treatment as far as Parkinson’s are movement problems such as tremor, slowness and stiffness. To improve the quality of life, that’s the purpose, not to cure the disease. But we can improve the quality of life for our patients and allow them to do the things they want to do.”
For more information go to TGH Parathyroid and Thyroid Institute, USF Health/TGH Heart and Vascular Institute and TGH Neuroscience Institute.
This story is underwritten by USF Health and Tampa General Hospital through a media partnership to spotlight the innovation coming out of their academic medical center.