ESCP offered 3-month Functional Disorder Fellowships and 6-month Robotics Fellowships for 2023-2024, as well as three Travelling Fellowships. Fellows report here on their experiences.
Click on a fellow's name to read their report. The most recent report is from Zoe Garoufalia.
| Name | Country | Host Centre or Country | Fellowship | Dates |
|---|---|---|---|---|
| Udo Kronberg | Germany | South Korea | KSCP Travelling Fellowship | Complete |
| Laura Koskenvuo | Finland | USA | ASCRS Travelling Fellowship | June 2024 |
| Zoe Garoufalia | Greece | Japan | JSCP Travelling Fellowship | November 2024 |
| Eleni Andriopoulou | Greece | Bordeaux Colorectal Institute, Bordeaux, France | 6-Month Robotic | February to July 2025 |
| Hazim Elyteb | United Kingdom | Limerick Hospitals Group, Limerick, Ireland | 6-Month Robotic | October 2024 to 16 April 2025 |
| Przemyslaw Gajewski | Poland | Vall d'Hebron, Barcelona, Spain | 6-Month Robotic | December 2024 to May 2025 |
| Georgios Kriakopoulos | United Kingdom | To be confirmed | 6-Month Robotic | January 2026 |
| Florian Kühn | Germany | Ospedale San Paolo, Università di Milano, Milano, Italy | 6-Month Robotic | July to December 2024 |
| Frida Ledel | Sweden | Vall d'Hebron, Barcelona, Spain | 6-Month Robotic | 16 June to 12 December 2024 |
| Blanca Montcusí Ventura | Spain | Geneva University Hospitals, Geneva, Switzerland | 3-Month Functional | 20 May to 20 Aug 2024 |
| Michael Okocha | United Kingdom | St. Marks Hospital, London, UK | 3-Month Functional | 30 Sept to 31 Dec 2024 |
Sponsors
6-month Robotics Fellowships were sponsored by Intuitive
3-month Functional Disorder Fellowships were sponsored by Medtronic
Laura Koskenvuo
From: Finland
Visited: ASCRS Congress 2024 in Baltimore, USA
Time period: June 2024
At the last ESCP meeting in lovely Vilnius in September 2023, I was honoured to be awarded ESCP's best paper for our MOBILE2-trial. This double-blind, randomised trial compared mechanical bowel preparation with and without oral antibiotics in patients undergoing rectal anterior resection and colorectal or coloanal anastomosis. The results showed a benefit of oral antibiotics in terms of overall complications, surgical site infections and anastomotic leaks.
I was thrilled to travel to Baltimore to present our trial. The travel arrangements went smoothly with a help of ESCP and Vanessa McCourt, and congress arrangements, coordinated with Kristi Conley from ASCRS, were equally efficient.
I arrived in Baltimore on the evening of 31 May and was fortunate to attend the entire meeting. The jet lag made it easy for a European to wake up early for the sessions 😉 and the convenience of staying at a hotel connected to the congress centre made access effortless.
The meeting was thoroughly enjoyable, spanning four days filled with fascinating lectures. I found the Rectal Cancer Super Sessions and the session on 'Watch and Wait' particularly compelling. I must commend our American colleagues for their exceptional lecturing skills; they have a remarkable ability to convey a wealth of information succinctly and effectively.
Many lectures discussed recent RCTs in rectal surgery, including PROSPECT, RAPIDO, PRODIGE, OPRA, to name a few, providing valuable new insights for me into these well-known trials. There was also a notable synergy from having concurrent meetings, as some new trials initially introduced at ASCO were also discussed at the ASCRS meeting. Additionally, I benefited from the breakfast session on robotic surgery.
In addition to the scientific sessions, the congress offered numerous opportunities for networking and collaboration. I had the pleasure of meeting and exchanging ideas with colleague, which was an enriching aspect of the experience. The social events organised as part of the congress were also delightful.
