New technologies are driving medical innovations across Central Florida. A sample of activity reveals great promise for the treatment of cancer, robotic surgeries, cardiology care and the emergence of new products.
By Michael Candelaria
Math makes a difference, right?
While cancer therapies that target a specific protein have improved outcomes for patients, many others eventually develop resistance to those targeted therapies and their cancer comes back.
In response, researchers at Moffitt Cancer Center in Tampa are using an uncommon approach by combining typical cell culture studies with mathematical modeling. In turn, they are determining how tumor cells and the surrounding environment affect responses to targeted drug therapies – with the understanding that differences among tumor cells may contribute to drug resistance.
The big advantage: This mathematical approach can analyze many different tumor scenarios and drug combinations, and offers a way to more accurately predict heterogeneous tumor responses.
“We’re only just beginning to understand the importance of nongenetic heterogeneity,” explained lead study authors Dr. Eunjung Kim and Dr. Alexander Anderson of the Department of Integrated Mathematical Oncology at Moffitt. “Much more needs to be done in teasing apart the contributions of genetics, cells and the microenvironment; how they interact and modulate one another, and how this might alter our current combination of treatment strategies.”
Cells within a single tumor may have different genetic characteristics, leading to different protein levels or activity, and act differently in response to a stimulus or targeted therapy. In addition, the surrounding tumor environment can produce chemical signals that further alter tumor cells and their response to targeted therapies.
At present, the typical approach researchers use to study cancer development and treatment is to consider the cells within a given tumor to be the same and to have a similar response to therapy. By using mathematical modeling and experimental data, Moffitt researchers are able to take tumor cell heterogeneity into consideration – enhancing the percentage of accurate prediction.
The idea was for Florida Hospital to bring high-tech features and lower costs to robotic-assisted surgeries – and do it sensitively.
Last fall, Florida Hospital introduced the TransEnterix Senhance Surgical System, a new surgical robotic system available to patients in the United States for the first time. Previously in use in Europe, it received FDA approval last October, as the first new robotic surgical system to receive such approval since 2000. In turn, Florida Hospital became the first U.S. healthcare system to utilize the Senhance, both for training and for clinical use.
The system is expected to benefit patients across a range of procedures and specialties, including gynecology and colorectal surgery. As 2018 began, several Florida Hospital surgeons already had completed their training on the system.
“The FDA approval of Senhance in the United States and the early adoption of the system at Florida Hospital are milestones in the progress of robotics,” said Todd M. Pope, president and CEO of TransEnterix, Senhance’s manufacturer. “Senhance will strengthen the senses, precision and comfort of the surgeon, minimize the invasiveness of surgery for the patient and maximize value for the hospital.”
“Senhance will strengthen the senses, precision and comfort of the surgeon, minimize the invasiveness of surgery for the patient and maximize value for the hospital.”
– Todd M. Pope, President and CEO of TransEnterix
According to Dr. Steve Eubanks, executive medical director of the Florida Hospital Institute for Surgical Advancement, the system represents “innovative technology to advance patient care” at Florida Hospital.
The controls for the Senhance mimic traditional laparoscopic surgery, allowing for an accelerated adaptation for surgeons currently performing surgeries with these tools. The surgeon sits in an ergonomically comfortable position and can see inside the body with 3D visualization. Optical sensors allow surgeons to move the camera and select commands simply by moving their eyes.
The Senhance is also the first robotic system that offers “haptic feedback,” which re-creates the sense of force feedback for surgeons so they can “feel” forces encountered via the system’s robotic arms.
Shockwave and Awe
“The best and most successful technologies in medicine are the ones that are simple,” said Dr. Vijay Kasi, an interventional cardiologist and director of cardiovascular research at Orlando Health. “The complex technologies are often not practical, and they don’t translate to everyday medical use. That’s the beauty of this technology.”
