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ach year ESCP provides the opportunity for ten young surgeons with an interest in coloproctology to undertake a three-month fellowship in a different country. The 2013/14 fellowships were generously supported by a grant from Medtronic, as well as funds from ESCP. Here, four of the 2014 fellows report on their experiences:
Felix Aigner
from Innsbruck Medical University, Austria
visited University Clinic Gasthuisberg, Leuven, Belgium under the direction of André D’Hoore
From January to March 2014 I spent a three-month fellowship funded by the European Society of Coloproctology (ESCP) at the department of abdominal surgery at Gasthuisberg Leuven hosted by Professor Andre D’Hoore.
My primary intention for choosing this renowned institution was to focus on laparoscopic colorectal surgery with special regard to treatment options for inflammatory bowel diseases and colorectal cancer. The University Clinic Gasthuisberg belongs to the biggest clinics in Benelux with 1995 beds and 450 medical staff members. The department of abdominal surgery comprises 65 beds and is divided into four subunits (colorectal surgery and proctology, hepato‐pancreato-biliary surgery, bariatric surgery, abdominal wall and pediatric surgery) with seven clinical chiefs and three supervisors and two or three fellows as well as ten surgical trainees.
A total of approximately 4700 operations are performed each year at the department of abdominal surgery with the vast majority covering colorectal interventions. In these three months I could observe and actively scrub in 180 colorectal procedures excluding the huge amount of examinations under anaesthesia and proctology day case surgeries I could additionally join during my fellowship.
The colorectal lists I basically attended were organized and scheduled by a common secretary office and mainly covered by the three staff surgeons Professor D’Hoore, Dr Albert Wolthuis and Dr Anthony De Buck, also the out-patients clinic and day case clinic which facilitated standardized indications, approaches, and teaching standards.
Gasthuisberg has also a well-known reputation as tertiary referral center for inflammatory bowel disease and provides a close collaboration between IBD gastroenterologists, colorectal surgeons and radiologists on the base of weekly board meetings. Indications are discussed on a high academic and collaborative level for both ulcerative colitis and Crohn’s disease patients. I really appreciated the minimal invasive approach to mainly young patients including single-incision approaches.
During my fellowship I followed several ventral mesh rectopexies, a technique established by my host Professor D’Hoore and former chief of the department Professor Penninckx encountering a couple of indications (full-thickness rectal prolapse, genital prolapse, rectal intussusception, rectocele and enterocele) which I will definitely transmit to my clinical practice.
I was very honoured to take part in the academic course of the department as well, by giving a grand round lecture on “Anatomical considerations on pelvic floor surgery” and collaborate with the colorectal staff in terms of research on transanal minimal invasive surgery (TAMIS) for colorectal cancer. We were able to launch future research projects on clinical questions.
Looking back to an outstanding and educational time in Leuven, I want to thank the ESCP for this great fellowship and Professor D’Hoore and his team for hosting me during these three months.
Dank u wel en tot ziens!
Pamela Buchwald
from Helsingborg Hospital, Sweden
visited St Mark´s Hospital, Harrow, UK under the direction of Ian Jenkins
I had the opportunity to spend three months at St Mark’s hospital Harrow, UK. I was there to learn more about pelvic exenterations and laparoscopic colorectal surgery. St Mark’s is a high volume colorectal hospital that offers all kinds of colorectal procedures such as complex cancers, IBD surgery including IPAA, intestinal failure and polyposis related procedures, advanced proctology etc. The hospital is a national referral centre for intestinal and colorectal disorders and a recognized centre of excellence.
I was lucky to join Mr Ian Jenkins’ team, since he is a very skilled surgeon. He demonstrated new approaches to pelvic exenterations such as subcortical sacrectomy and resection of sciatic spine for lateral side wall disease. Mr Jenkins and his colleague Prof Kennedy, who worked at the same team, taught me different ways, to what I am used to, to perform laparoscopic colorectal surgery including small tips and tricks.
I really enjoyed the time I spent at St Mark’s and I would really like to thank ESCP for the scholarship. I would especially like to thank Mr Jenkins, Prof Kennedy, Prof Clark, Mr Warusavitarne and the RSOs who guided me through the British healthcare system. For all practical issues Mrs Janice Ferrari was extremely helpful.
Dobromir Dimitrov
from Medical University Pleven, Bulgaria
visited Imperial College London, UK under the direction of Peter Dawson
It was a great honor and privilege for me to be a Fellow of the ESCP in Imperial College-London and to spend three wonderful months with the surgery team there.
During this period, I had the opportunity to participate in many laparoscopic, SILS and conventional surgery operations in Coloproctology. I took part in weekly academic meetings of the GI team, and once a week in the outpatient clinics. I had the opportunity to attend meetings of the MDT, where I learned contemporary approaches to the management of colorectal cancer. It was an excellent opportunity for me to have full access to the library of Imperial College.
For every young surgeon it is essential to meet, discuss and work with experienced surgeons. Modern medicine requires introduction into the clinical practice of many innovative and minimally invasive methods. I believe that these three months gave me a lot of new knowledge and experience that I can try to apply in my practice or introduce to the University Hospital in Pleven.
I want to thank the whole team from the Department for surgery and cancer at Imperial College-London, for the warm welcome, the efforts to help me adapt easier, and for the friendly approach.
Maziar Nikberg
from County General hospital, Västmanlands county, Västerås, Sweden
visited The Royal Marsden Hospital, London, UK under the direction of Paris Tekkis
I was fortunate and very honored to have been a part of Prof Paris Tekkis team during a period of 3 months from January – May 2014, as a fellow of ESCP, sponsored by Medtronic. My primary goal was to gain experience in complex colorectal surgery especially locally advanced and recurrent rectal cancer surgery. This was achieved by assisting Prof Tekkis and being a part of his team. We performed several operations, including extralevator abdominoperineal resection APE and pelvic exenterations. These operations were always preceded by the MDT meetings wherein a substantial number of patients with locally advanced rectal cancers were discussed in detail and the procedures to follow were planned. I was also privileged to participate in several operations (laparoscopic and open abdominal) for inflammatory bowel disease.
In addition to the above, I also assisted in operations such as coloanal pull through, cecal flip, and Carter stoma formation, and plastic surgery with rectus abdominis and Gracilis flap reconstruction of the pelvic floor. It is pertinent to point out that these procedures were completely new to me.
Furthermore, in addition to the heavy clinical practice we found time to start a collaborative research project in squamous cell carcinoma of the anus. A comprehensive data base was set up and the results of this study will be presented as an abstract at the ESCP meeting in Barcelona September 2014.
I take this opportunity to thank Prof P. Tekkis and all the members of his team; especially Mr Rasheed and Mr Kontovounisios; who went out of their way to make my stay memorable. It has been my privilege to have made new friends.
I thank the ESCP and Medtronic for having afforded this opportunity to have widened my horizons.
