17 August 2015ChennaiIn a world’s first audacious attempt, team of surgeons from LIMA (Lifeline Institute of Minimal Access) Keyhole Surgery, Chennai, with the team headed by Dr JS Rajkumar, have deployed anti-coagulant technology used by the US soldiers to save a patient who was earlier declared as inoperable!
A 55 year old farmer from Nadia district, West Bengal, India, noticed a tumor growing in his abdomen about 5 months ago. In a matter of months, this aggressive tumor made his stomach swell up like that of a woman carrying a full term baby. Initial investigations carried out (not in LIMA) diagnosed that the tumor is in fact a liposarcoma (lipid = fat, lipo = related to fat, sarcoma = cancer), a cancer of the fat cells.
These cancer cells typically grow about 27 to 30 times as fast as normal cells. To fuel such rapid growth, they sprout new blood vessels that feed all nooks and carnies of the tumor. To cut away a tumor this large would mean interrupting thousands of tiny blood vessels. Cutting through these blood vessels and then sealing them before substantial blood loss occurred would have been a time consuming process. The chances of the patient bleeding to death on the table were very high.
Before coming to LIMA, the patient was either turned away at other hospitals, or was offered a choice to undergo the surgeon’s knife with no guarantees for life.
Amylopectin is a plant derived starch. In some varieties of rice and potato, almost all the starch in them are made up of amylopectin. Ancient China made super-strong mortars using amylopectin derived from sticky rice. Recently, US military started using a modified form of amylopectin for stopping bleeding in the battlefield, like severed arteries!
Amylopectin is either applied in its power form or, more often, packed into a gauze pad, and applied on the wound site along with manual pressure. Amylopectin, contracts the arteries and arrests the bleeding quickly. The good thing about amylopectin is that it has no side effects and it doesn’t sting!
In 2009, a landmark animal study was carried out to demonstrate the efficacy of amylopectin (here). They took 16 of pigs, cut their arteries and let them bleed. 6 of the bleeding pigs were dressed with gauze and manual pressure applied to arrest the bleeding. With the remaining 10 pigs, amylopectin was applied on the bleeding artery and manual pressure applied. Every animal that was treated with the conventional sadly gauze died. Whereas, every animal that was treated with amylopectin survived! That’s how efficacious this product with arresting bleeding. Even from cut arteries.
Amylopectin is approved by US FDA as a regular hemostatic (hemo = blood; static = stopping) agent in humans. Though the starch has potential to deal with even serious bleeding, it is being sold as over the counter solution for quickly and permanently arresting bleeding from minor bruises.
Amylopectin in surgeries
Around the world, surgeons have been using amylopectin for stopping the bleeding from dermatological, dental and other topical procedures. Though there are no recorded cases of using amylopectin in a major surgery, the surgical team at LIMA, headed by Dr JS Rajkumar, decided that the case of patient BM would benefit tremendously from the hemostat (blood stopper).
As mentioned before, the tumor developed by patient BM had thousands of blood vessels feeding into it. In the process of excisioning the tumor, the surgeons would be cutting all of them, resulting in massive bleeding. Given the number (large) and size (small) of the blood vessels, it would very likely be impossible to suture all of them within a reasonable amount of time. More time taken for arresting the blood would mean more risk to the life of the patient.
Having been personally briefed by the Chief Medical Officer of StopsBleeding, one of the amylopectin hemostat vendors, about the efficacy of the product, Dr Rajkumar decided to use it to arrest the bleeding from the blood vessels after cutting away the tumor. This would reduce the length of surgery and blood loss, thereby substantially increase the probability of patient survival.
Removal of the tumor
In a surgery that took almost 4 hours, Dr JS Rajkumar and his team made a 12cm long incision in the patient’s abdomen, accessed its innards and removed a tumor weighing 6.4 kg (compare this with a new born child, which weighs just about 2.5kg)! The tumor was about a foot across and was larger than a football.
Because amylopectin helped the surgical team to arrest the profuse bleeding quickly, the blood pressure of the patient could be maintained within safe limits throughout the surgery. Also, the volume of blood transfusion needed was less than half of what would’ve needed otherwise.
After Successful Surgery
19 August 2015ChennaiOn the third day of the surgery, the patient BM walked to a press meet and joined LIMA surgeons to tell the world how a revolutionary new consumer technology (or, should we say, an US military technology) has helped him get a new lease of life.
Patient BM is now several kilograms lighter as an estimated 98% of his cancerous tumor has been removed. In order to beat back his aggressive cancer, he will now take up chemotherapy after returning home. In his fight for his life, BM helped accelerating the adoptation of amylopectin in surgical rooms all over the world, thereby reducing the cost and risk of surgery for millions of patients to come!
The real significance of using amylopectin in a major surgery won’t be appreciated by the untrained eyes at the first glance. To do that, you will have to see it through the prism of Exponential.Healthcare.
As a consequence of exponentially growing technology, healthcare has embarked on a journey on a warp drive of change. The changes will result in making medicine, and healthcare, simpler and cheaper. Besides, the changes will end up increasing our life expectancy beyond our wildest dreams (see Lifeline’s longevity initiative Rewind Science)!
To say that the coming changes in medicine and healthcare are tectonic will be an understatement. The changes will lay to waste the existing healthcare business model and pave way for brand new players, with their disruptive solutions, to sprout.
Things like this happen often in electronics and information technology. Digital cameras in the phones killed Kodak. Cheap mobile phones vanquished Motorola’s multi-billion dollar Irridium communications satellites. 3D additive manufacturing is threatening to rip apart the entire manufacturing industry the world over. Amateurs often produce better solutions in highly complex areas like astronomy and algorithm design than million dollar projects employing professionals.
The commercial brand of amylopectin used by LIMA in this major surgery, called StopsBleeding, is a consumer product available off the shelves of Wallmart. This $20 worth product had reduced both the surgical time and blood transfusion to nearly half, thereby reducing the cost of surgery and surgical risk. With passing time, amylopectin is bound to become a mainstream hemostat (blood stopper) for all surgeries, thereby reducing the cost and skill required in carrying out all types of surgeries.
In medicine, more such revolutionary changes are under way. Healthcare will become cheaper, better AND faster. At LIMA (Lifeline Institute of Minimal Access), we are going to ride the coming excitement right from the eye of the storm!