Minimally Invasive and Robotic Cardiac Surgery Leading-Edge

Minimally Invasiveand RoboticCardiac Surgery

Leading-EdgeVascular Surgery

The Forefront ofUrological Surgery

SurgicalAdvances forBreast Cancer

Dramatic Resultswith Weight-LossSurgery

BreakthroughProcedure ReducesRisk of Stroke

HW Spring06 PDF 3/14/06 9:16 AM Page 1

http://www.mhs.net

“Iwas at my high school reunion in September 2003 when I received acall from my doctor,” says Jan R.

Cummings. “There were areas of concernon my annual screening mammogram andshe wanted a follow-up.”

After receiving a diagnostic mammogramand stereotactic needle biopsy, Jan receivedthe diagnosis: breast cancer. “I was in shock,” she says.

From Diagnosis to Treatment

“Some friends and family suggested that I go elsewhere for care,” says Jan, “but I knew that I could get quality care in Broward County.”

Jan made an appointment with PhyllisNeimark, MD, surgical oncologist on the medical staff at Memorial RegionalHospital, Memorial Hospital West andMemorial Hospital Miramar, and took itupon herself to learn as much as she couldabout her situation.

“My husband, Jim, and I were immediatelyimpressed with Dr. Neimark’s knowledge,as well as her caring and professionalmanner,” says Jan. “The best advice shegave me was to let her take a conservativeapproach to surgery.” After additionalprocedures at Memorial Cancer Institute,including a lumpectomy and sentinel node

biopsy, a pathology report came back withmixed news: The lymph nodes werecancer-free, but the tissue removed did nothave clean margins, meaning there wasstill pre-invasive cancer within themammary ducts.

Dr. Neimark recommended a mastectomyof the right breast. “I never wanted to gothrough this again so I asked her to do apreventive mastectomy on the left side, aswell,” says Jan, “with an immediatereconstruction of both breasts.”

Jan then met with Jonathan R. Weiser, MD,plastic and reconstructive surgeon on themedical staff at Memorial RegionalHospital, Joe DiMaggio Children’s Hospital,Memorial Hospital West and MemorialHospital Pembroke. “Dr. Weiser wasengaging, caring, professional andcompassionate. He patiently answered mymillion questions,” says Jan. He determinedthat Jan was a candidate for breastreconstruction using tissue expanders thatwould be replaced by implants.

Dr. Neimark performed the skin-sparingmastectomies in January 2004, followed byimplantation of the tissue expanders by Dr. Weiser. “I was amazingly calm,” saysJan. “My family and friends were extremelysupportive, and I was very confident withmy choice of doctors.”

Later, a clean biopsy report showed noneed for radiation or chemotherapy. Andalthough her chance of cancer recurrencewas very low, Jan chose to go on hormonetherapy with Tamoxifen.

Expressing Gratitude

“Dr. Neimark and Dr. Weiser are mysuperheroes,” says Jan. “Though themammogram diagnosis saved my life by catching the cancer early, these twophysicians, with their expertise andcompassion, made me whole again — both emotionally and physically.”

1

Surgical Advances for Breast CancerMemorial Breast Cancer Center Offers Greater Results for Women with Breast Cancer

S U R G I C A L I N N O V A T I O N S — E N H A N C I N G P A T I E N T S ’ L I V E S

M E M O R I A L P H Y S I C I A N R E F E R R A L S E R V I C E ( 8 0 0 ) 9 4 4 - D O C S • w w w . m h s . n e t

Phyllis Neimark, MDSurgical Oncologist

Jonathan R. Weiser, MDReconstructive Surgeon

ScreeningRecommendations

• Obtain yearlymammograms starting at age 40

• Receive clinical breast exams (CBE)as part of a periodic health exam —about every three years for womenage 20-39 and annually for womenage 40 and older

• Discuss additional screeningmeasures with your healthcareprovider if you are at increased riskdue to family history, genetics orprevious breast cancer

40

“I was very confident with my choice

of doctors.”Jan Cummings


http://www.mhs.net/Physicians/

JERI

LYN

Just a few years ago, cardiacsurgeons had to make asternotomy (neck-to-navel

incision) and spread apart apatient’s ribs to access the heart.While this is still necessary forcertain heart operations, Memorialcardiac surgeons can now repairor replace damaged valveswithout opening the chest. As aresult, more people previouslyconsidered high risk for openheart surgery can undergo much-needed procedures.

