The liver is the second most important organ in your body side and liver cancer strikes approximately 33,000 Americans each year.
For patients diagnosed with liver cancer, what treatment options are available?
Learn more from Dr. Reid Adams, a board-certified surgeon and chief of surgical oncology; as well as the chief of liver and pancreatic surgery at UVA Cancer Center
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Treatment Options for Liver Cancer
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Learn more about Dr. Reid Adams
Learn more about UVA Cancer Center
Reid B. Adams, MD
Dr. Reid Adams is a board-certified surgeon and chief of surgical oncology; as well as the chief of liver and pancreatic surgery at UVA Cancer Center. His specialties include liver, pancreatic and biliary cancers and diseases.Learn more about Dr. Reid Adams
Learn more about UVA Cancer Center
Transcription:
Treatment Options for Liver Cancer
Melanie Cole (Host): Have you been told that you might have to have spine surgery? That could be a scary thought, although with some new advances in spinal surgery, recovery may be easier than you think. My guest today is Dr. Jeff Gleimer. He’s an orthopedic spinal surgeon with Lourdes Health System. Welcome to the show, Dr. Gleimer. Tell us a little bit about what reasons people would need spine surgery.
Dr. Jeff Gleimer (Guest): Yes. Hi, Melanie. Thanks for having me. Spinal surgery is obviously, as you mentioned, a last resort and a concern for a lot of patients out there. One of the major reasons is pain-- pain in the back, pain in the buttock, pain in the leg, weakness in the leg. These issues, that do not improve after physical therapy, anti-inflammatory medications, modifying activities, the pain that just doesn’t go away. At a minimum of six weeks, potentially no longer as six months, people reach an area where surgery on the spine is appropriate and indicated. And, again, everyone is truly an individual when it comes to these problems and it’s really something that must be discussed and really reviewed with a spinal surgeon in detail before surgery is really, truly appropriate for that given patient.
Melanie: So, people have all kinds of issues with their spine-- scoliosis and stenosis--catch all terms and arthritis and they get that sciatic pain you described; the weakness in the legs and the pain down the legs. What would, then, signal to you, that this is a surgical need? This needs an intervention. When does it come to that?
Dr. Gleimer: It is, unfortunately, all too common. I think it’s rare if any of us have gone through our lives without meeting someone that has either had back or leg pain at some point in their lives. It’s the pain that just won’t go away. I tell all my patients, “This is never an operation that I will have to sell to you or encourage you to have.” These patients will come in and they know full well they have tried everything like physical therapy and medications and maybe they’ve been through pain management injections, things like epidural steroid shots in their spine and they just get temporary relief from these modalities. And, they just reach a point where they can’t live with the back pain or the leg pain and, at that point surgery, is appropriate. Surgery helps a large majority of these patients that have the right type of problem in their back.
Melanie: As we mentioned at the beginning, spinal surgery sounds scary- long recovery. Tell us what’s going on, that’s changing the world of spinal surgery for the better.
Dr. Gleimer: There have been dramatic improvements. As most of us have hoped, with technology there have been dramatic improvements. The goal, always, is to make surgery safer, more efficient, better outcomes in a shorter period of time. One of these advances has been robotic spinal surgery, which really allows for patients to have truly less invasive surgery on their spine. Traditionally, they would need a large incision, a lot of stripping of muscle and tendons off their back. With this new technology, we’re able to make smaller incisions with nearly 100% accuracy in placing pedicle screws, for example, and performing operations to stabilize scoliotic spine and painful spines with degenerative disc disease, arthritis, removing herniated discs. The less invasive our surgeries are, the quicker patients are recovering. The surgery can be done and they can go home the same day.
Melanie: Wow, fascinating. Tell us a little bit about the Mazor Robotics Renaissance Guidance System. Tell us about this Mazor surgery. What does it entail? How does it work?
