ESCP offered 3-month Functional Disorder Fellowships and 6-month Robotics Fellowships for 2022-2023, as well as three Travelling Fellowships. Fellows report here on their experiences.
Click on a fellow's name to read their report. The most recent fellow to report back is Hadiel Kaiyasah.
| Name | Country | Host Centre or Country | Fellowship | Dates |
|---|---|---|---|---|
| Marta Pascual Damieta | Spain | South Korea | KSCP Travelling Fellowship | Aug-Sept 2023 |
| Florian Herrle | Germany | USA | ASCRS Travelling Fellowship | June 2023 |
| Pascal Herzog | Switzerland | Japan | JSCP Travelling Fellowship | Nov 2023 |
| Jennifer Park | Sweden | Queen Alexandra Hospital, Portsmouth, UK | 6-Month Robotic | Feb-July 2023 |
| Susano Ouro | Portgual | University Hospital Marqués de Valdecilla, Spain | 6-Month Robotic | Oct-Mar 2024 |
| Eleanor Rudge | UK | Vall d’Hebron University Hospital, Spain | 6-Month Robotic | Mar-Sept 2023 |
| Hadiel Kayasiah | UAE | Royal London Hospital, UK | 3-Month Functional | Sept-Nov 2023 |
| Jurij Aleš Košir | Slovenia | Meander Medisch Centrum, The Netherlands | 3-Month Functional | Oct-Dec 2023 |
| Liene Melberga | Latvia | UZ Brussel, Belgium | 3-Month Functional | Sept-Nov 2023 |
Sponsors
6-month Robotics Fellowships were sponsored by Intuitive
3-month Functional Disorder Fellowships were sponsored by Medtronic
Marta Pascual Damieta
From: Hospital del Mar, Barcelona, Spain
Visited: Colorectal Research Summit (ICRS) 2023 and three medical centres in Korea
Time period: August to September 2023
Host: Prof. Joon-seok Park
It was a great privilege to be awarded with the 2023 KSCP Travelling Fellowship. The fellowship was organised in an excellent way. I would like to thank both the ESCP and de KSCP secretariats for the great help that both gave me.
It was for me a magnificent experience not only for having the opportunity of attending the exceptional Colorectal Research Summit (ICRS) 2023 but to visit three of the most important centres in Korea and to meet so kind and warm people.
The first day of the arrival, I was invited to a reception dinner were my host Prof. Joon-seok Park prepared with some fellows and faculty of the KSCP. I had the opportunity there to meet Prof. Al Najami from the Netherlands and Dr. Minhye Jeong, the fellow from Prof. Park that would be my guide in all my trip everybody was very nice.
On the second and third day I visited one of the most incredible hospitals that I have ever visited, the Asan Medical Center, with more than 2700 beds, including 220 ICU beds, 21 CT scans and 15 MRI and where they perform more than 22.000 cancer surgeries per year, 2.000 of them being colorectal cancer surgeries. We could observe surgeries performed by Prof. Im Ja Park, the actual editor of the Annals of Coloproctology Journal, and we can visited the international patients area of the center.
After that I actively participate in the International Colorectal Research Summit (ICRS) 2023 at Seoul from 1st to 3rd of September.
The conference was inspiring and full of interesting presentations. The main topics of ICRS were the use of new technologies as robotic platforms for colorectal cancer treatment, specially the Single Port platform, and the use of other biomarkers and the Indocianine Green to check the anastomosis. I was lucky to assist to great conferences from international faculty as Masaaki ITO and Takeru Matsuda from Japan and Simon NG form Hong Kong.
The invited faculty and gala dinner were places for close contact and exchange of ideas.
The second part of the fellowship was visiting other two Korea hospitals. I travelled to Daegu and during one week I was participating in the activities of the Colorectal Surgery department lead by Prof. Joon-seok Park and Prof. Kyu-seok Choi at the Kyungpook National University Chilgok Hospital.
I had the opportunity of observed robotic surgeries, two of them performed using the SP Da Vinci Platform, and two robotic low anterior resections with lateral lymphadenectomy.
During this week I visited another hospital, the Chinjujeil Hospital in Jinju, in this hospital, a secondary one, we could attend to proctology surgeries and some endoscopies.
Besides the academical activities I was lucky to visit Seoul and Jinju Castle and enjoy some of the magnificent gastronomy of this fantastic country.