Overall, attending the ASCRS Congress was a highly enriching experience, offering new perspectives and enhancing my knowledge in the field of rectal surgery. I am grateful for the support of ESCP and ASCRS in making this trip possible. The insights gained and connections made during this congress will undoubtedly contribute to my ongoing research and clinical practice. I look forward to applying what I have learned and continuing to collaborate with the global surgical community. This was my first time at the ASCRS meeting, but definitely not my last!
Zoe Garoufalia
From: USA
Visited: Japanese Society of Coloproctoly Meeting, Tokyo, Japan
Time period: November 2024
Background
My passion and interests have always been rooted in medicine, the privilege of serving those in need, relieving pain, and helping patients achieve a better quality of life. In the final two years of medical school, I noticed that while surgery is grounded in scientific principles, it transcends into the realm of art. Surgical artistry, merges science, technique and strategy with the divine biological harmony of physiology. This unique nature of surgery ignited a new passion, especially for colorectal surgery.
This passion first ignited during my residency at Laiko University Hospital inspired by my mentor at that time Professor Gregory Kouraklis. Working in an institution with a long legacy and history of development, based on dedication and personal sacrifice, rendered the reference to history and awareness of developmental phases as the norm. This flourished my interest in history and the history of colorectal surgery in particular. Through this study on the evolution of colorectal surgery and the distinguished personalities who shaped the field, I made the realisation that colorectal surgeons worldwide are part of a 'surgical genealogical tree,' endowing 'surgical genes' from mentor to mentee. Inspired by this lineage I aspired to become part of this global faculty and was fortunate to secure a research fellowship under Professor Steven Wexner, one of the father figures of colorectal surgery. Under his guidance, I developed my research skills over two years, and this led to my acceptance into one of the most prestigious and competitive colorectal fellowship programmes in the United States: the Advanced Colorectal Surgery Fellowship at the Ellen Leifer Shulman and Steven Shulman Digestive Disease Center at Cleveland Clinic Florida.
Being cognisant of the importance of collaboration early in my career, I became actively involved in the European Society of Coloproctology (ESCP) while completing my general surgery residency at the Laiko University Hospital in Athens, Greece. ESCP is a unique society that provides young surgeons with invaluable opportunities to engage with leading figures in colorectal surgery. Through my involvement with ESCP, I gained the tools, and network I needed to grow as a budding colorectal surgeon. In this journey, I had the privilege of being elected Chair of Y-ESCP, a position that allowed me to contribute to a society committed to transparency, equity, and continuous advancement in the field of colorectal surgery.
One of the many remarkable opportunities ESCP has provided - thanks to its collaboration with the Japanese Society of Coloproctology (JSCP) - was the JSCP Traveling Fellowship. This programme fosters connections with Japanese colleagues, provides the chance to observe their clinical practices, facilitates the exchange of ideas, and helps build lasting professional relationships.
Thrilled with this opportunity, I submitted my CV and research abstract, and I was excited to be short-listed for an interview. Shortly after the interview, Mr Kaphil Sahnan conveyed the joyous news: “Zoe, you have been chosen to represent ESCP for the JSCP Traveling Fellowship.” It was a truly memorable moment.
ESCP journey - JSCP opportunity - the power of collaboration
“If I have seen further, it is by standing on the shoulders of giants” - Isaac Newton
This phrase from Sir Isaac Newton is one that I can deeply relate to, collaboration is an incredibly powerful force, it is through combining the ideas and visions of others with our own that progress is often achieved. Identifying a group of individuals, early in life, who challenge you is essential for growth; both personal and professional.
Once the decision for awarding this travelling fellowship was finalised, Professor Jun Watanabe kindly reached out to make the all aspects of my journey as smooth as possible. From the start, everything was handled with precision and efficiency.
Days 1–2: A robotic start at Kansai Medical University Hospital
After landing in Osaka, I headed to Kansai Medical University Hospital. The hospital’s scale and modernity left a strong impression. Dr Toshinori Kobayashi and Professor Jun Watanabe warmly welcomed me, and I had the opportunity to observe the Hinotori Robot in action, along with several laparoscopic procedures. That evening, Dr. Kobayashi introduced me to authentic Japanese sushi, a perfect way to end a fulfilling day in surgery (Fig. 1, 2).
