Gold is used in a number of surgical applications including a new treatment for prostate cancer that uses grains of gold, approximately the size of a grain of rice. The surgical procedure involves inserting three gold grains into the prostate using ultrasound. The position of the gold grains can be detected using x-rays (gold is opaque to x-rays) allowing the doctors to accurately target the prostate position within one or two millimetres.

Gold-plating has a history of use in the coating of coronary stents. Inserted inside large arteries and veins, these implants act like scaffolding, propping up the blood vessels and keeping them open to allow adequate blood flow. Boston Scientific produced the NiroyalTM stent as one of the first gold-plated stents in 2001, largely in response to the need for stents that could be more accurately placed. The radiopacity of gold means that gold-plated stents offer the best visibility under an x-ray enabling them to be positioned where the surgeon wants them. The biological inertness of gold is important in this application and according to at least one published study by Tanigawa et al, [ N Tanigawa, S Sawada and M Kobayah, Reaction to the Aortic Wall to Six Metallic Stent Materials, Acada. Radio.2:379-384] gold-plated stents were found to produce the fewest macroscopic changes in surrounding intravascular tissue.

Gold-plated stents are used to help support weak blood vessels.
Many surgeons prefer gold-plated stents because these have the best visibility under an X-ray.
(Picture courtesy of BostonScientific, USA)

Gold of high purity (typically 99.99%) is used as an implant material in the upper eyelid for the treatment of facial nerve paralysis. The aim of this treatment is to allow the patient’s upper eyelids to close where paralysis of the eyelid muscles is preventing this motion. Following the implantation of the gold device (typically a few grams in weight), the closing is produced by the gravitational pull on the implant.

Gold is also widely used in implants for drainage and aeration of the middle ear (the tympanic cavity). In treating the condition commonly known as ‘glue ear’ it is sometimes necessary to implant a medical device that has a high infection resistance and low susceptibility to incrustation. It has been established that gold fulfils these requirements, showing a high degree of resistance to bacterial colonisation in the ear and a range of gold prostheses are commercially available in high purity gold for this application.

Middle ear gold implant.
Dresden type gold prostheses in pure gold (99.99% Au).
Picture courtesy of Heinz Kurz GmbH

Middle ear gold implant.
A pure gold tube conductor for insertion into the eustachian tube
in chronic aeration disorders of the middle ear.
Picture courtesy of Heinz Kurz GmbH

Middle ear gold implant.
Myringotomy tubes used for implanation in the tympanic membrane to drain
and temporarily aerate the tympanic cavity (gold plated).
Picture courtesy of Heinz Kurz GmbH