It was a great honour to be selected as the recipient of the 2011 ESCP Japan Travelling Fellow. This allowed me to spend a week at the world renowned National Cancer Centre (NCC) in Tokyo before attending the 66th Japan Society of Coloproctology (JSCP) meeting in Tokyo. During my research years in London, I had read many high quality scientific journals from Japan and had hoped that one day I would be able to visit and observe the Japanese health system.
I am therefore extremely grateful that this Travelling Fellowship was awarded to me and gave me the opportunity to have a closer look at the Japanese surgical practice.
With the help and advice from the committee members of JSCP (Professor Kameoka, Professor Maeda, Dr Itabashi and Dr Ohno) my week of attachment at the NCC was organised by the local host, Dr Akasu, Chief of the colorectal unit. I was staying at the New Otani Hotel during the entire visit; this was also the place where the JSCP was held, around the picturesque surrounds of a beautiful Japanese garden.
Dr Akasu planned my itinerary during my time at the NCC and gave me a personal guided tour of the hospital. I was made very welcome by all the staff at the department and enjoyed the hospitality, in particular from Dr Takawa, the Chief resident.
The NCC in Tokyo is located in Tsukiji, opposite the Tsukiji fish market, famous for being the biggest fish market in the world. The hospital itself has 600 beds and around 20 operating theatres. There are 4 consultants (Dr Akasu, Dr Moriya, Dr Fujita and Dr Yamamoto), 1 chief resident and 3 residents in the firm. The hospital mainly provides elective services. There are around 450-600 cancer resections/year. It boasts of having a paperless patient record management system and all the records are computerised.
I participated in ward rounds, theatre sessions and endoscopic procedures. Ward rounds typically started between 7 to 7:30am run initially by the residents, they were responsible for checking on the progress of patients and devised care management plans. At the end of the ward round they would present their updates to all the consultants. This offered the team opportunity to fine-tune their management plans.
I observed several operations during my stay at the NCC including ultra-low anterior resection, total mesocolic right hemicolectomy, laparoscopic high anterior resection and a reduced ports laparoscopic right hemicolectomy, where a SILS port and one extra 5 mm epigastric port were used. I learnt that it was not common practice to have defunctioning ileostomy, even for an ultra-low anterior resection on male patients. Irrespective of whether the approach was open or laparoscopic, surgeries were performed with perfection meaning that there was virtually no blood loss, each operation was assisted by at least two residents and with strong emphasis on teaching in particular. I was impressed with the meticulous approach taken by all the surgeons, for example before a laparoscopic procedure; the operating surgeon would personally check the theatre table and equipments. All the tubings/cords from the laparoscopic equipments were aligned and tied with sutures before any incisions were made.
At the NCC, endoscopic procedures were performed by the gastroenterologists. I saw an Endomucosal resection (EMR) and an Endosubmucosal dissection (ESD) performed during one of the afternoons. These were teaching cases whereby junior doctors performed the procedures under the supervision of the chief resident. The room was filled with Gastroenterologists from every continent of the world, all eagerly watching to master the techniques.
I was waiting with bated breath for an opportunity to witness a lateral lymph node dissection. Unfortunately there were no suitable cases during my week in the hospital. However Dr Moriya gave us (together with residents and a couple of overseas doctors) a personal tutorial that included some of the educational video collections for example total pelvic exenteration with sacretomy for fixed recurrent tumour in the pelvis. I was given a collection of videos by Dr Moriya and Dr Akasu on various high quality open and laparoscopic surgeries including lateral lymph node dissection. One of my interests is editing surgical videos so I knew I could fully appreciate the quality and educational value of the videos. They will continue to serve me well and are an excellent source of reference for my own practice.
During the weekend, Dr Takawa, the chief resident took my wife and I on a personal tour around Tokyo. After lunch at a famous local fish restaurant, we went to the North East part of Tokyo including Asakusa, where we walked through and admired the surrounding temples and museums.
The 66th JSCP meeting lasted for over two days and it was well attended. The pre-meeting dinner was attended mainly by the senior colorectal surgeons. Dr Akasu introduced me to many famous Japanese Surgeons and I was made especially welcome by Professor Maeda. Most of the presentations were given in Japanese and many had presented with the use of high definition operative surgery video clips. I was impressed with the overall quality of the presentations. One of the highlights of the meeting was the Korean-Japan Joint Symposium and I was overwhelmed by how widely Robotic colorectal surgery is being practised in this part of the world. There were overseas speakers including Professor Solomon from Australia who presented his results on recurrent rectal cancer surgery, Dr Coleman from the UK who presented the laparoscopic colorectal surgery training programme in the UK, Dr Bleier from America who presented the LIFT procedure, and he surprised us all by having all his presentation slides translated into Japanese. My own presentation was on single incision laparoscopic colectomy in South Australia and it was chaired by Professor Maeda.
Overall I found the Japan Travelling Fellowship fruitful and rewarding in many ways. I left Japan feeling I had gained valuable insights and ideas. It is perhaps my new friendship with Japan that has instilled the deepest impression in me and I am truly thankful to the ESCP and JSCP for this award. I feel particularly honoured to have this opportunity, sharing our common goals and embracing the diversities from within and between our clinical practices.
Samson Tou, Laparoscopic Colorectal Fellow
The Queen Elizabeth Hospital, Adelaide, Australia
