Interview with Dr. Alan Sihoe

Dr. Alan Sihoe is a thoracic surgeon who has been practicing in Hong Kong for more than twenty years. He was clinical associate professor of the Department of Surgery at the University of Hong Kong and chief of thoracic surgery at the University of Hong Kong Shenzhen Hospital before he moved to private practice in Hong Kong a few years ago. He currently serves as an honorary consultant in cardiothoracic Surgery at Gleneagles Hong Kong Hospital.

Dr. Sihoe received his basic medical training at the University of Cambridge, where he won a number of awards while still a medical student. He spent his early career working as a surgical trainee in Scotland and England, where he first developed an interest in cardiothoracic surgery. From there, he returned to practice in Hong Kong, where he was trained with Prof. Anthony Yim, the father of video-assisted thoracic surgery (VATS) in Asia. This sparked Dr. Sihoe’s lifelong passion for minimally invasive surgery and for advancing the quality of scientific research in the specialty. As he pursued his academic career, he eventually practiced in both Hong Kong and mainland China, contributing to and witnessing the incredible rise of advanced thoracic surgery in this part of the world.  

Although a cardiothoracic surgeon by training, today Dr. Sihoe specializes exclusively in general thoracic surgery. In particular, he has been involved in the development of “next generation” VATS techniques—especially uniportal and needlescopic chest surgery—and of the perioperative clinical pathways to complement them. He has a keen interest in medical education, and has been invited to demonstrate surgery and lecture at surgical conferences and workshops on every continent in the world. In his words, “A good surgeon helps the patients they meet, but a good surgical teacher helps many more patients they have never met through the surgeons they have guided.” 

Read the interview below to learn more about him. The conversation has been edited for clarity and length. For more from Alan, see also his recent Guest Editor Series, Segmentectomy for Lung Cancer.

CTSNet: What is the biggest advance you have seen in thoracic surgery recently? 

Dr. Sihoe: It is easy to point to advances in techniques and technology as the most eye-catching advances in our specialty. For example, who wouldn't be mesmerized by complex uniportal and robotic sugery, or hi-tech gadgetry to localize and ablate small lung lesions? However, for me the most important recent advance for patients with lung cancer lies outside the operating room: the advent of of advanced multimodality therapy for thoracic malignancy. The emergence of the latest targeted therapy and immunotherapy have been shown to potentially improve the oucomes for resected lung cancer dramatically when used in adjuvant or neoadjuvant settings. Today, surgeons should learn that survival can be improved even for stage IB patients, and get used to referring even some stage I patients for consideration of adjuvant therapy.

More excitingly, the development of multimodality therapy regimes potentially puts even selected patients with stage III and stage IV disease within reach of curative surgery. For all stages of diseases, thoracic surgeons should also adopt modern advances in surgical management to best adjust for preoperative induction therapy or best complement subsequent adjuvant therapy. The ongoing research in this field will not only benefit patients but possibly revolutionize the way thoracic surgeons work within a multidisciplinary team.

CTSNet: What is the biggest challenge facing thoracic surgery right now?

Dr. Sihoe: The allure of glitzy and glamorous aspects of thoracic surgery is potentially distracting impressionable surgeons from what really matters for patients. The widespread availability of surgical videos and images on social media and other non-peer-reviewed platforms has allowed the overhyping of exotic techniques and technologies. These include demonstrations of increasingly hypercomplex operations performed via increasingly fantastic minimally invasive approaches, or the use of ultraexpensive technology that simply cannot be afforded by the vast majority of units around the world. Worryingly, many of these innovations—though promising—have been over-advertised, while the level of supporting clinical evidence is still very weak or even barely existent. An unfortunate consequence of such distraction is that less glamorous developments that can truly make a big difference for patients often get neglected, such as Enhanced Recovery After Surgery (ERAS) programs, lung cancer screening, and so on (This is one of the reasons why you will not see me posting videos of my operations on social media!).

CTSNet: How important is the international exchange of ideas, information, and techniques in cardiothoracic surgery?

Dr. Sihoe: I have been blessed to have witnessed thoracic surgeons working on literally every continent on Earth. I have spoken to trainee surgeons who have been so stressed out over picking the "best" training program in their own superpower country that they fail to recognize that the best training for the operation they wish to perform actually lies abroad. I have counseled young surgeons in another major country who lament their papers being repeatedly rejected, but who cannot see the thought and effort that those in other countries put into their papers to ensure acceptability. There are also countless examples of certain parts of the world being especially experienced or skilled in specific diseases or operations. In thoracic surgery, the grass very often is greener on the other side of the fence. Every thoracic surgeon should realize this and see the entire world as a learning opportunity. Modern travel is so convenient that the only barrier to improving one's practice is the sloth, pride, or envy that prevents engagement with international peers.

In short, international exchange needs to become an integral element in the training and continuing practice of every cardiothoracic surgeon. The modern chest surgeon's armamentarium cannot be considered complete unless it contains exposure to the wide range of ideas, information, and techniques from around the globe.