Dr. Gleimer: So, it is a state-of-the-art technology that has been around now for quite a few years and it’s really catching speed here on the East coast. What it is, in essence, is a tiny robot. So, truly good things come in small packages. This is a very small robot that is placed just over the patient when they’re under anesthesia and through a computer system as well as CT scans or a Computed Tomography scan, which is a very, very detailed x-ray, we’re able to see, in detail, the patients spine--the bones in their back. This robot then aligns a special type of drill to perfectly place pedicle screws, specifically. Pedicle screw is a large screw. It looks like a drywall screw for any of the construction folks out there or contractors. And, this gets placed into the spine. This robot that is about the size of a soda allows for nearly perfect trajectory to place these screws into the spine, avoiding all the big, scary concerns people have such as being paralyzed, damaging a nerve, or having a severe amount of pain after surgery. So, the robot really guides the surgeon’s hand. The surgeon is still needed, so we haven’t become obsolete yet, but the robot really has perfected this portion of spine surgery to really make pedicle screw placement nearly perfect.
Melanie: And, what’s it like for the patient, Dr. Gleimer, in terms of recovery and after-pain?
Dr. Gleimer: That’s one of the best things, Melanie. Traditionally, spinal surgery is exceedingly painful because of the dissection. What we need to do traditionally to see the right area of the spine to, in essence, place these pedicle screws freehand which takes a high amount of skill, without a doubt, which I’ve been doing for years. So, you can really appreciate using the Mazor Robot that you now can do it through a small stab incision in the patients back, maybe about a centimeter. That’s about it. And the guide is about the diameter of a pencil, that’s placed in the right position. You then drill with a high-speed drill and then you place the pedicle screw directly down this channel and these screws end up in just the right spot much more rapidly and the patient has less surgical time which is always better for the patient . It allows them to recover much more quickly. They don’t have that pain that is typically present from all the dissection that’s needed to put these screws in traditionally. Furthermore, one of the biggest things for myself, who has been doing less-invasive spine surgery, is the robot allows you to minimize the amount of radiation that the patient is exposed to during the surgery. Otherwise, we have to use a lot of x-rays, for the patient, for myself, for any surgeon that’s performing this, there’s a lot of x-ray that has to take place in order to place these screws in an otherwise less-invasive way. And, this robotic technology really negates the need for all these x-rays. We take one x-ray to start, one x-ray at the end and the rest of it is without x-ray.
Melanie: Are there any people that might not be a candidate for this type of surgery?
Dr. Gleimer: One of the great things, no. Anyone that meets those indications to have a spinal surgery done that requires screws in their back, what is commonly referred to as a “fusion” operation for that nagging low back pain that just won’t go away with everything that they’ve tried. This allows for near perfect placement of the screws. So, no. There’s no patient that is not a candidate to have this technology for them, if they need the surgery to begin with, of course.
Melanie: Wow. That is absolutely fascinating information, Dr. Gleimer. In the last few minutes, wrap it up for us about spinal pain, when surgical intervention is needed and the latest technologies--why you’re so excited about these types of procedures.
Dr. Gleimer: It really allows patients to undergo an otherwise horrifying type of surgery from the stories we’ve heard from our grandparents to our aunts and uncles that have had a friend or a neighbor that has had spinal surgery and was never the same again, I can assure you that there are far more good outcomes from spinal surgeries these days than without. And now, with this Mazor Robotic surgery, it allows it to be that much better. Patients feel better quicker, they get better quicker, and, if I can leave the audience out there with one concept to remember it is that patients that have spinal surgery with the Mazor Robotic technology, they get better and they don’t just get better, they get better quicker than they would without it.
Melanie: What great advice. And, just tell us Dr. Gleimer about your team at Lourdes Health System.
Dr. Gleimer: My opinion, one of the best in the country and I’ve been everywhere from Los Angeles and back. They are top notch. There’s a dedicated team that only does spinal surgery. The consistency is key. You have the same team, the same nurses, and the same anesthesia providers that are in the room that just make everything so smooth and perfect, you couldn’t ask for a better place to have the Mazor Robot utilized to get people better, quicker, with less pain.
