ESCP offered 3-month Functional Disorder Fellowships and 6-month Robotics Fellowships for 2021-2022. Fellows report here on their experiences.

Click on a fellow's name to read their report

NameCountryHost CentreFellowshipDates
Christina Fleming Ireland CHU Bordeaux, France 6-month  
Jeremy Meyer Switzerland Amphia Hospital, Breda, The Netherlands 6-month  
Kapil Sahnan UK Hospital Valle de Hebron, Barcelona, Spain 6-month April-Sept 2022
Constantinos Simillis UK QA Portsmouth, UK 6-month  
Gaetano Gallo Italy The Royal London Hospital, UK 3-month Nov-Dec 2021 and Jan-Feb 2022
Tsvetomir Miroslavov Ivanov Bulgaria Hospital Universitario Marques de Valdecilla, Santander, Spain 3-month  
Necdet Fatih Yasar Turkey University Hospital of Pisa, Italy 3-month June-Aug 2022

Sponsors

6-month Robotics Fellowships were sponsored by Intuitive

Intuitive

3-month Functional Disorder Fellowships were sponsored by Medtronic

Medtronic new logo


Kapil SahnanKapil Sahnan

From: UK

Visited: Vall D’Hebron, Barcelona, Spain

Supervisors/Trainers: Professor Eloy Espin Basany (lead), Dr Francesc Vallribera, Dr Alejandro Solis, Dr Miquel Kraft

I am extremely grateful to the colorectal unit at the Vall D’Hebron Hospital, the ESCP education committee and Intuitive for this opportunity. The unit led by Professor Espin has four robotically trained surgeons who perform ~300 robotic resections a year.

The unit is incredibly hospitable, and all the staff were extremely welcoming, kind and patient with me as I embarked on my robotic learning curve. I was given the opportunity to work through their modular training approach to robotic surgery and began to understand robotic surgery and the various nuances in ways I had not appreciated before.

With respect to robotic surgeries, I became familiar with right hemicolectomies with intracorporeal anastomosis, partial/complete mesocolic excision, abdominoperineal resection, ventral mesh rectopexy, retrorectal cyst surgery and TTSS (Transanal transection and single-stapled anastomosis).

The Unit has a very modular approach to understanding and training in robotic surgery. As a novice before my fellowship, I was sent operative videos to help understand the standardised operative approaches, I started as a bedside assistant and then adopted a modular approach to operating on the robotic platform before operating as the main surgeon. Through this approach, I began to appreciate the fundamentals and grow from a strong foundation to achieve robotic competence.

The academic unit at the Vall D’Hebron is incredibly prolific and varied. There is a weekly academic meeting that follows the clinical handover and updates for each of the projects are discussed. The unit’s research output includes clinical trials, educational videos and database registry work.

I have been fortunate to contribute to some of the educational video content from the unit and look forward to a collaborative academic partnership in the future.

The unit is exceptional in many other fields other than robotic surgery and I had the opportunity to work with the other fantastic attendees (Dr Sanchez, Dr Marti, Dr Marinello) and learnt about the results driven approaches to surgical site infection, the detection of anastomotic leak and training junior residents.

My time with Professor Espin in Barcelona has been a career highlight and I feel that I have not only developed my robotic competencies but also have matured and grown as a surgeon. I have made some lifelong friendships in Barcelona, and I look forward to future collaborations with my Catalan friends and colleagues.

Kapil Sahnan fellowship - a collage of photos

Fellowship sponsored by IntuitiveMedtronic new logo


Gaetano GalloGaetano Gallo profile

From: Italy

Visited: The Royal London Hospital, Barts Health NHS Trust, UK

Supervisor: Mr Pasquale Giordano, Consultant Surgeon and Honorary Senior Lecturer, Pelvic Floor & Abdominal Wall Service Clinical Lead

I owe a huge debt of gratitude to Mr Giordano who warmly welcomed me to the Royal London Hospital. I would like to thank him for his friendship and mentorship.

I was involved in surgery for faecal incontinence, constipation, rectal prolapse, perianal, pilonidal and rectovaginal fistulas and haemorrhoids (both office-based and operating room procedures). For these procedures (e.g. dearterialization and mucopexy; anolift), Mr Giordano is considered one of the leading
experts and promoters.

Moreover, although my primary focus was on proctology and functional disorders, Mr Giordano has considerable experience in dealing with complex abdominal wall reconstructions as well as colorectal cancer treatment. For this reason, I had the opportunity to assist in surgery for both these conditions and multidisciplinary team meetings.

I was actively involved in research projects, many of which are in progress, and I hope to publish the related articles in the coming few months.

Apart from the activity at the Royal London Hospital, I followed the outpatient and surgical activities of Mr Giordano in two other places, The Holly Private Hospital and The London Clinic in which he performed not just surgical procedures in the operating theatre but also colonoscopies and office-based procedures.

