Thoracic Surgery Services

The Stanford Center for Minimally Invasive Thoracic Surgery (SMITS), co-directed by Drs. Mark Berry and Joseph Shrager, was founded in 2014 to recognize Stanford's position among the leading thoracic surgery centers in the United States in experience and expertise in minimally invasive approaches to chest diseases.  

Our surgeons were early adopters of minimally invasive techniques as it became clear that they have substantial benefits to patients when used appropriately. Our surgical outcomes have consistently been in the top quartile of the Society of Thoracic Surgeons General Thoracic Surgery Database, which tracks outcomes primarily for specialized, large, academic medical center thoracic surgery practices. In other words, our results fall within the top quarter of a very elite group.

We consider excellence in lung cancer surgery to be at the core of the mission of the Thoracic Surgery service at Stanford. You will be treated at Stanford by thoracic surgeons who are super-specialized in the management of lung cancer and have trained to treat this disease at some of the top thoracic surgery units in the country. We work together with oncologists, radiation oncologists, pathologists, and radiologists at the Stanford Cancer Center to provide a comprehensive approach to therapy.

At Stanford, we provide a wide range of minimally invasive surgical treatments for gastroesophageal reflux disease (GERD), achalasia, paraesophageal hernia, and Barrett’s esophagus. Minimally invasive treatments are beneficial because, in some cases, they may eliminate the need for more complex surgeries, and in most cases, minimally invasive treatments reduce the patient's length of hospital stay and shorten recovery time. We have general thoracic surgeons that are specially trained in these methods to treat non-malignant esophageal diseases.

Stanford has begun a CT Lung Cancer Screening Program as a collaboration between our radiologists, pulmonologists, and thoracic surgeons. CT screening has been shown to reduce mortality from lung cancer in certain current and former cigarette smokers by approximately 50%. Please see the CT Lung Cancer Screening Program webpage for details on the program and contact information for enrollment.

Stanford thoracic surgeons evaluate and treat a high volume and wide variety of mediastinal diseases. Since many of these lesions are benign, minimally invasive approaches, which allow for less discomfort and faster recovery, can often be utilized. As in all areas of thoracic surgery, Stanford thoracic surgeons have sub-specialty training in the surgical management of mediastinal tumors and diseases. They have far more experience with these relatively rare diseases than general surgeons and even cardiothoracic surgeons at surrounding community hospitals.

(also known as Endoscopic Thoracic Sympathectomy or ETS)

Stanford surgeons have performed approximately over 200 Thoracoscopic (VATS) sympathectomies for hyperhidrosis over the past 10 years, representing a very extensive experience and demonstrating our significant commitment to the care of patients with hyperhidrosis. All of our surgeons have a particular interest in this condition.

Current medical treatments of emphysema provide a modest degree of palliation, but there is no medical therapy that dramatically improves emphysema patients' shortness of breath or improves their survival. However, Lung Volume Reduction Surgery (LVRS) may be a viable solution for qualifying patients.

Stanford is the highest volume and highest quality esophagectomy center in the San Francisco Bay Area. We consider excellence in the surgical management of esophageal cancer, along with management of lung cancer, to be at the core of the mission of the Thoracic Surgery service at Stanford.

A metastasis is a type of lung tumor that develops when cancer from another body site (for example, the breast or colon) spreads to the lung. When this occurs, the tumors in the lung are referred to as metastatic lung (pulmonary) tumors. Because it acts as a sieve for all of the blood that passes through the body, the lung is a very common site for metastatic tumors to lodge. Fortunately, patients with tumors that spread to the lung from other sites often still have a chance to be cured by surgical removal of these metastatic lung tumors, frequently in combination with chemotherapy.

Malignant Pleural Mesothelioma (MPM) is a rare and aggressive form of cancer that originates in the pleura within the chest cavity. The treatment of malignant pleural mesothelioma depends on the tumor stage, and the patient's age and overall condition. Treatment strategies for MPM include chemotherapy, radiation, surgery, or a combination of these approaches. At Stanford, we believe in a surgery-based multimodality treatment approach, whenever possible. Drs. Leah Backhus and Mark Berry have special interest in this disease process.

Thoracic outlet syndrome (TOS) occurs when the nerves or blood vessels in the neck and shoulder regions are compressed by surrounding structures, such as the first rib or an abnormal rib, and the scalene muscles. Most patients have pain, weakness, numbness, or tingling in the neck, shoulder, or arm. There are three types of TOS: neurogenic, venous, and arterial. Treatment may involve surgical decompression of the thoracic outlet – removal of the first rib or an anomalous rib, partial removal of the anterior and middle scalene muscles, and decompression of the brachial plexus. Dr. Natalie Lui in Stanford's Division of Thoracic Surgery has a special interest in the surgical management of TOS.

Chest Wall

Chest wall tumors are uncommon. They can be either benign or malignant. The most common primary malignant chest wall tumors are sarcomas – chondrosarcomas specifically. Metastatic lesions (particularly from breast cancer) can also occur. Usually, the specific diagnosis can be made by a core needle biopsy. Occasionally, however, a firm diagnosis may require an open biopsy. Chest wall resection, with or without removal of adjacent lung tissue, can be done in reasonably straightforward fashion by experienced thoracic surgeons. Chest wall reconstruction may require placement of prosthetic materials and/or rotation of muscle flaps to create cosmetically acceptable and functional results. Patients with chest wall tumors may benefit from evaluation in the Comprehensive Thoracic Oncology Clinic or the Sarcoma tumor board, as multidisciplinary approaches involving surgery, chemotherapy, and radiation therapy may be necessary. Stanford physicians are highly experienced in dealing with these sorts of tumors.

Diseases of the Airway

Diseases of the trachea and major airways are uncommon; however, the Division of Thoracic Surgery has been interested in such diseases for years. Procedures such as tracheal resection, rigid bronchoscopy, laser ablation of tracheal tumors, and tracheal stenting are offered.

Video-assisted Thoracic Surgery

Over the last 5-10 years, the field of minimally invasive surgery has expanded dramatically. Initially used primarily by gynecologists, minimally invasive techniques and equipment were adapted for general surgical (abdominal) procedures and subsequently for intrathoracic use of procedures such as pulmonary resection, pleural biopsy, removal of mediastinal tumors, and sympathectomy (for reflex sympathetic dystrophy and hyperhydrosis).

Please see our other sections listed below that highlight use of video-assisted thoracic surgery for the treatment of specific thoracic problems:

Our Thoracic Team

Joseph Shrager, MD

Division Chief & Professor


Leah Backhus, MD, MPH, FACS

Associate Professor


Mark Berry, MD

Associate Professor


Natalie Lui, MD

Assistant Professor


The Division of Thoracic Surgery in the Department of Cardiothoracic Surgery at the Stanford School of Medicine is located in the San Francisco Bay Area in northern California. For more information about our services, please contact Donna Minagawa at (650) 721-2086 or Angela Lee, RN, MS, at (650) 721-5402. For new patient Thoracic Surgery Clinic Scheduling, please call (650) 498-6000.