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THE MEASURE OF QUALITY White Plains Hospital is equipped with the latest imaging equipment. Physicians are able to instantaneously view chest X-rays the moment they are performed. the chest to enable access for other instrumentation. These incisions provide the necessary pathways to remove everything surgeons remove in a traditional lobectomy. Patients often return home from the hospital within two to three days and come off pain medications within one to two weeks. "When we're talking about cancer patients, they want to get back to feeling normal. They want to get back to not being reminded they have cancer," says Dr. Chin. "They want to get back to their lives, or they need to move forward and get on with their lives or other treatment, if necessary. VATS can help with all of that." With the addition of Drs. Chin and Weiser, White Plains Hospital also gained surgeons with considerable experience in performing complex tracheal surgery. Dr. Weiser completed his cardiothoracic surgery residency at Massachusetts General Hospital, where the surgical techniques first evolved in the 1960s and 1970s. As he explains, the use of the procedure can arise when patients have used a breathing tube for a significant amount of time due to a heart attack, pneumonia or a larger operation with complications. Prolonged use of a mechanical ventilator can traumatize the inside of the trachea, creating scar tissue that can become so fibrotic that it narrows the windpipe. Cancerous growths can also cause narrowing. "The windpipe can get to a point where it becomes almost completely clogged by scar tissue or certain cancers. If the patient can't breathe, he or she can't live," says Dr. Weiser. "Patients for whom this surgery is appropriate present with a fair degree of medical urgency." For this procedure, Dr. Weiser makes an incision in the neck or the chest, depending on the location of the blockage. He isolates the impaired section of tissue and resects it. He then reattaches the windpipe by suturing the two newly formed edges together. If patients are properly selected, based on their pathologies, they very rarely experience a similar tracheal condition. The procedure does not involve an implant, although, according to Dr. Weiser, developing a successful product is the focus of ongoing research. MDNEWS.COM s MD NEWS Mid Hudson | 9 AS MORE INSURANCE carriers move toward a pay-for- performance reimbursement system, the incentive to provide quality results in the operating room is coupled with the need to report those outcomes. The Society of Thoracic Surgeons (STS) first began gathering data on surgical outcomes in 1989, specifically focusing on coronary artery bypass graft- ing, as a way to provide physicians a benchmark for patient risk based on preoperative characteristics and an avenue for professional improvement. Todd S. Weiser, M.D., thoracic surgeon, Director of Thoracic Surgery at White Plains Hospital, and Cynthia S. Chin, M.D., thoracic surgeon, Director of the Women's Cancer Program Services at White Plains Hospital, are familiar with the pro- gram, now known as the STS National Database. Dr. Weiser plays a significant role on the STS's national committee associated with the reporting initiative and assisted in writing the training manual for analyzing the database results. "We stand by the quality we deliver to patients," says Dr. Weiser. "No one knows more than us how important that principle is because we are intimately involved with it on a firsthand basis." Although patient results from the White Plains Hospital thoracic surgery program have been submitted, they have yet to be compared with results from other institutions. According to Dr. Chin, however, the infrastructure of ancillary services, nursing, and operating room and intensive care unit facilities has allowed the specialists to tackle the full range of cases with excellent overall outcomes. Dr. Chin performs daily rounds on a patient recovering from lung cancer surgery.