During the past two years, North Florida Regional Medical Center (NFRMC) has placed itself on the cutting edge of modern medicine. The hospital has invested more than $30 million to bring in state-of-the-art equipment, resulting in better care for patients and creating more than 120 jobs in the process. These machines — and the jobs created to work them — run the gamut of medical specialties, from general surgery, to orthopedics, stroke care, cardiac procedures and neurosurgery.
The new machines are marvels of science. Perhaps naturally, they have names that sound — and here we must get a big unscientific — really cool. For instance, there is the Da Vinci Surgical System; code name: the Da Vinci Robot.
The Da Vinci Robot helps with minimally-invasive surgery by giving surgeons 3-D imaging of the body as they work. It also has improved articulation, allowing for more precise motions.
Dr. Timothy Hipp
Dr. Timothy Hipp uses the robot for “diverse applications,” including colon surgery, hernia surgery and upper intestinal surgery, and he says that the machine’s precision makes it “better than operating with your hands.”
Another benefit, Hipp said, is in patient outcomes. “It allows us to do operations in a minimally-invasive fashion that would otherwise have to be done open. That shortens length of stay, decreases pain and allows people to get back to their normal lives faster.”
“As a surgeon that helps you sleep better at night,” he said.
Not to be outdone, there is the Biplane Neurovascular suite, which allows doctors to navigate through arteries and focus in on specific blood vessels in the brain. “It allows us to see very small blood vessels, sometimes smaller than one millimeter,” said Dr. Asif Khan, director of the Stroke and Interventional Program at NFRMC. “It’s awesome, actually.”
Dr. Asif A. Khan
As Khan explained, during the procedure the doctors make a tiny incision, “less than a centimeter,” in the leg. Using micro catheters and wires “the diameter of a human hair,” they can navigate through the arteries and literally pull out blood clots or fix aneurysms.
“If a patient comes in with a stroke, and we catch it early enough, we can go into the artery and open it up again,” Khan said. “The brain can recover and reverse the stroke symptoms. Right now, the scientific evidence is overwhelmingly positive on this machine.”
Khan said the machine is a boon to patients.
“I was practicing medicine before this became the standard of care,” he said. “You can see a clear difference. Some of these patients come in with weakness of an arm and leg and they can’t walk, and after opening the artery, they walk out of the hospital.”
NFRMC recruited Khan and his partner, Dr. Gregory Sherr, from Minnesota, where they had so much success with the biplane unit, they had to add a second one. “It says a lot about the dedication of North Florida Regional Medical Center to the community,” Khan said. “Our biplane unit is in use so much, we’re thinking of adding a second one here too.”
Dr. Gregory Sherr
Sherr said the new technology has helped improve stroke care not just in Gainesville but also in the region. “Gainesville has had an issue with stroke care, and up into Lake City and Putnam as well,” he said. “The sections of the city are surrounded by a ‘stroke belt,’ essentially an area where they’re underserved, there are dietary problems and an aging population. The community has been ripe for a stroke program to serve those folks. That is what the hospital hired us to do here; build a program from the ground, up. North Florida Regional invested a lot of time and effort and money to get the stroke program off the ground. They brought us from Minnesota and hired a whole new staff. The program in one year has doubled in size.”
Sherr’s proximity to the technology has not diminished his fascination with it. “It’s pretty space-agey stuff,” he said. “If you come in with a stroke, we put you in the CT scanner and look at the brain. If we find there’s a blockage, we put you in the biplane suite, Dr. Khan will come in and essentially put a corkscrew in there and pull out the blockage, and the patient wakes up. This is extraordinary.”
The CyberKnife is so precise it can predict a patient’s movements, such as breathing.
“Ten years ago, these people would have no option. We didn’t even know patients could walk out of the hospital the next day and survive, whereas they came in not able to move half of their body,” Sherr explains. “They’d have to go to a nursing home and not move half their body, and some of them would die. Now, it’s a pretty routine thing, there’s already about 1,000 strokes we’ve treated. The program has just skyrocketed. You can imagine the benefit to society.”
Rounding out the improvements to cardiovascular care is the newly introduced Transcatheter Aortic Valve Replacement (TAVR) procedure. TAVR is a minimally-invasive alternative to open-heart surgery. The TAVR team at North Florida Regional can replace valves in the heart through catheters in the groin.
“It’s absolutely incredible,” Tulli, cardiothoracic surgeon at The Cardiac and Vascular Institute, said. “There has historically been a large number of patients that were too high risk to undergo open heart surgery. TAVR allows them to still have the valve replaced. These new heart valves are metal mesh tubes, crimped down to get through the catheter. We guide it into the old valve and open it, and it kind of pushes the bad valve out of the way. And we only have to make a tiny incision.”
Dr. Mark Tulli
Tulli also mentioned that the procedure was originally only done on patients with a high risk of death from traditional open-heart surgery, but outcomes have been so good that it is now used on a much larger variety of patients. He was also quick to praise the efforts of the hospital and its administrators in bringing this new technology to Gainesville.
