ESCP offered 12 opportunities in 2017-2018 - five 3-month fellowships, three 6-month fellowship (including one robotic) and four observerships. Fellows report here on their experiences.
Click on a fellow's name to read their report
| Name | Country | Host Centre | Fellowship Type | Dates |
|---|---|---|---|---|
| Gabie de Jong* | The Netherlands |
St Marks Hospital, London, UK |
3-Months | Feb - Apr 2018 |
| Frank McDermott* | UK |
Bellvitge University Hospital, Barcelona, Spain |
3-Months | Apr - June 2018 |
| Milica Nestorovic | Serbia | Medical University of Vienna, Austria | 3-Months | June - Sept 2018 |
| Giuseppe Portale | Italy | Bordeaux University Hospital, France | 3-Months | Jan - Mar 2018 |
| Qamar Hafeez Kiani | Pakistan | Geneva University Hospital, Switzerland | 3-Months | Jan - Apr 2018 |
| Francesco Pata | Italy | Hospital del Mar, Barcelona, Spain | 6-Months | Apr - Sept 2018 |
| Mohammad Reza Keramati | Iran | Barts Health NHS Trust - Whipps Cross University Hospital, London, UK | 6-Months | Feb - Aug 2018 |
| Marco Vito Marino | Italy | Hospital Universitario Marques de Valdecilla, Santander, Spain | 6-Months Robotic |
Oct 2018 - Apr 2019 |
| Anvar Makhmudov | Russia | Leeds Teaching Hospital NHS Trust, UK | Observership | July 2018 |
| Lisa Massey | UK | Hôpital St. Antoine, Paris, France | Observership | Jan 2018 |
| Cosimo Riccardo Scarpa | Italy | Bordeaux University Hospital, France | Observership | Oct 2017 |
| Armen Vardanyan | Russia | Beaujon Hospital, France | Observership | Nov 2017 |
*Fellowship sponsored by Medtronic
Gabie de Jong
From: Department of Surgery, Rijnstate Hospital Arnhem and Amsterdam UMC, The Netherlands
Visited: St. Mark's hospital (London, UK) under the direction of Professor Sue Clark and Miss Carolynne Vaizey
From February until April 2018 I have had the privilege to visit the outstanding St. Mark's Hospital in London, UK as an ESCP fellow. In this small section I would like to express my warm gratitude to all consultant surgeons, fellows, nurses, supportive staff and the ESCP community for a wonderful and extremely valuable experience. In return, I have studied the origin of the St. Mark's retractor and hope to publish the article soon. Hopefully, this little piece of historic knowledge will be enjoyable to read for everyone involved in colorectal surgery.
The St Mark’s retractor is an instrument essential in open pelvic surgery. Although the instrument is internationally known as 'St Mark's retractor', the origin and its creator are unknown. In the article, the authors aim to discover the origin of this useful instrument in order to appreciate its historic value and acknowledge its developer. Via literature search, through archives, musea, movies and personal correspondence several leads were traced. First the name 'St Mark's' was explored. Next, the evolution of handheld retractors is discussed. Finally, the development of (abdomino-perineal) rectum resections was studied, leading to research on manufacturers of instruments for St Mark's Hospital. In the epilogue, the authors acknowledge the likely developer of this crucial instrument.
Fellowship sponsored by Medtronic
Frank McDermott
From: Royal Devon & Exeter Hospital, UK
Visited: Bellvitge University Hospital, Barcelona (Spain), under the direction of Professor Sebastiano Biondo
I had the privilege of being selected to spend 3 months as travelling fellow under the supervision of Professor Sebastiano Biondo from April to June 2018 at Bellvitge University Hospital. Having completed my coloproctology surgical training in the United Kingdom in 2017, I was keen to complete some specialist fellowships in international centres before taking up my post as a Consultant Surgeon in Exeter. I had previously referenced Sebastiano’s work many times in previous papers and read some of the excellent research that he and his colleagues have published over the years. I was therefore delighted to have the opportunity to spend 3 months working as a fellow in this unit.
