The sparkle of creativity
2020; Elsevier BV; Volume: 160; Issue: 3 Linguagem: Inglês
10.1016/j.jtcvs.2020.03.176
ISSN1097-685X
Autores Tópico(s)Science, Research, and Medicine
ResumoCentral MessageThinking creatively leads to new discoveries and better ways to do things, enhances personal well-being and self-worth, and ultimately benefits our patients.PerspectiveSince their inception, cardiothoracic surgery and molecular biology have been the most forward moving specialties in medicine. We stand on the shoulders of giants, who forged solutions to problems by thinking creatively and "out of the box." In recent years, physicians have been overwhelmed with the burdens of modern-day practice. We must rededicate ourselves to being creative individuals, who have the potential to solve problems in our field and better the outcomes and experiences of our patients. Thinking creatively leads to new discoveries and better ways to do things, enhances personal well-being and self-worth, and ultimately benefits our patients. Since their inception, cardiothoracic surgery and molecular biology have been the most forward moving specialties in medicine. We stand on the shoulders of giants, who forged solutions to problems by thinking creatively and "out of the box." In recent years, physicians have been overwhelmed with the burdens of modern-day practice. We must rededicate ourselves to being creative individuals, who have the potential to solve problems in our field and better the outcomes and experiences of our patients. It has been my privilege to serve as the 43rd President of the Western Thoracic Surgical Association. This experience has been a great honor and certainly a highlight of my career. When one stands up at the podium, you realize that this moment is not about you. Rather, it is a celebration of all the people who have inspired and supported you both in life and in surgery. I would like to recognize a few of these people. I grew up in a large family with 2 brothers and 2 sisters. I was the middle daughter and the fourth child. My siblings have had an enormous impact on who I am today. Growing up together, we supported each other in good times and in bad times, as only a family can. My sister, Susie, is the eldest and is 11 years older than me. She is the free-spirit of the family. Susie recently retired from a long career as an anesthesiologist in Bethesda, Maryland. She raised 4 children, 3 of whom became physicians. I appreciate her motherly support and love, particularly when I was young. My brother, Dick, is 1 year younger than Susie and 10 years older than me. He is considered the smart one in the family. Dick recently retired from a career as an abdominal transplant surgeon at the University of Chicago. He is 1 of the 3 surgeons who performed the first split-liver transplant in the world. His wife, Susan, is a PhD theologian and author of more than 10 books. Together, they have raised James, a physicist and MBA in Chicago; Bill, a family practice doctor in northern Virginia; and Doug, an exhibit designer for the Exploratorium in San Francisco. I'm grateful for all the personal and professional advice that Dick has given me over the years. My brother Bill was 2 years older than me. He was the star athlete of the family. Bill married a Southern girl, Mary Jane, and practiced general surgery for many years in Mayfield and Glasgow, Kentucky. He loved small-town life, coaching high school lacrosse and serving as the high school football team doctor. Bill and Mary Jane raised 2 phenomenal individuals: Taylor, an antique dealer in Washington, DC, and Clay, a geologist in Louisville. Last August, Bill was diagnosed with a very aggressive form of cancer. He succumbed to this disease in March. In the months before his death, we had many conversations together. He told me that no matter what, he would be here today for me. Bill, you are here in spirit. I am delighted that Bill's wife, Mary Jane and son, Clay, are here today to represent that branch of the family and celebrate my big day. My sister Peggy and I grew up almost as twins, although I'm actually 2 years older than she is. She has been my confidant and close friend my entire life. She is a retired general surgeon, who has been married for many years to Bob, a urologist in Northern Virginia. Together they have raised 2 great children: Ashley, a lawyer in Central Virginia and Robby, a civilian defense contractor in Washington, DC. I'm so happy that Peggy and her family are here today to support me. Thank you. It is easy to trace my interest in cardiothoracic surgery to the surgeons at the Massachusetts General Hospital. Drs Grillo and Vlhakes and the residents who worked under them were the most technically gifted and most knowledgeable of the entire hospital staff. After my general surgery residency at the Massachusetts General Hospital, I moved to Pittsburgh for my cardiothoracic surgery training at the University of Pittsburgh, under Dr Bartley Griffith. Dr Griffith is a true gentleman