Who, What, Where, When, and Why...

So basically this is the who is who, what we do, where we do it, when we do it, and why we do it post. Hopefully this information is a helpful tool that gives you a handle on what we do at JBEDS. If you have any questions about JBEDS feel free to email us and we will try our best to respond in a timely fashion.

Director: Raymond J. Leveillee, MD, FRCS-G
Division of Endourology, Laparoscopy, and Minimally-Invasive Surgery
Department of Urology
University of Miami Miller School of Medicine
1400 NW 10th Ave, Suite 509
Miami, FL 33136
(305) 243-4562 (office)
rleveill@med.miami.edu

Assistant Director: Nelson Salas, PhD
(305) 243-3531 (office)
nsalas@med.miami.edu

Current Address: Elliott Building
University of Miami Miller School of Medicine
1800 NW 10th Ave, Suite 2070A
Miami, FL 33136

Phone: 305-243-3532 (laboratory)
305-243-3531 (Dr. Salas’ office)
Fax: 305-243-3381 (Division of Endourology, Dominion Towers)

Hours of Operation:
Mon- Fri 9-5

General Description:
The Joint Bioengineering and Endourology Developmental Surgical (JBEDS) Laboratory was created by Raymond J. Leveillee, MD (brief biography in Addendum), chief of the Division of Endourology, Laparoscopy, and Minimally-Invasive Surgery in the Department of Urology, University of Miami Miller School of Medicine, through the gift of an anonymous donor ($1.5 million for five years). This laboratory is being developed as a joint collaborative effort with the Department of Biomedical Engineering, University of Miami, Coral Gables, FL. The laboratory, which opened its doors on March 01, 2008, is currently comprised of approximately 307 square feet in room 2070A at the second floor of the Elliott Building, University of Miami Miller School of Medicine.


Research Focus:
The overall goal of the JBEDS Laboratory is to develop and optimize both diagnostic and therapeutic modalities within the field of Endourology. Our research focus is on the following:

· Optimization of Computed Tomography (CT) and Ultrasound Guided Radiofrequency Ablation (RFA) for treatment of renal tumors.

Radiofrequency ablation is the current and more widely used minimally-invasive treatment modality for small renal tumors. A radiofrequency electric current is emitted from a probe inside the tumor and is received by a grounding pad on the skin surface. Heat is induced around the probe by the flow of current and is diffused to the surrounding tissue. Tissue coagulation and cell death is achieved within seconds when the tissue reaches approximately 60 oC. This procedure is performed either laparoscopically (ultrasound guidance) or percutaneous (Computed Tomography (CT) guidance), depending on the location of the tumor. At the University of Miami, the treatment endpoint is determined by measuring the temperatures at the tumor periphery with fiber-optic thermocouples. The endpoint is reached when the temperature at the tumor periphery rises above 60 oC.
Despite its success, certain limitations remain that must be investigated in order to reduce risk of residual tumor and increase patient safety. Due to the variety of renal tumor geometries (spherical, ellipsoid, tear-drop), temperature measurements in discrete points may not always guarantee a total ablation of the tumor. Kidneys also have a salt concentration gradient from the center to its periphery, resulting in a possible anisotropy of its electrical properties. Different locations may give different results under the same ablation parameters (irradiation time, power).

· Comparison of optimized CT guided RFA treatment of renal tumors with other available treatment modalities

One of the goals of the JBEDS laboratory is to determine and develop the most efficient, minimally-invasive treatment modality for renal tumors that has the least risk for residual tumor and that most enhances patient safety. Other modalities currently in the market have the potential to be more efficient in treatment renal tumors than radiofrequency ablation. This includes microwave (MW) technology (ValleyLab MW Ablation System, Covidien, Inc.), irreversible electrophoresis (IRE) (Nanoknife, Angiodynamics, Inc.), and lasers. Our investigations will be evaluating these modalities.

· Kidney Stone Ablation – Lithotripsy

Current kidney stone modalities include extracorporeal shockwave (ESWL), laser, and pneumatic lithotripsy. ESWL uses focused ultrasound to crush the stone in the ureter. A main disadvantage is the collateral damage to surrounding tissue, especially when the stone is out of focus. The pneumatic and laser modalities can be affected by the difference in stone composition. Another disadvantage with these modalities is the retraction of the stone calculi to the pelvic region of the kidney.

· Development of a novel biopsy system for renal tumors

Accuracy of biopsies for renal tumors is no better than 80%. Our research will focus on developing a smart biopsy needle that will signal when the needle is in tumor tissue. Efforts will be made to develop a system for both tracking and accurate placement of biopsy needles