Can you spot which hand Emily Fennell was born with, and which was recently attached? Hint: the bandage is the only real give away.

The latest recipient of a hand transplant is coping well in Los Angeles. On March 5th, Emily Fennel, age 26, received a donor right hand to replace the one she lost nearly five years earlier in a car accident. Now, more than six weeks later, she once again has two working hands and is on the road back to a normal life. In the weeks and months ahead, Fennel will continue to undergo occupational therapy – picking up small objects and relearning how to use her right hand. Doctors think she’ll one day have as much as 60% of the functionality of her original limb. You can see Emily discuss her condition before and after the transplant in the videos at the bottom. With more than a dozen cases in the US, and over 40 worldwide, these transplants are slowly becoming a more common procedure…but seeing doctors attach a new hand to Emily’s arm still seems utterly incredible!

In order to transplant the new hand onto Fennel’s arm, surgeons had to connect 23 tendons, 2 bones, 2 arteries, and at least 3 nerves. The connection was made along a skewed ellipse, rather than a circle like a bracelet. This was to ensure that scar tissue didn’t create a ring at the wrist that would impair movement or healing. While Fennel is reportedly adjusting well to the transplant, at this point in the recovery process she has no feeling in the attached hand. The connected nerves grow slowly (~1 millimeter per day) and so it will take many more weeks or months before she can receive sensations from the new limb. This numbness, however, has not stopped her from training to rebuild atrophied muscles in her arm and dexterity in her hand.

Hand transplants are extraordinary works of surgical finesse, but they come with a high price. Fennel will have to spend the rest of her life on immunosuppressant drugs to keep her body from rejecting the donor tissue. Those medications increase risks for high blood pressure, liver damage, kidney damage, cancer, and body wide infections.

Despite these dangers, Fennell is not alone in pursuing hand transplants at UCLA. The UCLA Hand Transplantation Program is still seeking prospective patients for the procedure, and while eligibility is limited, and the screening process rigorous (involving medical and psychological tests), I’m sure many will pursue entry into the program. Especially as the first success, Fennell, seems very happy with the results of her transplant.

The general field of transplants has become increasingly bold in the past few years, which has paid off with remarkable successes. We’ve seen several double hand transplants, as well as full face transplants. With stem cells, we’ve seen new organs grown inside patients using nothing more than their own cells and a donated ‘scaffold’ of the organ. Combined with Emily Fennell’s recent surgery, these accomplishments paint a picture of a field of medicine that is accomplishing tasks that would have seen impossible a few decades ago. In the next few years, some of these surgeries could become almost common.

That’s assuming, of course, that they don’t get replaced by something better. While Fennell decided that prosthetics weren’t the right solution for her amputation, others have chosen that route. We’ve seen how not only are robotic limbs becoming more adept, the most advanced prototypes are able to provide sensory feedback. As hand transplant surgeries improve in the years ahead, so too will these robotic alternatives. How long until they become as good as the biological versions? Fennell was able to find a near perfect match for her missing hand, but what about all the amputees who aren’t so fortunate? Whether it’s due to hopes of augmentation (eventually robotic limbs will surpass biological ones, even if takes fifty years) or a limit in opportunity, I think prosthetics will continue to be a strong solution for amputees even as hand transplants improve. If I had to weight the risks of immunosuppressant drugs versus the comfort of having a biological hand…I’m not sure how I would decide.

The beautiful thing is that patients can decide. We have options for amputees that simply weren’t available a generation ago. Advanced robotic hands or waiting for a biological replacement – these are both pretty amazing options. Someday in the future we’ll probably be able to add ‘grow a new hand from your own stem cells’. Fennell’s success with her new limb is another sign that we live in an extraordinary age. Medical technology keeps improving, and as it continues on its accelerated trajectory there may soon be no injury that we cannot repair, no tissue that we cannot replace, and no one that we cannot help.

I love medical science.
…Now check out the videos below to see the incredible procedure:

*note: If videos do not appear below, please refresh your browser.

This first video is a brief overview of Fennel’s story, with a focus on the most recent updates on her condition. Her recovery is amazing.

