Reports from ESCP Fellowships 2014–2015

ESCP offered nine 3-month fellowship opportunities between August 2014 and June 2015, each worth €8,000 and eight of these were taken up. ESCP would like to express their sincere thanks to Ethicon and Medtronic, each company supported three fellows and ESCP supported three too.

These fellowships were awarded to:

Aránzazu Calero Lillo

I was delighted to visit the Colorectal Department of Oxford University Hospitals thanks to ESCP's Fellowship grant, sponsored by Medtronic. I stayed between 1 October and 22 December 2015 in this marvellous department.

The main interest of my visit was to see pelvic floor diseases, but once I arrived, I could not only see this, but also I had to see the rest of fields of colorectal surgery. British laws are very strict about hospital activity, and as I was an Observer, I was not allowed to scrub or visit patients by my own, but I am really happy for the time spent and how much I have learnt.

• On Mondays I went to pelvic floor theatre with Mr Lindsey, Mr Jones and Ms Gorissen. I saw lots of ventral rectopexies, Delormes, STRAP, HALO procedures.
• On Tuesdays I observed TEM procedures performed by Mr Cunningham.
• On Wednesdays one could see mainly inflammatory bowel disease surgery or colorectal cancer surgery with Mr George and Mr Guy.
• On Thursdays I went to the Endoscopy Department in the morning, and to the Pelvic Floor Clinic in the afternoon.
• On Fridays I was going to theatre, mainly seeing rectal cancer surgery in taTEM approach with Mr Hompes.

Despite the recent retirement of Professor Mortensen, I have been really glad to see him at theatre.

I was lucky to assist to the Pelvic Floor Physiology Department leaded by a wonderful Nurse Team, where I could learn more about colonic irrigations, plugs, rehabilitation and anal ultrasound and manometry.

I also was fortunate enough to assist in teaching sessions almost every week, and to assist to the Oxford Colorectal Summit in October and to the fabulous taTEM course in December.

I want to thank this amazing team for everything they taught me and to the ESCP for supporting my stay in Oxford.

Anvar Makhmodov

From: Medical Academy of Postgraduate Education, Belarus

Visited: Leicester General Hospital, United Kingdom under the direction of Mr Sanjay Chaudri

I was honoured to be selected for the three month fellowship from ESCP from January to April 2015. It was a unique opportunity to get acquainted with advanced colorectal surgery in the UK. I saw many colorectal operations and procedures at Leicester General Hospital (LGH) - some for the first time. Among them were robotic colorectal surgery, certain types of abdominal wall reconstruction for giant postoperative and parastomal hernias.     

LGH has extensive experience in the treatment of inflammatory bowel diseases, colon and rectal cancer. Most of the operations are performed laparoscopically, which was the main focus of my fellowship. I also had an opportunity to see an enhanced recovery program and day-case surgery. Besides colorectal operations, I was able to track the tactics for advanced colon cancer, including liver resection for metastatic lesions.  

With the support of my supervisor and Cook Medical company, represented by Paul Boden and Helene Falconer, I also attended a course ‘Component Separation for Abdominal Wall Reconstruction’ in Cambridge. It was very useful to learn about AWR, and in particular training on cadavers.        

In addition, I had the honour to visit the Queen Alexandra Hospital in Portsmouth at the invitation of Professor Amjad Parvaiz. He shared with me their experience of treatment and answered many of my questions. During these couple of days I was able to assist him in the laparoscopic resection of the colon and see the robotic colon resection. I want to thank Professor Parvaiz for this opportunity.
 
During my fellowship, I got acquainted with English culture, and visited wonderful cities such as London, Edinburgh, York, and Birmingham. During my visit, I was well supported by my supervisor Dr Sanjay Chaudhri. It was a wonderful time, with great benefit for my professional growth. I am very grateful to ESCP, my supervisor Sanjay Chaudhri and all those who helped and supported me during this fellowship.

Zaman Mamedli

From: N.N.Blokhin Russian Cancer Research Center, Russia

Visited: Universitätsklinikum Erlangen, Germany under the direction of Prof Werner Hohenberger

I spent three months from January to March 2015 in Erlangen University clinic hosted by Professor Hohenberger. It was an excellent opportunity and I am very grateful to ESCP and the Fellowship sponsor companies for their support. This fellowship broadened my knowledge in the field of abdominal surgery, colorectal surgery especially. Professor Werner Hohenberger is a great surgeon and teacher and I am very thankful to him for sharing his experience with me.  

During my visit, I observed and participated in many surgeries, especially gastrointestinal cancer cases. Professor Hohenberger is a follower of the “Erlangen style” of surgery and the best performer in my opinion. His surgical technique is excellent, and despite being very busy with everyday routine work, he always found time to explain or discuss matters with me.