and pioneer in ventricular assist devices and heart and lung transplant surgery. He taught me a lot about heart surgery, a lot about how to be a leader, and a lot about life. Drs DiMarco and Kormos were consummate surgeons and superb teachers. I am grateful that they helped make me into the surgeon that I am today. It is said that timing is everything in life. Completing a cardiothoracic surgery residency in 1997 was perfect timing, because a position opened up at the University of California, San Diego (UCSD). I am honored to have Dr Stuart Jamieson here today. What do you say to the person to whom you owe your career? I've learned from your guidance that the most important quality a chairman and mentor can possess is that he/she believes in you through mistakes and missteps and sees them as lessons learned. One who inspires you, gives you confidence, and keeps you on the ball. The greatest surgeons possess the following characteristics: maturity of judgment, dexterity of hand, devotion to teaching, serenity in crisis, and creativity in endeavor. You possess all of these qualities. I am honored to be your protégé. Michael Madani, my current chairman, I am awestruck by your technical ability, your passion for our specialty, and your eternal optimism. I have also been fortunate to work with Dr Brian Clary, our Chief of Surgery at UCSD. He is a visionary chairman, a "can-do" kind of guy, and a true physician–scientist. I would also like to acknowledge all the cardiothoracic surgeons in our division as dear friends and colleagues that I hold in highest esteem. Each is a dedicated, focused, academic surgeon who strives to make a difference every day and move our specialty forward. I thank all of you for your support and for being here today. I have 2 close friends who I have known most of my life that I would like to mention. Dwight Nishimura and I met on our first day of college, as we were assigned to the same freshman dorm. He came from Hawaii, and I came from Maryland; about as far apart as 2 people can be from Palo Alto. Yet, we became the closest of friends. Dwight currently serves as the Chair of the Department of Electrical Engineering at Stanford. I so value all the phone conversations we have had over the years, covering every imaginable idea and subject. Dwight, you have been a true friend. Karen Parolin and I met in the early days of medical school, living in a Harvard dorm with a class of 160 men and just 10 women. She is a retired endodontist and is one of the most energetic people I know. A normal day for Karen would be to ride her bike 125 miles or climb an 8000-foot elevation mountain in a few hours. I am grateful for her friendship and the support that she has given me in good times and bad. I found love late in life in the form of John Gwynne. It is as if opposites attract. John is a research psychologist and is a quiet, inquisitive person. He loves the great outdoors. His idea of a perfect day is to be walking alone in the wilderness. Together, he has shown me some of the most beautiful, remote places in California. We have also traveled the world together. I am grateful for his loving support through all the challenges and victories of life. Finally, I would like to thank my parents. If they were alive today, my mother and father would have been very proud. My parents had the firm belief that children should be well-educated and independent. My father was a general surgeon who absolutely loved what he did. I saw this many times over, as he went out late at night to do emergency cases or when he missed family holidays and celebrations to take care of his patients. Several of his colleagues have told me that he was the most naturally-gifted surgeon they had ever seen. I wish I could have operated with him. One of his colleagues also told me that he was the type of person who would walk into Mortality and Morbidity Conference or case conference and sit quietly in the back of the room. Everyone in the front of the room would discuss and argue about patients and problems. After a while, all would turn to the back of the room, waiting to hear the final definitive opinion of my father. My dad also loved to fly fish, saying that trout lived in the most beautiful places in the world. He went on fly fishing trips on the Potomac River near my childhood home, as well as on excursions abroad, taking my mother along. She always wanted to be with him and make him happy. With my dad's love of fishing, many of my life's lessons were learned while floating on a bass boat amongst the reeds of a sound or holding a surf rod at the ocean's edge. I am grateful for the goodness that was my father. He taught me the strength to jam my hands in my pockets and meet the wind and the salt in my eyes, to keep my balance on shifting sand, and to stand tall against the undertow of sadness and self-doubt. When I think of my father in all of his glory, it makes my heart sing. My mother was the unsung hero of our family. She single-handedly raised 5 successful