Featured Profile and Interview With T. Sloane Guy, MD, MBA

T. Sloane Guy, MD, MBA, is an associate professor of cardiothoracic surgery and the Director of Robotic Cardiac Surgery at Weill Cornell Medicine/NewYork-Presbyterian Hospital. Dr Guy earned his MD and his MBA in Healthcare Administration from the University of Pennsylvania’s School of Medicine and Wharton School of Business, respectively. He continued his training in general surgery at Walter Reed Army Medical Center and then at the University of Pennsylvania, where he also completed research and clinical fellowships in cardiothoracic surgery.

After completing this training, Dr Guy returned to Walter Reed Army Hospital, and then was assigned to the San Francisco Veterans Affairs (VA) Medical Center in California. While at the San Francisco VA Medical Center, he developed a robotic and minimally invasive cardiac surgery program.  He also served three active duty tours in the US Army as a trauma surgeon, twice in Afghanistan as chief of clinical services and once in Iraq as chief of surgery. After completing his military service as a decorated Lieutenant Colonel, Dr Guy was a cardiothoracic surgeon at St Joseph’s Hospital in Atlanta, Georgia, and then became the Chief of Cardiothoracic Surgery and Robotics at Temple University in Philadelphia, Pennsylvania. In 2015, he moved to his current position at Weill Cornell School of Medicine/NewYork-Presbyterian Hospital.

Dr Guy’s primary clinical interest is in the management of mitral valve disease, particularly using minimally invasive robotic techniques, and he is also passionate about minimally invasive approaches for treating other cardiac pathologies. Dr Guy is a member of The Society of Thoracic Surgeons, the American Association for Thoracic Surgery, and the International Society for Minimally Invasive Cardiothoracic Surgery. He is the CTSNet Guest Editor for the upcoming series Advances in Minimally Invasive Valve Surgery, which will run this January.

Claire Vernon for CTSNet: You spent part of your training and professional career as a military surgeon. What was the most interesting or valuable aspect of this experience?

Dr T. Sloane Guy: If you look at the history of innovation in cardiothoracic surgery, many of the early pioneers were young surgeons returning from WWII.  The reason for this is that wartime surgery puts younger surgeons in senior positions of clinical responsibility and in an austere environment facing an extremely broad set of clinical challenges.  This forces you to function way outside of your comfort zone and to learn to manage a team under very challenging circumstances.  There is no better preparation for a life of innovation in minimally invasive cardiac surgery than this.

CTSNet: You developed one of the first VA Health System robotic and minimally invasive programs when you were in San Francisco. Can you tell us a bit about that experience from a teamwork and training perspective?

TSG: This was a learning experience like none other.  There is no doubt that it can be challenging in a VA hospital to perform extremely complex procedures, but it can be done. I was very lucky to be at the San Francisco VA, which had a close affiliation with UCSF and was very well staffed with excellent nursing, anesthesia, perfusion, and other team members.

CTSNet: Why is the well-functioning cardiothoracic surgery team especially important for successfully performing robotic procedures?

TSG: This is so important.  I think the reason many surgeons and hospitals struggle with robotic cardiac surgery in general is that it really requires team competency, both for the individuals on the team and for the team as a whole.  It’s really no different than a sports team.  Many of the changing power dynamics of modern cardiac surgery operating rooms make it necessary for the surgeon to be more of a team facilitator and a coach than a “boss.”  Standard cardiac surgery can be tough, but it is less dependent on the team dynamic than robotic and minimally invasive cardiac surgery are.  One important aspect a surgeon must honestly reflect on when starting such programs is whether the support and the technical abilities are truly in place or not—all places say they have that, but many do not.

CTSNet: How important is continued individual and team training for robotic surgery?

TSG: Incredibly important.  When I arrived at NewYork-Presbyterian Hospital, one of the top programs in the country, it took me over 3 months to train the team to perform totally endoscopic robotic mitral valve procedures at the level of proficiency that is demanded.  We did 10 mock cases and the administration set aside two days a week as a first start simulation in the actual OR.  We worked on the choreography, and we developed the culture of teamwork rather than the traditional “silo” approach.  It was successful, and it just demonstrates how critical the team aspect is.  Even one new team member added to the dedicated OR team (which is essential) can present a challenge.  We select new team members based on technical abilities, but also on interpersonal skills and ability to work cohesively with a multidisciplinary team.

CTSNet: Your first postgraduate degree was your MBA in Healthcare Administration. Does that training give you a unique perspective on the organization of the surgical team?

TSG: Well, my standard joke is that an MBA and $4.50 will buy you a latte!  On a more serious note, when I embarked on this journey, my mentor Dr and Senator Bill Frist told me that part of being a surgeon leader in my lifetime would by necessity include the need for knowledge of understanding of the management of people and resources.  Many actually criticized me when I first expressed interest in getting an MBA back in 1989, believe it or not.  When I applied to the Wharton School, they told me there was one other cardiac surgeon who had been through the program (Mehmet Oz).  Today, I hear over half the medical school class at Penn desires an MBA.  If doctors want to continue to be leaders, they must get leadership training.

CTSNet: What does the future hold for robotic approaches in adult cardiac surgery?

TSG: The future is bright.  What is driving innovation more than anything at this point is the patients’ desire to have less invasive but effective approaches to their medical problems.  Frankly, our specialty has lagged behind urology, OBGYN, general surgery, and others in this regard.  Many surgeons use the excuse that “our surgeries are more complicated and the stakes are higher”.  I am not so sure this is true any longer, as our colleagues are doing very complex procedures endoscopically on a routine basis.  Sure, the challenges are greater for our procedures, but we are supposed to be better!  Robotic cardiac surgery can be done well, but it’s not easy and requires a level of innovative thrust and courage that many prior generations honestly lacked in times of plenty.  With a tsunami of catheter-based approaches upon us, I see a renewed interest in minimally invasive approaches, including robotics.

CTSNet: If you had a magic wand to create the next innovation in CT surgery, what would it be?

TSG: A single 12 mm port robotic system (to fit between the ribs) with “medusa-like” robotic arms and instruments that could be used for robotic mitral valve repair.  Also, a robotic catheter-based system to deploy TAVR and TMVR interventions.

CTSNet: What is your favorite thing about CTSNet?

TSG: CTSNet is a great equalizer of opportunity and knowledge.  It provides an online community where any cardiothoracic surgeon, team member, and industry representative can share important information such as novel procedures, job opportunities, “how to do it” videos and discussions, and more.  I consider it to be at the very heart of profession, no pun intended!