An encore for Gary Onik
The father of US-guided tumor ablation turns
By C.P. Kaiser
In 1982, Dr. Gary M. Onik, then a second-year radiology resident at
the University of California, San Francisco, was performing a CT-guided liver
tumor biopsy when an idea changed the direction of his medical career--and
medicine itself. If a needle for biopsy could be guided deep within a patient's
body by cross-sectional imaging, then a destructive agent might also be guided
directly into the tumor in the same manner.
Working with Boris Rubinsky, a biomedical engineer at the University of
California, Berkeley, Onik designed an ultrasound-guided system that for the
first time enabled cryosurgeons to see what they were doing. To this day, Onik
corresponds with one of his first cryosurgery patients, who at the time had
seven metastatic liver lesions and was deemed terminal. She was 34 then, with a
"One the great joys of my career has been to watch her and her family grow
for the last 16 years," he said.
After nearly two decades of refining his percutaneous ablative therapies,
Onik wants to teach them through robotic telementoring. Robotics and
percutaneous procedures are a good mix because there's no cutting and sewing:
just guide an instrument to the site and freeze.
"From a robotics point of view, that's pretty simplistic," he said.
Celebration Health/Florida Hospital, where Onik is director of surgical
imaging at the Center for Surgical Advancement, has just opened a high-tech
surgical learning center. When Onik gets finished with his project, he'll be
able to robotically control students' instruments, whether they're in Orlando or
Friends and colleagues are not shy about calling Onik a genius. He dismisses
the label and says he merely sees things that are obvious. Not so, said Dr. Fred
Lee Jr., chief of abdominal radiology at the University of Wisconsin.
"His thinking is not limited by specialty or modality," he said. "His liver
tumor ablation technique was pure genius, a radiology solution applied to a
surgery problem using an engineering device."
Onik is still rolling out new techniques and instruments. Last year, he
introduced a safety procedure for percutaneous prostate cryosurgery that
involved injecting fluid into Denonvilliers' fascia to artificially increase the
space between the prostate and the rectum. Later this year, he'll publish a
study of a potency-sparing technique that preserved sexual functionality in 80%
of prostate cancer patients. Then he'll swing up to Wisconsin where he and Lee
will test a patent-pending device: a combination radio-frequency/cryoprobe that
takes advantage of each ablative procedure's strengths. The government gave its
blessing to Onik twice in the last year--it approved Medicare payments for
cryosurgery, first as a primary treatment for prostate cancer, then for patients
without curative options.
At home, where there are two dogs, two teenagers, and two pre-med progeny,
Onik insists he's all thumbs.
"My wife thinks I'm useless and have always been that way," he said. "As a
kid, my erector set got put in the corner and stayed there."
But sitting in his garage is what Onik describes as "a revolutionary safety
instrument" that recognizes when it's about to puncture a vessel. It sends out a
pulse of light, looks at the spectra coming back, and teaches itself over time
what a particular structure looks like. Developed with Boris Rubinsky and David
Otten, a Rubinsky protégé, it can be trained to recognize veins,
arteries, nerves, bile ducts, whatever.
Talk with Onik long enough and he'll slip into the subject of sailing. Not
one to sit quietly, he's making his presence felt dockside. He's lobbying boat
companies to adopt a high-tech refrigeration system initially designed for NASA,
and he thinks the electric engine of the Mars rover has good potential for
As for his healthcare initiatives, he has two major projects pending. One is
The other project is a percutaneous anterior lumbar diskectomy procedure, for
which he invented a grasping forceps that pushes all but the disk material out
of the jaws of the grasper. The instrumentation and animal studies have been
ready for five years, but he's been waiting for a sophisticated intraoperative
CT scanner with an integrated guidance system. Now that such systems are
available, he's lobbying manufacturers to install one in his OR.
The anterior diskectomy project brings Onik full circle and back to an early
idea: image-guided posterior lumbar diskectomy, which he proposed as a
first-year resident at UCSF. Onik's advisor at the time was Dr. Clyde Helms, now
chief of the musculoskeletal section in the radiology department at Duke
"Nothing like that had been done before," Helms said. "I thought he was crazy
until I read his proposal. He had everything thoroughly worked out."
It took Onik two years to develop the tiny instrumentation. Then he had to
find a patient willing to take the risk.
"Gary's very persuasive," Helms said. "He explained to the man that it might
not help, but it probably wouldn't hurt."
The instant the procedure was finished, the man got off the table and gave
Onik a big hug, according to Helms. The pain he had felt for years was suddenly
and dramatically gone.
It was a great pro- cedure for 1981, Onik said, but very limited. The
anterior diskecto-my can provide solutions for those limitations.
"Now we could remove extruded fragments on Monday and that man could play the
Super Bowl on Sunday," Onik said.