Minimally Invasive Surgery

“Last week I operated on an 87-year-old woman who had been admittedwith heart failure. She didn’t think she couldhave surgery, but she did fine. The day aftersurgery, she was sitting up eating breakfast.She went home in four days,” says MichaelRosenbloom, MD, Chief of Cardiac Services atMemorial Regional Hospital and cardiacsurgeon on the medical staff at MemorialHospital West. “Another patient went homeon the third postoperative day and drove toTampa the next day.”

Recovery is often “unbelievable,” he adds.Patients have very little discomfort and usuallyreturn to normal activity quickly.

To perform minimally invasive valve surgery,Dr. Rosenbloom makes a single, 4-inchincision in the chest to locate the heart and toreach the aortic valve, which lies near thefront of the heart.

Memorial Cardiac & Vascular Institute is a

leader in minimally invasive, “off pump”procedures like this that don’t stop the heartor split the breastbone.

Expertise in Robotics

Reaching the mitral valve, which is locateddeeper in the heart, requires robotic assistanceand the skills of Christopher Akins, MD,cardiac surgeon on the medical staff atMemorial Regional Hospital and MemorialHospital West. He has the distinction of beingthe first physician in Florida to haveperformed mitral valve surgery using robotictechnology.

“Robotics is infinitely more precise than thehuman hand,” says Dr. Akins. “The da Vinci®Surgical System easily accomplishes thecomplex maneuvers required to repair orreplace the mitral valve.”

The benefits to patients are extraordinary.

Because the incision is so small, roboticsurgery can reduce blood loss anddramatically decrease the chance of infection.The minimally invasive approach also allowspatients to return to normal activities quickly— in as little as one week, compared to 6-12 weeks after traditional surgery.

For more information about this and otherhealth matters, visit the Memorial website,www.mhs.net.

MEMORIAL REGIONAL HOSPITAL JOE DIMAGGIO CHILDREN’S HOSPITAL MEMORIAL HOSPITAL WEST MEMORIAL HOSPITAL MIRAMAR MEMORIAL HOSPITAL PEMBROKE

Nationally Renowned Cardiac SurgeonsPioneering Minimally Invasive and RoboticCardiac Surgery Procedures

M E M O R I A L P H Y S I C I A N R E F E R R A L S E R V I C E ( 8 0 0 ) 9 4 4 - D O C S • w w w . m h s . n e t 2

Jerilyn, a 49-year-old working mother oftwo, is grateful for robotic heart surgery.Although she was diagnosed with afaulty mitral valve at age 25, she hadnever experienced any slowdown orcomplications. But when she got aninfection that most likely resulted fromoral surgery, she grew weak andexperienced labored breathing.

Jerilyn was hospitalized and treated forthe infection, but learned somethingmuch more alarming: She was just daysaway from heart failure. Her cardiologistdiscovered she had severe mitral valveregurgitation, in addition to a slightenlargement of her left ventricle. She wasreferred to Dr. Christopher Akins, whotold her, “We need to move quickly.”

When Jerilyn asked if she was acandidate for robotic surgery, the answerwas a resounding “yes.” Only a weekafter surgery, Jerilyn felt well enough toresume her normal activities, including atrip to the beach. “I feel so good,” sheshares, “that I have to remind myselfthat I had heart surgery.”

