CT Surgery

[ollaguna]

Any info regarding CT Surgery Programs? Worse, middle teir, most competitive? Greatest variety of case, etc...

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[MS3NavyFS2B]

Any info regarding CT Surgery Programs? Worse, middle teir, most competitive? Greatest variety of case, etc...

CT surg will be converting to non-cardiac thoracic surgery in upcoming years. Take your training to a field that'll have patients. Cardiologists aren't about to share with all of their new technology.

 

[Bo Hurley]

CT surg will be converting to non-cardiac thoracic surgery in upcoming years. Take your training to a field that'll have patients. Cardiologists aren't about to share with all of their new technology.

Yes I'm sure CT surgery will be switching over to non-cardiac surgery. I guess cardiologists will be able perform all the valve surgeries, thoracic aortic surgeries, heart transplantations, LVAD implantations, trauma surgery to the heart & great vessels, and not to mention all the congenital heart surgeries.

 

[CardiacSurgeon]

CT surg will be converting to non-cardiac thoracic surgery in upcoming years. Take your training to a field that'll have patients. Cardiologists aren't about to share with all of their new technology.

Jesus....not again please

 

[SocialistMD]

Yes I'm sure CT surgery will be switching over to non-cardiac surgery. I guess cardiologists will be able perform all the valve surgeries, thoracic aortic surgeries, heart transplantations, LVAD implantations, trauma surgery to the heart & great vessels, and not to mention all the congenital heart surgeries.

There was a conference a few years ago in Chicago where a cardiologist presented that he has done endovascular valve replacements and aortic aneurysm repairs in animal models. I've hesitated to post this because I'm not sure at what conference it was, but a surg onc fellow at Pitt was there and he told me about it. The cardiologist claims that with in the next 15-20 years, he will be able to perform everything except transplants, congenital defects and trauma. A lot of trauma surgeons deal with cardiac trauma now, so CT surgeons are not used in that regard anyway. With the advances in laparascopic, endovascular and minimally invasive surgery, that is where the future of surgery is. Just look to the changing face of vascular surgery to see its effect. If it can't be done already in a minimally invasive way, it's only a matter of time until it can be, and that is what patients will choose.

 

[Celiac Plexus]

If it can't be done already in a minimally invasive way, it's only a matter of time until it can be, and that is what patients will choose.

highly unlikely that the milnimally invasive millenia is on the horizon any time soon.... at least the way you describe it.

for better or for worse, physicians (like everyone else) are at least in part driven to make as much money as they can. consequently all specialties will be attempting to stake out new ground that will generate more income. sometimes this is a good thing, and sometimes it's not.

a few examples... ob/gyns doing botox injections. ent guys doing mediatinoscopies (particularly humorous when most of the ent guys at my program have placed less than 5 central lines in their lives).

a baaaaad example of this dynamic is a group of japanese gastroenterologists who are pushing a trans-gastric endoscopic appendectomy. they justify this proposed procedure by saying that there will be no scar... not counting the one that they will make on the stomach, or the ones that the general surgeon will make when the procedure converts to open... and never mind the additional cost of iv abx to treat the accompanying sepsis...

fields change... i guess ct is not nearly as attractive a field as it once was. the training/lifestyle is the same, but the reimbursement and prestige levels are way down from what they once were. kinda sucks for guys just finishing their training now. but then, if you pick a field based on cash/prestige only then you are setting yourself up for that kind of disappointment. for those truly interested in ct, i don't think they'll care too much that they'll only make 300-450K/yr instead of 1 mill/yr. hopefully they won't mind taking care of older and sicker patients either... (can you say cabg for thrice failed coronary stents?)

 

[dr.evil]

I'll bite.

After countless hours of stress, numerous discussions with staff, and finally just saying "screw it", I've decided to do CT surg. Why? Because I enjoy it the most of all things surgical. Naive? Maybe.

I know the CT guys can be A-holes but not all. I know the lifestyle isn't great. I know the main procedure is declining in number although not completely disappearing. I know reimbursement sucks compared to the golden days. I know it's an extra 2-3 years of brutal training where I won't be making big cash, my debt's interest is growing, I have to move my family (likely), and I still have no control over my life.

This has all been said on these boards a million times. We all know. So let's answer ollaguna's question, OK?

