Dual port thoracoscopy for diaphragmatic plication with Dr. Edgard Gutierrez Puente

Talking with the energetic and innovative Colombian surgeon, Dr. Edgard Gutierrez Puentes.

Dr. Edgard Gutierrez Puente is a Colombian thoracic surgeon that I had the pleasure of interviewing in February of 2010.  He is a professor of Thoracic Surgery at the University of Cartagena.  As the only board certified thoracic surgeon in that city (of over 1 million people) – he currently operates in several facilities including: Hospital Naval de Cartagena, Clinica Universitaria San Juan de Dios, Hospital universitario del Caribe, Clinica Medihelp.

As part of a previous project on surgeons in Cartagena, I spent a considerable amount of time with Dr. Gutierrez, seeing patients in all of these facilities.  As a result, I have a deep and profound respect for his dedication to his patients and his work.  (As a matter of fact – I saw my first true* uni-port thoracoscopic surgery in Dr. Gutierrez’s operating room at Medi-help.)

I recently contacted Dr. Gutierrez on a return visit to Cartagena, and he was happy to tell me about some of his recent cases including a Diaphragmatic plication utilizing dual port thoracoscopy.  He is currently writing up the case for publication in surgery journals.  (This is more impressive than it may sound to many of us – traditionally Diaphragmatic plication requires open surgery or traditional VATS (with five ports). This is a big development in thoracic surgery, and I will be bringing you more information as soon as possible. (I don’t want to jeopardize his upcoming article – but still wanted to bring it to you first, here at Cirugia de Torax.)

* Often surgeons call a procedure with a small but 3 -5cm surgery a uni-port surgery, but this is actually more akin to a mini-thoracotomy.  A true uniport VATS procedure, is as the name implies – using an incision that is only large enough to accommodate a single port – and is then used with thoracoscopy equipment (not open surgery instrumentation).  This distinction is important because the amount of post-operative pain depends on the size of the incision and trauma to surrounding tissues and nerves.  (A small incision that is heavily stretched from the use of open surgery instrumentation may actually be more painful post-operatively that a sightly larger incision that is under less stress.)

More about Dr. Edgard Gutierrez Puente

Contact details:

Centro Medico Bocagrande
Consultorio 606
Bocagrande Calle 5  #6 -19
Telefonos: 6658300
Celular: 3114115130

Dr. Gutierrez is a specialty trained thoracic surgeon.  After completing medical school at the University of Cartagena, he completed his general surgery residency at the University of Costa Rica.  He returned to Colombia for his thoracic surgery fellowship at Universidad El Bosque.  He has been operating as a thoracic surgeon for over twenty years.

While his English is limited, his surgical skills aren’t.  In reviewing cases and spending time in the operating room with Dr. Gutierrez, I was very impressed by his extensive use of thoracoscopy for many of the cases that often remain in the realm of open surgery.  Having said that – I would like to clarify that Dr. Gutierrez is no ‘showboat’ – the decision to perform VATS in each of these cases was based on his skills, the patient’s anatomy and the ability to complete the surgery under safe and appropriate conditions via thoracoscopy  Had Dr. Gutierrez been unable to visualize the anatomy easily, or access structures during surgery (or encountered any other problems during the cases) he would have immediately converted to open thoracotomy (as is appropriate.)

Dr. Thomas D’Amico: Duke Thoracic Surgery

A brief interview with Dr. Thomas D’Amico, Chief of Thoracic Surgery at Duke University Medical Center.

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.