Michael Rosenbloom, MDChief of Cardiac ServicesMemorial Regional Hospital

Christopher Akins, MDCardiac Surgeon



Ric Potter can’t recall a time when hedidn’t have a weight problem. The 36-year-old exercised regularly and

tried many diets. “I’d lose weight for awhile, then become ravenously hungry,overeat and gain all the weight back,” the registered nurse says.

Eventually, he reached 330 pounds andsuffered from sleep apnea, joint pain, highblood pressure and high triglyceride levels.By the end of a 12-hour nursing shift, hewas too tired to go to the gym or even drivehome. “I was a heart attack waiting tohappen,” he says.

Ric knew he needed help and sought the expertise of Thomas Bass, MD, abariatric surgeon on the medical staff atMemorial Regional Hospital, MemorialHospital Miramar and Memorial HospitalPembroke. Dr. Bass offers two procedures:laparoscopic banding and gastric bypasssurgery.

Ric’s New Life

After consulting Dr. Bass and learning all he could about his options, Ric

underwent laparoscopic banding inOctober 2004. He then modifiedhis diet and began working out atthe gym, walking, riding his bikeand doing yard work. As aresult, he has lost more than

100 pounds ... and continuesto lose. He now shops inregular clothing stores andshares that he can fit in an airline seat with roomto spare.

More importantly, hishealth issues have

subsided. “I believe if Ihadn’t gone to Dr. Bass, I’d

have had a heart attack bynow,” he says. “I think the lap band procedure saved

my life.”

Surgical Options

Laparoscopic banding is a reversibleprocedure that involves inserting aninflatable band around the top portionof the stomach to create a small pouch.Once the ring is adjusted — byinjecting or removing saline via a port

under the skin — optimal weight loss canbe achieved.

“Patients get hungry, but they are satisfiedwhen they eat only a small amount,” saysDr. Bass. “Weight loss occurs at the rate of apound or two a week for two to three years.As the weight is dropped, weight-relatedhealth problems often improve.”

Another alternative is the non-reversibleRoux-en-Y gastric bypass procedure, whichcreates a small pouch from part of thestomach. Food leaving the pouch bypassesthe duodenum and part of the smallintestine so it is not fully absorbed. Weightloss can be rapid — up to 30 pounds permonth in the beginning — and continuesfor about 18 months.

Which One Is Right for You?

Dr. Bass explains that most patients aregood candidates for either procedure butthat weight loss is never guaranteed.

“The procedures are simply tools to achieve an end,” he says. “Patients who are dedicated often experience lastingimprovements in health and a dramaticallynew lifestyle.”

For more informationabout this and otherhealth matters, visit theMemorial website,www.mhs.net.

S U R G I C A L I N N O V A T I O N S — E N H A N C I N G P A T I E N T S ’ L I V E S

Thrilled Patient Shares, “Weight-Loss Surgery Gave Me Back My Life!”

THEN: 265 POUNDS

POUNDS LOST

101

3

“I believe if I hadn’t gone toDr. Bass, I’d have had a heartattack by now … I think thisprocedure saved my life.”

Ric Potter

Weight-Loss Surgery


Thomas Bass, MDBariatric Surgeon



Angioplasty with stenting is a cardiaccatheterization procedure that enablesthousands of patients each year to

“bypass” having bypass surgery.

Now a similar procedure performed in thecarotid arteries of the neck allows patients tohave stroke-prevention treatment withoutmajor surgery. Hoang Duong, MD, and LaszloMiskolczi, MD, interventionalneuroradiologists on the medical staff atMemorial Regional Hospital, Joe DiMaggioChildren’s Hospital, Memorial Hospital West,Memorial Hospital Miramar and MemorialHospital Pembroke, perform the innovativeprocedure.

Minimally Invasive Surgical Alternative

Approximately one-third of all strokes occurwhen the carotid arteries, which carryoxygen-rich blood to the brain, becomeclogged and restrict blood flow.

