BY ANN M. O’PHELAN
Highlands Today correspondent
SEBRING — As a medical resident, Dr. Maurice Tom Pak was always interested in technology. “After residency I completed a Sports Medicine Fellowship where 90 percent of the surgery was arthroscopic,” Tom Pak said.
Those were long days looking at 2D images. However, during his spine fellowship, most of his cases used 3D navigation. Those were even longer days looking at a 3D image. “Technology in the operating room is nothing new and will continue to evolve in the future,” Tom Pak, an orthopedic surgeon and a new spine surgeon at Florida Joint and Spine Institute, said.
Technological advances have allowed more spine conditions to be treated with less exposure by using minimally invasive techniques. These techniques have evolved over several decades and are being used for a wider range of spine procedures.
“The aim is to decrease significantly the damage to the muscles and other structures surrounding the spine,” Tom Pak said. “In most cases, this results in less blood loss, less pain after surgery and a faster recovery.
“Surgeons must now use specialized instruments to access the spine through smaller incisions. Microsurgical techniques, specialized retractors and high-tech operating microscopes allow the surgeon to see through the smaller incisions,” he said.
Tom Pak added that surgeons now rely more and more on advanced imaging to map a surgery.
Another addition to a surgeon’s arsenal of tools has been the development of Intraoperative Computer-aided Navigation.
“Basically this technology uses multi-planar reconstructions and 3D volume rendering or preoperative imaging to give the surgeon a real-time intraoperative 3D image of the spine,” Tom Pak said.
Using specialized tools, the surgeon can now accurately and confidently perform surgery on the spine through smaller incisions. In certain cases, it can now be done percutaneously. The same technique has been done on hip and knee replacement for years.
While the “gold standard surgery” (e.g. microdiskectomy, decompression or spinal fusion) is still performed, it is now through a smaller exposure, and in some aspects it is safer.
“Today’s surgeon now has more high tech tools in his toolbox,” Tom Pak said, and these high tech tools are being used for a variety of surgeries.
Dr. Juan Alvarez, an orthopedic surgeon also with Florida Joint and Spine Institute, sees many patients with painful hips and knees who have not responded to medications or other conservative treatments. They are also now being treated with high tech tools.
“Anterior hip replacements and computer navigated, as well as robotically-assisted, joint replacement, are new in the field of orthopedics and I am active in both,” Alvarez said.
Alvarez, who performs these procedures, also teaches these procedures and trains surgeons throughout the world in these new techniques. “Using computers, I am able to perform quad sparing knee replacements to help decrease pain and speed up recovery,” he said.
The newer technology benefits both the patient and the doctor. “These new procedures help patients with a quicker return to a normal life after joint replacement surgery, while the doctor who performs these newer techniques has the satisfaction of seeing their patients do very well after joint replacements with quicker recoveries than have been seen in the past,” Alvarez said.
Many of the robotically assisted partial knee replacement patients can go home the day or day after surgery.
Alvarez engages in a lot of medical missionary work where he travels to other countries to perform some of the most complex joint replacement surgeries that country has to offer. One case in Guatemala is a memorable for him:
“In May of 2015, I traveled with an organization called Faith in Practice to Guatemala to perform complex hip replacement surgeries,” he said. “In Guatemala, I was referred to a 22-year old male patient that was involved in an automobile accident in 2013.
“He sustained severe fractures of his right hip in the accident and orthopedic surgeons in Guatemala removed his severely damaged hip,” Alvarez continued. “He was left wheelchair-bound and crutch dependent, and without a right hip.
“I was asked to see if I could put in a new artificial hip. Since he had gone for two years without a hip, and there was a lot of shortening and muscle atrophy of that leg, it was an extremely difficult procedure,” he said. “After 2 1/2 to 3 hours of very complex surgery, the patient had a new hip, his legs were equal lengths and his pain was significantly reduced.
“He was also able to take the first step he had taken in years the morning after surgery,” Alvarez said.
This case is representative of how Alvarez works to educate surgeons on a worldwide basis. In 2014, he presented a lecture on Anterior Total Hip Replacements at the WCORT-2014 conference in China. In September, he was in China again, where he was an instructor and Hip Arthroplasty and Reconstruction Chairman at the WCORT-2015 conference in Xi’an. Chinese orthopedic surgeons and others from around the world attended the conference. He has already been asked to return for the 2016 conference.
Alvarez has been selected to be one of eight orthopedic joint replacement surgeons to go on Operation Walk’s Mission Trip to Cuba, which will take place Nov. 11-18.
“It is a humanitarian and educational mission where a team of surgeons, physician assistants, nurses, physical therapists, and other staff travel to Cuba to perform 50-60 [hip and knee] joint replacements in a week’s time on the neediest of Cuba’s patients,” he said.
“This is the first time in 11 years that an Operation Walk team can go to Cuba to do this,” Alvarez said. He will be joined by some of his joint replacement team staff from Florida Hospital Heartland Medical Center.
The mission trip also involves educating the local surgeons and staff on joint replacement surgery. The first two days of the mission trip will include lectures, where Alvarez will be lecturing on the anterior total hip replacements.
“I will also be showing the Cuban surgeons how we have been able to improve recovery, decrease blood loss, and allow more patients to go directly home instead of rehab sooner and happier than ever before using our new rapid recovery joint replacement techniques,” Alvarez said.
For more information, call the Florida Joint and Spine Institute at 863-385-2222.