Dr. Inderpal Sarkaria, Chief of the Division of Thoracic Surgery at UT Southwestern Medical Center, shares how cutting-edge robotic technologies, including single-port robotic surgery, are helping reduce pain, speed recovery, and improve the patient experience without compromising cancer outcomes. Beyond technology, he emphasizes that the real key to advancing cancer care lies in strong multidisciplinary collaboration, streamlined care pathways, and a culture focused on rapid access, measurable outcomes, and patient-centered innovation. Together, these elements are shaping the future of thoracic oncology and setting a new standard for high-quality cancer care.
So I'm pleased to be joined by Doctor Inderal Sarkaria, Chief of the Division of Thoracic Surgery and a professor in the Department of Cardiovascular and thoracic Surgery at UT Southwestern Medical Center. Doctor Sarkaria, thanks so much for being with us today. Thank you. Thank you for the invitation. Now, you've been a major force in advancing thoracic surgery, particularly with minimally invasive and robotic assisted techniques. From your perspective, how are those kinds of technologies and, and things like the single port robotic surgery that you've been pioneering, changing patient recovery and outcomes? You know, whenever we introduce new technology, and I've been interested in robotics for a long time, we always have to go back to basic principles. What are we trying to improve upon with any new technology? That's really the broader question, you know, robotics is something I've been interested in for a long time. I've been involved in developing new operations, new technologies, assessing and trying to understand where the value is in adopting these technologies. You know, you specifically ask about SP or single port robotics. You know, many robotic systems right now have multiple access points, allow for terrific visualization, manipulation of tissue, precision, really just allows surgeons to have far more control over the conduct of the operation. I think that's where that technology really has terrific value and maybe improve the conduct and not only the conduct, but the quality of the operation that we're performing. Less trauma to the patients, improve recovery and less pain. As we look at the evolution of robotics, that's exactly where we're trying to achieve value when we adopt these, these systems. Should be with the thought process behind it again. Are we maintaining the basic principles of the operation is the most important thing. We don't need a glitzy new toy to do something if we're not doing it as well as we did before and maintaining the quality of the operation. That's always the base principle we have to work from. But if we get these new technologies and they do improve upon what we do, then we take a hard look and say, can we improve outcomes for our patients? When it comes to robotics, I think we do. I think we do that to a tremendous. I think advancement from what we've done before, say from open surgery where we made large incisions to then minimally invasive operations where, you know, still the same operation internally again, important that we're maintaining the quality, but small access points and now small access points but with tremendous control over the conduct of the operation internally. SP or single port now takes it down to a single incision. And to be quite fair, I've been involved in a lot of these technologies, but in running a division, in working with many colleagues, this is far from a single individual's effort in helping to develop. There's, there's a large team behind these, these endeavors always and a community that's investigating, and my partners and I and really some of my partners who've been really moving this forward, Dr. Noguchi, Dr. Salami. Been looking at single port in the context of larger adoption in the US for lung operations, so lung resections for, say, lung cancer, and potentially even for other operations like esophagectomy, where we're removing parts of the esophagus for esophageal cancers, the The idea is that if we can decrease the number of incisions and not work through the chest, through the ribs, this is an approach that allows us to approach through the diaphragm, another organ that separates these spaces with less painful incisions. Now I'll tell you that the anecdotal evidence that we have seen, as well as trials, large national trials that have looked at this. Do suggest that we are improving the pain profile of patients, meaning they get up and out of bed day one, less pain, less tubes in the chest or tubes that come out earlier, and ultimately getting them back to their daily lives faster, back to work, back to what whatever the things they love to do earlier and getting them moved along the care spectrum faster. That's, I think, where we're seeing a lot of the benefit from these platforms. Whether we're improving the actual cancer care, as long as we are doing as good a job, that's still a terrific value proposition to get people back to their daily lives faster, uh, and that's ultimately what we're here for, to get them past this if we can. Cancer is a very sort of uh variable disease process, but for those that just require surgery, can we get them past that episode of care back to their lives? Uh, and get it behind them. That's really the ultimate goal for many of these, I think, technologies and especially in robotics, trying to decrease or minimize the impact of the operation on the patient and get them to earlier recovery. I think the long term outcomes have to be maintained. Are we