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In the Introduction to the previous edition of this textbook, the senior editor, David Sugarbaker, presented an elegant history of the emergence of thoracic surgery. Our field evolved from general surgery in the early 1900s, largely as a response to chest morbidities prevalent at the time, including pulmonary tuberculosis and World War I–related trauma. Over the course of the twentieth century, thoracic surgery experienced a series of dramatic and tumultuous changes that initially threatened but ultimately strengthened the integrity of the discipline. In 1953, the first successful application of extracorporeal circulation in humans began an era of precipitous innovation in chest surgery in the United States, resulting in a paradigm for cardiothoracic training that married cardiac and thoracic surgery. In the 1990s, transformative developments in cardiovascular disease diverted funding in cardiothoracic programs in favor of cardiac training; however, it was not long before this model was recognized as suboptimal for training leaders in thoracic surgery.

Meanwhile, events transpired somewhat differently in Canada, where thoracic surgery emerged as an independent discipline with dedicated training programs and surgical services. Dr. F. Griffith Pearson, a pioneer in lung transplantation and thoracic oncology, was the first chief of the Division of General Thoracic Surgery at Toronto General Hospital. Dr. Pearson is widely regarded as the father of modern thoracic surgery. He mentored countless surgical leaders around the globe and was known for his role in establishing thoracic surgery as an independent discipline in North America. American surgeons with an interest in noncardiac thoracic surgery sought training in Canadian programs and brought their experiences and commitment back to the United States. The first independent division of thoracic surgery in the United States was founded in 1988 at the Brigham and Women’s Hospital and was led by David Sugarbaker following his training with Dr. Pearson. It was there, in 1993, that the first training program in the United States with a track dedicated to general thoracic surgery was approved by the Residency Review Committee of the Accreditation Council for Graduate Medical Education (ACGME), the body that oversees the accreditation of all residency programs in the United States.

Since the start of the twenty-first century, there has been a vast increase in the number of thoracic surgery training programs, driven by a wave of surgical innovation in our specialty. Technological advances have been rapid in recent years, including improvements in minimally invasive thoracic surgery, endoscopic therapies such as per oral endoscopic myotomy (POEM) and endoscopic submucosal dissection (ESD), and techniques to facilitate lung transplantation, such as ex vivo lung perfusion (EVLP). As a specialty, thoracic surgery is viewed as a leader in minimally invasive surgical technique with the widespread application and advancement of thoracoscopic, robotic, and uniportal approaches. Two decades ago, most surgeons would not have foreseen that more than half of all lobectomies or one-third of all esophagectomies among participants in the Society of Thoracic Surgeons database would be performed via minimally invasive approaches.1,2...

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