Alper Toker1, Kenney Hong2, Lucine M. Gao2
1Division of Thoracic Surgery, Director of Tracheal Reconstruction Program, Department of Cardiovascular and Thoracic Surgery, West Virginia University Heart and Vascular Institute, Morgantown, WV, USA; 2VATS Editorial Office, AME Publishing Company.
Correspondence to: Kenney Hong. VATS Editorial Office, AME Publishing Company. Email: vats@amegroups.com.
Editor’s Note
Video-Assisted Thoracic Surgery (VATS) aims to promote the development of video-assisted thoracic surgery around the world by providing a professional platform for the sharing of experience in video-assisted thoracic surgery between peers so that all patients may benefit. It has published a number of special series reporting the cutting-edge findings and application of video-assisted thoracic surgery in recent years, and received overwhelming responses from academic readers around the world. Our success cannot be achieved without the contribution of our distinguished guest editors. Taking this opportunity, this year VATS launched a new series, “Interviews with Guest Editors”, to highlight our active contributors. We hope to express our heartfelt gratitude for their tremendous effort and to further uncover the stories behind the special series.
The special series “Minimally invasive VATS thymectomy for Myasthenia Gravis” (1) and “Robotic Segmentectomies” (2) led by Prof. Alper Toker (Figure 1) from West Virginia University Heart and Vascular Institute have attracted numerous readers since they were published. These special series introduced the contemporary techniques in thymectomy for myasthenia gravis and studied on the robotic thoracic surgery. Hereby, we are honored to have an interview with Prof. Toker to share his experience in thoracic surgery and his insights on these special series.
Expert Introduction
Prof. Toker received his MD degree after completion of Marmara University, School of Medicine (1992). He then started the residency program at Istanbul University, Istanbul Medical Faculty, Department of Thoracic and Cardiovascular Surgery (1992). He took part as the Chief Resident in re-organization Department of General Thoracic Surgery at Istanbul University, Istanbul Medical Faculty, (2001-2019) under the vision of Prof Dr. Kalayci. He served the Professor of Thoracic Surgery and Director from 2009 to 2019. He also developed Thoracic Program at Group Florence Nightingale Hospitals (2010-2019) and created one of the first Robotic Thoracic Programs in Europe. Prof. Toker continued his career as interim chief and professor of Division of Thoracic Surgery, Department of Cardiovascular and Thoracic Surgery at West Virginia University, School of Medicine.
Prof. Toker worked as a council member of European Society of Thoracic Surgeons from 2009 to 2017 and he was the president of the ESTS 2014-15. He is a member of Society of Thoracic Surgeons and American Association of Thoracic Surgery.
His academic interests include extended surgery for lung cancer, complex tracheal surgery, extended mediastinal surgery and robotic mediastinal tumor and lung cancer operation. His love in Thoracic surgery is extended lung cancer surgery either with an open thoracotomy or robotic surgery and complex tracheal reconstructions. I enjoy reading academic articles, educating young surgeons, and finding new talents in the field of surgery.
Figure 1 Prof. Alper Toker.
VATS: As a reputable expert in the field of thoracic surgery, what drove you into this field in the first place?
Prof. Toker: As a high school student, I always loved physics and mathematics more than any other course. I perceived the “lung and heart” as physics-applicable organs. Since I took the heart and lung committee in 3rd Class, I always wanted to be a thoracic surgeon.
VATS: Thank you for leading the two special series “Minimally invasive VATS thymectomy for Myasthenia Gravis” and “Robotic Segmentectomies” for VATS. Which part of the content impressed you most in these two special series? Compared with other similar projects, what do you think are the unique advantages of these two series?
Prof. Toker: Minimally invasive VATS thymectomy for Myasthenia Gravis was one the highest-ranking issue. We studied in depth with expert authors. The selected titles were written by experts in the field. To tell you the truth, all articles were written with expertise and extreme care. The same is true for the series of Robotic Segmentectomies. Articles in both series showed a similarly high level of expertise. The unique advantages of these two series are being popular and recently developing surgical fields. Also, both topics provide a higher level of patient care both in the postoperative period and long term.
VATS: Could you please tell us about the biggest challenge of using minimally invasive VATS thymectomy for Myasthenia Gravis? As a chest surgeon, are there any cases that impress you a lot?
Prof. Toker: The biggest challenge in Myasthenia Gravis surgery is the management of myasthenia gravis disease during the perioperative period and proper thymic surgery. A proper thymic surgery should include the mediastinal fat and thymic tissue located in the anterior mediastinum from thoracic inlet down to diaphragm. The biggest challenge of the surgery is the management of major bleeding from one of the major vessels of chest. We have published these cases in the article with Dr. Ozkan “Catastrophes of VATS thymic surgery” (3).
VATS: The COVID-19 pandemic has had a severe impact on healthcare systems. Do you think the pandemic also affects the safety and efficacy of robotic thoracic surgery and VATS? How could they be better performed during the COVID-19 pandemic?
Prof. Toker: For sure COVID -19 pandemic affected the safety and efficacy of robotic thoracic surgery and VATS. All malignant cases had a priority in our system in WVU Medicine. We worked hard so as not to delay the malignant cases. This not only created a risk for us but also for patients. Both parties, did their best to overcome the delays and possible complications. We had a couple of patients developed COVID after the surgery. Some cases were postponed due to patients’ having the diagnosis of COVID-19 before the surgery. It appears that pandemics like this would happen to continue. Every country, state and hospital has to develop plans and programs for similar situations. Source utilization and distribution would always be a problem. Experience the World and Healthcare professionals gained during this pandemic and successful outcomes increased our self-confidence. I am pretty sure the next pandemic would be managed better than the 19.
VATS: What kind of projects are you recently working on? How is the topic of these special series associated with them?
Prof. Toker: Recently, I am working on larger-scale problems with big data source. These are related to the changing spectrum of lung cancer treatment for example with the introduction of immunotherapy and other treatment modalities. Now the job of thoracic surgeons become more prominent. The task is simple. How we can increase the survival by contributing surgery in the treatment of those patients who were considered to be inoperable until last year. Eventually, the next step would be how to implement VATS and robotic surgery in this changing era of medicine.
VATS: If there is a chance to update these two special series, what content do you want to moderate, and or emphasize more?
Prof. Toker: I would emphasize more in the implementation of robotic segmentectomy in patients with preoperative oncologic treatments. One other topic would be Straightforward segmentectomy operations with robotic surgery without a diagnosis and a wedge resection intraoperatively. This is also another topic I am working on.
Acknowledgments
Funding: None.
Footnote
Provenance and Peer Review: This article was commissioned by the editorial office, Video-Assisted Thoracic Surgery for the series “Interviews with Outstanding Guest Editors”. The article did not undergo external peer review.
Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form. The series “Interviews with Outstanding Guest Editors” was commissioned by the editorial office without any funding or sponsorship. AP serves as an unpaid editorial board member of Video-Assisted Thoracic Surgery from August 2021 to July 2023. KH and LMG report that they are full-time employees of AME Publishing Company. The authors have no other conflicts of interest to declare.
Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.
References
- Minimally invasive VATS thymectomy for Myasthenia Gravis. Available online: https://vats.amegroups.com/post/view/minimally-invasive-vats-thymectomy-for-myasthenia-gravis-edited-by-alper-toker.
- Robotic Segmentectomies. Available online: https://vats.amegroups.com/post/view/robotic-segmentectomies.
- Berker Özkan, Alper Toker. Catastrophes during video-assisted thoracoscopic thymus surgery for myasthenia gravis. Interact Cardiovasc Thorac Surg. 2016 Sep;23(3):450-3.