Minimally invasive surgery on the rise

PITTSBURGH — Brenda Henzel has a huge, non-cancerous tumor in her brain. It is about to be removed with cutting-edge, minimally invasive surgery in the most unlikely way.

"I just find it unbelievable that they can go up through the nose and do this" says Henzel.

That's right, the nose. Dr. Amin Kassam, at the University of Pittsburgh, is perfecting surgery using the nostrils as portals to a large area of the brain. 

"It's terrific," says Kassam. "What it allows you to do is get directly into the tumor — direct access. The nose is a straight conduit right into the middle of the tumor."

Minimally invasive surgery is one of the biggest trends in medicine. Typically, surgeons insert two small tubes and use what are called endoscopes. One carries a fiber optic camera and light source, the other carries miniaturized surgical instruments. The surgeons operate by watching a TV monitor. For almost eight years, Kassam has been working to adopt the technology to the highly complex field of brain surgery.

"We bring the endoscope in through the nose and we bring that right to our target," says Kassam. "Now, God gave us two nostrils, so we can come right up to the target [and] see what we're doing directly."

Kassam has had to invent an entire collection of new instruments to work in the limited area beyond the nostrils.

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"This drill has diamond filings as well as coarse filings, so that it can undertake detail drilling without cutting through important vessels," says Kassam as he shows off the instrument.

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Kassam can not reach all areas of the brain through the nostrils, but he believes the technique will eventually replace many of today's brain operations. What percentage of brain surgery could be done through the nose?

"Today, with the technology that we understand and after the learning curve we've acquired, I'd estimate about 60 to 70 percent," says Kassam.

And the main advantage? With regular surgery, Brenda Henzel would have needed drilling through her skull and at least a week's recovery in the hospital. With the minimally invasive nose technique, she's awake hours after the operation and home the next day.