children, never complained, always led by example, stood for what she believed in, and most importantly, always put everyone else before herself. She was a true genteel, gracious Southern woman. I am grateful for the unconditional love that both my parents gave me. Today, I would like to talk about the elusive topic of creativity. Let us begin in Istanbul, Turkey, near the Strait of the Bosphorus. In 532 A.D., at the beginning of the Middle Ages, the Roman emperor, Justinian I, commissioned the building of a great cathedral, called the Hagia Sophia (Figure 1).1Hagia Sophia.https://en.wikipedia.org/wiki/Hagia_SophiaDate accessed: October 1, 2019Google Scholar The cathedral was designed by 2 Greek mathematicians, Isidore of Miletus and Anthemius of Tralles. Neither individual had ever designed a building before. What was unique about the Hagia Sophia is its mammoth dome and underlying architectural support to hold up this dome. The dome measures 108 feet in diameter and 182 feet tall, is 2 feet thick and composed of mortar mixed with brick shards, and weighs 150 pounds per square foot. In contrast to all other Greek and Roman buildings up until that time, which had domes that rested on the external walls of buildings, the dome of the Hagia Sophia rested on 4 internal arches, held together at the top by pendentives or concrete triangular corners. The columns of the arches were marble and were mined from all over the Roman Empire, as far away as Ireland and Egypt. The architectural concept of this building was innovative in that the dome sat in a "tongue-in-groove" fashion into the circular opening formed by the top of the 4 pendentives and 4 arches, preventing lateral displacement of the base of the dome and collapse.2Mainstone R.J. Hagia Sophia: Architecture, Structure, and Liturgy of Justinian's Great Church.1st ed. Thames and Hudson, London1988Google Scholar The pendentives overlying the columns of the arches held most of the weight. In 1453, Constantinople was conquered by the Ottomans. Sultan Mehmet II rode his horse into the cathedral, proclaimed it the most beautiful building he had ever seen, and promptly declared it a mosque. In 1935, the building became a non-secular museum of Turkey. To this day, the Hagia Sophia is one considered one of the most creatively-designed structures in the world and is the greatest surviving example of Byzantine architecture. Seven hundred fifty years after completion of the Hagia Sophia, the townspeople of Florence, with the support of the Medici family decided to build a grand cathedral, named the Cathedral de Santa Maria del Fiore or Cathedral of Saint Mary of the Flower (Figure 1).3Florence Cathedral.https://en.wikipedia.org/wiki/Florence_CathedralDate accessed: October 1, 2019Google Scholar Construction was begun in 1300 and the nave, or bottom portion of the building, was completed 118 years later. In 1418, a competition was held to pick the architect to design the dome that would cover the transept of the cathedral. A 35-year-old clock-repair man named Filippo Brunelleschi submitted an application and refused to reveal his architectural plans to the judging committee. He had never studied architecture, nor had he ever designed a building before this competition. Ultimately, he won the commission and designed one of the greatest masterpieces of the Renaissance. It took 16 years to build the dome, which was built on top of the outer octagonal-shaped walls of the transept. From each point of the octagon, 8 vertical curving ribs of sandstone were constructed to meet at the apex of the dome. The inner shell of the dome was made of brick, arranged in a herringbone pattern, while the outer shell of the dome was constructed of tile on marble. The design of the dome was innovative in that structural stability was achieved through the use of concentric horizontal, internal bands of sandstone and iron chain embedded within the inner dome, which served like barrel hoops, holding the dome structure in place and preventing lateral collapse.4King R. Brunelleschi's Dome: How a Renaissance Genius Reinvented Architecture.1st ed. Chaatto and Windus, London2000Google Scholar To this day, the Duomo di Firenze, as it is now called, is the largest brick masonry dome in the world. It is 125 feet wide, 376 feet tall, weighs 40,000 tons, and was constructed using over 4 million bricks. The Duomo is considered the greatest architectural achievement of the Renaissance and an expression of unparalleled innovation and creativity. Both of these grand structures were designed by men who had no architectural experience, yet they had a great creative vision. The architects of the Hagia Sophia and the Duomo never met one another, never studied each other's plans for their domed buildings, and came from different countries and cultures. They devised completely different solutions for the same problem: how to create a large domed building that has withstood the test of time. It is as if these creative individuals existed in parallel