In this extended video you get to see even more of Fennel’s backstory and recovery from the operation:

This final video focuses on the surgery itself, which took place March 4th and 5th over 14 hours.

[image credit: UCLA Health System/Ann Johannson Photography]
[video credits: LA Times, UCLA Health System]
[sources: UCLA News, LA Times]

Tyson Smith woke up on Valentines Day with two hearts. A rare surgery called "piggyback" transplantation allowed two hearts to do what neither could do alone.

Klingons are no longer the only race in the galaxy that benefit from having redundant organs. Straight out of Star Trek, surgeons last month at University of California, San Diego’s Thorton Hospital performed a rare surgery to save Tyson Smith’s life. He woke up on Valentine’s Day with two hearts—literally.

The thirty-six year old Smith was suffering from congenital heart disease which made his heart grow progressively larger. A normal heart is about the size of a person’s fist––Smith’s heart is three times that size. It’s abnormal size caused it to beat irregularly, weakening its ability to pump blood. It was working at about three- to four-fifths the capacity of a healthy heart. To make matters worse, Smith has pulmonary hypertension, a type of high blood pressure in the lungs that made it even more difficult for the impaired heart to deliver blood and oxygen to the body. The reduced blood flow turns the simplest activity into a grueling endeavor. It took Smith three breaths to deliver the same amount of oxygen carried by a single breath of a healthy person. That sort of exertion is debilitating: before the surgery, he was sleeping 20 hours a day. The condition runs in the family. Smith’s father had died of congenital heart disease at the age of 28. A father of four himself, the cardiologists at UCSD deemed their patient critical. At the time of the surgery they estimated that Smith had about a month to live.

Smith’s pulmonary hypertension further complicated matters. A conventional transplant in which his heart was replaced with a healthy one wasn’t going to work. The new, donor heart wouldn’t have the pumping power required to force blood through Smith’s constricted lung arteries.

Okay, if one heart isn’t enough, try two.

Nicknamed the piggyback transplant, heterotopic heart transplants leave the patient’s heart in place to work in cooperation with the donor heart. The donor heart is situated to the right of the patient’s heart and the filling chambers of each—the left atria—are surgically connected. This allows oxygenated blood to pass from the patient’s heart to the new one where it is ejected by the new heart’s more capable left ventricle into the aorta and to the rest of the body. Together, the two hearts pump about three times as much blood as the original heart. Watch Smith’s two beating hearts in the phenomenal video below.

Piggyback surgeries are rare. Out of approximately 2,000 heart transplants performed in the U.S. each year, one or two will be piggybacks. Not surprisingly, the surgeries pose a greater technical challenge than conventional transplants. But Smith was in good hands. Dr. Jack Copeland, who performed the surgery, is himself a heart transplant pioneer. Now the director of cardiac transplantation and mechanical circulatory support at UCSD Health System, Dr. Copeland made history in 1979 when he performed Arizona’s first heart transplant. He made history again in 1985 when he became the first surgeon to implant the Jarvik 7 artificial heart into a patient, buying the patient time until he could receive a real heart. Although he has performed about 850 transplants over a 33 year long career, Smith’s surgery marked only the fifth time Dr. Copeland had performed a piggyback transplant. As an interesting side note, the piggyback surgery meant Smith needed only one surgery instead of two. This saved him a cool $400,000, as the cost of the operation was about $100,000 instead of a half million.

The "piggyback" transplant was performed by UCSD's Dr. Jack Copeland, one of the world's premier heart transplant surgeons.

The prognosis for heart disease patients is continually being improved by advances in technology and, as with Smith’s case, technique. In 1983 there were 172 transplants performed in the U.S. In 2008, that number climbed to 2,163. A consequence of the increased success of transplants is increased demand. At any given time there are about 3,000 people in the U.S. waiting for a heart with only 2,000 donor hearts available. Although I have no doubt they one day they will, today’s artificial hearts can’t yet replace real ones. But they do serve as crucial bridges to transplantation while the patient waits for his turn (artificial hearts have supported a person for up to 1,100 days). We’ve followed major advances in artificial heart technology such as those created by AbioCor and SynCardia Systems, Inc. Dr. Copeland is a co-founder of SynCardia which developed the first and only Total Artificial Heart to be approved by the FDA. We reported on Charles Okeke, the first person in the U.S. to be released from a hospital with a TAH. His release was made possible by replacing the TAH’s power supply weighing 418 lbs with a backpack unit called Freedom Driver that weighed only 13.5 lbs. By the end of 2010, two other patients with TAHs had gotten their freedom and left their hospital rooms behind.