Most competitive or top tier programs (my list and opinion and definitely not the end all-be all):

Cleveland Clinic (they see it all, do it all)
Duke (just hearsay but supposedly an excellent place)
Texas Heart or Baylor (you pick. they're similar. Debakey and Cooley)
Wash U (as usual, this place has great fellowships. Good transplant)
Mayo, Hopkins, Mass General (the ole mainstays)
Probably should put UAB and UT-SW up here to

Middle tier/upper tier: Louisville, UVA, Vanderbilt, Stanford
Good places:Wisconsin, Minnesota, Indiana, UCLA,St. Louis


I don't really know how to put places on a lowest tier. Maybe if you don't have good peds or transplant (although a lot of people think that's a blessing). A lot of places are really strong in non-cardiac thoracic (Michigan, USC come to mind).

A lot of this is hearsay so take it with a grain. Any additions/subtractions would be great

 

[HiddenTruth]

Upenn is definately up there. I would say top tier.

 

[johnny_blaze]

This is kinda like the turf war between interventional radiologists and vascular surgeons. Some people think that the Inter. Rads are gonna take over the vascular surgeons jobs, but that’s not the case because a radiologist can never revert to an open repair if there are complications. Now that endovascular techniques are being taught to vascular surgeons they are reclaiming their field. I was told by a neurosurgeon that they are also taking back the berry aneurysm game by learning the new techniques themselves.

So I’m curious as to why CT surgeons don’t learn how to do coronary stenting and other minimal invasive cardiac procedures and reclaim their territory? I know the training is long enough but if vascular and neuro can do it so can CT… know what I mean?

 

[Tenesma]

Cardiac sucks at MGH.... while their Thoracic is awesome... only go to MGH if you want to be a great Chest/thoracic surgeon.... If you have any intention of doing hearts, MGH will scar you and ruin you... word to the wise

 

[Pilot Doc]

Some people think that the Inter. Rads are gonna take over the vascular surgeons jobs, but that’s not the case because a radiologist can never revert to an open repair if there are complications.

Right conclusion - wrong reasoning. Surgeons have been cleaning up behind non-surgeons' procedural misadventures for decades. Nothing new there. Vascular surgery's future looks bright because of referral patterns. Take a man presenting to his PCP with claudication. He is not referred to a radiologist. He is not referred to some medical vasculologist who will dispense pletal and conduct ABI's until the disease progresses to rest pain or tissue loss. He is referred to a vascular surgeon who specializes in the 1) diagnosis, 2) operative management and 3!!) non-operative management of vascular disease. A vascular surgeon will only lose a procedure if he chooses to refer it out.

So I’m curious as to why CT surgeons don’t learn how to do coronary stenting and other minimal invasive cardiac procedures and reclaim their territory?

Cardiac surgery, in stark contrast, only does #2 of the above list. Cardiology handles diagnosis and medical mgmt - and they get to keep all the procedures unless they choose to refer them out. Even if cardiac surgery as a specialty added angiographic intervention to their repertoire (which would be quite a catch up game) the cardiologists would just laugh at them. Why would any cardiologist refer his patient (and his income stream) to surgery unless forced to?

 

[johnny_blaze]

Right conclusion - wrong reasoning. Surgeons have been cleaning up behind non-surgeons' procedural misadventures for decades. Nothing new there. Vascular surgery's future looks bright because of referral patterns. Take a man presenting to his PCP with claudication. He is not referred to a radiologist. He is not referred to some medical vasculologist who will dispense pletal and conduct ABI's until the disease progresses to rest pain or tissue loss. He is referred to a vascular surgeon who specializes in the 1) diagnosis, 2) operative management and 3!!) non-operative management of vascular disease. A vascular surgeon will only lose a procedure if he chooses to refer it out.

Ahhh, that makes more sense, thanks for clearing it up 4 me.
I was thinking about going into vascular surgery … my future looks good hehe

 

[hans19]

Ahhh, that makes more sense, thanks for clearing it up 4 me.
I was thinking about going into vascular surgery … my future looks good hehe

Not so fast! Interventional cardiologists are also being trained in 'peripheral interventions' too.

Of the big 3 (IC, VS, IR), I think IC will have the most pull in the future. How many Cards fellows are trained per year vs VS and IR fellows? Who sees the patient first?

