Clarity of Purpose and Focused Attention Embodied in Sugarbaker’s Adult Chest Surgery

The field of general thoracic surgery field evolved from general surgery in the early 1900s, largely as a response to chest morbidities prevalent at the time, including pulmonary tuberculosis and World War I-related trauma. Over the course of the twentieth century, thoracic surgery experienced a series of dramatic and tumultuous changes that initially threatened but ultimately strengthened the integrity of the discipline.

In 1953, the first successful application of extracorporeal circulation in humans began an era of precipitous innovation in chest surgery in the United States, resulting in a paradigm for cardiothoracic training that married cardiac and thoracic surgery. In the 1990s, transformative developments in cardiovascular disease diverted funding in cardiothoracic programs in favor of cardiac training; however, it was not long before this model was recognized as suboptimal for training leaders in thoracic surgery.

This unmet need was recognized by surgeon innovators and the first independent division of thoracic surgery in the United States was founded in 1988 at the Brigham and Women’s Hospital and was led by David Sugarbaker. It was there, in 1993, that the first training program in the United States with a track dedicated to general thoracic surgery was approved by the Residency Review Committee of the Accreditation Council for Graduate Medical Education (ACGME), the body that oversees the accreditation of all residency programs in the United States.

Since the start of the twenty-first century, there has been a vast increase in the number of thoracic surgery training programs, driven by a wave of surgical innovation in our specialty. Technological advances have been rapid in recent years, including leading improvements in minimally invasive thoracic surgery, endoscopic therapies, such as per oral endoscopic myotomy (POEM) and endoscopic submucosal dissection (ESD), and techniques to facilitate lung transplantation, such as ex vivo lung perfusion (EVLP). Consequent to the rapid pace of our field, thoracic surgery residency and fellowship programs are proliferating, flourishing, and producing leaders, innovators, and the technically excellent surgeons.

David Sugarbaker, the founding leader of BCM’s first Division of General Thoracic Surgery, was the penultimate surgeon innovator who studied excellence in surgery and distilled it’s essence to clarity of purpose and focused attention. The first edition of his textbook, Adult Chest Surgery, was published in 2009 and is one of the most comprehensive and referenced texts in general thoracic surgery.

Dr. Sugarbaker was a mentor to countless residents, fellows, and medical students, but proudly viewed himself as a teacher to any and all of the individuals who cared for his patients. It is not surprising that his textbook is commonly found in the thoracic surgery clinics, hospital wards, intensive care units, and operating rooms where thoracic surgery is practiced, and is equally referenced by surgical attendings and trainees, advanced care practitioners, medical assistants, and nurses. The 3rd edition of this textbook is soon to be published this year, has been aptly renamed Sugarbakers’ Adult Chest Surgery, and will promote clarity of purpose and focused attention by all of those who care for thoracic surgery patients.