ESCP Fellowships 2023–2024 Update

ESCP offered 3-month Functional Disorder Fellowships and 6-month Robotics Fellowships for 2023-2024, 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 report is from Blanca Montcusí Ventura.

Sponsors

6-month Robotics Fellowships were sponsored by Intuitive

3-month Functional Disorder Fellowships were sponsored by Medtronic

Laura Koskenvuo

From: Finland
Visited: ASCRS Congress 2024 in Baltimore, USA
Time period: June 2024

At the last ESCP meeting in lovely Vilnius in September 2023, I was honoured to be awarded ESCP's best paper for our MOBILE2-trial. This double-blind, randomised trial compared mechanical bowel preparation with and without oral antibiotics in patients undergoing rectal anterior resection and colorectal or coloanal anastomosis. The results showed a benefit of oral antibiotics in terms of overall complications, surgical site infections and anastomotic leaks.

I was thrilled to travel to Baltimore to present our trial. The travel arrangements went smoothly with a help of ESCP and Vanessa McCourt, and congress arrangements, coordinated with Kristi Conley from ASCRS, were equally efficient.

I arrived in Baltimore on the evening of 31 May and was fortunate to attend the entire meeting. The jet lag made it easy for a European to wake up early for the sessions 😉 and the convenience of staying at a hotel connected to the congress centre made access effortless.

The meeting was thoroughly enjoyable, spanning four days filled with fascinating lectures. I found the Rectal Cancer Super Sessions and the session on 'Watch and Wait' particularly compelling. I must commend our American colleagues for their exceptional lecturing skills; they have a remarkable ability to convey a wealth of information succinctly and effectively.

Many lectures discussed recent RCTs in rectal surgery, including PROSPECT, RAPIDO, PRODIGE, OPRA, to name a few, providing valuable new insights for me into these well-known trials. There was also a notable synergy from having concurrent meetings, as some new trials initially introduced at ASCO were also discussed at the ASCRS meeting. Additionally, I benefited from the breakfast session on robotic surgery.

In addition to the scientific sessions, the congress offered numerous opportunities for networking and collaboration. I had the pleasure of meeting and exchanging ideas with colleague, which was an enriching aspect of the experience. The social events organised as part of the congress were also delightful.

Overall, attending the ASCRS Congress was a highly enriching experience, offering new perspectives and enhancing my knowledge in the field of rectal surgery. I am grateful for the support of ESCP and ASCRS in making this trip possible. The insights gained and connections made during this congress will undoubtedly contribute to my ongoing research and clinical practice. I look forward to applying what I have learned and continuing to collaborate with the global surgical community. This was my first time at the ASCRS meeting, but definitely not my last!

Blanca Montcusí Ventura

From: Spain
Visited: Colorectal Surgery Unit, Department of Visceral Surgery, Geneva University Hospitals, Switzerland
Time period: May to August 2024

Knowledge and clinical skills acquired

Throughout my Fellowship, I acquired an extensive range of knowledge and clinical skills in the management of functional and pelvic floor disorders, while also furthering my education in colorectal surgery and complex proctology. This training provided me with the ability to diagnose, treat, and surgically manage diseases pertinent to these fields. I gained an extensive comprehension of prevalent disorders, including faecal incontinence, obstructed defecation syndrome, rectal prolapse, rectocele, enterocele, and chronic pelvic pain. The fellowship enabled me to understand the complex nature of these diseases, encompassing both functional and mechanical dysfunctions, as well as the value of a multidisciplinary approach.

During my experience in outpatient clinics, I obtained expertise in the assessment and advanced diagnostic techniques for evaluating functional and pelvic floor disorders. I acquired knowledge in conducting an adequate history and a comprehensive physical examination, considering the three compartments of the pelvic floor from a multidisciplinary perspective. I also received training in anorectal and dynamic transperineal ultrasound. In addition, I developed competence in non-surgical approaches to manage these disorders, including pelvic floor physical therapy, biofeedback, and pharmacological interventions. Conservative treatments frequently serve as the initial intervention and can provide substantial symptom improvement.

The fellowship offered hands-on experience with a variety of surgical techniques. I earned skills in procedures for faecal incontinence, such as sphincteroplasty and sacral neuromodulation. Moreover, I had the privilege to gain practical experience with an innovative surgical technique for repairing the puborectalis muscle disruption. I developed expertise in performing minimally invasive procedures for rectal prolapse, utilising laparoscopic and robotic approaches, as well as different techniques, including anterior and posterior dissection. I also learned perineal techniques for prolapses, such as rectocele repair and perineal rectosimoidectomy. This training in the operating rooms highlighted the importance of selecting the most suitable procedure based on the patient’s anatomy and functional requirements.