I met people there that I hope that will be contacts not only for future collaborations but for future exchanges programs.
Florian Herrle
From: Germany
Visited: ASCRS Congress 2023 in Seattle, USA
Time period: June 2023
In Sept 2022 I was the lucky one to get the best abstract ESCP award for our DeloRes-RCT during the ESCP Congress in Dublin. This long-running multicenter RCT compared two traditional surgical approaches for full thickness rectal prolapse. The results showed a highly significant benefit for the laparoscopic resection rectopexy in terms of time to recurrence during two-year follow-up and also in functional terms.
The organisation of my journey to the ASCRS Congress in Seattle 2023 went smoothly thanks to the great support of the ESCP team around Vanessa McCourt. My presentation was scheduled for 4. June during a Super Session in Pelvic Floor Abstracts.
I enjoyed two inspiring congresses in June: after having attended the World ERAS Congress in Lisbon from 31st of May until 2nd of June, I traveled to Seattle on 3rd of June. During a two-hour immigration process at the airport, I was able to attend the first interesting congress session on my Tablet 'Holistic Surgical Care for older adults - a toolbox for surgeons'. I was impressed by the functionalities of the digital ASCRS Congress Platform and App: most main sessions were available live-online, sessions could be reviewed retrospectively and bookmarked easily. Notes could be added and saved.
My presentation went smoothly. As a majority of surgeons within the United States are using laparoscopic resection rectopexy and not Delorme’s procedure for full thickness prolapse, our main result of superiority for the laparoscopic approach was not surprising but affirming for the audience and panel.
After my talk I had a lot of stimulating sessions and encounters with colleagues from Germany, United States and South Korea. An important ongoing discovery for me were the articulating surgical tools from the South Korean company Livsmed (Artisential). As I know the great advantages of articulating devices from DaVinci Surgery but don’t dispose of a robotic platform in my current hospital, I dived into the training with these instruments during the congress. I was surprised by the short learning curve during only two days. Moreover I met the leading Artisential-surgeon and colleague from Germany, Dr. Ibrahim Darwich, and the Livsmed Company team around Holger Schippers and the CEO Jung Joo Lee during an excellent networking steakhouse dinner. I can highly recommend to any colorectal surgeon the amazing surgical videos on YouTube by Ibrahim Darwich. The composition, handling and also cut and music are first class, relaxing and inspiring to view. Meanwhile I use those videos in my department to teach best practice MIC colorectal surgery.
The ASCRS Congress was my first surgical congress attended in the United States. I enjoyed the discipline of the presenters to be focused and their very open and lively culture during discussions. What surprised me is that several times presenters or panelists mentioned that RCT-results (e.g. from large well designed oncological European RCTs) were not yet confirmed by similar RCTs within the own country. This had the connotation that only RCTs from USA may have full trust and validity for surgeons there. I guess this is different in Europe, at least in Germany.
As weather was great, I enjoyed some highlights of Seattle after the congress sessions: a trip to the top of the Seattle needle and a dinner with Ibrahim Darwich on the harbor quay with the stunning view on the Mount Rainier.
I thank the ESCP and the organizing team for a wonderful journey with long-lasting effects in my surgical practice and network.
Pascal Herzog
From: Cantonal Hospital Baden, Switzerland
Visited: Japan
Time period: November 2023
Host: Prof. Shigeki Yamaguchi
At the end of November 2019, I received an email from ESCP informing me that they had awarded me the Travelling Fellowship to Japan based on the highest score achieved in the 2019 EBSQ exams. I was really looking forward to this unique experience. A few months later, the Covid pandemic hit, and the trip had been postponed every year. Finally, at the beginning of 2023, I received the good news that the fellowship could take place this year in November. Prof Shigeki Yamaguchi got in touch with me so that we could plan the trip. I was given the opportunity to choose three different hospitals that I would like to visit during my trip. He organised all the flights, train connections and hotels for my stay and put me in touch with the hospitals I would be visiting.