 

[Bo Hurley]

Cardiac sucks at MGH.... while their Thoracic is awesome... only go to MGH if you want to be a great Chest/thoracic surgeon.... If you have any intention of doing hearts, MGH will scar you and ruin you... word to the wise

Yes I'm sure training in cardiac surgery at MGH will "ruin you" and you'll be a horrible heart surgeon and nobody will want to hire you. Way to over-exagerrate there sport

 

[Tenesma]

Bo... like i said, if you go to MGH purely for cardiac training you will graduate with mediocre training in cardiac and be a miserable, ruined vegetable. As far as employment goes, a grad will definitely get hired somewhere --- purely on the mystique that the name of the program carries... however, a grad from MGH would make a fantastic thoracic surgeon

 

[hotlanta]

Bump. Its been awhile since this was addressed and I'm sure a lots changed. Anyone with input into the good the bad and the ugly CT fellowships? It would help the current apps out.

 

[hotlanta]

Bump. Its been awhile since this was addressed and I'm sure a lots changed. Anyone with input into the good the bad and the ugly CT fellowships? It would help the current apps out.

seems a few ct applicants are out there based on other threads. Nobody has any input on the above? We can avoid program bashing but what are the top programs out there now?

 

[Buzz Me]

seems a few ct applicants are out there based on other threads. Nobody has any input on the above? We can avoid program bashing but what are the top programs out there now?

Either there really aren't that many currently applying, or they're scared of leaking any "secrets" and want to remain competitive.

 

[jc7721]

seems a few ct applicants are out there based on other threads. Nobody has any input on the above? We can avoid program bashing but what are the top programs out there now?

OK, I'll bite, best to break it down by category for a VERY FEW places:

Total major cases:
Brigham/MGH/UW/WashU > MD Anderson/Sloan/Mich/Pitt

Anatomic lung resections:
Sloan a little more than the rest, except >>Mich and Pitt

Esophageal resections:
MGH/Mich/WashU/MD Anderson > Brigham/Sloan/Pitt >> UW

VATS:
about the same except > MD Anderson and Mich

Adult Cardiac:
UW > Brigham/Anderson/MGH/Mich/Pitt/WashU > Sloan

PM me if you want more detail

 

[JackADeli]

OK, I'll bite, best to break it down by category for a VERY FEW places:

Total major cases:
Brigham/MGH/UW/WashU > MD Anderson/Sloan/Mich/Pitt

Anatomic lung resections:
Sloan a little more than the rest, except >>Mich and Pitt

Esophageal resections:
MGH/Mich/WashU/MD Anderson > Brigham/Sloan/Pitt >> UW

VATS:
about the same except > MD Anderson and Mich

Adult Cardiac:
UW > Brigham/Anderson/MGH/Mich/Pitt/WashU > Sloan

PM me if you want more detail

Interesting, where does someone get these or arrive at these perceptions? I recall from general surgery residency , seems like forever ago: that Duke was home to a famous Guru VATS lobe surgeon and Penn was home to a guru minimally invasive esophageal surgeon. I though there was some institution and/or surgeon that was apparently the most busy in the country??? Would that be a Brigham? Also, I thought michigan is regarded for its transhiatal esophageal surgeries????

 

[HNANAL]

OK, I'll bite, best to break it down by category for a VERY FEW places:

Total major cases:
Brigham/MGH/UW/WashU > MD Anderson/Sloan/Mich/Pitt

Anatomic lung resections:
Sloan a little more than the rest, except >>Mich and Pitt

Esophageal resections:
MGH/Mich/WashU/MD Anderson > Brigham/Sloan/Pitt >> UW

VATS:
about the same except > MD Anderson and Mich

Adult Cardiac:
UW > Brigham/Anderson/MGH/Mich/Pitt/WashU > Sloan

PM me if you want more detail

Hm, i'm currently interviewing as we speak. These programs listed are thoracic intensive, which is perfect because that's what i'm into. I'll be interviewing at most of these places, so i'll be able to give a better sense of what these places are like.

According to many of my attendings, the rankings in terms of general thoracic surgery is something like this...

top programs – Wash U/Barnes, Brigham, U penn, Pitt
One attending said Barnes > Upenn > brigham. Barnes is definitely up there. As a resident you do everything, 3 cases a day everyday for 2 years. You come out awesome. Brigham is believe to be top 3. Sloan and MD andersons are good at oncologic thoracic obviously. Pittsburgh is big on esophageal but there are 3 other non-acgme fellows who will take away your cases. Big on lung transplant. These are big names, but I am also looking at smaller programs with good thoracic surgeons, e.g. Cedar (mcKenna), Alabama (Cerfolio), Duke is big too, Wahington (wood), Pitts (luketich). Everyone seemed to be applying to pitt this year.

