Where are the most exciting advances in medicine today? Take your pick. According to Sarasota neurosurgeon Dr. Peter Mayer, "I don't think you'll find one area of medicine that isn't seeing rapid change." Even in Sarasota, where no university teaching hospital is spurring the development and use of the latest techniques, Sarasota physicians participate in clinical trials, lobby local hospitals to purchase the latest technology and undergo extensive training in the latest techniques.

Many of the advances are the result of ever-improving technology, which is creating more precise tools for diagnosis and treatment. Such technology often enables physicians to replace invasive surgery with outpatient procedures that are faster to perform, easier to endure and, most important, more successful.

Engineers are designing smaller and smaller instruments for minimally invasive surgery. Computers can reconstruct the insides of our bodies on TV screens so surgeons can perform complicated surgeries through tiny incisions. Cancer radiation therapy is becoming so accurate that it can nuke a tumor while leaving healthy tissue virtually unharmed.

But not all breakthroughs are high-tech. Sometimes common sense, a simple shift in procedure and the commitment to improve care provide that extra edge for the patient. Case in point: Sarasota Memorial Hospital began to give each patient in the emergency room an aspirin as soon as it was determined the patient might be having a heart attack. The hospital also assembled an emergency team of cardiologists who committed to being on call seven days a week, 24 hours a day, and then brought the average length of time from doorway to operating room down from 120 minutes to under an hour. The result: More lives are being saved.

We asked area hospitals and physicians to give us the names of local doctors who are using some of the most exciting advances in medicine. From that extensive list, we chose five physicians who are on the leading edge of new technologies. Here's a look at how medical innovations are changing the way Sarasota doctors work-and improving the lives of their patients.

Dr. James J. Fox-coated stents

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Dr. James Fox, a bear-sized man with bushy hair and the curious distinction-for a doctor, at least-of being a former amateur boxer and an attorney, dislikes frequent flyers. No, not the sort who collect free airfare, but the kind he sees as medical director of interventional cardiology at Sarasota Memorial Hospital.

In cardiology, frequent flyers are patients who return after an angioplasty because their arteries have become blocked again-a process called restenosis. In the initial angioplasty, a small balloon is threaded through an artery in the groin up to the blocked artery in the heart. The artery is then cleared of the sticky plaque clinging to its walls and a stent-a stainless steel mesh tube smaller than a spring in a ballpoint pen-is often installed to keep the artery open after the procedures. More than 1.5 million angioplasties were performed last year; many are outpatient procedures, requiring only intravenous sedation and a local anesthetic. They have been extremely successful in restoring blood flow to the heart.

The problem, however, is that within six months, up to 30 percent of all angioplasty patients develop scar tissue around the stent, and the artery is blocked once more. Hence the frequent flyer label, as patients return for radiation therapy to clear away scar tissue, or worse yet, for bypass surgery, a major open-heart procedure, requiring four to seven nights in the hospital and up to eight weeks to recuperate.

Different methods are being used to prevent the build-up of scar tissue, but Fox is most excited about a new type of stent he and other Sarasota interventional cardiologists are using. These stents, which are in clinical trial through Sarasota Memorial's Clinical Research Center, are called drug-eluting stents or "coated" stents, and they're painted with a chemotherapy drug. Essentially, the coated stent emits a medicine that penetrates the coronary artery wall and prevents scar tissue from growing. The hope is that coated stents will prevent most by-pass surgeries.

"It has the potential to dramatically change the way a huge population of patients is treated," Fox says. "The hope is that people are never going to come back."

Dr. Thomas Sweeney II, endoscopic spinal fusion

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Sometimes, smaller is better-at least when it comes to incisions.

More than one million Americans undergo spinal surgery every year for chronic back pain. Until about a year ago, about 350,000 of those patients had a procedure called spinal fusion, in which the surgeon made a four-to-10-inch incision along the back and inserted rods along the vertebrae to stabilize the spine and, it was hoped, end the pain. Recovery time was eight to 12 weeks, and often, the procedure was painful and created additional problems.