The JSCP meeting took place on 10 and 11 November in Kumamoto. I travelled to Tokyo on a direct flight from Zurich on 4 November. After a 12 ½ hour flight, I was met at Narita Airport on the morning of 5 November by a friendly member of staff from the travel agency that organised the trip. He gave me the train and flight tickets for my round trip. As my flight had unexpectedly arrived on time, he helped me to change my train tickets to Nagoya to an earlier connection. I then travelled alone on the Narita Express to Shinagawa and from there on the Shinkansen to Nagoya. I arrived there in the afternoon. After a short walk through the city centre and an early dinner, I went to sleep.
The next morning, after a Japanese breakfast, I took the underground to the outskirts of the city and from there a taxi to Fujita Health University Hospital. I was welcomed by Dr Gaku Inaguma and accompanied to the operating theatre. A colostomy repositioning with subsequent robotic sigmoidectomy using the da Vinci Xi was planned for an elderly patient with stenosing sigmoid carcinoma and metastasis following neoadjuvant FOLFOX therapy. I was very impressed by the size of the operating theatres. In Switzerland, at least two theatres would have been built in this space. There was also plenty of room for the students who were watching the operation. The operation was performed by a fellow, assisted by Prof Koki Otsuka. The patience with which he gave instructions at the assistant's console and guided the young colleague through the procedure was impressive.
For lunch I had my first Kishimen. Afterwards, Dr Inaguma gave me a tour of the Robotic Training Centre and the cadaver lab. The majority of colorectal operations at Fujita Health University Hospital are performed robotically. In the operating theatre there are three da Vinci Xi, a da Vinci SP, a Hugo and a Hinotori, which is a Japanese robot similar to the da Vinci.
After the tour of the campus, I headed back into the city centre to the hotel. On the way, I strolled through a Japanese department store.
The next morning, I took the Shinkansen towards Mishima. I was expected at the Shizuoka Cancer Centre after midday. Dr Akio Shiomi, the head of colorectal surgery, showed me around the clinic. Afterwards, I was able to witness a robotic low anterior rectal resection, which Dr Shiomi performed using the da Vinci Xi. When we arrived outside the operating theatre, there was no patient in the room yet. Shortly afterwards, the patient walked past us into the operating theatre accompanied by a nurse anaesthetist and lay down on the operating table. Barely 35 minutes later, the trocars were in place and the console docked. A truly remarkable performance by the entire team. Dr Shiomi demonstrated a very impressive and precise surgical technique. It was a pleasure to watch. At the end of the procedure, a transanal drain was inserted and left in place for 4 days. A protective ileostomy is not performed, regardless of the anastomosis height, if the intraoperative leak test with air is negative. Dr Shiomi told me that the Shizuoka Cancer Center, like many other clinics in Japan, avoids neoadjuvant therapy for rectal cancer whenever possible and performs a primary resection in accordance with Japanese guidelines. In the evening, Dr Shiomi and his team organised a dinner party for me. We enjoyed Japanese specialities in a local restaurant in Mishima and had stimulating conversations.
The following morning, after breakfast on the 13th floor of the hotel with a view of Mount Fuji under a cloudless sky, I decided against taking a taxi to the Shizuoka Cancer Centre and instead took one of the local buses. After registering again at the entrance, Dr Kasai took me into the operating theatre. Today a robotic low anterior rectal resection for a locally advanced rectal carcinoma 6 cm above anal verge in an elderly woman was scheduled. As neoadjuvant therapy is not used as standard in this case, a Japanese D3 lymphadenectomy with resection of the bilateral lateral lymph nodes was planned. Dr Manabe performed the procedure very precisely. I was particularly excited about the lateral lymph node dissection, as this is very rarely performed in Switzerland. At the end of the almost 6-hour procedure, the lymph nodes were completely removed on both sides and the view of the pelvic floor, the iliac vessels, the obturator nerve, the hypogastric plexus and the ureters was clear. The anastomosis was finally just above the pelvic floor. As the leak test was negative, a protective ileostomy was not performed.
The next day was a day of travelling: a 6-hour journey from Mishima via Shin-Osaka to Kumamoto awaited me on the Shinkansen, where the 78th Annual Meeting of the Japan Society of Coloproctology was to be held over the next two days. In the evening, I was invited to the conference dinner. I had an appointment with Dr Yuji Nishizawa at the hotel. He was awarded the JSCP/ESCP Fellowship to Europe before the Covid pandemic. We went to dinner together, where he introduced me to various doctors.
