UVA Health welcomed two new thoracic surgeons this month who aim to advance the use of minimally invasive procedures to treat a large variety of lung and esophageal conditions, from cancer and COVID-19 to chronic thromboembolic pulmonary hypertension. Learn more about their areas of expertise and their approach to patient care in the Q&A below.
Title: Associate Professor; Surgical Director, Lung Transplant Program
Residency: Brown University, Surgery
Fellowship: University of Virginia, Thoracic Surgery
What is your clinical focus?
I specialize in thoracic surgery and lung transplantation. The most common conditions I treat are lung and esophageal cancer, paraesophageal hernias, rib fractures and chest wall tumors. There are many surgical options available. My main focus in thoracic surgery is a minimally invasive approach to treating those things. I use a minimally invasive approach for all surgeries except lung transplant.
You are the surgical director of the Lung Transplant Program at UVA. What are your goals for the future of this program?
We’re trying to grow the program and ensure good quality in terms of the organs we’re using. There is a wide variety in donors and recipients and trying to match those for the best outcome is one of the challenges in transplant, so that is a major goal. We are always trying to grow the program to better serve patients in Central, Western and Southern Virginia, as well as West Virginia. We are also looking to incorporate new technologies such as ex vivo lung perfusion to make the transplant procedure safer.
What unique challenges has COVID-19 presented?
First, the lung disease people are getting with COVID-19 can be quite challenging to treat because air can leak out of the lung inside of the chest wall, and also cause bleeding complications. It’s been a real problem for some of these patients. It causes more of a severe fibrosis than other viruses in a larger population of patients. The flu does a similar thing with respiratory failure, but the lung damage is different, and it can take a very long time to recover in some cases.
The patients who have required the most care are the ones with lung failure. We’ve had some patients recover on ECMO, but it’s taken months. The infrastructure that UVA has in ECMO, being able to take on these long cases, may be unique in central Virginia. We are always learning in these uncertain times, and gaining experience in COVID-19 is a challenge, but one that is developing as both the medical and surgical teams care for these complex patients.
COVID-19 has also been a new source of lung transplant patients. We’ve now done four double lung transplants for COVID patients at UVA. Hopefully we won’t be seeing a greater number of patients who need lung transplant as a result of COVID-19 in the future, but there are a lot of unknowns still.
What are your research interests?
I’ve been involved in research at other places that I hope to also do at UVA. One is improving the blood supply of the stomach before esophagectomy or pre-operative conditioning of the stomach. This involves a staging procedure, a short outpatient laparoscopic procedure done about a month before esophagectomy. It involves taking out some of the blood supply we would ordinarily take during the main esophagectomy. Doing it at a different time, the stomach then improves or reroutes its blood supply after the procedure, which improves healing in this complicated procedure.
In addition, I also hope to continue looking at outcomes around our different procedures, how can we improve. Some of this we’re already doing at UVA with enhanced recovery after surgery.
What would you like referring providers to know about your practice?
I am always happy to answer any questions if someone has a referral to try to find a solution for these patients. I enjoy thoracic surgery for many reasons, but one is because it encompasses a very wide variety of conditions –the variety of unusual things that come up in thoracic patients keeps it a very interesting field. Also, we have a very enthusiastic team for both lung transplant and general thoracic surgery, and I can guarantee we will do our best to provide the very finest care for their patients.
Title: Assistant Professor
Residency: University of Cincinnati, Surgery
Fellowship: Duke University, Thoracic Surgery
You attended medical school at UVA, correct? Why did you decide to return at this point in your career?
Yes, I completed undergraduate and medical school at UVA. I thought this presented a great opportunity to come back to an institution I always respected. I got a great medical education here and I always enjoyed the culture. During my time at the University of Colorado, my first job out of training, I had a chance to develop and grow a couple clinical programs, which was a great experience. But the opportunity arose to come to Charlottesville to share some of the interests and programs I had developed in Colorado and bring that expertise here by contributing to the lung transplant program and the Department of Surgery.
Another really big reason I decided to come back is family. I have family in Virginia and my wife has family in Ohio. Having an 18-month-old now, it was difficult being so far away in Colorado. Everyone experienced new challenges during the pandemic. While it was just a moment in time, hopefully it did highlight what’s important and we realized we wanted to make family a priority. So the move to UVA was the perfect opportunity in all of those respects.
Talk about your accomplishments at the University of Colorado.
I was there for three-and-a-half years. In terms of clinical programs, I started and was director of the robotic thoracic surgery program. Prior to that, they didn’t have one. I joined a group of three other surgeons to get the program going and others got really interested in it. There were about six months involved in training all of them, getting them up to speed and then, collectively, we were able to create a nice, busy robotic program. Through that process, we cultivated many clinical research projects involved in training both residents and fellows. We were also designated a national mentor site for robotic thoracic surgery, meaning people not in the practice who wanted to learn how to do these techniques were able to visit, observe surgeries and then we were able to then mentor them through the process and initiate those programs at their own institutions.
I am a national proctor for thoracic surgery, so I’ve done many national proctoring engagements. I go out and train surgeons, whether in the community or academic practices. I help them through cases and help train their teams. I’ve been involved for a few years now with national curriculum in terms of training surgeons. This is one area I’m very interested in — teaching and training and the research that goes along with that program.
Another program I was heavily involved in starting and getting off the ground was surgery for chronic thromboembolic pulmonary hypertension. This is a really severe disease that affects people who develop pulmonary embolism. In small percentage of patients, this turns into a chronic and occlusive disorder. It blocks up pulmonary arteries and leads to significantly elevated pulmonary artery blood pressures and heart failure related to that.
