[HN Gopher] Surgeons Perform First Human Tracheal Transplant Sur...
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Surgeons Perform First Human Tracheal Transplant Surgery
Author : Ovah
Score : 72 points
Date : 2021-04-11 10:07 UTC (12 hours ago)
(HTM) web link (www.mountsinai.org)
(TXT) w3m dump (www.mountsinai.org)
| 1-6 wrote:
| I'm curious to hear their new voice.
| surfsvammel wrote:
| I really hope this is different from what Paolo Macchiarini was
| doing, where it seems most patients later died. One of the
| biggest scandals in Sweden.
| exotree wrote:
| 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.
| mgkimsal wrote:
| 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?
| [deleted]
| throwawaysea wrote:
| 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?
| rscho wrote:
| 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.
| ceejayoz wrote:
| https://en.wikipedia.org/wiki/Tracheal_intubation and
| https://en.wikipedia.org/wiki/Tracheotomy
| lhorie wrote:
| > 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?
| annoyingnoob wrote:
| 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.
| rscho wrote:
| 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.
| marsven_422 wrote:
| Good thing China have a ready supply of Uyghur donors.
| gumby wrote:
| 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.
| Layke1123 wrote:
| Why is my first thought I wonder how much that costs and not
| instantly wanting a potentially life saving or quality
| improvement?
| sampo wrote:
| 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.
|
| https://en.wikipedia.org/wiki/Paolo_Macchiarini
| [deleted]
| benatkin wrote:
| 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.
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