ESCP 6-Month Colorectal Robotic Fellowships 2020–2021

Despite all the challenges of the Covid-19 Pandemic, five surgeons completed their ESCP Colorectal Robotic Surgery Fellowship in 2020/2021. Robotic surgery fellows received overwhelming support from their host centres and experiences described by fellows indicate high quality of training delivered through modular training programmes. Individual reports of these fellows are available here.

Click on a fellow's name to read their report

Carlijn Witjes

From: The Netherlands 

Visited: Amphia Hospital, Department of Surgery, under the direction of Mr. George van der Schelling and Mr. Rogier Crolla

First of all, I regret this fellowship is about to end! I had an amazing time, had great trainers, worked in an excellent team and was part of a good teaching hospital for months. I am grateful to ESCP for this opportunity and for making it possible to officially become a robotic surgeon.

In the beginning I was learning how to perform a robotic colorectal procedure. At the end, I was teaching and supervising the Locum Consultant and Specialty Registrars on how to perform left sided colonic resections. I got independent in colorectal robotic surgery and alongside could see all the possibilities robotic surgery has on different levels within different specialties. Becoming independent on the robot for colorectal surgery was my goal. Achieving a supervisor role felt like a dream come true!

The ESCP Robotic Fellowship gave me the opportunity to visit one of the largest teaching hospitals in the Netherlands. My two robotic surgical trainers were Mr. George van der Schelling and Mr. Rogier Crolla, both experienced Colorectal Surgeons who also practice Upper GI-, HPB- and Endocrine Surgery. With them already being robotic surgeons for more than a decade, this visit turned out to be a unique opportunity. It became a mixture of getting robotic skills, being educated in colorectal and colorectal side specialties, and being taught in everything a robot can do or can be used for.

During my fellowship both the Si and an Xi robot were used. Having the opportunity to be trained on both robots and getting to know them in detail was great. During the switch from Si to Xi there were a lot of wet lab training sessions where my trainers took me alongside. Their experience in setting up a robotic service and how to introduce a new robot was very insightful.

The focus was on Colorectal Surgery but it was on a ground of General Surgery. It felt like something extra, and it was useful to see how for instance colorectal metastatic disease could be treated. Or, how the robot can assist you during complication surgery e.g., abdominal wall reconstructive surgery. This wider knowledge of HPB-, Upper GI- and Endocrine robotic surgery was useful technically and medically as patients usually don’t come with one disease at a time.

I sat by MDT’s, handovers, grand rounds, team- and governance meetings. Mr. van der Schelling and Mr. Crolla showed me around on the ward, in clinic and introduced me to the consultant body. I got a supervising role for Surgical Specialty Registrars, junior doctors, and medical students in general.

Beside monitoring my skills and progression of skills they took me alongside their pre-operative, intra-operative and post-operative decision-making process which was very insightful.

During my stay in the Amphia Hospital I joined research meeting, journal clubs and teambuilding events. I am currently working on two mainly IBD orientated research papers in collaboration with the UK.

Mr. van der Schelling and Mr. Crolla are international proctors and often national and international surgical consultants came over for a visit. I was invited to join these meetings and further along my fellowship I even got the opportunity to show my robotic skills to a visiting colorectal consultant while performing a low anterior resection independently.

I am grateful I got the chance to work with these two highly experienced and skilled surgeons. It felt as a huge achievement to train Specialty Registrars and Locum consultants, it was beyond expectations. The skills I developed during my robotic fellowship made me a better surgeon in general and made me signed off as an independent robotic surgeon, what else could a person wish for!

Getting to know the Dutch medical health system and the possibilities a Dutch teaching hospital has was educational. With all innovative steps already taken, robotic surgery will be part of each surgeons future. I am pleased to be trained and ready for this future.

Deena Harji 

From: Manchester University, NHS Foundation Trust, UK

Visited: CHU Bordeaux, France, under the direction of Prof. Quentin Denost

The fellowship at CHU Bordeaux provided me exposure to a high-volume rectal cancer practice, with 350 rectal cancer cases discussed at our MDT and 226 rectal cancer resections over a 12-month period (6-month fellowship funded by ESCP)

This provided me with in-depth knowledge and detailed understanding of the management of rectal cancer across its spectrum from tailored treatment strategies to the management of the long-term functional sequalae, whilst providing a patient-centred, data-driven, evidence-based, state of the art clinical service. 

