Why you should have attended VATS Peru 2016

Why you should have attended VATS Peru 2016

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There were plenty of reasons for surgeons from all over Latin America to converge on Cuscu, Peru for the 2nd annual VATS PERU Uniportal Master Class, which covered the basics of the uniportal approach as well as nonintubated and awake uniportal surgery.  There were subxiphoid and uniportal cases streamed live from Shanghai Pulmonary Hospital. But beyond the usual reasons of networking, discussing and sharing case knowledge, and the presentation of research findings and evidenced-based practice, there were several reasons why VATS Peru was more than just your average regional thoracic surgery conference.

Why attend VATS Peru?  The three best reasons:

1. The wet lab – which allowed surgeons and their surgical assistants to apply the theoretical knowledge they learned during the first two days of lecture in operating room scenario en vivo.  The “en vivo” is critical, fancy simulators aside, there is no better challenge to ‘book knowledge’, and application of practical skills than in the scenario of an operating room, with  real models and active bleeding.

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A surgeon in the master course receives instruction from Dr. Diego Gonzalez Rivas

 

2.  Lectures from the master surgeon himself; Dr. Diego Gonzalez Rivas:  That’s where the second critical component comes in, in the form of the candid, direct and straight-forward lecture by Dr. Diego Gonzalez Rivas on Control of Inter-operative Bleeding.  If you weren’t paying attention during this lecture, it’s obvious in the lab.  This isn’t a computer course where you can dial in your answers, fast-forward thru lectures and print off a shiny new certificate.  This isn’t a computer app, or a simulation that you can reset and re-start as soon as the surgery heads off course, to try again..  It’s real surgery.

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3.  Dr. Carlos Fernandez Crisosto

Lastly, if you didn’t attend VATS Peru, then you missed an opportunity to know and to talk to Dr. Carlos Fernandez Crisosto.  VATS Peru is his brainchild, and the organization was created specifically to advance minimally invasive surgery in Peru.  VATS Peru is separate from ALAT (the Latin American Society of Thoracic Surgeons), of which Dr. Fernandez is the current president.  VATS Peru is also separate from the Peruvian Society of Thoracic Surgeons which has its own focus in the thoracic surgery specialty.

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Dr. Carlos Fernandez Crisost0, Cardiothoracic and Vascular surgeon

 

Dr. Fernandez, a Tacna native, works at Daniel Alcides Carrion Essalud facility in the southernmost region of Peru.  He is the sole cardiovascular and thoracic surgeon for the city of Tacna, and performs cardiac, vascular, and endovascular surgeries in addition to general thoracic surgery.  While he is a trained cardiovascular surgeon, (in addition to general thoracic) thoracic surgery is what he enjoys most.

He trained in Argentina, and practiced in Cordoba, Argentina for 23 years before returning to Tacna in the last few years.

His average case volume is around 380 surgeries a year, and he reports that all of his thoracic surgeries are generally performed using the uniportal thoracoscopic approach.  He also does transplant, which requires him to travel to Lima specifically to perform the procedure.  The transplant program is small and performs 4 to 5 transplants per year.

In his practice he sees the usual oncology cases, and empyemas but he also sees a large number of patients with tuberculosis, as well as an assortment of hydatid cysts, and pectus cases.  Trauma from accidents, as well as injuries from guns, and knives also comprises a large part of his practice.

Dr. Fernandez is pleased with the success of his course, since this is only the second time the course has been available here in Peru.  It was a complex logistical arrangement to hold the course in Cusco this year, but with the help of his wife, a professional events planner, they were able to pull of the event with very few hiccups.  Next year, they plan to hold the event in Lima, the capitol of Peru and a city famed for its gastronomic offerings.

If you missed this year’s VATS Peru, look for VATS Peru 2017 here at Thoracics.org next fall.

Dr. William Guido and the state of thoracic surgery in Costa Rica

Cusco,  Peru

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Dr. William Guido Gerrero

One of the guest lecturers at the 2nd VATS Peru Uniportal Master course is Dr. William Guido Gerrero from Costa Rica. Dr. Guido talked about the challenges of implementing a minimally invasive thoracic surgery program in the small central american nation that boasts a total population of less than 5 million.

Despite the small population and the low surgical volumes that accompany it; Dr. Guido is one of ten thoracic surgeons in Costa Rica, who are affiliated with two thoracic surgery departments within the nation.

Dr. Guido initially performed his first two uniportal cases with some trepidation.  The first cases were simple biopsies and drainage of pleural effusions.  He then performed his first lobectomy but it was a slow tedious process.  After that experience, he traveled to Shanghai, and the Shanghai Pulmonary Hospital to attend and train with Dr, Diego Gonzalez Rivas  in the wet lab, practicing cases on live animals.

At Hospital Rafael Angel Calderon Guardia

Dr. Guido primarily operates in a 350 bed hospital in the capital city of 1.4 million habitants.   The thoracic surgery unit consists of eight beds, and cases are performed three days a week with an annual case volume of around 350 cases.

Majority of cases by Uniportal VATS

The majority of surgical cases  (67%, includes all types of cases) are performed using the uniportal approach.  31% of the remainder are performed via a traditional ‘open’ approach with only 2% of cases performed using traditional (multiport) VATS.  This discrepancy is explaned by Dr. Guido in that there is currently only one thoracoscope in the hospital, and it is not always available.  He predicts that the rate of uniportal VATS cases will soon increase, as the second thoracoscope is scheduled to arrive in just a few weeks, followed by a third thoracoscope next year.  These equipment limitations are not the only challenges for Dr. Guido and his fellow thoracic surgeons.

Low volumes, suboptimal equipment and a lack of institutional support

The low volume of surgical cases and a lack of institutional support are also problems.  Unfortunately, it’s harder to convince the medical community of the value of uniportal VATS (and thus boost surgical volume) than it is to order new equipment. Despite these limitations, Costa Rica also manages to maintain a struggling lung transplantation program, that performs approximately two transplants per year, with five patients with pulmonary fibrosis and pulmonary hypertension currently on the waiting list.

Excellent care, at home

Dr. Guido hopes that many of these problems can be resolved in the future.  He wants Costa Rican patients to feel that they can stay in Costa Rica for their thoracic surgery without making any sacrifices in care.  He’s already lost one patient to Dr. Gonzalez Rivas himself (when the patient traveled to Spain for surgery) and another to the United States (where the patient ended up getting an open thoracotomy).  Losing a patient to the Master of Uniportal Surgery himself is inevitable, but losing a patient to a country where the patient received an inferior procedure at an exorbitant cost is a bit harder to swallow.

Best of luck to Dr. Guido and his colleagues.