Finding a Better Way: Dr. Rachel Medbery on Technology in Thoracic Surgery
Rachel L. Medbery, MD, is a double board certified thoracic surgeon — and like most surgeons, she’s not afraid of the cutting edge. She was the first female thoracic surgeon in Central Texas and has become much sought after for her expertise with minimally invasive robotic approaches to thoracic oncology.
But robots aren’t the only place Dr. Medbery is at the forefront of medicine. She’s now worked with MedCAD on a dozen cases correcting pectus excavatum (sunken chest) with the Ravitch procedure, which expands the chest cavity by surgically lifting the sternum, trimming away cartilage, and lifting the ribs to be secured with a plate. She collaborates with us to produce patient-specific surgical planning and case reports that take the guesswork out of the equation, and she continues to innovate alongside our engineers to create new solutions. Dr. Medbery has moved back to her alma mater, Emory, where she talked with us at the end of a planning call with our design engineer and product manager. We asked her about her practice, her embrace of technology, and what the future holds for thoracic surgery.
Q: You’ve earned a reputation for innovative minimally invasive surgeries, but your work with MedCAD involves a very different kind of procedure. What kind of cases need the patient-specific solutions that we provide?
Dr. Medbery: I love minimally invasive surgery — it is very fun to sit down and use that robot. But my work with MedCAD is the exact opposite of minimally invasive surgery, which is also perhaps why I like it, because it keeps my job interesting. I have days where I’m minimally invasive and days where I’m maximally invasive.
So, as you might imagine, the chest wall is really important in patients for multiple reasons. First of all, it’s a protective force for our vital organs, our lungs, and our heart. But it has to also be dynamic; the chest wall needs to move because it helps with breathing. So anytime you’re looking at a congenital malformation like pectus excavatum or a tumor or a malignancy that’s invading the chest wall where we’re going to have to resect the chest wall, the big question is always how to reconstruct so that patients can have a good quality of life. We want to be sure that we’re providing both the protection and the dynamics that the patients need.
Specifically with regards to pectus, it’s pretty much a math problem, since you’re looking at the depth-to-width ratio that makes up the Haller index. It occurred to me that using some sort of 3D modeling system could really help solve that math problem, so you’re getting a more exact correction of their defect, rather than just eyeballing it in the operating room.
I was always bothered by the fact that, intraoperatively, it seemed like a very subjective repair: “Oh this looks good, and let’s cut here, and do this…” So I was talking with my rep during a case in Texas and I said, “Brett, there has to be a better way.” And he told me that MedCAD does it for mandibles, and that we should be able to do it for the sternum, and that was it. It kind of just took off from there.
Q; How much time do you spend planning before a procedure with MedCAD?
Dr. Medbery: Because this was something that was so new for MedCAD, those first few planning sessions were longer. I think the first couple times it was easily 30 – 45 minutes. But once they understood what we were doing intraoperatively, our planning sessions now are down to less than five minutes. It’s fantastic. We’ve really kind of gotten into a nice groove and it doesn’t take up much of my time at all.
Q: Does it save you time when you’re actually in surgery?
Dr. Medbery: Oh, yes! In surgery, I know exactly where I’m going to cut the sternum. No more looking like, “Eh, where does it angle down? Maybe we should cut it here.” And I know not only where to make the wedge, but how big to make the wedge. We used to do that intraoperatively, and once we’d made the wedge, then we would get our plate and bend it, which as you can imagine takes time. I would estimate this is probably saving a good 30 minutes in the operating room.
Q: You use a lot of advanced technology, 3D planning being one of them, robotics being another. Could you talk about why you’ve embraced these methods?
Dr. Medbery: To me it’s all about tools. Like any consumer, you’re looking for something that’s going to make your job easier, make your job more enjoyable, and provide a better outcome. I think that surgeons are the same way — anything that’s going to save us time in the operating room.
We can do things faster with the robot. The ergonomics are better, and we feel like patient outcomes are better because of that. It’s similar with the 3D modeling, because saving time and getting better precision for the patient is going to lead to better patient outcomes. They’re not asleep as long in the operating room, and they’re going to get that better surgical repair.
“To me, it’s all about tools — anything that makes the job easier, more enjoyable, and leads to better outcomes.”
Q: What’s the next technology that you’re excited about?
Dr. Medbery: Well, I know that Intuitive is looking at incorporating virtual 3D modeling intraoperatively within the robots — not specifically with regards to chest wall per se, but knowing exactly where your pulmonary arteries, your pulmonary veins, your airways are with regard to tumors, and being able to have a little screen in your console and spin around a 3D model virtually. It’s very similar to what we do with the pectus. But the technology is also coming there so you can kind of use your road map during surgery to go where you need to go and not go where you don’t need to go.
Q: What led you to become a doctor, and then into thoracic surgery?
Dr. Medbery: I’m the first doctor in my family. When I dissected a frog in the fifth grade, I thought it was the coolest thing ever, and I literally came home that night and told my parents I want to be a surgeon. At the moment they were like, “Oh, that’s great, honey” and gave me a pat on the head. But I never wavered from that. I was lucky to have the support of my parents who provided me with opportunities, and then to find a college with a good premed program. I went to college at Emory, stayed at Emory for medical school, and went into medical school knowing I wanted to be a surgeon.
Thoracic surgery was not on my radar at all during medical school, and so I applied to general surgery residency and then found thoracic surgery when I was a second-year general surgery resident. I enjoyed the people that I met, and being able to operate in the chest was really fascinating to me. Everybody told me I was too nice. They said there’s no way you can do this, and that motivated me to prove everyone wrong.
So I did a general surgery residency and then cardiothoracic surgery fellowship. I fell in love with the robot during that. I felt like it took this maximally invasive procedure, and you got to do it with small incisions, better visualization, better ergonomics, better outcomes for the patient. I mean, it was better for everybody involved. I loved that technology, but also was trained in the chest wall stuff, which was just fun.
When I arrived in central Texas, I was the first female thoracic surgeon there, but also the only one who did chest wall stuff and pectus. And so it was one of those ‘If you build it, they will come’ moments. Patients started coming out of the woodwork wanting a chest wall reconstruction, and I got quite the reputation for doing pectus surgery in central Texas.
The more I did it — thanks to knowing the capability of technology and perhaps the robot — the more I was sure that we should be able to advance this somehow.
We are getting ready to submit our case series of what we’ve done so far to the Society of Thoracic Surgeons. Hopefully it’ll be accepted to their meeting so we can present to others what we’re doing.
I consider myself pretty lucky. It’s a fun job and I really enjoy it. I’m also a mom. I have two little boys and they’re the loves of my life. And I have an amazingly supportive husband; without him, I probably wouldn’t be able to do all of this. So, I never want to forget to acknowledge that I didn’t get here by myself.
Q: What’s the best part of your job?
Dr. Medbery: The patients. I mean everything from our pectus patients, who are so grateful because this really dramatically improves their quality of life, to the cancer patients — the patients you get to cure. Any time you take somebody and forever change their life.
Q: So, you’ve got a very busy practice, but you’re also a frequent presenter, speaker and author. Why do you think that part of your job is important?
Dr. Medbery: When I’m in the operating room, I’m helping one patient, which is great. I love that. But spreading our knowledge, teaching others — that takes it to a whole other level. Then I feel like I’m no longer just helping one patient, but I’m helping numerous patients. I feel like my contribution is kind of exponential in that way.