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CT SURGERY IN THE USA Society of Thoracic Surgeons i n the 21 st Century Keith S. Naunheim, M.D . President, Society of Thoracic Surgeons

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Page 1: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USA

Society of Thoracic Surgeons

in the21st Century

Keith S. Naunheim, M.D.

President, Society of Thoracic Surgeons

Page 2: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USA

STS IN THE21st CENTURYFinancial Disclosure

I only wish

Page 3: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USA

STS IN THE21st CENTURYSurgeon Demographics

Ikonomides JS

Ann Thorac Surg 2016; 102:2118

4343 active STS members

29% response rate

Median age 54 yrs

Academic 37%

Hospital employed 40%

Private practice 18%

Govt employed 2%

Other 3%Over 7300 members

in 95 countries

Page 4: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USA

STS IN THE21st CENTURYSTS Mission

Enhance the ability of

cardiothoracic surgeons to

provide the highest quality

patient care through education,

research, and advocacy

How the hell do we do that?

Page 5: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USA

STS IN THE21st CENTURY

Fiscal year 2017-18, the TSF

Raised $1.5 million dollars for charitable use

Gave almost $900,000 in awards to surgeons

Since 1998 as the TSFRE

$16 million for CT surgery research/education

200 research and fellowship grants awarded

Basic, applied & health policy research

Residents, early & mid career attendings

Funding Research

Page 6: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USA

STS IN THE21st CENTURYSTS Databases

TVT

Registry

570 sites

100% of cases

140,000

General

Thoracic

288 sites

35% of cases

560,000

Congenital

Cardiac

117 sites

95% of cases

475,000

Adult

Cardiac

1080 sites

95% of cases

6.5 million51 papers 31 papers 19 papers

Page 7: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USA

STS IN THE21st CENTURYSTS Databases

TVT

Registry

570 sites

100% of cases

140,000

General

Thoracic

288 sites

35% of cases

560,000

Adult

Cardiac

1080 sites

95% of cases

6.5 million

STS

Intermacs

163 sites

99% of cases

>19,000

Page 8: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USA

STS IN THE21st CENTURYCardiac Surgery Trends

0

20000

40000

60000

80000

100000

120000

140000

160000

180000

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

CABG

MVR

AVR

Page 9: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USA

STS IN THE21st CENTURYCardiac Surgery Trends

0

20000

40000

60000

80000

100000

120000

140000

160000

180000

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

CABG

MVR

AVR

US population All + 7.7%

> 65 + 24%

Page 10: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USA

STS IN THE21st CENTURYCardiac Surgery Trends

0

20000

40000

60000

80000

100000

120000

140000

160000

180000

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

CABG

MVR

AVR

CABG Off Pump 12%

IMA 99%, BIMA 5%, Radial 5%

Page 11: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USA

STS IN THE21st CENTURYCardiac Surgery Trends

0

20000

40000

60000

80000

100000

120000

140000

160000

180000

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

CABG

MVR

MVR Repair/Replace 60/40

AVR

CABG Off Pump 12%

IMA 99%, BIMA 5%, Radial 5%

Page 12: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USA

STS IN THE21st CENTURYCardiac Surgery Trends

0

20000

40000

60000

80000

100000

120000

140000

160000

180000

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

CABG

AVR Declining volumes

MVR

MVR Repair/Replace 60/40

AVR

CABG Off Pump 12%

IMA 99%, BIMA 5%, Radial 5%

Page 13: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USA

STS IN THE21st CENTURYSTS Databases

TVT

Registry

570 sites

100% of cases

140,000

General

Thoracic

288 sites

35% of cases

560,000

Adult

Cardiac

1080 sites

95% of cases

6.5 million

STS

Intermacs

163 sites

99% of cases

>190,000

Page 14: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USA

STS IN THE21st CENTURYCardiac Surgery Trends

SAVR vs TAVR

29829 3026528493

25580

18384 1809017507

1591017544

28857

43548

47779

0

10000

20000

30000

40000

50000

60000

2014 2015 2016 2017

AVR

AVR & CABG

TAVR

STS/ACC TVT Registry March 2018

65,757 89,269

Low risk

High risk

Intermediate

SAPIEN 3

PARTNER 2SURTAVI

Page 15: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USA

STS IN THE21st CENTURYMoral of the Story

TAVR is absolutely here to stay

TMVR is probably here to stay

If you a. Are under the age of 55

b. Want to implant valves

It’s time to get some wire skills

Page 16: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USA

STS IN THE21st CENTURYSTS Databases

TVT

Registry

570 sites

100% of cases

140,000

General

Thoracic

288 sites

35% of cases

560,000

Adult

Cardiac

1080 sites

95% of cases

6.5 million

STS

Intermacs

163 sites

99% of cases

>19,000

Page 17: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USA

STS IN THE21st CENTURYSTS Intermacs Database

LVAD Intermacs

Over 160 programs

Over 19000 patients

Continued growth

Page 18: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USA

STS IN THE21st CENTURYLVAD Trends

