Houston cardiac surgeon outpaces much of the country in game-changing robotics

matters of the heart

Dr. Kenneth Liao, chief of cardiothoracic transplantation and mechanical circulatory support at Baylor St. Luke's Medical Center, is one of around 50 surgeons in the country considered experts of this new surgery robotics tool. Photo courtesy of Baylor St. Luke's

Dr. Kenneth Liao is pioneering a less invasive form of heart surgery at a time when distanced medicine has become more important than ever with the help of six team members and one robot.

As the chief of cardiothoracic transplantation and mechanical circulatory support at Baylor St. Luke's Medical Center, Liao has performed 116 robotic cardiac surgeries since coming on board in 2019 (as of press time). With Liao at the helm, Baylor St. Luke's has become a top cardiac robotics program in the country and is the only hospital in Houston to practice this highly-specialized form of surgery.

Liao's four-armed robot friend is known as the da Vinci robotic system and was first designed to assist in battlefield procedures. Now on its fourth generation, the robot allows surgeons like Liao to treat heart diseases and conditions that typically would require open heart surgery through a one-to-two inch incision near the ribs. In many surgeries, it also allows surgeons to keep a patient's heart beating, lowering the risk of stroke.

"It's a totally game changing component to conventional surgery," Liao says, who's one of about 50 surgeons in the country with his level of command over the tool.

Once inside, the da Vinci robot uses tiny instruments to perform surgical practices from suturing to cutting to tying a knot all within the rigid chest cage, which in a typical open heart surgery would have to be broken to perform such tasks.

The surgeon, who's seated about 10 feet away from the patient, controls the tools through a joystick connected to a computer console that shows an enhanced 3D view of the patient's chest. Liao says the screen provides a better visual of the heart than if he was seeing it with his own eyes, as it magnifies the field of surgery tenfold. This method also gives surgeons a better view of areas of the heart that they cannot easily see from above during traditional procedures.

The da Vinci can be used for bypass, grafting, pacemaker, and valve repair surgeries, and it has been proven to result in less blood loss and a faster, less painful recovery. Similar technology has also been adopted for prostate and gynecological surgeries. "It gives you the advantage of minimizing the trauma," Liao says.

And though the da Vinci was developed years before the pandemic, it puts patients at a lower risk of exposure to any outside contaminants, Liao adds, as the robot alone is interfacing with the patient through a small port, compared to doctors, nurses, and assistants hovering over an open chest cavity.

"Technology will theoretically reduce a patient's exposure to COVID in the operation room," he says. "I think that's common sense."

Liao was an early adopter of robotics, when the technology was much less user friendly. He performed the first robotic heart surgery in the state of Minnesota in 2003 and has worked with the developers of the da Vinci ever since to help improve the product after many other surgeons dismissed it.

He says today there is a renewed interest in the highly technical process and he believes it will become an emphasis for younger surgeons.

"This generation of surgeons are young and they are very indebted to computer technology and games. For them looking at screens and controlling the hand joystick control is much more familiar than for the older generation that was trained 20 years ago." he says.

The incredible technology helps, too. "A lot of times, as surgeons, we train in the old way. It's very difficult to change the systems," he says. "You need a major technology revolution to change the teaching and training."
Ad Placement 300x100
Ad Placement 300x600

CultureMap Emails are Awesome

Property Showcase

Here are 3 breakthrough innovations coming out of research at Houston institutions

Research Roundup

Research, perhaps now more than ever, is crucial to expanding and growing innovation in Houston — and it's happening across the city right under our noses.

In InnovationMap's latest roundup of research projects, we look into studies on robotics advancing stroke patient rehabilitation, the future of opioid-free surgery, and a breakthrough in recycling plastics.

The University of Houston's research on enhancing stroke rehabilitation

A clinical trial from a team at UH found that stroke survivors gained clinically significant arm movement and control by using an external robotic device powered by the patients' own brains. Image via UH.edu

A researcher at the University of Houston has seen positive results on using his robotics on stroke survivors for rehabilitation. Jose Luis Contreras-Vidal, director of UH's Non-Invasive Brain Machine Interface Systems Laboratory, recently published the results of the clinical trial in the journal NeuroImage: Clinical.