Bellvitge University hospital is located in the city of Hospitalet de Llobregat in the greater metropolitan area of Barcelona. I chose to live in the city centre near Placa de Catalunya which was a short 15-minute metro ride to the hospital each morning. Bellvitge is a tertiary referral centre catering for a large population locally of over 300,000 and specialist services to a population of 2 million south of the city.
The benefit of working in international centres is being exposed to different healthcare systems. Bellvitge's structure has Professor Biondo as Chief of Surgery and Dr Esther Kreissler as Chief of coloproctology with a further 6 colorectal specialists: Dr Javier De Oca, Thomas Golda, Riccardo Frago, Domenico Fraccalvieri, Loris Trenti and Ana Galvez. In addition, there were several residents going through their surgical training.
What struck me immediately and throughout the 3-month period was the discipline of the unit and structure. There was a daily ward meeting with all team members and nursing representation to discuss all surgical patients and the operations for the day at 8am. Every Tuesday was morbidity and mortality for the entire surgical department. Every resident presented the activity for the previous week including M&M with more ‘interesting’ cases discussed in more depth with the evidence base. Every Thursday morning was residents teaching again attended by all the surgical departments including specialists.
The other thing I had to get used to was wearing a white coat again. I have not worn a white coat since being a house officer in 2004, but this is completely normal in Bellvitge. Following the ward meeting, I spent most days in theatre not only as that’s the place I most enjoy being but also sadly my Spanish is mostly reserved to being able to order a cerveza, and therefore ward rounds were a bit of a struggle. Thankfully between my pigeon Spanish and my hosts excellent English I understand most things being said. Also, due to the Latin derivations of most of our medical language a sigmoidectomy is a sigmoidectomie in Spanish. As for the Catalan language that will unfortunately forever remain a mystery to me.
There was theatre everyday with an excellent variety of coloproctology with an emphasis on colorectal cancers due to the understandable pressures on expediting these cases. Most of the cases were laparoscopic and I scrubbed and assisted many laparoscopic low anterior resections with splenic flexure mobilisations and other colonic resections. In addition, Drs Kreissler and Golda perform robotic cases using the Da Vinci Xi system which was good to see as there a limited amount of high volume robotic colorectal programmes in the UK. However, they do have the same struggles as other centres competing with our urology and gynaecology colleagues for time on the robot! I also spent time in the new hospital built adjacent to the old hospital with its 3 towers that impose themselves on the skyline. Currently only day surgery is performed there in purpose- built state of the art theatres. Being a university hospital with forward thinking surgeons the unit is involved with many studies and new techniques including the use of autologous fat transplantation for perineal defects. Other procedures included combined endoscopic laparoscopic surgery (CELS) for large polyps.
I have a specialist interest in advanced disease and have been active member of the PelvEx Collaborative which held its first meeting in June 2018 in Dublin and now Bellvitge will be joining. During my training, I have only seen ileal conduits used for urinary diversion so it was really interesting to see an alternative technique being used: the wet colostomy. This is a different technique from the original wet colostomy described that fell out of favour. This uses a loop colostomy where the 2 ureters are anastomosed to the distal component of the loop colostomy. The Spanish local population culturally are stoma averse and much prefer the option of having one stoma over two. This is the standard technique for urinary diversion in Bellvitge and the report good outcomes and patient satisfaction. The other procedure that I have not seen being performed before is the Turnbull-Cutait procedure for colo-anal anastomoses and Bellvitge is currently enrolled in a multi-centre international RCT for this procedure.
Some of the variations I witnessed in Bellvitge compared to my own practice in the UK was the use of stomas bridges, on-lay meshes for all laparotomies (including some emergency cases) and additional 2-0 sutures to circular stapled end-end anastomoses following anterior resection. I really enjoyed and appreciated the many conversations and debates I had with my Spanish colleagues and all things that we do the same and those that we do differently. For me this 3-month period gave me the opportunity not only to make new friends and see quality high volume surgery but also to have debate with colleagues who have had different experiences from my own. Being a surgeon who is half Irish and half Belgian living in England I thoroughly enjoyed my time with the colorectal department that boasts 1 German, 1 Peruvian, 3 Italian and 3 Spanish surgeons; truly an international team.