Before I went to Colorado, they did not have a surgical treatment strategy in place, so patients were being sent to California. But we were able to put together a multidisciplinary team of pulmonologists, surgeons, cardiologists, radiologists and ancillary staff to offer support necessary. We started seeing these patients and performing operations, which was very satisfying experience for me as well.
Now we are starting the process at UVA to put together our own multidisciplinary team to get that program up and going here. They have been very receptive to that.
Will you be involved in lung transplant as well?
Yes, actually the chronic thromboembolic pulmonary hypertension program piggybacks onto my involvement in lung transplantation. In some situations, lung transplantation is required for these patients. It’s a good merger between my two interests. I’ll be partnering with Dr. Carrott, the surgical director of lung transplant, to do more of these surgeries.
How would you describe the robotic thoracic surgery program at UVA?
I would say it’s evolving rapidly. When I started in Colorado in 2017, robotics wasn’t a new thing, but it wasn’t as widespread. But there has been continual, steady growth and it’s nice to see that here, UVA is already doing a good volume of robotic surgery — not so much in thoracic, but in other surgeries. I am on a committee now to help further the adoption of this technology. We’ve acquired several more robotic platforms to help open up availability and be able to do these cases. It’s an exciting time as we’re growing the infrastructure. The interest is definitely there – and so, bringing those two elements together, we’ll be able to accelerate our growth in robotics.
For my minimally invasive thoracic surgeries, my practice is to use a surgical robot for every aspect of surgery, whether the patient has issues with their lung, perhaps a lung cancer, or an issue with the esophagus, an esophageal cancer or benign esophageal problem like reflux or hiatal hernia, a mediastinaltumor or mass, or disorders of diaphragm like diaphragm paralysis.
I do all of these cases using surgical robot and I’ve found that it’s excellent technology for it. Really, it’s my preferred method. I’ve seen awesome outcomes with this and I’m offering that option to all of my patients.
Of course, there is always the discussion of what would be the best option for any particular patient. Sometimes it’s invasive, sometimes no surgery, sometimes open surgery … having the ability to have that conversation and offer whatever treatment is needed is really important for patients coming to see us here so they have a comprehensive array of options. We want to come up with the best strategy or game plan to treat each patient individually.
What are the advantages of choosing UVA for this type of procedure?
I think that choosing UVA for thoracic surgery is an incredibly wise decision. From a patient perspective, there are options out there in terms of where they might want to be treated. In field of thoracic surgery, a lot of procedures we do have more than a trivial amount of risk and complication involved. While most of our cases are complication-free, when they do arise, you want to be in a place that has expertise and resources to be able to get you through that.
When you think about conditions like lung or esophageal cancers that require a multidisciplinary approach, it really does take an army to treat these types of patients – lung transplant would be at the top of this list. It really does take an army to navigate those patients through the process safely. All of testing required, all of support services. Those can be quite complex situations.
Another huge reason to choose UVA over other regional institutions is that we can offer every option in terms of surgical and non-surgical treatments depending on the complexity of the case. We make sure patients get through treatment safely with the best outcome possible for each individual.
What do you find most rewarding about your work?
For me, I’ve found multiple aspects equally rewarding. I really enjoy patient interactions, seeing a patient from beginning of their diagnosis, getting them through whatever treatment they need, whether it’s surgery or not, and seeing how they do after. In thoracic surgery, there’s a lot of continuity. We start our relationship at the beginning. Often, we become one of the main doctors involved. That interaction with the patient and the team involved in navigating them through — that is rewarding.
Of course, successful treatments and surgeries are incredibly rewarding. The other area I find rewarding is the interaction amongst various specialties, the training we provide here at UVA with our advanced fellows and residents, and the environment of learning. I’ve been impressed that no matter how senior a physician or surgeon you are, we’re constantly learning from each other. While you might be teaching someone else, I think in my experience that’s often the time I’ve learned the most. That’s a really awesome part of my daily experience and definitely something that attracted me to UVA. I wanted to stay in a very academic environment where education, training, research and innovation were at the forefront.
Lastly, besides patient care and training, I’m really interested in innovating. I think robotics lines up with that pretty well. Through innovation and research, we have come up with some very novel approaches to treating diseases and offering more options for patients from a surgical standpoint and being involved in that process has been really rewarding and an area I really enjoy as well.
Will you be involved in clinical trials?
I currently don’t have any trials I’m the PI on, but there are many trials in the area that I work, including thoracic oncology. The cancer patients I see are all evaluated in a multidisciplinary cancer conference where we discuss what active trials are available to them. I may not be the PI, but all trials we have at UVA are open to patients I see. It is a team-based approach in that effort.
What else would you like referring providers to know about your practice?
I want referring providers to know that I’m going to take the best care of their patient as possible, to treat them as any of us would want to be treated. Even if they think surgery may not be indicated, it does not mean I wouldn’t be happy to see them. We just never know and I hate for someone to hesitate to send a patient to me because they thought he may not be a surgical candidate or a fruitful interaction. I am happy to see anyone if there’s a chance they need surgery or if they just want to speak to a surgeon. Also, I really try to close the loop with all referring providers to make sure they’re in the loop with what we’re doing. Keeping the lines of communication open is really important to help ensure the patient has a positive experience.
To refer a patient to UVA Health, call UVA Physician Direct at 800.552.3723.