david zimmermanEver since visiting Chūo General Hospital (Tokyo) in 1999 to visit dr. Junichi Iwadare, it has been my sincere wish to visit Japan again. The wonderful combined initiative by the Japanese and European Societies has finally made this possible for me.

It was a great honour, to be selected for this wonderful opportunity. I would like to express my sincere gratitude to my hosts, prof. Tadahiko Masaki and Dr. Hiroyoshi Matsuoka for organising and hosting my trip to and through Japan.

Initially, I travelled to Osaka, where I visited Dr Ichiro Takemasa. Dr Takemasa is one of the international pioneers in reduced- and single port colorectal surgery. After publishing the first report on single port surgery in 1998, he has performed over 2000 procedures since. His tremendous experience with this type of surgery was apparent and very instructive. The many helpful tips and tricks, as well as cautions, will be very helpful in implementing this technique in our centre.

david zimmerman2It was a delight to visit Chūo General Hospital (Tokyo) again. Dr Tetsuo Yamana welcomed me very warmly. He showed me several interesting aspects of proctology. The level of expertise and experience in the treatment of benign anorectal disease in this centre was impressive. Also in Tokyo I visited the home-university of my hosts; Kyorin University Hospital. In this beautiful and modern facility I had a very open and honest encounter with several aspects related to training and education. I was very impressed by the kind, yet firm way in which medical students, residents and fellows are trained by Prof. Masaki. Also this center offers a unique method of intraoperative radiotherapy. Unfortunately no cases were scheduled, but dr. Matsuoka was kind enough to present the results as well the details on the technique to me.

David Zimmerman and Dr Matsuoka
Dr Matsuoka joined me in the visit to Kyoto University, where professor Yoshiharu Sakai welcomed us. The gastrointestinal surgery division of Kyoto has an international reputation for its surgical expertise, especially for minimal invasive techniques. Before visiting the hospital, Dr Matsuoka showed me the beautiful sites of Kyoto. We visited Shimizu Temple and the beautiful Kinkaku-Ji.

David Zimmerman and Professor Sakai Professor Sakai introduced me to the excellent results of neoadjuvant chemotherapy utilizing a combined FolFox and Bevacizumab regimen. Prof. Sakai showed a perfect (D3) laparoscopic intersphincteric resection in a patient with a complete response to this neoadjuvant chemotherapy! D3 (total mesocolic dissection) for stage II or III colonic cancers is practiced in many Japanese centers and highlights a major difference in surgical philosophy and technique between European and Japanese surgeons. The method of clearance of lymphatic tissue from the superior mesenteric vein trunk, as utilized by my hosts was impressive and inspiring.

I was very grateful that I was offered the opportunity to present the results of the introduction of minimally invasive techniques in our Hospital to the 67th Annual Meeting of the Japan Society of Coloproctology. Also, I enjoyed the meeting itself a lot. Several sessions were in English, but also most talks in Japanese were relatively easy to understand because of the consistent use of many English terms and acronyms in Japanese presentations. Also I had a lot of help with translation from Dr Matsuoka. The topic of intersphincteric resection is extremely interesting. I was very impressed with the detailed research that is being performed into this subject, as well as with the honesty with which the disappointing functional results are shared. Japanese surgeons are to be commended for their consistency and honesty in striving for high quality treatments for both benign and malignant colorectal diseases.

In conclusion, my visit to Japan was foremost inspiring. Also I had the opportunity to learn and observe many practical matters that will prove to be useful in my daily practice. Furthermore I have met many interesting people and have made several friends. I am looking forward to meeting many of my Japanese friends and colleagues again in the near future! I am very grateful to my hosts, Prof. Maeda, Prof. Hase, Prof. Shirouzo, Prof. Masaki, Dr Takemasa, Prof. Sakai, Dr Yamana and last but not least Dr Matsuoka.

This exchange fellowship, organized in collaboration between the two societies (ESCP and JSCP) is an excellent way for young surgeons to further develop their knowledge and I sincerely hope it will be continued in future. I would like to express my gratitude again to both societies as well as to Prof. Dawson and Ms Helfer for allowing me this honour and helping me in the organization of this trip.

David D.E. Zimmerman, M.D., Ph.D., F.E.B.S. (Coloproctology)

ESCP Affiliates