AxialCentrifugal

Intermacs Annual Report 2017MOMENTUM 3

HeartMate II vs III

Centrifugal flow in III

Fewer strokes

Fewer reoperations

NEJM 2018; 378:1386

Page 19: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USA

STS IN THE21st CENTURYECMO Trends

McCarthy et al Sem Thorac Cardiovasc Surg 2015; 27:81

2015: 61: 31-6

Page 20: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USA

STS IN THE21st CENTURYEvolving Your Practice

LVAD

ECMO

Page 21: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USA

STS IN THE21st CENTURYSTS Databases

TVT

Registry

570 sites

100% of cases

140,000

General

Thoracic

288 sites

35% of cases

560,000

Adult

Cardiac

1080 sites

95% of cases

6.5 million

STS

Intermacs

163 sites

99% of cases

>190,000

Page 22: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USA

STS IN THE21st CENTURYThoracic Surgery Trends

National Lung Screening trial NEJM 2011

Cohort Person Lung ca Mortality Mortality

Years Deaths per 10,000 Reduction

LDCT 144,103 356 247

CXR 143,368 443 309

20%p = 0.004

“Screening with low dose chest CT

conclusively reduces mortality from lung

cancer in high risk patients.”

Medicare & USPSTF cover for screening

Page 23: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USA

STS IN THE21st CENTURYThoracic Surgery Trends

Screening will lead to smaller, early stage lesions

Suppositions

Americans want less invasive treatment methods

Increased usage of minimally invasive surgery

Increased usage of sub lobar resections

Increased usage of non surgical therapy (SBRT)

Page 24: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USA

STS IN THE21st CENTURYThoracic Surgery Trends

Limited to the STS General Thoracic Database

Page 25: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USA

STS IN THE21st CENTURYThoracic Surgery Trends

VATS and Robotic Surgery

Open

VATS

Robotic

Unpublished quarterly analysis of the Premier Database

2009 2012 2014 20162010

Page 26: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USA

STS IN THE21st CENTURYThoracic Surgery Trends

SEER Data

2000-2010

Stage I

NSCLC

Resections

Kapadia et al Ann Thorac Surg 2017; 104:1881

Pneumo

4 2%

Lobe

83 80%

Sublobar

13 18%

Page 27: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USA

STS IN THE21st CENTURY

National Cancer Database (70% of all cancer pts)

2008 to 2013 107,233 pts stage IA NSCLC

Demographics, comorbidity, treatment type & year

Trends in SBRT

JNCI Ca Spect 2017; 1:1-6

Page 28: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USA

STS IN THE21st CENTURY

Surgery

12% relative decline

Trends in SBRTHolmes et al JNCI Ca Spect 2017; 1:1-6

49.5%43.7%

Lobe/Pneum

SBRT

6.7%

16.3% SBRT

240% relative rise

Are patients getting

adequate treatment?

No RCT proves

SBRT is equivalent

No RCT proves

SBRT isn’t

Page 29: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USA

STS IN THE21st CENTURY

Highest quality clinical care

Research

Education

Advocacy

Mission

Page 30: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USA

STS IN THE21st CENTURYMeetings

Page 31: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USA

May 18-19, 2018 ● Chicago, IL

sts.org/roboticthoracic

New in 2018!

Thoracic Meetings

Page 32: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USA

ASTRO ASCO STS

Page 33: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USA

Shanghai Medical

Association

September 8-9,

2018

Shanghai, China

Thoracic Meetings

Page 34: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USA

Page 35: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USACardiothoracic Meetings

Page 36: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USA

November 8-9,

2018

Shenyang, China

Chinese Society of Thoracic and Cardiovascular Surgery

Cardiothoracic Meetings

Page 37: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USACardiac Meetings

Page 38: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USACardiac Meetings

Page 39: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USACardiac Meetings

Page 40: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USACardiac Meetings

Page 41: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USA

STS IN THE21st CENTURYSTS Annual Meeting

Tech

Con

Didactic

Sessions

STS

University

Page 42: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USA

STS IN THE21st CENTURY

Page 43: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USA

STS IN THE21st CENTURYVideos Webinars Podcasts

Page 44: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USA

STS IN THE21st CENTURYAnnals of Thoracic Surgery

Monthly CME Articles in

General Thoracic Surgery

annalsthoracicsurgery.org

Page 45: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USA

STS IN THE21st CENTURY

Highest quality clinical care

Research

Education

Advocacy

Mission

Page 46: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USA

Page 47: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USA

STS IN THE21st CENTURYPatient Safety & Education

Page 48: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USA

STS IN THE21st CENTURYctsurgerypatients.org

The Patient Guide to Heart, Lung, and Esophageal SurgeryA Website Presented by Cardiothoracic Surgeons Committed to Improving Patient Care

