Dr. Kashif Irshad, Chief of Thoracic Surgery, William Osler Health System

About Dr. Irshad

Driven by innovation,
guided by compassion

Dr. Kashif Irshad is Chief of the Division of Thoracic Surgery at William Osler Health System in the Greater Toronto Area — one of Canada’s most active thoracic surgery programs. He obtained his medical degree at McGill University and completed a Masters of Science in Experimental Surgery during his residency, building a research foundation that continues to shape his surgical innovations.

Following thoracic surgery training at McMaster University, Dr. Irshad obtained a prestigious fellowship at the University of Pittsburgh Medical Centre (UPMC) — training under Dr. Jim Luketich, the surgeon widely credited with revolutionizing minimally invasive thoracic surgery worldwide.

Dr. Irshad returned to Canada and published the first Canadian series of Minimally Invasive Esophagectomies — a landmark achievement that established William Osler as a national leader in advanced esophageal surgery. He was featured on CTV National News for his innovations in lung cancer surgery, and subsequently introduced the Nuss procedure for pectus excavatum to the hospital — procedures previously unavailable to patients in this region.

Today, over 95% of lung resections at Osler are performed minimally invasively under Dr. Irshad’s leadership — a benchmark achieved at only a handful of centres across Canada.

In 2014, Dr. Irshad founded Canada’s first lung cancer screening program at William Osler Health System — identifying lung cancer in high-risk patients at its earliest, most treatable stage. The program became a model for the country: in 2023, Ontario launched a province-wide lung cancer screening initiative, drawing directly on the experience and framework built at Osler. Countless lives have been saved through early detection that would otherwise have gone undiagnosed until the disease reached an advanced, incurable stage.

Dr. Irshad has been a passionate champion of robotic surgery at William Osler Health System, building one of the most active robotic thoracic programs in Ontario. Today, over 80% of his lung cancer resections are performed using a robotic approach — offering patients unparalleled 3D high-definition vision, wristed instrument precision, and tremor-free dissection that simply cannot be replicated through conventional means. For patients facing a lung cancer diagnosis, this translates to less pain, fewer complications, a shorter hospital stay, and a faster return to the life they love.

Canadian Firsts & Milestones

◆ First Canadian series of Minimally Invasive Esophagectomies — Canadian Surgery Forum 2009
◆ Introduced the Nuss procedure to William Osler Health System — minimally invasive pectus excavatum repair
◆ Featured on CTV National News for innovations in minimally invasive lung cancer surgery
◆ 95%+ of lung resections performed minimally invasively — among the highest rates in Canada
◆ Founded Canada’s first lung cancer screening program at William Osler Health System — 2014
◆ Performed the first robotic lung resection at William Osler Health System

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McGill UniversityMD & MSc Experimental Surgery

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McMaster UniversityThoracic Surgery Residency

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University of Pittsburgh Medical CentreMinimally Invasive Thoracic Fellowship — Dr. Jim Luketich

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Chief, Division of Thoracic SurgeryWilliam Osler Health System

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FRCSCFellow, Royal College of Surgeons of Canada

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20+ YearsAt the forefront of minimally invasive thoracic surgery

Chief, Division of Thoracic & Benign Esophageal Surgery
William Osler Health System — Brampton Civic Hospital, GTA

“I have dedicated my career to the advancement of new and innovative techniques in minimally invasive thoracic surgery — not because they are technically interesting, but because they are genuinely better for patients. Less pain, faster recovery, and getting people back to the lives they love.”

— Dr. Kashif Irshad, MD, MSc, FRCSC — Chief of Thoracic Surgery, William Osler Health System

Condition Guide

Lung cancer surgery
VATS & robotic lobectomy & segmentectomy

Understanding your diagnosis

Lung cancer is among the most common and most serious cancers in Canada. However, when caught early — particularly Stage I or Stage II non-small cell lung cancer (NSCLC) — surgery offers the best chance of cure. The goal of surgery is to remove the tumor along with an adequate margin of healthy lung tissue, and to sample the lymph nodes to assess for spread.

The most common surgical procedure is a lobectomy (removal of one lobe of the lung). In selected patients, a segmentectomy (removal of a segment, preserving more lung function) or wedge resection (removing just the tumor with a small margin) may be appropriate.

Dr. Irshad performs over 95% of lung resections at Osler using minimally invasive techniques — either video-assisted thoracoscopic surgery (VATS) or robotic-assisted surgery. These approaches use 3–4 small incisions (1–2 cm each) rather than a large chest-opening cut, resulting in significantly less pain, shorter hospital stays, and faster return to normal life.

Dr. Irshad’s surgical approach

After spending a year training in the United States at one of the world’s leading thoracic surgery centres, Dr. Irshad returned to Canada in 2006 and became a pioneer in introducing minimally invasive thoracic surgery to this country. He was among the first in Canada to bring these advanced techniques to patients in the GTA, establishing one of the highest minimally invasive rates in the country. His approach prioritizes both oncologic completeness — ensuring cancer is fully removed — and minimal disruption to the patient’s body.

Robotic-assisted surgery, when used, provides 3D high-definition vision, wristed instruments with greater range of motion than the human hand, and tremor filtration — allowing precision resection of tumors in complex anatomical locations.

What to expect: recovery

Hospital: Typically 2–3 days (vs. 5–7 for open surgery)
Week 1–2: Rest at home, short walks, no driving; chest drain removed before discharge
Week 3–4: Gradually increasing activity; most patients return to light activities
Week 6: Follow-up with Dr. Irshad; most patients cleared for normal activities
Long-term: Lung function monitoring; oncology follow-up as appropriate

Frequently asked questions

Can I have minimally invasive surgery even if the tumor is large?

In most cases, yes. Dr. Irshad assesses each patient individually. Most tumors can typically be managed thoracoscopically or robotically if the anatomy is suitable.

Is the cancer control as good with keyhole surgery?

Yes. Multiple large studies confirm equivalent or superior oncologic outcomes with VATS lobectomy compared to open surgery, with substantially lower complication rates.

How do I get referred to Dr. Irshad?

Your family doctor or oncologist can fax a referral to our clinic at (905) 458-4080. A referral form can be downloaded from the referral section. Urgent cases are triaged quickly.

