Vasileios K. Kouritas1, Jin Ye Yeo2
1Department of Thoracic Surgery, Norfolk and Norwich University Hospital, Norwich, UK; 2ASJ Editorial Office, AME Publishing Company
Correspondence to: Jin Ye Yeo. ASJ Editorial Office, AME Publishing Company. Email: asj@amegroups.com
This interview can be cited as: Kouritas VK, Yeo JY. Meeting the Editorial Board Member of ASJ: Dr. Vasileios K. Kouritas. AME Surg J. 2025. Available from: https://asj.amegroups.org/post/view/meeting-the-editorial-board-member-of-asj-dr-vasileios-k-kouritas.
Expert introduction
Dr. Vasileios K. Kouritas (Figure 1) is a Consultant in Thoracic Surgery at the Norfolk and Norwich University Hospitals, NHS Foundation Trust, Norwich, United Kingdom. His area of expertise includes, amongst others, lung cancer, pleural and mediastinal pathology, and chest wall and diaphragm surgery, with a special interest in Robotic-Assisted Thoracic Surgery (RATS). Dr. Kouritas is leading the department’s robotic surgery program and has switched to solely robotic surgery since June 2021. He has published numerous research publications on pleural transportation and physiology, as well as their extrapolation to animal models. He has participated in the writing of a relevant chapter in Shield’s Textbook of Thoracic Surgery, amongst other chapters in books. He also has numerous clinical publications on different aspects of thoracic and thoracic surgery pathology. He is serving as the research lead of the Thoracic Surgery department.
Dr. Kouritas is participating in numerous leadership and quality improvement projects within his department and organization after completing a master’s degree in business administration. He also acts as co-editor in numerous journals and has recently been appointed an EACTS Thoracic Domain member.
Figure 1 Dr. Vasileios K. Kouritas
Interview
ASJ: What inspired you to pursue a career in thoracic surgery?
Dr. Kouritas: Whilst in medical school, the respiratory system was my favorite subject, but I also loved surgical specialties. A diagnosis of lung cancer in my family made me decide that I would like to follow the Thoracic Surgery specialty to help my family member. Of course, I never regretted following this career pathway as I was able, apart from my family, to help many other cancers and not only patients. I realized that Thoracic surgery procedures are rewarding in terms of improving survival in cancer patients or improving quality of life, for example, in emphysema patients.
ASJ: Your career has evolved significantly, particularly in your shift to robotic surgery. Can you share what drew you to robotic-assisted thoracic surgery and how it has transformed your practice?
Dr. Kouritas: I was never convinced that the traditional Video-Assisted surgery (VATS) was truly minimally invasive because the wounds are long (utility incision), and the pain was still an issue for patients. Moreover, a surgeon would rely on traction to achieve dissections, lacerating the lung, and consequently, complications seemed to be unavoidable. Furthermore, I would have to rely on a competent assistant to successfully do the procedure, leaving me extremely tired at the end of the list. Finally, for more complex procedures, VATS could not achieve the exposure or the angles necessitated, and hence, in those cases, I would have to proceed to a thoracotomy. I felt very early in my consultant years that there must be a better way of achieving the ultimate minimally invasive experience for patients without sacrificing outcomes and, at the same time, making surgery more enjoyable for me. I was exposed to RATS during my fellowship in the USA, but I had the chance to do my first cases as a trainee in Leeds, and at that point, I realized the benefits of this approach. Practically, I realized that all the above were resolved with RATS, enabling me to perform the procedure with only 8mm ports, avoiding lacerations on the lung, and because of the stable ports, the pain was very minimal. RATS showed its efficiency in complex procedures, and ultimately, it feels that RATS brings my hands very close to the point of interest, imitating an open procedure but via tiny ports. I switched completely to RATS many years ago, and since then, nearly 30% of my patients go home the next day, which is something I never achieved with VATS. Also, my patients have experienced fewer complications, fewer re-admissions to the hospital, and nearly none return to theatre or escalation to the critical care unit. All these have made my professional life smoother and allowed me to enjoy a better personal and family life. I feel that I live now and I can live later, without medical issues, as I enjoy operating and my body is not strained.
