Dr. Diego Gonzalez Rivas, made history, again, today in the operating room of the National Cancer Institute in Bogota, Colombia. Along with Dr. Ricardo Buitrago, the two thoracic surgeons performed a painstaking procedure which is believed to be the first single port thoracoscopic surgery in the city of Bogota.
Building on existing techniques
Single port thoracoscopic surgery, also known as uni-port surgery, is the latest and most efficient advancement in surgical technology since the invention of video-assisted thoracoscopy (VATS) over 25 years ago. This technique is one of several “minimally invasive” procedures, and utilizes only one 2.5 cm incision between the ribs to perform large scale thoracic surgeries. This allows surgeons to avoid rib spreading techniques and large incisions.
Few surgeons trained in advanced technique
Dr. Diego Gonzalez and his colleagues, Maria Mercedes de la Torre Bravos and Dr. Ricardo Fernandez Prado in La Coruna, Spain, along with just a handful of other surgeons worldwide are performing large surgeries such as lobectomies, even pneumonectomies through these tiny incisions. This is something that few American surgeons attempt; even with more traditional video-assisted thoracoscopic surgery (VATS), which utilizes three or more incisions. Several recent studies show that despite the overwhelming evidence of the safety and utility of the traditional VATS from several decades, it is grossly underutilized. According to Peterson & Hansen (2006) VATS procedures only accounted for 32% of all thoracic surgeries in the US. Only a tiny fraction of these are performed using the single-port technique. The remainder of thoracic procedures are performed by thoracotomy, or large open incisions (from 10 to 20 cm in length) using rib-spreaders, which often fracture ribs during the procedure.
Advanced techniques underutilized in the United States
Theories regarding the underutilization of these techniques which reduce pain, complications and recovery time cite statistics showing that the vast majority of thoracic procedures in the United States are performed by general surgeons, not thoracic surgery specialists trained in this technique. Other theories discuss the older median age of most American surgeons and well as a the wide breadth of training required of cardiothoracic surgeons, who perform both cardiac and thoracic procedures versus thoracic surgeons who elect to perform thoracic surgery only.
While few statistics exist comparing the utilization of thoracoscopic surgery techniques in Europe, Asia and Latin America, amble evidence suggests that in many areas, minimally invasive surgery is the standard, with “open” surgeries like thoracotomies being rare exceptions.
Today’s surgery: Mediastinal Mass
During this procedure, Dr. Diego Gonzalez Rivas, one of the Spanish pioneering thoracic surgeons famous for this technique, carefully and painstakingly removed a large neuroendocrine tumor located in the patient’s left hilal area. This mediastinal tumor is adjacent to the pulmonary arteries making this surgery technically challenging. But the surgery proceeds quickly, and without complications in his skilled hands. In just under an hour, this patient had a malignant tumor removed with just a small linear incision to show for it. The patient will be able to avoid a lengthy hospital stay in addition to a large, painful, and unsightly incision.
More than just operating
But Dr. Gonzalez is doing more than just operating; this weekend he is teaching this technique to a select group of surgeons here in Bogota, Colombia. Next month, he heads to Florida with several of his colleagues to teach another multi-day course. Hopefully, a large number of American surgeons will be in attendance.