In a darkened operating room at Ascension Saint Thomas Hospital in Nashville, something extraordinary happens. As John F. Lazar, MD, peers into a surgical console, the lung tissue on his 3D monitor begins to glow. What was once invisible to the human eye — tiny, early-stage cancer cells — is now illuminated in vivid fluorescent green.
That glow is powered by Cytalux, a first-in-class fluorescent imaging agent that binds to cancer cells and lights them up under a specific wavelength of near-infrared light. For Dr. Lazar, an associate professor of thoracic surgery in the University of Tennessee Health Science Center College of Medicine – Nashville and chief of Thoracic Surgery and Thoracic Oncology at Ascension Saint Thomas, it’s nothing short of revolutionary.
“It completely changes the way we treat lung cancer,” Dr. Lazar said. “With Cytalux, I can find nodules that are just six or seven millimeters — so small that even if I put my hand inside the chest cavity, I wouldn’t be able to feel them. Now they light up like stars.”
Illuminating Cancer, Literally
Cytalux works by targeting folate receptors, proteins that are overexpressed on the surface of many cancer cells. The agent combines a fluorescent dye with a folate analog, a molecule that cancer cells readily absorb. Once administered intravenously before surgery, Cytalux binds to the tumor tissue. Under special near-infrared light on the camera, the malignant tissue fluoresces, helping surgeons distinguish cancerous from healthy tissue in real time.
“It’s like switching on another dimension of vision,” Dr. Lazar said. “In white light, everything looks the same. But in the fluorescence spectrum, the cancer reveals itself. It helps us resect more precisely and preserve more healthy lung.”
Dr. Lazar first became involved with Cytalux while working with a small consortium of elite thoracic surgeons from the Cleveland Clinic, University of Pittsburgh Medical Center, New York University, and St. Barnabas Hospital. Together, they guided early clinical trials for the technology.
“My colleagues were leading some of the pivotal studies,” he said. “When they invited me to join the group, I immediately saw the potential. The ability to make cancer literally visible — it’s the kind of leap forward that doesn’t come along often.”
Dr. Lazar and his team at Ascension Saint Thomas were among the first in Tennessee to use the technology regularly. The University of Tennessee, Knoxville and UT Health Science Center in Memphis had trialed it briefly, but Nashville became the state’s hub for ongoing application once Lazar’s team acquired their own imaging system.
“We recruited Dr. Lazar to Ascension Saint Thomas and UTHSC Nashville to bring the best-in-class science and care to our Middle Tennesseans,” said Brian Wilcox, Jr., MD, associate dean of Clinical Affairs and Graduate Medical Education at the university’s College of Medicine – Nashville. “Dr. Lazar’s innovative vision and surgical excellence is already redefining general thoracic care in our part of the state, which is exciting for patients, the university, and Saint Thomas.”
Dr. Lazar and his collaborators also played a role in advancing Cytalux through the CMS (Centers for Medicare & Medicaid Services) approval process, paving the way for it to be used more widely across surgical specialties.
“Now that it’s commercially available, it’s also being used in gynecologic oncology,” Dr. Lazar noted. “But I think the biggest opportunity is still in thoracic surgery, especially in community hospitals where it can really change outcomes.”
A Fearless Early Adopter
A decade ago, when robotic thoracic surgery was still viewed as investigational, Dr. Lazar became one of the world’s first fellowship-trained thoracic robotic surgeons.
After training under Richard Lazzaro, MD, a pioneer of robotic thoracic techniques at Lenox Hill Hospital in New York, Dr. Lazar helped prove that robotic systems could safely and effectively replace traditional surgery for lung and esophageal cancers.
“I was at the beginning of the wave,” he recalled. “Now robotic surgery is the standard of care in thoracic surgery, but back then, people thought it was futuristic. I had a sense that it had greater potential and where the field was headed.”
“Dr. Lazar shows what’s possible when great clinicians lean into research and bring that discovery right back to their patients. This is exactly the kind of work that strengthens care across Tennessee.”
Dr. Michael Hocker, Executive Dean of UT Health Science Center’s College of Medicine
That same spirit of curiosity led Lazar to tackle tracheobronchial malacia (TBM), a rare condition that causes the airway to collapse during breathing. Working alongside his mentor in New York, he assisted in the first robotic repair of TBM in the world, a procedure that now offers life-changing relief to patients who once lived with constant infections and breathlessness.
When he arrived in Nashville, Dr. Lazar performed the first robotic TBM repair in Tennessee.
Advancing the Academic Mission in Nashville
Dr. Lazar’s work at Ascension Saint Thomas also represents something larger: UT Health Science Center’s expanding academic and research presence in Middle Tennessee.
“I came from Georgetown, where academics were always front and center,” he said. “When I came to Nashville, staying affiliated with a university was nonnegotiable. Being part of UT Health Science Center allows me to mentor residents, collaborate on research, and keep pushing innovation forward.”
He now works with general surgery residents and medical students in UT Health Science Center’s Nashville program and is helping build stronger bridges between the university’s thoracic surgery divisions in Knoxville, Memphis, and Chattanooga. His goal is a statewide network for research and robotic training, enabling seamless collaboration on both clinical trials and surgical education.
“Dr. Lazar shows what’s possible when great clinicians lean into research and bring that discovery right back to their patients,” said Michael Hocker, MD, executive dean of UT Health Science Center’s College of Medicine. “This is exactly the kind of work that strengthens care across Tennessee.”
Dr. Lazar’s current research focuses on developing objective performance indices (OPIs), data-driven metrics that analyze robotic movements to quantify surgical skill. By correlating motion data with patient outcomes, he hopes to redefine how surgeons are trained and evaluated nationwide.
“The idea is to give precise, objective feedback instead of vague advice,” he explained. “We can literally measure how smooth or efficient your movements are and tell you exactly where to improve.”
A Statewide Vision for Cancer Care
For Dr. Lazar, the technological breakthroughs are always secondary to what they mean for patients, and for Tennessee’s future.
“People in Nashville already know that St. Thomas and UT Health Science Center have the best outcomes in cardiac surgery,” he said. “I want them to know the same is true for thoracic and cancer care, that we’re on the cutting edge, doing clinical trials, and giving people their lives back.
As UT Health Sciences continues to lead the Tennessee Statewide Cancer Collaborative, Dr. Lazar’s work is a vivid example of how the university’s partnerships are translating research into real-world impact, from Knoxville to Memphis to Nashville.
“Dr. Lazar’s work is an exemplar of the kind of cutting-edge care patients receive when we ensure that research and discovery go with us everywhere we go as UT Health Sciences,” said Jessica Snowden, MD, vice chancellor for Research at UT Health Sciences and organizer of the recent Tennessee Statewide Cancer Collaborative scientific meeting.
She said part of their work going forward with the Tennessee Statewide Cancer Collaborative is ensuring patients everywhere in the state have access to the same kind of life-changing care.
“We’re trying to give patients not just longer lives, but better ones,” Dr. Lazar said. “Every time that cancer lights up under the robot, that’s what I see, a chance to give someone their future back.”