ASJ: With your expertise in robotic surgery, where do you see the future of this technology in thoracic surgery? Are there any exciting developments on the horizon that you believe will revolutionize the field?
Dr. Kouritas: As more complex surgeries are performed robotically, I would anticipate that most thoracic surgeons will become robotic surgeons and most procedures will be performed via this technology. Open surgery will be reserved for only special complicated procedures and VATS will become obsolete. With the advances of artificial intelligence (AI) in the medical world, I envision this technology to innovate robotic surgery by, for example, providing information about the procedures, the decision-making, the surgical plan, and others. Fast internet will allow operating from a distance, and this can be used to support colleagues and patients when a very expert surgeon cannot be available in physical presence. Thinner staplers (now 8mm) can allow procedures to be done via tiny ports, and with the ION platform, surgeons can offer diagnosis and treatment in one step.
ASJ: You have contributed significantly to research on pleural transportation and physiology, especially in relation to animal models. What key findings from your research do you believe could have the most impact on clinical practice?
Dr. Kouritas: The finding that the pleura is an active organ and should be protected during surgery was the most important finding of my research. Respecting its integrity and realizing its involvement in the chest’s normal function can provide better surgical outcomes, for example, the respect of the caudally located parietal pleura, the understanding of the presence of hormone receptors on the pleura, and others.
ASJ: You have been leading the robotic surgery program at Norwich University Hospital since June 2021. What challenges and opportunities have you encountered during this transition?
Dr. Kouritas: The most important challenge was to convince colleagues and management that RATS is not a fancy toy for surgeons to perform the same procedure one could perform via thoracotomy in a more fashionable way, but instead, it is a game-changing approach that benefits both surgeons and patients. Very early in the course of events, I had to provide a way of quantifying the impact of my operating to my practice in order to retain my lists and to ensure enlargement of the program. The greatest opportunity was that RATS was not accepted by other surgeons, and hence, there was enough space for me to evolve and promote the program. The challenges have now changed; more surgeons want to come on board with the program, and in many instances, this is not done in a professional way, leading to clashing and unacceptable behavior. Despite this, nowadays, robotic operation in Thoracic surgery is an accepted approach, and hence, the funding and research opportunities have skyrocketed throughout the last years. There are many technological advances that have developed recently and complemented robotic surgery. For example, 3D reconstructions, the Firefly mode, better stapling devices, and others can augment and improve the efficiency of the robotic approach.
ASJ: What do you consider the most rewarding aspect of your work in thoracic surgery, especially with your specialized focus on lung cancer and chest wall surgeries?
Dr. Kouritas: The most rewarding aspect is that everything is being done via the RATS approach with tiny cuts and as such, cancer patients get treated efficiently without major complications and can go home quickly back to their families and loved ones to spend their post-cancer treatment time. This alleviates their anxiety of being swamped in the hospital and feeling that they miss important developments at home. We all understand that diagnosis of cancer is very stressful for patients, and when they realize that they can go home very quickly without huge long cuts and minimal aches rather than pain, they feel that they have a second chance in life. We have achieved chest wall resections and reconstructions with mesh robotically, leaving patients’ muscles unharmed. Consequently, they are pleased by the fact they are not hugely marked with big scars and that they can still function post-surgery and get back to their normal lives.
ASJ: Could you tell us about some of the leadership or quality improvement projects you are currently involved in? What key outcomes or changes have resulted from these initiatives?
Dr. Kouritas: The most important project I am leading at the moment is the Lung health check and its utilization in the augmentation of emphysema lung volume reduction interventions in the area and nationally. The Lung health check screening program was implemented to diagnose lung cancer in a specific population, but on the side, it provides information about the emphysema findings of those patients. Many of them would otherwise be left to their fate, but they can now be picked up and offered lung volume reduction (LVR) intervention in order to improve their quality of life. As a result of this program, the emphysema service implemented a couple of years ago has increased its practice, providing treatment to more patients who benefit from these procedures.
ASJ: As an Editorial Board Member, what are your expectations and aspirations for ASJ?
Dr. Kouritas: My aspiration is to see the journal become one of the most important journals in its field. I expect this to be done legitimately and by abiding by all international guidelines and laws around non–biased publishing.