Alessio Mariolo1, Jin Ye Yeo2
1Department of Thoracic Surgery, Insitut Mutualiste Montsouris (IMM) – Institut du Thorax Curie-Montsouris – Paris, France; 2CCTS AME Publishing Company
Correspondence to: Jin Ye Yeo. CCTS Editorial Office, AME Publishing Company. Email: ccts@amegroups.com
Expert introduction
Dr. Alessio Mariolo (Figure 1) obtained his MD degree from Palermo University Hospital in 2013 and specialized in Thoracic Surgery and Lung Transplantation in Milan in 2020. Dr. Mariolo is a cardiothoracic surgeon, working in the field of oncological minimally invasive thoracic surgery, video-assisted thoracic surgery (VATS), and robotic-assisted thoracic surgery (RATS). He is the Chief of the Thoracic Department at Institut Mutualiste Montsouris (IMM) in Paris where he has worked since 2018.
He was involved in Minimal Thoracic Surgery and since 2011 he and his department have developed active pedagogic sessions on VATS and RATS resection from simple to complex procedures. His expertise includes General Thoracic Surgery, VATS Lobectomy and segmentectomy, Thoracoscopic Surgery, Robotic Surgery, and Extensive Chest Resection for Lung Carcinoma.
Dr. Mariolo plays an active role in numerous scientific organizations, including the European Society of Thoracic Surgeons (ESTS), the French Society for Thoracic and Cardiovascular Surgery (SFCTCV), and the Italian Society of Thoracic Surgery (SICT), and he also authored several articles in the thoracic field, especially about sublobar lung resections and robotic-assisted thoracic surgery.
Figure 1 Dr. Alessio Mariolo
Interview
CCTS: What inspired you to specialize in oncological minimally invasive thoracic surgery?
Dr. Mariolo: My inspiration to specialize in oncological minimally invasive thoracic surgery stems from a combination of personal experiences and professional observations. Throughout my medical training, I witnessed the significant impact that cancer has on patients and their families. This experience instilled in me a desire to contribute positively to patient outcomes and quality of life during such a challenging time.
I was particularly drawn to minimally invasive techniques because they offer substantial benefits over traditional approaches, including reduced recovery times, less postoperative pain, and minimal scarring. I have always been fascinated by the intricate anatomy of the thoracic cavity, and the challenge of performing delicate surgeries in this area motivated me to pursue further training in robotic and thoracoscopic surgery.
Moreover, I believe that using advanced technologies in surgery can lead to better precision and improved patient outcomes. The ability to combine cutting-edge technology with compassionate care is what truly inspires me to work in this field. Ultimately, my goal is to provide my patients with the highest standard of care while ensuring they maintain the best possible quality of life.
CCTS: Could you provide a brief overview of the recent advancements in Video-Assisted Thoracoscopic Surgery (VATS) and Robotic-Assisted Thoracoscopic Surgery (RATS)? Are there any examples that stood out to you and/or had a significant impact on your practice?
Dr. Mariolo: In recent years, we have seen significant advancements in both VATS and RATS. One of the key developments has been the enhancement of visualization technology. High-definition cameras and 3D imaging systems have greatly improved surgical precision, allowing for better outcomes. Additionally, advancements in surgical instruments—such as articulating and multi-functional tools—have provided us with more dexterity during procedures.
Training has also evolved with the introduction of simulation-based programs. These allow surgeons to practice and refine their skills in a risk-free environment, which has led to a notable reduction in complication rates and improved patient outcomes. Furthermore, the integration of artificial intelligence into surgical planning is becoming more common, enabling more tailored approaches to individual patient needs.
Robotic-assisted techniques have shown great promise in managing more complex cases, such as for lung-sparing surgery like in complex segmentectomies or mediastinal tumor resections.
Notably, subxiphoid robotic surgery has emerged as an innovative approach, providing excellent access to the thoracic cavity while minimizing visible scarring and postoperative pain. Furthermore, non-intubated thoracic surgery (NITS) is gaining attention as a truly minimally invasive option combining offering a reduced impact of anesthetic stress, allowing for minimally invasive surgical procedures even for more vulnerable patients impact.
These advancements have significantly impacted my practice. They have allowed me to offer patients less invasive options with quicker recovery times and fewer complications. Overall, the shift toward minimally invasive surgery aligns well with our goal of providing patient-centered care, emphasizing improved quality of life after surgery.
CCTS: In your opinion, what are some aspects of minimally invasive thoracic surgery that you believe have received insufficient attention?
Dr. Mariolo: In my view, several aspects of minimally invasive thoracic surgery have not received the attention they deserve. One significant area is the long-term psychological impact on patients undergoing these procedures. While we focus extensively on the physical benefits—such as reduced pain, shorter recovery times, and fewer complications—we often overlook how patients psychologically adjust to the experience of surgery and the implications of their diagnosis.
Additionally, the training and education of surgeons in these advanced techniques is another critical aspect that requires more emphasis. As minimally invasive methods evolve, it is essential that surgical education keeps pace to ensure that upcoming surgeons are well-versed in the latest technologies and approaches.
Moreover, the role of multidisciplinary teams in optimizing patient outcomes in minimally invasive thoracic surgery is often understated. Collaboration among surgeons, anesthesiologists, and nursing staff can enhance the patient experience and outcomes, yet we need more research and guidelines on effective teamwork in the surgical setting.