On the second day, I participated in morning rounds and case discussions before observing robotic surgeries and a Gants-Miwa procedure, a technique I had not encountered before. My time at Kansai concluded with a traditional sukiyaki dinner alongside the entire department, a wonderful opportunity to engage in meaningful conversation. I felt privileged to discuss research ICG related research with Professor Watanabe, the principal investigator of the Essential Trial 1), and I am looking forward to the results of the SPECTACLE study 2). I am deeply grateful to Professor Watanabe and Dr Kobayashi for their hospitality and for making my experience at Kansai Medical University Hospital both productive and memorable.
Day 3 and 4: Osaka International Cancer Center
Osaka International Cancer Center represents a state-of-the-art facility focused on patients suffering from colorectal cancer. I was very warmly welcomed by Dr Yoshinori Kagawa, Dr Masayoshi Yasui, and Dr Ryota Mori, with a wonderful view of Osaka Castle. Dr Kagawa made sure my time was well spent. He demonstrated his artistry along with all the wonderful aspects of Osaka and Japanese culture.
On the first day, after observing a very impressive D3 right colectomy for cancer, I had the opportunity to engage in fascinating discussions around their recent achievements and co-authoring cutting-edge research via trials like CIRCULATE-Japan Galaxy 3) and Ensemble 4). The team represents true mastery in advancing the treatment for colorectal cancer, with lots of differences in perioperative management compared to European and US practices (Fig. 3, 4).
To top this off, I had the most exclusive sushi dinner where culinary precision met artistry, engaging in very interesting discussions with Drs Kagawa and Mori. On my last day, I observed their multidisciplinary team meeting along with their clinical routine. Afterwards, Dr Kagawa kindly showed me Osaka Castle along with the busiest areas in the centre of Osaka, where I tried takoyaki and kushikatsu. The generosity, kindness, hospitality and scientific depth of Dr Kagawa really left a long-lasting impression and an immense feeling of gratitude.
Day 5-6: Osaka Police Hospital
My journey continued at the Osaka Police Hospital, where I had the privilege to be welcomed by Dr Takahashi Hidekazu (Fig. 5) and observed their robotic practice using the DaVinci Xi. It was a great experience, and the next day Dr Iwami graciously showed me around her beautiful hometown of Kyoto. This was a memorable experience and a blessing to witness with local guidance. This time, I tried local ramen and was amazed by the temples, wood artistry, and culture (Fig. 6).
Day 7-9 Yokohama
I travelled to Yokohama on the bullet train enjoying a comfortable trip and mesmerising views of Mount Fuji. Yokohama is a beautiful urban city where I tried okonomiyaki, which left me very impressed (Fig. 7).
My journey continued in Matsushima Hospital, a centre of excellence for proctology. Drs. Sayuri Matsushima and Makoto Matsushima welcomed me and showed me their impressive premises, along with the historic journey of the hospital, which is a family business. Dr Okamoto (Fig. 8) allowed me to observe his impressive practice and discuss differences between practices, while Dr Kono Yoichi demonstrated and explained endoscopic ultrasound and endoscopies.
The next day, I had the honour to observe procedures in Yokohama City University Medical Center, a large establishment with a plethora of specialties. I was warmly welcomed by Dr Yusuke Suwa (Fig. 9), who showed me his practice in robotic colorectal surgery and discussed key differences between practices. The day ended with a wonderful sukiyaki dinner with other faculty, delving into pleasant discussions.
Japanese Society of Coloproctoly Meeting
My journey concluded with the Japanese Society of Coloproctology Meeting. I was kindly introduced at the faculty dinner where I had the privilege of engaging in discussions with Professor Ishihara from Tokyo University. The kindness and hospitality of the meeting’s faculty was truly heart-warming. (Fig. 10).
I had the honour of presenting our latest National Cancer Database Analysis on Outcomes of Colectomy for Right Colon Cancer at the podium (Fig. 11). The significant gap in 5-year overall survival between the two populations was notable, and I engaged in several meaningful discussions with experts in the field on methods and approaches for a more homogenised practice. The session was gracefully moderated by Professor Watanabe.
