Thoracic Anesthesia (TGH) Toronto General Hospital (3 positions annually).
Surgical oncology procedures makes up the bulk of thoracic surgery at the Toronto General Hospital. Interventions for lung cancer vary from diagnostic procedures, minimally invasive resection (video assisted and robotic thoracic surgery) to major incision and resection.
There is an active caseload of esophageal surgery, both resection and reconstruction for cancer and functional surgery for benign disease. As a referral center for major airway surgery, airway stenting, resection and reconstruction are frequent. Thymectomy is also routinely performed, both for malignancy and for the treatment of myasthenia gravis. A comprehensive approach to acute perioperative pain practice in thoracic surgery patients includes multimodal systemic analgesia, the use of truncal blocks and epidural placement.
There is emphasis for fellows to become proficient at the care of patients with end-stage lung disease undergoing high-risk surgery: lung transplantation (over 200 cases per year), pulmonary endartectomy (60-70 cases annually) and lung volume reduction (10-15 cases per year). The anesthesia department plays an active role in the assessment, selection and perioperative management of these cases.
Thoracic anesthesia fellows gain extensive experience in a number of extracorporeal life supporting technologies. ECMO, both veno-venous and veno-arterial are used as a treatment for acute lung injury and hemodynamic failure respectively. Intra-operative ECMO support is common during lung transplant surgery, and less commonly used for bridge to transplant or bridge to recovery scenarios.
