2010 International Scholar Report:
Fellowship experience will enhance delivery of colorectal care in Jamaica
By Joseph Plummer, MB BS, DM (SURG), Consultant General and Colorectal Surgeon
University of the West Indies, Kingston, Jamaica
Encouraged by Dr. Robin McLeod of the University of Toronto, I was fortunate enough to be awarded one of the American Society of Colon and Rectal Surgeons International Scholarships. As the ASCRS Annual Meeting was in Minneapolis, I organized to visit the Mayo Clinic at Rochester prior to the annual conference and, later, the Cleveland Clinic Foundation. These institutions have two of the leading colorectal faculties worldwide, and both are rated in the top five of surgical management of colorectal diseases in North America.
My objective with both these visits was to obtain first world experience on minimally invasive and endoscopic colorectal surgery and complex pelvic operations. I can now say that the time spent at both these institutions did not disappoint.
First, I arrived at the Mayo Clinic under the guidance of Dr. Heidi Chua. I was introduced to some of the other CR faculty, including Drs. Robert Cima, Eric Dozois, and David Larson. My striking first impression was how these faculty members were friendly and took a keen interest in my wellbeing. I attended and participated in the multiple-disciplinary and ward rounds. I also met Mr. Ian Jenkins, 2010 traveling fellow from St. Marks Hospital, who was visiting the Mayo Clinic at the same time.
Dr. Chua and her team had daily experience with laparoscopic colectomy. Also, here I was introduced to the hand assisted laparoscopic colectomy, for the difficult cases. Dr. Eric Dozois was keen to share his experience with recurrent rectal cancers, including the use of intra-operative radiotherapy. Dr. Larson was also kind to provide me with the opportunity to observe some robotic rectal surgery.
Given that I was returning to a general surgical practice in Jamaica, I decided to spend one day with Dr. Michael Kendrick, observing some upper gastrointestinal and hepatobiliary laparoscopic procedures. I was fortunate to see a complete laparoscopic Whipple’s procedure, including partial portal vein resection. It was an amazing experience, as he did several other cases on that day!
I then went on to the Annual Conference, and in Minneapolis I was joined by the other ASCRS Scholarship recipients including Drs. James O’Riordan, Mr. Angus Watson, and later Dr. Martin Hubner from Switzerland. Meeting fellow recipients allowed me to realize the prestigious nature of the award, as these physicians were emerging leaders in their home countries.
On the first day of the Annual Meeting, we attended the International Council of Coloproctology meeting, where I gave a presentation on the current state of colorectal surgery in Jamaica. We met Drs. Stanley Goldberg and Maher Abbas, both of whom offered to assist with their knowledge and influence in industry to help with equipment acquisition and development of the service in Jamaica. Mr. Watson also introduced the possibility of fellowship training in colorectal surgery in Scotland for another Jamaican.
The conference had several high impact lectures from world leaders in colorectal surgery, including Prof. Philip Quirke, Mr. Bill Heald and Dr. Robin McLeod. Dr. Mathew Albert presented a new technique of rectal cancer resection via a single incision laparoscopic surgery (SILS) port place in the anus. For me, however, the highlight of the conference was the Resident/Fellow presentations, where I spoke about diagnosing Lynch Syndrome In Jamaica.
After a successful conference and a brief trip back to Jamaica to share some of my newly acquired experience at the University of the West Indies, I was back in the U.S., now at the Cleveland Clinic Foundation, Cleveland, Ohio. There I met Drs. Victor Fazio, Ian Lavery, James Church, and Feza Remzi. I was surprised about how these masters of CRS were friendly and comfortable with sharing their experience.
While I spent most of the operative time with Dr. David Dietz observing complex operations for inflammatory bowel disease, I was free to rotate among the entire colorectal staff. I especially liked observing Dr. Ian Lavery, and watching his techniques with minimal reliance on advanced or complex technology in the operating room.
I spent one day observing Dr. Church performing lower gastrointestinal endoscopy. He shared aspects of his techniques, including those used in advanced polypectomy, and we discussed familial colorectal cancers, an area of mutual interest. I had the opportunity to observe Dr. Luca Stocchi perform a trans-anal excision of a rectal tumour via a SILS port. The procedure was instructive in multiple ways.
Overall the International Fellowship allowed me to meet world leaders in colorectal surgery in their most comfortable arena, the operating theatre, and allowed me to take their shared experience and advice back home to Jamaica and the University of the West Indies. I have benefited tremendously from this award and since then have transferred aspects of this experience to the patients, medical students, and residents under my care and supervision.
I would like to take this opportunity to thank Dr. Graham Newstead and other members of the ICCP, plus the ASCRS for giving me the opportunity. In addition, I want to thank all colorectal faculty members of the Mayo and Cleveland Clinics, for the warm welcome enjoyed in both departments. Finally, my thanks to Dr. Robin McLeod and the Toronto colorectal faculty for their initial training and continued support.