About 10 years ago, there was an Italian surgeon in Sweden who claimed to have a technique to use patient's cells to seed a synthetic base structure for a trachea. But he was found out to have conducted research fraud.
Had to check - it was Theranos style fraud where he had a noble vision but tried to cheat to make it work, rather than a case where his only vision was to commit fraud.
These achievements never fail to make me emotional. The incredible amount of effort, risk tolerance, teamwork, and talent for all parties involved is humbling. Every one of these achievements feel to me as another version of landing on the moon.
> The complex surgery involved a team of more than 50 specialists including surgeons, nurses, anesthesiologists, and residents
> Their observations will inform the development of Mount Sinai’s Tracheal Transplant Program, enabling Dr. Genden to offer this therapeutic approach to patients nationwide and internationally
This is without a doubt an impressive achievement.
Can someone speak to the logistics of expanding this program though? I don't suppose a 18 hour, 50 person procedure is in any way easy to coordinate, and I imagine it must be extremely expensive, both in terms of financial cost and time investment.
How feasible is it to propagate the expertise? Are there factors related to the novelty that make it attractive for other medical teams to invest time in training for this procedure? Is risk a deterrent in terms of insurance coverage?
It is very difficult to propagate expertise for rare procedures. Oftentimes the teaching center already has limited volume, so trainees may become "experts" with a rather limited number of procedures under their belt. The problem becomes apparent when those trainees migrate back to smaller centers where volume is almost nil. I'm the perfect example of this myself, although being a cardiothoracic anesthesiologist it's easier to maintain my expertise compared to surgeons because surgical expertise almost only relies on continued practice, while anesthesiology mostly relies on know-how. The end result is mostly catastrophic outcomes on complex surgery that is rarely done. So this is very expensive and risky surgery, but the economics surrounding this type of program are a bit obscure. Some people are obviously making tons of money with such cases, but I doubt anyone really has a comprehensive overview of all the economic pro/cons. In Europe at least, insurance companies don't seem that reluctant towards transplants and there are other lower hanging fruits if the system wants to spend less.
As for logistics, it's probably not that different from transplanting another organ. In anything involving the trachea, the technical details of the procedure and the coordination between surgery and anesthesia is where the difficulty lies.
I suspect a some of those folks were on-shift or on-call and just doing their job. Since anything over 12 hours spans shifts I'm guessing nurses had a shift change during the case for example.
My wife worked as an Operating Room Nurse at a medium sized hospital for over 10 years.
Curious what effect this will have on their voice, and how they react to a new voice 'sensation'. Will they recognize their own voice at first? Will they adapt? Might there be some psychological issues that stem from this? Are there other examples of someone's voice changing (rapidly, assuming this does affect their voice) and what were the effects?
I thought I'd read of 3D printed trachea but I just did a search and discovered the work is all still experimental.
There was also promising work on printing a biodegradable one that be used as a matrix or scaffold for growing a new one from the patient's own cells. This sounds like a better one; though you could print a non-immune-triggering one, one made of the patient's own cells would be more compliant (flexible) which I assume from taking animals apart is required for good breathing.
This sounds like quite a complex surgery with lots of staff, and also something new and novel. If someone here is a medical expert, I’m curious what happens if someone’s trachea is damaged significantly in some incident - is there currently no “emergency” treatment for that situation?
The emergency treatment depends on the extent and location of damage. For damage lying high enough, tracheostomy is an option. If the extent of damage is small enough one might get through with (very risky) emergency intubation and later tracheal repair. In case of critical damage to the lower airways, you usually don't have to think because patients are dead by the time they reach an airway expert.
I've known a few people who have gotten surgeries in this area. It takes months of recovery before they can or should speak at more than a whisper, and about a year (or two?) before their voice is expected to "settle". I'd say "be patient", but maybe the better thing to say is imagine the patience they'll need
https://en.wikipedia.org/wiki/Paolo_Macchiarini
> Their observations will inform the development of Mount Sinai’s Tracheal Transplant Program, enabling Dr. Genden to offer this therapeutic approach to patients nationwide and internationally
This is without a doubt an impressive achievement.
Can someone speak to the logistics of expanding this program though? I don't suppose a 18 hour, 50 person procedure is in any way easy to coordinate, and I imagine it must be extremely expensive, both in terms of financial cost and time investment.
How feasible is it to propagate the expertise? Are there factors related to the novelty that make it attractive for other medical teams to invest time in training for this procedure? Is risk a deterrent in terms of insurance coverage?
As for logistics, it's probably not that different from transplanting another organ. In anything involving the trachea, the technical details of the procedure and the coordination between surgery and anesthesia is where the difficulty lies.
My wife worked as an Operating Room Nurse at a medium sized hospital for over 10 years.
There was also promising work on printing a biodegradable one that be used as a matrix or scaffold for growing a new one from the patient's own cells. This sounds like a better one; though you could print a non-immune-triggering one, one made of the patient's own cells would be more compliant (flexible) which I assume from taking animals apart is required for good breathing.