John Kit Chung Tam1, Jin Ye Yeo2
1Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; 2ATM Editorial Office, AME Publishing Company
Correspondence to: Jin Ye Yeo. ATM Editorial Office, AME Publishing Company. Email: editor@atmjournal.org
This interview can be cited as: Tam JKC, Yeo JY. Meeting the Editorial Board Member of ATM: Dr. John Kit Chung Tam. Ann Transl Med. 2025. Available from: https://atm.amegroups.org/post/view/meeting-the-editorial-board-member-of-atm-dr-john-kit-chung-tam.
Expert introduction
Dr. John Kit Chung Tam (Figure 1) is a Senior Consultant in the National University Health System (NUHS) and founding Head of Thoracic Surgery at the National University Heart Centre, Singapore (NUHCS). He is also an Associate Professor of Surgery at the National University of Singapore Yong Loo Lin School of Medicine. He is a Fellow of the Royal College of Physicians and Surgeons of Canada (FRCSC).
Dr. Tam specializes in performing advanced minimally invasive surgery using single-port techniques with Uniportal Video-Assisted Thoracoscopic Surgery (UVATS). He was an early pioneer in UVATS lobectomy, performing the first UVATS lobectomy in 2009. He is a champion of enhanced recovery protocols and opioid free analgesia to maximise patients’ comfort, well-being, and quality of life after surgery. He leads a high-performance team of thoracic surgeons with excellent surgical outcomes.
Dr. Tam specializes in translational clinical research which encompasses applied science in the surgery domain, including minimally invasive techniques, enhanced recovery protocols, opioid free analgesia, pain reduction techniques, surgical devices and pneumo-static sealants. He also pursues translation of ground-breaking scientific research to clinical applications, which includes the mapping of specialized cells in the lung, extracellular vesicles, exosomes, miRNA, and liquid biopsies for early lung cancer detection.
Dr. Tam is a passionate educator, accomplished faculty developer, and esteemed academic leader. He is currently Chairman of the Cardio-Thoracic Surgery Residency Advisory Committee at the Ministry of Health, Singapore. He is Chair of the Multi-disciplinary Thoracic and Lung Cancer Programme at the National University Cancer Institute, Singapore (NCIS). He holds numerous leadership roles and administrative appointments and has won multiple awards in clinical excellence, research, and education.
Figure 1 Dr. John Kit Chung Tam
Interview
ATM: What inspired you to specialize in thoracic surgery, and what led you to focus on minimally invasive techniques like uniportal video-assisted thoracic surgery (UVATS)?
Dr. Tam: I found my love for thoracic surgery from the very beginning in medical school when I learned anatomy and physiology. The chest anatomy and the pulmonary physiology just make sense, and I really enjoyed learning them. After my second year of medical school, there was a research project that was offered by a thoracic surgeon and a respiratory physician. They were studying a drug that could optimize pulmonary physiology during surgery. With that, I had the opportunity to learn how to do clinical studies and how to assess whether the drug can work. I also had the opportunity to be in the operating theatre and watched how the thoracic surgeon performed lung surgeries and followed the surgeon as he talked with patients. He became a mentor to me, and the rest was history. The lung is a beautiful organ, and lung surgery is a delicate procedure. Almost 30 years ago, lung surgery was still performed as open surgery, and I could see that it was not so nice for the patient because the patient would experience a lot of pain after open surgery. At that time, it was well known that lung surgery was the most painful surgery among all the surgical disciplines because the incision is a thoracotomy or a thoracoabdominal incision. Patients end up having long periods of medical leave where they need a lot of strong medications for their pain, such as narcotics and opioids, which can cause a lot of side effects and dependency. In some cases, patients may experience chronic pain and become more debilitated. The outcome was not satisfactory, and that inspired me to want to do better surgery for our patients.
During my residency, one of my family members was diagnosed with cancer and had to undergo surgery. Immediately after the operation, she was in a lot of pain, and it was very uncomfortable for me to witness her pain as the doctors and nurses were unable to provide adequate pain relief in an expedient manner. The helplessness of watching the suffering of a loved one further inspired me to want to do better. This motivated me to seek better solutions for my own patients.