Heart disease is the leading cause of death worldwide, claiming 7.2 million lives each year. Important risk factors include high blood cholesterol, obesity, physical inactivity and smoking. Unfortunately, it’s much easier to develop treatments for bad habits than it is to get people to change those habits. Of course genetics and age are also factors, but if we remember that before 1900 very few people died of heart disease, the fact that today it’s the number one killer means the nature vs. nurture argument becomes very easy to figure out. The Industrial Revolution transformed whole industries from human to machine, and we steadily saw less potato farmers transformed into couch potatoes. The rise in heart disease occurrence was so rapid between 1940 and 1967 that the World Health Organization declared it the world’s most serious epidemic. The impact of technology changes not only our world, but our bodies too.

Just ask Tyson Smith.

When he woke up on Valentine’s Day and heard the thump of two heartbeats in his chest, he called it a blessing. The second heart had given him a second chance. He was so impressed with the people around him, people like Dr. Copeland, that he made a promise to himself that he would do better. Currently a janitor, Smith said that he was going to go back to school and become a radiologist. I think we all would like to wish him well on his making a change for the better. And for many of us, he could very well wish us the same.

[image credit: ABC via New York Daily News, Syncardia Systems, Inc.]
[video credit: UCSD Medical Center via YouTube]

Lipo Control in action - Cannula is inserted under the skin and display (bottom left) maps what areas have been treated.

Looking to get rid of your love handles, or perhaps an extra chin?  Be ready to, quite literally, feel the burn.  Okay so you don’t actually feel the burn (thank you, anesthetics) but Osyris Medical’s newly FDA approved Lipo Control device uses a laser to melt your fat cells, then whisks them away to a biohazard container, never to bother you again.  While the concept of liposuction is nothing new, the folks over at Osyris have streamlined the process using a magnetic field and realitme 3D tracking to map the treatment area, as well as the dosage administered at each point.  Their patented technology has transformed the typical blunt force trauma assult on your fat cells to a smooth and controlled process that makes shedding a pound or two easier than ever before.  But is this really a good thing?  Come on people, what ever happened to good old fashioned exercise?

As recently reported here at Singularity Hub – Americans are fat.  For the truly lazy among us, liposuction has always promised a fast solution to the weight loss problem.  It is no surprise that in today’s instant gratification seeking society, people would rather spend money to do it the easy way than put in the time and energy to do it the right way.  Naturally, the cosmetic surgery industry is more than happy to oblige, coming up with faster, easier and more effective ways to slim down.  Lipo Control is the newest tool in their arsenal, and yet another testament to the fact that technology is permeating even the superfluous parts of our society.

The base technology here is laser lypolysis.  If you have ever seen video of traditional liposuction, then you know it’s no picnic (ha- eating, liposuction… get it?).  The doctor inserts a blunt tipped cannula (hollow tube that is inserted under the skin), and using physical force alone, blindly rams into your fat tissue to physically break it up and then suck it away.  As you can imagine, this leads to bruising and swelling in the treatment area, not to mention that skin is left saggy when it is no longer inflated with fat.  Adding a laser to the tip of the cannula greatly improves on traditional methods.  Fatty tissue absorbs energy most efficiently in the 900-1100 nm range, so adding a 980 nm diode laser into the device selectively melts your fat cells, leaving surrounding tissue intact.  The liquid fat is then sucked out of your body.  The heat produced by the laser also stimulates collagen production and skin tightening in the area of the procedure.