 

[HNANAL]

Interesting, where does someone get these or arrive at these perceptions? I recall from general surgery residency , seems like forever ago: that Duke was home to a famous Guru VATS lobe surgeon and Penn was home to a guru minimally invasive esophageal surgeon. I though there was some institution and/or surgeon that was apparently the most busy in the country??? Would that be a Brigham? Also, I thought michigan is regarded for its transhiatal esophageal surgeries????

the best way to figure this stuff out is to ask for case logs. Most programs will give this out if you ask them nicely. They are recorded their data on the STS (?).

pitt for sure is into minimally invasive esophagectomy and do many

 

[SLUser11]

Hm, i'm currently interviewing as we speak. These programs listed are thoracic intensive, which is perfect because that's what i'm into.

I would agree that UAB probably has very high non-cardiac thoracic volume. I've read some of Bob Cerfolio's papers, and his numbers are ridiculous. He cranks out lobectomies/esophagectomies/VATS etc to the tune of 3-6 big cases per day.

I would speculate that this also means a lot of fellow autonomy, because there's no way he's scrubbed in skin to skin on that many cases.

 

[jc7721]

the best way to figure this stuff out is to ask for case logs. Most programs will give this out if you ask them nicely. They are recorded their data on the STS (?).

pitt for sure is into minimally invasive esophagectomy and do many

Exactly: my rough rankings are based off of real case numbers from each institutions recent graduates, for the last couple of years. Every program that I went to was open to providing this information, and most did it without asking. Obviously, don't base your decision on numbers alone, but it's an important factor.

 

[SouthSideSteve]

I would agree that UAB probably has very high non-cardiac thoracic volume. I've read some of Bob Cerfolio's papers, and his numbers are ridiculous. He cranks out lobectomies/esophagectomies/VATS etc to the tune of 3-6 big cases per day.

I would speculate that this also means a lot of fellow autonomy, because there's no way he's scrubbed in skin to skin on that many cases.

I dont know the specifics on UAB's CTS fellowship, but it has been on the decline. They have had 1 fellow in the past 3 years, and Im not sure if there will be more. They do use 3 RNFA's, but the residents get to do a lot.

But Cerf is ridiculous, sub 3 hr esophagos (including flip), and 13+ cases a day.

 

[Thanatos]

So we've been talking about general thoracic, anybody have any more input on cardiac?

You hear about UW, Cleveland clinic and Texas Heart, Baylor, etc....who else is strong out there?

 

[Black Surgeon]

So we've been talking about general thoracic, anybody have any more input on cardiac?

You hear about UW, Cleveland clinic and Texas Heart, Baylor, etc....who else is strong out there?

Reputable Cardiac:

Minnesota

Utah ( Salt lake has always been a cardiac power house)

Columbia
(based on the volume, the cases,their numbers, and some of the names in that programs, Columbia should be on many's top choice list).

 

[DOCpa]

For cardiac I have always heard Cleveland Clinic is head and shoulders above the competition as far as case load. Is there any truth to this? What other programs are strong in cardiac?

 

[DO_Surgeon]

For cardiac I have always heard Cleveland Clinic is head and shoulders above the competition as far as case load. Is there any truth to this? What other programs are strong in cardiac?

Granted I have no first hand knowledge of the program being that I cancelled my interview there last year but from what I have heard the volume is amazing but things to consider...

There is a superfellow for every aspect of CT surgery thus plenty of people around looking to do a case.

Even though there maybe 20 cardiac OR rooms running...you are only one person. It doesn't benefit you in the least bit being that you can only do 1 to 2 cases a day. This means more critically Ill patients to manage at night when you are on call that you had no hand in on during the operation.

The first year from what I heard is spent entirely in the unit learning management and little operating. I had several PDs and fellows along the interview trail last year tell me that the "Clinic" has a great reputation and a wonderful place to get your heart operation done at, but a poor place to train. I am not trying to bash on any program and again I have no first hand experience, but that was the rumor I was hearing over and over at places.