Professor Biondo and the colorectal team are involved with the running of many courses for international delegates and I was fortunate enough to help in the running of a THD course for surgeons from United Arab of Emirates. This was a 2-day course with lectures and live operating on 5 patients. I also helped deliver an excellent course on fistula management utilising laying open, seton placement, fistula plug and LIFT procedures to give the course delegates a wide variation of some of the techniques that are available.
During my 3 months, I was invited to deliver 2 lectures on surgical topics of my choosing. I chose to talk about 2 areas that I have been involved with recently. The first was on genomics and its relevance to surgeons. I am just completing a Masters in Genomic Medicine from University of Exeter which was part of my role in the UK 100,000 genome project. My research concerns rectal cancer epigenetics and I delivered a talk on the background to genomics, the 100,000-genome project and my own research. I have to say I was concerned how this topic would go down to a mixed audience of general surgical specialist and trainees but was pleasantly surprised at how it was received. My second talk was based around the recent ACPGBI parastomal hernia guidelines that I have written with several colleagues soon to be published in Colorectal Disease.
Bellvitge is a university hospital and the University of Barcelona is based adjacent to the hospital allowing for close collaboration with the clinicians in the surgical department. During my three-month period in Spain I joined in with the other academic activity such as randomising patients for RCTs, meeting with university colleagues and was able to contribute to a paper on stage 2 colorectal cancer.
Towards the end of my stay I was invited to a presentation in Hospital del Mar by Professor Miguel Pera to listen to a talk by Alvaro Garcia-Granero. This was an excellent presentation on the work they are doing with cadaveric dissection to improve surgical technique for example in complete mesocolic excisions and perianal fistula/ sepsis anatomy. Miguel took me out for a lovely lunch and very much enjoyed his hospitality and discussions about surgical academia.
This was a very productive fellowship, and I must thank my lovely hosts especially Sebastiano and Esther who made me feel so welcome into their department. I really felt part of the team and my hosts took me out for several dinners during my stay to sample the excellent Spanish cuisine and hospitality. I also got to explore a wonderful and vibrant city. During my stay, I was able to scrub for over 60 varied coloproctology procedures including open, minimally invasive, benign proctology and advanced disease. In the spirit of international collaboration, I am delighted that one of the Spanish residents will spending a fellowship with me and my colorectal colleagues next year. I would like to thank ESCP for this wonderful opportunity and wholeheartedly recommend this wonderful institution. I have made some collaborators and friends for life!
Download this report with photos here (PDF 5.3MB)
Fellowship sponsored by Medtronic
Giuseppe Portale
From: Hospital of Cittadella, Padova, Italy
Visited: Unité de Chirurgie Colorectale, Hôspital Haut-Lévêque, Universitè de Bordeaux (France), under the direction of Professor Eric Rullier
I had the great pleasure of being awarded a three-month ESCP fellowship (January-March 2018) at the Department of Colorectal Surgery, Haut-Lévêque Hospital in Pessac, Bordeaux, under the direction of Professor Rullier. I decided to choose this unit because it is a very high-volume center for all types of colorectal diseases, from colorectal cancer to inflammatory bowel disease to pelvic floor disorders. They perform over 600 major colorectal operations/year, mostly with minimally-invasive techniques, as referral center for the Aquitania region and the south of France, with several patients coming also from abroad. I realized that the great results they have achieved in the last 20 years are due to an excellent 'team work' with all the assistants and residents involved in the surgical activities. In fact, there are two to three operating rooms running every day to cope with the high workload of this surgical unit.