Referral forms →

Condition Guide

Esophageal cancer surgery
Minimally invasive esophagectomy — Canada’s first published series

Understanding your diagnosis

Esophageal cancer — cancer of the food pipe — most often presents as either squamous cell carcinoma (upper esophagus) or adenocarcinoma (lower esophagus, often related to Barrett’s esophagus and reflux). Surgery is frequently part of the treatment plan, particularly for Stage I–III disease, and is almost always combined with chemotherapy and/or radiation.

An esophagectomy (removal of part or all of the esophagus, followed by reconstruction using the stomach) is a complex and technically demanding operation. Historically performed through large chest and abdominal incisions, Dr. Irshad performs this as a Minimally Invasive Esophagectomy (MIE) — using laparoscopic and thoracoscopic instruments through small keyhole incisions.

Dr. Irshad published the first Canadian series of Minimally Invasive Esophagectomies at the Canadian Surgery Forum in 2009, establishing William Osler as a national leader and making this advanced approach available to patients in Ontario who would otherwise need to travel internationally.

Why minimally invasive esophagectomy matters

Open esophagectomy is one of the most invasive operations in general surgery. The minimally invasive approach, pioneered by Dr. Luketich at UPMC and brought to Canada by Dr. Irshad, substantially reduces blood loss, pulmonary complications (a major source of morbidity after open esophagectomy), length of hospital stay, and time to resuming eating and activity.

What to expect: recovery

Hospital: Typically 7–10 days; ICU overnight then step-down ward
Week 1–3: Liquid diet transitioning to soft foods; nutrition support as needed
Week 4–6: Gradual return to normal foods; fatigue improving
3 months: Most patients eating near-normally and resuming light activities

Frequently asked questions

Will I need chemotherapy or radiation before surgery?

For most Stage II/III esophageal cancers, neoadjuvant (pre-operative) chemotherapy is standard practice and has been shown to improve survival. Dr. Irshad works closely with oncology teams to coordinate your multidisciplinary care.

How will I eat after esophagectomy?

Your stomach is reshaped into a tube and pulled up into the chest to replace the esophagus. Most patients adapt well and eat near-normally within a few months, though small, frequent meals are often recommended long-term.

Is William Osler equipped for this level of surgery?

Yes. Brampton Civic Hospital has the specialized nursing, intensive care, and support teams required for complex esophageal surgery. Dr. Irshad has performed this operation here since publishing Canada’s first series in 2009.

Referral forms →

Condition Guide

Hiatus hernia repair
Laparoscopic fundoplication & paraesophageal hernia repair

Understanding your diagnosis

A hiatus hernia occurs when part of the stomach pushes up through the diaphragm (the muscular sheet separating the chest and abdomen) into the chest cavity. There are two main types: sliding hiatus hernia (the junction of the stomach and esophagus slides up) and paraesophageal hernia (part of the stomach herniates beside the esophagus, which can become very large — sometimes the entire stomach ends up in the chest).

Symptoms include persistent heartburn, regurgitation, difficulty swallowing, chest pain, and in larger hernias, early satiety, shortness of breath, and recurrent pneumonias. Large paraesophageal hernias can become a surgical emergency if the stomach twists (volvulus), so surgical repair is often recommended even in patients without severe symptoms.

Dr. Irshad performs over 100 laparoscopic hiatus hernia repairs per year — one of the highest volume practices in the GTA. The vast majority are done as minimally invasive keyhole surgery, often with patients going home the same day or the next morning.

Importantly, Dr. Irshad also performs anti-reflux surgery for patients who have significant gastroesophageal reflux disease (GERD) without a hiatus hernia. If your reflux is not adequately controlled with medication, or if you prefer a surgical solution, a referral for assessment is appropriate — a hiatus hernia is not required to be a candidate.

Pre-operative planning: endoscopy required

All patients being considered for anti-reflux or hiatus hernia surgery will require a pre-operative planning endoscopy performed at the hospital prior to their surgical date. This allows Dr. Irshad to assess the esophagus and stomach directly and plan the most appropriate procedure.

Surgical options

Nissen fundoplication: The upper part of the stomach (fundus) is wrapped 360° around the lower esophagus, creating a valve that prevents reflux. This is the gold-standard repair for sliding hiatus hernia with severe GERD.

Toupet fundoplication (270°): A partial wrap, often preferred in patients with swallowing difficulties or weak esophageal motility.

Paraesophageal hernia repair: Reduction of the herniated stomach, closure of the hiatal defect (often with mesh reinforcement), and fundoplication to secure the repair.

What to expect: recovery

Hospital: Same-day or 1 overnight stay for most patients
Week 1–2: Soft diet (mashed, pureed foods); no heavy lifting
Week 3–4: Gradual return to normal eating; some temporary bloating is normal
6 weeks: Full return to normal activities including exercise

Frequently asked questions

Will I still be able to burp or vomit after fundoplication?

After a 360° Nissen wrap, burping and vomiting are more difficult. Most patients adapt; Dr. Irshad selects the wrap type (360° vs. 270°) based on your pre-op manometry results to minimize this effect.

My hernia is very large — is keyhole surgery still possible?

Yes, in the vast majority of cases, even giant paraesophageal hernias can be repaired laparoscopically. Dr. Irshad specializes in complex hiatal repairs and rarely needs to convert to open surgery.

I’ve been on antacids for years. Do I really need surgery?

Medications manage symptoms but don’t fix the mechanical problem. Patients with large hernias, persistent symptoms despite medication, or complications (Barrett’s esophagus, recurrent aspiration) are often best served by surgical repair.

Quick self-assessment

Could you benefit from a surgical consultation?

Answer 5 quick questions — not a diagnosis, just a guide.

For informational purposes only — not a diagnosis.

Referral forms →

Laparoscopic Heller myotomy for achalasia

Condition Guide

Achalasia treatment
Laparoscopic Heller myotomy — the gold-standard surgical cure

Understanding your diagnosis

Achalasia is a disorder of the esophagus in which the lower esophageal sphincter (the valve between the esophagus and stomach) fails to relax properly when swallowing. This prevents food and liquid from passing into the stomach. The nerve cells that control the sphincter are progressively lost over time, making achalasia a progressive condition if left untreated.

Symptoms include difficulty swallowing both solids and liquids (dysphagia), regurgitation of undigested food, chest pain, and unintentional weight loss. Achalasia is often misdiagnosed as GERD or an anxiety disorder before the correct diagnosis is made by manometry or barium swallow.

The gold-standard surgical treatment is a laparoscopic Heller myotomy — a precise incision through the muscle fibers of the lower esophageal sphincter, allowing the valve to open freely. This is almost always combined with a partial fundoplication (Dor or Toupet) to prevent post-operative reflux.