This fellowship has provided me with new clinical insights into MDT decision-making in rectal cancer, including, the use of total neoadjuvant treatment with dynamic imaging for locally advanced and recurrent rectal cancer and organ preservation strategies including watch and wait and local excision. 

My robotic skills have hugely improved, having performed over 100 robotic TME resections. I have gained core skills in robotic pelvic exenteration and pelvic sidewall lymphadenectomy. I have been able to make the transition from robotic trainee to trainer and have been able to train the two Chef de Cliniques within the unit
in key components of robotic TME surgery. 

The colorectal team at CHU Bordeaux have an international reputation for excellence in clinical research and colorectal trials through the GRECCAR group. I had the opportunity to be integrated into this innovative research group and understand how to maintain the longevity, enthusiasm and dynamism of a longstanding national research collaborative. 

This fellowship has accelerated and advanced my clinical and operative skills in colorectal surgery exponentially, providing me with new clinical skills and operative techniques. Professor Denost has trained me to use the robot to achieve technical precision in the pelvis, combine robotic approaches with transanal approaches and has built complexity into my robotic training pathway by training me in robotic pelvic exenteration and pelvic sidewall lympadenectomy. Alongside this, he has given me the opportunity to transition to become a robotic trainer and further develop the robotic training programme at CHU Bordeaux using the principles of parallel, component training. Training my junior peers in key components of robotic TME surgery has been an incredibly enjoyable and rewarding experience, and one which has taught me many skills required to be a good trainer. 

This fellowship has been the highlight of my training career, led by a knowledgeable and generous trainer, Professor Quentin Denost, and a warm, welcoming, and engaging team. The ethos of the unit is to work hard, aim for technical perfection and continue to push the boundaries to achieve the best patient outcomes through high quality surgery and clinical research. I have no doubt that I will take the lessons learnt from Bordeaux and adopt them in my consultant practice in the UK. Bordeaux has provided me with invaluable clinical lessons, lifelong friendships and a fresh perspective. 

Konstantinos Tsimogiannis  

From: Uppsala University Hospital, Sweden 

Visited: Queen Alexandra Hospital, Portsmouth, UK, under the direction of Dr. Jim Khan  

During my fellowship I was actively involved in both observing and performing colorectal, upper gastrointestinal and general surgical procedures, robotically and laparoscopically. I had a great exposure to the robotic surgery procedure and attended the Portsmouth course on the basic principles of robotic surgery. I have also taken part in multidisciplinary meetings for bowel cancer, outpatient clinics and ward rounds. I performed many robotic procedures under supervision, mainly colorectal.

The fellowship helped me to gain a good understanding of precision surgery for colorectal cancer, in particular TME surgery and CME for colon cancer. I developed skills, confidence and experience in robotic colorectal surgery.

Courses I attended during the fellowship:

• Portsmouth Robo-CERT Basic Robotic Skills Course
• Upper GI Robotic Surgery Course - facilitator

PHU has a very dynamic research program and I was actively involved in prospective trials, studies and submission of abstracts to various meeting such as: Single unit experience of Transanal Robotic Surgery (TARS) for early rectal cancer. Tsimogiannis K, Kumar L, Khan J Colorectal Dis 2021. Various other projects are at different stages of acceptance.

Prof Khan has an amazing teaching attitude and dedication. What I found to be significant in my learning was the fact that every procedure was performed in a standardised way, something that makes learning easier. 

QA Hospital and Prof Khan made my fellowship worth the time spent away from my family. I strongly believe that I could not have learned robotic surgery in such a depth if I had not been in Portsmouth. I have already performed my first independent Robotic case in Uppsala with great outcome.

‘It was an absolute pleasure to have Kostas at Portsmouth as ESCP fellow for 6 months. He brought in a wealth of experience and energy to the unit. With his can do attitude and smile on the face he became very popular amongst peers and staff. He is a very good surgeon and was always open to learn new ways of operating. His quest to get better always helped him to learn faster and I was extremely pleased and satisfied with his solo performance in robotic surgery towards the end of his placement. He certainly has a bright career ahead of him.’ – Dr Jim Khan.