I also visited the department of coloproctology under Prof. Klaus Matzel. The department sees a huge number of patients with benign colorectal disease every day and I had the chance to observe, learn and get hands-on experience in a wide variety of colorectal surgical diseases.  The experience I gained helps me in my daily practice now.

In addition to the heavy clinical practice, we found time to start a collaborative research project in rectal cancer patients who had complete clinical response. A comprehensive database was set up and investigation is ongoing. I do hope that we will get optimistic results in the next 2-3 years, and they will be published and presented at future ESCP meetings.

I really enjoyed the time I spent at the Erlangen Clinic and I would like to thank ESCP for this opportunity. Receiving this fellowship made a huge contribution to my colorectal surgery career. This experience is very important to my work, professional improvement and future life.  I would like to thank all staff in the department of visceral surgery at Erlangen who helped me so much; special thanks to secretaries Kristina Wolf and Petra Burbach-Magassa for their kind assistance and their help in organising my stay. My sincere gratitude also to my department for allowing me to leave for three months.

Nicoletta Pipitone Federico

From: Ospedale Santa Croce di Cuneo, Italy

Visited: Kantonsspital St.Gallen, Switzerland, under the direction of Dr Lukas Marti

Thanks to ESCP, I had this great opportunity to spend three months at the unit of coloproctology at Kantonsspital St. Gallen, directed by Dr. Lukas Marti. From day one, the whole team proved to be helpful, open to dialogue and discussion, and had a high level of preparation and great teaching skills.

I directly took part in all surgical activity at the operating theatre, both for oncological and functional colorectal elective surgery. I assisted with open and laparoscopic colorectal resections, TME down to up, colpo-sacro-rectopexy according to the ‘D’Hoore’ procedure; helping or operating as principal surgeon for proctological interventions (haemorrhoidectomy with ligasure, Longo hemorroidopexy, anal fissure surgery, STARR with PPH or TRANSTARR, treatment of perianal abscesses and fistula in ano, placement of sacral neuromodulators) I also witnessed the first anal magnetic sphincter implantation in Switzerland!

I also had the opportunity to participate in emergency surgical procedures such as colorectal resection for perforated diverticulitis, strangulated mesohernias, abscesses and fistulas in ano. Parallel to surgical activity in the operating theatre, I followed the outpatients’ consultations for colorectal and proctological diseases 3 days a week, and the interdisciplinary outpatient consultations dedicated to anal skin abnormalities (i.e. condylomata, anal intraepithelial neoplasia, follow-up on HIV-positive MSM) on Monday morning. Collaborating with Dr. Christine Maurus, I could improve my knowledge on faecal incontinence treatment with peripheral tibial nerve stimulation (PTNS), writing a manuscript is still in progress.

I therefore had three really intense months, rich in training, which allowed me to develop considerably from a professional point of view. I sincerely thank all the team and in particular Dr. Marti and Dr. Maurus, who patiently supported me daily with my coloproctological training.

Sebastian Smolarek

From: Connolly Hospital, Blanchardstown, Ireland
Visited: University of Rome Tor Vergatta, Italy under the direction of Prof Pierpaolo Sileri

I was fortunate enough to be granted this prestigious ESCP Fellowship in 2015. I spent three months from January to March 2015 at the Department of Abdominal Surgery in Policlinico Rome Tor Vergata, hosted by Professor Pierpaolo Sileri.

My primary intention for choosing this institution was to focus on laparoscopic colorectal surgery, colorectal oncology as well as the treatment of pelvic floor dysfunction. Policlinico Rome Tor Vergata is one of the most modern University Hospitals in Italy, with state-of-the-art medical equipment. The university hospital is well-equipped with diagnostic and therapeutic vanguard structures and is considered a flagship hospital at both national and international levels. The colorectal department, run by Prof Pierpaolo Sileri, is a part of the "General Surgical Department A" and performs approximately 1300 major colorectal procedures per year, most of them laparoscopically. The Colorectal department in Tor Vergata is a tertiary referral centre for the treatment of pelvic floor dysfunction, particularly obstruction-defecation syndromes, as well as being a regional referral centre for colorectal cancer.

During my fellowship, I followed several laparoscopic ventral mesh rectopexies, as well as STARR procedures for rectal prolapse.  I definitely plan to utilise these procedures in my future clinical practice. I also learned a new technique for the laparoscopic mobilisation of the left colon, for anterior rectal resections, as well as a new method for creating a laparoscopic coloanal anastomosis.

Prof Pierpaolo Sileri ranks among one of the most experienced surgeons in the treatment of deep pelvic endometriosis in Italy. During my fellowship, I was involved in the management of patients with deep pelvic endometriosis, as a part of multidisciplinary team involving colorectal and gynaecological surgeons.

Apart from the great ''hands on experience'' during my fellowship, I also had a great opportunity to expand my academic skills. I was very honoured to take part in the academic course within the department and collaborate with multiple research projects. Some of them will be presented in the ESCP meeting in Dublin, as well as two further articles that are awaiting publication.