In these final days, I had a wonderful dinner in Yokohama’s China Town with the entire entourage of the SPECTACLE study. I was also introduced to Kampo Medicine by Dr Mamoru Uemura.
Attending this conference was a unique experience and a real treat.
Japanese Culture
I was stunned by the beauty and ethics of the Japanese Culture. Our Japanese colleagues strive tirelessly for excellence, to improve their practice and outcomes, with one ultimate goal, to achieve the best possible results for their patients. Their integrity and quality of work is undeniable; and this is broader than medicine. Japan is instilled with traditional values that reflect a healthy society: the respect of their elders and legacy of predecessors, the honesty, the importance of societal contribution, the safety of their cities.
Impact on my career and advice to future fellows
JSCP Travelling Fellowship was a true experience and great honour. I had the opportunity to collaborate with exceptional surgeons, who strive for excellence, forged new friendships and established pathways for future collaborations.
Conclusions
JSCP Travelling Fellowship really impacted me in many ways. I wish to send my many thanks and deepfelt gratitude to all my hosts and I look forward to a future collaboration.
References
- Watanabe J, Takemasa I, Kotake M, et al: Blood Perfusion Assessment by Indocyanine Green Fluorescence Imaging for Minimally Invasive Rectal Cancer Surgery (EssentiAL trial): A Randomized Clinical Trial. Ann Surg 278:e688-e694, 2023
- https://rctportal.niph.go.jp/en/detail?trial_id=jRCTs032230212 (accessed on 2025-02-02)
- Nakamura Y, Watanabe J, Akazawa N, et al: ctDNA-based molecular residual disease and survival
in resectable colorectal cancer. Nat Med 30:3272–3283, 2024 - Kagawa Y, Watanabe J, Uemura M, et al: Short-term outcomes of a prospective multicenter phase
II trial of total neoadjuvant therapy for locally advanced rectal cancer in Japan (ENSEMBLE-1). Ann Gastroenterol Surg 7:968-976, 2023
Florian Kühn
From: Germany
Visited: Ospedale San Paolo, Università di Milano, Milan, Italy
Time period: July to December 2024
Knowledge and clinical skills acquired
As a consultant surgeon and an associate Professor of Surgery at LMU Munich with a broad experience of over 15 years in open and laparoscopic surgery but only limited access to a robotic platform, I decided to apply for the ESCP Robotic Fellowship. Having submitted all documents and a successful application and interview process, I was placed with my preferred host centre at Ospedale San Paolo, Università di Milano, Milan, Italy, under the supervision of Professor Paolo Bianchi.
Due to various reasons, I have a strong connection and interest in the Italian people and culture, which is why this fellowship seemed like a great opportunity for clinical, scientific, and personal growth. Once everything was arranged, I moved with my family to Milan to start my journey in robotic surgery.
Prof. Bianchi is a real pioneer in robotic surgery. His department is aligned to run a complete robotic program covering most general surgery procedures with an emphasis on colorectal surgery. His team consists of several very experienced and skilled robotic surgeons including Giampaolo Formisano, Wanda Petz, Adelona Salaj, and last but not least the young but very supportive Francesco Toti.
During the ESCP fellowship, I gained experience in a large variety of robotic procedures and have learned to independently conduct robotic colorectal and abdominal wall procedures. I was able to complete a structured training pathway including working with two simulation systems (DaVinci and HugoRAS), table assistances, robotic case observations, and supervised conducting of robotic colorectal and general surgery procedures. The very experienced team of Prof. Bianchi could also give great advice for trouble-shooting in robotic surgery.
Training and education experiences
I was able to participate in all the educational activities of the service including outpatient clinics, conferences, rounds, and seminars. Next to the daily clinical activities, I was invited to several meetings and conferences, e.g. the Annual Meeting of the Clinical Robotic Surgery Association (CRSA) which took place in November in Rome. Furthermore, Prof. Bianchi arranged a two-day visit at Professor Antonino Spinelli at Humanitas Research Hospital Milan which was another a great add-on to my fellowship.