Many companies, including Osyris, already sell laser lipolysis machines, so you may be wondering what all of the hubbub is about.  Its Osyris’s patented magnetic tracking and dosage control technology.  Each Lipo Control machine emits its own magnetic field, and the handle of the cannula contains a sensor that allows the machine to calculate in realtime the 3D position and 3D angle of inclination of the cannula – sort of like your Nintendo Wii remote.  Having first mapped out the area to be treated, the physician then moves the cannula around within that space.  The position information is used to show the physician which areas have already been treated.  And that isn’t all, the machine also monitors the dosage to the treated areas.  The colored lines that are displayed on the screen indicating an area has been treated vary in brightness, and this brightness corresponds to the dosage at that particular spot.

So instead of randomly poking around under your skin, the doctor can actually see where he has already been and how much energy was delivered to that area.  Its easy to see how this technology could revolutionize the liposuction procedure.   With smaller incisions and less damage done to surrounding tissue, you could instantly lose a pound or two with this body sculpting technique, and be back at work the next day.  The procedure itself is faster too – a map of where you’ve been ensures that you aren’t re-treating already liquefied fat.  Visit the Lipo Control website to check out videos of the device in action.

All of this sounds pretty great, but don’t run off to your local cosmetic surgery office just yet.  The average cost of treatment with Osyris’s Lipo Control will be somewhere in the neighborhood of $4000 dollars.  That is a bit cheaper than traditional liposuction, which usually starts around $6000, but still quite a chunk of change.  Despite the price tag, Laser lipolysis is quickly becoming popular – according to the American Society of Plastic Surgeons, over 198,000 procedures were performed in 2009 alone.  That is a little bit crazy, especially because Lipolysis is recommended for people who already exercise and eat right – the idea being that the treatment will sculpt and tone your body.  It seems that the pursuit of perfection has no limits, and fear not fellow scientists, there is math to support that claim.  Since 2000, breast augmentations have increased by 36%, Botox injections have increased by an astronomical 509% and tummy tucks have increased by a whopping 84% in the United States.  Will the rat race never cease?

In today’s society where first impressions are everything and youth reigns supreme, people will do anything to get an edge.  Are you ready to feel the burn?  With technological advances like these, liposuction and other cosmetic procedures are becoming safer and more effective than ever before.  We each have to decide which (if any) of these technological advances is right for us.   Personally, if I ever see anything resembling a second chin staring me down in the mirror, I will be making an appointment faster than you can blink.  While I’m not a fan of lipo in lieu of a healthy lifestyle, sometimes there are certain areas that just won’t budge.  So, if you are in great shape but have a stubborn jiggle that won’t go away (and a few thousand dollars burning a hole in your pocket), Lipo Control will melt away your problem.

[image credits: Osyris Medical]

[Source: Osyris Medical]

This tiny implant is able to monitor important chemicals near a tumor.

The little implant works in a really cool way. Only five millimeters long, the cylinder contains magnetic nanoparticles coated with antibodies. These antibodies will bond to whichever chemical the implant is designed to monitor. A semi-permeable membrane keeps the nanoparticles in the implant while still allowing ambient particles in and out. When the antibodies bond to a chemical they form clumps. These clumps are then read using an MRI.

It’s surprising what you can learn from clumps. Chorionic gonadotropin is a hormone produced by human tumors. The CCNE implant Dr. Cima designed can help monitor levels of this hormone to determine the relative size of a tumor over time. Already, Cima’s team has tested the effectiveness of their implant by using them on mice that have human tumors transplanted inside. Over the period of a month Cima was able to track the changes in tumors using their setup.

The CCNE implant uses antibodies to clump around important indicator particles (analytes).

Giving mice human tumors sounds a little too much like mad-science, but the technology speaks for itself. While some researchers are developing take home kits to test for cancer, and others seek for robots to explore the body or have nanobots fight the disease, a passive and continuous monitor is a unique and necessary addition. The ability to correlate chemotherapy drug levels with tumor size is going to be crucial in customizing care to each patient. The implant, which could help determine if a tumor has metastasized, can be placed during the first biopsy, removing the need for repetitive exploratory surgery.

As mentioned by Catherine Mohr in her talks on advances in surgery, improvements in sensing are going to be as important as improvements in cutting. Surgeons need a better understanding of how their operations have affected their patient. The implant can serve that purpose while still helping other doctors choose chemotherapy levels or monitor how their patient is responding to another treatment.

