Michael Troutman had a choice — get his face cut apart to remove the kiwi-sized tumor clogging a nostril, or wait three months for the mass to be pulled out of his nose at University of Colorado Hospital.
“At first, I wanted to get it done quicker,” said Troutman, 14. “I was like, ‘I want to breathe now.’ ”
Troutman’s parents encouraged him to wait, he said, so that a surgeon from the UC Denver School of Medicine could use a tiny scope and instruments to make only one small cut, deep inside his nose.
No visible scar. Two or three days of recovery.
Colorado surgeons increasingly are using such “minimally invasive” techniques in repairing hernias, fusing vertebrae and removing tumors — all without cutting bones or carving through layers of tissue to get to their destination.
While some physicians say this trend is reducing patients’ recovery time and pain, others say many of the new technologies and techniques are still unproven.
“We need to innovate without taking risks,” said Jandel Allen-Davis, an obstetrician with Kaiser Permanente in Denver.
“It’s all gotten cooler, slicker, faster and more expensive,” Allen-Davis said. “We just have to take a very measured approach to it.”
Troutman was a good candidate for a minimally invasive approach through the nose, said his surgeon, Todd Kingdom, an ear, nose and throat specialist with the UCD School of Medicine.
The Montrose teenager had a rare type of tumor that grows in the nasal and sinus cavities, fed by blood vessels, Kingdom said.
The benign tumor had to come out before it started putting pressure on the boy’s brain or started eroding bone.
“You damage . . . stuff”
In the conventional, still-widely used surgery, incisions are made around an eye, the nose and lips to get at the tumor, Kingdom said, or a surgeon might hide a cut inside the patient’s mouth, cutting though the upper jaw.
“That’s a great way to get to the sinuses, but it requires you damage a lot of stuff, collaterally,” Kingdom said.
Instead, he went in through Troutman’s nose, loosened the tumor from surrounding tissue and blood vessels, broke it into a few pieces and pulled them out through the nostril.
Kingdom said many innovative surgical techniques are still too new for patient outcomes to be confirmed with clinical trials.
“For cancer, we can’t say yet that it’s every bit as good, but my interpretation is that it is,” he said.
Patients, however, need to understand that minimally invasive surgery doesn’t always make sense, said Dale Varner, a thoracic surgeon with Kaiser Permanente.
Asking for procedures
“A problem for us is that the market puts pressure on the process,” Varner said. “Before there’s evidence that it’s helpful for the patient, they’re all asking for it.”
For example, laproscopic hernia surgery in which a surgeon uses a scope and tiny instruments to sew a patch into torn tissue turns out to be harder on patients than more conventional external cuts, Varner said.
“We really thought it would be less painful for the patient, but I finally abandoned it,” Varner said. “Patients weren’t getting back to work any faster.”
Still, Varner said, some minimally invasive techniques show real promise.
About 18 months ago, he started using a technique that allows surgeons to thread a scope into a patient’s chest, using video technology and tiny instruments to remove cancerous lung lobes.
The alternative for lung-lobe removal — making a big chest incision, spreading apart or cracking ribs, cutting muscle and fascia — makes for a painful recovery, Varner said.
Tumors through nose
Earlier this month, Kevin Lillehei, the chief of neurosurgery at the UCD school, also pursued a tumor through a patient’s nose.
This time it was a pituitary gland tumor in a middle-age man.
In the operating room, the only part of the man’s body not covered by blue surgical drapes was his nose, magnified several times on video screens scattered around the room.
Five years ago, most surgeons would have opened the man’s skull and lifted part of his brain to get at the tumor, Lillehei said.
“Here’s our approach now,” Lillehei said, adjusting a tiny clamp that held the man’s nostril open. “At the very back of the nose here, we’re going to open the mucosa. That’s our only incision.”
Over the next couple of hours, he pulled out the gelantinous tumor.
After his surgery in November, Troutman said he felt immediate relief.
“I could breathe again,” he said.
By January, he was playing basketball again — and he took a hard pass in the face.
“It slammed me, and if I had had that other thing, it could have been bad, really bad,” Troutman said. “But I didn’t even have a nosebleed.”
Katy Human: 303-954-1910 or khuman@denverpost.com
