Dr. Demetrio Aguila III’s medical practice — Healing Hands of Nebraska — is aptly named.
The Norfolk-based peripheral nerve surgeon recently began offering a new procedure to treat carpal tunnel syndrome that he calls “micro-invasive,” resulting in a shorter recovery time from the painful condition that affects the hands of his patients.
“The patients could come in and have the procedure done over their lunch hour and go back to work afterward,” Aguila said. “The only restrictions they have as far as activity has to do with water.”
Aguila, a Milwaukee native and U.S. Air Force veteran, has practiced medicine in Norfolk for about five years. He specializes in peripheral nerve surgery, which entails a focus on nerves located outside of the brain or spinal cord.
The specialty in peripheral nerve surgery has led Aguila to perform hundreds of conventional operations to treat carpal tunnel syndrome, a common and painful condition that involves the compression of the median nerve that travels between the hand and wrist.
The conventional procedure used to treat the malady includes a 3- or 4-inch incision in the palm of the hand; surgeons have to go through multiple layers of tissue to reach the layer that needs to be addressed for the patient to find relief, Aguila said.
“That’s part of the reason we have all of these (post-operative) restrictions,” Aguila said of conventional surgery. “And that’s one of the reasons endoscopic carpal tunnel surgery was developed.”
Aguila said he has done many endoscopic carpal tunnel release surgeries, as well, and patients bounce back faster than they do with conventional surgery because they aren’t as invasive, but patients still have restrictions and face a lengthy recovery time afterward.
Plus, there are a number of safety concerns that still arise despite the much smaller incisions used in endoscopic surgery, he said.
Aguila said a more widespread use of ultrasounds in muscle, bones and nerves has allowed physicians the ability to see structures in the body that might otherwise not be seen.
That insight led physicians at Mayo Clinic in Rochester, Minnesota, who are experts in musculoskeletal ultrasounds, to develop an ultrasound-guided carpal tunnel release procedure after seeing some of the more delicate structures in the hand and wrist, Aguila said. The technology used allows surgeons to visualize in real time where the instruments are relative to those structures, he said.
“When I started doing the training on this (procedure) and saw which structures we were looking at, I was blown away,” Aguila said. “I think most surgeons aren’t aware of how critically close they are to these smaller structures, which could have a significant impact to the patient’s quality of life — not to mention their recovery.”
Xanat Naranjo, a nurse at Healing Hands of Nebraska, was the first person on whom Aguila performed the new procedure. Using a local anesthetic, Aguila completed the procedure on both hands in the same sitting and, immediately afterward, she went back to work.
“The incisions were so small,” Naranjo said, twisting her wrists to display small, blister-sized reminders of the procedure.
“We don’t use stitches because the incision is so tiny all you need is a Steri-Strip or Band-Aid,” Aguila said.
Aguila said any post-operative discomfort is treated with over-the-counter pain relievers like Tylenol or ibuprofen, and the main restriction is to avoid submerging the incision areas in water to avoid infection.
The procedure is more cost effective, as well, Aguila said, as patients do not have to take a considerable amount of time off work to heal, and it does not require the significant amount of instrumentation, drugs or operating rooms that conventional surgery requires.
Aguila said there are fewer than 40 surgeons in the world who offer the new procedure, but he anticipates over the next few years, it will become the most widely used way to perform surgery on sufferers of carpal tunnel syndrome.
“There might still be situations where conventional carpal tunnel surgery is the way to go, but I would say for greater than 95% of patients, this will be the wave of the future. We just happen to be on the front edge of that,” he said.