The prospect of surgery usually causes fear, if not outright panic, for many patients. But what if doctors didn't have to make a single cut?
A procedure is being tested that uses high-tech images and beams of sound to do the cutting. It's known as "focused ultrasound surgery" and some believe it to be the greatest leap in medicine since the scalpel.
Wendy Perkins knows all about it. She suffered with a fibroid tumor for years. At its maximum, the fibroid was roughly the of a football.
"You can only imagine what I went through in terms of pain on a daily basis," she recalled.
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The pain came from the tumor taking up so much space, putting an almost crushing force down on her bladder. Though a bit past child-bearing years, she looked pregnant.
An Alternative Approach
Uterine fibroids are non-cancerous growths that affect 25 percent of women. Surgically removing the uterus is the most common treatment with some 200,000 annual procedures in the U.S.
Perkins found a bias toward that approach.
"With each doctor that I went to-- and I saw eight-- with each one except for the last, they only wanted one thing for me, and that was hysterectomy," she said.
That last physician was Dr. Suzanne LeBlang of University MRI in Boca Raton, Florida. LeBlang is a pioneer in this new surgery.
"In October of 2004, FDA approved this technology to be used for uterine fibroids," LeBlang explained. "So we actually performed the first case after FDA approval and it was so exciting."
Three years later, that excitement became Perkins' too. She decided to go with ultrasound.
How it Works
Surrounded by a standard MRI machine, the patient lies down with the ultrasonic surgery device immediately below the abdomen. The multiple ultrasound beams come up from there and destroy the fibroid tissue with controlled heat.
"They're focused to a point and only at that point where they're focused will they have an impact. It's just like someone would take a magnifying glass and use the magnifying glass to focus the light of the sun," explained Dr. Joy Polefrone.
Polefrone is Director of Patient Support Organizations at the Focused Ultrasound Surgery Foundation and heads Fibroid Relief, both in Charlottesville, Va.
Now with 160 of these surgeries performed, LeBlang says the procedure is like the ultimate video game -- thousands of clicks per surgery. She says that she's a rare parent because playing video games with her children actually helps her in her work.
A Tedious Procedure
But the results are much more than virtual for her patient, Robin, who wanted an effective surgery with immediate recovery for family reasons. Robin found one of the more difficult aspects was keeping her lower torso still during the several hours of the operation.
LeBlang directs the entire process with computers from an outer control room. That's necessary because the MRI that guides the beams and analyzes tissue status is a huge magnet. That strength isn't compatible with computers.
The surgery begins with adjusting the equipment for major factors such as beam energy, angle, and depth of penetration. LeBlang performs a few test blasts with lower temperatures. Eventually when she's sure everything is calibrated, the actual surgery begins.
That involves continual adjustments as she fires away dozens of times gradually burning away the fibroids blast after tiny blast until the tumors are gone. LeBlang only needs to get the bulk of the fibroid tissue because small remaining pieces will fade away on their own.
Everything on the monitors is color coded. For instance, the blue spots are areas of the tumor already done; the green circles are future targets; and the red circles tell LeBlang that an area is too close, for instance, to an adjacent part of the bowel.
Those red circles are red flags "telling me we can't do it right now," LeBlang explained. She will have to bring the ultrasound beams in from a different angle to avoid that risk.
On the Path to Healing
CBN News followed Robin through her surgery as she walked to recovery on her own. Fifteen minutes later she spoke to us.
"I'm ready to go, just a little groggy, but that's because I had a little bit of anesthesia," she said.
Robin's now back home and expecting the final results patients like Perkins have seen. Perkins says there were immediate effects on the bulk of her fibroid being removed.
She also noted gradual changes as the remaining unwanted tissue went away.
"It took about maybe a month, perhaps two, for it to really become completely invisible," she said.
LeBlang added that the process can take up to three months.
Insurance Companies Say No to Coverage
So what does this cost and who pays? Despite that 2004 FDA approval, insurance companies aren't paying. Patients can expect to pay more than $10,000 out of pocket.
LeBlang says focused ultrasound doesn't lend itself to providing the typical research that insurance companies want to see.
"We're broaching on a whole new world going from invasive procedures and invasive surgeries to minimally invasive to non-invasive surgery," she said. "There's no standard to compare it to."
Dr. Neal Kassell, a distinguished professor of neurosurgery at the University of Virginia, is helping lead the effort to get insurance coverage and to have the surgery used for more than fibroid tumors.
Kassell is on the board of the Focused Ultrasound Surgery Foundation. Founded in 2006, the organization's mission is "to shorten the time from technology development to patient treatment, develop new applications, and accelerate the worldwide adoption of MR-guided focused ultrasound surgery."
That means, Kassell says, exploring applications, "to treat a whole variety of benign and malignant tumors, to treat stroke and Parkinson's Disease, heart disease, atrial fibrillation." For him, that includes efforts in his specialty to use ultrasound for a wide variety of brain tumors and diseases without a knife.
Potential to Help Treat Other Diseases
Polefrone says the procedure also has great promise for controlling breast, prostate and other cancers.
"We'd view it as a disease that has to be maintained and monitored in treatment - so a chronic disease instead of a fatal disease," she said.
In other words, focused ultrasound is unique in that the procedure could be used time and again to keep cancer in check. Radiation and invasive surgeries have a narrow limit because of the collateral damage they produce.
One potential heart application is to zap life-threatening clots blocking blood vessels. Another possibility is using the ultrasound beams to pinpoint and release injected medicine.
That is, medicine can be micro-encapsulated in heat-sensitive "envelopes." The ultrasound is focused right where it's needed with just enough heat to dispense the drug, herb, or nutrient -- fighting tumors or promoting healing of many kinds. The medicine is released no where else and the rest of the body remains free of side effects.
With so much promise, Kassell and a growing number of physicians, researchers and patients are working to get ultrasound treatments out there as quickly as possible.
"Absolutely, our goal is to compress the technological development time so that the impact on lives is far greater," Polefrone said.
That way multiplied millions would be able to get back to enjoying the beautiful world God made.