“It costs a lot of money to put this all in place,” he said. “You have to have your hospital administrators and your leadership team on board. They spent millions of dollars building a brand new operating room that is made for procedures done by the TAVR. Then there are hundreds of thousands of dollars of inventory so we have all the equipment that we need. North Florida Regional Medical Center is very good — if you show you are going to improve patient outcomes and do it in a high quality situation that is efficient, they’re very supportive of it.”
He also noted that technology means nothing if it doesn’t improve patient outcomes. In that area, he said, the TAVR technology has been a “no-brainer.”
The Biplane Neurovascular suite can view blood vessels smaller than a millimeter and allows doctors to directly remove clots from stroke patients.
“In the first studies, it cut the number of people that died in the first year in half,” he said. “They have not seen anything like that in medicine. You’re taking the sickest of sick patients who have no other options and you’re offering them something that will save their lives.”
Dr. Charles Klodell, who also uses the TAVR procedure, echoed Tulli’s praise of NFRMC’s investment in new technology.
“NFRMC saw what the future holds,” Klodell said. “They understand that quality counts, and quality costs. It takes visionary leadership to put forth the necessary resources to make it possible.”
Klodell also praised the technology. “TAVR is the pinnacle of minimally-invasive heart surgery,” he said. “Most of medical advances are evolutionary steps. This one is a revolutionary step. This has changed the way we think about heart disease, the way we treat it, and it has changed the patients’ lives. It’s very professionally gratifying. We all envision the care we want to deliver, but we can’t always get the administrative buy-in to put forth those resources. That’s what has been so special about the cardiovascular program here — we have the same vision as the administrators, and we can provide the level of care that we would want for our own family.”
Dr. Allison Grow
In cancer care, Drs. Cherylle Hayes and Allison Grow and their team work with the CyberKnife System. The CyberKnife allows for precise targeting of tumors. It can also predict a patient’s movements, such as breathing, and move with the patient to make sure the radiation continues targeting the tumor and not the healthy tissue around it.
“The machine actually breathes with you,” Hayes said. “As a result, you have improved quality of life with decreased toxicity. We can put more dosage into the tumor, thus killing more of the malignant cells and improving outcomes. It’s more efficient.”
Hayes said that the machine helps her achieve a greater “sense of fulfillment” as a doctor. “When you see patients with less symptoms and their outcomes are better,” she said, “you feel like you’ve done something really good.”
Grow added that the CyberKnife allows for shorter courses of radiation treatment, which represents a major advancement.
“You get the whole treatment done between one and five days as opposed to six weeks like we usually do,” she said. “We want to have better outcomes for less money. One way to do that is to give shorter courses of radiation. If you can do the treatment and get just as good an outcome or better in a shorter time, not only is it better for the patient, it’s better for the healthcare system.”
For certain cancers, like lung cancer, the CyberKnife can almost match surgery in terms of cure rate, which Grow said is another huge advancement.
“I see a lot of people with stage 1 lung cancer who can’t be operated on because they have other problems — heart problems, etc.,” she said. “The cure rates with regular radiation were 40 to 50 percent on them, which isn’t great, considering that surgery can get to 95 percent. With the CyberKnife treatment, my cure rates are over 90 percent.”
Grow said that giving her patients better treatment and better outcomes is what makes her job worthwhile.
“I love it,” she said. “The patients go through it and they don’t even bat an eyelash. They’re on their feet living their lives during the entire treatment. It’s a beautiful thing for a lot of people.”
For orthopedic care, NFRMC invested in Mako Robotic-Arm Assisted Surgery. According to Dr. Jonathan Pritt, the Mako robot helps with precision in orthopedic surgery.
“You get 3-D imaging with a CT scanner of a person’s joint,” Pritt said. “You tell the machine exactly where you want to cut, and it won’t let you go outside of those parameters. It’s precise within .05 millimeters.”
Dr. Jonathan Pritt
Pritt said that this allows for smaller incisions, better surgeries — such as hip and knee replacement — and quicker healing.
Dr. Tristan Altbuch elaborates: “What the Mako allows you to do is fine-tune where you put the prosthetic device and make sure that it’s implanted in an almost perfect position. It allows for better range of motion and better functioning implant. It’s a very reliable device. It’s not doing the surgery, but it’s providing us with information and letting us take as little amount of bone as possible. We’re talking within millimeters, or even less than a millimeter. I think it’s the future of medicine.”
Dr. Tristan Altbuch
Because of massive investment from NFRMC, not only in new technology, but also in doctors and technicians to use it, the future of medicine is happening right now, in Gainesville. As Klodell noted, “There’s nowhere in the world doing anything more advanced than what is happening right here at North Florida Regional Medical Center.”
“Despite all the advances in technology we have made, the team at North Florida Regional Medical Center is committed to building a better community,” said Brian Cook, CEO of NFRMC. “We truly feel like our most important assets are the dedication of our people, and their healing touch.”
Nothing makes a doctor happier than a patient who feels better. Perhaps Khan said it best: “Being a doctor, studying all those years, working all those sleepless nights, all the sacrifices not just I, but also my family made… seeing a patient recover makes it all worthwhile.”
“It’s why we do it.”
The small cuts from the Mako Robotic-Arm are ideal for quicker recovery from procedures like hip or knee replacements.