On the first day of the congress, I was able to present a Swiss study from Winterthur as part of an ESCP fellowship session. The session was moderated by Prof Yamaguchi. It was a great honor for me to speak in front of the visitors. After the presentation, I was approached by several doctors. They all gave me their business cards. A nice custom and for me a sign of appreciation.
On the afternoon of the second day of the congress, I visited Kumamoto Castle in fine weather and strolled through the streets of the city.
The journey continued the following day. I flew from Kumamoto to Tokyo Haneda and took the train to Ueno. When I arrived at Ueno station in the evening, I was overwhelmed by the many lights of the hotels, restaurants, and shops. Unfortunately, this made it very difficult for me to find my way around, so I initially looked for my hotel in the wrong direction. But thanks to Google Maps, I managed to find my destination after all.
The next morning, I set off early from the hotel to Tokyo University Hospital. After a 30-minute walk, I reached the university campus. I met with Prof Emoto in his office. He took me to the research team meeting and then to discuss the upcoming operations for the next few days. I had the opportunity to introduce myself at the team meeting. Afterwards, we went to the operating theatre together. A robotic sigmoid resection with the da Vinci Xi was scheduled. The patient had a BMI of 27, which was above average by local standards. The operation was performed by Prof Ishihara, who assisted a robotic fellow in the lateral mobilisation of the sigmoid colon. Despite the unusual weight conditions, Prof Ishihara prepared very nicely in the plane. As I have always seen in Japan, the sigmoid is clamped and rinsed before stacking. Finally, a tension-free end-to-end anastomosis could be performed. This was checked endoscopically for tightness. The ICG also showed optimal perfusion conditions. Here too, a transanal drain was inserted for decompression. This remained in place for 3 to 4 days until the first bowel movement.
After the operation, I went to the university canteen for lunch with Prof Ishihara and Prof Emoto, where I was invited to enjoy a delicious Ramen.
The next morning, I walked through Ueno Park towards the university campus under a bright blue sky, where I also strolled around the campus. I then met up with Prof Emoto so that we could go to the operating theatre together. Two operations were scheduled at the same time today: A laparoscopic Hartmann reversal after sigmoid resection for open perforated sigmoid diverticulitis, which is less common in Japan than in Europe. In the next room, a laparoscopic anterior rectal resection with placement of a definitive descendostomy was performed in an elderly, comorbid patient with synchronous rectal carcinoma and stenosing sigmoid carcinoma after stent placement. The Hartmann reversal was performed by a resident. The rectal stump was resected a little and finally an end-to-end anastomosis was performed using a 25 mm circular stapler. The 25 mm stapler was a little unusual for me, as we always use larger stapler diameters in our operating theatre. But all the colorectal anastomoses I was able to observe on my trip to Japan were performed with a 25 mm stapler. I moved a little between the operating theatres. In the afternoon, I was allowed to be present during a Soph-A-Port insertion. It was a young patient with a T1b sigmoid carcinoma, which was removed endoscopically. Completely contrary to expectations, the staging examinations revealed peritoneal dissemination. A diagnostic laparoscopy with insertion of a port system was now planned for intraperitoneal chemotherapy with paclitaxel as part of a trial. In addition, systemic therapy with FOLFOX was planned for this patient. Unfortunately, significant peritoneal metastasis was found intraoperatively. The procedure was performed without any problems. I had not been familiar with this port system.
Afterwards, I met up with Prof Ishihara again for a few souvenir photos.
On my last day in Japan, I went sightseeing in Tokyo. I bought a 24-hour subway ticket shortly before 8.00 a.m. and made my way to the Imperial Palace. I first took a walk around the grounds and then, at 9.00 a.m., the eastern part of the gardens and the grounds of the former Edo Palace were opened to the public spot on time (the guard was on the stroke of the hour). I continued to Tokyo Station, from where I travelled to Ginza. There I strolled through the streets and admired the impressive shops of the big luxury brands. I also visited the Tsukiji-Hongwanji temple. Afterwards, I took the underground to Roppongi. The Roppongi Hills building with its 47 floors is breathtaking. The small shops in the neighbouring Azabu-Juban district are a contrast to the large Roppongi Hills building. The next stop took me to Meiji Jingu Shrine and then to Takeshita-dori Street, which is a sight. The many colours and sweets on offer give you a sugar shock just looking at them. By now quite tired, I continued to Shibuya, where I mainly wanted to see the Shybuya crossing. It's really stunning how many people from all sides cross the intersection at once: everything seems very organised. The next day I took the flight from Narita Airport back to Switzerland.
