ESCP offered seven opportunities in 2016-2017 - two observerships, four 3-month fellowships and one 6-month fellowship. Fellows report here on their experiences.
Click on a fellow's name to read their report
| Name | Country | Host Center | Fellowship Type | Dates |
|---|---|---|---|---|
| Alexander Forero | Spain | St James's University Hospital, Leeds, UK | 3-week Observership | February - March 2017 |
| Goran Šantak | Croatia | Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands | 4-week Observership | April - May 2017 |
| Manol Sokolov | Bulgaria | Maastricht University Medical Center, Maastricht, The Netherlands | 3-month Fellowship | January - March 2017 |
| Mostafa Mohamed Shalaby | Egypt | Policlinico Rome Tor Vergata Hospital, Italy | 3-month Fellowship | November 2016 - January 2017 |
| Fung Joon Foo | Singapore | Beaujon Hospital, Paris, France | 3-month Fellowship | January - March 2017 |
| Olatunbosun Ayokunle Oke | South Africa | Leicester General Hospital, UK | 3-month Fellowship | February - April 2017 |
| Esmira Ahmedova | Azerbaijan | Barts Health NHS Trust, London, UK | 6-month Fellowship | July 2017 - January 2018 |
Alexander Forero
From: Hospital Universitario del Sureste, Madrid, Spain
Visited: St James's University Hospital under the direction of Professor David Jayne
I had the privilege to receive an observership funded by the ESCP and I would like to express my gratitude to the ESCP for the opportunity to visit St James's University Hospital under the direction of Professor David Jayne.
I spent three weeks in the John Goligher Colorectal Unit at the St James's University Hospital, Leeds, UK. This colorectal unit is a high-volume referral centre that manages routine colorectal cancers, complex pelvic floor disorders, inflammatory bowel disease, and other related pathologies. I was particularly interested in pelvic floor disorders, and proctologic procedures, and my knowledge in the field has broadened.
From day one, I was introduced to all staff, including the theatre personal. The whole team was friendly and helpful, I took part in surgical activities. During my first week, I had the opportunity to observe the laparoscopic approach of colorectal cancers, TAMIS and recurrent rectal cancer procedures. I also participated in Professor David Jayne's clinic.
During my second week, I participated in the MDT Meeting where I assisted highly qualified consultants during the case discussions. I observed laparoscopic APR with sacrum- exeresis, and the management of rectovaginal fistulas. I also attended a robotic assisted surgery for a ventral mesh rectopexy and I had the opportunity to work on simulations in the da Vinci System for robotic surgery, supervised by my mentor.
In my last week, I assisted at the pelvic floor meeting in which I could attest the meticulous discussion of difficult cases and learn the management of different pelvic floor disorders. I visited the GI Physiology Unit, and observed several SNS (Sacral Nerve Stimulations), apart from some laparoscopic ventral mesh rectopexies and a Krukenberg tumor resection.
I am deeply grateful to the ESCP, and to Professor David Jayne and his entire team at the John Goligher Colorectal Unit for this great opportunity that has exponentially improved my surgical knowledge. All experience will be very useful to me on a daily basis and it will expand my skills on how to deal with complex scenarios. I am looking forward to visiting the unit again in the near future.
Goran Šantak
From: County Hospital Požega, Croatia
Visited: Elisabeth-TweeSteden Ziekenhuis, Netherlands under the direction of Dr David Zimmerman
It was my great honour to receive a four-week ESCP observership at Elisabeth-TweeSteden Ziekenhuis in Tilburg, The Netherlands.
I spent four weeks in April and May 2017 at the Department of Abdominal Surgery in Tilburg hosted by Dr David Zimmerman and his team. I chose their department because of the high frequency of the minimally invasive colorectal operations. During my observership I was involved in various laparoscopic and proctological operating procedures in perfectly equipped operating rooms as well as interesting discussions at the multidisciplinary meetings and outpatient’s clinic. I also had the privilege to visit great hospitals in Eindhoven and 's-Hertogenbosch where T4 and metastatic colorectal cancers are treated.
I was impressed how well run and organised are the units I have visited in the Netherlands. In all hospitals patients are treated with an exceptionally high standard of care. The procedures are done according to the strict national algorithms and are based on the multidisciplinary and evidence-based approach.
This fellowship along with the knowledge and experience I gained, will be of great benefit to me and my patients.
I really enjoyed the time I spent in the Netherlands and I would like to thank ESCP for this opportunity as well as every member of Tilburg GI surgery unit for making my stay pleasant.
