In November of 2016, I had the great honour of travelling to Japan as an ESCP Japan travelling fellow. This is a prestigious annual fellowship, established in recognition of the history and friendship between the European and Japanese societies.
Previous fellows have detailed their experience here:
- 2015: Martyn Evans (UK)
- 2014: Colon Peirce (Ireland)
- 2013: Mohamed A Thaha (UK)
- 2012: David Zimmerman (Netherlands)
- 2011: Samson Tou (Australia)
- 2010: Matthew Tutton (UK)
Applications for this now highly competitive fellowship are usually announced in the spring/summer of the year of the travelling fellowship and the visit is tailored to include time in a number of Japanese colorectal centres chosen by the successful applicant. The visit is also timed to coincide with the annual autumn JSCP annual meeting, during which the ESCP fellow gives an invited lecture.
Recently, a separate fellowship has also been set up to allow ESCP Fellows to visit Korea. A report from the first travelling fellow to Korea is given here:
In preparation for my fellowship, the Japanese Society of Coloproctology (JSCP) had nominated a previous JSCP European travelling fellow to 'host' me and become my travelling companion/local guide. I owe a huge debt of gratitude to Dr Kenji Matsuda, who expertly arranged my visit over the course of a number of emails prior to my journey, accommodating my preferred centres, communicating with surgical departments and arranging everything, from train tickets, to my hotel stays throughout my trip. His assistance was invaluable and it is not an exaggeration to say that his patience, friendship and guidance throughout the visit were one of the most important aspects of this fellowship’s success.
I flew from Manchester, UK via Schipol, Amsterdam to the city of Tokyo (population 14 million) - an 18-hour journey. On arrival, the disorientation of jet lag and inability to read the majority of signs is perhaps the most obvious cue that you are about to embark on a real adventure. The transfer process from Narita airport to Tokyo central allowed my connection on the impressive bullet train (shinkansen) to Mishima. Here, I greeted Dr Matsuda who treated me to an excellent traditional Japanese welcome meal, as we reviewed the plans for the forthcoming visits.
The next day, we travelled to the Shizuoka Cancer Centre. This is a modern, ultra-clean institution with stunning views of Mount Fuji and an impressive atmosphere of calm and well-being. There I met with Dr Yusuke Kinugasa and his excellent and enthusiastic team, discussed patient cases and observed robotic ultra-low anterior resection with lateral lymph node dissection. In this centre, this is a very common approach to the treatment of primary rectal cancer, avoiding the use of radiotherapy/chemotherapy. Of note, the number of oncologists in Japan is small in comparison to UK levels, and in a number of Japanese centres, Japanese colorectal surgeons are responsible for the management of radiotherapy/chemotherapy.
There is a high volume of robotic surgery performed in this largely private specialist cancer centre, but it is performed with impressive team efficiency and dynamic. That night, Dr Kinugasa and his whole departmental team kindly treated me to an amazing traditional meal in two separate Japanese restaurants. This kind of Japanese hospitality was a consistent theme throughout my visit.
Towards the end of the first week, from Shizuoka, we next travelled by shinkansen to Nagoya and onto the annual JSCP meeting in Ise. There, we were warmly welcomed by Prof Maeda, JSCP past-president, and joined the organising committee (with invited guest ESCP president Emmanuel Tiret) at a beautiful traditional banquet.
During this, the wearing of ceremonial robes (kimono) was a mandatory (and novel) experience, and Prof Tiret and myself were honoured to take part in the traditional ceremonies during the meal. One of the most enjoyable, entertaining and fascinating meals I have ever had the pleasure of attending.
The next day, after attending the opening of the JSCP meeting, Dr Matsuda kindly guided me to the nearby Ise shrine. Ise is a beautiful and peaceful sanctuary with a large Shinto shrine built inside dense forest, on the Isuzu river. A special place of amazing calm and reflection, surrounded by the stunning beauty of Japanese scenery.
Later, we returned to the meeting, a gathering of over 2,000 colorectal surgeons, were I gave my invited lecture on the updated findings regarding social media and colorectal surgery. I was delighted by the local audience engagement, insightful questions, and enthusiasm for the concept of free and global exchange of surgical knowledge online.