Wee Sing Ngu 

From: South Tyneside District Hospital, South Shields, UK

Visited: Hospital Valle De Hebron, Barcelona, Spain, under the direction of Dr Eloy Espin Basany  

The ESCP Intuitive Robotic Fellowship has provided me with the opportunity for complete immersion into robotic colorectal surgery over a 6-month period in a large, tertiary, innovative teaching hospital – Vall d’Hebron University Hospital in Barcelona, Spain. I am grateful to have met and worked with an amazing group of surgeons who were extremely welcoming and open to collaboration and teaching.

My main supervisor was Professor Eloy Espin Basany; I also worked with Dr Francesc Vallribera and Dr Alejandro Solis who were my robotic trainers. In addition, I was able to participate in a fortnightly robotic theatre list at Bellvitge University Hospital under the supervision of Professor Sebastiano Biondo, Dr Esther Kreisler and Dr Thomas Golda.I was encouraged to scrub in and participate in the operating theatres early on.

As a result of the step-by-step approach to training employed by Professor Espin and support and encouragement from the whole team, I was able to hone my skills and confidence in performing robotic colorectal procedures to the point where I was able to practice robotic surgery independently by the end of the fellowship.

The robotic procedures I participated in include right hemicolectomy with complete mesocolic excision, low anterior resection, abdominoperineal resection, sigmoid colectomy, subtotal colectomy, ventral mesh rectopexy, perineal hernia repair and excision of retrorectal cyst. This fellowship has exceeded my expectations and provided me with a great foundation to build on.

This fellowship was an invaluable experience, and I am grateful to ESCP and Intuitive for the opportunity to have met and worked with amazing surgeons in a large tertiary innovative teaching hospital. This was an excellent and hugely productive time, and I would highly recommend this fellowship to any surgeon who wants to be competent in robotic surgery.

Patricia Tejedor

From: University Hospital Gomez Ulla, Madrid, Spain 

Visited: Valdecilla University Hospital, Santander, Spain, under the direction of Dr Marcos Gomez Ruiz & Dr Julio del Castillo Diego 

Since the first day, the involvement in every robotic colorectal case has been obvious. The unit has 3-4 robotic lists per week, and I was always able to assist with the cases, scrubbed since the beginning of the intervention, which gives the opportunity to learn trocar and patient positioning and robotic docking. The centre has two robotic systems (DaVinci X and Xi), which brings the chance to learn how to operate with both, learn the differences and the advantages of both systems. I also had the chance to perform robotic low anterior resections and some intracorporeal anastomosis, always supervised and assisted by the trainers. 

Ward round is organised early morning, where the robotic fellow is the person in charge of the round at this time. Consultants are always available for discussion and then for a second ward round late morning-early afternoon in order to supervise. Colorectal MDT is organised once a week, where every colorectal case is discussed within a multidisciplinary team.

I have also had the opportunity to go to a pelvic floor course in Pisa with Dr. Julio Castillo, where not only proctology cases where discussed, but also pelvic floor interventions and their approach, including the option of the robotic surgery. 

I have learned lots of tips & tricks that are extremely useful for daily practice, not only for robotic cases but also for laparoscopic and open surgery, or those parts of the intervention that have to be done open (such as the pursestring and the anvil positioning).

Courses/ Simulated Training/Formal Training/ Educational Sessions attended during fellowship:

• The robotic simulator was available after OR sessions. 
• A robotic cadaveric course was organised during the 6-month period; I had the chance to assist to the educational sessions.
• Pelvic floor masterclass Pisa September 2021

Audit/Research/Publication/Presentations during fellowship:

• Oral presentation at the National Colorectal Conference 2021
• Collaboration in other projects from the unit (videos, oral presentations & posters), also presented at the National Colorectal Conference 2021
• Currently working on a manuscript for publication

In summary, the high volume and the referrals that the hospital has, made it an amazing host centre for a short-time experience such as this robotic fellow, thanks to the high number of cases available. Overall, the experience has been awesome and very useful for my daily clinical practice. I have gained experience for my independent practice, with many robotic tips & tricks that will be extremely helpful. 

Last, but not least, I have met amazing colleagues with great experience in colorectal & robotic surgery, willing to teach and help junior colleagues.