Manol Sokolov, PhD
From: Medical University of Sofia, Sofia, Bulgaria
Visited: Maastricht University Medical Center in Maastricht, The Netherlands under the direction of Professor Laurents Stassen
I had the great pleasure of receiving a three-month fellowship at the coloproctological unit of the Maastricht University Medical Center (MUMC +) in Maastricht, The Netherlands from January to March 2017. I was warmly welcomed by Professor Laurents Stassen, who introduced me to the entire surgical team and immediately immersed me into the busy schedule of the surgical department. I came to an extremely well-appointed, beautiful, and highly organised university hospital. This hospital is a tertiary reference center for a wide range of surgical diseases, specialising in coloproctology. I was very impressed by the remarkable academic spirit, in both the scientific aspect of the work and the daily practical surgical activity. From the very first day I was involved in a laparoscopic surgery for rectal cancer. I actively took part in numerous open and laparoscopic colorectal interventions including surgery for metastatic colorectal cancer. The varied surgical activity and laparoscopic focus of the coloproctological team fulfilled my clinical interest and my expectations.
I was fortunate to observe several robotic resections of the rectum and sigmoid colon, observing the perfect surgical technique of my mentors. The use of fluorescent angiography to evaluate the perfusion of anastomotic intestinal segments as well as plastic methods for the recovery of large tissue defects after multivisceral resections were among the other new and useful surgical tricks I observed. There were numerous interesting scientific discussions on different clinical cases during the daily morning meetings, weekly MDTs as well as intra-operative discussions with my colleagues and mentors. I was guided and helped by my mentors - Prof. L.P.S. Stassen, Dr Jarno Melenhorst and Dr Stephanie Breukink in conducting research on 'Quality of Life in Surgery of Locally Advantageous Colorectal Cancer', which is still ongoing and I hope to finish with a quality publication. During my stay, an extension of the surgical complex was completed. This included the opening of 20 new operating rooms, which were fitted with state-of-the-art devices and equipment. The Medical Centre now has an impressive 46 operating rooms. Furthermore, I was able to participate in many other operations in the field of general surgery, hepato-pancreato- billiary and urgent surgery, soft-tissue tumours and retroperitoneal large tumours and breast cancer. Through a number of interesting clinical cases requiring immense resources and clinical experience, I observed a high academic and professional level of work in the endoscopic sector and by interventional radiology specialists.
I received a warm and friendly welcoming from my colleagues and I was very fortunate to receive support from the administrative and service staff throughout my stay.
Maastricht is an incredibly beautiful city with a remarkable river, pleasant parks, beautiful buildings, clean streets and warm winter. And the Netherlands itself is a unique place with countless sights that everyone should visit.
I would like to express my extreme gratitude to the ESCP for the great opportunity to complete my fellowship with genuine erudite surgeons in an excellent coloproctological center.
Mostafa Mohamed Shalaby, MD, MSc, PhD
From: Mansoura University Hospital, Egypt
Visited: Policlinico Rome Tor Vergata Hospital, Italy under the direction of Professor Pierpaolo Sileri
It was an honor to be selected for the three-month fellowship from the European Society of Coloproctology from 1 November 2016 to 31 January 2017. It was a unique opportunity to get acquainted with advanced colorectal surgery, especially minimally invasive approach in Italy.
Policlinico Rome Tor Vergata hospital is one of the most modern university hospitals not only in Italy but also in other European countries. The Policlinico Rome Tor Vergata has multiple agreements with other European universities like Oxford University in the UK, and a further six national hospitals in Rome forming a strong surgical training program for residences and fellows.
The colorectal unit in Tor Vergata University is a high volume, academically orientated tertiary referral unit with an extensive experience in the treatment of inflammatory bowel diseases, functional disorders, and colorectal cancer. Furthermore, the unit ranks among one of the most experienced places in the treatment of deep pelvic endometriosis in Italy. It is run by Professor Pierpaolo Sileri and performs approximately 1300 major colorectal procedures per year, most of them laparoscopically. Minimally invasive surgery was an everyday practice; the surgeons were very skilled in these techniques, laparoscopic and trans-anal procedures.