When I completed my residency in 2005, minimally invasive techniques were starting to become more prominent. At that time, the top center for minimally invasive thoracic surgery was at the University of Pittsburgh Medical Center, and I became a lecturer and pursued a fellowship in minimally invasive thoracic surgery there to learn video-assisted thoracic surgery (VATS). Back then, there was only five-port VATS, which was what I did when I came to Singapore. Very quickly, I started to think about how VATS can be further improved and perfected. I started to reduce the number of incisions one by one, and by 2007, I was doing two-port VATS.
ATM: You were an early pioneer of UVATS lobectomy. Can you share the experience of performing the first UVATS lobectomy in 2009 and how the field has evolved since then?
Dr. Tam: In 2008, single-incision laparoscopic surgery (SILS) emerged. That inspired me to think about the possibility of single-port thoracic surgery, as that could better align what we see and what we do into one visual field through the same uniport. In that year, I contemplated and figured out how to do single-port thoracic surgery safely. Nevertheless, I sat on the idea for one year as I did not want to subject my patients to something new without making sure that the technique was safe and had a guaranteed better outcome.
In June 2009, I happened to have a young patient who was a medical student and suffered from pulmonary sequestration in his right lower lobe. He had multiple recurrent infections and hospitalizations, which greatly affected his studies. The surgical option that we could offer was a lobectomy to remove that lobe. This procedure was not easy due to recurrent scarring and the presence of an aberrant vessel from the aorta. I informed him that I would do two-port VATS, and he was actually the one who asked me whether I could do single-port and suggested that I should try doing UVATS on him. With that being the first UVATS, it was a long surgery lasting 10 hours, but he had a wonderful outcome, living a full life free from any subsequent infection or hospitalization. With this proof of concept that UVATS was indeed possible and could be safely performed, we quickly rolled this option out for other patients. Currently, 95% of all the thoracic and lung surgery cases in our center are performed using UVATS, and it has become a standard of care and procedure of choice for my team of surgeons.
Since the first UVATS, the field has evolved greatly. Firstly, this technique is widely propagated and there are now many excellent surgeons who can do advanced UVATS of higher complexities. Secondly, there has been development in non-intubated VATS (NIVATS), which is another level and can be beneficial for a selected group of patients. Another major advancement that we have been very blessed to be part of the journey is that UVATS is one of the best minimally invasive techniques perfectly suitable to combine with enhanced recovery after thoracic surgery (ERATS). By minimizing the surgical incision and reducing the pain, we can significantly fast-track and enhance recovery. The most essential key for patient recovery after thoracic surgery is early mobilization. By minimizing the pain and eliminating the use of opioids and narcotic pain medicine, patients can be ambulated and discharged from the hospital very quickly. In our center, we typically do total muscle-sparing UVATS. For lobectomy or sublobar resection, we do not cut the muscles nor break any ribs. We just split the muscles apart and are very gentle to protect the nerves. This helps to minimize the pain to the lowest level. Our patients typically can ambulate and eat the next day and only require paracetamol for pain relief.
ATM: Your research spans both applied surgical science and translational medicine. Can you highlight a recent breakthrough in your research that excites you?
Dr. Tam: One of the things that excites me is the area of biomarker profiling for early lung cancer detection and diagnosis. We work on a variety of platforms, such as miRNA and exosomes, and we work with a team of researchers to do liquid biopsies and find better methods to detect various biomarkers.
Recently, we published a paper on using magnetic augmentation to profile circulating biomarkers for cancer diagnosis. It is exciting because lung cancer is a major cancer that can affect many people’s lives, and early detection and diagnosis can mean a significantly better chance of achieving a cure. In Asia, we are seeing a lot of new lung cancer cases. In Singapore, there was an increase of 1000 more lung cancer cases diagnosed within a 5-year interval. I see this as both a challenge for us to tackle the rising disease burden, as well as a testament to the good work our team of doctors has been doing to help detect more lung cancer cases.
ATM: You are a strong advocate for enhanced recovery protocols and opioid-free analgesia. How does your team implement enhanced recovery protocols, and how have these approaches improved patient outcomes?
