The interview lasts an hour, and despite being tired from flying from Naples, Italy where he taught another course on single port thoracoscopy, he is gracious and disarmingly charming. At just 38, the dynamic young surgeon is changing the future of thoracic surgery. Despite being one of the most famous thoracic surgeons in the world, being featured on television internationally and ranking alongside Dr. Thomas D’Amico, Dr. Robert McKenna, and Colombia’s own Dr. Mauricio Velasquez as experts in the field; he remains humble and unaffected.
A native of Coruna, Spain, the European board certified surgeon currently works in four hospitals in the coastal city, though presumably he has offers to work in prestigious institutions around the world. He is the head of the Minimally Invasive thoracic Surgery Unit (UCTMI) and he works at Coruna University Hospital, a 1,200 bed facility and performs a variety of procedures including an estimated 30 – 40 lung transplants per year
Single port thoracoscopy / single incision thoracic surgery (SITS)
But his specialty and his creation is single port surgery, mainly lobectomies which is the surgical removal of a lobe of the lung. He first started performing lobectomies with this method in June of 2010, after innovating the technique of single port surgery in 2007. With this procedure, only one very small (1cm to 2cm) incision is used instead of more conventional video –assisted thoracoscopy (VATS) or traditional open surgery. In cases of very large lung tumors, the incision may be slightly enlarged to facilitate removal at the conclusion of the procedure.
Less pain, faster recovery
In comparison to VATS which utilizes multiple incisions; less really is more, as Dr. Gonzalez explains. Less pain, less recovery time and less scarring for his patients. For the surgeons themselves, single port surgery offers additional advantages. Standard three port VATS techniques use a cross-body approach as ports are spread in a triangular configuration. Surgeons then work within these angles to position their instruments to perform delicate operations such as lung resections. Unfortunately, this configuration sacrifices the visibility available with traditional techniques using one very large (10 to 20 cm) incision. Three port approaches also force surgeons into uncomfortable anatomic positions for the duration of the surgery. The surgeons are forced to contort their bodies, and adopt an uncomfortably wide stance to be able to easily manipulate all of the instruments simultaneously. It was these challenges that led Dr. Gonzalez to conceive of and develop single port surgery. To the surprise of the thoracic surgery community, the single port approach conquers many of these difficulties; by inserting all of the instrumentation in the same port of the camera, surgeons gain visibility and maneuverability without sacrificing ergonomics.
Teaching the thoracic surgery community
After publishing several papers on the topic, with more pending publication, surgeons around the world are finally taking notice with Dr. Gonzalez becoming hot property on the lecture and training circuit. He has teaching seminars scheduled for the biggest thoracic surgery conferences in the United States and Europe, in addition to his trip here to Santiago, Chile. He also offers training at his hospital in Spain, as well as a video series available on-line at the Multimedia Manual of Cardio-thoracic Surgery.
While he recommends a background in traditional VATS and dual port thoracoscopy, he reports that this is not necessary for experienced thoracic surgeons. In fact, he reports that his thoracic surgery fellows are able to perform the technique easily with minimal assistance. With more and more surgeons learning this technique, it will be coming soon to a hospital near you.
For more about Dr. Gonzalez Rivas and his single port technique: www.videothoracoscopy.com