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We recently spoke with Dr. Gianluca Torregrossa, Director of Robotic Coronary Revascularization at Lankenau Heart Institute, part of Main Line Health, in Philadelphia, PA. Our conversation centered around Dr. Torregrossa’s fascinating journey and expertise in cardiac surgery. We spoke with him about the evolution and transformation he has witnessed in cardiac care since his early years understanding heart valve tissue engineering, to his more recent focus on robotic mitral valve repair and coronary artery bypass grafting. We also wanted to get Dr. Torregrossa’s perspective on the opportunities and potential impact that digital surgery solutions can afford surgeons today.
REFLECTING BACK TO 2006 WHEN YOU BEGAN YOUR FELLOWSHIP TO PRESENT DAY, HOW HAS THE DELIVERY OF CARDIAC SURGERY EVOLVED?
During the last 10 years, cardiac surgery has changed dramatically. The major push has been towards a more refined, technologically advanced surgery. The most important revolution in the last 10 to 20 years of heart surgery has been with the advent of transcatheter technologies. In this sense, robotics has advanced the panorama of cardiothoracic surgery and furthered a surgeon’s ability to provide long-term, durable results for their patients.
TO DATE, YOUR CAREER HAS SPANNED THREE CONTINENTS. WHAT HAS BEEN THE MOST FASCINATING OR EYE-OPENING EXPERIENCE RELATED TO DELIVERING CARE IN DIFFERENT PARTS OF THE WORLD?
I had the opportunity to work with retired cardiothoracic surgeons that were coming from all around Europe to Africa for two to three week rotations. As a junior surgeon, my role was to pick them up at the airport and make sure they were ready the next day to perform three to four surgeries on congenital heart valve patients at a center of excellence in the middle of the desert. Thanks to this experience, I learned a lot and had the opportunity to meet and scrub with many excellent surgeons.
One day, one of the surgeons helped me perform an Aortic Valve Replacement. The case went very well, but that night, I received a call that the blood pressure went very high during the extubation and the patient bled. I went to see the patient and decided to bring him back to the operating room. There was minor bleeding from one of the sternum wires. After surgery, the patient was returned to the ICU and safely extubated.
The next morning, I was called into the office of the president of the hospital. He asked me what happened last night. More specifically, he asked how many blood transfusions were given to the patient. I told him, “This is cardiac surgery and there was bleeding. I took care of it. Everything is fine and the patient was extubated.” But yet, he was not happy. He brought me to the blood bank and told me that three units of blood were used on my patient and that to have these types of resources is very difficult in Africa. So he asked me to donate three units of blood that morning. That moment, I told him, “You're crazy. I have to go to the operating room in a half hour. There's no way.” He didn't want to hear any stories. I had to sit down and I donated two units of blood. The good nurse at the blood bank saw me becoming pale, almost fainting, and stopped there. Then I went to the operating room.
I think that this was a very important and eye-opening experience about the unforeseen challenges and implications in delivering excellence in surgical care throughout the world.
WHERE DO YOU SEE THE FUTURE OF CARDIAC SURGERY HEADED? WHAT ROLE DO YOU SEE DIGITAL TECHNOLOGIES SUCH AS 3-D IMAGING AND INTRAOPERATIVE VIDEO REVIEW HAVING IN ADVANCING SURGICAL PROCEDURES AND POSITIVELY IMPACTING OUTCOMES?
The future of cardiac surgery is headed towards more technologically advanced, minimally invasive options for treating patients with cardiac disease. There will be an integration of imaging, knowledge, know-how and technologies that will allow surgeons to access a robotic platform which will suggest or guide physicians to take the best option. For instance, the technology will soon suggest where the left internal thoracic artery is, where the branches are, and how to safely take it down to perform a bypass.
HOW HAS USING THE C-SATS PLATFORM ENHANCED YOUR SURGICAL LEARNING?
C-SATS has been an incredible journey and opportunity for me. Thanks to C-SATS, I have the daily opportunity to review videos of peers and colleagues around the world that perform surgeries similar to mine. I have the opportunity to see other surgeon’s moves, maneuvers and techniques, and to continue learning how to perfect my technique in efforts to improve my outcomes. C-SATS is the most advanced platform to allow a knowledge exchange between surgeons in a safe and protected environment through video review. C-SATS has definitely helped me improve.
WHAT DO YOU FIND TO BE THE MOST VALUABLE ASPECTS OF THE C-SATS PLATFORM?
First, is the community of people that populate C-SATS. These are surgeons who are willing to share their knowledge, activities, and skills in a very open way. The second important and valuable aspect is the safety of the environment where we are practicing, where we are sharing all of this knowledge, where we are sharing all of these videos. Another incredible aspect of the C-SATS platform is the ability to receive and provide feedback. This is very important for your own growth. One of the major elements that limits your growth at a certain point is the fact that you don’t have anyone else that tells you, “You could do this one slightly differently in a more efficient way.” C-SATS offers exactly this type of platform. You have a leader ahead of you, or you have peers or maybe even someone more junior than you that does better than you in a single step of the surgery. Just by reviewing the videos, by offering suggestions, by looking at how other people deal with the same problems, you learn and you enhance your own activities.
WHAT IS ONE PIECE OF ADVICE YOU WOULD GIVE TO SURGEONS TO MAXIMIZE THE VALUE THEY CAN GET FROM THE C-SATS PLATFORM?
To maximize the value of this platform, the most important element is consistency. Keep spending time on the platform. Keep logging in every day, one hour, half hour, even 15 minutes. In the same way in which you check your social media, you should spend time on C-SATS. It should become a habit. And that’s so important because consistency allows you to understand and look at those details that are present in each video and from which you can learn. So be there, be present, be part of the community, and be consistent in logging into this community.
ANYTHING ELSE YOU'D LIKE TO ADD?
C-SATS is an incredible platform that is made of surgeons that are willing to share, educate, learn from, and review the works of others, with the final aim of offering better care for patients. We should be grateful for this level of expertise and this open roundtable for everyone.