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Interviews with Thoracic Surgeons, Thoracic surgery programs

Dr. Thomas D’Amico: Duke Thoracic Surgery

Dr. Thomas D’Amico is one of the first American thoracic surgeons I’ve had the privilege of interviewing for the website, after he was recommended to me by several other surgeons in Colombia.  (Dr. D’Amico went to Medellin as an invited guest a few years ago and apparently made quite an impression.)

The irony in this scenario is unmistakable, since I worked for Duke (at another facility) for over three years – and knew of Dr. D’Amico, but had never met or spoken to him before.

Today, Dr. D’Amico took some time out of his busy schedule so we could talk about minimally invasive surgery, esophageal surgery programs and robots.

Dr. D’Amico is the Chief of Thoracic Surgery at Duke University Medical Center in Durham, North Carolina.  Together with several other physicians that make up the thoracic surgery program; the surgeons at Duke perform 1600 – 1800 cases per year.  This includes the entire spectrum of thoracic surgery procedures (thoracoscopic surgeries including lobectomies, wedge resections, mediastinal tumors, etc).

Last December, Duke started a minimally invasive esophageal surgery program, as well as a robotic thoracic surgery program.  (Both of these concepts should be familiar to readers since we published articles on these very topics earlier this month, talking about the TIME trial in Europe, comparing outcomes between traditional and minimally invasive esophageal surgery, as well as previous post exploring the dearth of published literature on Robotic Thoracic Surgery. )

Since its inception six months ago, the program has done 80 -100 cases of minimally invasive esophageal surgery.  Notably, Duke has an established esophageal cancer program - which performs about 70 – 80 esophagectomies a year.  This doesn’t sound like a lot, but it actually distinguishes this program as a high volume center, which is important for reducing morbidity and mortality.  Multiple studies have confirmed that esophageal surgery patients do better (less deaths, less complications) when they have surgery with thoracic surgeons at high volume centers.

The Robotics program, headed by Dr. Mark Onaitis is performing about 8 to 10 cases per month.  The program is currently limited due to access to the Divinci robot.  (Currently, thoracic surgery has use of the robot one day per week.)  Dr. D’Amico reports that surgical case times have been increased on the robotic cases but states that much of this is robot maneuvering time as the robot is brought into position for surgery.

I’ve asked to observe a robotic case so I can bring you first hand observations (a la Bogotá Surgery style), as well as have a chance to look around the dedicated thoracic surgery unit at Duke hospital.

Pleural mesothelioma and related conditions are less well-defined within the Duke Thoracic surgery program.  They only see about 20 or 25 cases per year, and don’t really have an established program for these patients.  Dr. D’Amico reports they are not actively pursuing brachiotherapy or HITHOC (intrathoracic hyperthermic chemotherapy) options.  The main focus of the program remains minimally invasive procedures, which is where Dr. D’Amico sees the future of thoracic surgery.

As for the surgeon himself, he is surprisingly closed lipped about his personal and professional life, and declined to answer any questions on the subject.  He has a reputation around Duke as a shy, quiet and gentle man but my time with him was extremely limited, so  I have no insights, or impressions to pass along to readers. Hopefully, I’ll get another chance to speak with him in the future, so I am able to give more details about these programs, and the surgeon behind it all.

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