Pearson-Ginsburg Chair of Thoracic Surgery Tom Waddell

Tom with his wife Lisa and their children Alexandra, Harrison and Nathaniel

Recently appointed to the Pearson - Ginsburg Chair of the Thoracic Surgery Division of the Department of Surgery Tom Waddell is keenly aware of the contributions of those two historic thoracic surgery leaders. Both have been his mentors. Griff Pearson launched the careers of a large segment of the current leaders of Academic Thoracic Surgery, among them Shaf Keshavjee, Alec Patterson, and Joel Cooper. These and others trained in Toronto are leaders in the specialty in Canada, the United States, and around the world.

Describing the Division, Tom says: “Shaf Keshavjee has put together a productive and happy team of Canadian and International thoracic surgeons, including Mark De Perrot from Switzerland and Kazu Yasufuku from Japan. There is a large contingent of international fellows and scientists within the division. These surgeons are active in their national surgical societies, bringing greater recognition and outreach to the division all around the world”.

Lung transplantation, the signature activity of the thoracic division is at a peak of world pre-eminence. The perfusion and gene therapy of damaged lungs conducted outside the body, developed by Shaf and his colleagues has increased the supply of these exceptionally fragile organs for transplantation. “This technology is being adapted by Markus Selzner for resuscitation of the liver and it could become a great source for donor hearts. Currently, grade 4 ventricles identified on echo prior to harvest are discarded, though they generally have no structural damage. They are temporarily disabled by catecholamines released by brain injury. Similarly, hearts from deceased donors may come back with extracorporeal resuscitation. The work has captured the imagination of the transplant community through Shaf ’s perseverance and work as a spokesman, and it is now capturing the imagination of the biotech world”.

A team system approach that has been possible in the Thoracic Division “because it is small enough and cohesive enough to accomplish that goal” will be more widely adopted. For example, because referring doctors want rapid access for their patients with thoracic disease, the division has set up a Rapid Access Management Program (RAMP) that facilitates referrals without reducing the traditional patient -

centered approach. Doctors like the team approach, with all of the surgeons managing the patients and performing the procedures with equal skill and without idiosyncratic management approaches. “This system developed from the lung transplantation program. We can all take over a case at any point, knowing the rest of the team does it the same way we do.” Bob Ginsberg started this synthesis when he fused the Princess Margaret, Mount Sinai Thoracic Surgery Division with the Toronto General unit. Shaf has carried this forward into oncology and critical care as well as transplantation.” The division is increasingly active in critical care, using extracorporeal lung support to bridge patients to transplantation. Our work with the Novalung pumpless oxygenator involving cannulation of the pulmonary artery and left atrium, using the hypertrophied right ventricle as the driving pump is a great example of a team success. Seven patients have been treated with this unique technique in Toronto and a similar number in Hannover.

“The thoracic division has been blessed with the resources of a committed hospital, a well developed laboratory program, the Toronto General Research Institute, the Toronto General and Western Foundation and private contributors such as the Latner family, the R. Fraser Elliot Foundation, the Thomson family, the Menkes family, the Kress family, the McEwen family. The success of the research program was originally built on peer reviewed grants and then has greatly expanded through foundation and private contributions.” For example, Tom, Shaf, Ming Yao all have CIHR and numerous other peer-reviewed grants. This conveys to the philanthropic community, the quality of the ongoing work they support.”

In his own lab, Tom is using stem cell biology as the basis of his research, including studying malignancies and lung regeneration, e.g. growing lung tissues experimentally from progenitor cells. He is working with embryonic stem cells and induced pluripotent stem cells to generate airways and lungs, and bone marrow cells that home to the lung to help regenerate damaged lung tissue.

“The cancer research program including the thoracic division is headed by pathologist Ming Tsao, and Kazu Yasufuku plays a key role. Kazu is doing interesting work on endobronchial diagnosis of lung cancer. He has recruited a large contingent of fellows to his excellent laboratory program. Ming Yao Liu works with Shaf on lung injury and recovery. Mark de Perrot works with respirologist John Granton on pulmonary hypertension. Over time, our vision is that the thoracic unit will continue to integrate and evolve in the way that the Munk Cardiac Centre has grown into an internationally renowned multidisciplinary cardiology, imaging and surgery group.”

Tom’s wife Lisa continues her career as an architect, though her projects are reduced during this period of very active family life. 11 year old daughter Alexandra is a skier, 8 year old son Harrison is a multi-sport athlete, and two year old son Nathaniel keep the family busy - two days a week of skiing, two nights of soccer, and three nights of hockey. Tom has coached Harrison’s hockey team this year, and missed only two of his daughter’s ski races.

M.M.