During my three-month fellowship I was involved in several laparoscopic procedures, including complex ones (as ta-TME, pelvectomy, etc) or assisted plastic reconstructions after multivisceral pelvic resections. I took part, as well, to interesting multidisciplinary meetings (colorectal cancer, IBD, pelvic floor, etc.) and outpatients' clinic. I really appreciated the great attention in explaining me each operation, from the general principles in complex cases to the finest technical details and surgical tricks. During three-month fellowship I enjoyed the two-day Workshop in January (once/month) and the one-week Masterclass in March (twice/year) with live surgery of very complex colorectal cases and lots of interactive sessions which involved all the participant surgeons.
Once again, I am grateful to the ESCP, Professor Rullier and his entire team for this great opportunity to improve my knowledge in the management of colorectal patients. I am sure the experience I gained in Bordeaux will be of profit for my patients in Italy. As I told the team the last day, just before leaving, if I had to summarize my experience at Haut-Lévêque I would say this has been an 'everyday' Masterclass with top level not only in the surgical theatre with 'hands-on' training but in every aspect of colorectal patients' management! Thanks again for letting me be part of your excellent team.
Mohammad Reza Keramati
From: Tehran University of Medical Sciences, Tehran, Iran
Visited: Barts Health NHS Trust (the Royal London Hospital and Whipps Cross University Hospital), London, UK, under the direction of Mr Pasquale Giordano
It was my great honor and pleasure to be a recipient of ESCP fellowship grant this year. I had the privilege to do my hands-on clinical fellowship in the field of colorectal surgery at Barts Health NHS Trust hospitals, the Royal London Hospital and Whipps Cross University Hospital.
The colorectal units in these hospitals are high-volume referral centres providing a full range of colorectal services including colorectal cancer, perianal diseases, inflammatory bowel diseases, functional bowel, and pelvic floor disorders. These colorectal departments have a well-established laparoscopic colorectal service as well. During my fellowship, I had the chance to directly take part and attend a large number of advanced laparoscopic and open surgical operations for benign and malignant colorectal problems and complex pelvic floor disorders. In addition to an experienced scientific and academic team, the anorectal physiology unit at the Royal London Hospital is a very well-equipped unit with high-resolution manometry, 3D endoanal ultrasound, colonic transition study, and dynamic defecography. It allowed me to learn and perform all these diagnostic tests for the patients as well. Multi-disciplinary team (MDT) meetings for colorectal cancers and colorectal pelvic floor diseases also gave me the time to learn proper management and decision-making for complicated colon and rectal cancers, functional bowel, and pelvic floor problems.
In general, this clinical fellowship provided me with an excellent opportunity to improve my surgical skills and clinical knowledge in colorectal surgery. I am very grateful to ESCP for affording me this clinical fellowship opportunity. I also would like to express my sincere gratitude to Mr Pasquale Giordano (Consultant Colorectal Surgeon and Clinical Lead), Professor Charles H. Knowles (Professor of Colorectal Surgery) and all consultant surgeons, fellows, registrars, and supportive staff at Barts Health NHS Trust. Many thanks to Vanessa Wise for organising my fellowship and for her support.
Anvar Makhmudov
From: Minsk Regional Clinical Hospital, Russia
Visited: St. James’s University Hospital (Leeds, UK) under the direction of Professor David Jayne
Firstly, I would like to express my great appreciation to ESCP for this observership. It was a great honor for me to have the opportunity to visit one of the modern clinics in the UK. I spent my observership at St James's University Hospital in Leeds under the guidance of Professor David Jayne and It was a pretty significant clinical experience for me in colorectal surgery. Professor David Jayne was kind enough to arrange my observership in Leeds, I am also grateful to his team, for their warm welcome.
During my visit, I observed many general surgical and proctologic operations. Of particular interest to me were the laparoscopic and robotic operations for colon and rectal cancer that were performed on a daily basis. Some of the interesting operations which were done included: electrode implantation for sacral nerve stimulation, total pelvic exenteration with sacrectomy; abdominoperineal resection; laparoscopic mesh rectosacropexia. I am sure that the experience and knowledge I gained during this observership will be very useful for my professional development. In conclusion I want to thank once again ESCP and Professor David Jayne with all his team for the kindness and hospitality.
