Posted on in General


We have found that if a client is facing major surgery, then a second opinion can be very helpful.

Here is a case study: a 45 year old previously well engineer had major chest surgery planned within two weeks.

The mass in his anterior mediastinum ( in front of his heart) had been discovered by accident when he had a chest CT because of prior chest trauma.

Because he lived in a northern community, he was flown to a major university chest surgery clinic for an opinion. The surgeon advised him that he required a major procedure that would require his breast bone or sternum be split with a saw.  The client felt perfectly well and was anxious about the extent of this procedure.

We were retained for a surgical second opinion. We got his CT and MRI studies and his medical records. Then we sent them to 3 cardiac/chest surgeons and to 3 specialty chest radiologists for second opinions.

The 3 cardiac surgeons whom we sent the information to, all agreed that they could remove the mass with a minimally invasive procedure with or without the use of the Da Vinci surgical robot. One of the chest radiologists took the case to a case conference at his hospital and came back with the advice to cancel the operation because he felt the mass was a harmless lymph node. He suggested that the patient get another MRI done in 6 months.

This client “happily” cancelled his operation, will get his MRI chest redone in 6 months and if the mass increases in size, then he will choose a surgeon able to remove the mass with a minimally invasive approach.

Instead of having to take 2 months off work, he will likely be back at work within a week.

At Rupert Case Management (RCM) we call this service SurgicalTriage.

This is the detailed assessment of clinical need, paired with the matching with a surgeon who uses advanced surgical technology that is minimally invasive and has the least number of potential complications.

SurgicalTriage is the secret sauce for which our clients are very appreciative and keep calling us if they face major surgery for any reason.