universes. I was born just before 1960, and during my lifetime, I have witnessed the burgeoning of 2 creative parallel universes in medicine—that of cardiothoracic surgery and genetics/molecular biology. Each is a young specialty, starting near the time of my birth. Both fields are, I believe, the most forward-thinking and innovative specialties in medicine today. We stand on the shoulders of giants. I would like to review some of the most creative moments in these 2 fields over the past 60 years (Figure 2). In 1956, if one needed a pacemaker, you would be hooked up to a large device that required its own cart and relied on wall current for power. In October 1957, there was a 6-day blackout in Minneapolis, Minnesota. At that time, C. Walton Lillihei was beginning to correct congenital heart defects in children, using a cross-circulation technique with the mother. He realized that he needed a reliable way to pace his congenital heart surgery patients in the postoperative period. Dr Lillihei asked a 27-year-old oscilloscope repair technician in the hospital, named Earl Bakken, to devise a portable, battery-driven pacemaker for human use. Four weeks after studying a circuit diagram for a metronome in Popular Electronics in his garage workshop, Mr Bakken delivered a battery-powered, transistorized, external pacemaker to Dr Lillihei.5Lillihei C.A. Gott V. Hodges P. Long D.M. Bakken E.E. Transistor pacemaker for treatment of complete atrioventricular dissociation.J Am Med Assoc. 1960; 172: 2006-2010Crossref PubMed Scopus (58) Google Scholar Much to Mr Bakken's surprise, the pacemaker was used the next day in an 8-year-old boy, who underwent atrial septal defect repair. The first fully implantable pacemaker was designed in Stockholm, Sweden, by an engineer named Rune Elmqvist and was first implanted by Drs Ake Senning and Clarence Crafoord at the Karolinska University Hospital in 1958.6Elmqvist R, Senning A. An implantable pacemaker for the heart [abstract]. Second International Conference on Medical Electronics. 1960. In: Aquilina, O. A brief history of cardiac pacing. Images Paediatr Cardiol. 2006;8:17-81.Google Scholar If our goal as physicians is to alleviate suffering and to prolong meaningful life, I can think of no other invention that has been as effective. In 2018, there were 40 million people with pacemakers and 1.4 million pacemakers implanted worldwide. In the United States, there were 3 million people with pacemakers and 250,000 implanted that year.7Puette J.A. Pacemaker. StatPearls – NCBI Bookshelf. Treasure Island. Stat Pearls Publishing, FL2018https://www.ncbi.nlm.nih.gov/books/NBK526001/Date accessed: October 1, 2019Google Scholar Now, Food and Drug Administration–approved, implantable pacemakers are leadless and are smaller than the size of a nickel. Indeed, the Poon pacemaker that is powered and recharged remotely, which is under development at Stanford University, is smaller than a grain of rice.8Ho J.S. Yeh A.J. Neofytou E. Kim S. Tanabe Y. Patlolla B. et al.Wireless power transfer to deep-tissue microimplants.Proc Natl Acad Sci USA. 2014; 111: 7974-7979Crossref PubMed Scopus (339) Google Scholar Clearly, the field of pacemaker technology has been a fertile area of creative design and innovation. In 1957, Francis Crick proclaimed, "I have solved the mystery of life."9Lawrence P.A. Francis Crick: s singular approach to scientific discovery.Cell. 2016; 167: 1436-1439Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar Francis Crick had solved the chemical structure of DNA, but he had not solved the mystery of life. At that time, it was unknown whether DNA encoded amino acids, sugars, or other compounds. It took a 35-year-old scientist from the National Institutes of Health (NIH), named Marshall Nirenberg, to crack the genetic code. Dr Nirenberg ran a small lab with one postdoctoral fellow. Although there were many large labs around the world that were trying to figure out what DNA encoded, including the lab of Francis Crick, Nirenberg thought that he would work on this problem. He hypothesized that the smallest "DNA word" or codon would be a nucleotide triplet that would encode a single amino acid. His reasoning was based on the fact that DNA contained 4 different nucleotides: adenine, guanine, cytosine, and thymine, whereas there were 20 known amino acids. Thus, one nucleotide could not encode one amino acid, because there were not enough nucleotides. Likewise, 2 nucleotides in random combination would yield only 16 permutations, so a doublet of nucleotides would not account for 20 amino acids. In 1961, Nirenberg devised his famous experiment to test whether a triplet of nucleotides would encode a single amino acid.10Nirenberg M.W. Matthaei J.H. The dependence of cell-free protein synthesis in e. coli upon naturally occurring or synthetic polyribonucleotides.Proc Natl Acad Sci U S A. 1961; 47: 1588-1602Crossref PubMed Scopus (797) Google Scholar He used a cell-free system while the rest of the world was studying this question