Lisa Massey
From: Royal Devon and Exeter Hospital, UK
Visited: l’Hôpital St Antoine, Paris, France; under the direction of Professor Yann Parc
I was delighted to receive an ESCP observership to l’Hôpital St Antoine in Paris. I visited for 2 weeks in January – February 2018 hosted by Professor Yann Parc and his team. The first 2 days of my visit coincided with their annual meeting, the 48th Journée de l’Hôpital St Antoine: Chirurgie Digestive et Viscérale. This meeting featured a focus on gastric cancer but also served as an introduction to the range of procedures performed in this unit as live operating included gastrectomy, pancreaticoduodenectomy, laparoscopic liver resection, proctolectomy and ileoanal pouch formation and laparoscopic colectomy with coloanal anastomosis. There were also many interesting presentations on topics including the management of gastric and rectal cancer and evidence for the use of CRP to predict post-operative complications and readmission in colorectal surgery.
The unit managed of a wide range of digestive disease including tertiary referrals for recurrent colorectal cancer, complex enterocutaneous fistulae, inflammatory bowel disease and genetic cancer syndromes. During my visit I spent most of my time in the 5 dedicated digestive surgery theatres but also attended clinics, ward round and cancer multidisciplinary team meetings. I was introduced to some procedures I had seen rarely or never in the UK including protectomy, mucosectomy and handsewn coloanal anastomosis which was frequently performed for cancer and inflammatory bowel disease. Having the opportunity to observe directly and ask questions of Pr Parc and his team about their technique and management was invaluable.
I am very grateful to ESCP for affording me this opportunity and to Professor Parc and his team for hosting me and making me welcome. I left with a great deal of admiration for the volume and breadth of high quality surgery being performed with great efficiency in their unit which will give me much to consider as I look to develop my own surgical practice during the rest of my colorectal training.
Cosimo Riccardo Scarpa
From: Geneva University Hospital
Visited: University Hospital of Bordeaux (France), under the direction of Professor Eric Rullier
I was honored to be one of the recipients of 2017 ESCP Fellowship. My 5 weeks' fellowship at University Hospital of Bordeaux gave me the opportunity to learn skills that will help my future career in colorectal surgery.
I would like to express my gratitude to Professor Eric Rullier and Dr Quentin Denost, who shared with me their experience and knowledge about colorectal surgical disease, especially in colorectal cancer and IBD.
I had the chance to participate in IBD, colorectal and pelvic floor operations, and to experience the outstanding multidisciplinary team set-up unique to this prestigious institution. I also observed Professor Rullier and his staff during impressive consultations and investigations of patients with rectal cancer in the outpatient department.
I was also very fortunate that my stay coincided with the postgraduate training term, and the Colorectal Masterclass, which all proved to be valuable educational experiences, with remarkable speakers and very skilled live surgery.
I am very grateful to Professor Rullier and his team for this useful and impressive visit. Thank you for your kindness and generosity.
Armen Vardanyan
From: Russia
Visited: Beaujon Hospital, France, under the direction of Professor Yves Panis
First of all, I would like to thank ECSP for the opportunity to have an observership in a unique department under the guidance of Professor Panis. And of course, many thanks to Professor Panis for his patience, brilliant qualities of a teacher and hospitality.
For four weeks I have been involved in a healing, practical and daily process that will undoubtedly have a big role in my life as a surgeon. Professor Panis team is unique in its kind. Interchangeability and support is felt from the first meeting.
During my observership, I had the opportunity to attend all types of surgical interventions in colorectal surgery, especially for IBD, colorectal cancer, diverticular disease and even short bowel syndrome. Most of the operations were performed laparoscopically, which was of the greatest interest to me.
I saw incredible patient care from all staff.
Every week I participated in MDT where the most difficult patients with IBD were discussed together with gastroenterologists. During the analysis of patients, it was possible to participate in the process yourself.
It was also possible to be present at the examination of outpatients, to study the tactics and plan of examination of all patients.
From my point of view, the experience gained is unique for me, and my friendship with Professor Panis has only grown stronger.