Planning for my journey was helped by the ICCP Chairman, Prof. Graham Newstead, and by ASCRS Assistant Director Julie Weldon, who answered all my questions, and helped with paperwork and scheduling. Furthermore, I had full support of the Chairman of our surgical department, Prof. Nicolas Demartines, who willingly released me from hospital work for my trip.
The first highlight of my “colorectal holiday” was the Society’s Annual Meeting in Minneapolis MN. Clearly, emerging techniques such as less invasive procedures (SILS, NOTES, hybrid, etc.) and robotics were the focus of this meeting and the respective presentations and videos were mostly excellent. However, surgical skills and advanced techniques seemed somewhat over-emphasized, as their clinical benefits remain arguable.
The patient again became a focus of attention during several sessions on perioperative care and postoperative outcome. I discovered that several aspects of patient care are quite different from ours back home, and I enjoyed informative discussions with American surgeons concerning bowel preparation, epidurals and enhanced recovery.
In my own talk on “The Surgeon’s Impact on Surgical Site Infections in Colorectal Surgery,” I presented data from a prospective database of more than 4,000 colon surgeries that identified the surgeon as one of the independent risk factors for surgical site infections.
All in all, the ASCRS meeting was a great opportunity to catch up with old friends and to meet many new ones.
At the conclusion of the ASCRS meeting, I remained in the Twin Cities and visited the University of Minnesota. I was assigned to Dr. David Rothenberger and his colorectal fellow, Dr. Munee Kapardia. After a personal campus tour, we attended the outpatient clinic and I saw many interesting cases after pouch surgery. I was impressed by an extremely fast and efficient diagnostic work-up, especially for patients coming from far away.
Following endoscopies and ward rounds, I came away very impressed with how clinical care is organized in the U.S. I had the privilege to give a talk on “Perioperative Nutrition and Postoperative Outcome” during the weekly educational meeting, and I appreciated the highly interested audience and good discussions with Drs. Robert Madoff, Genevieve Melton-Meux, and Prof. Stanley Goldberg, among many others. My thanks to Lisa Newstrom for organizing an interesting, enlightening program.
One evening, Dr. Anders Mellgren generously invited me to dinner. Another day, I had dinner with the current colorectal fellows and their families. I also visited the Weisman Museum of Art, enjoyed the relaxed atmosphere of Minneapolis downtown, and dined in amazing steakhouses.
For the next phase of my scholarship, I went to the Cleveland Clinic, Ohio, where my stay was perfectly organized by the International Program Coordinator Sara Ismail-Beigi. The first day, I was welcomed by Department Chairman Dr. Feza Remzi, and spent an interesting day with him in the outpatient clinic. I saw primarily IBD patients in the pre- and postoperative course.
The following days often required me to make difficult choices: there were usually five colorectal and proctological procedures turning simultaneously. I made the most out of it and observed quite a lot of open and laparoscopic complex operations for IBD or cancer. All staff members were very open to all my questions. I had interesting discussions and learned a lot.
Further, my colleagues took pains to ensure I had a good view of the operating field. It was interesting to watch perineal dissections by Drs. Ian Lavery, Jon Vogel and Luca Stocchi being performed in the prone position. In Switzerland, we usually perform them in the lithotomy position. I was also fortunate to watch several advanced minimally invasive procedures. One was a SILS total colectomy performed by Dr. Daniel Geisler, who explained to me his tips and tricks.
Extracurricular activities included walking tours around the University Circle, downtown Cleveland and the waterfront area; visits of the Cleveland Museum of Art and the Rock and Roll Hall of Fame; and dining in the warehouse district.
I next flew to Boston and visited the city afoot during two recreational days. I enjoyed Freedom Trail, Black Heritage Trail, the Institute of Contemporary Art, and fortified myself with a regular oyster & lobster diet before heading to the Lahey Clinic. I received a very warm welcome and nice introduction to the staff by Dr. Patricia Roberts. I was assigned to Dr. Thomas Read and his colorectal fellow, Dr. Tim Geiger, who took time to show me around. My time with them was very instructive and highly entertaining at the same time.
I spent most of my time in the OR watching a variety of laparoscopic and open colorectal operations and observing many subtle technical modifications. Special thanks go to Drs. Rocco Ricciardi, David Schoetz and Jason Hall. During a most enjoyable teaching operation for total laparoscopic colectomy by Dr. Peter Marcello, I learned many useful tips for my own practice. I also enjoyed constructive discussions on technical issues and perioperative care.
My final day ended with the annual complimentary barbecue for Lahey employees in the clinic park. I received a beautiful farewell present: a Lahey tie, which I will wear at next year’s ASCRS Annual Meeting in Vancouver.
In the end, the ASCRS International Scholarship exceeded my expectations. Professionally, I saw new and different techniques that broadened my mind, and benefited from many interesting discussions. Certainly, these experiences will influence my daily practice back home.
Further, it was a unique opportunity for a young surgeon to meet with many renowned colorectal surgeons. Hopefully, many of the nice people I met will also attend next year’s ASCRS meeting in Vancouver!