On a February afternoon at New York-Presbyterian Hospital in northern Manhattan, the operating room has been filling for half an hour with a steady trickle of surgeons, anesthesiologists, nurses, medical researchers, and a few curious observers.
Some are here to help, others to witness something they have never seen before. The patient is heavily sedated but still awake; an LED screen suspended above the operating table displays the vital signs. Normal blood pressure is anything below 120 over 80. This patient’s reading is 270 over 110. The astronomical numbers are why everyone has come today–to see whether chronic hypertension that drugs aren’t helping will respond to a radical new procedure.
Ajay Kirtane, an interventional cardiologist and head of the surgical team, begins with a small incision near the patient’s groin. He inserts a short, hollow sheath, his gloved hands speckling with blood. He then methodically threads a catheter–a long plastic tube–into the artery and, guided by a scan on an overhead display, to the blood vessels leading to the kidneys, which on the screen resemble giant gray beans. So far the procedure is a lot like any catheterization–complex yet utterly routine. The team pauses, however, while an assistant opens a 4-foot-long orange and white cardboard box marked with the word “symplicity” and removes what looks like a motorcycle throttle with an electrical cord at one end and a 3-foot-long wire on the other. He plugs the electrical cord into a generator and Kirtane threads the wire through the catheter till it reaches the kidneys. The assistant activates the generator. The patient doesn’t flinch as an energy burst destroys a swath of the renal nerves. For the next 20 minutes, Kirtane manipulates the wire, wiping out various sets of nerves. Toward the end, he turns around and says, modestly, “That’s all there is to it.”
But in truth there is much more to it than that.
