Few Questions for a Thoracic Surgeon

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

Dr Turkelton

Full Member
10+ Year Member
Joined
Jul 5, 2011
Messages
700
Reaction score
392
Hey there, I'm an M3 considering an integrated I6 program and had a few questions, have read the FAQ and most of the thoracic surgery threads here but haven't seen an answer to these

- How much arrhythmia surgery does the average community CT surgeon do? Do they routinely implant pacemakers and follow up with the device interrogations?

- Would an I6 program adequately train you in advanced endobronchial oncology techniques like laser therapy, cryotherapy or stent placement?

- Do most thoracic surgeons work up solitary lung nodules? Or do you only see patients with a confirmed surgical disease?

- Similar question in regards to esophageal diseases, do you often see patients with dysphagia that you would work up and manage medically before surgery? Or would the GI work up and manage them until intervention is required?

- How much endovascular work do graduates from I6 programs (Or CT surgeons in general) do? Would angioplasty or IABP placement be within their scope?

Thank you for your help. Very interested in the field but it's been hard to find out the typical practice of community thoracic surgeons vs the academic ones I have been exposed too.

Members don't see this ad.
 
n=1, the CT guys at my program's community site regularly do pacemakers. We don't have anyone else in the hospital equipped to do them, so they share all the inpatient pacemaker consults. I can't honestly tell you if they continue to follow these folks on the outside or defer to their cardiologists, but suspect the latter.
 
Members don't see this ad :)
Hey there, I'm an M3 considering an integrated I6 program and had a few questions, have read the FAQ and most of the thoracic surgery threads here but haven't seen an answer to these

- How much arrhythmia surgery does the average community CT surgeon do? Do they routinely implant pacemakers and follow up with the device interrogations?

- Would an I6 program adequately train you in advanced endobronchial oncology techniques like laser therapy, cryotherapy or stent placement?

- Do most thoracic surgeons work up solitary lung nodules? Or do you only see patients with a confirmed surgical disease?

- Similar question in regards to esophageal diseases, do you often see patients with dysphagia that you would work up and manage medically before surgery? Or would the GI work up and manage them until intervention is required?

- How much endovascular work do graduates from I6 programs (Or CT surgeons in general) do? Would angioplasty or IABP placement be within their scope?

Thank you for your help. Very interested in the field but it's been hard to find out the typical practice of community thoracic surgeons vs the academic ones I have been exposed too.

I'll try to address these as best I can. I work as a community thoracic surgeon.

1. Pacers - most are put in by cardiology. If you are at a place that doesn't have cardiologists, then you might be called upon to do them. I did a total of one during residency training.

2. Adv endobronchial procedures - this will be very program dependent. Some programs have a big experience in this, and some do not. As a community based surgeon, we don't have enough volume to be able to really do much of this, even though I had a large experience in my training.

3. Workup of lung nodules. I'd say most of the nodules I see are sent to me from med onc or rad onc. I will occasionally see one that is sent from the PCP or pulmonologist. I wish more were sent to us first. That would avoid many unnecessary biopsies being done. If there's a nodule and its pet avid, I don't need a biopsy unless I'm looking for a reason NOT to do surgery on that person.

4. Esophageal disease. These patients are almost totally seen by GI first and undergo workup by them. They are then sent to me with pretty much all of their workup finished.

5. Endovascular - This depends on the program. Many places are bringing more TAVR experience and that will get you those cases. IABP is a common thing that I would expect any cardiac surgeon to be able to do. I would not expect any cardiac surgeon to do coronary angioplasty. I would not expect them to do peripheral angioplasty either, but it probably does happen. I would also expect that some endovascular aortic component will be taught in your training. How much of this you'd do out in practice will depend on your institution.
 
  • Like
Reactions: 1 user
Hey there, I'm an M3 considering an integrated I6 program and had a few questions, have read the FAQ and most of the thoracic surgery threads here but haven't seen an answer to these

- How much arrhythmia surgery does the average community CT surgeon do? Do they routinely implant pacemakers and follow up with the device interrogations?

The real question is... why do you want to implant pacemakers and do the follow up device checks? I've done a few, and it's not that interesting a procedure. As a community cardiothoracic surgeon, your goal is typically to do cases and affect people's lives in significant ways that others just don't have the training to do. That means trying to fill your clinic with new consults so that you can fill your OR days with cases.

- Would an I6 program adequately train you in advanced endobronchial oncology techniques like laser therapy, cryotherapy or stent placement?

Varies.

- Do most thoracic surgeons work up solitary lung nodules? Or do you only see patients with a confirmed surgical disease?