The testing proved that most patients retained the benefits for at least two months after the therapy sessions ended, according to a press release from UH, and suggested even more potential in the long term. The study equipped stroke survivors who have limited movement in one arm with a computer program that captures brain activity to determine the subject's intentions and then works with a robotic device affixed to the affected arm, to move in response to those intentions.

"This is a novel way to measure what is going on in the brain in response to therapeutic intervention," says Dr. Gerard Francisco, professor and chair of physical medicine and rehabilitation at McGovern Medical School at The University of Texas Health Science Center at Houston and co-principal investigator, in the release.

"This study suggested that certain types of intervention, in this case using the upper robot, can trigger certain parts of brain to develop the intention to move," he continues. "In the future, this means we can augment existing therapy programs by paying more attention to the importance of engaging certain parts of the brain that can magnify the response to therapy."

The trial was funded by the National Institute of Neurological Disorders and Stroke and Mission Connect, part of the TIRR Foundation. Contreras-Vidal is working on a longer term project with a National Science Foundation grant in order to design a low-cost system that would allow people to continue the treatments at home.

"If we are able to send them home with a device, they can use it for life," he says in the release.

Baylor College of Medicine's work toward opioid-free surgery

A local doctor is focused on opioid-free options. Photo via Getty Images

In light of a national opioid crisis and more and more data demonstrating the negative effects of the drugs, a Baylor College of Medicine orthopedic surgeon has been working to offer opioid-free surgery recovery to his patients.

"Thanks to a number of refinements, we are now able to perform hip and knee replacements, ranging from straightforward to very complex cases, without patients requiring a single opioid pill," says Dr. Mohamad Halawi, associate professor and chief quality officer in the Joseph Barnhart Department of Orthopedic Surgery, in a press release.

"Pain is one of patients' greatest fears when undergoing surgery, understandably so," Halawi continues. "Today, most patients wake up from surgery very comfortable. Gone are the days of trying to catch up with severe pain. It was a vicious cycle with patients paying the price in terms of longer hospitalization, slower recovery and myriad adverse events."

Halawi explains that his work focuses on preventative measures ahead of pain occurring as well as cutting out opioids before surgery.

"Opioid-free surgery is the way of the future, and it has become a standard of care in my practice," he says. "The ability to provide safer and faster recovery to all patients regardless of their surgical complexity is gratifying. I want to make sure that pain is one less thing for patients to worry about during their recovery."

Rice University's breakthrough on recycling plastics

A team of scientists have found a use for a material that comes out of plastics recycling.

Houston scientists has found a new use for an otherwise useless byproduct that comes from recycling plastics. Rice University chemist James Tour has discovered that turbostratic graphene flakes can be produced from pyrolyzed plastic ash, and those flakes can then be added to other substances like films of polyvinyl alcohol that better resist water in packaging and cement paste and concrete, as well as strengthen the material.

"This work enhances the circular economy for plastics," Tour says in a press release. "So much plastic waste is subject to pyrolysis in an effort to convert it back to monomers and oils. The monomers are used in repolymerization to make new plastics, and the oils are used in a variety of other applications. But there is always a remaining 10% to 20% ash that's valueless and is generally sent to landfills.

Tour's research has appeared in the journal Carbon. The co-authors of the study include Rice graduate students Jacob Beckham, Weiyin Chen and Prabhas Hundi and postdoctoral researcher Duy Xuan Luong, and Shivaranjan Raghuraman and Rouzbeh Shahsavari of C-Crete Technologies. The National Science Foundation, the Air Force Office of Scientific Research and the Department of Energy supported the research.

"Recyclers do not turn large profits due to cheap oil prices, so only about 15% of all plastic gets recycled," said Rice graduate student Kevin Wyss, lead author of the study. "I wanted to combat both of these problems."

