Less pain, more gain. Exploring ‘Without a Scalpel Day’ with Dr. Roberto Iezzi

Less pain, more gain. Exploring ‘Without a Scalpel Day’ with Dr. Roberto Iezzi

Beyond diagnostic medical imaging, Guerbet accelerates its expansion in the interventional radiology field. We aim to provide interventional medical community with innovative image-guided solutions to help physicians advance their patients treatments and outcomes.

National Without a Scalpel Day is celebrated on January 16th each year, recognizes the opportunities to treat disease without a scalpel. On this day in 1964, pioneering physician Charles Dotter performed the first angioplasty. No surgery, no stitches, no scars…

To honour this day, we interviewed Dr. Roberto Iezzi who is an Interventional Radiologist in Policlinico A. Gemelli - Catholic University - Rome, Italy. Dr. Iezzi is a Member of the Italian Society of Radiology (SIRM), European Society of Radiology (ESR), and Cardiovascular and Interventional Radiological Society of Europe (CIRSE).

What is your primary message to the audience about the significance of National ‘Without a Scalpel Day’?

The public needs to be educated about minimally invasive image-guided procedures. Why are invasive diagnostic procedures centerstage when there are other options yielding similarly positive or potentially better health outcomes for patients? Patients should be empowered to “make informed decisions” and “educated about all treatment options”, especially beneficial alternatives to surgery and invasive diagnostics. Empowering the patient as both a consumer of healthcare, ability to exercise agency over their own bodies, and ability to consider their post-operative recovery in the choice to move forward with selected procedures is invaluable. ‘Without a Scalpel Day’. Internationally held on January 16, creates a culture of advocacy to spread this message by clinicians and patients alike.

What can you treat with Interventional Radiology these days? Interventional Radiology (IR) and technology are intertwined, with rapid technological innovation IR leading to new interventions being introduced into clinical practice. Technology helps us make the procedure and allows procedures to be less invasive; most of them via only moderate sedation and/or small hole (incision) without a scalpel.  This allows the patient to return to normal activities sooner while promising more efficient procedures.

Doctors can now treat a broad range of diseases in both standard clinical settings and even emergency medicine for trauma patients through IR. This includes being able to enter the vascular system using not just traditional femoral arterial access, but via radial and jugular, transabdominal arterial access, and others. Moreover, minimally invasive IR can be used to treat benign diseases such as benign prostatic hyperplasia (prostate enlargement) with these new procedures becoming available for cancer patients. Interventional Oncology represents the fourth pillar in the curative and palliative treatment & management of cancer patients together with (i) surgery, (ii) chemotherapy, (iii) radiotherapy, and even pain management (including procedures like abnormalities, vertebral ablation, facet denervation, and others etc.)- all using radiofrequencies to treat pain.

What’s the evolution and future of IR? Technology will be the key for harnessing more efficient and less invasive procedures moving forward. In the future, devices will be even smaller to ensure procedural efficiency, act as a vehicle for chemotherapy drugs, and offer true alternatives to surgery not only for well-established diseases & acute care, but also for the general management of patients. This means IR needs to be a real and solidified dimension of surgical discussions in Multidisciplinary Tumor Boards to help empower patients when considering their treatment course.

What is non-target embolization and when this issue can occur? Interventional Oncology and chemoembolization acting as a carrier for chemotherapy drugs includes risks; e.g how can we administer the maximum dosage of chemotherapy drugs into the tumor or embolic structures (structures that cause blocks in blood vessels) using non-target embolization. There is sometimes worry using embolic devices to administer such a high dosage of chemotherapy drugs, potentially increasing the risk of oxygen/pathogen deficiency & ischaemia (poor blood supply to essential organs) in both the diseased and healthy parts of the organ(s) in focus. Drugs need to be injected into the exact vascular and only the unhealthy portion of the organ(s) in focus while ensuring consistent blood flow.

Interventional Oncology and chemoembolization acting as a carrier for chemotherapy drugs includes risks. Non target embolization is one of the recognized complications when injecting chemotherapy drugs embolic materials or devices into the tumor, increasing intra/post-procedural complication rate and significantly changing management of treated patients. On the other hand, being scared of it, one could avoid to administer an high and complete dosage of chemotherapy drugs, potentially reducing procedural efficacy. As a matter of fact, a controlled reduction on non-target embolization could help us in improving both safety and efficacy of intra-arterial procedures.

What is your primary message to the public on this special day? The future is personalized medicine, but education of patients and clinicians is the missing link for patients to understand their options while accessing medical services. Without this essential piece, the innovative breakthroughs made in IR will not reach their full potential and population benefit. ‘Without a Scalpel Day’ represents the clinician led initiative to empower patients to exercise control over their treatment decisions while honoring the medical technologies of tomorrow.