Research experience
Kühn F., Bianchi PB. Current role of Robotic Surgery in Colorectal disease. Visc Med 2025
Reflective learning
The complete robotic approach for a great variety of elective general surgery procedures was in contrast to my previous way of conducting surgery and therefore provided a real, not only technical but also principal knowledge gain. Working together with a team of experienced robotic surgeons made me also understand the basic requirements in robotic surgery. To successfully run a robotic program, you need to know the strength and the limitations of the system.
Furthermore, I realised that you need to have a certain mindset to conduct robotic surgery: first of all you need to be convinced by the technique. If you are not fully convinced, you will not have the patience and diligence needed to successfully conduct robotic surgery. Being equipped with a second console gave me the chance to really comprehend the different steps as well as to learn several important tips and tricks in robotic surgery.
Overall experience
Prof. Bianchi was a great host who tried to make my stay as pleasant and worthwhile as possible. One of the best things I was allowed to experience during my fellowship in Milan was the hospitality from Prof. Bianchi’s team. From the beginning, I was treated as a team member by all colleagues, which made my stay even more pleasant.
I want to thank Prof. Bianchi and his great team for the hospitality and for letting me be part of their robotic program. I want to thank the ESCP for providing this invaluable experience and look forward to future interactions with society
Blanca Montcusí Ventura
From: Spain
Visited: Colorectal Surgery Unit, Department of Visceral Surgery, Geneva University Hospitals, Switzerland
Time period: May to August 2024
Knowledge and clinical skills acquired
Throughout my Fellowship, I acquired an extensive range of knowledge and clinical skills in the management of functional and pelvic floor disorders, while also furthering my education in colorectal surgery and complex proctology. This training provided me with the ability to diagnose, treat, and surgically manage diseases pertinent to these fields. I gained an extensive comprehension of prevalent disorders, including faecal incontinence, obstructed defecation syndrome, rectal prolapse, rectocele, enterocele, and chronic pelvic pain. The fellowship enabled me to understand the complex nature of these diseases, encompassing both functional and mechanical dysfunctions, as well as the value of a multidisciplinary approach.
During my experience in outpatient clinics, I obtained expertise in the assessment and advanced diagnostic techniques for evaluating functional and pelvic floor disorders. I acquired knowledge in conducting an adequate history and a comprehensive physical examination, considering the three compartments of the pelvic floor from a multidisciplinary perspective. I also received training in anorectal and dynamic transperineal ultrasound. In addition, I developed competence in non-surgical approaches to manage these disorders, including pelvic floor physical therapy, biofeedback, and pharmacological interventions. Conservative treatments frequently serve as the initial intervention and can provide substantial symptom improvement.
The fellowship offered hands-on experience with a variety of surgical techniques. I earned skills in procedures for faecal incontinence, such as sphincteroplasty and sacral neuromodulation. Moreover, I had the privilege to gain practical experience with an innovative surgical technique for repairing the puborectalis muscle disruption. I developed expertise in performing minimally invasive procedures for rectal prolapse, utilising laparoscopic and robotic approaches, as well as different techniques, including anterior and posterior dissection. I also learned perineal techniques for prolapses, such as rectocele repair and perineal rectosimoidectomy. This training in the operating rooms highlighted the importance of selecting the most suitable procedure based on the patient’s anatomy and functional requirements.
I underwent training in the management of postoperative care, which is essential for enhancing surgical outcomes and minimising complications. This involved the management during the hospitalisation, as well as during the follow-up in outpatient clinics. Furthermore, a significant component of my fellowship included a close collaboration with gynaecologists, urologists, physical therapists, and radiologists. This collaboration emphasised the need of a cohesive strategy in addressing complex functional and pelvic floor disorders, thereby ensuring a holistic care for patients.
Although the fellowship primarily focused on functional and pelvic floor disorders, I additionally had the opportunity to enhance my training with colorectal surgery and complex proctology. I gained proficiency in minimally invasive techniques for colectomies and proctectomies. In the field of complex proctology, I extend my education in advanced techniques for haemorrhoids, complex fistulas, and chronic fissures. Finally, I had the chance to participate in proctological surgeries employing local anaesthesia, occasionally incorporating virtual reality, which is a novel concept developed by the team.
