Shanghai Pulmonary Hospital is a dream come true for a thoracic surgery aficionado like myself.  Twelve operating rooms, a 30 ICU beds, 30 to 40 operations per day and over 40 staff surgeons means that there is always something interesting going on down the hall.

Am case presentations is like a review of Robbins’ pathology.  Bilateral nodules, ground glass opacity nodules, giant-sized tumors, mediastinal masses of all types and atypical presentations abound.   By tradition, all tuberculosis cases must come to the medical complex at Shanghai Pulmonary Hospital because they have a designated tuberculosis hospital on site.  Even with other facilities competing for some of the pathology, there is plenty to go around, and I am able to see a couple of lung abscesses as well as several varieties of cavitary lesions.  I am sure that there is still a wealth of untapped pathology for me to explore, but I suspect that more interesting infectious cases and occupational diseases are probably confined to the more distant provinces.

I briefly talk to one of the surgeons here, who is from Kashdar region, on the far western side of China.  Kashdar is located in one of the more mountainous regions of China, which was part of the famous Silk Road trade route explored by the likes of Marco Polo more than half a millennia ago.  We discuss the region and compare it to its American counterpart of West Virginia.  It’s not a perfect analogy but there are enough similarities to help me for a picture of life, and industry there.  That is where the mines are concentrated, and that is where I might find the black lung disease, the silicosis and similar type diseases, though the surgeon I speak with reports that the rates of occupational disease for this occupation to be quite low.  Given the dangerousness of underground mining, I wonder if many of the miners worry about living long enough to see a chronic disease like black lung.  I don’t know enough about China to ask a lot of the other interesting questions that are swarming in my mind, but I wonder about mesotheliomas and other diseases related to all the heavy industry that forms the backbone of the booming Chinese economy.  I wonder about the prevalence of empyemas given the pollution levels and the closeness in which many people are forced to live.  It seems like it would be a daily surgical feast, but I don’t know a polite way to ask directions to the hospital with the pus-filled buffet.

My hosts also tell me regretfully that they also only see a limited amount of esophageal cancer because many people are misled by the name of the facility, and are unaware that esophagectomies are performed here.  One of the surgeons looks so woe-begotten as he tells me this that I know he has the same love of that surgery  as I do – that feeling of joy when surgical planning, pre-operative optimization, surgical skill and aggressive post-operative care come together flawlessly for an uncomplicated post-operative course in a complex case.   It’s not just satisfaction with a job well-done but pure joy at seeing our patients walk out of the hospital and back to the regular lives.

I am here at part of the Uniportal VATS conference with Dr. Diego Gonzalez, but it’s also an opportunity to literally wander the operating rooms at will,  listen to case discussions and interview surgeons as I encounter them.  I always joke about feeling like a kid in a candy store, now I really am.  If I hear a particularly interesting case during am rounds, I am welcome to come into the operating room, watch the case, listen to the discussions and talk to the surgeons.

As one of the largest general thoracic surgery departments in the world*, it would be impossible for me to know and present all  staff surgeons in the few days that we are here for the Uni-portal Surgery conference.  Instead I would like to highlight a just a few of the interesting and talented surgeons at this busy facility.