These twelve days in Japan were a great experience and will remain unforgotten in my memory. I can recommend the Japan Travelling Fellowship to all young surgeons who are interested in colorectal surgery and enjoy getting to know foreign cultures. I would like to thank Prof Yamaguchi for organising the fellowship and my hosts Prof Otsuka, Dr Shiomi and Prof Ishihara for their hospitality.
Jennifer Park
From: Sahlgrenska University Hospital, Gothenburg, Sweden
Visited: Queen Alexandra Hospital, Portsmouth, United Kingdom
Time period: February to July 2023
Supervisor: Professor Jim Khan
As a colorectal surgeon mainly focused on colorectal cancer alongside conducting research, the ESCP robotic fellowship under the supervision and guidance of prof Jim Khan provided me with a focused robotic colorectal training program at a very well-timed stage of my career.
Prior to starting the fellowship, I was comfortable handling the DaVinci Xi system bedside and had also started doing cases in the console. The fellowship with Prof Khan is very well organized and the training is divided into different modules – of which all will be gone through and performed independently by the end of the fellowship. These include docking and bedside assisting, performing medial to lateral dissection, vascular ligation, splenic flexure mobilization and pelvic dissection. The main focus of the procedures were sigmoid and rectal cancer resections, but I did also get training in right hemicolectomies with complete mesocolic excision, transanal endoscopic microsurgery and ventral rectopexy. As a fellow, regardless of how complex a case might be – there would always be some part that I would be able to perform in the console and at the end of the fellowship I was able to perform whole procedures independently. In addition, I also had a great exposure to less common robotic procedures such as para-aortic and pelvic lateral node dissection, subtotal colectomies, hernia surgery etc.
During the fellowship I got to know the British medical system properly and work as a fellow included rounds, clinic and attending MDTs. I truly enjoyed being a part of professor Khans team and cooperating with all the staff members. I also had the opportunity of starting up some research projects that will be continued in the future. Apart from this I was also part of the organizing group of the annual Portsmouth Colorectal Congress with an impressive international faculty, as well as serving as facilitator at several Basic Robotic Skill Courses.
Coming back to my surgical department I now, more than ever, realize the importance and quality of the training I received through the fellowship. I am more confident when performing procedures and have a higher level of troubleshooting as well as utilizing and facilitating the possibilities of the robotic system in different clinical situations. I believe that I have been able to develop these qualities thanks to the ESCP robotic fellowship, and I am very grateful that I got the chance to spend 6 months in Portsmouth with such a skilled supervisor as Professor Khan.
Hadiel Kaiyasah
From: United Arab Emirates
Visited: Royal London Hospital Barts Health NHS, London, UK
Time period: September to November 2023
Host: Mr Pasquale Giordano
Embarking on a fellowship trip to the United Kingdom was a pivotal moment in my surgical career, as it opened the door to a transformative experience. Working at the colorectal and pelvic floor unit at the Royal London Hospital, under the supervision of Mr Pasqaule Giordano, was an invaluable opportunity.
During my time at the hospital, I was exposed to a wide range of learning opportunities that significantly enriched my knowledge and skills in the field. One of the highlights was the exposure to various pelvic floor surgeries, where I had the privilege to observe and participate in procedures that expanded my surgical repertoire.
The fellowship opened the door to a transformative experience in my surgical career - introduction to the world of robotic surgery. Robotic Surgical Skills ROBO-CERT Course organised by Portsmouth Colorectal Team is a highly recommended one, organised by Professor Jim Khan and his great team. This course paved the way to the fundamentals of robotic surgery. Then having access to a dedicated simulator console at the Royal London Hospital was instrumental in completing my phase one in robotic training pathway. The opportunity to train on a simulator provided a safe and controlled environment to familiarize myself with robotic surgical techniques and instrumentation. The simulator console allowed me to practice various surgical tasks, including suturing, tissue manipulation, and instrument handling, in a realistic virtual setting. This hands-on experience was invaluable in building my confidence and proficiency in robotic surgery.
Consulting on complex functional cases provided me with invaluable insights into the delicate aspects of patient care. Understanding the intricacies of each case and collaborating with Mr Giordano and the multidisciplinary team helped sharpen my diagnostic and management skills.