Houston biotech startup raises millions to battle pediatric cancer

fresh funds

Allterum Therapeutics Inc. has built a healthy launchpad for clinical trials of an immunotherapy being developed to fight a rare form of pediatric cancer.

The Houston startup recently collected $1.8 million in seed funding through an investor group associated with Houston-based Fannin Innovation Studio, which focuses on commercializing biotech and medtech discoveries. Allterum has also brought aboard pediatric oncologist Dr. Philip Breitfeld as its chief medical officer. And the startup, a Fannin spinout, has received a $2.9 million grant from the Cancer Prevention Research Institute of Texas.

The funding and Breitfeld's expertise will help Allterum prepare for clinical trials of 4A10, a monoclonal antibody therapy for treatment of cancers that "express" the interleukin-7 receptor (IL7R) gene. These cancers include pediatric acute lymphoblastic leukemia (ALL) and some solid-tumor diseases. The U.S. Food and Drug Administration (FDA) has granted "orphan drug" and "rare pediatric disease" designations to Allterum's monoclonal antibody therapy.

If the phrase "monoclonal antibody therapy" sounds familiar, that's because the FDA has authorized emergency use of this therapy for treatment of COVID-19. In early January, the National Institute of Allergy and Infectious Diseases announced the start of a large-scale clinical trial to evaluate monoclonal antibody therapy for treatment of mild and moderate cases of COVID-19.

Fannin Innovation Studio holds exclusive licensing for Allterum's antibody therapy, developed at the National Cancer Institute. Aside from the cancer institute, Allterum's partners in advancing this technology include the Therapeutic Alliance for Children's Leukemia, Baylor College of Medicine, Texas Children's Hospital, Children's Oncology Group, and Leukemia & Lymphoma Society.

Although many pediatric patients with ALL respond well to standard chemotherapy, some patients continue to grapple with the disease. In particular, patients whose T-cell ALL has returned don't have effective standard therapies available to them. Similarly, patients with one type of B-cell ALL may not benefit from current therapies. Allterum's antibody therapy is designed to effectively treat those patients.

Later this year, Allterum plans to seek FDA approval to proceed with concurrent first- and second-phase clinical trials for its immunotherapy, says Dr. Atul Varadhachary, managing partner of Fannin Innovation Studio, and president and CEO of Allterum. The cash Allterum has on hand now will go toward pretrial work. That will include the manufacturing of the antibody therapy by Japan's Fujifilm Diosynth Biotechnologies, which operates a facility in College Station.

"The process of making a monoclonal antibody ready to give to patients is actually quite expensive," says Varadhachary, adding that Allterum will need to raise more money to carry out the clinical trials.

The global market for monoclonal antibody therapies is projected to exceed $350 billion by 2027, Fortune Business Insight says. The continued growth of these products "is expected to be a major driver of overall biopharmaceutical product sales," according to a review published last year in the Journal of Biomedical Science.

One benefit of these antibody therapies, delivered through IV-delivered infusions, is that they tend to cause fewer side effects than chemotherapy drugs, the American Cancer Society says.

"Monoclonal antibodies are laboratory-produced molecules engineered to serve as substitute antibodies that can restore, enhance or mimic the immune system's attack on cancer cells. They are designed to bind to antigens that are generally more numerous on the surface of cancer cells than healthy cells," the Mayo Clinic says.

Varadhachary says that unlike chemotherapy, monoclonal antibody therapy takes aim at specific targets. Therefore, monoclonal antibody therapy typically doesn't broadly harm healthy cells the way chemotherapy does.

Allterum's clinical trials initially will involve children with ALL, he says, but eventually will pivot to children and adults with other kinds of cancer. Varadhachary believes the initial trials may be the first cancer therapy trials to ever start with children.

"Our collaborators are excited about that because, more often than not, the cancer drugs for children are ones that were first developed for adults and then you extend them to children," he says. "We're quite pleased to be able to do something that's going to be important to children."