I would have to second the comment about Minnesota being a strong place for cardiac!

 

[JackADeli]

Granted I have no first hand knowledge of the program ...volume is amazing but things to consider...

There is a superfellow for every aspect of CT surgery thus plenty of people around looking to do a case.

Even though there maybe 20 cardiac OR rooms running...you are only one person. It doesn't benefit you in the least bit being that you can only do 1 to 2 cases a day...

I think the comments above hint on some important considerations. Remembering to my GSurgery residency days, institutional volume does not equate to individual resident training. I would imagine, factory "power house" CV programs may have high numbers of over all cases but does not necessarily translate to individual resident participation on the same scale or grandeur.

Their needs to be some semblance of balance. You would probably want enough teaching attendings to support an ~average volume in conjunction with only a few other residents within the program. Otherwise, it seems like your operative training/experience to floor scut/ICU ratio could be poor. If you have such high number of attendings with large number of ORs and big CICU, you probably need alot of excess bodies to cover at night. During the day, you split too many cases. Or, if you are attending heavy with small resident cadre, you are exhausted from high volume over night coverage of numerous patients you don't operate on....

I dont know the specifics on UAB's CTS fellowship, but it has been on the decline. They have had 1 fellow in the past 3 years...

But Cerf is ridiculous, sub 3 hr esophagos (including flip), and 13+ cases a day.

Depending on what the support staff looks like NPs/PAs/surgery residents/etc... that combination could mean really good operative volume for those few fellows.

 

[ESU_MD]

I dont know the specifics on UAB's CTS fellowship, but it has been on the decline. They have had 1 fellow in the past 3 years, and Im not sure if there will be more. They do use 3 RNFA's, but the residents get to do a lot.

But Cerf is ridiculous, sub 3 hr esophagos (including flip), and 13+ cases a day.

Less than 3hr goose is fast, i think the fastest i seen is less than 4 for std. Ivor.lewis.

If he is doing 13 cases/day, then he probably still just does the critical parts to eliminate complications while he is in the other rooms, ie.. Cant afford to come back, So he probably comes in once the PA/pv is isolated and confirms the resection, helps with the. Bronchus and leaves the frozen and nodes to the resident. Once the pa is divided, the case is essentially over.

Last i heard, uab cardiac is still old school of old school... Residents just watch. No wonder people get fascinated with lung surgery there!

 

[ESU_MD]

I would have to second the comment about Minnesota being a strong place for cardiac!

U of Minn is essentially the birthplace of cardiac surgery. Probably sucks to live in the cold though..... Have you the book King of Hearts about Lillihei yet?? That is enough to pump anyone up. We all wish it was still like those days.
another good sort of interesting read is "this aint Er" which is about uab

 

[DO_Surgeon]

U of Minn is essentially the birthplace of cardiac surgery. Probably sucks to live in the cold though..... Have you the book King of Hearts about Lillihei yet?? That is enough to pump anyone up. We all wish it was still like those days.
another good sort of interesting read is "this aint Er" which is about uab

Read it a couple times during med school. The program gave everyone a copy of the book last year during their interview. Truely a must read for anyone going into cardiac surgery.

 

[SouthSideSteve]

Less than 3hr goose is fast, i think the fastest i seen is less than 4 for std. Ivor.lewis.

If he is doing 13 cases/day, then he probably still just does the critical parts to eliminate complications while he is in the other rooms, ie.. Cant afford to come back, So he probably comes in once the PA/pv is isolated and confirms the resection, helps with the. Bronchus and leaves the frozen and nodes to the resident. Once the pa is divided, the case is essentially over.

Last i heard, uab cardiac is still old school of old school... Residents just watch. No wonder people get fascinated with lung surgery there!

He will go do a vats/wedge during the flip on esophagos. But for his other cases he is in the room for pretty much the entirety of the case. He makes skin incision and stays until fascia/subcu is done. Typically will leave resident to close skin. The RNFAs will scrub of for larger cases, but they typically just make sure his rooms flow.

He is just a machine. It has been a while since I worked with him, but he starts a clock on skin for every Sx. I remember 17 min multiple wedges skin to skin. He demands efficiency. Definitely one of my favorite surgeons to work with.

 

[DO_Surgeon]

He will go do a vats/wedge during the flip on esophagos. But for his other cases he is in the room for pretty much the entirety of the case. He makes skin incision and stays until fascia/subcu is done. Typically will leave resident to close skin. The RNFAs will scrub of for larger cases, but they typically just make sure his rooms flow.

