Neurosurgeons with the Sylvester Comprehensive Cancer Center Brain Tumor Initiative and the University of Miami Miller School of Medicine’s Department of Neurological Surgery are performing carefully selected brain tumor and spinal surgery procedures on an outpatient basis.
For more than a decade, the neurosurgery team at UHealth—the University of Miami Health System has been a leader in minimally invasive procedures that shorten hospital stays and accelerate patient recovery. Now, in certain cases, there is no overnight hospital stay.
“Our program is the first in the state to offer same-day brain tumor and spinal surgeries,” said Ricardo J. Komotar, M.D., professor of neurological
surgery, director of the Sylvester Comprehensive Cancer Center’s Brain Tumor Initiative at UM, director of Surgical Neuro-Oncology and director of the Neuro-Oncology Fellowship Program. “We apply our deep experience and specialized training to offer safe and effective outpatient procedures for certain conditions.”
Leading the UHealth spinal surgery team is Michael Wang, M.D., professor of neurological surgery, chief of neurosurgery at UHealth Tower—the flagship hospital of the University of Miami Health System – and director of the Spine Neurosurgery Fellowship Program.
“For many years, we have been the only program in Florida to offer super-specialized minimally invasive spinal fusion procedures, such as the awake spinal fusion,” said Dr. Wang, a nationally recognized spine surgeon. “Now, we are continuing to lead the way in offering this spine surgery on an outpatient basis to qualified patients. It’s a remarkable feat made possible only with our specialized team, which includes anesthesiologists, nurses, therapists, and support professionals.”
Outpatient brain surgeries
Dr. Komotar began performing outpatient brain surgeries at UHealth Tower in August. One of his first patients was John Dunlap, a U.S. Army veteran in Lake Worth who was diagnosed with cerebral metastasis, a brain tumor stemming from a melanoma.
“When a CAT scan showed the tumor, we were very scared,” said his wife Yuna Kim. “But once we talked with Dr. Komotar, we felt there was light at the end of the tunnel. We also felt the outpatient surgery was the best choice to help his recovery.”
After his discharge, Dunlap was soon back to his active lifestyle. He went to the grocery store, walked the dog, and rebuilt an air-conditioning unit at the family’s home. While still recovering, Dunlap appreciates life without terrible headaches. To show his appreciation, Dunlap gave Dr. Komotar his Army badge and pin as a thank-you gesture.
“He’s the Navy SEAL of doctors,” said Dunlap, a father of several children, including two school-age girls with Yuna. “His team were the sweetest people. His staff was great and confident.”
Dunlap explained that his headaches began about ten months prior to getting surgery, and they kept progressing. They got intense about three or four months ago. He was getting shots for the pain but just couldn’t take it anymore. He said the condition also seemed to cause symptoms of PTSD; he saw white lights and sensed explosions.
Post-surgery, Dunlap said that he does have some trouble finding words, but the symptoms of PTSD, the white flashing light, and sensing explosions are gone. “It’s like a monkey off your back,” said Dunlap, who is receiving further treatment at Sylvester.
In general, the best candidates for same-day procedures are active younger patients like Dunlap in good overall health, said Dr. Komotar. “We typically do the procedures in the early morning, take follow-up images of the brain in the afternoon, and discharge the patients to go home that evening,” he said. “Then, we continue to monitor their recovery via telehealth or in-person visits.”
Two decades ago, brain surgery patients typically stayed in the hospital for a week after their procedures. Since 2012, the neurosurgeons at UHealth have reduced many of those long lengths of stay to overnight hospitalizations. “Doing same-day surgery is another step in the right direction,” said Dr. Komotar. “No one wants to be in the hospital unless it’s necessary, so being able to send patients home is better for a patient’s recovery and peace of mind.”
Innovative spinal procedures
Sandra Grant, a 62-year-old Miami resident, had been suffering from back pain for many years. She began taking medications in 2016, but the pain continued, and she had a slight limp when she walked. Her primary care doctor referred Grant to Dr. Wang for spinal fusion surgery, and he performed the outpatient surgery in July.
“Dr. Wang assured me that everything would go fine, and he was right,” said Grant.
“My recovery has been great. I can walk around without people wondering why I’m leaning to the side. Best of all, I’m pain-free and don’t have to take the medicine anymore.”
Noting that his patient’s painful condition was a form of arthritis called spondylolisthesis, Dr. Wang said, “Sandra had a dislocation of her vertebrae that caused an entrapment of the nerve. The good news is we know that when we fix that problem, we will likely see a very good outcome. Instead of keeping these patients in the hospital overnight, we can send many of them home the same day, and they do fine.”
Since launching the innovative procedure in 2013, Dr. Wang has treated more than 500 patients, including compromised patients on dialysis, transplant recipients, and patients in their eighth or ninth decade of life, using “awake” techniques with light anesthesia. This minimally invasive approach incorporates a 6 mm endoscope and miniaturized special tools and implants and genetically-engineered proteins. The procedures typically take about 50 minutes, compared with four to six hours for traditional spinal fusion surgery.
The same-day procedure is suited for patients of all ages, according to Dr. Wang. “We started with young adults but have expanded to include older patients with complex, chronic conditions. We have had excellent results, reducing chronic pain, and improving our patients’ overall quality of life. In Florida, we’re still the only ones doing this type of procedure in this way.”