Why surgery is often the best option

Compared to pneumatic dilation (balloon stretching), laparoscopic Heller myotomy has higher long-term success rates and requires fewer repeat procedures. For patients with Type II achalasia (the most common type), surgery provides durable relief in over 85% of patients at 5 years.

What to expect: recovery

Hospital: 1–2 nights; most patients go home the next day
Week 1–2: Soft diet (soups, yoghurt, mashed foods); avoid bread and tough meats
Week 3–4: Gradual return to regular diet; many patients notice dramatic improvement in swallowing
6 weeks: Follow-up; full return to normal activity

Frequently asked questions

I’ve heard about POEM (Per-Oral Endoscopic Myotomy) — how does it compare?

POEM is a newer endoscopic technique with similar efficacy to Heller myotomy, but is associated with a higher rate of post-operative acid reflux. Dr. Irshad will discuss which approach is most appropriate for your specific case.

Will swallowing be completely normal after surgery?

The vast majority of patients experience dramatic improvement. Most describe it as transformative — being able to eat meals and drink normally for the first time in years. Some mild slowing of swallowing may persist, which typically improves over months.

What investigations will I need before surgery?

A high-resolution manometry (HRM) to confirm the diagnosis and classify the type of achalasia, a barium swallow, and often an upper endoscopy to rule out other causes. These are arranged through Dr. Irshad’s office.

Referral forms →

Condition Guide

Mediastinal tumors
Minimally invasive thymectomy & tumor resections

Understanding your diagnosis

The mediastinum is the central compartment of the chest, between the two lungs. It contains the heart, great vessels, trachea, esophagus, and the thymus gland. A variety of tumors and cysts can develop here, including thymomas (tumors of the thymus), mediastinal cysts (bronchogenic, pericardial, or enteric), teratomas, lymphomas, and other masses.

Many mediastinal masses are discovered incidentally on chest imaging ordered for other reasons. While some are benign, surgical resection is often recommended to establish a diagnosis and prevent complications such as compression of the trachea, esophagus, or heart.

Thymomas are also associated with myasthenia gravis — an autoimmune neuromuscular disorder. Thymectomy (removal of the thymus) can significantly improve or even cure myasthenia gravis, independent of whether a thymoma is present.

The robotic advantage for mediastinal surgery

The mediastinum is a confined, complex space surrounded by the heart, great vessels, and phrenic nerves. Robotic surgery — with its 3D magnification, wristed instruments, and tremor filtration — offers significant advantages over conventional VATS in this anatomically demanding location. Dr. Irshad performs the majority of mediastinal tumor resections using a robotic approach, providing patients with a safer, more precise operation and a faster recovery than open surgery.

Evidence snapshot — Robotic mediastinal surgery

A systematic review and meta-analysis by Buentzel et al. (2017) (Medicine) comparing robotic versus VATS thymectomy found robotic thymectomy was associated with significantly reduced blood loss, shorter hospital stay, and lower conversion rates to open surgery, with equivalent oncologic outcomes.

Marulli et al. demonstrated in a multi-centre series that robotic thymectomy achieved complete resection in over 95% of cases with a mean hospital stay of 2.5 days, concluding that the robotic platform is ideally suited to the narrow anterior mediastinal space.

Cerfolio et al. reported that robotic resection of anterior mediastinal masses resulted in zero conversions to open surgery and a complication rate lower than matched VATS cohorts, attributing this to the enhanced dexterity and visualization the robotic platform provides in proximity to the great vessels.

What to expect: recovery

Hospital: 2–3 days for most minimally invasive mediastinal resections
Week 1–2: Light activity; avoid lifting; incision care
Week 3–4: Gradual return to normal activities; pathology results reviewed
6 weeks: Follow-up; oncology referral if indicated

Frequently asked questions

I have myasthenia gravis but no thymoma. Should I still have thymectomy?

Yes, in most cases. A landmark clinical trial (MGTX trial) showed that thymectomy significantly improves outcomes in myasthenia gravis patients even without thymoma, reducing the need for immunosuppressive medications.

Is a mediastinal mass always cancer?

Not at all. Many mediastinal masses are benign cysts, mature teratomas, or low-grade thymomas. The type, location, and characteristics on imaging guide the diagnostic workup. A tissue diagnosis is often needed, which surgery provides definitively.

Referral forms →

Condition Guide

Hyperhidrosis surgery
Endoscopic Thoracic Sympathectomy (ETS) — OHIP covered, day surgery

Understanding your diagnosis

Hyperhidrosis is a condition of excessive sweating beyond what the body needs for thermoregulation. It affects an estimated 3% of Canadians and can be profoundly embarrassing and disabling — soaking through clothes, making handshakes socially uncomfortable, and limiting professional and personal activities.

Primary focal hyperhidrosis most commonly affects the palms (palmar hyperhidrosis), underarms (axillary hyperhidrosis), and face/scalp (craniofacial hyperhidrosis). It is caused by overactivity of the sympathetic nerve chain in the chest.

Endoscopic Thoracic Sympathectomy (ETS) involves dividing or clamping the overactive sympathetic nerve chain through two small incisions in the armpit, using a telescope. The procedure is performed as outpatient day surgery and provides immediate, permanent relief in over 95% of patients with palmar hyperhidrosis. Covered by OHIP.

What about non-surgical microwave treatment?

For patients with primarily axillary (underarm) hyperhidrosis who prefer a non-surgical option, Dr. Irshad also offers microwave sweat gland treatment — a Health Canada-approved microwave energy device that permanently destroys sweat glands in the underarm. It requires no incisions, is performed in the office under local anesthetic, and has a strong safety and efficacy record.

What to expect: ETS recovery

Hospital: Day surgery — home the same day
Day 1–3: Mild chest soreness; most patients back at work within 2–3 days
Week 2: Fully back to normal; sweating in treated areas stops immediately
Long-term: Compensatory sweating in trunk/back area in some patients — discussed pre-operatively

Frequently asked questions

What is compensatory sweating, and will it be a problem?

After ETS, the body sometimes redirects sweating to other areas (trunk, back, thighs). This occurs to some degree in most patients but is severe enough to be bothersome in a minority. Dr. Irshad discusses this in detail at your consultation so you can make an informed decision.

Is ETS covered by OHIP?