In summary, I had an outstanding and educational time in Rome. This Fellowship will be an exceptional addition to my surgical training and it will definitely influence and boost my own practice. I want to thank the ESCP and sponsors for this great fellowship, and I particularly would like to express my gratitude to Prof Pierpaolo Sileri and Prof Luana Franceschilli, as well as the whole colorectal team, who made my stay both educational and enriching.

Cristi Tarta

From: University of Pharmacy and Medicine "Victor Babes" Timisoara, Romania
Visited: University Hospital, Aarhus, Denmark under the direction Prof Søren Laurberg

I would like to express my gratitude to ESCP for providing me with a great opportunity and surgical experience in the Colorectal Division of the Aarhus University Hospital for three months, from January to March 2015, hosted by Professor Søren Laurberg and his impressive team. Receiving this fellowship lead to a giant step forward for my surgical career.  
 
The Colorectal Division of Aarhus University Hospital is a highly specialized unit as their fields of interests are only a few: advanced colorectal cancer, rectal malignant and benign diseases, complex proctologic procedures and retroperitoneal sarcomas.
 
My main objective during this fellowship was to observe different aspects of colorectal surgery in order to improve my skills and utilize them back at home.

During the three months, I had the chance to observe, learn and get hands-on experience in a wide variety of colorectal surgical diseases. I was actively involved in robotic surgeries, and began training with robotic devices. I also observed and participated in methods (many for the first time) for the treatment of colorectal cancer, such as procedures for advanced colorectal cancer, HIPEC procedure, APR with different flaps or mesh reconstruction techniques. Minimally invasive surgery was an everyday practice at Aarhus and the surgeons were very skilled in these techniques, laparoscopic and trans-anal procedures.

The proctology department at Aarhus Hospital was involved in many research projects, and many difficult cases from nearby hospitals were referred here. I had the chance to participate in anal sphincter reconstruction, rectal prolapse and SNS (Sacral Nerve Stimulation) device placement, treatment of anal fistula with stem fat cells injections. The meetings inside the department were very intense and provided me with a lot of information.

Andrea Warwick

From: Royal Devon and Exeter Hospital, UK

Visited: University Hospital, Aarhus, Denmark under the direction Prof Søren Laurberg

From April to July 2015 I had the privilege to visit the Coloproctology unit at Aarhus University Hospital under the auspices of Professor Søren Laurberg and Dr Knud Thygesen. The department of anal physiology is a high volume, academically orientated tertiary referral unit for complex proctology, pelvic floor and functional disorders, run by Dr Lilli Lundby and Professor Peter Christensen, and these conditions were my primary focus.  The unit is internationally renowned and I was delighted to be offered the opportunity to spend 3 months as part of the team. I gained immeasurably from the experience.

I was integrated in to the unit, experienced a broad range of conditions and was exposed to several innovative procedures and techniques. I was taught to perform endoanal USS and manometry and was given extensive opportunity to practice. I experienced the management of difficult functional problems including in patients with neurogenic bowel dysfunction. I saw how conservative techniques employed meticulously can be used with excellent effect. For those with intractable problems I had the opportunity to perform the laparoscopic Malone procedure, insert Chait catheters and was given tips to manage these patients after their procedures. I was involved in surgery for faecal incontinence, including sphincter repair, SNS and Gatekeeper; I assisted and performed surgery for complex and recurrent fistula including pioneering stem cell treatment, LIFT, and fistulectomy with primary reconstruction.

I paid particular attention to how well run and organised the unit is, with a view to emulating this in the future. The patients are treated with an exceptionally high standard of care, in a streamlined, multidisciplinary, evidence based fashion.  The nursing staff within the unit are highly specialised practitioners and took the time to share their experience and knowledge with me. Particular thanks must go to Margit, Anette and Lotte. Thank you for making me so welcome.

Although my primary focus was on proctology and functional disorders I was also welcomed by other members of the colorectal team. I had the opportunity to assist in robotic surgery and I had unlimited access to a robotic simulator. I assisted in surgery for advanced and recurrent cancer, HIPEC, transanal proctectomy, transanal TME, and an S2 sacrectomy.

I was actively involved in research projects undertaken in the department and in particular undertook a project assessing functional rehabilitation after cancer treatment that I hope to publish later this year.  

The unit has inspired me in innumerable ways. I thoroughly enjoyed spending time in an innovative, evidence based (and also exceptionally friendly!) unit. I am overwhelmingly grateful for the teaching, discussions and hospitality that I was shown, and I’d like to particularly thank Dr Knud Thygesen, Dr Lilli Lundby, and Professor Peter Christensen, but also Helene, Irene, Mette, Henrik, Kenn, Peter, Jacob and all the others that I can’t mention personally! The 3 months that I spent in Aarhus will radically change my future practice and should be of great benefit to the patients that I treat in the future. Thank you ESCP!