Carotid stenting with certain devices is FDA-approved for patients who are poor candidatesfor surgery, who have a blockage of 70 percentor more and who are experiencing symptomsof a pending stroke, such as weakness,difficulty speaking or temporary loss of vision.

Poor candidates for surgery includethose who have already undergonecarotid endarterectomy (a surgicalprocedure to manually remove blockagesin the carotid artery) and have a newblockage, who have post-radiationnarrowing or who have blockages thatare difficult to access.

Carotid artery stenting is a minimally

invasive procedure that requires only a smallincision in the groin, where a balloon-tippedcatheter is inserted and threaded up to theneck. The balloon is inflated to compressfatty tissue and to open up the artery, whilean accompanying filter, or cerebral protectiondevice, catches and removes pieces of plaque.Then a cylindrical, mesh-like stent is insertedinto the newly expanded artery to prop it open.

“The results of carotid stenting appear to be asgood as surgery. We think more people willchoose stenting as primary treatment whenongoing clinical trials comparing carotidstenting with carotid endarterectomy — the‘gold standard’ for carotid artery disease — arecompleted,” says Greg Zorman, MD, Chief ofStaff at Memorial Regional Hospital andneurosurgeon on the medical staff at JoeDiMaggio Children’s Hospital, MemorialHospital West, Memorial Hospital Miramarand Memorial Hospital Pembroke.

Dr. Zorman feels that more patients willrequest the procedure because it requires noincision in the neck, recovery is quicker andthere is little discomfort. Most patients gohome within 24 hours and can resumenormal activities within days.


Carotid Artery StentingBreakthrough Procedure Clears Blockages and Reduces Risk of Stroke

• Numbness or weakness of the face,arm or leg, especially on one side of the body

• Confusion or dizziness

• Trouble speaking or understanding

• Problems seeing in one or both eyes

• Difficulty walking, loss of balance orloss of coordination

• Severe headache with no known cause

• Trouble swallowing

Call 911 immediately if you experienceany of these early warning signs.

Larry Solomon recently became very illwhile working in his Hollywood UPS Store.“I felt nauseated, clammy and faint,” heremembers. He was rushed to the hospital,where a 90- to 95-percent blockage wasfound in his left internal carotid artery. “It was shocking. I thought I was in goodhealth,” says the slender, 61-year-oldbusinessman, who does not smoke and

eats a reasonable diet. Larry was referredto Dr. Hoang Duong, who explainedcarotid artery stenting and encouragedhim to consult a surgeon, as well,regarding endarterectomy. When Larrylearned that the configuration of arteriesin his brain could increase his risk forstroke during surgery, he opted for theless-invasive stenting procedure. Six days

after treatment, he was back on the job. “I was a little sore for a couple days, butthat was all. I felt great,” says Larry. Healso was very pleased with Dr. Duong.“I’ve been in this community for a longtime, and I have never met another doctorwho was so reachable and who took somuch time explaining everything. I reallyappreciated it.”LA

RRY


Hoang Duong, MDInterventionalNeuroradiologist

Laszlo Miskolczi, MDInterventionalNeuroradiologist

Greg Zorman, MDChief of StaffMemorial Regional Hospital

Stroke Warning Signs



On the morning of November 14, 2003,John Elias was taking a shower whenhe suddenly felt a punch in his

kidneys that knocked him to the ground. His wife called 911 and in minutes, the 6’4”retired cop, who had curled into a fetalposition, was in an ambulance on his way tothe hospital.

A few hours later, the family learned howclose their husband and father came to dying from a ruptured abdominal aorticaneurysm (AAA). That’s because when abubble in the body’s main blood vessel bursts,the patient can bleed to death in minutes. Inthis case, John’s life was saved by the fastaction of David M. Feldbaum, MD, FACS,Chief of Vascular Surgery at MemorialRegional Hospital and vascular surgeon on the medical staff at Memorial Hospital West,Memorial Hospital Miramar and MemorialHospital Pembroke.