Additionally, attending sessions at the GI physiology unit was enlightening. It allowed me to delve deeper into the physiological aspects of gastrointestinal disorders, further enhancing my understanding of the complexities of colorectal and pelvic floor conditions.
Along with that, I was lucky to get the chance to learn endoscopy from skilled and experienced clinical endoscopists at the Early Diagnostic Center (EDC) at Mile End and Royal London Hospital Barts Health NHS Trust, London, UK. It provided me with valuable insights and hands-on training in OGDs and colonoscopies, both for diagnostic and therapeutic purposes. I will always be grateful to my mentors, the clinical endoscopists: Shamim Akhter, Benidick Batallones and Paul Trainor.
My fellowship experience at the Royal London Hospital was truly enriching and transformative. It provided me with a wealth of learning opportunities that spanned various aspects of colorectal and pelvic floor surgery. From mastering endoscopy techniques to delving into the world of robotic surgery, and finally gaining invaluable experience in pelvic floor surgery, every aspect of my training at the hospital contributed to my growth as a surgeon.
Beyond enhancing my clinical skills, the fellowship instilled in me a profound understanding of the importance of a multidisciplinary approach to patient care. Collaborating with esteemed colleagues from different specialties emphasized the significance of teamwork in achieving the best possible outcomes for patients.
Wrapping up my ESCP functional fellowship with a meeting with Miss Carolynne Vaizey, ESCP Secretary, and Mr Janindra Warusavitarne, ESCP Education Chair, was the perfect culmination of an enriching experience. Visiting St Mark's Hospital and learning from their state-of-the-art procedures was truly invaluable.
Overall, my fellowship experience at the Royal London Hospital was truly transformative. It not only broadened my clinical expertise but also instilled in me a deeper appreciation for the multidisciplinary approach to patient care. I am grateful for the mentorship of Mr Giordano and the opportunity to learn from the esteemed colleagues at the hospital. This experience has undoubtedly shaped me into a more competent and compassionate surgeon, ready to make a meaningful difference in the lives of my patients.
Thank you, ESCP, for this incredible opportunity to learn, grow, and contribute to the field of coloproctology. I am honoured to have been a part of this esteemed society and look forward to continuing to be an active member in the years to come.
Jurij Aleš Košir
From: Slovenia
Visited: Meander Medisch Centrum, Amersfoort, The Netherlands
Time period: October to December 2023
Hosts: Professor Esther CJ Consten and Dr Paul M Verheijen
The fellowship was a wonderful experience and Amersfoort with always hold a special place in my heart. Not only did I meet wonderful people, but I also learned a lot.
Meander Medisch Centrum is a referral centre for pelvic disorders so during my visit I saw many cases of operations for pelvic organ prolapse. Professor Consten and Dr Verheijen are experts in performing robotic ventral mesh rectopexies, Delorme and Altemeier operations and so I am really glad they taught me how they perform these procedures. They also perform oncologic operations and operations for inflammatory bowel disease, so I saw many minimally invasive colorectal resections ranging from intense laparoscopic right hemicolectomies with CME to robotic low rectal resections and abdominoperineal resections. The surgeons operate with precision and without performing extra or unneeded steps. I was very pleased when I was invited behind the robotic console or when I was invited to assist during operations. In Meander I performed my first robotic operations, having had experience of more than a hundred robotic operations as a bedside assistant in my hometown.
It was great to experience the way surgeries are performed in Meander due to a very fast turnover of patients with all involved teams working very skilfully, maintaining focus and meanwhile being welcoming. It was nice to learn how OR nurses help and how organisation of operations are in a different centre. These are all the things that I brought with me from Amersfoort and that I will keep in mind when implementing new things or what to strive for.
During the fellowship I was invited to Amsterdam Skills Centre with Professor Consten on two occasions. She is an internationally-recognised surgeon, and surgeons from Italy, Germany and Poland came to attend her courses on colorectal surgery. The courses had lectures and practical exercises on cadavers, so it was an invaluable experience. I also went with Professor Consten when she proctored at Medisch Centrum Leeuwarden, to help with robotic operations. During my stay in Amersfoort there were also lectures on the topic of pelvic floor disorders that I attended. Healthcare practitioners from all branches involved in pelvic floor disorders attended either as lecturers or as listeners. Other educational sessions were during the morning meetings at Meander, these included morbidity and mortality sessions and other interesting talks.