Later that day, I enjoyed many of the talks on advanced surgical techniques, lectures about surgery from the various countries in Asia, a large number of talks on robotics and transanal total mesorectal excision (TaTME), and I watched the SNS hands-on course in action. It was also a pleasure to catch up again with the young surgeons from Shizuoka cancer centre and watch them present their excellent surgical outcomes.
That night, I was invited to a stunning presidential meal hosted by Prof Maeda. Here, amongst a group of top international colorectal surgeons, I learned about developments in Korea and Japan and explored the close ties that many Japanese surgeons have with Europe, having visited or been on fellowships previously.
On the second day of the JCSP meeting, I heard many more fascinating talks on a wide variety of colorectal surgical approaches and outcomes and watched whilst our own ESCP president gave his invited talk and was honoured for his fellowship and friendship of the JSCP. Thankfully, whilst many of the conference talks are delivered in Japanese, the slides are often in English – leading to a great educational insight on the trend of developments in colorectal science in Japan.
Later that day, we left Ise and travelled by shinkansen to Kyoto. This part of the trip was carefully arranged by Dr Matsuda to allow a broad and rich experience of Japanese culture and tradition, and whilst in Kyoto I visited a number of truly amazing sites, temples and shrines, including the Shogun palace.
After a memorable experience in Kyoto, I travelled to Tokyo, and the Tokyo University Hospital with the internationally recognised team led by Professor Watanabe. Here again, the team were exceptionally welcoming and I observed complex rectal cancer resections, colo-anal anastomosis, intra-peritoneal chemotherapy and surgery for cancer in the setting of vascular variants. The quality of the pre-operative planning, ongoing research studies and pre-operative work-up/radiological technology was exceptional. Prof Watanabe’s team took great care of me whilst I was there, and it was a pleasure to visit this prestigious centre and see the remarkable work undertaken.
During the Japanese national holiday the following day, I toured the various sites in Tokyo, a truly outstanding city in both the quantity and vibrancy of culture and the sheer volume of humanity that surrounds you on your daily travels through it. It was also around this time that I woke up to my first earthquake (there were two during my visit). To this Irishman, this was a somewhat alarming wake-up call on the 7th floor of a hotel building, but the local population of course simply shrugged and returned to their normal daily activities within minutes. These events are in fact regular occurrences in Japan and my inexperience of them was regarded with some gentle bemusement by my hosts – but for me, it was yet another first in Japan.
Later that day, I travelled to the beautiful and historical port city of Yokohama. Here, I visited the Yokohama marina and later had the honour of a private meal with two established greats of Japanese IBD surgery, Professors Fukushima and Sugita. Amongst the stunning cuisine, we spoke for a number of hours on European and Japanese surgery, politics and culture – a truly fascinating and privileged experience.
In Yokohama, I was involved in and observed the team’s morning patient review meetings, and was able to move freely amongst several simultaneous operating theatres and learn from the brilliant senior and junior staff. Throughout my time, I was able to interact with the unit’s surgeons and explore and exchange thoughts on IBD and surgical culture. Again, the Yokohama team treated me to a wonderful meal and very warm send off to complete an excellent fellowship.
Throughout this fellowship, I explored the fascinating and rich Japanese culture and had the privilege of observing how colorectal expertise, techniques and research in this country has evolved quite separately to that of European colorectal surgery. Sometimes the practice was very similar but there were also quite often subtle and important differences, revealing an alternative view or insight into colorectal disease. This experience provides an amazing opportunity to reflect on one’s own practice and principles and underlines the huge potential benefit, opportunity and importance of the free and open international exchange of ideas and practice.
In conclusion, the ESCP Japan fellowship was truly outstanding. This fellowship provided a humbling and inspirational life experience and deep and invaluable surgical education in equal measure. Thinking back, it is difficult to pay justice to the care, thoughtfulness, and generosity of my hosts, who prided themselves on a warm culture of open hospitality throughout my visit. I have made many new friends on my journey, which I will hopefully continue to work with and be in contact.
I absolutely recommend that any young European colorectal surgeon strive to gain the privilege to travel to these or other Japanese colorectal centres, optimally as part of this ESCP exchange fellowship or indeed independently. The benefits to one’s own personal education and reflective practice are immeasurable and the experience truly unforgettable.
Mr Richard Brady FRCSEd MD
ESCP Japan Travelling fellow 2016