Robotics, artificial intelligence, less invasive procedures lead way at Region’s health systems

Taking biopsies of nearly inaccessible lung tumors is now as easy as mastering a joystick, said Dr. Marvi Bikak, a pulmonologist for Northwest Health-La Porte.

She uses a robotic-assisted bronchoscopy system to perform minimally invasive lung biopsies, allowing for early detection of potential cancer without the need for open surgery.

“You drive a catheter into the trachea with a joystick. We use navigational technology, a machine learning algorithm and real-time imaging to find the abnormal spots and you biopsy them,” Bikak said.

“Before, it would be done blindly, relying on your luck whether you were in the right spot or not.”

Because the success rate could be low, doctors frequently had to wait and rescan the chest to look for other signs of cancer, which required more radical surgery.

“The surgeon would just chop out that part of the lung, so people are being subjected to a lot more risk,” she said.

One older procedure, inserting needles through the chest wall, could cause a partially collapsed lung. While the older procedures aren’t yet obsolete, she and other area medical professionals are opting for the speedier and more delicate technology.

Dr. Janet Seabrook, CEO of Community HealthNet and Gary’s first female health commissioner, agrees that new technology is making health treatments faster, safer and more cost-effective.

“Insurance companies obviously like getting patients out of the hospital faster, with fewer complications and readmissions seen in manual surgery,” she said. “Hospitals like that too. It makes room for other patients.”

More health systems are offering the latest technologies.

“About 15 years ago, these robotics procedures were available, but there were very few on the market, and they were so pricey that only a few early adopter hospitals acquired them, while everyone waited on the feedback,” Seabrook said.

Time is now for many of these new procedures, she said.

“The benefits do outweigh the risks,” Seabrook said. “You need fewer staff in the surgery trying to retract or push organs away while the principal surgeon tries to do the procedure itself.

“Over time, local health systems have started to use more of them, more come on market, costs have come down, and others have become willing to pay for them.”

Dr. Samer Abbas, director of cardiovascular services at the Cardiac Catheterization Lab at Powers Health in Munster, said they also offer another perk.

“These new procedures attract patients to Northwest Indiana, so they don’t have to travel to Chicago or Indianapolis,” Abbas said.

Same-day service

Abbas said the hospital recently completed its 500th Watchman implant, a technique that corrects a heart defect that can cause blood clots, leading to a major stroke.

“The only way to do it in the past was riskier,” he said. “Now the Watchman plugs it in about an hour. The patient goes home the same day.”

Moving down the anatomy, Dr. Vivek Mishra, interventional radiologist, said Northwest Health — Porter’s Prostate (Magnetic Resonance Imaging) MRI gives surgeons a more accurate look at whether a prostate gland is cancerous and whether the cancer is spreading.

“The MRI only takes a half hour and doesn’t involve any invasive penetrations,” he said.

Northwest Health — Porter recently opened a $5.85 million hybrid catheterization laboratory, an operating room that accommodates minimally invasive cardiac procedures and major open-heart surgery.

Powers Health is in the midst of installing an advanced, state-of-the-art laboratory system at Community Hospital, St. Catherine Hospital and St. Mary Medical Center that reduces time to analyze and process tests.

Another state-of-the-art therapy, Yttrium-90 radioembolization, is used to treat liver tumors too large for surgery. Dr. Carl Valentin, an interventional radiologist at Franciscan Health Munster, offers the procedure.

“We put small catheters into blood vessels that feed the liver, and inject tiny, microscopic glass beads impregnated with Yttrium,” a short-lived radioactive isotope that irradiates and shrinks a tumor.

Valentin said Y-90 replaces previous procedures approaches, like blocking the tumors’ blood supply or dousing tumors with chemotherapy, which had limited success.

“The injection of radioactive particles has brought the therapy to a higher level. You get precision, efficacy and low risk of side effects,” he said, adding it can be done on a same-day, outpatient basis.

Hospital modernizations, robotics and the introduction of new minimally invasive surgeries cause less blood loss, scarring, pain and reduce the risk of post-operative infection in the hospital, said Indiana University Professor Kun Huang, chair of biostatistics and health data science.

“It’s amazing,” he said.

Living longer, better

Physicians say competition in the Northwest Indiana health care market and the demand for better patient outcomes drives innovation.

Deanna Frank, 74, of Crown Point refused to give in to her severe aortic valve stenosis, a debilitating disease that can cause sudden death.

She first felt symptoms about five years ago when her weakened heart left her breathless after a 50-foot walk across her house.

Initially, she was told she had to wait for valve replacement surgery because her symptoms weren’t bad enough yet.

“Life was miserable. I was ready to throw in the towel,” she said. “Out of desperation, I went back to cardiac care and said if you can’t do something for me, I’m not coming back.”

She was referred to Dr. J. Michael Tuchek, a veteran cardiothoracic surgeon, at Franciscan Crown Point. Tuchek recognized her plight, having dealt with many who weren’t considered candidates for traditional open-heart surgery.

“Some 60 percent of those who have severe aortic stenosis do not want to go through such a big surgery. They are just going home and dying. But, if I can give them the chance to live to 94, they may say ‘yes’ to it,” he said.

He recommended Frank undergo a transcatheter aortic valve replacement (TAVR), a procedure he helped pioneer in 2011. U.S. Food and Drug Administration trials have proven TAVR’s effectiveness and safety.

“I started that program in Crown Point because I grew up here. I’m a Region Rat,” Dr. Tuchek said.

Frank said she became the first patient at Franciscan Crown Point to receive TAVR last year.

Instead of cutting open the rib cage to directly access the faulty heart valve, the TAVR surgeon inserts a thin, flexible tube, called a catheter, into a small incision in the groin and threads it up a major blood vessel to the heart, where the compressed replacement valve can be attached over the faulty valve.

