Nano-surgery to Improve Treatment and Outcomes for All Patients

By Michael Jablonski, MD

Orlando is on the verge of becoming one of the most advanced minimally invasive orthopedic surgery destinations in the world. The implications of this extend well-beyond highperforming athletes and will improve treatment and outcomes for anyone.

To understand the importance of this, it is probably a good idea to remind ourselves of how significant surgery is to any patient. Surgery is by its very nature traumatic to the human body. We are making incisions, removing matter, disrupting tissue, reattaching or replacing things, and then stitching it all back together. We do incredibly good things for our patients through surgery, but it is invasive. And patients must recover not only from what brought them to the doctor’s office, but also from the surgery itself.

So, if we can make that surgery less invasive, less traumatic, we will make our patients’ recoveries – and their lives – vastly better.

For years you’ve heard medical professionals talk about minimally invasive procedures and techniques. Arthroscopic camerabased surgery, for example, can be performed with a tool the width of a standard pencil or ball-point pen. As remarkable as that is, it still requires a patient to undergo general anesthesia.

But what if we are able to perform surgery with something even smaller? Instead of the tool being the width of a pencil, what if the tool is the width of the lead inside that pencil. That is about 2 millimeters, or the width of a 14-gauge needle. Besides being obviously less invasive, such surgery can be performed without general anesthesia; it can be done with a local anesthetic. That means less trauma, less pain and pain treatment, less risk of infection and other complications. It also means significantly less time in the hospital.

That is what is about to become reality at the Orlando Health Jewett Orthopedic Institute Downtown Campus later this summer when we open our nano-surgical suite. Once credentialing is complete, the Orlando Health Jewett Orthopedic Institute will become one of only four Centers of Excellence for orthopedic nano-surgery in the United States. While nano-surgery is available elsewhere, the Orlando Health Jewett Orthopedic Institute has specific Nano ArthrOscopy Procedural Suites within the ambulatory surgery center that are fully accredited to perform minimally invasive arthroscopic and endoscopic techniques.

WHAT DOES THIS MEAN FOR A PATIENT?

Well, imagine that you have sustained an injury to your shoulder that requires surgery. You might drive to the downtown complex, and park in the garage and walk across a breezeway to the ambulatory surgery center. After checking in and getting prepared, you will walk into the nano-suite, which is unlike any operating room you have ever seen before. For one thing, there are windows admitting natural light into the room, which we’ve tried to replicate throughout the facility. Natural light is good for people’s mental state; it makes everyone happier, and in my opinion is good for healing.

In the surgical suite you can either enjoy the view out the window or watch what the surgeon is doing on a video monitor if you wish. It’s a form of social medicine or social surgery because you can actually talk to the surgeon during the procedure.

When it’s done, you’ll be able to leave much as you would from a dentist’s office. Obviously, if it is surgery on one of the joints involving your leg or foot, you might not be able to walk on it right away without crutches, but your recovery time will be dramatically shortened.

This started out as a diagnostic tool. If a physician wanted to inspect the inside of a knee, for example, they could use the nano-camera to look for something like, say, loose cartilage instead of sending the patient for an MRI. Now, the technology has advanced to where we can use it not only to view and diagnose the problem, but also to treat it. This is the case for labral tears in the shoulder and meniscus tears in the knee.

One of the things I am especially excited about is that we are not only introducing this surgical option to our patients, but we will be helping to teach the next generation of surgeons through our fellowship and residency programs. And we will be participating in research to help continue the advancement of orthopedic surgery.

Now, it is important to note that this level of nano-surgery is not suitable for every situation. For example, the needle is not long enough to be used in treating hips. But it has many applications, especially when it comes to treating the shoulder, the elbow, the wrist, and the knee.

It is also important for doctors to help their patients understand that this level of treatment is not exclusive to highperforming athletes. Today, many people are active throughout their lives. Helping them to get back on the court, the driving range or whatever their choice of activity as soon as possible really has an impact on their quality of life. And if we can use technology to reduce the risks of complications and to deliver speedier and better outcomes, that’s a benefit to everyone.

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Michael V. Jablonski, MD, is a board-certified orthopedic surgeon and the physician leader of Orlando Health Jewett Orthopedic Institute. He specializes in knee joint replacement, using Mako® Robotic Arm Assisted Surgery, as well as in sports medicine. Dr. Jablonski completed medical school and residency training at the University of Florida College of Medicine, followed by a fellowship with the renowned Dr. James Andrews at the American Sports Medicine Institute. He served as the chief medical officer for 2022 USA Special Olympics, an immensely rewarding experience that fostered a strong interest in advocating for inclusive, quality orthopedic care for people with intellectual disabilities. Dr. Jablonski grew up in Central Florida and has enjoyed practicing in the area for more than 20 years.

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For these devastating conditions for which there are no known cures, we have a responsibility to mobilize every avenue for new therapies and research opportunities. Orlando Health is committed to participating in medical research as well as training and educating the next generation of neurologists. At the institute, we are expanding our research programs. Just one example is becoming a site for two national investigational studies for new multiple sclerosis therapies. These research protocols offer patients with many different neurological conditions treatment options outside what is conventionally available. New advances like this will further enhance care for an even broader range of patients throughout Central Florida and beyond.

Christian Rosado, MD, is a board-certified vascular neurologist and medical director of neurology with the Orlando Health Neuroscience Institute. Dr. Rosado works within a multidisciplinary team that includes specialists in neurology, neurosurgery, interventional pain management, rehabilitation and neuropsychology as well as neuroradiology, lung and sleep medicine, cardiology and oncology. This collaborative approach enables the institute to offer the most comprehensive, advanced treatment and management options to patients with neurological conditions. Dr. Rosado earned his medical degree from Indiana University in Indianapolis and completed all of his specialty training at the University of Florida in Gainesville, which included an internship in internal medicine followed by a neurology residency and a vascular neurology fellowship.