Training and education experiences
Every Thursday, the Department of Visceral Surgery at Geneva University Hospitals conducts Morbidity and Mortality Sessions to evaluate and enhance the management of complex patients, accompanied by lectures on various topics aimed at advancing team’s knowledge. I was able to attend this sessions and lectures, which will also contribute to my development as a surgeon.
In addition, I joined the 5th Oncology, Sexology, and Proctology Symposium organised by the team. The symposium was an opportunity to address, without taboos, issues impacting the intimate sphere of patients. Through fascinating presentations and interactive discussions, I could openly address these issues that significantly affect the quality of life of our patients.
Finally, I had the privilege to observe the first hysterectomy performed using the MIRA robot in Europe. This is a compact and efficient miniaturised robot, designed for convenience and capability. It can be utilized in any available operating room, set up in minutes, and easily relocated as needed.
Research experience development
I am a member of the Clinical and Translational Research Group in Colorectal Neoplasia at the Hospital del Mar Research Institute. Our research has primarily concentrated on the response to surgery and colorectal cancer recurrence. We have recently obtained the results of two projects that pertain to the metabolomics and microbiome, and colorectal cancer recurrence. Thanks to the fellowship, I was honoured to present these findings to Swiss professionals at the Annual Meeting of the Swiss Society of Gastroenterology (SGG-SSG), the Swiss Society of Visceral Surgery (SGVC-SSCV), the Swiss Association for the Study of the Liver (SASL) and the Swiss Society of Endoscopy Nurses and Associates (SVEP-ASPE) in Interlaken.
As a consequence of the aforementioned and the interest of the Geneva’s team, we are planning to perform an external validation of the metabolomics’ results in a larger independent cohort that will include patients from Geneva University Hospitals. Validation is mandatory to determine a prediction model’s reproducibility and generalisability to new and different patients, and its development would improve patient care and outcomes.
Future practice and utility of experience
As previously mentioned, I had the privilege to acquire knowledge and skills regarding an innovative surgical technique for the reparation of the puborectalis muscle disruption. Patients who have experienced puborectalis rupture may present some form of faecal incontinence or evacuation disorder, sexual dysfunction, or pelvic organ descend.
Over the past two decades, the Geneva’s team has devised a novel technique that reconstructs the muscle anatomy by transvaginal approach up to the vaginal vault. They have conducted an analysis of their cohort, and this technique appear to offer several advantages over the ones in the existing literature, with excellent short- and long-term outcomes including significant improvement in functional symptoms. However, it is a specific technique that is not well-known by the majority of surgeons. Consequently, we are organising a workshop at Hospital del Mar in Barcelona to introduce this puborectalis muscle repair technique to the Spanish surgeons. This will enable the enhancement of the quality of life of patients with this condition, who currently have limited opportunities to improve.
This fellowship has equipped me with an in-depth understanding of functional and pelvic floor disorders, along with the essential knowledge and clinical skills to effectively manage these challenging conditions, from diagnosis to surgical intervention.
It has had a substantial influence on my current daily practice, extending from outpatients to the operating room. I am now confident in my ability to conduct a comprehensive history, physical examination, and anorectal ultrasound for my patients who suffer from functional and pelvic floor disorders. I have also underscored the importance of remaining informed about the constantly changing surgical techniques. Moreover, the fellowship has emphasized the value of a multidisciplinary team in the treatment of complex functional and pelvic floor disorders. As a result, I intend to apply these knowledge and skills I have acquired, which I am confident they will improve the quality of care I offer to my patients.
Michael Okocha
From: United Kingdom
Visited: St Mark's Hospital, London, UK
Time period: 30 Sept to 31 Dec 2024
I am profoundly grateful to the European Society of Coloproctology (ESCP) and Medtronic for the opportunity to undertake this fellowship. I extend my sincere thanks to my supervisors, Mr Greg Thomas and Miss Carolynne Vaizey, who welcomed me warmly to St Mark's National Bowel Hospital and whose mentorship has been invaluable. Their wealth of experience and commitment to education have provided me with an unparalleled learning environment. I would also like to express my gratitude to Ms Carmen Ugarte-Cano for her exceptional coordination and support throughout my time at St Mark's.
