Lung cancer surgery has evolved from its recent past when it was performed through a large thoracotomy primarily by cardiac surgeons at the end of the day when the other cardiac cases had finished. The modern practice of lung cancer surgery involves a comprehensive pre-operative work-up utilizing both PET and CT scans, often in conjunction with pre-operative endobronchial ultrasound and biopsy for accurate pre-operative clinical staging. Surgery for early lung cancer should involves a minimally invasive approach using eithe thoracoscopic or robotic technique and should include a full lymph node dissection. Surgery for late lung cancer should be contemplated after discussion at a multi-disciplinary lung tumor board often in conjunction with neoadjuvant chemo and radiation therapy to the lesion and mediastinum.

Many patients with previous malignancy or with other risk factors often require a biopsy of a newly detected radiographic finding. At centers without a dedicated thoracic surgeon, this is typically done through a morbid thoracotomy or via a percutaneous core needle biopsy, which unfortunately 1) often provides non-diagnostic results due to a missed lesion and 2) does not provide the substantive amount of tissue that is nowadays required for genetic assessment of the cancer. Modern thoracic surgical techniques allow for rapid accurate assessment of these nodules with small ports and hospitalizations that are often less than 24 hours. This allows for a greater and faster flow through the multi-disciplinary lung tumor assessment process and leads to overall faster better treatment.

Data from the national Lung Cancer Screening Trial in 2010 showed that yearly screening with low dose CT scans of heavy smokers and ex-smokers could reduce lung cancer specific mortality by over 20% in a 3 year period. This study was terminated prematurely because of the huge improvement in survival that was seen in patients who were screened. Had the study been allowed to continue it is likely that an even larger benefit would have been seen. The Michigan Thoracic Institute will offer a comprehensive annual physical and radiological evaluation on a yearly basis to screen for early lung cancer and to encourage cessation of cigarette use and to optimize pulmonary status in patients with known emphysema.

Benign and malignant pleural effusions represent major morbidities that significantly deteriorates patients quality of life and often their lifespan as well. Centers without dedicated thoracic surgeons often treat these conditions in a haphazard fashion with large bore chest tubes that mandate hospitalization and pigtails catheters which are not designed or safe for intermediate or long term usage.

Dr Sternberg treats more pleural effusions than any other thoracic surgeon in Michigan and was currently invited to join the national Carefusion design team to create the next generation of Pleur-X catheters. His expertise in treating these disorders without the use of large bore catheters, general anesthesia, or prolonged hospitalization allows patients to live symptom free with minimal morbidity and to return to chemotherapy far more quickly than otherwise achievable.

Patients with large refractory pulmonary abscess cavities or pleural infection (empyema) represent specialized thoracic conditions that require the expertise of a thoracic surgeon. Lobectomies for abscesses represent challenging cases in thoracic surgery because of the extensive enlargement and adhesiveness of intrapulmonary lymph nodes. Empyema and decortication while traditionally treated via thoracotomy are now routinely treated thoracoscopically by Dr Sternberg. This represents a huge morbidity benefit to the patient who is already coping with serious infection and who is now spared a large rib spreading incision as well. These cases should only be approached by an experienced thoracic surgeon who is well versed in minimally invasive techniques and thoroughly familiar with intra-pulmonary vascular anatomy.

Primary and Secondary forms of pneumothorax (Collapsed lung) represent common but sometimes dangerous medical conditions. Non-experts often place or request tubes to manage collapsed lungs in the short term but are plagued with recurrence rates that often approach 85%. Dr Sternberg routinely treats these patients with minimally invasive apical wedge resection and mechanical pleuodesis and experiences shorter hospital stays than non-operatively managed patients as well as a long term recurrence rate that is less than 5%.

Severe reflux, achalsia, and para-esophageal hernia represent benign forms of esophageal and foregut disease that when treated minimally invasively can provide long term relief from debilitating eating difficulties as well severe reflux symptoms. Correction of severe reflux also protects patients from increased likelihood of esophageal cancer as well and saves many lives. Dr Sternberg performs these procedures using minimally invasive techniques through the abdominal cavity.

Esophageal cancer, like lung cancer, has evolved into a disease that is now treated through an integrated multi-disciplinary team of surgeons, medical oncologists, radiation oncologists, as well as gastroenterologists. These patients are typically treated with multi-modal therapy utilizing radiation therapy and neoadjuvant chemotherapy prior to surgical resection. The post-surgical care and surveillance of these patients is especially difficult since patients often don't resume eating for a prolonged period of time and because they lose significant amounts of weight and strength. Due to the cancer imposed eating difficulties prior to treatment, many patients head into this process already weakened from weeks or months of near starvation. Treatment of this disease should only be undertaken by an experienced thoracic surgeon.

Thymomas and myasthenia gravis represent tumors that, although traditionally resected by median sternotomy, can now be approached using robotic technology. Dr Sternberg performs these resections robotically, and has also developed skill in the specialized peri-operative management of myasthenic patients as well.

Chest wall injuries including rib and sternal fractures painful conditions that are increasing in frequency as the population in Southeast Michigan ages. Due to the large accumulation of assisted living facilities in the West Bloomfield area, Dr Sternberg has developed considerable experience in managing patients with multiple complicated fractures and has developed a minimally invasive method for plating and reducing fractures thereby decreasing patient pain and hospital stay. Reduction of painful fractures also improves the patients requirement for supplemental oxygen and pulmonary toilet. Dr Sternberg also treats sternal fractures, infections, and tumors of the chest wall as well.