I directly took part in all elective colorectal surgical activity at the operating theater, for oncological colorectal pathology, inflammatory bowel diseases, functional disorders, and benign anorectal pathology. I assisted with open and laparoscopic colorectal resections, TME down to up, colpo- sacro-rectopexy. I was operating as the principal surgeon for proctology interventions like haemorrhoidectomy with LigaSure, Longo haemorrhoidopexy, anal fissure surgery, EPSiT technique for pilonidal sinus, STARR with PPH or TRANSTARR. I performed surgery for complex and recurrent fistula including pioneering autologous mesenchymal cells transplantation, LIFT, VAAFT and anal paste or plug.
During my fellowship, I was involved in the management of patients with deep pelvic endometriosis, as a part of the multidisciplinary team involving colorectal and
gynecological surgeons. I also had the opportunity to participate in emergency surgical procedures such as colorectal resection for obstructed colorectal cancers.
Apart from the great ''hands on experience'' during my fellowship, I also had a great opportunity to expand my academic skills. I was very honored to collaborate with multiple research projects. Some of them were presented in the DDW 2017, ESCP 2017, or will be presented in SICCR 2017, others are awaiting publication.
In summary, this fellowship is an exceptional addition to my surgical training and it definitely influenced and boosted my own practice. I think this fellowship has broadened my knowledge in the field of colorectal surgery. The experience I gained helps me in my daily practice now.
Fung Joon Foo
From: Department of Colorectal Surgery, Singapore General Hospital, Singapore
Visited: Beaujon Hospital under the direction of Professor Yves Panis
I had the opportunity to spend time with Professor Yves Panis at Beaujon Hospital in Paris, for a three-month fellowship in inflammatory bowel disease (IBD). Modern lifestyle and changes in diet have dramatically increased the incidence of IBD in many Asian countries including Singapore, where the IBD expertise has been limited in comparison to European centres. I wanted to gain more exposure to complex IBD in order to provide a tertiary referral service at my institution.
Under the leadership of Professor Panis, the department is a colorectal surgery unit which receives referrals from the local catchment area as well as tertiary referrals from other centres in France. The main remit of the unit is IBD and colorectal cancer. The IBD service handles routine IBD work as well as complex and redo IBD cases, usually sent from other hospitals. In addition, it provides subspecialist services for intestinal failure and salvage colorectal surgery. It has a lower general surgical or emergency workload, which allows focus on complex elective cases, thereby concentrating the experience of this subspecialist referral centre.
The colorectal unit itself occupies a whole hospital floor and is staffed by hospital allied professions including specialist nurses, a psychologist and stoma therapists. It is well supported by a rare/complex gastrointestinal diseases unit and an inherently important nutrition service. Complimenting this colorectal unit are an excellent gastroenterology and small bowel transplant unit.
Every morning starts with a staff meeting where the progress of all the current inpatients is discussed. There are between two to three colorectal theatres running each day to cater for the high work load of the unit. A ward round of all the unit’s patients occurs every late evening. Each week there is a multi-disciplinary meeting where cases are discussed. There is also a pre-operative meeting where the following weeks operations are meticulously planned.
Despite a very busy schedule and heavy workload, the daily morning coffee and lunch break are sacred customs, attended by all, thereby encouraging good camaraderie. In addition, an apéro session one evening a week in the office of the Assistant Professor, Dr Magiori.
I took away from this unit numerous nuggets of wisdom from the technical operative perspective, decision making and service/unit setup. I learned the finer points of laparoscopic resection done through a very reproducible, consistent and safe method. In addition, transanal approaches to surgery including intersphincteric resection, TEMs and reverse TME. Prof Panis shares all his tips and tricks for IBD surgery including non-conventional stricturoplasty technique, MIS IBD surgery, complex proctology, rectovaginal fistula surgery and pouch reconstruction. There were techniques I had heard off but never seen including the Baulieu procedure for salvage surgery and segmental ileal reversal for intestinal failure. I observed complex and evidenced based IBD decision making and a setup of an IBD unit which clearly works very well. While on fellowship, there was further educational opportunity as we attended the ECCO congress and a regional colorectal masterclass hosted in Beaujon.
On my return to Singapore, I have managed to replicate some of the techniques learned in my MIS work and now lead for the IBD surgical work in my unit. The fellowship is perfect for those already involved in IBD work, seeking to advance their experience. It provides a very concentrated learning experience in a short span of time. I am thankful to ESCP and my host institution for this invaluable opportunity.
Dr Olatunbosun Ayokunle Oke
From: Groote Schuur Hospital, Cape Town, South Africa
Visited: Leicester General Hospital, UK under the direction of Mr Sanjay Chaudhri
I am grateful to the ESCP for selecting me to spend three months at the Leicester General Hospital in the United Kingdom from February to April 2017 under the supervision of Mr Sanjay Chaudhri.
