Top Treatments from Head to Toe
Torrance Memorial physicians are experts in advanced technologies to improve care and speed recovery.
Written by John Ferrari
What is it? “It’s like a GPS for the brain,” says Paula Eboli, MD, Torrance Memorial’s medical director of endovascular neurosurgery.
What does it do? Brainlab imaging equipment and software “enables you to do complex neurosurgery. Brainlab interacts with the microscope we use and tells you exactly where you are operating. As you operate to remove a brain tumor, you can overlay the tumor’s contours on your microscope.” The system also incorporates digital ultrasound. “You can make an ultrasound image of the area, and Brainlab will fuse that image with MRI images,” Dr. Eboli says.
Why is that important? “Knowing exactly where the tumor is helps with resection [removal] of the tumor.”
How does it improve on previous technology? Torrance Memorial’s Brainlab suite adds new imaging capabilities, allowing neurosurgeons to see the area of the brain they’re operating on with unparalleled precision.
Who is a good candidate for this technology? “I use it for every single brain tumor patient.”
What’s the bottom line? “You want to have the best technology in order to ensure complete brain tumor removal with the least amount of damage.”
What is it? Extracorporeal Membrane Oxygenation is an emergency life support machine.
What does it do? “ECMO takes blood from the body, removes carbon dioxide, adds oxygen, then pumps it back into the body,” explains Aziz Ghaly, MD, medical director of cardiac surgery at Torrance Memorial’s Lundquist Lurie Cardiovascular Institute. “It’s used on patients who have serious heart and lung injuries.”
Why is that important? “It gives the patient’s heart and lungs time to rest and heal. For example, we’ve used it on extremely ill COVD-19 patients whose lungs were compromised by the disease. It’s also an extremely important addition to the hospital in general.It allows us to perform more complex cardiac operations.”
How does it improve on previous technology? “ECMO is used in emergency situations to support the functions of the heart and the lung together. It can be applied very quickly on patients who have no other option to survive. ECMO is a rarity outside major academic medical centers. Torrance Memorial has several ECMO machines and can use them to support up to five patients.”
Who is a good candidate for ECMO? “Patients who have a failing heart after a cardiac arrest or who fail to recover after open-heart surgery,” Dr. Ghaly says. “We also use ECMO for lung conditions like severe lung disease not responding to traditional measures and on patients awaiting heart or lung transplants.”
What’s the bottom line? “ECMO is a lifesaving device. It’s not a treatment.It’s a support device that can substantially improve a critically ill patient’s chance of recovery. It gives patients more time.”
What is it? MarginProbe is a device that uses electromagnetic waves to identify potentially cancerous tissue during a lumpectomy procedure for breast cancer.
What does it do? “MarginProbe uses radio frequency electrical fields to evaluate tissue that has been removed during a lumpectomy procedure in order to identify any cancer that may be remaining on the surface of the tissue,” explains Melanie Friedlander, MD, surgeon and co-director of the breast cancer program at the Torrance Memorial Hunt Cancer Institute. “If MarginProbe identifies cancer on the surface of the tissue, the surgeon will remove additional tissue from the breast.”
Why is that important? “The edges of a lumpectomy cannot be analyzed by a pathologist during surgery, so this is the best technology available to help the surgeon get all the cancer out at the initial surgery, eliminating the need for a second procedure to take a little more tissue.”
How does it improve on previous technology? “Before we had MarginProbe, there really was no way to check the margins other than a visual estimate by the pathologist, which is done with solid tumors but cannot be done with DCIS, a microscopic type of cancer,” says Dr. Friedlander.
Who is a good candidate for this technology? “MarginProbe can be used for lumpectomy for all types of breast cancers, including invasive ductal carcinoma, invasive lobular carcinoma and ductal carcinoma in situ (DCIS).”
What’s the bottom line? It’s totally safe and can reduce the need for additional surgery.
What is it? A robotic system that assists in partial and total knee replacement and total hip replacement surgery.
What does it do? Mako allows surgeons to operate with unparalleled accuracy and precision. “Using a detailed 3D image of the joint, the Mako system allows more accurate assessment of soft tissues, more accurate preparation of the patient’s bone for the implant and more accurate placement of the implants,” says orthopedic surgeon John Tiberi, MD, a hip and knee replacement specialist.
Why is that important? “There are clear correlations between good outcomes and optimal implant position,” says Dr. Tiberi. “Also, proper ‘balancing,’ or tensioning, of the joint’s soft tissues and appropriate leg length restoration are important for a good outcome.”
How is it better than previous procedures? Using the Mako system, “the surgeon has the ability to plan the procedure based on the patient’s 3D anatomy, and the measurement calibration is very accurate,” explains Dr. Tiberi. “With manual technique, the information is quite limited because it is based on a 2D X-ray, and the measurement calibration is almost always inaccurate.”
Who needs it? The Mako system is appropriate for any patient undergoing partial knee, total knee or total hip replacement.
What’s the bottom line? Better outcomes after surgery and less post-operative pain.
Da Vinci XI
What is it? A robotic system that assists surgeons performing minimally-invasive surgery.
What does it do? “The da Vinci system allows for conversion of advanced open surgery to minimally-invasive laparoscopic surgery,” says gynecologic oncologist Ramin Mirhashemi, MD. The system comprises a suite of instruments the surgeon guides via a console, and imaging tools that provide magnified, 3D, high-definition views of the surgical area. The instrument size makes it possible for surgeons to operate through small incisions.
Why is that important? “Reducing the incision size and trauma to tissue results in more rapid recovery and shorter hospital stays,” Dr. Mirhashemi says. This means more surgeries can be performed on an outpatient basis.
