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Archive for Tuesday, November 3, 2009

Doctors at KU Hospital perform unique surgery on 19-year-old with bone cancer

Rare surgery helps enhance quality of life after arm amputation

Surgeons and other medical professionals gather around the operating table Tuesday at Kansas University Hospital in Kansas City, Kan., during a surgery on a 19-year-old man who had bone cancer. The 10-hour operation involved amputating the man’s left arm, shoulder blade and collarbone. What makes the surgery unique is that it saved six nerves, which will enable greater use of a prosthesis.

Surgeons and other medical professionals gather around the operating table Tuesday at Kansas University Hospital in Kansas City, Kan., during a surgery on a 19-year-old man who had bone cancer. The 10-hour operation involved amputating the man’s left arm, shoulder blade and collarbone. What makes the surgery unique is that it saved six nerves, which will enable greater use of a prosthesis.

November 3, 2009

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KU hospital performs rare surgery

Surgeons at KU Hospital in Kansas City performed a medical procedure that has only been attempted a handful of times around the world. Doctors say the operation was performed successfully and the 19-year-old boy they performed it on was saved. Enlarge video

Matt Luetke holds a prosthetic arm while showing a video on his computer that demonstrates the difference between two types of surgery following an amputation. Luetke, a certified prosthetist of Hanger Orthopedic Group, is working with the 19-year-old patient to adapt to a new prosthetic arm.

Matt Luetke holds a prosthetic arm while showing a video on his computer that demonstrates the difference between two types of surgery following an amputation. Luetke, a certified prosthetist of Hanger Orthopedic Group, is working with the 19-year-old patient to adapt to a new prosthetic arm.

— Kansas University Hospital surgeons performed a unique procedure Tuesday on a 19-year-old man from southwest Missouri who had bone cancer in his left arm.

The 10-hour procedure involved amputating the cancerous limb and then saving as many nerves as possible to use with a prosthesis.

By saving the nerves and implanting them in his chest muscles, he should be able to use the prosthesis more easily and do more with it.

Only 35 of these procedures, called targeted muscle reinnervation, have been done worldwide and KU’s surgery was the first to be performed on a cancer patient — not a trauma patient. It also was the first to be done on such a high level of amputation. The first successful surgery was done in 2001.

Dr. Todd Kuiken, director at the Neural Engineering Center for Artificial Limbs at the Rehabilitation Institute of Chicago, developed the procedure and witnessed the operation.

“This surgery will greatly enable what his options are for controlling an artificial arm,” Kuiken said. “He’s a young man who’s going to have a lot of opportunities with the improvements in time.”

The procedure

Dr. Kim Templeton, chief surgeon and an orthopedic oncologist, said her patient’s surgery consisted mainly of two processes.

The first was amputating the man’s arm, collar bone and shoulder blade — a procedure that she does a few times a year for a variety of reasons.

For bone cancer, doctors typically salvage the limbs by removing the cancer and reconstructing the limbs, Templeton said. But, his bone broke just below the shoulder and the cancer cells spread. Without amputation, his survival rate would have been very poor, if not close to zero.

He had chemotherapy before the surgery and tests revealed the cancer had not spread outside the area that was amputated. He will undergo more chemotherapy after the surgery to make sure any cancer that might not have been detected doesn’t appear. It’s another measure to improve his survival.

“When we are dealing with cancer patients, the first thing obviously is to get rid of the cancer and to try to do our best to keep people alive,” she said. “After that you worry about function and what will they be able to do.”

Most artificial limbs are controlled by remaining muscles — usually between two and four — near the amputation. To use the prosthesis, it requires effort and thought. To open a hand, for example, a person has to move a chest muscle.

During Tuesday’s surgery, Templeton cut through the mass of nerves up in the armpit — called a brachial plexus — and separated them based on what part of the arm they would have gone to. Then, the nerves were implanted into the muscles in his chest. She was able to save six nerves.

She was assisted by Dr. Bruce Toby, chairman of the Department of Orthopedic Surgery at KU Hospital.

“What we are hoping for is that those nerves will trigger electrodes in the (artificial) arm to actually get the arm or hand movement that those nerves would have generated with his own arm,” Templeton said.

If the patient is thinking about opening his hand, it will automatically do that.

