Date: Jul 15, 2014 Author: Doyle Murphy Source: New York Daily News (
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Death seemed preferable to surgery when Aleksandra Gelfand learned she had a bulging aneurysm.
"I say, ‘Never,'" Gelfand told the News. "I live 75 years. That's it."
A former school principal in northern Russia, Gelfand had recovered slowly and painfully from two hernia surgeries, and she wasn't about to go under the knife again.
Only her equally stubborn daughter, a doctor at Maimonides Medical Center in Brooklyn, could eventually persuade her to change her mind.
It didn't hurt that surgeons at the Borough Park hospital were pioneering new procedures to take the guesswork out of complicated operations.
Traditionally, Gelfand would be a tricky case.
The aneurysm, a bulbous mass ballooning to 6.7 centimeters at a weak spot in the aorta, was embedded in a twisted knot of blood vessels in her abdomen.
Advances in the past decade now allow surgeons to open a small hole near a patient's groin and thread a patch through the femoral artery to the needed area without the major cutting that was once common.
It's a minimally invasive method that eliminates a lot of pain and speeds recovery, but Gelfand's vessels were so twisted it would be a little like driving the switchbacks of a mountain road with no headlights.
"It's never really a sure thing until you get in there," said Dr. Robert Rhee, chief of vascular and endovascular surgery at Maimonides.
Rather than take the risk of discovering a complication in the middle of surgery, Rhee and Dr. Brian Gillett, who runs the hospital's training simulation lab, used Gelfand's CAT scan to make a 3-D digital model of the arteries Rhee would need to navigate.
Simulation technology is one of the new frontiers of the medical industry. Like pilots using flight simulators, doctors can hone their skills working through virtual operations on high-tech mannequins or video game-like computer programs.
Maimonides has a half-dozen simulated operation rooms on its third floor, equipped with space-age dummies and monitored by a central control room lined with eight video screens that show simulated surgeries from every angle.
Using an exact digital model of Gelfand's blood vessels, Rhee practiced the surgery on Gillett's simulator to confirm the operation would work.
"It gives you a road map," Gillett said. "It answers the question, ‘How can you prepare for challenges that are unforeseen?'"
Gelfand's daughter, Dr. Inna Gelfand, said it helped put the family at ease. "We felt much more comfortable that someone had performed the surgery on the same anatomy," she said.
The doctors believe it was the first time the procedure-specific method had been used in New York City for the operation.
Three days later, on Apr. 28, Rhee performed the surgery for real, using a thin wire to gently push a tiny Gore-Tex tube into the weakened aorta, where it fused to the tissue, rebuilding the vessel wall.
Gelfand spent the next couple days in the hospital and returned home. She had far less pain than either of her hernia surgeries, and her recovery has been rapid.
Gelfand was reasonably impressed by the process, but her daughter thinks the results have been absolutely stunning.
"It's a miracle," Inna Gelfand said.
