Video-Atlas of VATS Pulmonary Sublobar Resections

1. Can you share a bit about your journey to becoming a Consultant Thoracic Surgeon, and what inspired you to specialize in minimally invasive thoracic surgery?

As you well know, the path to becoming a consultant surgeon is not easy… After studying at the multi-centennial University of Valladolid (the oldest Medical School in Spain, founded in 1404), I passed the national MIR exam to access our specialized medical training program.

Then I moved to the beautiful city of Valencia to invest the next 5 years in my specific training as a surgeon, at the General University Hospital. I think it took a few more years to acquire a certain "surgical solvency", once I moved to my current position, at the Clinical University Hospital of Valencia. Here I had the opportunity to develop a minimally invasive surgery program, as well as a progressive incorporation of anatomical segmentectomies into our clinical practice.

What inspired me to follow this path were the clear advantages we observe in the post-surgical recovery of our patients through these approaches and techniques, without a doubt some of the most relevant achievements of recent decades to reduce pain, risk of complications and hospital stay.

2. As the Coordinator of the Teaching Committee in the Spanish Society of Thoracic Surgery, how has your role influenced your approach to educating fellow surgeons?

Well, before acquiring this responsibility I already had experience in training residents, but of course now I see everything from a broader perspective and I think I better understand the needs of the new generations. At the Spanish Society of Thoracic Surgery we try to offer a multidisciplinary teaching plan, with special emphasis on the development of technical skills but also extensive oncological knowledge, scientific communication strategies, bioethics, artificial intelligence.

3. Your book, "The Video-Atlas of VATS Pulmonary Sublobar Resections," is focused on operative technical aspects. What motivated you to create a multimedia reference book specifically for Thoracic Surgeons?

The four editors of the Video-Atlas shared a concern: we wanted to offer a publication that unified all the technical knowledge around anatomical lung segmentectomies. To date, no one had carried out a similar project in this format, including detailed videos of each procedure, so the challenge was even greater. But we thought the effort was worth it, to provide a valuable tool for the global community of Thoracic Surgeons, especially considering that these surgical techniques are on the rise and learning them is not easy without adequate guidance. We surgeons love to operate, so there is no greater motivation than helping your colleagues operate better.

4. Could you elaborate on the importance of minimally invasive techniques in thoracic surgery and how your book contributes to the field?

As I mentioned before, minimally invasive lung resection techniques have made a key contribution to improving the results of our surgeries, with a significant reduction in morbidity and mortality. For example, we have reduced the risk of complications or death after an anatomical lung resection by half, as well as improved postoperative pain rates and decreased hospital stays. Our book fundamentally contributes to the technical mastery of the most complex type of lung resection, which is often a challenge even for experienced surgeons. In this way, we hope to provide greater confidence and security when performing these procedures.

5. The book features anatomical 3D reconstructions and bronchoscopic anatomy illustrations for each segmentectomy. How do these visual elements enhance the learning experience for the readers?

Extensive knowledge of intrapulmonary anatomy is essential to perform a segmentectomy with guaranteed success. That is why we decided to include these 3D reconstructions and bronchoscopic images: to help readers in this sense and encourage them to delve deeper into the exciting world of segmental anatomy.

6. The main steps of the procedures are illustrated in high-definition video clips and figures. How do you believe this multimedia approach benefits thoracic surgeons in understanding and mastering the techniques?

Some previous publications have addressed the surgical technique of segmentectomies through text and static images, but we wanted to make a difference with absolute prominence of the videos, since we think it’s the best way to teach the different steps of each surgery in a precise, comprehensive and pleasant way. As an added benefit, this allows for synchronized narration by the authors, further enriching the learning experience.

7. In your book, expert authors provide specific tips & tricks for successful resections. Can you share an example of a particularly valuable tip that you believe could significantly impact a surgeon's practice?

Wow, that's a great but difficult question... I'll choose two tips, actually related: focus on your patients' results, not your own ego... and look for windows, not mirrors to inspire you.

8. Anatomical variations are also highlighted in HD video clips. How crucial do you think it is for surgeons to be well-versed in handling variations, and how does your book assist in this aspect?

Anatomical variations are really the key to sublobar resections. A high percentage of mistakes and complications in these procedures are explained by misinterpretation of the anatomy. So a thorough description of all these variations is made in each chapter of the video-atlas, not only mentioning them, but also describing how to handle them correctly.

9. How do you envision your book being utilized by thoracic surgeons in their daily practice and training?

Anatomical sublobar lung resections still represent a relative low percentage of the surgeries used in the treatment of lung cancer in our environment, but the scientific evidence published in recent years places it on a clear upward trend. So European and American Thoracic Surgeons are increasingly aware of the need to master these procedures. Our work can become a "bedside book" to help both trainees and more experienced surgeons in this task.

10. In what ways does the Video-Atlas serve as a valuable tool for both learning and improving surgical techniques in sub-lobar resections?

Highlighting again what has been said: the Video-Atlas presents a thorough review of the most frequent anatomical variations of segmental lung anatomy, it describes step by step the recommended technique for each segmentectomy, including tips and tricks based on the experience of the different authors and it also offers a video-summary of each complete procedure. The learning curve for these procedures can be long and even frustrating sometimes, so our goal is to make it easier.

11. Given the dynamic nature of medical advancements, how do you see the field of minimally invasive thoracic surgery evolving in the coming years, and how might this impact future editions or companion materials for your book?

Well, everything seems to indicate that technological advances in the field of Thoracic Surgery have only just begun, so possibly robotic surgery is the closest revolution in the short term. Although the current generations of surgical robots have not demonstrated conclusive advantages in the specific field of lung resection surgery, no one doubts this will change very soon. So perhaps our next edition of the Video-Atlas will focus on this approach, it is something that we editors have not decided yet.

12. Are there any upcoming projects or areas of research that you are excited to explore within the realm of thoracic surgery?

Maybe we could have another full interview to answer this question!

In summary, I would say that Thoracic Surgery is experiencing an exciting stage of development in many ways, so very diverse areas of research can be proposed. Personally, I find the most interesting those related to lung cancer screening and new trends in combined treatment with immunotherapy, although we cannot leave aside everything related to artificial intelligence, which is going to revolutionize our way of understanding Medicine.

13. As we conclude, what message or key takeaway would you like to convey to thoracic surgeons and readers who are considering delving into "The Video-Atlas of VATS Pulmonary Sublobar Resections"?

First of all, I would honestly recommend that they analyze what the real impact of developing an anatomical sublobar resections program may be in their clinical practice. There are certain environments in the world where the indications for these procedures remain quite limited.
Now, to all those interested in learning these techniques, which require deep anatomical knowledge and a long learning curve, I would strongly recommend trusting our work as a valuable tool to help them in their professional development. This Video-Atlas has been created with a very pragmatic approach, based on the difficulties that we editors ourselves have encountered along our way. And as far as we know, there is no published work with similar characteristics to date.

14. Is there anything else you would like to share with our readers about your book or your experiences as a thoracic surgeon and author?

Perhaps just a reflection about piracy and illegal access to scientific content: Of course our priority when publishing this book was to reach as many Thoracic Surgeons as possible, but from the perspective of the Editorial Team one realizes the damage that the illegal distribution of the content does. In a global world like the one we live in, we can only call for individual responsibility, so that it is possible to continue developing projects like this one.
And, of course, thank you all for your interest in our work. We have put a lot of effort and enthusiasm into it during the three years it has taken to publish it, and we trust it will become a really useful tool for many colleagues around the globe.

--Issue 03--