Dr. Cima believes that a version of the implant that tests for pH levels could be ready in as few as five years. That’s still a ways off, but it won’t take long after the pH implants are approved before the hormone and oxygen level monitors follow suit. Continuous observations will be a successful ingredient in maintaining our health. Just like big brother always said.

Catherine Mohr is on the cutting edge of robotic surgery. Photo by Liz Hafalia

The wonderful thing about robotic surgery is that it is already here. Thousands of robotically assisted surgeries are performed every year in the U.S. The da Vinci robot, which has been around since 1999, and which Singularity Hub has discussed before, has become the most popular method for conducting prostatectomies. Surgeons are able to use 3D imaging, and intuitive controls to manipulate da Vinci’s pincers and clamps in a way that is more precise than typical manual surgeries. More importantly, they can do these procedures through just a few incisions rather than opening up the entire chest cavity. The combination of precision and minimal invasion allows these robots to sew a blood vessel onto a beating heart.

Catherine Mohr, of course, isn’t satisfied with a “few” incisions. She’s aiming to bring that down to one. Instead of having a high-definition camera on one stalk of a robot, and a manipulation tool on another stalk, Mohr is advocating combining each of these instruments into a single unit. In this fashion, all the necessary devices would spring out from the one tube, branching out and turning back to face the point of interest. It’s like putting a complete and tiny surgical team inside the body through just one cut.

Mohr’s TED talk took the scenic approach to discussing modern robotic surgery. Feel free to skip ahead 9 minutes to get to the cool stuff. Fair warning to the squeamish, her examples are graphic! While I am suitably in awe of her new single-incision robotic surgery system (I can’t believe the TED audience didn’t applaud for it), her discussion of indicating markers really got me excited. These non-radioactive chemicals bond to tissue and are made to fluoresce. You can pinpoint cancer cells, or blood flow in vessels, or delicate nerve tissue by looking for what glows. In Mohr’s words: “…we can reach it all, and we can see it all.”

An average day for heart transplant specialists

Modern day heart transplants are normally conducted by donations from recently deceased or brain-dead donors.  The heart is taken out of the donor and given a potassium chloride injection to stop the heart from beating.  It is capable of surviving outside of the body for about 4-6 hours.  In this last year in the United States, there were about 2300 successful heart transplants (3500 worldwide) while 800 U.S. patients died while waiting for a suitable donor.  More than half of U.S. heart transplant patients are between 50 and 70 years old.

The road to successful heart transplants was a bit of a rocky one.  The first heart transplant was conducted in 1964 when a monkey heart was placed in the chest of a dying man.  This, of course, raised a great number of ethical considerations.  Unfortunately, the man’s life was only prolonged for about 90 minutes, but the procedure set the stage for future operations between humans.  The first intra-human operation was performed in 1967 with a heart from a brain-dead donor.  The patient lived only 18 days before succumbing to pneumonia.

The procedure for a heart transplant is tricky at best.  The body is opened with a cut through the sternum and the heart is exposed.  A heart/lung machine is attached to the blood vessels leading in and out of the heart, which acts to pump and oxygenate the blood during the operation.  After the patient is weaned off of the defective heart, it is literally cut out of the body, leaving only a little bit of the original heart behind.  The part left behind contains the pulmonary veins and some heart tissue.  The donor heart is trimmed to fit to the remaining tissue and is then sewed in place.  The heart is restarted (and defibrillated if necessary) and the patient is removed from the heart/lung machine.  At this point, the patient is surviving solely by their new heart.  The patient is closed up with plenty of sutures and some metal wire to reconnect the sternum.  NOVA Online has a very informative and slightly eerie interactive game that describes exactly how the procedure is conducted.  Be sure to check it out if you never wish to forget how to replace a heart.

Ready For Heart Transplant!

Overall, the transplant process is about 7 hours long and costs roughly $150,000.  The patient is generally sent home as quickly as possible (about 1 to 2 weeks after the operation) to avoid contracting any diseases.  Anti-rejection medication must be taken for the rest of the patient’s life or else they risk the body rejecting the new tissue and causing heart failure.  Survival rates from the procedure are about 86% after the first year but drop to about 70% after five years among US citizens.