in bacteria. Nirenberg took Escherichia coli and ruptured their membranes with sonication, creating a bacterial-protein "soup." He placed this mixture into 20 test tubes. Into each test tube, he added a different single 14C-labeled amino acid and 19 other cold amino acids. Nirenberg then added poly-uracil (UUU) into each tube. He hypothesized that if UUU encoded a single amino acid, the cell-free mixture would start to produce a long chain of a single amino acid. If the 14C-labeled amino acid in the test tube was similar to the one being produced, the radiolabeled peptide would be incorporated into the growing peptide chain, which could then be isolated by size filtration through a series of membranes. On the first test tube he examined, he found that UUU stimulated the production of a long phenylalanine chain that incorporated the radiolabeled phenylalanine. Nirenberg realized that he had cracked the genetic code for a single amino acid. Knowing that his lab was small and the competition was fierce, he called the heads of the each Institute at the NIH and asked them to bring their best researchers to his lab to help him perform the massive number of experiments that would be needed to put together all combinations of triplet nucleotides in his experimental system. They enthusiastically came and helped him, knowing that a Nobel Prize was likely at stake. This group effort has come to be known as "NIH's finest hour." In December 1961, the entire genetic code was determined.11Nirenberg M.W. Matthaei J.H. Jones O.W. Martin R.G. Barondes S.H. Approximation of genetic code via cell-free protein synthesis directed by template RNA.Fed Proc. 1963; 22: 55-61PubMed Google Scholar I grew up a few miles from the NIH in Bethesda, Maryland. There is a wonderful museum there where one can see the actual vial of UUU that Nirenberg used for his experiment. Marshall Nirenberg went on to win the Nobel Prize in Medicine in 1968. He is the only scientist at NIH to have ever won a Nobel Prize. In the 1970s, researchers who were interested in cancer were studying retroviruses, which caused tumors in chickens and mice. Scientists were sequencing the genomes of these viruses, which was not an easy thing to do at that time. They found specific genes in these viruses that encoded polypeptides, which they felt were crucial to carcinogenesis in animals. These viral genes were named "oncogenes." A young postdoctoral fellow in the laboratory of J. Michael Bishop, MD, at the University of California, San Francisco, named Harold Varmus, asked the simple question, "Does the human genome contain oncogenes, like those found in retroviruses?" He probed the human genome for these sequences and found, indeed, that every human cell contains what he termed "proto-oncogenes" or silent oncogenes.12Varmus H. The molecular genetics of cellular oncogenes.Ann Rev Genet. 1984; 18: 553-612Crossref PubMed Scopus (497) Google Scholar In normal cells, proto-oncogenes are not expressed and silenced. However, in cancer cells, proto-oncogenes are altered, either by: (1) deletion or point mutation, (2) gene amplification, or (3) chromosomal rearrangement causing splicing of nearby regulatory sequences next to the gene to induce overexpression or fusion of an actively-expressed gene with an oncogene, resulting in a protein that is hyperactive.13Spector D.H. Varmus H.E. Bishop J.M. Nucleotide sequences related to the transforming gene of avian sarcoma virus are present in the DNA of uninfected vertebrates.Proc Natl Acad Sci U S A. 1978; 75: 4102-4106Crossref PubMed Scopus (137) Google Scholar Look at where this field has gone in the past 30 years. Now we know that there are specific oncogenic driver mutations in most forms of cancer. For example, in adenocarcinoma of the lung, there are now 14 known driver mutations (ALK, EGFR, MET, ROS being the most common), whereas in squamous cell carcinoma of the lung, there are 7 known driver mutations (FGFR1, KRAS, PIK3CA, and EGFR being the most common).14Yoda S. Dagogo-Jack I. Hata A.N. Targeting oncogenic drivers in lung cancer: recent progress, current challenges and future opportunities.Pharmacol Ther. 2019; 193: 20-30Crossref PubMed Scopus (42) Google Scholar Targeted molecular therapy drugs are now made to first-, second-, and third-generation mutations in these gene targets. Targeted therapy drugs have been remarkably effective. For example, a patient with stage 4 non–small cell lung cancer whose tumor harbors an EGFR exon 19 or 21 mutation has a 4-fold survival advantage at 40 months compared with a patient whose tumor lacks oncogenic mutation and who receives conventional chemotherapy.15Maguire F.B. Morris C.R. Parikh-Patel A. Cress R.D. Keegan T.H. Li C.S. et al.First-line systemic treatments for stage IV non–small cell lung cancer in California: patterns of care and outcomes in a real-world setting.JNCI Cancer Spectr. 