Houston expert calls for more innovation within the construction industry

guest column

The construction industry has the opportunity to drive positive change through the development and deployment of technologies influencing the way we work and live, ultimately affecting our environment, communities, and personal well-being.

Carbon emissions come from a handful of broad categories, including transportation, electricity production, and industry. According to the International Energy Agency, more than a third of all global greenhouse gases come from the building and construction industry. Concrete production alone contributes an estimated 8 percent of global carbon emissions. As a result, in Houston, we are vulnerable to longer, hotter summers, stronger hurricanes and once-in-a-lifetime storms. But I'm optimistic that there is opportunity for our industry to come together and reverse the current trajectory.

We must continue developing and deploying new technologies and best practices to reduce emissions. By using data to understand the environmental implications of the materials we use, we can make adjustments that are beneficial to both our clients and the environment.

One such example is the Embodied Carbon in Construction Calculator, known as "EC3." Skanska USA developed the open-source, freely available software in collaboration with Microsoft and C Change Labs. The tool democratizes important building data and allows the construction industry to calculate and evaluate carbon emissions associated with various building materials.

Now hosted and managed by Building Transparency, a new 501c3 organization, the EC3 tool was incubated at the Carbon Leadership Forum with input from nearly 50 industry partners. Like the tech industry, we should promote knowledge-sharing among general contractors to drive innovation and sustainability.

The demand for this tool is growing because it's not only the right thing to do, but it also benefits our communities and drives stakeholder value. Now more than ever, clients want to be responsible global citizens and they know that adopting green building practices is attractive to their prospective workforce and their clients and customers.

In Houston, the current population of 7.1 million will double to 14.2 million by 2050. With that population growth comes the need for more housing, more office space and more transportation options. Last April, Houston enacted a climate action plan that sets goals aligned with those from the Paris accord — carbon neutrality by 2050.

Similar local plans have been and are continually being developed all around the world, a necessary step to address a global issue that impacts all of us. Like others, the Houston plan contemplates how to reduce carbon emissions that are the result of energy consumption which accounts for about half of Houston's greenhouse-gas emissions.

Innovations in energy efficiency can help drive down energy consumption. As conscientious global and local citizens, we also have to consider the emissions that are created by the raw materials that are used in construction. That's become a much easier process with the EC3 tool. Now architects, engineers and others involved in the design process can make data-driven decisions that can have significant impact on the carbon footprint — as much as a 30 percent reduction in embodied carbon — of a structure that are mostly cost-neutral.

Embodied-carbon reductions can be made simply by smartly using data. The EC3 tool is one of many steps toward innovative building practices and complements the important ongoing work done by the U.S. Green Building Council, which oversees LEED certification.

Opting for sustainable building practices is good for the environment, but it's also good for the people who will spend time in these spaces. Green building reduces the use of toxic materials, and studies have found that sustainable structures, such as schools, health care facilities and airports, have positive impacts on cognitive ability, seasonal affective disorder and overall happiness.

We are also seeing an influx of client requests for sustainable and healthy building upgrades, especially since the onset of COVID-19. These upgrades are changing the way we live and work while supporting infection control, from touchless elevators to advanced air filtration systems.

For example, innovation has been instrumental throughout the pandemic for the aviation industry's safe operation. Increased biometrics across airport touchpoints, flexible passenger gathering areas that include modifications to passenger hold rooms and departure lounges, and environmental monitoring and wayfinding technology to alert passengers of airport congestion points are a few new concepts airports are incorporating into builds to keep travelers healthy now and in a post-COVID world.

Overall, the construction sector will play an essential role in how we approach expanding the built environment over the next 30 years. Using data and striving for continual innovation, we have a great opportunity to come together as an industry and create real change that will benefit our collective lives and those of generations to come.

-----
Dennis Yung is executive vice president and general manager at Skanska, one of the world's leading project development and construction groups, where he oversees building operations for Houston and North Texas.
View All Listings