George Rakovich1, Jin Ye Yeo2
1Division of Thoracic Surgery, Department of Surgery, Hôpital Maisonneuve-Rosemont, University of Montreal, Montréal, QC, Canada; 2CCTS AME Publishing Company
Correspondence to: Jin Ye Yeo. CCTS Editorial Office, AME Publishing Company. Email: ccts@amegroups.com
This interview can be cited as: Rakovich G, Yeo JY. Meeting the Editorial Board Member of CCTS: Dr. George Rakovich. Chin Clin Oncol. 2024. Available from: https://ccts.amegroups.org/post/view/meeting-the-editorial-board-member-of-ccts-dr-george-rakovich.
Expert introduction
Dr. George Rakovich (Figure 1) obtained his MD from the University of Montreal. He completed a residency in general surgery and subspecialty training in thoracic surgery at the University of Montreal and Laval University (Quebec City). He also holds a postgraduate degree in medical education from the University of Montreal and is completing a minor in philosophy, with an interest in the philosophy of medicine.
He has been on staff at the University of Montreal affiliated Maisonneuve-Rosemont hospital since 2008 and chief of the hospital’s division of thoracic surgery since 2015. He is also a clinical associate of the hospital’s research center. His interests include advanced thoracoscopic techniques (including anatomic sublobar lung resection), active multispecialty approaches in thoracic oncology, and complex intrathoracic infections.
Dr. Rakovich co-leads a research team investigating lung biomechanics in collaboration with the Polytechnique Engineering School (Montreal, Canada). He is also currently developing a research program exploring advanced imaging techniques in thoracic surgery (Concordia University - Montreal, Canada).
Dr. Rakovich has previously served as Associated Editor of the Canadian Respiratory Journal where his focus was on developing educational case-based content. He currently also serves on the editorial board of the World Journal of Surgery.
Figure 1 Dr. George Rakovich
Interview
CCTS: What inspired you to pursue a career in thoracic surgery, and specialize in advanced thoracoscopic techniques?
Dr. Rakovich: At some point in one’s career path, something just captures one’s interest and one’s imagination. What attracted me to thoracic surgery was the opportunity to investigate a variety of complex problems and to come up with original solutions. I was also attracted by new opportunities for technical development. During my training, video-assisted thoracic surgery (VATS) lobectomies were just gaining traction in North America, and as I gained proficiency in advanced thoracoscopic techniques, I became interested in anatomic sublobar resections. This gave me the opportunity to explore the potential clinical applications of segmentectomy in an era of stereotactic radiotherapy and percutaneous ablation, as well as to describe some original surgical approaches. This process also gave me a lot of insight into surgery as an ever-evolving field, where the natural fate of therapeutics is one of ongoing refinements and eventually replacement by more effective and less invasive alternatives.
CCTS: You recently led a special series on advances in perioperative care in thoracic surgery and anesthesia. Could you highlight some of the significant advances in this area, and how they impact patient outcomes?
Dr. Rakovich:When I go back and look at the list of papers that made up this series, what stands out most to me is the multidisciplinary nature of the contributions. This highlights the fact that outcomes in thoracic surgery are the result of a multidisciplinary collaboration between surgeons, anesthetists, and perioperative care teams; outcomes reflect the sum of a multitude of nuances in the management of these fundamentally complex patients.
The series also highlights how important it is for streamlined perioperative care pathways to incorporate a variety of different concepts into a well-structured and well-organized evidence-based protocol that, at the same time, is adapted to each institution’s needs and resources. In my opinion, it really underscores the extent to which what we do in thoracic surgery is a systems-based endeavor. As care pathways are being refined, outcomes are improving, and perhaps we are even getting closer to routinely performing anatomic lung resections as day surgeries.
CCTS: Looking ahead, which subtopics in this special series do you think could be further studied in the future?
Dr. Rakovich:From a practical point of view, the two major factors that still keep patients in the hospital and account for most of the perioperative morbidity in thoracic surgery remain postoperative pain and air leaks. While advances in pain management have been significant, optimal pain control remains elusive; so pain control is definitively an issue worth exploring further.
Air leaks are an ongoing problem in lung surgery that remains fundamentally misunderstood. In my experience, discussions on air leaks have been permeated by misunderstandings, misconceptions, and unproven “historical” notions. What I like to call surgical “lore”. The fact is we do not know much about the mechanical behavior of the lungs, and even less about the mechanical behavior of pulmonary staple lines. Beyond extensive epidemiological descriptions of risk factors, we really do not have much to go on to address the air leak problem.
CCTS: You are currently co-leading a research team investigating lung biomechanics of staple lines in pulmonary and parenchymal resections. Could you share the significance of this aspect of lung biomechanics in thoracic surgery? What goals do you hope to achieve with research in this area?
Dr. Rakovich: The fundamental principle underlying our research program is that in order to solve the air leak problem in thoracic surgery, we first need to understand the underlying biomechanics of the lung. Only an adequate understanding of pulmonary and staple line biomechanics can allow insight into the causes and mechanisms of air leaks, and inform the development of dedicated technologies such as surgical staplers, biologic or synthetic sealants, and chest drainage systems.
Our technical expertise as surgeons ends where the expertise of biomedical engineers begins. This is why addressing the air leak problem necessarily requires an interdisciplinary approach. Interdisciplinary collaborations are inherently complex and challenging, but they can also be particularly rewarding. Successful interdisciplinary collaborations tend to produce completely novel solutions that are foreign to any individual field, which makes our research particularly exciting.
CCTS: As an Editorial Board Member, what are your expectations for CCTS?
Dr. Rakovich: I am most grateful for the opportunity to guest-edit a special series for CCTS. The support provided by CCTS at all levels was critical because editing work may be difficult, even tedious at times, long before the gratification of the final finished product. CCTS promotes a positive atmosphere favorable to creativity and innovation, where editors and authors alike may feel comfortable expressing their ideas and interacting with each other and the editorial team. This spirit is embodied by an openness to publish multidisciplinary articles, such as several of those included in the special series on perioperative care. This is so important because, in my opinion, such multidisciplinary work is at the core of meaningful progress in thoracic surgery.