This past year, the steady hands of , helped make surgical history 鈥 guiding a high-tech robotic system to complete the
world鈥檚 first fully robotic lymphovenous bypass.
In some ways, that feat makes perfect sense considering the family tradition those
same hands share.
Dr. Panetta鈥檚 grandfather was a sculptor and wood carver whose art was recognized
in his local community. His father put his sure-handedness to work in multiple ways
鈥 as a lineman for General Telephone & Electronics after high school, carefully hanging
and repairing cables, and later as a self-taught home builder who constructed the
family鈥檚 first three houses.
鈥淲ithout a doubt, I grew up in a very hands-on environment,鈥 Panetta said with a smile.
Given that predisposition to craftsmanship, it鈥檚 no surprise that Panetta built a
career working at a scale measured in millimeters.
As chair of the USF Health Morsani College of Medicine Department of Plastic Surgery and chief of the , he is pushing the boundaries of microsurgery, advanced robotics and the treatment
of cancer-related lymphedema.
Guiding his work is that same combination of precision and manual dexterity, directed
toward restoring lymphatic flow and providing new hope for patients who historically
had limited options for treatment.
Nicholas J. Panetta, MD. (Photo by Freddie Coleman)
Finding solutions for lymphedema patients
Lymphedema is a swelling that develops from the build-up of lymph fluid in soft tissue, frequently affecting the arms or legs, caused by a damaged or blocked lymphatic system. The condition often occurs after cancer treatments such as lymph node removal or surgery, and in some cases, can result from a person鈥檚 genetics.
Patients with lymphedema find its effects difficult to escape: persistent swelling,
tightness and a feeling of heaviness in the arms and legs. Managing these symptoms
can quickly dominate a person鈥檚 life, as they often rely daily on compression garments,
specialized massage therapy and pumps to move accumulated fluid.
Historically, such treatments have focused only on managing the symptoms, rather than
fixing the underlying lymphatic problem, which worsens over time.
Early in his career, Panetta became convinced that more could be done for lymphedema
patients.
Having earned his medical degree from Indiana University in 2004, he completed a general
surgery residency at USF, and was the Hagey Fellow in Pediatric Regenerative Medicine
at Stanford University. But it was during additional training in plastic surgery and
microvascular and reconstructive surgery at the University of Pittsburgh that he began
to see the possibilities of lymphatic microsurgery.
Panetta already understood the magnitude of cancer-related lymphedema from his training
in general surgery. What struck him was the contrast between the tremendous progress
being made in treating cancer and the comparative deficit of reasonable solutions
for patients living with one of its lasting complications.
Too often, he said, patients and physicians alike seemed resigned to accepting lymphedema
as the price of survival, believing little could be done to fix the condition.
鈥淚 routinely heard patients saying, 鈥業 should just be happy to be alive鈥 or 鈥榣ymphedema is just something I鈥檒l have to deal with the rest of my life,鈥欌 Panetta recalled. 鈥淎nd I thought, this seems like an anatomic issue similar to other blood vessels, just on a smaller scale. We should be able to do better here.鈥
That determination to find better solutions led him to lymphatic microsurgery, a field
still in its infancy and ripe with potential.
鈥淭he first time I had any real exposure to lymphatic surgery was when I was at Pittsburgh
for plastic surgery and my microsurgery fellowship,鈥 Panetta said. 鈥淔aculty there
were just in the process of starting to think about how to address the clinical problem
of lymphedema. During fellowship I ended up doing several of the first microsurgical
cases in Pittsburgh. Nobody had a good understanding of how to best approach the problem
.鈥
Fast-forward to today, and Panetta is among only approximately 600 surgeons worldwide
doing performing lymphatic supermicrosurgery. He joined the USF Health Morsani College
of Medicine Department of Plastic Surgery in 2015. Since then, he has helped USF and
Tampa General Hospital become one of the nation鈥檚 leading destinations for innovative
microsurgery. His program is not only restoring quality of life for patients suffering
from lymphedema, but is also working to directly address the damaged pathways causing
it.
鈥淲e are pushing the limits of microsurgery,鈥 he said. 鈥淲hat we鈥檙e really doing is
applying the core principles of fluid dynamics, physics and anatomy, and then saying,
鈥榃e鈥檙e just going to try to do this at a smaller and smaller scale, early in the disease
process when we can make the biggest difference for patients, to tackle these really
challenging issues.鈥欌
Precision beyond the human hand
In the cutting-edge world of microsurgery, Panetta believes that robotics represents
the next frontier of surgical innovation.
Microsurgeons routinely work with extraordinarily small blood vessels and lymphatic
channels. In lymphedema surgery, some of the structures that Panetta operates on measure
less than a millimeter across. Robotics technology allows him to maneuver with levels
of precision previously unimaginable.
鈥淩obotics will define the future of microsurgery, especially in lymphedema work where
sub-millimeter precision is essential,鈥 he said.
鈥淩obotics will define the future of microsurgery, especially in lymphedema work where sub-millimeter precision is essential."
Dr. Nicholas J. Panetta
Stopping lymphedema before it starts
Panetta鈥檚 ultimate goal is not simply to treat lymphedema more effectively after it develops, but to identify patients at risk and intervene early enough to keep the condition from occurring in the first place.
鈥淲e鈥檝e made really big strides on preventing this from happening altogether,鈥 he said. 鈥淚t is still very early in the game, and we're learning a lot all the time. As imaging continues to improve and collaborations with industry continue to improve technology, I think things are only going to continue to get better.鈥
He points to the use of preventative lymphatic surgery 鈥 a procedure known as immediate lymphatic reconstruction. A substantial body of evidence, he says, now exists indicating that surgical interventions designed to preserve or restore lymphatic drainage can substantially reduce a patient鈥檚 risk of developing lymphedema.
With continued advances in imaging, lymphatic research and precise surgical tools,
physicians are gaining the ability to operate on structures that once seemed unimaginably
small.
That鈥檚 changing what surgeons like Panetta believe is possible.
鈥淚 believe the possibility is out there, if you catch patients with disease early
enough, where we can really cure this disease. We're kind of on the precipice of being
able to reliably offer that hope to patients, and that's amazing progress.鈥