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September 20, 2021  

Dr. Craig L. Levitz

Dr. Craig L. Levitz: Improving the Technology of Shoulder Surgery

August 14, 2002

A graduate of Cornell University and the University of Pennsylvania School of Medicine, Dr. Levitz had the honor of refining his surgical skills as a fellow under Dr. James Andrews and Dr. William Clancy at the American Sports Medicine Institute in Birmingham, Alabama. Dr. Levitz is currently the Director of the Knee & Shoulder Center at Orlin-Cohen Orthopaedic Associates in Rockville Centre, New York and is the Director of the South Nassau Center for Cartilage Repair. He works closely with Smith & Nephew Endoscopy in developing new technologies for orthopedic surgery.

Shoulder1: You are working on some great new shoulder products with Smith and Nephew Endoscopy.
Dr. Levitz: They have several new devices that are set to hit the market within the next week or so. They are already FDA approved its more of just getting them out there. One is the ElectroBlade, which is as a new instrument that really allows bloodless shoulder surgery. In the past, we have had instruments that actually coagulate blood vessels while we are doing the surgery, but you have to stop the surgery remove the instrument you are using input in some type of coagulating device and coagulate it. Now we have rigged it all into one instrument so that while you are going along doing the surgery, it automatically coagulates all the bleeders. We found that basically when you do this surgery, it is pretty much bloodless and what that does is speeds things along. It shortens the surgical time. Most pain is due to the shoulder filling with blood and fluid, so (shorter surgical time) decreases post-operative pain and allows you to accomplish many more of these procedures in a closed manner rather than an open manner.

Shoulder1: How do you see technology like the ElectroBlade really improving not just surgery itself but the patient's recovery?
Dr. Levitz: I think that technology in time will allow us to do surgeries without any bleeding both during the surgery but, more importantly, after surgery. If you can eliminate post-operative bleeding, that will have a dramatic affect on decreasing pain, which a lot of studies have now shown that pain is related to the time of surgery. An hour-and-a-half procedure, no matter what you do, hurts more than a 20-minute procedure. Because even if you're sleeping or are anesthetized, studies have shown that our body still senses that pain; we still have a response to it afterwards. If you could eliminate the pain both during surgery and after surgery, by a eliminating the bleeding component of it, you eventually will have a quicker recovery and a less painful recovery.

Shoulder1: Can the ElectroBlade be used for other types of surgery or just for shoulders?
Dr. Levitz: It can be used in other areas of the body. We have been trying to perfect it first initially for the shoulder. But it can be used just about everywhere. It's really a utility tool. All types of shoulder surgery we use microscopic devices that kind of remove tissue or shave tissue. All this is is one of those removers or shavers that now has the ability to prevent bleeding as it goes along.

Shoulder1: Is this a tool that a patient is going to ask for or is it just going to become standard in operating rooms?
Dr. Levitz: Physicians that embrace it will just do it. It's not something that you really would ask about. I think initially though a lot of physicians kind of do things the way they have been doing them for 10 years, and they are slow to increase in new technologies and use a new instrument. If they don't do a lot of shoulder surgeries … it's hard to get a feel of these things using them once a week or once a month as opposed to using them everyday.

Shoulder1: What other new devices have you been helping with?
Dr. Levitz: (Smith & Nephew Endoscopy has) a new bioabsorbable anchor. We have been using suture anchors for arthroscopic rotator cuff repairs for several years now. However, this new development uses a completely bioabsorbable model. Basically the anchor is completely absorbed after it's been in the shoulder for a period of time. What that allows us to do is we don't have to worry about the anchor becoming loose six months to a year down the road. We don't have to worry about any metal in the shoulder. Metal generally migrates in the shoulder. To have a bioabsorbable constrict basically means of there really is no record that we have been there. They don't have any foreign bodies in there shoulder. They don't have any chance for infection that a mental foreign body can cause. They don't have to worry if it dislodges it would start beating up their shoulder because it would just absorb. I only use absorbable anchors in the shoulder; don't put any metal in the shoulder. And their anchor is a specially designed anchor that it really makes it easier to perform arthroscopic rotator cuff repairs.

Over the next six months to a year, there basically should be no need for an experienced shoulder surgeon to perform can open rotator cuff repair. With the new devices that should hit the market in the next six months, 99.9% of rotator cuff repairs will be able to be done through the camera, as well as Bankart repairs and instability repairs. I haven't opened a shoulder personally in three years. And I think the newer technology that helps me will help the non-shoulder specialist even more because it makes all of these steps a lot easier.