During my fellowship I met with PhD students that work under Professor Consten and so I even attended research meetings with PhD student Ritch Geitenbeek who is performing very interesting research on the topic of minimally invasive colorectal resections.
During my time visiting Meander Medisch Centrum I saw my first Altemeier and Delorme operations, I performed my first robotic operations and I saw the first PPH operations and fistula excision with apple core excision technique. After seeing these operations, I will feel more confident starting similar operations later on in my career. Professor Consten also performs robotic rectal mesh rectopexies with very little effort and I will definitely try to perform these operations again the way she does them. The small tips and tricks that I learned will prove invaluable in my career without a doubt.
I would rate my overall fellowship experience as excellent, 10/10, five stars out of five stars. All aspects were outstanding, including the social programme, the working hours, life in The Netherlands in general. I met some young trainees, nurses, surgeons and even people I interacted outside the hospital who treated me very well and I hope we will meet again sometime, somewhere.
In the future I will feel more confident performing colorectal and proctologic operations at my centre and I will definitely try to imitate the way work is performed in the Netherlands.
Liene Melberga
From: Latvia
Visited: UZ Brussels, Belgium
Time period: September to November 2023
Hosts: Jasper Stijns and Ellen Van Eetvelde
I was awarded an ESCP 3-month Fellowship - a unique opportunity and possible because it was supported by Medtronic.
UZ Brussels provides a great deal of complex pelvic floor surgery like complex fistula surgery, prolapse surgery, incontinence, IBD and colorectal cancer surgery.
I participated in advanced pelvic floor clinic every week, where surgeons work closely with advanced gastroenterologists, pelvic floor physiotherapists, gynaecologists etc. I observed HRA, anal manometry and ultrasound done by enthusiastic gastroenterology colleagues and discussed patients on pelvic floor MDT monthly. Knowledge in pelvic floor surgical anatomy, pathogenesis of diseases, in my opinion, is mandatory for this fellowship.
Every other Monday we had a full proctology operating list with surgeries like fistulotomy, haemorrhoidectomies (Milligan Morgan, LHP etc.), flap for fistula treatment, pilonidal disease - phenol or flap - most commonly used, TAMIS and others.
The colorectal team mostly work with a robot for colorectal resections-cancer and IBD, rectopexies, emergency colorectal surgery. And to be honest I can see why. Being a team is the key, always trying to help each other when needed. The team always tries to find at least 15 minutes for a lunch together, which is really nice for team-building.
I participated in IBD case discussions with gastroenterologists, and not only. Some challenging surgeries as well, one of worth mentioning is Michelassi strictureplasty.
Assisted mainly in proctology cases (fistula surgery, haemorrhoids, ventral rectopexies, TAMIS etc), laparoscopies for IBD, etc., and observed many robotic cancer surgery.
During this fellowship there was an opportunity to do basic robotic training in UZ Brussels. After hours or if robot was not in use. Which is great chance even if you do not work with the robot in your daily practice. To broaden you knowledge and to see things differently.
I had an amazing opportunity to visit another centre thanks to my host centre and network that is provided by ESCP. I visited David Zimmerman in Tilburg, The Netherlands. On this day we discussed complex fistula and treatment options, observed three LIFT procedures and other fistula surgery too. I was particularly interested in how does he do his LIFT, and that is exactly what I saw and will definitely try to do my LIFT procedure a bit different from now on. Also participated in laparoscopic ventral mesh rectopexy for rectal full thickness prolapse.
I believe I have gained more confidence in complex proctology. Particularly in complex fistula and prolapse surgery which was my goal for this fellowship. I believe you can visit UZ Brussels if you have minimal experience in proctology and gain a lot from it, and also if you have good experience you can observe things being done differently, have great discussions with experts in this field. If you thinking about fellowship in UZ Brussels, robotic skills would be desirable.
I would like to say thank you to my host and mentor Jasper Stijns for being fun and kind and showing his enthusiasm for proctology. Also to Ellen Van Eetvelde, brilliant robotic surgeon, and to the amazing Magali Surmont, gastroenterologist - I would like to have a colleague like her in my hospital. And to many others who I met along this journey.