“It will be more intuitive,” she said. “The hope of this is that it will make his function faster. If research continues and we can get a prosthesis that has a functional shoulder — which is currently being worked on — then, eventually, this patient will qualify for that, too.”

Road ahead

Typically, a person is fitted for a prosthesis in six to eight weeks after the swelling goes down.

But, this patient will have to wait about six months until the nerves mature in the muscle and become functional.

“So, perhaps, it could be a year before we know exactly what his function is going to be,” Templeton said.

The patient and his family have been working with Matt Luetke, a certified prosthetist of Hanger Orthopedic Group that has partnered with KU Hospital.

Luetke said once the patient is healed and he is able to move the muscles, they will start the process of fitting the prosthesis, which cost about $80,000. He said each prosthesis is custom made by scanning the body with a laser and creating a 3D image with a computer. They will align each electrode with the appropriate muscles to make the limb function. He said having more nerves connected in the chest muscles will allow for more electrodes and ultimately, more functions.

The surgery should allow the patient to do things, like pick up a cup and put it down, two and half times faster.

Luetke said the process will require lots of therapy that will begin soon after the surgery. The patient will need to be thinking about opening and closing his hand and straightening his elbow.

“There is a tendency when you lose a limb to forget about it because you aren’t using it,” he said.

Luetke said he develops close relationships with the patients because he is there for each step of their journey — one that is not easy to endure.

“It’s just an amazing testament to the human spirit,” Luetke said. “In general, losing any limb — whether it’s your leg or arm — if you talk to psychologists, you go through the same grief and the same mourning as losing a sibling. It’s on the exact same level as losing a brother or a sister. So, this is not an easy thing to deal with.”

Templeton described the patient as amazing.

“He and his family have excellent attitudes with this,” she said. “Their primary goal, and I would say solo goal, is to cure his cancer and get him back home and have a normal lifespan.

“For him, the function is important, but he really doesn’t want to talk about that much now. He just wants to get the cancer gone, finish his chemotherapy and survive all of this. That is really the perfect attitude to have for this.”

Comments

Leslie Swearingen 4 years, 5 months ago

We have technology to thank for creating artificial limbs that are better and better and having surgeons with the training to integrate them into the patient. Unfortunately we also have the war to thank as battlefield surgical units have been forced to be innovative in treatment techniques.

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frankfussman 4 years, 5 months ago

We have the best health care that money can buy. $$$ I still want to know who paid for this. You can't say the Obama plan wouldn't cover this. My friends in Canada and Germany have procedures like this -- as expensive as this -- and it is covered by their "socialized" health care. Get real, for God's sake. Our current system here in the U$A leaves poor people out of luck. That's why I want to know who paid for this procedure. I certainly wouldn't be able to pay for it, and my insurance wouldn't cover it. So it might be a charity case, as many people resort to here in our great country, the lowest in the industrialized world as far as health care assistance is concerned. Pray for the plan going through Congress!!!

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jonas_opines 4 years, 5 months ago

Surely would like to know what terms of service that post violated.

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think_about_it 4 years, 5 months ago

Thank God he lives in the country with the best healthcare in the world!!

Under ObamaCare his life would not be worth the cost of this procedure.

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Norma Jeane Baker 4 years, 5 months ago

If the health care reform gets passed by Congress, frankfussman, you can be that this kind of surgery will not be covered.

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jonas_opines 4 years, 5 months ago

This comment was removed by the site staff for violation of the usage agreement.

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FarneyMac 4 years, 5 months ago

My only regret is that I have ... boneitis.

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frankfussman 4 years, 5 months ago

So who is paying for all of this? What kind of insurance does this man have? Let's all hope that the health care reform going through Congress gets done as soon as possible!!!

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parrothead8 4 years, 5 months ago

I wish the advances that have been made in cancer research had been available to my best friend in high school, who died from non-Hodgkins lymphoma 20 years ago. It's great to see how much they can help people now.

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Pywacket 4 years, 5 months ago

This is totally amazing and fascinating! We often focus so acutely on all the bad news & things that people do wrong, that it's refreshing to read about an area in which medicine or science is making huge strides.

Kudos to surgeons, researchers, everyone else involved in this project, and most of all to the patient, who still has a long road ahead of him. So young to have such a terrifying, life-threatening illness! May he recover fully and live a long, cancer-free life.

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