Dr. Mauricio Velasquez is probably one of the most famous thoracic surgeons that you’ve never heard of. He conducts thoracic surgery at the Fundacion Valle del Lili in Cali, which was recently ranked by AmericaEconomica as the seventh best overall hospital in Latin America.
Anesthesia: Surgical Apgar: 8.5
Joint Commission accreditation: no
Velasquez’ surgery program is one of just a handful of programs in the world to offer single port thoracic surgery. Dr. Velasquez has also single handedly created a surgical registry for thoracic surgeons all over Colombia. This registry allows surgeons to track their surgical data and outcomes, in order to create specifically targeted programs for continued innovation and improvement in surgery.
Dr. Velasquez is also part of a team at Fundacion Valle del Lili which aims to add lung transplant to the repertoire of services available to the citizens
of Cali and surrounding communities.
Specialized education and training
After completing medical school at Universidad Pontificia Bolivariana in Medellin in 1997, he completed his general surgery residency at the Universidad del Valle in 2006, followed by his thoracic surgery fellowship at El Bosque in Bogota.
The Colombia native has also trained with thoracic surgery greats such as Dr. Thomas D’Amico at Duke University in Durham, North Carolina, and single port surgery pioneer, Dr. Diego Gonzalez Rivas in Coruna, Spain. He is also planning to receive additional training in lung transplantation at the Cleveland Clinic, in Cleveland, Ohio.
Single port surgery
Presently, Dr. Velasquez is just one of a very small handful of surgeons performing single port surgery. This surgery is an adaptation of a type of minimally invasive surgery called video-assisted thoracoscopy. This technique allows Dr. Velasquez to perform complex thoracic surgery techniques such as lobectomies and lung resections for lung cancer through a small 2 – 3 cm incision. Previously, surgeons performed these operations using either three small incisions or one large (10 to 20cm) incision called a thoracotomy.
By using a tiny single incision, much of the trauma, pain and lengthy hospitalization of a major lung surgery are avoided. Patients are able to recovery and return to their lives much sooner. The small incision size, and lack of rib spreading means less pain, less dependence on narcotics and a reduced incidence of post-operative pneumonia and other complications caused by prolonged immobilization and poor inspiratory effort.
However, this procedure is not just limited to the treatment of lung cancer, but can also be used to treat lung infections such as empyema, and large mediastinal masses or tumors like thymomas and thyroid cancers.
Part of his success in due in no small part to Dr. Velasquez’s surgical skill, another important asset to his surgical practice is his wife, Dr. Indira Cujiño,a anesthesiologist specializing in thoracic anesthesia. She trained for an additional year in Spain, in order to be able to provide specialized anesthesia for her husband’s patients, including in special circumstances, conscious sedation. This allows her husband to operate on critically ill patients who cannot tolerate general anesthesia. While Dr. Cujiño does not perform anesthesia for all of Dr. Velasquez’s cases, she is always available for the more complex cases or more critically ill patients.
In the operating room with Dr. Velasquez
In the operating room, Dr. Velasquez is thoughtful and deliberate in his actions. A methodical pre-operative checklist is completed with the patient participating in the process. This checklist is part of a specialized process recommended by the World Health Organization (WHO), the Joint Commission for hospital accreditation and several surgical societies for the prevention of patient injuries and medical mistakes.
CT scans and patient history are reviewed and confirmed prior to the induction of anesthesia. Proper endotracheal tube placement with a double lumen endotracheal tube is confirmed with direct visualization via bronchoscopy and auscultation. Proper patient positioning and preparation is undertaken to prevent patient injury, and maintain sterility during the case. All video equipment and hemodynamic monitoring devices are new and fully functional. There are two video monitors; both are high quality, of adequate size with excellent resolution.
During all of the surgeries, patient’s vital signs were aggressively monitored with continuous anesthesia monitoring. Sterility was maintained in all cases. Dr. Velasquez demonstrated finesse and advanced technique skill, using single port thoracoscopy for all cases. One case required conversion to open thoracotomy due to patient anatomy, but this was not reflective of Dr. Velasquez’s surgical skill. The surgeries proceeded quickly in an appropriate fashion with limited bleeding and no intra-operative complications such as hypoxia or cardiac arrhythmias.
At the conclusion of the cases, patients were awakened and successfully extubated in the operating room prior to transfer to the recovery room.
As part of surgical evaluations, objective criteria such as adherence to the WHO checklist and other recommended surgical protocols and procedures are rated. However, as discussed in the article, the quality of surgery is dependent on additional factors such as the quality of anesthesia. Thus, the overall surgical scoring incorporates the quality of anesthesia in addition to surgical skill and intra-operative performance.
The surgical apgar score, designed by Dr. Atul Gawande in 2007 is a validated scoring system used to rate the quality of anesthesia and predict the incidence of complications. In previous studies; Gawande and his colleagues found that in cases with surgical apgar scores less than four, over 50 percent of patients experienced serious and even fatal complications.
Author Kristin Eckland, ACNP-BC, MSN, RN is an acute care nurse practitioner specializing in cardiothoracic surgery and owner of medical weblog Thoracic Surgery.