New Regional Thoracic Surgery Center: Ontario, Canada

Creation of a new ‘regional thoracic surgery center’ in Hamilton, Ontario highlights some of the issues we’ve talked about here before: high volume centers, optimizing outcomes, decreasing wait times, and quality/ consistency of care.

The new agreement to create a ‘regional thoracic surgery center’ in the Hamilton area of Ontario, Canada highlights some of the things we’ve been talking about here at Cirugia de such as the importance of having thoracic surgery performed by thoracic surgeons, and improved outcomes with more complex cases (esophagectomy, pneumonectomy) being performed at high volume centers.

Since this center is in Canada – it is also important to note that this change will decrease waiting times (initial presentation to treatment) for patients.  For people unfamiliar with socialized medicine – these waiting periods can be significant.  The article phrases this differently, stating time of initial presentation to diagnosis – which can have a different meaning – (or if the diagnosis is made from surgical tissue, essentially the same.)  However, that time was 95 DAYS (or over three months) and has now been reduced to 35 days.

In other Thoracic Surgery news – I am currently researching articles on high-altitude lung surgery, so there may be a gap in between postings as I continue to review the existing data.

Dr. Dov Weissberg: Treatment of Lung Abscess

Thoracic Surgery (Cirugia de Torax. org) welcomes Dr. Dov Weissberg, noted thoracic surgeon and memoirist as our first guest commentary. Here, Dr. Weissberg comments on one of his previously published articles from 2010 on the history of lung abscess.

We at Thoracic Surgery are delighted to present Dr. Dov Weissberg, a renown thoracic surgeon with a distinguished career as a surgeon, a scholar and professor of surgery with an extensive resume and list of contributions to the field of Thoracic Surgery as our first guest commentator.  Dr. Weissberg has published an exhaustive list of articles, and papers in addition to several books, including his memoirs which include his boyhood accounts of life in Poland as a hidden jew during the Holocaust, personal experiences of starvation, and his experiences as a surgeon.

He is an expert in his field, with contributions to the development of pleuroscopy and the body of knowledge surrounding a wide range of thoracic surgery topics including mediastinoscopy, thymomas, lung abscess, empyemas, traumatic thoracic injuries, tracheal disease and tracheal surgery, pleural effusions, lung cancer and lung resection.

Dr. Dov Weissberg: Treatment of Lung Abscess – commentary based on Editorial published in 2010 entitled, “The Treatment of Lung Abscess from Hippocrates to Present.

The treatment of lung abscesses has come full circle since it was first described by Hippocrates. The treatment at that time was surgical drainage (of the accumulated pus and dead tissue matter). A small tube was placed in the chest, and the accumulated pus drained out. This remained the standard of treatment until the 195o’s when the widespread use of antibiotics became popular, replacing surgery with medications. Antibiotics remained the primary treatment for this condition through the 1960’s to the 1980’s. Surgical intervention was relegated as a treatment of last resort, after multiple medication failures. In those cases, patients were usually referred for lobectomies or lung resections. On our service, (in 1980) our experiences with several patients referred for medical treatment failure showed surgical drainage to be an effective treatment and preferable over both long-term antibiotics and lung resection, thus coming back to Hippocrates.  We presented these findings at several conferences, and meetings.  Now in 2011; surgical drainage is once again, the treatment of choice for lung abscess.

Note: Lung resection should be reserved only for cases of extensive tissue destruction (pulmonary gangrene).

Biography of Dr. Dov Weissberg

In this particular case, with a gifted memoirist such as Dr. Weissberg, it is not possible to tell his story as well as he does.


1. The Limits of Starvation – a personal experience : Dr. Weissberg recalls his wartime experiences as a 13 year boy.

2. The Handbook of Practical Pleuroscopy (1991)

3. I Remember – memoir
4. The Holocaust – one boy’s story
5. I have chosen surgery: A surgeon’s memoir

Lung cancer patients die awaiting surgery

the health care crisis hits home: prolonged waiting times for patients with lung cancer results in the deaths of several patients in Canada – and this scenario is projected to be repeated in the USA and Europe due to surgeon shortages and limited access to health care.

In disturbing news from Canada, as reported by the Vancouver Sun in April 2011, as part of an ongoing court case, an estimated 250 lung cancer patients died awaiting surgery due to prolonged wait times. In this case, the thoracic surgeon, Dr. Ciaran McNamee had previously complained to hospital administrators at Capital Health in Alberta, Canada about the prolonged waiting times patients were experiencing due to insufficient operating room facilities. For his patient advocacy efforts, Dr. McNamee was fired, and slandered as experiencing ‘mental health issues.’ Dr. NcNamee also alleges that other doctors who complained about the problem were also punished or paid off to keep silent about the problem while their patients suffered.

While in this case, the prolonged wait times were caused by insufficient operating room facilities, in the future the problem may be more directly related to the lack of thoracic surgeons themselves.

May 13, 2011

I admire Dr. McNamee for his convictions and patient advocacy in the face of serious repercussions.  I wrote to him at Brigham Womens & Childrens Hospital in Boston, where he is now a professor of surgery as part of the thoracic surgery program to extend an invitation to submit a guest post.  (He specializes in esophagectomies along with VATS which are two subjects we always like to hear more about here at cirugia de torax.)

October 30, 2011 – the Calgary Herald updated this story among controversy over the original comments by Dr. McNamee and his successor, Dr. Tim Winton.

March 2, 2012 – The Vancouver Sun reports that the Canadian politicians continue to argue over the issue but do very little to address these allegations and the shortage of health care services affecting Alberta residents.