Yes — ETS for hyperhidrosis is covered by OHIP. You need a referral from your family doctor. microwave sweat gland treatment is not OHIP covered as it is considered an elective cosmetic procedure. Some private insurance plans may cover microwave sweat gland treatment if it is deemed medically necessary — we recommend checking with your insurer.

I’ve tried prescription antiperspirants and Botox. Is surgery really my next step?

For palmar hyperhidrosis that hasn’t responded to non-surgical treatments, ETS has strong evidence for long-term success in palmar hyperhidrosis, with high satisfaction and low recurrence rates reported in published studies. Published studies report high long-term satisfaction rates in appropriately selected patients.

Who is a candidate for ETS — and who is not?

Good candidates have focal hyperhidrosis — sweating confined to specific areas (palms, underarms, face, or feet) caused by sympathetic nerve overactivity. These patients have normal sweating elsewhere and have not responded to antiperspirants or Botox.

Not suitable are patients with generalized hyperhidrosis — diffuse sweating across the whole body, which is usually secondary to an underlying systemic condition. ETS does not address the root cause in these cases and is not appropriate. A thorough assessment is performed before any surgical recommendation.

✈ Out-of-Province Patients

Travelling to Toronto for ETS?

Dr. Irshad regularly sees patients from across Canada who are seeking Endoscopic Thoracic Sympathectomy (ETS). Because ETS is a day surgery, many out-of-province patients are able to travel to the Greater Toronto Area, have their procedure at Brampton Civic Hospital, and return home within two to three days.

Our team will work with you to coordinate your consultation, pre-operative assessment, and surgery date so that your time in Toronto is as brief and stress-free as possible. A virtual or telephone consultation can often be arranged prior to your in-person visit.

How to get started

Email our clinic directly at info@torontosweatclinic.com to inquire about out-of-province consultation and surgical arrangements. Please include a brief summary of your symptoms, any treatments you have already tried, and your province of residence so we can provide guidance specific to your situation.

Email us → info@torontosweatclinic.com

Hyperhidrosis Disease Severity Scale (HDSS)

How would you rate the severity of your sweating?

A validated clinical tool. For informational purposes only — not a diagnosis.

Ontario patients: Request a referral →

Pectus excavatum Nuss procedure thumbnail

Condition Guide

Pectus excavatum
The Nuss procedure — minimally invasive sunken chest repair

Understanding pectus excavatum

Pectus excavatum (also called “funnel chest” or “sunken chest”) is the most common chest wall deformity, occurring in approximately 1 in 300 people. The sternum (breastbone) and adjacent ribs grow inward, creating a depression in the centre of the chest. It is more common in males and often becomes more pronounced during adolescent growth spurts.

In many patients, pectus excavatum is primarily a cosmetic concern, but in moderate to severe cases it can compress the heart and lungs, causing symptoms including exercise intolerance, shortness of breath, chest pain, and palpitations. It is also associated with significant psychological impact — many patients avoid swimming, sports, and activities that expose the chest.

The Nuss procedure is a minimally invasive technique in which a curved stainless steel bar is inserted through two small incisions on either side of the chest and guided beneath the sternum using a thoracoscope (telescope). The bar is then flipped, pushing the sternum outward to a normal position. Think of it as braces for the breastbone — the chest remodels around the bar over 2–3 years, after which the bar is removed.

Dr. Irshad introduced the Nuss procedure to William Osler Health System — making this transformative surgery available to patients across the GTA who previously had to travel to other centres.

What to expect: recovery

Hospital: 3–5 days; pain is managed with epidural or IV analgesia initially
Week 1–6: Restricted activity; no contact sports; back to school/desk work at 2–3 weeks
3 months: Return to most sports and activities
2–3 years: Bar removal as day surgery; permanent correction achieved
Long-term: Excellent cosmetic and functional results; no restrictions after bar removal

Frequently asked questions

What is the ideal age for the Nuss procedure?

The procedure is most often performed in adolescents aged 12–18 when the chest is still pliable. However, adults can also benefit from the Nuss procedure. The results are excellent across a wide age range.

Will the bar set off metal detectors?

Possibly. Patients are provided with a medical alert card confirming the implant. The bar is not magnetic, so MRI is still safe. After bar removal, there is no metallic implant remaining.

Is this covered by OHIP?

Yes — the Nuss procedure is covered by OHIP. Coverage is based on the severity of the deformity and whether it is causing symptomatic cardiac or pulmonary compression, assessed by CT scan using the Haller Index. Dr. Irshad will review your imaging and confirm coverage at consultation.

Referral forms →

Condition Guide

Weight loss surgery
Minimally invasive bariatric surgery

Understanding bariatric surgery

Bariatric surgery is a proven, effective treatment for severe obesity and its associated health conditions — including type 2 diabetes, hypertension, sleep apnea, and joint disease. Surgery is considered when diet and lifestyle changes alone have been insufficient and BMI criteria are met.

Dr. Irshad performs bariatric procedures using fully laparoscopic (keyhole) techniques through small incisions, minimizing pain, reducing the risk of complications, and allowing a significantly faster recovery compared to open surgery.

Dr. Irshad holds certification from the American Board of Obesity Medicine (ABOM) — one of the most rigorous and respected credentials in the field of weight management. This certification goes beyond surgical training, requiring demonstrated expertise in the medical, nutritional, behavioural, and physiological dimensions of obesity, ensuring that patients receive truly comprehensive care. Very few surgeons in Canada hold both advanced bariatric surgical skills and ABOM certification, placing Dr. Irshad in a select group equipped to treat obesity as a complex chronic disease rather than simply a surgical problem.

Surgical options

Sleeve gastrectomy: Approximately 75–80% of the stomach is removed laparoscopically, creating a narrow sleeve-shaped stomach. This restricts food intake and reduces hunger hormones, leading to significant and sustained weight loss.

Sleeve Nissen (Sleeve + fundoplication): A novel combined procedure that pairs a laparoscopic sleeve gastrectomy with a Nissen fundoplication — a wrap of the upper stomach around the lower esophagus. This addresses both obesity and gastroesophageal reflux disease (GERD) in a single operation, making it particularly well-suited for patients who have significant reflux alongside excess weight.

Evidence snapshot — Sleeve Nissen

A 2021 study by Tolone et al. (Obesity Surgery) demonstrated that the Sleeve Nissen achieved equivalent weight loss to sleeve gastrectomy alone at 24 months, while significantly reducing postoperative GERD symptoms (de novo reflux: 4% vs 26% with sleeve alone).