Finally, the potential for cost-effectiveness in minimally invasive procedures is an area ripe for exploration. While these techniques often lead to shorter hospital stays and quicker recoveries, a comprehensive analysis of their long-term economic benefits to healthcare systems has not been thoroughly investigated.
By addressing these underexplored areas, we can further improve the quality of care and the overall success of minimally invasive thoracic surgeries.
CCTS: Your department has developed active pedagogic sessions on RATS and VATS resection. What inspired you and your department to develop these sessions?
Dr. Mariolo: The inspiration to develop active pedagogic sessions on RATS and VATS stemmed from our commitment to advancing surgical education and improving patient outcomes. We recognized the rapid evolution of minimally invasive techniques in thoracic surgery and understood the importance of equipping our surgical team with the latest knowledge and skills.
By creating these interactive sessions, we aimed to foster a collaborative learning environment where surgeons, residents, and nursing staff could engage in hands-on training. This approach not only enhances technical proficiency but also encourages teamwork and communication among our multidisciplinary team, which is crucial for successful surgical outcomes.
Moreover, we wanted to address the knowledge gap in these advanced techniques. Many surgeons may not have had exposure to RATS and VATS during their training, so providing comprehensive educational resources ensures that everyone in our department is confident and competent in using these innovative methods.
Ultimately, these sessions are designed to empower our surgical team to deliver the highest standard of care to our patients, ensuring they benefit from the advantages of minimally invasive surgery, such as reduced recovery times and improved quality of life. We are excited about the positive impact this initiative will have on our practice and the patients we serve.
CCTS: Can you describe the curriculum your team has created for these sessions? How have you seen measurable improvements in surgical techniques or outcomes among participants after attending these sessions?
Dr. Mariolo: Our curriculum for the active pedagogic sessions on RATS and VATS resection is designed to be comprehensive and hands-on, consisting of several key components. We start with foundational knowledge through a series of lectures that cover the principles of minimally invasive surgery, including the anatomy involved, indications for RATS and VATS, and the latest advancements in technology. This theoretical framework sets the stage for practical application.
Participants then engage in simulation-based training using advanced surgical simulators that replicate real-life scenarios, allowing them to practice techniques in a controlled environment while focusing on instrument handling, suturing, and other essential skills. We also incorporate live surgical demonstrations, where experienced surgeons perform RATS and VATS procedures while explaining their techniques and decision-making processes. This observation component is invaluable for participants to see how theory translates into practice.
Following each session, we facilitate interactive case discussions, enabling participants to analyze real cases, share experiences, and discuss complications and solutions. This promotes critical thinking and collaborative learning. To ensure continuous improvement, we include a robust feedback mechanism, allowing participants to receive constructive evaluations of their performance during simulations, helping them identify areas for growth.
As for measurable improvements, we have observed significant positive outcomes among participants after attending these sessions. Post-training assessments indicate increased confidence levels and proficiency in performing RATS and VATS procedures. Notably, we have seen a reduction in complication rates among participants in the months following the training, which correlates with their enhanced skill sets. Regular follow-up evaluations of surgical outcomes have shown improved recovery times and higher patient satisfaction, reflecting the positive impact of the training on both surgical techniques and overall patient experiences. Ultimately, this initiative has fostered a culture of excellence in our department, enhancing our ability to provide high-quality care to our patients.
CCTS: What challenges have you faced in teaching minimally invasive techniques? How have you addressed them in your pedagogic approach?
Dr. Mariolo: Teaching minimally invasive techniques presents several challenges, primarily the steep learning curve for trainees transitioning from traditional surgery. To address this, we incorporate simulation-based training, allowing participants to practice in a risk-free environment and build their skills gradually with advanced surgical simulators.
Another challenge is ensuring that all team members, including nurses and support staff, are proficient in these techniques. We address this by including interdisciplinary training sessions that promote collaboration among surgeons, anesthesiologists, and nursing staff. Additionally, we recognize the varying levels of experience among participants, so we offer tailored training modules that accommodate different skill levels.
Finally, to keep our curriculum current with rapid technological advancements, we prioritize continuous education, ensuring our team stays at the forefront of minimally invasive techniques. By tackling these challenges, we enhance the proficiency and confidence of our surgical team, ultimately improving patient outcomes.
CCTS: As an Editorial Board Member, what are your expectations for CCTS?
Dr. Mariolo: As an Editorial Board Member for CCTS, I expect the journal to focus on high-quality research that bridges surgical discoveries and clinical applications, with a particular emphasis on minimally invasive techniques such as VATS and RATS.
These methodologies represent the future of surgical practice and offer significant benefits in patient outcomes, so it is vital that we prioritize innovative studies and advancements in this area. I also hope to see a diverse range of submissions, encouraging contributions from both early-career and established researchers to enrich the field.
Furthermore, promoting transparency and reproducibility in research is essential to enhancing the credibility of our publications. Lastly, engaging with our readership through initiatives like webinars and special issues will foster collaboration among researchers and clinicians. By centering our focus on minimally invasive surgery, we can ensure that CCTS remains at the forefront of clinical and translational science.