Melanie: Well I’m sure they couldn’t ask for a more amazing doctor than you. What a doll you are and thank you so much for being with us today, Dr. Gleimer. You’re listening to Lourdes Health Talk and for more information you can go to LourdesNet.org. That’s LourdesNet.org. This is Melanie Cole. Thanks so much for listening.
Treatment Options for Liver Cancer
Melanie Cole (Host): Have you been told that you might have to have spine surgery? That could be a scary thought, although with some new advances in spinal surgery, recovery may be easier than you think. My guest today is Dr. Jeff Gleimer. He’s an orthopedic spinal surgeon with Lourdes Health System. Welcome to the show, Dr. Gleimer. Tell us a little bit about what reasons people would need spine surgery.
Dr. Jeff Gleimer (Guest): Yes. Hi, Melanie. Thanks for having me. Spinal surgery is obviously, as you mentioned, a last resort and a concern for a lot of patients out there. One of the major reasons is pain-- pain in the back, pain in the buttock, pain in the leg, weakness in the leg. These issues, that do not improve after physical therapy, anti-inflammatory medications, modifying activities, the pain that just doesn’t go away. At a minimum of six weeks, potentially no longer as six months, people reach an area where surgery on the spine is appropriate and indicated. And, again, everyone is truly an individual when it comes to these problems and it’s really something that must be discussed and really reviewed with a spinal surgeon in detail before surgery is really, truly appropriate for that given patient.
Melanie: So, people have all kinds of issues with their spine-- scoliosis and stenosis--catch all terms and arthritis and they get that sciatic pain you described; the weakness in the legs and the pain down the legs. What would, then, signal to you, that this is a surgical need? This needs an intervention. When does it come to that?
Dr. Gleimer: It is, unfortunately, all too common. I think it’s rare if any of us have gone through our lives without meeting someone that has either had back or leg pain at some point in their lives. It’s the pain that just won’t go away. I tell all my patients, “This is never an operation that I will have to sell to you or encourage you to have.” These patients will come in and they know full well they have tried everything like physical therapy and medications and maybe they’ve been through pain management injections, things like epidural steroid shots in their spine and they just get temporary relief from these modalities. And, they just reach a point where they can’t live with the back pain or the leg pain and, at that point surgery, is appropriate. Surgery helps a large majority of these patients that have the right type of problem in their back.
Melanie: As we mentioned at the beginning, spinal surgery sounds scary- long recovery. Tell us what’s going on, that’s changing the world of spinal surgery for the better.
Dr. Gleimer: There have been dramatic improvements. As most of us have hoped, with technology there have been dramatic improvements. The goal, always, is to make surgery safer, more efficient, better outcomes in a shorter period of time. One of these advances has been robotic spinal surgery, which really allows for patients to have truly less invasive surgery on their spine. Traditionally, they would need a large incision, a lot of stripping of muscle and tendons off their back. With this new technology, we’re able to make smaller incisions with nearly 100% accuracy in placing pedicle screws, for example, and performing operations to stabilize scoliotic spine and painful spines with degenerative disc disease, arthritis, removing herniated discs. The less invasive our surgeries are, the quicker patients are recovering. The surgery can be done and they can go home the same day.
Melanie: Wow, fascinating. Tell us a little bit about the Mazor Robotics Renaissance Guidance System. Tell us about this Mazor surgery. What does it entail? How does it work?