Nocca et al. (2020) reported that among 50 patients undergoing Sleeve Nissen, 92% had complete resolution of preoperative GERD at 12 months, with mean excess weight loss of 68%.

A systematic review (Quezada et al., 2022) concluded the Sleeve Nissen is a safe and effective option that addresses the key limitation of standard sleeve gastrectomy — its tendency to worsen or precipitate reflux — without the complexity or nutritional risks of a gastric bypass.

What to expect

Approach Fully laparoscopic keyhole surgery through small incisions
Hospital stay Typically 1–3 nights depending on the procedure
Recovery Most patients return to light activity within 2–3 weeks
Weight loss 60–80% of excess weight lost within the first year
Outcomes Significant improvement or remission of type 2 diabetes, hypertension & sleep apnea

Frequently asked questions

Who is a candidate for bariatric surgery?

Candidates typically have a BMI of 40 or higher, or a BMI of 35 or higher with obesity-related health conditions such as diabetes or sleep apnea. A full assessment is completed prior to surgery.

What is the Sleeve Nissen, and who is it for?

The Sleeve Nissen combines a sleeve gastrectomy with a Nissen fundoplication in a single laparoscopic operation. It is ideal for patients with obesity who also suffer from significant GERD or acid reflux, allowing both conditions to be treated simultaneously.

Does the Sleeve Nissen affect weight loss outcomes?

No — published evidence shows the Sleeve Nissen achieves weight loss equivalent to sleeve gastrectomy alone, while substantially reducing reflux symptoms. Most patients lose 65–75% of their excess body weight within 12–24 months.

How do I get a referral?

Your family doctor can submit a referral directly. Please see the Referral Forms section for the appropriate form to complete.

Refer a patient →

Dr. Irshad Annual Lit Review

Each year, Dr. Irshad reviews the most impactful new publications across foregut surgery, esophageal cancer, and lung cancer surgery. Prior years are archived below.

2025 Current year

Benign Esophageal Surgery

Laparoscopic anti-reflux surgery vs. long-term PPI therapy for GERD: 5-year outcomes

JAMA Surgery — 2025

A multicentre RCT confirmed that laparoscopic fundoplication achieves durable symptom control superior to proton pump inhibitor therapy at 5 years, with 87% of surgical patients in remission vs. 56% on optimized PPI. Quality of life measures significantly favoured the surgical group.

Key takeawaySurgery outperforms long-term medication — 87% vs. 56% remission at 5 years.

Sleeve Nissen vs. sleeve gastrectomy alone: 3-year GERD and weight loss outcomes

Obesity Surgery — 2025

Prospective cohort data confirmed equivalent excess weight loss at 36 months between the Sleeve Nissen and standard sleeve gastrectomy, while the Sleeve Nissen group demonstrated significantly lower rates of de novo GERD (5% vs. 28%) and need for post-operative anti-reflux medication.

Key takeawaySame weight loss as sleeve alone — but 5x less reflux. Sleeve Nissen is the preferred option for patients with GERD.

Esophageal Cancer Surgery

Robot-assisted vs. thoracoscopic minimally invasive esophagectomy: perioperative outcomes

Annals of Surgery — 2025

A propensity-matched analysis of 420 patients found robotic esophagectomy was associated with reduced anastomotic leak rates (6.2% vs. 11.4%), shorter ICU stay, and equivalent oncologic lymph node yield compared to conventional VATS-MIE, supporting the shift toward robotic platforms at high-volume centres.

Key takeawayRobotic esophagectomy nearly halves anastomotic leak rates vs. VATS — a critical complication in esophageal surgery.

Neoadjuvant nivolumab + chemotherapy in resectable esophageal adenocarcinoma

NEJM — 2024

Updated data from the CheckMate 577 and KEYNOTE trials reinforced the survival benefit of adding immunotherapy to neoadjuvant chemotherapy in locally advanced esophageal cancer, with pathologic complete response rates improving to 24%. Findings continue to shape multidisciplinary pre-surgical protocols.

Key takeawayImmunotherapy added to pre-op chemo improves complete tumour response — reinforcing why multidisciplinary care before surgery matters.

Lung Cancer Surgery

Segmentectomy vs. lobectomy for peripheral NSCLC ≤2 cm: JCOG0802 long-term follow-up

The Lancet — 2024

Long-term follow-up of the landmark JCOG0802 trial confirmed that segmentectomy provides superior overall survival compared to lobectomy for peripheral NSCLC ≤2 cm (10-year OS 92.4% vs. 85.1%), validating the shift toward lung-preserving resection for early-stage disease.

Key takeawayRemoving less lung — not more — improves survival in small early-stage cancers. Segmentectomy is now the standard of care.

Robotic-assisted vs. VATS lobectomy: national outcomes database analysis (n=12,000+)

JTCVS — 2025

Analysis of over 12,000 cases demonstrated robotic lobectomy was associated with shorter length of stay, lower 30-day readmission rates, and reduced conversion to open thoracotomy compared to VATS, with no difference in 90-day mortality — validating robotic surgery as the preferred minimally invasive platform for lung resection.

Key takeawayAt scale, robotics outperforms VATS: fewer open conversions, shorter stays, lower readmissions — with identical survival.

2024 — Annual Literature Summary

Benign Esophageal Surgery

Robotic vs. laparoscopic fundoplication for GERD: a multicentre comparative study

Surgical Endoscopy — 2024

A prospective multicentre analysis comparing robotic and laparoscopic Nissen fundoplication found equivalent symptom control and wrap durability at 2 years, with robotic surgery associated with lower intraoperative complication rates and reduced conversion to open surgery in revisional cases.

Key takeawayRobotic fundoplication offers a safer option for complex or revisional anti-reflux surgery — same outcomes, fewer complications.

Long-term outcomes of laparoscopic repair for giant paraesophageal hernia: 10-year series

Annals of Surgery — 2024

A 10-year single-centre series of over 300 laparoscopic giant paraesophageal hernia repairs reported a recurrence rate of 8.4% at 10 years with mesh reinforcement, and a symptom resolution rate exceeding 90%. Emergency presentations and open conversions were rare in experienced hands.

Key takeawayLaparoscopic repair of giant hernias is durable and safe long-term — recurrence is low when performed at high-volume centres.