“The morning after surgery, I told my husband, ‘I can breathe!’” Frank said. “A nurse invited me to walk down the hallway. We walked over 750 feet without stopping. I could have walked another 750 feet.”

She hasn’t stopped since.

“I got out of the hospital the next day, and since then, I haven’t slowed down,” Frank said.

She said she later met a woman who had a valve installed through her chest and spent nearly a month in the hospital because of complications from pneumonia.

Novel remedies but at a cost

Dr. Tuchek said TAVR is more expensive than many open-heart surgeries.

“The (valve) right out of the box, is around $35,000,” he said.

Dr. Sandeep Sehgal, a cardiologist for Northwest Health — Porter, said the minimally-invasive TAVR can be considered a bargain when compared to traditional open-heart surgery.

“In the long run, you are saving,” Sehgal said. “You have a one-night stay for TAVR instead of four to five nights and you have to account for the cost of ICU and staff.”

He said Northwest Health has performed more than 1,200 TAVR and Watchman implants.

“The Watchman gets many people off blood thinners. That is a cost benefit because elderly people on blood thinners can fall and that will trigger a hospitalization, which could cost thousands of dollars. It’s a one-time thing to put in a Watchman.”

Dr. Abbas said Powers Health recently celebrated their 1,000th procedure.

“For anybody older than 65, TAVR is quickly becoming the gold standard.”

“We do mitral valve repair and perform bicuspid valve replacement,” he said. “Also, there is a new valve treatment technology coming to the market here (in 2025), because we were part of the research for it.”

Atrial fibrillation, an irregular heart beat causing chest pains and threatening heart failure, was once difficult to treat surgically, Dr. Siddarth Kakodkar, a clinical cardio electrophysiologist for Methodist Hospitals said.

Decades ago, researchers first developed a technique to thread a catheter through a blood vessel into the heart and burn or freeze abnormal nerves interfering with the heart’s normal rhythm.

Kakodkar said these older procedures had limitations.

“There was a chance for collateral damage (to the esophagus or other heart tissues) because it’s difficult limiting your burning only to that heart tissue.”

“Today, we have pulse field ablation,” he said. The catheter zaps abnormal cardiac tissue with a focused electrical burst.

“This procedure is quick, efficient and much safer. It’s all done under anesthesia, so it’s pain-free. Anyone who has gone into pulsed field ablation is no longer doing it the old way and has completely moved on,” Kakodkar said.

Dr. Dwight Tyndall is another surgeon offering a new minimally invasive procedure. He uses SeaSpine’s FLASH Navigation System for spine surgery. It allows instruments to be placed more precisely without needing excessive radiation.

“The 7D machine-vision technology gives me an unparalleled 3D view of the anatomy during surgery, allowing for greater accuracy in placing instrumentation,” said Tyndall, who is a partner of the Lakeshore Bone and Joint Institute, based in Northwest Indiana.

A clearer picture

Joel Markanich, director of molecular and anatomic pathology operations at Alverno Laboratories of Hammond, said they recently adopted artificial intelligence to improve early diagnosis of prostate, breast and gastric cancers.

Alverno is partnering with Ibex Medical Analytics of Tel Aviv, Israel, which has developed algorithms to help pathologist to detect hard-to-find cancer sites.

Alverno daily processes hundreds of biopsies — body tissues extracted from suspicious growths — for 21 hospitals and scores of independent pathologists across Indiana and Illinois.

Their central lab slices biopsies into thousands of microscopically thin wafers, scans them into digital images and dispatches them by computer to pathologists for examination.

Markanich said Ibex culls suspected malignancies out of a multitude of otherwise benign tissue samples and flags them for additional testing to confirm whether it is cancer.

“So, AI can pick up something that could have been missed with the naked eye and then prioritize their caseload,” he said.

“We are really excited to have started last May using it on prostate tissues. We added breasts in November. We are waiting to see if we get those efficiency gains.”

Hospitals heart AI

Dr. M. Shakil Aslam, an interventional cardiologist with South Bend’s Beacon Health System, said AI is being used within a non-invasive heart imaging system. AI amplifies the data to diagnose whether a patient has abnormal blood pressure indicating atherosclerosis, caused by age, elevated cholesterol and a sedentary lifestyle. Symptoms range from chest pains to heart attacks.

Aslam said surgeons usually perform an angiogram, an imaging technique providing a two-dimensional image of the branching vascular anatomy.

“But sometimes an angiogram’s read out doesn’t look concerning because it isn’t telling us whether there is blockage causing a reduction in blood flow,” he said. “Then we have to put a wire in the artery to check the blood pressure and get all the information we need to fix it or not.”

He said the system enhances X-rays and other medical imaging to visualize blood flow through the coronary arteries and more precisely identify the location and severity of arterial narrowing and blockages.

“It doesn’t require medication or large tubes into the arteries, so it’s definitely safer,” he said.

Since last spring, Beacon cardiologists have used it to successfully treat over 50 patients.

Aslam said getting health systems like Beacon to invest in advanced procedures involves a cost-benefit analysis.

“Health care is expensive, insurance companies are reducing reimbursements, and the cost of labor is going up,” he said.

“The decision-makers need to know whether there is enough research and data behind a new procedure, if it’s covered by insurance and works for a majority of the patients we treat so the hospital doesn’t lose money on it.”

Surgeons say many health insurances, including Medicare and Medicaid, provide reimbursement for the higher costs of these advanced technologies when medically necessary and if performed under conditions approved by the U.S. Food and Drug Administration.

“These procedures have definitely shown they are cost effective,” he said.

Seabrook said technology will keep evolving. “It’s just human nature to strive for the next level,” she said. •

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