ESCP Fellowships 2025–2026 Update

ESCP offered three fellowships for 2025-2026. Fellows report here on their experiences.

Click on a fellow's name to read their report. First to report back is Tina van Loon.

Sponsor

3-month Functional Disorder Fellowships were sponsored by Medtronic

Tina van Loon

From: The Netherlands
Visited: Annual Meeting of the Japanese Society of Coloproctology in Tokyo
Time period: 2-12 November 2025

Background

Just over 10 years ago, I attended my first ever annual scientific meeting of the European Society of Coloproctology (ESCP) in Dublin in 2015. I distinctly remember feeling inspired by the depth of knowledge and the opportunities offered by this outstanding international network of colorectal surgeons. From that moment, I aspired to become part of this community and have since consistently contributed to the Society as an active Young ESCP member and member of the Education Committee.

Over the past years, I have channeled my passion for coloproctology into both my surgical career and my engagement with the ESCP. The Society has provided a platform, network, and opportunities that have been instrumental in my professional development. My commitment is reflected in my roles as a member of the Education Committee, the Diversity, Equity and Inclusivity Working Group, and most recently the Executive Committee. These roles have provided valuable insight into leadership and governance within a growing international society, and into how meaningful change can be achieved for colleagues in the field.

Mentorship from influential colorectal surgeons further reinforced my belief in the value of a formal coloproctology diploma, leading to my involvement in organising the annual European Board of Surgery Qualification (EBSQ) examination in coloproctology. Although I was already familiar with the structure and conduct of the examination, I was delighted to learn that I had been awarded the Lars Påhlman Medal for 2024. This medal is presented annually to the highest-scoring candidate in the EBSQ examination and is accompanied by the prestigious JSCP Travelling Fellowship.

I am deeply grateful to Professor Jun Watanabe and particularly Dr Akihiro Kondo for organising an outstanding fellowship programme, including inspiring host institutions and exceptional hospitality. All logistical aspects, including flights, transport and accommodation, were meticulously arranged, for which I wish to express my sincere appreciation to them and to Japanese Society of Coloproctology (JSCP).

JSCP Fellowship

On my first day of my fellowship, I was invited to observe the colorectal surgical practice at Kansai University Medical Center under the supervision of Prof. Dr Jun Watanabe. The colorectal team was attending a morning meeting, which was not a formal handover (these are conducted via a secure messaging application) but rather a surgical indication meeting.

All colorectal consultants, fellows, residents, and medical students were present in a small conference room to review surgical indications for the upcoming week. The discussion was notably interactive, supported by high-quality cross-sectional imaging, predominantly predominantly from patients with a notably low body mass index compared with European practice! Several innovative surgical indications were discussed, including the placement of a biological spacer between an unresectable tumour and the bowel to facilitate radiotherapy.

Following this meeting, I was given a tour of the surgical ward, which offers splendid panoramic views over the city. The average length of inpatient stay is approximately one week, largely influenced by insurance structures and hospital reimbursement policies.

Later in the morning, a robot-assisted total mesorectal excision (TME) was observed using the Hugo™ robotic platform. The operating theatre was densely staffed, including two circulating nurses, two scrub nurses, three surgeons at the table, representatives from Medtronic providing technical support, medical students, Prof. Dr Watanabe, and one other international observer (besides myself) coming from China.

The procedure began with obtaining open umbilical access using a single port system, which was subsequently used for specimen extraction. Six additional trocars were placed before docking the robotic system. A high-quality TME was performed with meticulous attention to detail, despite significant tissue oedema related to neoadjuvant radiotherapy. High ligation of the inferior mesenteric vessels with selective lymph node station 253 resection was performed routinely.

Lymph node station 253 was a previously unfamiliar entity within oncological colorectal surgery to me. It had not been encountered during my surgical training or at attended medical conferences. Despite extensive discussions and presentations regarding high tie versus low tie ligation of the inferior mesenteric artery, the concept of lymph node station numbering and the selective identification and retrieval of a specific nodal station was new to me. Metastatic involvement of lymph node station 253 is associated with an adverse prognosis, and its resection may potentially reduce the risk of para-aortic and distant metastases. [1,2]

Vascular structures were double-ligated and sealed, and the bowel segment designated for anastomosis was secured with additional reinforcing sutures. Prior to bowel transection, perfusion was assessed using indocyanine green (ICG) fluorescence imaging with a handheld device. Prof. Dr Watanabe is the principal investigator of a large randomised controlled study evaluating bowel perfusion based using ICG (ESSENTIAL trial [3]) and is currently investigating time duration and quantitative analysis of fluorescence intensity with the help of artificial intelligence- based models while using ICG. These results of this study are highly anticipated!