He is just a machine. It has been a while since I worked with him, but he starts a clock on skin for every Sx. I remember 17 min multiple wedges skin to skin. He demands efficiency. Definitely one of my favorite surgeons to work with.

Not sure if I am more impressed by the surgeon or the anesthesia staff. Not sure how you can turn room over that fast considering most chest cases require lines and dual lumen tubes, etc. Especially if there is a teaching residency for anesthesia. I don't know many general surgeons who can crank out 13 cases a day and that includes scopes.

 

[JackADeli]

...Not sure how you can turn room over that fast considering most chest cases require lines and dual lumen tubes, etc. Especially if there is a teaching residency for anesthesia. I don't know many general surgeons who can crank out 13 cases a day and that includes scopes.

I remember at a surgery conference hearing how efficient thoracic surgeons are publishing about doing most cases without central lines or arterial lines.... will have to do a lit search. Maybe it was UAB.

 

[SouthSideSteve]

I remember at a surgery conference hearing how efficient thoracic surgeons are publishing about doing most cases without central lines or arterial lines.... will have to do a lit search. Maybe it was UAB.

Cerf rarely, rarely lets anesthesia put a CVL in. The esophagos may or may not get an aline. I'm fairly certain he doesn't even do a lines on meds, just a sat probe.

He is pretty adamant about unnecessary lines.

 

[JackADeli]

...I'm fairly certain he doesn't even do a lines on meds, just a sat probe...

I am pretty certain my thoracic attendings in general surgery never did arterial lines in medianstinoscopies and that was about 5+ years ago. Those patients were outpt, no arterial lines, the cases took under 30 minutes.

 

[SLUser11]

...the cases took under 30 minutes.

Until you biopsy the innominate.....

 

[ESU_MD]

I am pretty certain my thoracic attendings in general surgery never did arterial lines in medianstinoscopies and that was about 5+ years ago. Those patients were outpt, no arterial lines, the cases took under 30 minutes.

Those guys are pretty brave! I think the med is pretty underrated in the danger factor. The pure thoracic oncologists I worked with rarely do them, in fact the residents may not even get the numbers (10) since they do almost exclusively EBUS for staging. Luckily, the dinosaurs still occasionally do them so we can learn.

 

[JackADeli]

Until you biopsy the innominate.....

In general surgery, I never saw the thoracic surgeons biopsy the inominate. They used a long needle into each node to test it. I did see a patient flown in from the community. His inominate was biopsied by the community general surgeon.

...UAB probably ...some of Bob Cerfolio's papers...

...The pure thoracic oncologists I worked with rarely do them ...they do almost exclusively EBUS for staging...

Maybe it has changed alot since my residency noon conferences. That seems like an oxymoron or paradox or something... given the difference in sensitivities between medianstinoscopy and EBUS. I just don't see a "pure...oncologist" settling for what may be considered a less sensitive staging procedure. This is what google found for me:
http://en.wikipedia.org/wiki/Lung_cancer_staging
http://www.ncbi.nlm.nih.gov/pubmed/20667324
http://ats.ctsnetjournals.org/cgi/content/abstract/90/2/427
http://www.oncologyreport.com/pdf/lung1003.pdf

Interesting, Cerfolio comes up everywhere on this topic.

 

[ESU_MD]

settling for what may be considered a less sensitive staging procedure. This is what google found for me:
http://en.wikipedia.org/wiki/Lung_cancer_staging
http://www.ncbi.nlm.nih.gov/pubmed/20667324
http://ats.ctsnetjournals.org/cgi/content/abstract/90/2/427
http://www.oncologyreport.com/pdf/lung1003.pdf

Interesting, Cerfolio comes up everywhere on this topic.

Nice data/studies, hard to argue with those numbers. Judging from the way I've seen a group of thoracic surgeons(in the same league as UAB thoracic) rapidly adopt EBUS I wonder if there is some sort of institutional bias pro-con. Looks like Cerfolio doesnt believe in EBUS. Not sure if he did them himself, but IMHO EBUS results could be different depending on what the operators attitude toward the procedure is. ie if you take 3 passes at a node vs 10 etc..