How is it better than previous procedures? “It’s more precise and spares normal tissue while we dissect pathologic tissue. And the 3D visualization is significantly better than our eyes alone.”
Who needs it? “Any patient who is being considered for open surgery can be a candidate for robot-assisted surgery.” The da Vinci system may be used for general, cardiac, colorectal, gynecologic, urologic, head and neck and thoracic surgery.
What’s the bottom line? “Less pain and faster recovery with better overall outcomes!” says Dr. Mirhashemi.
What is it? A way to selectively kill cancer cells by using a photosensitizing agent and light.
What does it do? Photodynamic therapy (PDT) begins with the photosensitizing agent entering the bloodstream or applied to the skin, where it is absorbed by the body’s tissues. The agent remains in cancer cells longer than in normal cells. When most of the agent has left healthy cells but is still in cancer cells, it is activated with light—an LED or a laser—causing a chemical reaction that kills the cancer cells.
Why is that important? “The normal cells right next to the cancer cells are left uninjured,” explains Clark Fuller, MD, surgical director of thoracic oncology at Torrance Memorial's Hunt Cancer Institute. “It’s a highly selective form of therapy that allows surgeons to specifically target cancer cells.”
How is it better than previous procedures? Many other forms of cancer treatment are less targeted, more invasive and may result in harmful, long-term side effects. “And,” says Dr. Fuller, “a single injection allows us to treat the patient as many times as needed… until we have the desired effect.”
Who needs it? “PDT can be used to treat cancers causing obstructions of the esophagus and the airways that can be reached with only an endoscopy.”
What’s the bottom line? “It’s more non-invasive than surgery and may be done on an outpatient basis treating tumors that may otherwise not have a successful management plan.”
What is it? SpaceOAR (Spacing Organs At Risk) is a temporary gel placed between the prostate and rectum prior to radiation treatment for prostate cancer,” explains Torrance Memorial Hunt Cancer Institute radiation oncologist Usama Mahmood, MD.
What does it do? “SpaceOAR helps physically separate the prostate from the rectum so when radiation is used to treat prostate cancer, there is less unnecessary radiation exposure to the nearby rectum.”
Why is that important? “By decreasing the amount of unnecessary radiation exposure, SpaceOAR has been shown to decrease both short- and long-term side effects of radiation treatment for prostate cancer.”
How does it improve on previous technology? Although radiation treatment for prostate cancer is safe, this makes it even safer.
Who is a good candidate for this technology? “Patients with early-stage prostate cancer who have not undergone surgery and are to receive radiation treatment.”
What’s the bottom line? Dr. Mahmood puts it succinctly: “Less radiation exposure, less side effects!”
ECMO - Katherine Vasquez
21-year-old Katherine Vasquez arrived at Torrance Memorial’s ER in July with terrible stomach pain. It was a recurrence of COVID-19, which she’d had in June. The second time around, it put her in the hospital. She doesn’t remember the experience of being on the ECMO device because she was in a coma for three weeks. “When I woke up,” she recalls, “I cried because I was happy but also scared. I was very grateful… that all the pain was gone and I was alive, because the doctor had told my family I only had a 10% chance of living. I was very close to death.” Vasquez was the first COVID-19 patient at Torrance Memorial to be placed on ECMO’s lifesaving support, and it made the difference.
Da Vinci XI - Eileen Trombly
Eileen Trombly has benefitted from the da Vinci XI system twice. In 2017, after surgery for endometrial cancer, “I couldn’t believe when I woke up I didn’t have any pain,” she remembers. “I was amazed that I was back on my feet so quickly. I was very happy and very relieved.” In 2020, she wasn’t even nervous about her surgery. “I thought, ‘I can do this,’” she says. “I felt confident I would be fine.” Dr. Ramin Mirhashemi performed both surgeries. “He’s a great doctor...the best,” Trombly says. “I have a lot of confidence in him, and it was a really great experience.”
Photodynamic Therapy - Jack McComas
At first, Jack McComas didn’t think much about his shortness of breath – until he had to go to urgent care and ultimately was diagnosed with a non-cancerous tumor. His surgeon, Dr. Clark Fuller, said complete removal of the tumor using traditional surgery would leave him with only 20% of his right lung and suggested photodynamic therapy as an alternative. “It was a piece of cake,” McComas says. “It took four tries, but we got it all, using a laser to zap it… I was up and about in a day, without even an incision. It was really remarkable.” Now about a year later, he says, “I feel 100 percent back to normal. Dr. Fuller was definitely looking out for my best interests. He’s a hero to our family.”
Mako System - Lillian Burnett
Lillian Burnett has played soccer for most of her life. She’s familiar with the wear and tear athletics can cause. Still, she was surprised when an X-ray revealed her hip had deteriorated to a bone-on-bone condition. Torrance Memorial physicians didn’t pressure her to schedule hip replacement surgery though. “All the doctors told me, ‘You’ll know when you’re ready.’” When she couldn’t play soccer any longer, Burnett knew it was time. “I was looking for someone who used the Mako system,” she says. “I wanted someone who would be really precise, and I knew Dr. John Tiberi was really, really good.” She had hip replacement surgery at the end of July as an outpatient procedure. “All the pain I’d been having stopped immediately,” she says. She didn’t have to worry about heavy-duty pain medication, either. “I didn’t even have full anesthesia, just a spinal nerve block. They gave me Tylenol for pain, but by the second day I was off the Tylenol. I was able to walk around the block in three days and to walk three blocks in five days, without using a cane or walker.” Burnett credits her speedy recovery to good health and the Mako system. “With the Mako system, everything is so precise—that’s how perfected this surgery has become.” Six months later, she was back on the soccer field testing herself in a scrimmage. “It felt great!”