Shoulder1: Your were fortunate to earn a fellowship at the American Sports Medicine Institute under the direction of renowned orthopedic surgeon Dr. James Andrews. How would you describe that experience?
Dr. Levitz: I think you have to start with the whole concept of being a team of physician in the year 2002. Unfortunately, the concept that the professional teams will get the best doctor around to care for their teams has fallen by the wayside. It's now a corporate sponsorship deal. Who is going to pay the most for the right to be called a team physician? As a result of that these high-profile players have sought out treatment by other team physicians by someone who in their opinion is the best in sports medicine in their area or the country. And by all means, Jim Andrews is a league above everybody else. He pioneered shoulder arthroscopy and did the earliest shoulder arthroscopies and ACL reconstructions. Based on his tremendous volume and his experience, he really became the number one expert in this area. And to train under him is an incredible experience. There are fellowships all over the country but there is none quite like his.

Between him and Dr. William Clancy, they perform on the upside of 3000 cases a year. You have a hands-on experience where, in your first week there, you will do more complicated shoulder procedures and knee procedures than most surgeons will do in a year. And it's an independent operative experience. You're not just watching; you are involved in all the aspects of the care from the initial evaluation up to the surgery itself of under the guise one of the best. (Dr. Andrews) is able not only to guide you in doing the surgery, but if you have any problems during the surgery he teaches you all the techniques and all of his wisdom of getting out of those problems. The difference between a good doctor and a bad doctor is not the ability to perform a surgery; it's the ability to get out of trouble. When we're dealing with the human body … it is inevitable that you're going to run into unexpected problems in surgery: a lesion that shouldn't be there, a tear that is worse than the MRI has shown, poor tissue to quality, bleeding. The difference between the good guy with the training that (Dr.) Andrews (provides) verses the average guy … is the ability to deal with all those problems and have the end result be just as though none of those problems existed.

I think the common thing that you will find between all of his fellows is a very calm, cool demeanor in surgery. They never lose their edge; they never lose their composure. No matter what happens, they are very calm because they have seen this problem before, and they can handle it. It really gives you a tremendous amount of confidence when you go out into practice. I think most of us our operative skills are actually enormously better a year after we leave the fellowship than actually in the fellowship. Because not only does he teach you all the things he knows, he gives you the building blocks to be able to expand your own skills, and that's a valuable thing. During my fellowship with him he wasn't doing arthroscopic rotator cuff repairs yet, (but) he taught us all the necessary skills to be able to advance to that next level. When the instruments came along, most of us advanced to that next level very rapidly. It really is a unique experience.

Shoulder1: We hear a lot about cartilage repair in knee. Is there something similar to that being done in the shoulder?
Dr. Levitz: Yes and no. The shoulder is subject to this same cartilage loss that we see in the knee. The problem is access to the shoulder to do cartilage transplantation is much more difficult. However, the shoulder has a great advantage in that it's a non-weight bearing joint, so certain techniques like abrasion arthroplasty, which is where you stimulate the bone to bleed and form a scar cartilage, actually work very well in the shoulder. It would nice to eventually do like a Carticel or osteochondral grafting in the shoulder. Once again though, because of the access to the shoulder, at the current state of the art, it's probably more trouble than it's worth. We probably have to wait for arthroscopic Carticel in order to be able to do it in the shoulder. It is very deep in there. There is not space … you have actually dislocate the shoulder in order to do that, which you wonder whether you're doing a patient more good than bad. Also, the shoulder is a lot more forgiving than the knee. The knee you have to walk on everyday, so if you have a cartilage defect, you're going to need to get it fixed. The shoulder in get by with cartilage defects because you are not bearing weight.

In the next couple of years hopefully we will develop even better arthroscopic techniques that will allow us to dramatically repair the shoulder in such a way that early activity can be done a week or two after shoulder surgery. As opposed to even when we do it arthroscopic (surgery) now, it's a good one or two months before they're back to doing their activities. It would be nice to get constructs that are strong enough that we can get back to their activities in a week or two. So I think we're really going to dramatically cut down of the rehab time and almost eliminate the need for open shoulder surgery.

Last updated: 14-Aug-02

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