While many pediatric surgery programs are still playing catch up with the trend toward laparoscopic surgery, a variety of techniques are evolving that could seemingly make laparoscopy obsolete down the road. These techniques make 'stealth' incisions through the umbilicus or axillary to make scars virtually unrecognizable while other techniques use natural orifices, eliminating scarring altogether. A new technique, Single-incision pediatric endoscopic surgery (SIPES) has been developed as an application of single incision surgery to infant patients. A new study slated to be published next month (but e-published this April) details this technique in pyloromyotomy.
This push is being driven by the desire from parents of pediatric patients to ekunubate scarring on their children due to the potential for scars to grow into adulthood.
How far will this force push pediatric surgeons in the field of MAS? Should we expect the least invasive methods to one day be used for all procedures? In pediatric surgery, the answer is likely 'no', or at least not for a long time. Conceptually, natural orifice transluminal endoscopic surgery (NOTES) is the least invasive MAS method, as surgeons can access the abdomen without making a single external incision.
Pediatric MAS - How far will it go?
Nanomaterial-based cancer therapies have been cited as having potentially higher potency and effectiveness than traditional protein-based therapies, as well as the possibility of facilitating simultaneous imaging and therapy, or theranostics. While the first-generation of nanomaterial-based medicines has already been introduced into clinical use, the field continues to grow as novel uses of nanomaterials for cancer therapy are uncovered. Recently, nanoscientists at Memorial Sloan-Kettering Cancer Center published a paper that reviews research efforts to date as well as recent breakthroughs in using nanomaterials as potential multifunctional therapeutic agents in cancer treatments, making a significant new contribution to the growing body of literature on this topic. The researchers at MSKCC feel that the field of clinical nanomaterials is on the rise, given the large amount of research funding (more than a billion dollars was dedicated to nanomaterial research efforts at US government agencies over the past decade) that has been allocated to this effort in recent years, as well as the agents' novel properties, size, and shape that could potentially be harnessed to improve cancer therapies.
Nanomaterial-Based Medicine Holds Promise for Future of Cancer Care
The Subcutaneous ICD (S-ICD), which had notable exposure at last year's HRS sessions, has returned to the spotlight this year in Denver with a simultaneous presentation and publication of the latest clinical data.
The device, developed by Cameron Health, uses entirely subcutaneous leads rather than transvenous leads to deliver life-saving shocks to patients experiencing potentially fatal ventricular tachycardias. Because the leads do not enter the vasculature, they are easier to replace or repair and thereby carry significantly less risk of lead-related issues than traditional ICDs. Their ability to detect arrhythmias, however, has always been a concern among physicians. The data presented this week may provide a little more confidence in the technology.
A few different sets of data were presented, some on lead placement, and others on long-term outcomes of patients implanted with an S-ICD. A small prospective trial that followed 55 patients for about 10 months was the most significant in terms of providing insight into the clinical use of the technology. In those patients, 100 percent of induced VF episodes were successfully detected during controlled electrophysiologic testing. In the ten months after implantation, the S-ICD had detected and successfully treated 12 episodes of spontaneous VT that occurred in three patients. The data was presented by Dr. Gust Bardy of the Seattle Institute for Cardiac Research, who is also a cofounder of Cameron Health; it was also published online May 12, 2010 in the New England Journal of Medicine to coincide with the presentation at HRS.
The S-ICD could establish a niche in device therapy for primary prevention patients that require no pacing support. The ease of implant and lower risk of lead issues could help overcome common concerns related to ICD therapy, but the higher energy output needed to deliver a life-saving shock will likely cause physicians to hesitate using the device.
The device is still likely a few years away from commercial release in the United States. The S-ICD's pivotal trial enrolled it's first U.S. patient earlier this month, and will ultimately look at roughly 330 subjects at up to 35 sites in the U.S., Europe and New Zealand.