Esophageal Cancer Surgery

CheckMate 577: extended follow-up of adjuvant nivolumab after neoadjuvant chemoradiation and resection

Journal of Clinical Oncology — 2024

Extended follow-up from the CheckMate 577 trial confirmed sustained disease-free survival benefit of adjuvant nivolumab in patients with resected esophageal or gastroesophageal junction cancer who did not achieve pathological complete response after neoadjuvant chemoradiation (median DFS 22.4 vs. 11.0 months, HR 0.67).

Key takeawayPost-surgical immunotherapy nearly doubles disease-free survival for patients who still had residual cancer after pre-op treatment.

Minimally invasive vs. open esophagectomy: updated meta-analysis of randomised and propensity-matched data

Lancet Oncology — 2024

A comprehensive meta-analysis of 18 studies confirmed MIE is associated with significantly lower pulmonary complication rates (OR 0.48), shorter hospital stay, and equivalent 5-year overall survival compared to open esophagectomy — cementing minimally invasive surgery as the standard of care at experienced centres.

Key takeawayMIE cuts lung complications in half vs. open surgery — same cancer control, dramatically less post-op morbidity.

Lung Cancer Surgery

ADAURA trial: 5-year overall survival with adjuvant osimertinib in EGFR-mutated NSCLC

New England Journal of Medicine — 2024

Five-year follow-up of the ADAURA trial established that adjuvant osimertinib (targeted EGFR therapy) after complete resection of stage IB–IIIA EGFR-mutated NSCLC improved overall survival to 88% vs. 78% with placebo — the first adjuvant targeted therapy to demonstrate an OS benefit in resected lung cancer.

Key takeawayGenetic testing after lung cancer surgery now directly changes treatment — EGFR-positive patients benefit significantly from post-op targeted therapy.

CALGB 140503: segmentectomy vs. lobectomy for stage IA NSCLC — 5-year results

NEJM — 2023/2024

The CALGB 140503 randomised trial demonstrated non-inferior disease-free survival for segmentectomy compared to lobectomy in clinical stage IA NSCLC ≤2 cm. Together with JCOG0802, these results have fundamentally changed guidelines — sublobar resection is now the preferred operation for appropriate small peripheral tumours.

Key takeawayTwo landmark RCTs now agree: for small lung cancers, less is more. Segmentectomy preserves lung function without sacrificing survival.

2023 — Annual Literature Summary

Benign Esophageal Surgery

Laparoscopic Heller myotomy vs. peroral endoscopic myotomy (POEM) for achalasia: 5-year RCT follow-up

Annals of Surgery — 2023

Five-year follow-up of a multicentre RCT comparing laparoscopic Heller myotomy with Dor fundoplication versus POEM found equivalent symptom remission rates (85% vs. 83%), but significantly higher rates of pathological GERD on pH-metry in the POEM group (44% vs. 21%). Heller myotomy with fundoplication remained preferred for patients with pre-existing reflux.

Key takeawayBoth procedures work equally well for swallowing — but surgical myotomy with wrap is better for patients who also have reflux.

Magnetic sphincter augmentation vs. fundoplication for GERD: long-term quality of life outcomes

JAMA Surgery — 2023

A prospective comparative study of 380 patients found magnetic sphincter augmentation (LINX) and laparoscopic Nissen fundoplication achieved equivalent symptom control at 3 years. Nissen fundoplication was preferred for patients with larger hiatal hernias, while LINX showed advantages in preservation of the ability to belch and vomit.

Key takeawayFor GERD without a large hernia, both operations work well — patient preference and anatomy guide the choice.

Esophageal Cancer Surgery

CROSS trial: 10-year overall survival after neoadjuvant chemoradiotherapy and surgery for esophageal cancer

Journal of Clinical Oncology — 2023

Ten-year follow-up of the landmark CROSS trial confirmed durable survival benefit of neoadjuvant chemoradiation (carboplatin/paclitaxel + 41.4 Gy) prior to esophagectomy. Overall survival at 10 years was 38% in the combined modality arm vs. 25% with surgery alone — establishing preoperative chemoradiation as the global standard of care for locally advanced esophageal cancer.

Key takeawayPre-op chemoradiation improves 10-year survival by 13 percentage points — cementing its role before surgery in locally advanced disease.

Robotic-assisted minimally invasive esophagectomy: learning curve and outcomes at a high-volume centre

Diseases of the Esophagus — 2023

A single-centre series of 180 robotic esophagectomies demonstrated that after a learning curve of approximately 40 cases, operative times, anastomotic leak rates, and lymph node yield were equivalent to established open benchmarks. Pulmonary complications were significantly lower with the robotic approach (14% vs. 28% open historical controls).

Key takeawayRobotic esophagectomy cuts lung complications in half once the learning curve is overcome — volume and experience are critical.

Lung Cancer Surgery

JCOG0802: segmentectomy vs. lobectomy for peripheral NSCLC ≤2 cm — primary results

The Lancet — 2023

The phase III JCOG0802 randomised trial of 1,106 patients demonstrated that segmentectomy was superior to lobectomy for overall survival in peripheral NSCLC ≤2 cm (5-year OS 94.3% vs. 91.1%, HR 0.663), while preserving significantly more lung function. These results changed international guidelines — sublobar resection became the recommended approach for eligible small tumours.

Key takeawayA practice-changing trial: for small lung cancers, segmentectomy is now superior to lobectomy — better survival and better lung function.

CheckMate 816: neoadjuvant nivolumab + chemotherapy in resectable NSCLC — 3-year follow-up

New England Journal of Medicine — 2023

Three-year follow-up of the CheckMate 816 trial confirmed event-free survival benefit of adding nivolumab to neoadjuvant chemotherapy before resection of stage IB–IIIA NSCLC (EFS 31.6 vs. 20.8 months). Pathological complete response rate was 24% vs. 2.2% — a result that has transformed pre-operative protocols for resectable lung cancer.

Key takeawayAdding immunotherapy before lung cancer surgery dramatically increases the chance of no residual cancer at the time of resection.

2022 — Annual Literature Summary

Benign Esophageal Surgery

Laparoscopic anti-reflux surgery for chronic GERD: systematic review and meta-analysis of 20-year data

Gut — 2022

A comprehensive meta-analysis of 28 studies and over 4,000 patients confirmed that laparoscopic fundoplication achieves durable symptom control in 80–90% of patients at 10 years, with 60–70% remaining off PPIs at long-term follow-up. Reoperation rates were low (5–8%) and quality of life scores significantly exceeded those of patients on continuous medical therapy.