Clinical Experience
This fellowship provided extensive exposure to the management of functional and pelvic floor disorders. I gained a comprehensive understanding of conditions such as faecal incontinence, obstructed defecation syndrome, rectal prolapse, rectocele, enterocele, chronic pelvic pain, rectovaginal fistulas, and the treatment of obstetric anal sphincter injury (OASIS). The experience reinforced my appreciation of the complex interplay between functional and mechanical dysfunctions and the necessity of a multidisciplinary approach to optimise patient outcomes.
I had the privilege of attending outpatient clinics alongside my supervisors, allowing me to refine my diagnostic acumen and clinical decision-making. Additionally, I participated in ward rounds, contributing to the holistic care of patients undergoing pelvic floor interventions. A highlight of my fellowship was learning the St Mark's approach to laparoscopic ventral mesh rectopexy, SNS insertion, as well as surgical strategies for Delorme's, Altemeier's, and rectovaginal fistula repairs.
Multidisciplinary Experience
A defining aspect of this fellowship was the opportunity to work within a truly multidisciplinary environment. I attended joint surgical cases with gynaecology teams for the management of vaginal prolapse and concomitant laparoscopic ventral mesh rectopexy. These cases provided invaluable insights into the collaborative surgical management of complex pelvic floor disorders.
I actively participated in the St Mark's pelvic floor multidisciplinary team (MDT) meetings, which were exceptionally well-organised and aspirational. The discussions were enriched by input from leading radiologists, including Dr Arun Gupta, as well as the biofeedback team and colorectal pelvic floor surgeons from across Greater London who presented their cases for expert review. These meetings deepened my understanding of the nuanced decision-making processes that underpin complex pelvic floor surgery.
Further hands-on experience included participation in the Endoanal Ultrasound Course, where I received one-on-one teaching. I also worked closely with the biofeedback team, learning the intricacies of physiotherapy-based interventions under the guidance of Anna Brophy and Athena Rosa. Additionally, I gained proficiency in performing anorectal physiology assessments, conducting multiple investigations over the three-month fellowship.
Research and Academic Contributions
My time at St Mark's was academically productive, and I was fortunate to engage in several research projects:
- Assessment of UK pelvic floor training – I presented at the UK Pelvic Floor Society Meeting in November 2024.
- Patient experience with rechargeable sacral nerve stimulators – Study completed and submitted for publication.
- Review of stoma formation for faecal incontinence – Data collection and analysis ongoing.
- Study on young patients with rectal prolapse – Data collection and analysis ongoing
- Comprehensive review of rectovaginal fistula assessment and management – Drafting manuscript
I attended the weekly St Mark's Grand Rounds, where I gained exposure to cutting-edge research and operative innovations from both internal fellows and visiting experts. Additionally, I participated in the St Mark's Frontiers conference, which proved to be an outstanding educational event, further solidifying my interest in the management of obstetric anal sphincter injuries.
Reflections and Future Directions
This fellowship has been instrumental in refining my clinical and operative skills, equipping me with the expertise required to pursue a career in benign colorectal and pelvic floor surgery. I have developed a significant level of confidence in my decision-making and procedural capabilities. Furthermore, I have built valuable connections with consultants and industry representatives, which will serve as a crucial support network as I advance in my career. I look forward to contributing to the education and training of others, particularly in the field of obstetric anal sphincter injury management.
Beyond the clinical and academic gains, my experience at St Mark's has been personally fulfilling. I had the privilege of being invited by the team to attend the regional awards, where Miss Vaizey was nominated for a Lifetime Achievement Award. I also thoroughly enjoyed the social aspects of the fellowship, including the renowned St Mark's Christmas Review Show, which showcased the camaraderie and culture of this exceptional institution.
St Mark's remains a world-leading, multi-award-winning centre of excellence, and I am deeply grateful for the opportunity to have been part of this unique and inspiring environment.
