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Prof. Joel Dunning:胸外领域的未来充满了未知与可能

Published at: 2015年第1卷第S1期

高凤平 , Bella
关键词:

编者按英国伦敦皇家内科医学院此前迎来了第四届国际胸腔镜研讨会,在此次研讨会上,国际胸外科专家齐聚一堂,聚焦微创胸外科手术热点话题,包括微创手术的应用现状与原则,肺叶切除前沿技术,机器人与胸腔镜之争,微创手术未来发展等,进行了精彩的演讲与讨论,为参会者带来了一场胸腔镜交流盛会。会议上,来自James Cook University Hospital,任CTSNet副主编的Prof. Joel Dunning围绕“Microlobectomy”一话题分享了他的技术与经验,让参会者都获益不少。借此机会,AME出版社有幸邀请到Prof. Dunning进行采访,分享他对机器人以及微创肺叶切除术的宝贵看法,此外,Prof. Dunning也与我们分享了他平衡工作与生活的秘诀。

人物聚焦:Joel Dunning

Prof. Dunning did the medical school training at Oxford University at a time when evidence based medicine was taking off. Then he went to Manchester for his junior doctor positions and worked for Professor Mackway Jones who had just set up Best Evidence Topics in Emergency Medicine and encouraged Prof. Dunning to set up a 10 centre study in children's head injuries that became his PhD and Prof. Dunning helped NICE to create National Guidelines in this area. Later Prof. Dunning entered Cardiothoracic Surgery and continued projects in Evidence Based Surgery first inspired by Prof. Ludwig Von Segesser to create Best BETS in Cardiothoracic Surgery for the ICVTS and then by Sam Nashef on the EACTS Clinical Guidelines committee to start to produce guidelines for our community.

He is currently promoting guidelines for the management of arrests after cardiac surgery which he thinks is the most important guideline that he has ever helped to create and has the potential to save the most lives.

Clinically Prof. Dunning spend a lot of time doing minimally invasive Thoracic Surgery. He particularly likes trying new techniques for both robotic and VATS surgery including subxiphoid approaches for lobectomy and the thymus. He’s involved in the development of a few novel devices including a new 5mm stapler.

Prof. Dunning is an associate editor of the European Journal of Cardio-Thoracic Surgery, managing the Cardiac General Section of the EJCTS and the Best BETs section of the ICVTS. He’s also CTSNet co-editor in chief, co-founder of the CALS course, which teaches safer emergency care after cardiac surgery to units and clinicians all over the world, and also the editor of a new edition of the annals of cardiothoracic surgery on mediastinal surgery.

图1. 为Prof. Dunning颁发Journal of Visualized Surgery (JOVS)编委证书

会议上,Prof. Dunning与Prof. Robort Cerfolio就“机器人与胸腔镜手术之争”进行了精彩辩论。虽Prof. Dunning是反方(支持胸腔镜手术),但实际上他在两种术式的应用上都颇有经验。采访中,Prof. Dunning与我们分享了他对机器人技术的钟爱,认为在sleeve resections与extended resections上,机器人会取得更好的效果,而对于标准的肺叶切除手术,VATS则能节省时间的同时达到更小切口的效果。

此外,Prof. Dunning也提到了在掌握两项技术上的各自难点:由于胸腔镜器械操作本身存在的限制(手与器械动作的相反性),掌握VATS这项技术会比机器人更难,对医生技能与培训的要求更多,但另一方面,机器人手术的成本则远远高于VATS。

采访中,Prof. Dunning也与我们说来了他此前进行Microlobectomy这一技术的初衷—主要是为了减少肋间无必要的切口。从上海肺科医院Jiang Lei教授的一次剑突下进路手术中,Prof. Dunning获益良多,但考虑到自身技术或许受限以及西方病人的特点,他因此想到了借助其他器械的帮助。同时,Prof. Dunning也简要介绍了Microlobectomy的手术原则:在肋间位置,切口不超过5毫米,接着是一个12毫米的剑突口用于吻合器的进入,而另一个剑突口则用于取出样本。

谈及Microlobectomy今后的发展,Prof . Dunning认为未来的发展一定程度上会倾向于机器人的广泛应用,单孔与剑突下单孔入路也会成为更多人的选择。总体而言,对于未来,Prof. Dunning表示其中充满了未知与可能,各种技术都会不断发展,外科医生也会不断进步,而这也正是胸外科领域让人兴奋之处—“谁能知道下个五年,我们将会讨论哪种技术?”

此外,作为CTSNet副主编,Prof. Dunning简要介绍了CTSNet的一些运营优势。而作为出版同行,Prof. Dunning更表达了对AME出版社工作的认可与赞赏。

采访最后,Prof. Dunning更与我们道来了他在生活与工作间取得平衡的一大秘诀——“我工作的内容,包括录制手术视频、采访医生等,本身就是我的爱好啊!”

现场答疑

  1. Yesterday you have a debate with Prof. Cerfolio about Whether Robotic Surgery is better than VATS. We know that you are both good at Robotic Surgery and VATS. Here would you share in which condition will Robotic Surgery reach better result that VATS and when will VATS be better than Robotic Surgery? 

  2. What’re the essential skills required respectively for Robotic Surgery and VATS?

  3. You have developed a novel technique for lung cancer resection called microlobectomy. Here would you share the features of this technique? Compared to the traditional technique, what would microlobectomy bring to our patients?

  4. What’s your expectation to future development of microlobectomy? Do you expect any improvement for this technique?

  5. We also know that you’re the CTSNet Co-Editor-in-Chief and have also interviewed quite a lot surgeons. Would you share what would you feel when you interview those surgeons since you’re as well a surgeon? What inspires you to be an editor and do these interviews?

  6. As a surgeon, an editor, as well as a co-founder of the CALS course, here would you share with us how do you balance your work and life? 

更多详情,请观看下方视频:


采写编辑:高凤平& Bella Poon,AME出版社

视频剪辑:麦雪芳,AME出版社

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