The day concluded with an informal dinner for the fellows and international observers, giving us the opportunity to discuss and gain insight of the Japanese and Chinese health care system and the work-life balance of surgeons, also marking the end of a highly inspiring and memorable first day of this observership.

The second host centre is the Osaka Cancer Institute where I got the opportunity to observe the colorectal surgical practice under the supervision of Dr Yoshinori Kagawa. This is a high-volume tertiary referral centre dedicated exclusively to oncological care.

The day commenced at 07:40 with a consultant-led ward round attended by four colorectal surgeons and one resident. Postoperative day-1 patients were reviewed in the high-care unit, followed by a brief visit to the surgical wards, including private and shared patient rooms. The round concluded with a structured meeting to discuss surgical indications for patients listed for surgery the following week.

This was followed by a multidisciplinary team meeting involving the colorectal surgeons, a medical oncologist, a radiation oncologist, and a gastroenterologist. Radiologists were not routinely included. In this setting, surgeons independently review MRI imaging, neoadjuvant therapy for rectal cancer is not standard practice in Japan, which partly explains the limited perceived need for radiological input.

The unit is actively involved in several clinical trials, including studies on total neoadjuvant therapy (TNT) and a randomised comparison of intracorporeal versus extracorporeal anastomosis following minimally invasive right hemicolectomy.

The first surgical procedure commenced at 09:00, with the patient entering the operating theatre ambulatory! Draping began at 09:30 following standardised preparation by a large multidisciplinary operating team. Patient positioning was meticulous and labor-intensive, involving extensive padding and routine use of pneumatic compression stockings.

A robotic sigmoid resection was performed using the Hinotori system. This platform, not yet available in Europe, has a console and docking concept comparable to the da Vinci system, with additional angulation points in the robotic arms. However, it lacks integrated sealing or stapling devices.

Access was obtained via a periumbilical incision with placement of a single-port platform for a 12-mm trocar, supplemented by three robotic trocars and one assistant port. Docking was achieved using a dedicated alignment instrument establishing a fixed abdominal wall pivot point.

A medial-to-lateral sigmoid resection was performed with division of the inferior mesenteric artery at its origin to facilitate lymph node dissection at station 253, necessitating an extended sigmoid resection. The operative approach was deliberate and highly meticulous. Bowel perfusion was again assessed using indocyanine green (ICG) fluorescence imaging using a hand-held device as part of prof. Watanabe’s clinical study. An end-to-end anastomosis was constructed using a circular stapler and reinforced with six interrupted sutures.

Dr Kagawa reported that approximately 500 procedures per year are distributed across the team. He personally oversees operative scheduling and clinical trial management in the absence of dedicated planning or research staff. The department operates without formal handover systems or on-call duties, reflecting its exclusive focus on oncological care.

This observership highlighted a surgical culture characterised by extreme technical precision, meticulous attention to detail, and a consistent pursuit of procedural perfection, supported by high procedural volumes and active participation in clinical research.

The day concluded with an exceptional omakase dinner with Dr Kagawa and another international observing fellow from China. We had engaging discussions while enjoying an outstanding omakase experience, which has changed my perception of sushi forever. I am very grateful for Dr Kagawa for his generosity, for sharing this part of his work and Japanese culture with me.

Up next was Kagawa University Hospital under the supervision of Dr Akihiro Kondo. The Department of Gastrointestinal Surgery consists of 15 attending surgeons. Notably, this was the first centre visited during this observership where a female attending surgeon was part of the faculty.

