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9
O
n Charter Day, RCSI awarded an Honorary
Fellowship to distinguished surgeon,
educator and researcher, Professor Donald
Edward Low, currently head of Thoracic
Surgery and Thoracic Oncology, and Director
of the Esophageal Center for Excellence under
the Digestive Disease Institute at the Virginia Mason Medical
Center in Seattle, in addition to being the Clinical Supervisor
for the Ryan Hill Thoracoesophageal Research Fellowship. This
outstanding innovator in oesophageal and thoracic surgery spoke
to Surgical Scope recently about his work and career.
SURGICAL SCOPE:
WHY DID YOU CHOOSE A SURGICAL
CAREER?
PROFESSOR LOW:
The surgical component of the practice of
medicine seemed to suit my personality and goals to a greater degree
than any other subspecialty. Also, I had the privilege in the formative
aspects of my medical career to work for several surgical mentors who
not only demonstrated how gratifying surgery could be as a career,
but also demonstrated that a surgical career could include significant
other components such as teaching, education and administrative
leadership.
Q:
IN THE LATE EIGHTIES, YOU CROSSED THE ATLANTIC
TO SPEND TWO YEARS AS A THORACIC REGISTRAR
IN THE UK. FROM A SURGICAL AND CULTURAL
PERSPECTIVE, WHAT ARE YOUR STAND-OUT MEMORIES
FROM THAT TIME?
A:
I came to the UK to start my General Thoracic training in 1988,
accompanied by my wife and three small children. I was given
this opportunity through my mentors in Toronto and, from the
beginning, found the experience to be profoundly positive from both
the clinical and social perspectives. I initially joined a 28-bed thoracic
unit in the Southwest of England and then moved to the Midlands to
do additional thoracic training and also cardiac surgery. The volume
of clinical material and the complexity of the clinical experience was
outstanding.
There is an impression by some in the US that socialised medical
systems are not efficient. My experience was exactly the opposite in
that I saw more patients and did more complex operations during
my time in England than at any time during my career in Canada or
the US. I also had the opportunity to meet a significant number of
friends and colleagues from the UK and Europe who have maintained
contact and who expanded the opportunity for international
collaboration and research when I returned to the US.
Q:
YOU RETURNED TO THE US IN JULY 1990 TO TAKE UP
THE POSITION OF FELLOW IN LUNG TRANSPLANTATION
AT BARNES HOSPITAL IN ST. LOUIS UNDER THE
MENTORSHIP OF TWO ICONIC FIGURES IN MODERN
THORACIC SURGERY, DR JOEL COOPER AND DR LARRY
KAISER. IN BROAD TERMS, HOW DID YOUR TIME IN
ST. LOUIS INFORM YOUR DEVELOPING VISION FOR
OESOPHAGEAL AND THORACIC SURGERY?
A:
My time at Barnes Hospital with Dr Cooper and Dr Kaiser came
at a very important evolutionary period of thoracic surgery in the
US. Lung transplantation in the US had only been introduced by
Washington University in the year prior to my arrival. As the lung
transplant fellow, not only was I exposed to a wide variety of complex
thoracic surgical problems, but also was intimately involved in the
first high volume year of lung transplants that occurred in the US.
This was a very exciting time, which set the stage for this service to be
extended across academic centres of the US.
Q:
COULD YOU OUTLINE THE NATURE OF YOUR CURRENT
ROLES AS HEAD OF THORACIC SURGERY AND THORACIC
ONCOLOGY, AND DIRECTOR OF THE ESOPHAGEAL
CENTER OF EXCELLENCE AT THE DIGESTIVE DISEASE
INSTITUTE?
A:
I am the senior member of the Section of Thoracic Surgery and
Thoracic Oncology which manages the complete array of thoracic
surgical procedures. I am also Supervisor of the Thoracoesophageal
Research Fellowship and run the Thoracic Tumor Board. As
Director of the Esophageal Center for Excellence, I am involved with
virtually every clinical and basic science research project involving
both malignant and benign oesophageal conditions and Barrett's
Oesophagus.
Q:
THE STANDARDIZED CLINICAL PATHWAY MODEL
DESIGNED BY YOU AND YOUR TEAM FOR PATIENTS
UNDERGOING AN OESOPHAGECTOMY HAS RESULTED IN
OVER 90 PER CENT OF YOUR PATIENTS BEING MOBILISED
ON THE DAY OF SURGERY, MEDIAN ICU STAY BEING
REDUCED TO LESS THAN ONE DAY AND A MORTALITY
RATE OF LESS THAN 0.5 PER CENT. COULD YOU OUTLINE
THE KEY PRINCIPLES UNDERLYING THE SUCCESS OF THIS
MODEL?
A:
Standardized Clinical Pathway has produced an infrastructure
for us to improve our outcomes with respect to oesophageal
resection. Surgeons have had to refocus away from believing that
all progress with respect to outcomes is related to the surgical
procedure itself. Good surgery is at the heart of every successful
INNOVATOR
EMPHASISES
PATIENT JOURNEY
9
PROFESSOR DONALD EDWARD LOW
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