In Part 4 of his report, ESCP Japan Travelling Fellow Fraser Smith is impressed by his Japanese colleagues' laparoscopic skills, and takes some time to reflect in beautiful surrounds.
After a long weekend of tourism and culture, it was back to business again on Monday! I got up early and met Professor Sakai at Kyoto University Hospital, a world-renowned professor of GI surgery and surgical author. He had lined up an anterior resection as he knew that I had an interest in rectal cancer. It was quite funny actually as he did it masterfully in less than two hours! It was also really great as he was trialling a 3-D laparoscopic stack - something I had never experienced before. Also, he used intraoperative perfusion assessment of the proximal limb for the anastomosis which again is something that I have never seen before.
After this brief but very interesting learning experience it was nearly midday so Professor Sakai very kindly offered to take me for lunch. We had some really delicious food and a great chat about rectal cancer, organ preservation/watch and wait and transanal TME, of which he has the biggest experience in Japan. To top it off he gave me a dedicated, signed copy of his latest textbook on laparoscopic colorectal surgery. Wonderful!
As he had no more cases he suggested that I spend the afternoon looking around Kyoto. I went to a beautiful park near Gion and for the first time since I arrived I felt no pressure to see/do anything. It was a sunny, crisp afternoon and I found a bench beside a beautiful lake full of Koi carp surrounded by Japanese gardens. Again, the scene was enhanced by people in kimonos and there was even a man playing a sort of Japanese flute/panpipe. It was perfection so basically I just sat there for about an hour reflecting on what I had seen, what I was looking at presently and how fortunate I was to be have been chosen for this fellowship. After that I went back to the hotel to work on some talks and had an early night in preparation for my trip to Osaka the following morning.
Tuesday and I got a bullet train at around 7:30 am to Osaka. I had to be early as my host, Dr Uemura had lined up a laparoscopic pelvic exenteration for an upper rectal cancer invading the uterus and bladder starting early. I arrived just as the patient was going to sleep and then watched, jaw dropped, for nine hours (with a short lunch break) as he performed a totally laparoscopic complete anterior pelvic exenteration (cystectomy, partial vaginectomy), bilateral lateral lymph node dissection, anterior resection and ileal conduit. His laparoscopic skills were really mind blowing. I also had the opportunity to chat to Dr Seikimoto who was Dr Uemura’s senior colleague who was a true laparoscopic pioneer in Japan himself and was a driving force in advancing the laparoscopic skills of younger Japanese surgeons. This was a really fantastic day, but a long day, and so I returned to my hotel with just a quick dinner and had an early night.