Available in English and Spanish

Page 49: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USA

STS IN THE21st CENTURYPatient Handouts

Page 50: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USA

STS IN THE21st CENTURYFuture Trends

Workforce

Technology

Transparency

Page 51: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USA

STS IN THE21st CENTURY

CT Surgery Applications

The Age of Darkness

0

40

80

120

160

200

1993 1994 1995 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Total Number of Applicants

Active Positions Available

U.S. Medical School Graduate Applicants

Page 52: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USA

STS IN THE21st CENTURYCT Surgery Resurgence

0

25

50

75

100

125

Six YearIntegratedPositions

Two/ThreeYear Standard

Positions

36

92107

Six Year

Integrated

Applicants

125

Two/Three

Year Standard

Applicants

25

125

100

75

50

0

Page 53: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USA

STS IN THE21st CENTURYActive Physicians

0%

10%

20%

30%

40%

50%

60%

70%

AAMC Data www.aamc.org/data/workforce/reports/458712/1-3chart.html

7%

All specialties 34%

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CT SURGERY

IN THE USA

STS IN THE21st CENTURYDemographics

Page 55: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USA

STS IN THE21st CENTURYActive Trainees

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

AAMC Data www.aamc.org/data/workforce/reports/458712/1-3chart.html

All specialties 46%

20%

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CT SURGERY

IN THE USA

STS IN THE21st CENTURYFemale Participation

New Female Diplomates

Total Women Certified

20

17

Page 57: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USA

STS IN THE21st CENTURYFemale Surgeons

U Michigan St Louis U

Page 58: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USA

STS IN THE21st CENTURYMore Women Surgeons

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CT SURGERY

IN THE USA

STS IN THE21st CENTURYTechnology Trends

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CT SURGERY

IN THE USA

STS IN THE21st CENTURY

Virtual Reality Preop planning

Education

Augmented Reality Preop planning

Intraop decisions

Artificial Intelligence All of the above PLUS

NLP EMR

Computer vision Imaging analysis

Neural networks Computer “judgment”

Machine learning Scary SkyNet Stuff

More Computer Stuff

Page 61: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USA

STS IN THE21st CENTURYMore Mechanical Assist

VAD ECMO TAH

Page 62: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USA

STS IN THE21st CENTURYMore Perc Valves

TMVRTAVR

Page 63: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USA

STS IN THE21st CENTURYMore Robotic Surgery

Page 64: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USA

STS IN THE21st CENTURYMore Robots

Transenterix

HapticFeedback

Eye sensingCamera control

ReusableInstrumentation

Page 65: CT SURGERY Society of Thoracic Surgeons in the 21st Century · CT SURGERY IN THE USA STS IN THE 21st CENTURY Fiscal year 2017-18, the TSF Raised $1.5 million dollars for charitable

CT SURGERY

IN THE USA

STS IN THE21st CENTURYMore Robots

Titan

ControlConsole

UniportalInstrumentation

RoboticArm

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CT SURGERY

IN THE USA

STS IN THE21st CENTURY

MedRobotics Flex

Robotic Trends

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CT SURGERY

IN THE USA

STS IN THE21st CENTURYMore Robots

MedRobotics Flex

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CT SURGERY

IN THE USA

STS IN THE21st CENTURYRobotic Evolution

Gort

Master - Slave

Robocop ED-209

Semiautonomous

T 800

Independent

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CT SURGERY

IN THE USA

STS IN THE21st CENTURYMore Transparency

OR

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CT SURGERY

IN THE USA

STS IN THE21st CENTURYPublic Reporting

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CT SURGERY

IN THE USA

STS IN THE21st CENTURYQuality Improvement

Public reporting is the right thing to do and the Society

regards this as a professional responsibility

Adult Cardiac

CABG

AVR

AVR + CABG

MVR

MVR + CABG

Congenital Cardiac

VSD Glenn/HF

TOF Fontan

CAVC Truncus

AS Norwood

AS/VSD Coarct

General Thoracic

Lobectomy

Esophagectomy

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CT SURGERY

IN THE USA

STS IN THE21st CENTURY

Quality reporting currently at program level

Individual procedures

Composite score

Next step - reporting at individual surgeon level

Individual procedures (summing the O/Es)

New composite score for five procedures

Confidential reporting to surgeons - or is it?