Rarely do solitary pulmonary nodules make it to the surgeon straight from the PCP. I feel like ground glass opacities are the most common undifferentiated/undiagnosed lesions that make it to the thoracic surgeon, but I could be wrong. Someone tried to biopsy it and it was indeterminate, or nobody knows whether it ought to be biopsied.

- Similar question in regards to esophageal diseases, do you often see patients with dysphagia that you would work up and manage medically before surgery? Or would the GI work up and manage them until intervention is required?

Almost always seems to be seen by a GI doc first.

- How much endovascular work do graduates from I6 programs (Or CT surgeons in general) do? Would angioplasty or IABP placement be within their scope?

IABP is a fairly easy procedure that I've done several times at the bedside. Any integrated resident should feel comfortable placing an IABP by the beginning of the 3rd year of residency.

Coronary angioplasty I've never done, but at the same time cardiologists have to do a lot of diagnostic caths to get a few PCIs, so I don't think it's worth giving up a lot of OR time to do diagnostic caths just for a few PCIs.

Peripheral interventions are alright, but vascular typically gets all these referrals. Most cardiac surgeons don't have the wire skills to do even the simplest procedures like an SFA, because it's a very specific skill set. Additionally, the endovascular technique is only part of the issue. That's why the vascular guys are always harping on interventional cardiologists and interventional radiologists who are doing these peripheral interventions. It's not the angiogram at the end of the case that matters... it's the outcome of managing the patient's wound or symptoms that really counts.

Vascular has a tight hold on endovascular aortic work, but in a few rare places cardiac surgery does the TEVARs. I have a particular interest in endovascular surgery, so I've become somewhat facile with it and have fun planning out cases. Having said that, I likely won't have the experience necessary to do EVARs in cases with difficult landing zones.

Thank you for your help. Very interested in the field but it's been hard to find out the typical practice of community thoracic surgeons vs the academic ones I have been exposed too.

I think the question you have to ask is... why do you want to become a cardiothoracic surgeon when your interests don't seem to be focused on the bread-and-butter of cardiothoracic surgery? Your interest seems to be focused on interventions that medical specialists do that are encroaching slightly on cardiothoracic operations? With something like PCI, it seems ill-advised to try to encroach on someone else's well-established turf, but people have tried it before...
 
  • Like
Reactions: 1 user
Hey there, I'm an M3 considering an integrated I6 program and had a few questions, have read the FAQ and most of the thoracic surgery threads here but haven't seen an answer to these

- How much arrhythmia surgery does the average community CT surgeon do? Do they routinely implant pacemakers and follow up with the device interrogations?

- Would an I6 program adequately train you in advanced endobronchial oncology techniques like laser therapy, cryotherapy or stent placement?

- Do most thoracic surgeons work up solitary lung nodules? Or do you only see patients with a confirmed surgical disease?

- Similar question in regards to esophageal diseases, do you often see patients with dysphagia that you would work up and manage medically before surgery? Or would the GI work up and manage them until intervention is required?

- How much endovascular work do graduates from I6 programs (Or CT surgeons in general) do? Would angioplasty or IABP placement be within their scope?

Thank you for your help. Very interested in the field but it's been hard to find out the typical practice of community thoracic surgeons vs the academic ones I have been exposed too.

(1) By "arrhythmia surgery" are you referring to the Maze procedure? Right- or left-sided Mazes, pulmonary vein isolation, left atrial appendage excision, etc. are often done in conjunction with other cardiac procedures as well. Pacemaker/ICD implantation is often institution-dependent. I did a lot of these as a fellow, but at my current institution Cardiology does them all.

(2) Depends on where you are. It all depends on how strong the Interventional Pulmonology service line is. In fellowship I was lucky to have learned a lot of advanced bronchoscopy - laser/cryo ablation, tracheobronchial stenting, EBUS, navigational bronchoscopy. Again, this is institution-dependent.

(3) Depends on how your tumor board is set up. Often the referrals with solitary pulmonary nodules will go to Pulmonology first for diagnosis (IR image-guided percutaneous biopsy vs. EBUS/navigational bronchoscopy). I see a handful of these in my office (referred by outside PCPs).

(4) If your institution has a strong GI/foregut Gen Surg program, then they will often be referred these patients by GI. You may or may not see them, again, depending on referral patterns.

(5) Again, depends on the program. Some are great at teaching wire skills. Others, not so much. TAVR, TEVAR, Mitraclip are all possibilities - angioplasty (if you're referring to coronary angioplasty) is much more rare. IABPs get placed in fellowship fairly often so you'll be comfortable with these most anywhere.
 
  • Like
Reactions: 1 user
Top