As observed in other Japanese centres, operating room attire is color-coded according to staff role, facilitating clear role recognition within the theatre environment. A substantial presence of industry representatives was again noted. Among them were developers of an artificial intelligence-based system (Anaut’s Eureka α [4]) designed to visualise dissection planes by colour-coding anatomical layers. Although currently lacking real-time overlay capability within the da Vinci console, the system produces high-quality visual reconstructions and may prove valuable as an educational tool, particularly in surgical training. The complete mesocolic excision (CME) technique observed was performed with a high level of technical precision.

The surgical team explained that Kagawa Prefecture is one of the smallest of Japan’s 47 prefectures. Each prefecture maintains its own university and affiliated medical school with dedicated academic staff, with the exception of larger metropolitan regions such as Osaka, where multiple university institutions coexist.

After completion of scheduled hospital duties, many surgeons routinely work additional hours in outpatient internal medicine clinics, health screening services, or general practice settings. This practice is widespread, part-time employment is uncommon, and extended working weeks are the norm in Japan.

An interesting cultural aspect of Japanese surgical practice is the continued use of German medical terminology, reflecting historical collaboration with German medical institutions during the development of Japan’s modern healthcare system. Historically, medical documentation in Japan used to be written in German.

The day concluded with a traditional Japanese izakaya dinner with members of the colorectal team. I want to express my heartfelt gratitude to them for their generosity and offering further insight into surgical training pathways, departmental leadership and Japanese life including an outstanding session of karaoke!

The observership continued in Yokohama, at the Matsushima Hospital, the largest specialised proctology centre in Japan, to observe clinical and surgical practice. The hospital is an extremely high-volumed referral centre dedicated exclusively to proctological disease, with integrated surgical, inpatient and outpatient divisions. The institution employs a large multidisciplinary team of colorectal surgeons and gastroenterologists.

After a very warm welcome by the managing director Dr Makoto Matsushima, I got the opportunity to observe proctology procedures by Dr Kosuke Okamoto. Dr Okamoto very kindly provided detailed explanations of the local surgical workflow and techniques. Due to the use of spinal anesthesia and highly standardised patient preparation protocols, operating room turnover times were exceptionally short.

All procedures were systematically documented, not only through full video recording but also by detailed preoperative and postoperative photographic documentation. These data are directly uploaded to the electronic patient record.

It was truly enlightening to observe the different procedures in the Matsushima way, since there are notable differences between the Japanese and the European practice. Rubber band ligation (performed using a Kocher clamp passed through a reusable ligator instead of a suction device) is followed by an additional transfixion suture, placed to minimise the risk of postoperative bleeding. Botulinum toxin is not currently approved in Japan for peri-anal use for anal fissures; consequently, management of anal fissures consists of fissurectomy without adjunctive botulinum toxin injection. Hemorrhoidectomy was performed without the use of diathermy or vessel-sealing devices! Instead, the hemorrhoidal pedicle was secured with a Barron ligature, supplemented by an additional transfixion suture. This transfixion suture was subsequently used to partially close the surgical wound. The Sumikoshi classification system is used rather than the Parks classification for peri-anal fistula.

In the afternoon, I observed an advanced endoscopic procedure with Dr Tomohiko Ohya, a talented gastroenterologist internationally recognised for expertise in endoscopic submucosal dissection (ESD). A 5-cm caecal polyp was resected en bloc using ESD technique. Dr Ohya regularly provides international training in ESD in collaboration with Olympus and has developed multiple simulation-based training models to facilitate acquisition of these advanced endoscopic skills.

Finally, I got the chance to observe outpatient proctology clinics. Patients initially undergo a comprehensive history-taking assessment by a triage physician, who determines referral to either a gastroenterologist or a surgeon. Surgical assessment included examination in the right lateral position, proctoscopy using metal proctoscopes and retractors, and a rigid rectoscopy. A very interesting clinical observation was the high prevalence of perianal dermatitis, which was attributed by the treating proctologist to the widespread use of the famous Japanese bidet toilet systems!

On the final day of my fellowship in Japan, I got to visit the Yokohama University Medical Center, hosted by dr. Yusuke Suwa. This is the largest tertiary referral hospital serving the metropolitan area of Yokohama.