Surgeon Level Composite

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CT SURGERY

IN THE USA

STS IN THE21st CENTURYMore Pressure Than Ever

More difficult patients

More needless paperwork

More ongoing scrutiny

Regulatory agencies

Third Party payers

Media (social & others)

STS involvement maximizes your

opportunity for self determination

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CT SURGERY

IN THE USA

STS IN THE21st CENTURYThe Surgeon’s Century

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CT SURGERY

IN THE USA

STS IN THE21st CENTURY

Thank You

Questions?

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CT SURGERY

IN THE USA

STS IN THE21st CENTURYTransplantation Trends

0

1000

2000

3000

4000

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

0

1000

2000

3000

4000

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Heart

Lung

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CT SURGERY

IN THE USA

STS IN THE21st CENTURYAugmented Reality

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CT SURGERY

IN THE USA

STS IN THE21st CENTURYAugmented Reality

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CT SURGERY

IN THE USA

STS IN THE21st CENTURYMan vs Robot

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CT SURGERY

IN THE USA

STS IN THE21st CENTURYThree Laws of Robotics

1. A robot may not injure a human being, or, through

inaction, allow a human being to come to harm

2. A robot must obey the orders given it by human

beings except where such orders would conflict with

the First Law

3. A robot must protect its own existence as long as

such protection does not conflict with the First or

Second Laws


Journal of Surgery and Surgical Research - Peertechz€¦ · Journal of Surgery and Surgical Research. ... as ell as mimi features of an aute adomen. Hoever, ... and CT was used

Doris: Surgery in the 21st century

STAGING of ESOPHAGEAL CANCER: ROLE OF CT and · PDF fileSTAGING of ESOPHAGEAL CANCER: ROLE OF CT and PET R. A. Halvorsen, ... Squamous cell carcinoma: ... Improved survival vs. Surgery

Reorganising specialist cancer surgery for the 21st century: a … · 2018-07-09 · Reorganising specialist cancer surgery for the 21st century: a mixed methods evaluation Professor

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CT Perfusion: The Basics - surgicalneurology.org · CT Perfusion: The Basics Professor of Radiology & Otolaryngology Head Neck Surgery, Radiation Oncoloy and Periodontics and Oral

Guide Surgery workflow - 3DII · Guide Surgery workflow Team ... software and cloud-based order system. ... Case Setup CT scan data and optical scan data loading Load data

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CT-MRI Image Fusion Effect on Dose Delivered and ... · CT and MRI imaging was done for all the patients after surgery. The PTV. CT. and PTV. MRI. tumor were measured and compared

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Porous Hydroxyapatite in Orbital Reconstructive Surgery ... · hydroxyapatite was used in orbital surgery, and demonstrate the postoperative CT appearance of this material, ie, an

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Comparative study of CT guided patient specific jig ... · The aim of this study was to compare the technology of CT guided jigs assisted surgery with conventional instrumentation

Robotic Cardiothoracic Surgery - PeaceHealth · Summary 1: Robotic CT Surgery For properly selected patients, results of robotic cardiothoracic procedures compare favorably with open

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Oral Surgery Bristol CT, Oral Surgeon - Risks and benefits of … · 2015-03-28 · Departments of Oral and Maxillofacial Surgery, St, Mary's Hospital, Montreal, and ... oral surgery

Concise Orthopedic Surgery in 21st Century

21st World Congress of the International Federation for the … · 2019. 3. 4. · The 21st World Congress of the International Federation for the Surgery of Obesity and Metabolic

+ A review on bariatric surgery Dr Dennis CT Lam TKOH

Clinics in Surgery Research Article · Peritoneal Cancer Indexes in Ovarian Carcinomatosis: Correlation between CT and Intraoperative Results and Survival. Is the CT a Good Tool for

International Journal of Surgery Case ReportsCASE REPORT – OPEN ACCESS 1018 T.P. Burke et al. / International Journal of Surgery Case Reports 4 (2013) 1017–1020 Fig. 1. CT image

Superimposition of 3D cone-beam CT models in …ortodontia.sites.uff.br/wp-content/uploads/sites/442/...Superimposition of 3D cone-beam CT models in orthognathic surgery Dental Press

Multi-detector CT Evaluation of Liver Neoplasms · C158 International ournal o Contemporary Medicine Surgery and Radiology Volume 3 Issue 3 July-September 2018 Multi-detector CT Evaluation

The radiobiological modelling challenges of 21st century ...• In the 21st century, radiotherapy retains a central place in cancer treatment, often in combination with surgery and/or

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Breckinridge CountyOctober 16th at 6 p.m. (ct) in the Extension Farmers’ Market & Educational Facility. Fall Open Rabbit Show is Saturday, October 21st at 9 a.m. (ct) at the reckinridge

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Hands-on Course in: Lateral Skull Base Surgery...Hands-on Course in: Lateral Skull Base Surgery 7-11 November 2016 Case n.03 Left VS in NF2 Pt Post-operative CT scan •Surgery - Removal