I underwent training in the management of postoperative care, which is essential for enhancing surgical outcomes and minimising complications. This involved the management during the hospitalisation, as well as during the follow-up in outpatient clinics. Furthermore, a significant component of my fellowship included a close collaboration with gynaecologists, urologists, physical therapists, and radiologists. This collaboration emphasised the need of a cohesive strategy in addressing complex functional and pelvic floor disorders, thereby ensuring a holistic care for patients.

Although the fellowship primarily focused on functional and pelvic floor disorders, I additionally had the opportunity to enhance my training with colorectal surgery and complex proctology. I gained proficiency in minimally invasive techniques for colectomies and proctectomies. In the field of complex proctology, I extend my education in advanced techniques for haemorrhoids, complex fistulas, and chronic fissures. Finally, I had the chance to participate in proctological surgeries employing local anaesthesia, occasionally incorporating virtual reality, which is a novel concept developed by the team.

Training and education experiences

Every Thursday, the Department of Visceral Surgery at Geneva University Hospitals conducts Morbidity and Mortality Sessions to evaluate and enhance the management of complex patients, accompanied by lectures on various topics aimed at advancing team’s knowledge. I was able to attend this sessions and lectures, which will also contribute to my development as a surgeon.

In addition, I joined the 5th Oncology, Sexology, and Proctology Symposium organised by the team. The symposium was an opportunity to address, without taboos, issues impacting the intimate sphere of patients. Through fascinating presentations and interactive discussions, I could openly address these issues that significantly affect the quality of life of our patients.

Finally, I had the privilege to observe the first hysterectomy performed using the MIRA robot in Europe. This is a compact and efficient miniaturised robot, designed for convenience and capability. It can be utilized in any available operating room, set up in minutes, and easily relocated as needed.

Research experience development

I am a member of the Clinical and Translational Research Group in Colorectal Neoplasia at the Hospital del Mar Research Institute. Our research has primarily concentrated on the response to surgery and colorectal cancer recurrence. We have recently obtained the results of two projects that pertain to the metabolomics and microbiome, and colorectal cancer recurrence. Thanks to the fellowship, I was honoured to present these findings to Swiss professionals at the Annual Meeting of the Swiss Society of Gastroenterology (SGG-SSG), the Swiss Society of Visceral Surgery (SGVC-SSCV), the Swiss Association for the Study of the Liver (SASL) and the Swiss Society of Endoscopy Nurses and Associates (SVEP-ASPE) in Interlaken.

As a consequence of the aforementioned and the interest of the Geneva’s team, we are planning to perform an external validation of the metabolomics’ results in a larger independent cohort that will include patients from Geneva University Hospitals. Validation is mandatory to determine a prediction model’s reproducibility and generalisability to new and different patients, and its development would improve patient care and outcomes.

Future practice and utility of experience

As previously mentioned, I had the privilege to acquire knowledge and skills regarding an innovative surgical technique for the reparation of the puborectalis muscle disruption. Patients who have experienced puborectalis rupture may present some form of faecal incontinence or evacuation disorder, sexual dysfunction, or pelvic organ descend.

Over the past two decades, the Geneva’s team has devised a novel technique that reconstructs the muscle anatomy by transvaginal approach up to the vaginal vault. They have conducted an analysis of their cohort, and this technique appear to offer several advantages over the ones in the existing literature, with excellent short- and long-term outcomes including significant improvement in functional symptoms. However, it is a specific technique that is not well-known by the majority of surgeons. Consequently, we are organising a workshop at Hospital del Mar in Barcelona to introduce this puborectalis muscle repair technique to the Spanish surgeons. This will enable the enhancement of the quality of life of patients with this condition, who currently have limited opportunities to improve.

This fellowship has equipped me with an in-depth understanding of functional and pelvic floor disorders, along with the essential knowledge and clinical skills to effectively manage these challenging conditions, from diagnosis to surgical intervention.

It has had a substantial influence on my current daily practice, extending from outpatients to the operating room. I am now confident in my ability to conduct a comprehensive history, physical examination, and anorectal ultrasound for my patients who suffer from functional and pelvic floor disorders. I have also underscored the importance of remaining informed about the constantly changing surgical techniques. Moreover, the fellowship has emphasized the value of a multidisciplinary team in the treatment of complex functional and pelvic floor disorders. As a result, I intend to apply these knowledge and skills I have acquired, which I am confident they will improve the quality of care I offer to my patients.