“We are at the leading-edge of techniques fortreating this silent killer,” says Dr. Feldbaum.

He raced to the hospital to take John intosurgery, replacing the damaged section ofaorta with a Dacron graft — a syntheticmaterial used to repair blood vessels.

John not only survived, but he also thrived.However, he is a rarity: Only 10 percent ofpatients live to tell about their experience.Ruptured AAAs are difficult to preventbecause they often do not cause symptomsuntil they burst.

The small percentage of AAAs diagnosedbefore rupturing typically are found byaccident, often through an ultrasound, CT scan or MRI for an unrelated condition.

For these patients, Dr. Feldbaum offers aminimally invasive procedure that preventsthe bubble from bursting. It requires makingsmall incisions in both sides of the groin and threading a catheter up to the aorta. A stent, or tiny, fabric-lined metal cage, isthen placed in the weakened area. It acts like a tunnel to direct blood flow throughthe artery and prevent blood from filling the bubble, which shrinks down like adeflated balloon.

Memorial hospitals are considered some ofthe most experienced healthcare facilities inSouth Florida treating AAAs with stents. Thesurgeons’ expertise attracts patients from allover the United States, the Caribbean andSouth America, including some patientsconsidered at high risk.

Nevertheless, Dr. Feldbaum is realistic aboutthe procedure. “Although an open operationremains the treatment of choice for youngpatients who might outlive a stent, olderpatients and those with co-morbidities suchas heart disease or frailty are great candidatesfor stents,” says Dr. Feldbaum. “And this is byfar the largest group of patients at risk forAAAs.”

Now age 65, John wishes he had knownabout his AAA and could have prevented itsrupture. But he is extremely grateful for thecare he received from Dr. Feldbaum.

5

Abdominal Aortic Aneurysm ProcedureHelps More Patients Survive

David M. Feldbaum, MD, FACSChief of Vascular SurgeryMemorial Regional Hospital


A C O M M U N I T Y H E A L T H P U B L I C A T I O N O F M E M O R I A L H E A L T H C A R E S Y S T E MS U R G I C A L I N N O V A T I O N S — E N H A N C I N G P A T I E N T S ’ L I V E S

Leading-Edge Vascular Surgery

Abdominal aortic aneurysm (AAA) is the 13th leading cause of death in theUnited States. White males have thehighest incidence, males are affectedseven times more often than females, and at least 75 percent of patients are 60 years or older.

Although most people do not havesymptoms, others may experience:

• Rhythmic, pulsating feeling in theabdomen or lower back

• Deep, steady pain in the abdomen orlower back

• Sudden abdominal or back pain, whichmay indicate imminent rupture

Call 911 immediately if you experience anyof these early warning signs.

Take Action

“I now celebrate twobirthdays a year. On November 14,

I give thanks to Dr. Feldbaum.”

John Elias

Memorial hospitals are consideredsome of the most experiencedhealthcare facilities in South Floridatreating AAAs with stents. Thesurgeons’ expertise attracts patientsfrom all over the United States, the Caribbean and South America.



Nothing can shake a man’s confidencelike learning he needs surgery for aurologic condition. Most patients

wrestle with fear of pain, impotence and timeaway from work and normal activities.

The good news is that many of these menqualify for minimally invasive procedures,which are far less painful than traditionalsurgery and allow them to quickly resumetheir normal schedules.

Innovative Robotic Surgery

Although Memorial surgeons have beenperforming minimally invasive laparoscopicprocedures for years, they now have taken itone step further with robotics.

With the computer-enhanced da Vinci®Surgical System, surgeons performprocedures while seated at a console in theoperating room, steps away from the patient.The surgeon guides special miniaturizedinstruments through a 3-D image of thepatient’s surgical site. The system translatesthe surgeon’s hand motions into precisemovements enacted by robotic arms,providing greater precision than normallyattainable with the human hand and eye.

