Are high-tech alternatives to surgery better?

Q. Radiologists have begun to perform procedures once done only by surgeons. What is interventional radiology and why is it an important development?

A. It’s a whole range of things that have been emerging for a number of decades. It starts out with the radiologist who took pictures and thought, 'Maybe I can fix things.'

The way they fix things is to stick long tubes called catheters through the blood vessels. They use the blood vessels like a highway system to get to almost every organ in the body. What this has done is created a whole set of alternative treatments for all kinds of conditions.

The best known example of interventional radiology done by cardiologists is putting in angiograms and stents. That’s where they’re operating under a live x-ray picture to put wire into the arteries of the heart to unclog them.

Interventional radiologists have a procedure where they repair uterine fibroids by putting a kind of "Crazy Glue" at the blood source to knock off the fibroid blood supply. The fibroids die. It could be an alternative to hysterectomy for a lot of women.

Other interventional radiology is done with blood vessels in the brain. They can use wire mesh screens for aneurysms and repairing venous malformations in the brain. These are both things that can lead to strokes. Bleeding in the brain can be life-threatening and dangerous.

Interventional radiology can be done for varicose veins and veins in the legs that get clogged and need amputation.

Some cancers that are being treated with interventional radiology, particularly liver and kidney cancers.

You can deliver drugs to the tumor or try to cut off the blood supply to the tumor in various ways. Interventional radiologists can either be guided by live x-rays or by live MRIs. It’s a lot of things at once and it’s a whole trend.

Q. You call minimally invasive surgery a big revolution in surgery in recent years. You're planning a segment this week on a University of Pittsburgh surgeon who operates on the brain by going through the nose. How will people benefit from that technique?

A. It goes under the heading of endoscopy where doctors operate by operating through two small holes—one with a fiber optic video camera and the other has tiny tool. This specific story is about a guy doing minimally invasive brain surgery, where he's removing tumors.

For the two ports into the brain he uses the two nostrils. He goes through the nose. It turns out he can reach an enormous amount of space in the brain. It takes an operation that would normally require days or weeks of recovery in a long hospital stay and makes it much shorter. There’s so much less cutting open of the body.

Gall bladder surgery is now done routinely this way as well as kidney removal. 

Q. Is it safer than traditional surgery?
There’s much less chance of infection, but there’s always a trade-off. You lose space of field. In other words, if you’re taking a tumor out of the colon, a very common operation, it can be done with minimal invasive surgery and it often is these days.

But the thing is, the doctor can’t feel it. You lose touch and that’s a big deal for a lot of surgeons. Especially when dealing with a tumor. You want to feel it and where it is.

But if you open someone’s stomach and intestines, you are risking a much bigger chance of infection than if you're going in through two small holes.

Doctors are operating by watching a TV screen. Once you’ve got these devices going in, you can hook it up to a robot. And by hooking up to a robot, you don’t even have to scrub because it can be automated and operated from a distance. You don’t have to worry about a tremor in your hand. A lot of surgery becomes like a complicated video game.

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