doing a good cancer operation that prevents the cancers from coming back as best we can and minimizes complications to those patients? Now, you, you mentioned, um, some of your colleagues, and, and, you know, the theme of this event is the future of collaborative cancer care. Uh, you know, we know that technology isn't the, the only solution or the silver bullet solution. It's often how we use it and how we integrate it into a system. Um, you know, how has the integration of, say, interventional pulmonologists and surgical teams changed the time to treatment, uh, that, that window between biopsy and procedure for your patients? Well, there's a lot packaged into that question, I will tell you, and there is a host of things that have to be looked at when it comes to, say, approach to a patient before they ever get to the hospital, the diagnosis, when was a nodule, for example, first seen in the context of lung cancer, interventional pulmonary sorry, interventional pulmonologists, thoracic surgeons, medical oncologists, radiation oncologist, there's a whole, whole ecosystem of docs out there that really have to bring their expertise to bear. To appropriately bring these patients through, but let's take a simple nodule. It's the infrastructure of how we create the service line. Is it multiple access points? Is it a single access point within that institution that can really. Create efficiencies for how we bring patients through the system, I think is very important. Access to care. Can we get them in in a timely manner? Is it going to take 1 week, 23 weeks to even get that patient for their first touch with us? That's the most critical time point in which we establish a relationship, trust, start to gather the appropriate information, and then truly start to act on what we see and what we need to do as next steps. So having that single infrastructure, single intake, and easy access to the system, I think is the first most important thing. How we've structured that here is by having multiple abilities or multiple access points for the patient to call in, but really a single focal point by which we schedule, and the mandate is to schedule within 3 days. Patient will always get a call back within 24 hours and we will schedule an appointment within 3 days. Now that may mean you may not have all the information you need to make a definite decision, but what we do by getting someone in within 3 days is alleviate the stress, the anxiety, and the. That that opportunity for the first touch, the first establishment of the relationship. Look, we can get CAT scans, we can get all that and other information and start to work on that immediately, but we have to establish that first relationship with the patient as soon as possible, and that I think is the most critical first step. But you mentioned interventional pulmonary, thoracic surgery. We are very much two sides of the same coin when it comes to lung cancer. And establishing us under a single management, a single service line, most importantly, we are co-localized. Putting the right team together in the same physical space, I think is of critical importance. I work very closely with my interventional pulmonary colleagues and vice versa. On every clinic day we probably have 5 to 10 patients. We just walk over to each other because we have structured our clinics in such a way that we are in the exact same space. We may have our independent clinics, but when the appropriate patients come up and we need the feedback from each other, it's right there in real time. 2, we are under a single. Scheduling structure and management structure, meaning the same schedulers schedule into the interventional pulmonary procedure room where a lot of these biopsies are done or with the thoracic surgeon or sometimes in the same room when we need to do procedures together to really expedite the care and you can see how that co-localization really starts to expand the opportunities for efficiency. Meaning I talked to my interventional pulmonary colleague, we need a biopsy tomorrow. Let's look at the schedule together with our schedule. What are the opportunities? Do we need to schedule with which practitioner or in which OR or in which suite to get that biopsy done? And do we agree on a plan? Meaning, can we do the biopsy and the surgery maybe the same day? Can we do the biopsy and the surgery on day 1, day 2? What other tests do we need and how quickly can we get it done, but our goal is to get from time of first contact. To biopsy and if appropriate for that patient, definitive surgery within 2 weeks. That is a standard by which if we can do that for the majority of patients. Maybe we can start to do that at 1 week. Maybe we can start to do that 3 days, and in some very rare instances, maybe we can do that in 24 hours. So we also have a lot of outreach into our communities, access points, different clinics by which UT Southwestern can take patients into the thoracic and IP service line. Hopefully decreasing the time to referral as best we can, that education that is so necessary to the community to say if there's a nodule, get them to the experts right away because that time from first identification to the nodule to definitive treatment, if it is cancer, is absolutely critical to the survival of that patient. So education, infrastructure, the right collegial and collaborative approach to patient care, and agreeing on what those pathways need to be. Is I think the secret sauce to really getting patients through the system in a an efficient manner that is really best for the quality of care, especially in when we're