My goal was to increase exposure to laparoscopic colorectal resections and pelvic floor procedures. I am glad I was matched to the right unit! The unit at LGH is staffed by six consultant colorectal surgeons, their trainees and a strong nursing support staff. Together with the colorectal unit at the Leicester Royal Infirmary, they constitute a high-volume center for laparoscopic and robotic colorectal resections.
I attended most of these cases and assisted in a significant number, seeing a marked improvement in my camerawork and laparoscopic decision-making. I learnt the technique of prophylactic mesh reinforcement of the perineal wound after an extralevator abdominoperineal excision of the rectum (ELAPE). I also observed trans-anal TME performed by Messrs. Chaudhri and Singh, and several trans-anal endoscopic resections (TEOs) by Mr Adam Scott. I learnt new techniques of managing ventral hernias. I was also able to spend time on the Lapco Simulator, which I found to be very useful in the practice of the basic steps of laparoscopic colorectal resections. I attended the multidisciplinary meetings in inflammatory bowel disease (IBD) and colorectal cancer (CRC), where I could appreciate the utility of small bowel ultrasound in triaging IBD patients, and CT colonography in CRC screening. I participated in many academic activities in the unit, including journal club meetings and attended the annual UK Update on Gastrointestinal Diseases in London in April. I conducted an audit of the outcomes of perineal wound healing in ELAPE with or without mesh reinforcement, which should be ready for publication soon.
The Leicester social scene is a very colourful one and I attended several cultural and sporting events. I also travelled to the cities of London, Warwick, Birmingham and Leeds and Bradford, taking in the beautiful sights and attractions.
I want to express my profound gratitude to the consultants, Messrs. Scott, Thomas, Jameson, Chaudhri, Singh and Sangal for going out of their way to make my stay a comfortable and rewarding one. Ms. Cunha, Messrs. Poulson and Varadahn were the registrars in the unit and were very accommodating to me. Thank you ESCP!
Esmira Ahmedova
From: Azerbaijan Medical University
Visited: Barts Health NHS Trust, London, under the supervision of Mr Giordano Pasquale
It was a great honour to be selected for a six-month fellowship by the European Society of Coloproctology. The host hospital was Barts Health NHS Trust London UK under the supervision of Mr Giordano Pasquale. The reason I applied for this fellowship was to improve my skills and to study more in the area of pelvic floor surgery.
During my six months in London I worked in the Colorectal Surgery Department of Whipps Cross University Hospital and Royal London Hospital. From the first day Mr Giordano was very friendly and easily communicable, so there were no difficulties on my side. He assisted me in securing a contract with Barts Health NHS Trust and after this I was allowed to scrub the surgical operations and examine patients.
Even before receiving my fellowship I spent my time usefully, studying all anal physiology investigations: anal manometry, endoanal ultrasonography and proctography. After receiving the fellowship, I made investigations at the anal physiology department of Royal London Hospital with its staff. All of the doctors in this department and their very kind nurses try to do the best for me. So I would have my weekly work plan during 6-month period. I spent some days in the theatre with Mr Giordano, one day per week I was present for operations with gynaecological doctors and on other days I saw patients in clinics or completed endoanal physiology examinations.
Mr Giordano is an excellent specialist in colorectal surgery and pelvic floor surgery. This was very useful for me. I got to practice a THD operation for hemorrhoidal disease. I was lucky, because he performs this operation very often. There was a training course for THD provided by him and I participated. I also participated in operations for anal fistula, anal fissure, rectal prolapse, including laparoscopic mesh rectopexies.
We saw a lot of patients with pelvic floor prolapse and defecatory disorders. First, we examined these patients at the clinic. Then I performed all anal physiology tests and as the last step - took part with the management (conservative or surgical). According to the long-term course I can follow patients during this time. In the mean time I had an opportunity to take part in operations for repair of rectocele, cystosele and genital prolapse. This was very useful for improving my skills and acquiring new techniques in this area. During my fellowship there was a congress in London - Dilemmas and Debates in Colorectal Surgery. With great pleasure and enthusiasm, I attended this very interesting and well-organised meeting. The last day of the congress was different workshops. I took part in the pelvic floor assessment workshop.
Finally, I want to thank the Educational Committee and its Chair, Professor Klaus Matzel for giving me this opportunity. Many thanks to Vanessa Wise for organising my fellowship so well and offering assistance when I needed it.