UConn Health Expands Thoracic Surgery Program With Dustin Walters, M.D.

Written by Steven Blackburn / Photography by Tina Encarnacion, UConn Health

Dustin Walters, M.D., has been quickly expanding the thoracic surgical care program at UConn Health despite only having recently arrived from Tufts Medical Center in Boston. Although not an uncommon specialty, thoracic care isn’t usually provided as comprehensively outside major cities. However, with Dr. Walters’ arrival, this advanced level of care is now offered at UConn John Dempsey Hospital in Farmington.

“It’s one of the more technically challenging surgical specialties,” said Dr. Walters, who originally served as Tufts’ interim chief of thoracic surgery. “The types of procedures we are now doing at UConn Health are more consistently seen in large tertiary care centers.”

Providing difficult-to-perform, minimally invasive surgery

Part of what makes this particular specialty so challenging is based on the complex tools that are required to perform certain life-saving procedures in a minimally invasive way. This is especially the case for treating lung cancer, which is one of the most common forms of cancer and the leading cause of cancer death, afflicting a quarter of a million Americans each year. For these procedures, Dr. Walters performs minimally invasive surgery with the Da Vinci robot.

“I have gravitated towards this platform since it provides superior visualization and more precise movement, allowing me to perform the same operation through smaller incisions that are often less than a centimeter in size,” he said. “This translates to less pain, decreased blood loss, shorter stays in the hospital and a quicker return to normal life without compromising the cancer operation.”

In fact, Dr. Walters strives to use the Da Vinci platform for every one of his treatments, even for esophageal cancer, which is less commonly performed because it’s one of the more challenging operations to do minimally invasively. “It’s hard to say that the robotic approach for esophagectomy is the gold standard, but patients definitely recover more quickly afterward compared to traditional approaches,” said Dr. Walters.

Being able to perform robotic surgery is such an important skill for doctors to master that it will be one of the offerings at a new fellowship program that Dr. Walters is launching at UConn Health. Dr. Walters will serve as the fellowship’s program director to train the next generation of cardiothoracic surgeons at UConn Health.

A full spectrum of thoracic care

With Dr. Walters, UConn Health now offers the full spectrum of thoracic care, from simple diagnostics to highly complex cancer operations. But it’s a team effort that wouldn’t be possible without the help of UConn Health’s other highly specialized experts. Dr. Walters can’t say enough good things about the team, including surgical oncologist Dr. Kevin Staveley-O’Carroll, who is chair of the Department of Surgery, with a strong interest in esophageal cancer, and Dr. Omar Ibrahim, director of interventional pulmonology.

“Dr. Staveley-O’Carroll has a lot of experience in advanced esophageal and pancreatic cancer,” said Dr. Walters. “Combining our ability to perform minimally invasive robotic surgery with experience in complicated esophageal reconstructions allows us to treat some of the most complicated cancers.”

“Dr. Walters is an outstanding person and a tremendous surgeon,” said Dr. Staveley-O’Carroll. “He will be providing destination services in minimally invasive lung and esophageal cancer. His collaboration with Dr. Ibrahim in interventional pulmonology takes our busy lung cancer program to the next level. And his minimally invasive skills are ideally suited to combine with my background in major resections of the stomach and esophagus and complex reconstructions with colon interpositions.”

With Dr. Ibrahim, Dr. Walters has a multidisciplinary clinic where they streamline patient care by collaborating on almost every patient who has lung cancer to ensure they can get what they need in as few visits as possible. “We will always do what is necessary in making it easier for the patient since nobody likes having to come in for multiple visits when they can be completed in a single day,” said Dr. Walters. “It’s somewhat rare to have a truly integrated clinic with multidisciplinary care, even at academic centers.”

“Dr. Walters has quickly integrated into our team and is already making strides in improving care delivery, incorporating cutting-edge technology, and advancing surgical techniques for our community,” added Dr. Ibrahim.

Minimizing narcotics use, expediting mobilization and returning to normal activities

Although his tenure only recently began, Dr. Walters has already implemented a new team approach involving the patients and their families to help expedite and improve recovery, which naturally required building consensus among staff and fostering a new culture to ensure nurses, physical therapists and other team members were on board. He and his former colleagues at the University of Virginia developed the pathway, which Dr. Walters successfully implemented at Tufts during his tenure there. Implementation also involved coordinating efforts, including medication distribution and process digitization.

Called Enhanced Recovery After Surgery (ERAS), the pathway strives to ensure patients and their families understand they are an important part of the team. “This allows them to take ownership and agency of their health. The best outcomes occur when patients and their families are truly partners throughout the process,” said Dr. Walters.

ERAS has three main tenets: control pain with minimal narcotics, promote early mobilization and ensure patients return to normal activities as quickly as possible. The tenet on pain control is based on the understanding that narcotics can slow recovery, on emerging evidence that they might actually worsen cancer outcomes, and on clear data that connects their use to the opioid epidemic.

Dr. Walters and his team minimize narcotics use by utilizing a variety of multi-modal pain control approaches. “We use nerve blocks before and during surgery along with several non-narcotic medications that are designed to be very effective for pain control,” said Dr. Walters. “This doesn’t mean that we don’t ever use narcotics. But we really try to be thoughtful about their use.”

For early mobilization, Dr. Walters ensures patients get out of bed and move the day of surgery to prevent blood clots and to make sure that patients do not lose their conditioning. This naturally leads into ERAS’ third main tenet, which is to ensure patients return to normal activities. “We want patients to return to the things they enjoy or to what gives them pleasure as soon as possible,” said Dr. Walters. “Being diagnosed with cancer is hard enough for patients. When faced with a prolonged recovery, it leaves people wondering when they can return to normal. We want to speed up that process, because it’s not just about curing their cancer, but giving patients their lives back.”

Combining this ERAS pathway with minimally invasive robotic surgery, Dr. Walters and his team are often able to get patients home the day after a lobectomy, one of the most common lung cancer operations, when the length of stay is generally four to five days across the U.S.

“Ultimately, we all care about achieving the best outcome for each patient. Everybody was on board with ERAS since we all will do anything to achieve the best possible outcome for our patients,” Dr. Walters concluded.

Steven Blackburn is a freelance writer with more than 10 years of journalism experience in various fields, including U.S. education and Connecticut community interest stories. He lives in Winsted.