2019; 3: pkz020Crossref Scopus (9) Google Scholar Today, liquid biopsies (blood biopsy) for cell-free circulating tumor DNA are being used for early screening for cancers, markers of recurrence of malignancy, and stratifying response and resistance of tumors to therapy. The identification of oncogenic driver mutations has led to molecular genotyping of tumors for targeted therapy, as well as drug development for personalized therapeutics. I suspect that, in the future, assays for cell-free circulating tumor DNA will become so sensitive and specific as to allow physicians to diagnose cancers before they are clinically manifest. For their discovery of proto-oncogenes and the mechanisms of their activation, Drs Varmus and Bishop were awarded the Nobel Prize in Medicine in 1989. One of the paradigm-shifting changes in cardiac surgery occurred in 1983, when Alain Carpentier, MD-PhD, of the European Hospital of Georges Pompidou in Paris published his work on mitral valve repair in the Journal of Thoracic and Cardiovascular Surgery, entitled "Cardiac Valve Surgery—the French Correction."16Carpentier A. Cardiac valve surgery—the "French correction".J Thorac Cardiovasc Surg. 1983; 86: 323-337Abstract Full Text PDF PubMed Google Scholar This paper outlined the basic pathophysiological classification of mitral valve lesions and provided the tools and essentially a game plan for how to successfully and reproducibly repair mitral valve regurgitation, particularly for degenerative myxomatous mitral valve disease. Many cardiac surgeons throughout the world were inspired by this paper to perform mitral valve repair instead of mitral valve replacement. Mitral valve repair was further refined by several other pioneers in this field, including Carlos Duran, MD-PhD, who recognized the importance of using a flexible mitral ring for recreation of a dynamic annulus, D. Craig Miller, MD, at Stanford, who showed that preservation of the posterior leaflet and chords preserved left ventricular geometry over time, Tirone David, MD, at Toronto General Hospital, who I trained with and who recognized the importance of the fibrous trigone in designing partial rings, and Lawrence Cohn, MD, at the Brigham and Women's Hospital, for his large series of patients who underwent mitral valve repair. Today, mitral valve repair has been shown to be superior to valve replacement for many types of mitral stenosis and regurgitation, with the exception of severe rheumatic calcific mitral stenosis, mitral insufficiency in the setting of massive acute infarction, and mitral valve endocarditis where leaflets are destroyed.17Jouan J. Mitral valve repair over 5 decades.Ann Cardiothorac Surg. 2015; 4: 322-334PubMed Google Scholar Whether one is performing a posterior leaflet repair with P2 resection or more complex anterior leaflet repairs with chordal reconstruction, mitral valve repair has come of age. In addition, the concept of valvular repair over replacement has led to pioneering repair techniques for the tricuspid and aortic valves in adults. Importantly, the basic principles of valve repair are now being used in designing percutaneous, less-invasive repairs of the mitral and tricuspid annuli and leaflets. 1992 was a major year for innovation and creativity in cardiothoracic surgery, as this was the year that the first successful reports of video-assisted thoracoscopic lobectomy (VATS) and thoracic endovascular aortic repair (TEVAR) were published. Although several surgeons between 1920 and 1940 attempted to put probes, lights, and other instruments into the chest to break up tuberculous adhesions, it wasn't until 1991 that that the first successful thoracoscopic lobectomy was first performed by Ralph J. Lewis, MD.18Lewis R.J. Caccavale R.J. Sisler G.E. Bocage J.P. Mackenzi J.W. One hundred video-assisted thoracic surgical simultaneously stapled lobectomies without rib spreading.Ann Thorac Surg. 1997; 63: 1415-1421Abstract Full Text PDF PubMed Scopus (40) Google Scholar Dr Lewis had seen the pioneering use of laparoscopy for gynecologic disorders and translated this technology to use in the chest. Subsequent to this, VATS surgery evolved by modifications made by Stephen Hazelrigg, MD, Rodney Landreneau, MD, who I trained with, Keith Nauheim, MD, and Mark Ferguson, MD. In the modern era, I think of Robert McKenna, MD, on the West Coast and Thomas D'Amico on the East Coast as the major teachers and innovators in this field. A minimally invasive approach to lung surgery has been shown to be superior to conventional thoracotomy with respect to length of hospital stay, postoperative pain and recovery, and return to work,19Whitson B. Groth S.S. Duval S.J. Swanson S.J. Maddaus M.A. Surgery for early-stage non-small cell lung cancer: a systematic review of the video-assisted thoracoscopic surgery versus thoracotomy approaches to lobectomy.Ann Thorac Surg. 2008; 86: 2008-2016Abstract Full Text Full Text PDF PubMed Scopus (509) Google Scholar while allowing adequate visualization and not compromising the thoracic surgeon from performing a definitive oncologic re
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