As in other large Japanese academic hospitals, the institution has access to two da Vinci robotic systems. These platforms are housed in a separate operating theatre complex comprising exceptionally large operating rooms, providing ample space for multi-team robotic procedures. The scheduled procedure was a two-team, robot-assisted transanal total mesorectal excision (taTME) performed in a male patient with a history of prior partial mesorectal excision for sigmoid colon cancer and radical prostatectomy for prostate cancer. The patient now presented with a cT1b rectal carcinoma, for which current Japanese guidelines recommend formal surgical resection rather than local excision. The procedure was technically demanding due to extensive adhesions resulting from previous abdominal and pelvic surgery. Nevertheless, the operation was performed with marked precision and meticulous attention to tissue handling. At the conclusion of the procedure, Adspray, an anti-adhesion barrier spray (Terumo [5]) was applied intraperitoneally, a practice commonly adopted in Japan. My last day of observership ended with a delightful sukiyaki dinner, with the colorectal faculty, cooked by ladies in beautiful kimonos, giving me one last opportunity to enjoy traditional Japanese cuisine and culture.

Japanese Society of Coloproctology Annual Meeting

The fellowship ended in Tokyo, at the majestic Grand Nikko Daiba hotel where the 80th Annual Scientific Meeting of the JSCP was being held. The evening before the meeting started with a faculty dinner where the President of the JSCP opened the meeting with his rendition of 'Stand by me' by Ben E. King - a very nice touch that I would love to see at the annual meeting of the ESCP as well! It was a truly entertaining evening and very nice opportunity to see and speak most of the amazing hosts again

I also had the honour to speak on stage about women in surgery, sharing our experiences and initiatives to improve diversity and inclusivity within the ESCP. In addition, attending this meeting provided me with the opportunity to engage in meaningful discussions, gain new knowledge and develop both new and longstanding professional relationships with highly esteemed international colleagues.

Japan experience and its impact

Japan has shown me the true meaning of state-of-the-art, innovative, and reliable public transportation; cultural harmony; exceptional culinary experiences; and breathtaking seasonal changes in nature - all brought together with heartwarming omotenashi. Japanese society is grounded in enduring traditional values that exemplify a well-functioning community, including respect for elders and, in particular, a strong sense of social responsibility that can be felt in everyday life.

Japanese colorectal surgeons are committed to achieving excellence, continuously refining their skills and outcomes with meticulous precision and never-ending patience. Their primary aim is to deliver the highest possible standard of care for their patients. Their professionalism and workmanship are beyond question, extending well beyond their working hours and the field of medicine.

This JSCP Travelling Fellowship has left me deeply impressed; it was truly an extraordinary and humbling experience. It has reshaped my view of patience and respect, as well as my appreciation for order and efficiency, and I wish to express my profound gratitude to the JSCP for this opportunity. It provided me with the privilege of meeting outstanding surgeons dedicated to excellence, while also allowing me to build lasting friendships and gain meaningful insights - both as a person and as a colorectal surgeon.

References

1. S. Hu, S. Li, D. Teng, Y. Yan, H. Lin, B. Liu, et al. Analysis of risk factors and prognosis of 253 lymph node metastasis in colorectal cancer patients.
   BMC. Surg., 21 (1) (2021), p. 280
2. S. Zhou, Y. Shen, C. Huang, G. Li. Prognosis of patients with colorectal cancer and apical lymph node metastasis at the inferior mesenteric artery: a systematic review and meta-analysis. Front. Med. (Lausanne), 8 (2021), Article 800717
3. Watanabe J, Takemasa I, Kotake M, Noura S, Kimura K, Suwa H, Tei M, Takano Y, Munakata K, Matoba S, Yamagishi S, Yasui M, Kato T, Ishibe A, Shiozawa M, Ishii Y, Yabuno T, Nitta T, Saito S, Saigusa Y, Watanabe M; EssentiAL Trial Group. Blood Perfusion Assessment by Indocyanine Green Fluorescence Imaging for Minimally Invasive Rectal Cancer Surgery (EssentiAL trial): A Randomized Clinical Trial. Ann Surg. 2023 Oct 1;278(4):e688-e694.
4. https://www.nsmedicaldevices.com/news/anauts-eureka-%CE%B1-surgical-visualisation-tool-gets-japanese-approval
5. https://tmcs.terumo.com/en/technology/adhesionbarrier/technology_solution/