Key takeawayAt 10 years, most surgical patients are still off antacid medication — surgery provides durable relief that pills cannot match.

Laparoscopic giant paraesophageal hernia repair: impact of surgical volume on outcomes

Surgical Endoscopy — 2022

A national database analysis demonstrated a strong inverse relationship between surgeon volume and morbidity in giant paraesophageal hernia repair — high-volume surgeons (>20 cases/year) had significantly lower conversion rates (4% vs. 14%), shorter hospital stays, and fewer major complications. The findings reinforced the importance of referral to experienced centres for complex hernia repair.

Key takeawayFor complex hernia surgery, volume matters — outcomes are dramatically better in high-volume hands.

Esophageal Cancer Surgery

KEYNOTE-590: pembrolizumab + chemotherapy as first-line treatment for esophageal cancer — updated survival data

Annals of Oncology — 2022

Updated analysis of the KEYNOTE-590 trial confirmed that adding pembrolizumab (immunotherapy) to platinum-based chemotherapy significantly improved overall survival in advanced esophageal cancer (median OS 12.4 vs. 9.8 months; HR 0.73). The benefit was most pronounced in PD-L1 CPS ≥10 tumours, shaping the standard of care for patients presenting with unresectable or metastatic disease.

Key takeawayImmunotherapy has become standard in advanced esophageal cancer — understanding PD-L1 status now guides first-line treatment decisions.

FLOT4 trial: 5-year survival outcomes of perioperative FLOT vs. ECF/ECX chemotherapy for gastroesophageal cancer

Lancet Oncology — 2022

Five-year follow-up of the FLOT4 trial confirmed the survival advantage of perioperative FLOT chemotherapy (fluorouracil, leucovorin, oxaliplatin, docetaxel) over ECF/ECX for resectable gastroesophageal junction and gastric adenocarcinoma (5-year OS 45% vs. 36%). FLOT is now the standard perioperative regimen at most high-volume centres.

Key takeawayFLOT chemotherapy before and after surgery improves 5-year survival by 9 percentage points — a meaningful gain in a difficult cancer.

Lung Cancer Surgery

CheckMate 816: neoadjuvant nivolumab + chemotherapy before surgery for resectable NSCLC — primary results

New England Journal of Medicine — 2022

The landmark CheckMate 816 phase III trial demonstrated that adding nivolumab to neoadjuvant chemotherapy before surgery for stage IB–IIIA NSCLC significantly improved pathological complete response (24% vs. 2.2%) and event-free survival (31.6 vs. 20.8 months). The trial established immunotherapy + chemotherapy as the new standard pre-operative regimen for resectable lung cancer.

Key takeawayA landmark trial that changed practice globally: immunotherapy before lung cancer surgery is now standard of care.

Robotic vs. VATS lobectomy for NSCLC: propensity-matched analysis of 8,000+ cases

Journal of Thoracic Oncology — 2022

A propensity-matched analysis of 8,400 patients from a national thoracic surgery database found robotic lobectomy was associated with lower conversion rates to open thoracotomy (2.3% vs. 5.1%), reduced blood transfusion requirements, and shorter length of stay compared to VATS, with equivalent 30-day mortality and oncologic lymph node yield.

Key takeawayAt scale, robotic surgery is safer than VATS for lung resection — half the open conversion rate, less blood loss, shorter stay.

Dr. Kashif Irshad performing thoracic surgery

Patient resources

Everything you need
before and after surgery

Being well-prepared for surgery leads to better outcomes. Below you will find detailed guides for every stage of your journey with Dr. Irshad — from your first consultation through to full recovery.

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New patient information

What to expect at your first consultation, what to bring, and how to prepare for your appointment with Dr. Irshad. Includes a checklist of medications, imaging, and referral documents to bring.

Read guide →

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Pre-operative preparation

Detailed instructions for preparing for your surgery, including which medications to stop and when, fasting requirements, what to arrange at home, and what to pack for hospital.

Read guide →

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Post-operative care

Week-by-week recovery milestones, wound care instructions, activity restrictions, warning signs to watch for, and when to call the clinic or go to emergency.

Read guide →

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Understanding your diagnosis

Plain-language guides to each condition we treat — lung cancer, esophageal cancer, hiatus hernia, achalasia, mediastinal tumors, hyperhidrosis, and pectus excavatum.

View condition guides →

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Video library

Watch Dr. Irshad explain procedures in plain language, including VATS lobectomy, hiatus hernia repair, and hyperhidrosis surgery. Also available: patient stories and surgical demonstrations.

Visit YouTube channel →

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Patient education portal

Access the Osler Thoracic Surgery patient education website for in-depth articles, procedure videos, and condition guides developed by Dr. Irshad’s team.

Visit portal →

New patient guide: your first consultation

What to bring

✓ Your referral letter from your family doctor or specialist
✓ All recent imaging (CT, PET, MRI, chest X-ray) on CD or digital format
✓ Pathology reports and biopsy results if available
✓ A complete list of your current medications (including supplements)
✓ OHIP card and any private insurance information
✓ A trusted family member or support person (recommended)

What to expect

Your initial consultation typically takes 30–45 minutes. Dr. Irshad will review your imaging and pathology in detail, perform a focused clinical assessment, and discuss the surgical options available to you in plain language. There is no pressure to make decisions on the spot — you are welcome to go home, discuss with family, and return with questions.

Questions worth asking at your consultation

◆ What is the best surgical approach for my situation?
◆ Can my surgery be done minimally invasively?
◆ What are the risks specific to my case?
◆ How long will I be in hospital and off work?
◆ What are my options if I choose not to have surgery?
◆ Will I need other specialists (oncologist, cardiologist) involved?

Our commitment to you

Every patient who sees Dr. Irshad receives a thorough, unhurried consultation. Decisions about surgery are made together, with full information and no pressure. You are the most important person in the room.

Pre-operative preparation guide

In the weeks before surgery

◆ Stop smoking immediately. Smoking significantly increases pulmonary complications after thoracic surgery. Even stopping 2–4 weeks before surgery makes a measurable difference.
◆ Blood thinners: Aspirin, Plavix, Coumadin, Xarelto, Eliquis — specific stop dates will be given by Dr. Irshad’s team. Do NOT stop without instruction.
◆ Herbal supplements (fish oil, vitamin E, ginkgo, garlic tablets) should be stopped 1–2 weeks before surgery as they can affect bleeding.
◆ Exercise: Light walking and breathing exercises (pursed-lip breathing, diaphragmatic breathing) in the weeks before major thoracic surgery improve recovery. Ask for a physiotherapy referral if helpful.