Still a young technology but I see it gaining ground, but it still needs general anesthesia

Of course, I still think a med is the gold standard and wouldnt utter the EBUS acronym in any type of board exam.

 

[SLUser11]

In general surgery, I never saw the thoracic surgeons biopsy the inominate....
Interesting, Cerfolio comes up everywhere on this topic.

It's not that the innominate actually gets biopsied...it's just my constant fear that it's going to happen whenever I do a mediastinoscopy.

As a PGY-3 at the VA, I did a redo mediastinoscopy on Friday the 13th while my staff was unscrubbed, dutifully typing progress notes on the VA computer....it was a very scary experience, but everything went fine I guess....they just make me very nervous....always have.


As for Cerfolio, he comes up everywhere because he is everywhere. And I give him props because the vast majority of my knowledge in chest tube management has come from his work.

 

[JackADeli]

...Looks like Cerfolio doesnt believe in EBUS...

I didn't really get that impression from my read of those... especially with DrRice commending DrCerfolio and his team for be "early adopters". The general gestalt I got was that staging and using these less invasive techniques represents additional tools to a multi-modality approach... as opposed to these techniques being the best/most modern replacement approach to staging.... My read in reference to these articles/links and the earlier comments, was that it would be strange for any self describing surgical oncologist to move to a predominantly/"almost exclusively" of cases MIS technique with ?inferior staging results.

 

[HNANAL]

So we've been talking about general thoracic, anybody have any more input on cardiac?

You hear about UW, Cleveland clinic and Texas Heart, Baylor, etc....who else is strong out there?

baylor is dead. Texas heart merged with baylor to make what it is now. THI is crazy cardiac intensive. Cooley is still around and is 91.
clevelend clinic i hear don't let you do much, but totally heresay.

 

[copacetic]

I found a list of integrated and fast track (4+3) programs. I would like to hear which of these have the best reputations for training cardiac surgeons.

FAST TRACK:

1. Brigham & Women’s Hospital/Children’s Hospital
2. Duke University
3. Massachusetts General Hospital
4. Mayo School of Graduate Medical Education (Rochester)
5. New York University School of Medicine
6. University of Maryland
7. University of Rochester
8. University of Virginia
9. University of Washington
10. Washington University School of Medicine

INTEGRATED

1. Medical College of Wisconsin Affiliated Hospitals Program
2. Medical University of South Carolina
3. Mount Sinai School of Medicine
4. Stanford University
5. University of Maryland
6. University of North Carolina at Chapel Hill
7. University of Pennsylvania
8. University of Texas Health Science Center at San Antonio
9. University of Washington

 

[JackADeli]

I found a list of integrated and fast track (4+3) programs. I would like to hear which of these have the best reputations for training cardiac surgeons...

When I was in general surgery residency, Stanford always came up as being ahead of the curve on integrated. I can not speak much to the rest beyond the few things I heard, i.e. just un-confirmed talk (While integrated is fairly new, thus by nature integrated programs are new...):

1. everyone has said, avoid integrated programs that have rep of "old school" track record of observe as opposed to actually operate. These programs, per report, are just milking the system for their senior guys to drag on into the next 5-10yrs without having to do anything.

2. Heard UNC Chap is very, very "new" but lacks any backbone in modern techniques when it comes to training residents. Though, you will likely have no difficulty getting to fiddle with simulators.

3. Heard, MUSC is also very, very "new" but apparently has some forward thinking/performing attending staff.

 

[wildcat2bmd]

Does anyone know anything about the integrated program at UT San Antonio??

 

[sinceremalang]

Does anyone know anything about the integrated program at UT San Antonio??

http://www.ctsnet.org/sections/residents/programprofiles/article-2.html

I hope this helps

 

[gensurgapp]

Just updating your list

FAST TRACK:
Brigham & Women's Hospital/Children's Hospital
Duke University
Massachusetts General Hospital
Mayo School of Graduate Medical Education (Rochester)
New York University School of Medicine
University of Maryland
University of Rochester
University of Virginia
University of Washington
Washington University School of Medicine

INTEGRATED
Medical College of Wisconsin Affiliated Hospitals Program
Medical University of South Carolina
Mount Sinai School of Medicine
Northwestern
Stanford University
University of Maryland
University of North Carolina at Chapel Hill
University of Pennsylvania
University of Texas Health Science Center at San Antonio
University of Virginia
University of Washington