talking about lung cancer, and then bringing to bear all those technologies you talked about, whether it's robotic bronchoscopy, the advanced endoscopy suite, the surgical robotics that we employ, sometimes none of that is needed, and we have to identify that appropriately, but using the entire spectrum of what we have at our. You know, within our toolbox, so to speak, is important, and that's best done when the experts are in the room together. I, I, my, my final question is, you know, another sort of big picture perspective question, uh, you know, for, for the healthcare, health system executives, hospital executives in our audience who are thinking about, you know, making the right technology investments, thinking about changing their workflows, perhaps, uh, to, to embrace collaboration and interdisciplinary, uh, cross-pollination. You know, what, what are some of the sort of, what's, what's one or two sort of key takeaways or, or kind of a call to action for them to think about minding all the things you've shared and, and the, the interesting things happening at UT Southwestern. I wonder if you were to sort of build kind of a futureproofed thoracic or oncology center that, that, you know, has, that, that has a positive impact for as many people as possible, you know, what, what might that look like? Well, I would start by saying that nothing is futureproofed, you know, as best we can, but you're right. How best to do that, that's a great question. I think number one, having the right intel, the right experts in the room, in the room to as best as possible, understand the future scape of what's occurring. What are the technologies coming down the pike? What do we do now? What are the areas of need that will have the greatest value? Is it early stage lung cancer? Is it advanced? esophageal cancer, is it therapeutics, what have you? What is coming that can truly move the needle on some of the things we do? That's not so clear to see all the time. But if you focus in an area, and a lot of these technologies come with a big price tag, I think that's probably the You know, the source of most agita. Otherwise everybody would acquire them and we would just use them and identify the opportunities. Number one, you have to maintain equipoise around these technologies, meaning, don't just assume the shiny new tool is going to do a better job. Have evidence around it and have the experts in the room that are going to be available to evaluate that appropriately. But as an executive bringing it on, listen to your experts. And understand your own institution. What are the abilities? Who are the players that are there? Do you need to bring in additional, or do you have the Collegiality and the collaborators who are going to come together and do this as a group, so that's, that's important. The local culture of an institution is critical. And creating that culture of collaborative care, understanding the value proposition, does it meet and jive with the mission? Is it in line with the mission of the institution? You know, a great example of that is, you know, every institution says we're going to strive for excellence. OK, well, show me the institution that says it's not going to strive for excellence, right? It's, it's a generic code word we want quality and excellence. Pick the value propositions that you think you can impact the most. Is it length of stay? Is it rate of resection or negative margin, whatever those quality indicators are that you are really trying to impact. Identify them, show the value, and then create the teams that really understand that value proposition and can execute the mission. I think that is key also for those executives to have to some degree boots on the ground. You have to have champions. If you don't have champions for these pathways. Those individuals or groups of people who are going to identify the value proposition, the mission, etc. all the things, and most importantly, the plan. Whether it's a business plan, whether it's a clinical plan to execute and bring together the right team and to execute that plan, then most importantly, what are the metrics by which you're going to gauge the success of that plan, because if you can say we're going to execute this plan, but if you don't know how to measure it, you really can't get a great handle on your success or areas of potential improvement opportunity. So for the health care executive, I think many of them are well educated in this, but you have to have your local champions. You have to listen to them and partner with them, and you've got to understand it really from the base level up. Boots on the ground. What are your physical plant structure? Do you have the appropriate teams co-localized? Do you have the technology on board that you want? And if there's opportunities to gain technology, Make sure you have the right team on board to use that technology the appropriate way. I think those are sort of the key takeaways for me. In improving, not just improving, but you know. Culture change management is really what it comes down to and bringing teams together in a cohesive, collaborative, and collegial way to execute what you think is an appropriate value for your institution. I think that's great perspective. I think the point on measuring and sort of tracking those outcomes too, you know, as challenging as it can be, is, is one to underscore as well. So, thank you for sharing that. And thank you for your time, Doctor Sarkaria. I really appreciate it and I know our audience will really benefit from your insights. My pleasure. Thank you for the opportunity.