So, where can it go from here?  Though any patient would prefer a 99% survival rate, the odds don’t seem all that bad for somebody who doesn’t have long to live otherwise.  The majority of problems occur in the body rejecting the new tissue and attacking it.  Current medication reduces the body’s ability to fight off the new tissue, but also makes the patient more vulnerable towards other infections.  It is in these complications that much of the focus should be placed.

The end goal is to make the rejection issue a moot point by growing organs in the laboratory that are autologous.  If the patient is given their own cells, then the body will not react negatively towards the transplant.  Lifelong suppressant medication would not be necessary and the immune system would be able to fend off many of the diseases that can cause complications among heart transplant patients.  Unfortunately, such an advancement is a long way off and the rejection problem is the issue to focus on in the near term.

It’s amazing to look back and see how far modern medicine has gone with the heart transplant.  For over forty years, the procedure has progressed and transformed into what it is today.  Ideally, it will continue to become more reliable and more accessible, but what modern medicine has created in the heart transplant is already astounding.

Credit: Andy Richards, NC State U

Normally, testing out cardiac surgery ideas goes something like this: Let’s say Dr. Robotnik thought up a new technique for repairing heart valves. Before it hits the OR, the technique gets tried out on live pigs.  Swine hearts are pretty similar to human hearts, making them the ideal (ahem) guinea pigs. But getting permission for live animal testing is time-consuming and expensive, costing around $2,500 a pop. Perfecting a technique might take a number of trials, which means a number of pigs, more time & money, then PETA gets involved… you get the idea. A real headache. So what’s a surgical innovator to do?

Fake it! A new machine at North Carolina State University takes a dead heart from your local butcher and makes it pump just like the real thing. This way, doctors can test out new tools and techniques for heart surgery without the time and money required for live trials. The machine pumps pressurized saline through the cardiac tissue, making it move in a sort of pig-heart version of Weekend at Bernie’s.  All this is controlled by a computer, and even has live cameras to film the action from inside. Plus, the new technique is recession-proof at a cool $25 bucks per trial. Check out this video of the system in action:

Of course, most new tools and techniques still get a live pig trial before it’s all said and done, just to be sure. But the new system gives doctors an intermediate stage, which helps them be sure their surgical concepts are sound before they start operating on live pigs, and eventually live humans.  That’ll save a few pigs from the operating table, save a few research dollars, and (hopfully) save a few human lives with the results.

Designed by engineering PhD student Andrew Richards, the project was funded by the NIH National Heart, Lung and Blood Institute. In their test study, the machine aimed to replicate a heart disease called mitral regurgitation, which is when blood leaks from the left ventricle into the left atrium (in case it’s been a while since your last bio class, that’s the wrong way). By simulating the disease with the machine, doctors can test out new ways to repair the disorder without the costs of live trials. The technique can be used to work out the kinks in all sorts of new heart repair operations.

This is different from the much-cooler living lung repair, which actually keeps human organs alive for repair during a transplant. Here, a dead pig heart gets to serve science before it goes… wherever it is dead pig hearts normally go. Recycling organs can make biomedical research just a wee bit more sustainable, and save a few pennies our enormously expensive health care system. Who says going green has to cost so much green? Waste not, want not!

So the next time you’re chowing down on a glazed ham, remember: your dinner’s heart might be pumping away in a lab somewhere. Hope that doesn’t ruin your appetite or anything.

Early adopters have been promoting the virtues of the Da Vinci for nearly a decade now, but only in the last year or so has the Da Vinci gained the critical mass to leap from fledgling technology to revolutionary game changer. The Da Vinci robot is being massively adopted by hospitals across the nation as its virtues to the patient including faster recovery, less blood loss, less risk of infection, and less pain have become overwhelming. Below is a promotional video from Intuitive Surgical that explains this amazing game changing innovation in the field of human health and medicine:

da Vinci Surgical System

Cochlear Implant Restores Partial Hearing to Completely Deaf Patient

Video of Real Heart Transplant Procedure

picture of heart transplant in action!