Dr. Gleimer: So, it is a state-of-the-art technology that has been around now for quite a few years and it’s really catching speed here on the East coast. What it is, in essence, is a tiny robot. So, truly good things come in small packages. This is a very small robot that is placed just over the patient when they’re under anesthesia and through a computer system as well as CT scans or a Computed Tomography scan, which is a very, very detailed x-ray, we’re able to see, in detail, the patients spine--the bones in their back. This robot then aligns a special type of drill to perfectly place pedicle screws, specifically. Pedicle screw is a large screw. It looks like a drywall screw for any of the construction folks out there or contractors. And, this gets placed into the spine. This robot that is about the size of a soda allows for nearly perfect trajectory to place these screws into the spine, avoiding all the big, scary concerns people have such as being paralyzed, damaging a nerve, or having a severe amount of pain after surgery. So, the robot really guides the surgeon’s hand. The surgeon is still needed, so we haven’t become obsolete yet, but the robot really has perfected this portion of spine surgery to really make pedicle screw placement nearly perfect.
Melanie: And, what’s it like for the patient, Dr. Gleimer, in terms of recovery and after-pain?
Dr. Gleimer: That’s one of the best things, Melanie. Traditionally, spinal surgery is exceedingly painful because of the dissection. What we need to do traditionally to see the right area of the spine to, in essence, place these pedicle screws freehand which takes a high amount of skill, without a doubt, which I’ve been doing for years. So, you can really appreciate using the Mazor Robot that you now can do it through a small stab incision in the patients back, maybe about a centimeter. That’s about it. And the guide is about the diameter of a pencil, that’s placed in the right position. You then drill with a high-speed drill and then you place the pedicle screw directly down this channel and these screws end up in just the right spot much more rapidly and the patient has less surgical time which is always better for the patient . It allows them to recover much more quickly. They don’t have that pain that is typically present from all the dissection that’s needed to put these screws in traditionally. Furthermore, one of the biggest things for myself, who has been doing less-invasive spine surgery, is the robot allows you to minimize the amount of radiation that the patient is exposed to during the surgery. Otherwise, we have to use a lot of x-rays, for the patient, for myself, for any surgeon that’s performing this, there’s a lot of x-ray that has to take place in order to place these screws in an otherwise less-invasive way. And, this robotic technology really negates the need for all these x-rays. We take one x-ray to start, one x-ray at the end and the rest of it is without x-ray.
Melanie: Are there any people that might not be a candidate for this type of surgery?
Dr. Gleimer: One of the great things, no. Anyone that meets those indications to have a spinal surgery done that requires screws in their back, what is commonly referred to as a “fusion” operation for that nagging low back pain that just won’t go away with everything that they’ve tried. This allows for near perfect placement of the screws. So, no. There’s no patient that is not a candidate to have this technology for them, if they need the surgery to begin with, of course.
Melanie: Wow. That is absolutely fascinating information, Dr. Gleimer. In the last few minutes, wrap it up for us about spinal pain, when surgical intervention is needed and the latest technologies--why you’re so excited about these types of procedures.
Dr. Gleimer: It really allows patients to undergo an otherwise horrifying type of surgery from the stories we’ve heard from our grandparents to our aunts and uncles that have had a friend or a neighbor that has had spinal surgery and was never the same again, I can assure you that there are far more good outcomes from spinal surgeries these days than without. And now, with this Mazor Robotic surgery, it allows it to be that much better. Patients feel better quicker, they get better quicker, and, if I can leave the audience out there with one concept to remember it is that patients that have spinal surgery with the Mazor Robotic technology, they get better and they don’t just get better, they get better quicker than they would without it.
Melanie: What great advice. And, just tell us Dr. Gleimer about your team at Lourdes Health System.
Dr. Gleimer: My opinion, one of the best in the country and I’ve been everywhere from Los Angeles and back. They are top notch. There’s a dedicated team that only does spinal surgery. The consistency is key. You have the same team, the same nurses, and the same anesthesia providers that are in the room that just make everything so smooth and perfect, you couldn’t ask for a better place to have the Mazor Robot utilized to get people better, quicker, with less pain.
Melanie: Well I’m sure they couldn’t ask for a more amazing doctor than you. What a doll you are and thank you so much for being with us today, Dr. Gleimer. You’re listening to Lourdes Health Talk and for more information you can go to LourdesNet.org. That’s LourdesNet.org. This is Melanie Cole. Thanks so much for listening.