Minimalistic Medicine

Two new procedures advance the less-is-more approach
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The TCAR procedure requires a smaller incision (right) than traditional carotid endarterectomy (left) and can often be performed using local anesthesia. With a smaller incision, cranial nerve injury rates are reduced and scarring is minimized.

When it comes to medical innovations, less is often much, much more: From smaller incisions to shorter recovery times to micro-level imaging, some of the most impactful medical techniques involve thinking small. To that end, doctors at Virginia Mason Medical Center and Overlake Hospital Medical Center have recently made some big strides.

Virginia Mason vascular surgeons Nathan Aranson, Damon Pierce and Derek Nathan are the first in Washington to perform transcarotid artery revascularization (TCAR) procedures to treat carotid artery disease, caused by the narrowing of the carotid artery—located in the neck—due to plaque (e.g., cholesterol, fatty deposits) buildup. Using this technique, the surgeons access the blocked artery via a small incision above the collarbone and temporarily reverse blood flow in it, diverting debris from the brain and reducing the chance of stroke during the procedure. A stent is then implanted to treat the blockage.

The traditional treatment, a carotid endarterectomy, involves more invasive surgery, with a large incision, which can lead to complications such as nerve damage and stroke. With TCAR, patients are under local anesthesia, and overall recovery is faster. Patients who undergo TCAR at Virginia Mason can also participate in a related special research study, according to Pierce, which will involve extra monitoring and data collection with the goal of increasing safety and improving results. 

Overlake in Bellevue is pioneering a new technique as well, for prostate cancer. The center is the first in the region to adopt new MRI-guided technology that can more accurately identify the type of prostate cancer and guide biopsies, which would reduce unnecessary procedures and treatments.
While prostate cancer is common—about one man in seven will be diagnosed with it in his lifetime—not all prostate cancers require immediate treatment, says urologic oncologist Dr. Khanh Pham of Washington Urology Associates. Being able to better distinguish between potentially deadly and nonfatal tumors is important, both to avoid unnecessary treatment and to better direct needed treatment. Some of the serious potential side effects of prostate cancer treatment include urinary incontinence and erectile dysfunction. In the past, limited and less precise information would lead patients and doctors to take a better-safe-than-sorry approach, adopting more aggressive treatment. Overlake’s use of new MRI technology will help cut down on those instances.

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