The night before and day of surgery

◆ Fasting: Nothing to eat after midnight the night before. Clear fluids (water, apple juice, black coffee) until 2 hours before your scheduled arrival time.
◆ Morning medications: Take only the medications specifically instructed by Dr. Irshad’s team with a small sip of water.
◆ What to wear: Loose, comfortable clothing; no jewelry, nail polish, or contact lenses.
◆ Arrange transport: You will not be able to drive yourself home, even for day surgery. Arrange a trusted adult to take you home and stay with you the first night.
◆ Home setup: For major surgery, prepare a recovery area on the main floor, stock easy-to-prepare foods, and arrange help with childcare, pets, and household tasks for 2–4 weeks.

Post-operative recovery guide

Week-by-week milestones (thoracic surgery)

Hospital (Days 1–3): Pain managed with IV and oral medications; physiotherapy will have you sitting up and walking the same day or the next morning. A chest drain may be in place for 1–2 days.
Week 1: Short walks at home (5–10 min, 3–4 times/day). Fatigue is normal — rest when needed. Avoid lifting anything over 5 lbs. Take pain medication as prescribed; don’t wait for pain to become severe.
Week 2–3: Gradually increase walking. Most patients feel significantly better. Shower normally (pat incisions dry). No driving until off narcotic pain medications.
Week 4–6: Return to light work and most daily activities. Follow-up appointment with Dr. Irshad at 4–6 weeks.
6+ Weeks: Most patients cleared for exercise, driving, and full return to work. Resumption of strenuous activities as advised at follow-up.

When to seek immediate care

Go to Emergency or call 911 if you have:

⚠ Sudden worsening shortness of breath
⚠ Chest pain that is new or different from expected post-op pain
⚠ Fever over 38.5°C (101.3°F)
⚠ Signs of wound infection: redness, warmth, pus, or foul odour at incision
⚠ Coughing up blood
⚠ Swollen or painful leg (possible DVT)

Call our clinic at (905) 458-4520 if you have:

◆ Pain not controlled by your prescribed medications
◆ Nausea preventing you from eating or taking medications
◆ Any question or concern about your recovery
◆ Difficulty understanding any instructions

Procedure-specific recovery guides — print & take home

Hiatus Hernia / Anti-Reflux Laparoscopic Hiatus Hernia & Fundoplication Recovery Guide ⇓ Download PDF Hyperhidrosis / Sweat Surgery Endoscopic Thoracic Sympathectomy (ETS) Recovery Guide ⇓ Download PDF Lung Surgery VATS / Robotic-Assisted Lung Resection Recovery Guide ⇓ Download PDF

Expert ThoracicSurgery Care

Driven by innovation,guided by compassion

Expert surgical careacross thoracic conditions

Lung cancer

Esophageal cancer

Hiatus hernia

Achalasia

Mediastinal tumors

Hyperhidrosis

Pectus excavatum

Weight loss surgery

Lung cancer surgeryVATS & robotic lobectomy & segmentectomy

Understanding your diagnosis

Dr. Irshad’s surgical approach

Esophageal cancer surgeryMinimally invasive esophagectomy — Canada’s first published series

Understanding your diagnosis

Why minimally invasive esophagectomy matters

Hiatus hernia repairLaparoscopic fundoplication & paraesophageal hernia repair

Understanding your diagnosis

Surgical options

Could you benefit from a surgical consultation?

Achalasia treatmentLaparoscopic Heller myotomy — the gold-standard surgical cure

Understanding your diagnosis

Why surgery is often the best option

Mediastinal tumorsMinimally invasive thymectomy & tumor resections

Understanding your diagnosis

The robotic advantage for mediastinal surgery

Hyperhidrosis surgeryEndoscopic Thoracic Sympathectomy (ETS) — OHIP covered, day surgery

Understanding your diagnosis

What about non-surgical microwave treatment?

Travelling to Toronto for ETS?

How would you rate the severity of your sweating?

Pectus excavatumThe Nuss procedure — minimally invasive sunken chest repair

Understanding pectus excavatum

Weight loss surgeryMinimally invasive bariatric surgery

Understanding bariatric surgery

Surgical options

Minimally invasive,maximally precise

Media coverage & recognition

Innovations in minimally invasive lung cancer surgery

Program detects early-stage lung cancer — a patient’s story

Little-known surgery cures excessive sweating

Dr. Luketich visits Brampton Civic Hospital for live surgical demonstration

First Canadian series of minimally invasive esophagectomies published

Osler joins select hospitals offering the Nuss procedure for pectus excavatum

Dr. Irshad Annual Lit Review

Everything you needbefore and after surgery

New patient information

Pre-operative preparation

Post-operative care

Understanding your diagnosis

Video library

Patient education portal

New patient guide: your first consultation

What to bring

What to expect

Questions worth asking at your consultation

Pre-operative preparation guide

In the weeks before surgery

The night before and day of surgery

Post-operative recovery guide

Week-by-week milestones (thoracic surgery)

When to seek immediate care

Procedure-specific recovery guides — print & take home

Clinical decision-makinga guide for referring physicians

When to refer

What to include in your referral

How to refera patient

Contact & clinic information

Thoracic SurgeryReferral Form

Toronto Sweat ClinicReferral Form

Expert Thoracic
Surgery Care

Driven by innovation,
guided by compassion

Expert surgical care
across thoracic conditions

Lung cancer surgery
VATS & robotic lobectomy & segmentectomy

Esophageal cancer surgery
Minimally invasive esophagectomy — Canada’s first published series

Hiatus hernia repair
Laparoscopic fundoplication & paraesophageal hernia repair

Achalasia treatment
Laparoscopic Heller myotomy — the gold-standard surgical cure

Mediastinal tumors
Minimally invasive thymectomy & tumor resections

Hyperhidrosis surgery
Endoscopic Thoracic Sympathectomy (ETS) — OHIP covered, day surgery

Pectus excavatum
The Nuss procedure — minimally invasive sunken chest repair

Weight loss surgery
Minimally invasive bariatric surgery

Minimally invasive,
maximally precise

Everything you need
before and after surgery

Clinical decision-making
a guide for referring physicians

How to refer
a patient

Thoracic Surgery
Referral Form

Toronto Sweat Clinic
Referral Form