Kasi went on to explain the Lithoplasty System, a treatment for calcified plaque in patients with peripheral artery disease, pioneered by California-based Shockwave Medical. Earlier this year, Orlando Health became one of the first nationwide to perform test cases.
Peripheral artery disease affects nearly nine million people in the United States, blocking blood flow to the legs and feet, causing significant pain and limited mobility, and potentially leading to surgery or even amputation in severe cases. Arterial calcification, caused by plaque that hardens over time, is increasingly common as preventive care and disease management enable patients to live longer, making vascular disease a chronic condition. The challenge is that, unlike cholesterol, the calcium “is very hard to remove … and very risky,” Kasi noted, adding, “Here comes along Shockwave.”
The Shockwave Medical Lithoplasty System is the first-ever device designed to selectively target hardened calcium in patients with cardiovascular disease. The device integrates two familiar and powerful technologies: the calcium-disrupting power of sound waves (known as “lithotripsy,” which is commonly used to treat patients with kidney stones) with the simplicity of angioplasty balloon catheter devices. Intermittent lithotripsy pulses disrupt both superficial and deep vascular calcium – breaking it into tiny fragments – while minimizing soft tissue injury, and an integrated angioplasty balloon expands blockages at low pressures to restore blood flow.
“By using Shockwave, it makes it much easier to push the calcium aside, just like we push the cholesterol aside. Then the balloons and stents expand nicely. … This could be life-saving in several situations,” Kasi explained.
A statistical ache definitely exists. Nationwide, total knee replacements are expected to increase 673 percent by the year 2030. Yet, studies have shown that approximately 30 percent of patients are dissatisfied after conventional surgery.
The potential solution: total knee replacement using Mako robotic-arm assisted surgery – just like first performed last October by Jewett Orthopaedic Clinic’s Dr. Pratik P. Desai.
The Mako technology, developed by the Michigan-based Stryker Corp., provides a surgeon with a patient-specific 3-D model to preplan your partial knee replacement. During surgery, the orthopaedic surgeon guides the Mako robotic-arm based on a patient-specific plan. That allows the surgeon to remove only the diseased bone, preserving healthy bone and soft tissue, and assists the surgeon in positioning the implant based on the patient’s anatomy.
Essentially, Mako Technology was designed to help surgeons provide patients with a personalized surgical experience based on their specific diagnosis and anatomy. This latest advancement distinguishes the Mako System as the first and only robotic technology that can be used to perform total knee, total hip and partial knee replacements.
While over the years, knee replacement techniques and instrumentation have undergone “countless” improvements, according to officials at Jewett Orthopaedic Clinic, the Mako technology is “transforming the way joint replacement surgeries are being performed.”
Notably, after the surgeons at Jewett guide the Mako robotic-arm to remove diseased bone and cartilage, they insert something called the Triathlon Total Knee implant. Yes, Triathlon.
Seeing the Light
If necessity is the mother of invention, Mark Nathan was in bad need. A frequent traveler on planes and in hotels, Nathan constantly was sick.
“There had to be a way to make disinfection easy,” he reasoned.
A subsequent decade of research and development brought Nathan to Violet Defense, a product tested and proven to kill up to 99.9 percent of bacteria and viruses in hospitals and, as it turns out, pretty much everywhere else.
Since landing on the solution in 2012, Nathan, CEO of Violet Defense LLC in Celebration, Florida, has been inching toward mass marketing. The product made its first appearance in 2017 at the “Wellness Home built on Innovation and Technology,” a one-of-a-kind living lab that features an integrated set of health and wellness solutions and technologies in Lake Nona.
The antibacterial effects of ultraviolet light were discovered 140 years ago, but the appropriate combination of technologies and materials have been identified, and Nathan’s breakthrough has produced a technology that not only kills all forms of germs/ microbes on the product itself, but also the surrounding areas and even within the air and nearby water/fluids.
“At the end of the day,” Nathan concluded, “what we’re trying to do is not create a sterile world; we’re trying to reduce potentials for infection.”