“This is the most advanced form of minimally invasive surgery. The roboticsystem greatly improves the surgeon’sdexterity and accuracy,” says Jonathan L. Masel, MD, FACS, urologist on the medical staff at Memorial RegionalHospital, Memorial Hospital West andMemorial Hospital Pembroke. “Complex,urological surgeries that used to take manyhours to perform with standard surgical

instruments now can bedone faster and withgreater precision.”

Robotics are frequentlyutilized for radicalprostatectomy surgery forprostate cancer, on selectpatients undergoingkidney or adrenal glandsurgery, and for surgeryto repair obstructedkidneys or ureters.Because the procedure isperformed through verysmall incisions, patientshave little discomfortafter surgery and usuallycan be discharged in oneto two days.

Other AdvancedUrological Surgeries

Full kidney removal alsocan be performedlaparoscopically, but doesnot require the use of therobotic system. “Iroutinely perform thisprocedure for cancer,where the kidney is freed and removedthrough a small incision. As with anylaparoscopic surgery, patients have less painand a faster recovery,” says Dr. Masel.

Men with benign prostatic hyperplasia (BPH),or enlarged prostate, can choose minimallyinvasive surgery, as well. In these cases,removal of the extra tissue is performed witha variety of laser or heat-producing

techniques. Both methods destroy the tissueblocking the flow of urine, without requiringa single incision.

“Often this can be performed in my officeunder local anesthesia,” says Dr. Masel.“Plus, patients benefit from minimal risk or discomfort.”

Complex, Urological Surgery Can Now Be Done Faster and With Greater Precision


EARL

Earl Smart, 45, was alerted by hisphysician when his yearly prostate exam,which included prostate specific antigen(PSA) testing, indicated rising antigenlevels. When a subsequent biopsyconfirmed the presence of cancer, Earl sought a second opinion and wasreferred to Dr. Jonathan Masel.“Dr. Masel is a true professional. He wasa calming source of comfort to me,” says

Earl. When it came time to make adecision about surgery, Earl relied on Dr. Masel’s expertise, adding, “He fullyexplained all the pros and cons and evenprovided an informative video for me to watch.”Earl was surprised at the differences heexperienced between traditional surgeryand robotic surgery. He shares that aftera previous surgery, he was in agony

from even the slightest bump in the roadon the way home from the hospital. Butafter his radical prostatectomy, he says,“I could have hit ditch after ditch withouteven flinching.” He even asked to returnto work sooner than scheduled.Now Earl says to his friends, “For me,robotics is the only type of surgery I’dconsider.”


At the Forefront of Urological Surgery

Jonathan L. Masel, MD, FACSUrologist

“Robotics is the most advancedform of minimally invasive surgery.The robotic system greatly improvesthe surgeon’s dexterity andaccuracy.”



Is Your Doctor a Memorial Doctor?Whether you require a routine checkup

or highly specialized medical care, you can trustour Physician Referral Service to help you find theright Memorial doctor for your healthcare needs.

Every Memorial physician meets ouruncompromising standards for training,experience and commitment to excellence.Backed by advanced technology and a widerange of innovative services, our doctors are

able to provide some of the very latest inmedical and surgical care. That’s why Memorialis one of Florida’s leading healthcare systems,and ranks among the best nationwide forpatient satisfaction.

To find your Memorial doctor, please callMemorial Physician Referral Service toll-free at(800) 944-DOCS. We’re available 24 hours a day, 7 days a week.

Memorial Regional Hospital • Joe DiMaggio Children’s Hospital • Memorial Hospital WestMemorial Hospital Miramar • Memorial Hospital Pembroke

www.mhs.net

Simply the Best!

Our Physician Referral Service Is Available 24 Hours a Day, 7 Days a WeekOur Physician Referral Service Is Available 24 Hours a Day, 7 Days a Week



Documents

Minimally Invasive and Robotic Cardiac Surgery Leading-Edge