The procedures below are only a part of what I have had the opportunity to observe/assist/perform:

OperationFrequency
Dearterialization and Mucopexy (THD Anolift) 10
Laparoscopic Ventral Mesh Rectopexy 4
Laparoscopic Right Colectomy 4
Endoscopic Pilonidal Sinus Treatment (EPSiT) 1
Laparoscopic Loop Ilestomy and Perineal reconstruction 3
Fistulotomy 4
Fistulectomy and flap 3
Sphincteroplasty 3
Laparoscopic Resection and rectopexy 2
Abdominal Wall Reconstruction 2

I attended multi-disciplinary team meetings on colorectal cancer, abdominal wall and pelvic floor
diseases, and training sessions on THD Anolift. I also contributed to the following publications:

  • 'Minor Anorectal Conditions', Colorectal Surgery, 7th edition. Sue Clark and Phil Tozer (editors)
  • 'THD Anolift for advanced haemorrhoidal disease: a video vignette'. Giordano P, Schembari E, Cocco F, Gallo G. Colorectal Dis. 2022 Aug; 24(8):1018-1019. doi: 10.1111/codi.16134. Epub 2022 Apr 15. PMID: 35368135
  • Special Issue 'From Precancerous Lesions to Anal Cancer: Screening, Diagnosis and Treatment',  Frontiers in Oncology ISSN 2234943X

This fellowship has inspired me in innumerable ways but there is one aspect that I would like to mention more than the others. Clinical practice and surgeon-patient relationship (communication, trust, decision–making and patient satisfaction) in the UK is substantially different from Italy. One of the things that struck me, in addition to the surgical skills acquired, and will affect my future activities is Mr Giordano's ability to discuss with patients highlighting the pros and cons of each type of procedure.

I strongly believe that, especially in the treatment of proctological and pelvic floor diseases, which are often functional, patient's quality of life is at risk and for this reason the impact of the discussion is decisive.

The technical and non-technical skills acquired are and will be of great benefit for my clinical practice and for my patients.

Fellowship sponsored by MedtronicMedtronic new logo


Necdet Fatih YasarNecdet Yasar with Gabriele Naldini

From: Turkey

Visited: Proctology and Pelvic Floor Clinical Center, University Hospital of Pisa, Italy

Supervisor: Professor Gabriele Naldini

I would like to express my gratitude to the ESCP for being awarded ESCP 3-month Fellowship (June-August 2022) at the Proctology and Pelvic Floor Clinical Center at the University Hospital of Pisa under the supervision of Professor Gabriele Naldini. I also extended my placement for an extra three months until December 2022 to get maximum benefit from this clinical fellowship.

Since the Proctology and Pelvic Floor Clinical Center at the University Hospital of Pisa is solely dedicated to proctology and pelvic floor diseases, I had a great opportunity to increase my experience in this specific field.

To start with proctology, I have learned more details about the treatment of hemorrhoidal disease, anal fissure, and fistula including all the available techniques. I have observed, assisted, and was the first surgeon in procedures such as Milligan-Morgan, stapling procedure, fissurectomy and myotomy, application of botox, flap, LIFT, VAAFT, FiLAC for perianal fistula, management of rectovaginal fistula with/out graciloplasty, as well as EPSIT and Bascom procedures for pilonidal sinus. Proctology and Pelvic Floor Clinical Center at the University Hospital of Pisa is one of the pioneer centers to use mesenchymal stem cells for proctological diseases such as fistula.

For pelvic floor diseases, I had the chance to observe in the multidisciplinary outpatient clinic where we examined the patients with urogynecologists. Also, I learned how to use endoanal and perineal ultrasound and anal manometry in decision-making in pelvic floor diseases. I increased my experience in sphincter repair and learned about Delorme and Altemeier procedures.

University Hospital of Pisa is a great centre for training in robotic surgery. Every Tuesday, I observed, assisted, and even partially did robotic surgery such as ventral mesh rectopexy for isolated rectal prolapse or colpoproctosacropexy for more complex pelvic organ prolapse and lateral suspension of pelvic organ prolapse. Sacral nerve modulation was another modality, that I have learned, for the treatment of fecal incontinence. Besides all these procedures, I observed the rehabilitation of pelvic floor disease patients using biofeedback.

OperationFrequencyPerformed/Assisted/Observed
Stapler procedure 3/week 5/25/50
Sphinter repair 2/month 0/3/10
Flap for anal fistula 4/week 4/30/50
Robotic colpoproctosacropexy 2/week 3 (partially)/20/40
Myotomy for anal fissure 2/week 4/30/50
Mesenchimal stem cells for proctological diseases 1/week 2/15/25
SNM 2/week 2/10/20
Delorme procedure 1/week 1/5/20
LIFT 2/week 2/5/20
Bascom 2/week 4/10/40

During my fellowship, I attended the pelvic floor diseases masterclass in Pisa and had the opportunity of learning from experts from other high-volume centers not only from Italy but all around Europe and also shared our experience with other colleagues from other hospitals. I had the opportunity to use the simulator for robotic surgery whenever I wanted without any limitation. Periodically, we also did educational sessions using operative videos with Professor Naldini. Every Friday, there was an audit where we discussed the patients in a warm and friendly atmosphere and planned the surgeries for the next week.

I have participated in five pieces of research and wrote a paper titled 'Could the robotic technology be the answer to reduce mesh erosion complication in pelvic floor suspension surgery?' that will be submitted.

Understanding the complexity of pelvic floor diseases and the importance of co-working with other departments such as urogynecology, gastroenterology, and pelvic floor rehabilitator has changed my attitude toward pelvic floor diseases.

Overall, I had a great experience with this clinical fellowship and learned so much in the field of proctology and pelvic floor diseases that will change my daily practice. I believe that I can establish a pelvic floor unit in my university, co-working with urogynecology and gastroenterology, and hopefully would start a pelvic floor rehabilitation unit as well. In addition to the operative techniques that I learned or improved, I learned to do endoanal and perineal ultrasounds, which I will start to do in my daily routine.

I am grateful to ESCP and Medtronic for providing me with this fellowship opportunity and would like to express my sincere gratitude to Professor Gabriele Naldini and all consultant surgeons at the Proctology and Pelvic Floor Clinical Center at the University Hospital of Pisa.

Necdet Yasar in surgery

Fellowship sponsored by MedtronicMedtronic new logo

ESCP Affiliates