Minimally invasive surgery is an exciting, fast-growing area of healthcare. We look at four procedures you may not have heard of
Broken-down cartilage in the kneeWhen your body is cut open, whether by a knife-wielding lunatic or a skilled surgeon, it goes through trauma that the body must recover from. That is why medical science always seeks to do the body the least damage possible. Minimally invasive surgical techniques offer far shorter recovery times, and many are also cheaper than older methods.
Procedures like lasik eye surgery, and even major, life-saving ones, like angioplasty, have become mainstream. What other operations are gaining ground? We asked some leading doctors to tell us about procedures that are useful, but yet to gain major popularity.
We must urge you, however, to not take medical decisions based solely on what you read here. Self-diagnosis is dangerous, more so in this age of easy information dissemination and access, where unverified falsehoods have as much chance of being read as rigorously researched facts.
Educate yourself by all means, but remember that it takes many years of hard work and concentrated study before you can become a doctor.
Autologous Chondrocyte Implantation (ACI)
Cartilage is the tough, elastic tissue that serves as a cushion between bones. People such as marathon runners who perform repetitive motions may damage their articular cartilage, causing pain and stiffness in the knees.
Approximately one-third of the general population suffer from osteoarthritis and spondylitis of knees and spines Treatment for such injuries is not trivial and includes bone marrow stimulation techniques, abrasion arthroplasty (debridement), drilling, micro-fracture, and mosaicplasty. The cells generated by techniques like mosaicplasty and micro-fractures could break down after a period of time, and the pain experienced earlier could return.
ACI, was pioneered by Lars Peterson, in Gothenburg, Sweden, in 1987. The outcome was reported in the New England Journal of Medicine in 1994.
Cartilage harvested from the patient is subjected to enzymatic digestion, to isolate the cells called chondrocytes. These are live cells; various techniques are used in the cell culture lab to grow and multiply them. Then the joint is opened, and the area with the defect is prepared. The chondrocytes are mixed with fibrin, a very sticky substance, to form a thick clot-like mixture that sticks to the affected area, forming a scaffold for the cells to grow into the bone.
ACI uses cells harvested from cartilage, and not fibro cartilage that results from the more common micro-fractures (which develops as a result of bleeding) that breaks down. Another specialist told us that ACI is good for lifelong treatment, whereas with micro-fractures, the person may have to come back again for treatment in a few years.
The downside is that it is expensive: About Rs. 2.5 lakh. The basic cost of harvesting and growing chondrocytes starts at Rs. 1.5 lakh. Doctors hope that if hospitals start to culture these cells in their own labs, the cost might come down. Reliance Life Sciences, which is also looking into this area, said its cartilage regeneration initiative is undergoing clinical trials.
Case File
Five years ago, John Smith (name changed on request), 43, got a swelling in his knee that grew into severe pain over the next few years. An arthroscopic examination in South Africa revealed a small (2cm x 2.5cm) defect of the medial femoral condyle. After micro-fracture treatment for the lesion, he improved marginally for a short period, but found his very active lifestyle much hampered.
Dr. Alexander Kutikov, Assistant Professor of Urologic Oncology, Fox Chase Center, Philadelphia, says, “The prostate is intimately related to the urinary sphincter that is responsible for continence; nerve fibers that are responsible for erectile function basically ‘shrink wrap’ the gland, and the cancer lies on the outer edges of the gland and is easily left behind if the operation is not performed correctly. [..] A few elite surgeons were able to master laparoscopic prostatectomy, but it took many cases to achieve results that were comparable to a traditional prostatectomy.”
(This story appears in the 05 November, 2010 issue of Forbes India. To visit our Archives, click here.)