Dr. Tam: We have a team of six consultant thoracic surgeons, who were all graduates from our local training program. That makes it easier to implement enhanced recovery protocol on an institution-wide level. The best way to implement these protocols is to integrate them seamlessly with daily routine clinical practice. It is important to write up a protocol and be explicit about what we do. It is also important to look at it from time to time to identify best practices and to improve the protocol based on the best evidence. It is even more important to live and breathe enhanced recovery as simply the standard of care. The concept of minimally invasive surgery is fundamentally a mindset, and so is enhanced recovery. It is a mindset that is embodied in the way we practice. Ultimately, it first starts with the mindset.
The mindset of minimally invasive surgery is asking how we can make the cut as small as possible and do things in a way that is as minimally invasive as possible so that we can minimize the surgical trauma introduced to patients and thereby enhance their recovery.
Enhanced recovery, as a mindset, is asking what we can and cannot do to help the patient recover faster. For example, if we know that using narcotics can introduce unwanted side effects, we can titrate the amount of medication they receive to prevent over-medication. If we know that early ambulation is important for enhanced recovery, we will do that and encourage patients to be ambulated, and avoid doing things that will slow down their ambulation.
ATM: With the increasing role of AI and robotics in surgery, how do you foresee these technologies influencing thoracic surgery and/or your clinical research?
Dr. Tam: These technologies will have a tremendous effect on thoracic surgery and clinical research. As an academic institution, we need to embrace these technologies and be at the cutting edge of new developments.
With regards to robotics, it is already practiced widely in many centers. Besides UVATS, many of our surgeons also do robotic-assisted thoracic surgery (RATS). As robotics become more sophisticated, technology becomes even more intuitive, and the cost of robotics reduces from economy of scale, more people will enter the field. Robotics can democratize surgery in a way that makes surgery potentially easier to learn and can remove manual variations between surgeons, which can help to standardize the quality of surgery to a certain level. It may no longer be the case where only those who are extremely skilled with manual dexterity can do surgeries. With the help of robotics, more people can do surgeries, and at a more complex level.
With AI, it is even more important that we embrace the technology, as AI can completely revolutionize all areas of medicine and surgery. With regards to thoracic surgery, in time to come, AI can improve lung cancer detection, complemented with other diagnostics such as x-rays, computed tomography (CT) scans, or liquid biopsies. X-ray has not been beneficial all this time as changes in X-rays may be subtle. With AI, subtle changes may now be identified. With increased detection and diagnosis, we need to be prepared for the coming surge in lung cancer cases. The challenge for our surgical community is whether we can successfully handle this surge and treat our patients successfully in a timely manner.
ATM: As Chairman of the Cardio-Thoracic Surgery Residency Advisory Committee, how do you approach training and mentoring the next generation of surgeons?
Dr. Tam: As academic surgeons, we live and breathe education and training, which is embedded in everything we do in our practice. We have the mindset of planting trees so future generations can enjoy the shade. I am blessed to have good teachers and mentors, and I endeavor to be one to my trainees to grow the next generations of thoracic surgeons.
In Singapore, the Cardio-Thoracic Surgery Residency Advisory Committee is changing the whole curricular structure from a previously competency-based curriculum to an entrustable professional activity-based curriculum. This shifts the training from focusing on isolated skillsets to concentrating on the various roles that the trainees need to perform. As a result, trainees are better prepared to become fully independent consultant surgeons as soon as they complete their training.
The role of educators and learners has also shifted. Residency is still an apprenticeship, but the relationship between the trainer and trainee has shifted from a traditional master-to-apprentice relationship to a senior-to-junior partnership model. The mindset has become more collegial, with a focus on partnership and co-creation to help the trainees succeed.
ATM: How has your experience been as an Editorial Board Member of ATM?
Dr. Tam: My experience has simply been fantastic. I am very honored and grateful to ATM for giving me the role of Editorial Board Member. The editors and editorial team have been very supportive, and the journal continues to enhance the landscape of translational medicine.
ATM: As an Editorial Board Member, what are your expectations for ATM?
Dr. Tam: ATM is a very important journal that encompasses vast areas of translational medicine in different disciplines. This allows us to learn the best practices across various fields. Many clinicians and surgeons are working in translational medicine because it is what brings basic scientific discoveries to clinical applications and routine practices. I would like to see more doctors in academic institutions engage in translational research, make efforts to systematically analyze their findings, and publish their work in ATM. I hope ATM can continue to be a beacon in translational medicine to showcase and highlight the exciting advancements and research that are happening across many fields, and that it will become a world-recognized journal for the field of translational medicine.