Report American College of Surgeons Dr. Abdol and Mrs. Joan Islami Scholar 2017 I was very fortunate of having been selected as a Dr. Abdol and Mrs. Joan Islami Scholar of the American College of Surgeons in 2017. I spent a total of five weeks in the United States of America visiting several centers of excellence in colorectal surgery, and attending the Clinical Congress of the American College of Surgeons in San Diego. Mayo Clinic, Rochester, Minnesota (Host: Dr. Robert Cima), 16 20 October My first visit was the colorectal unit at the Mayo Clinic in Rochester (MN). During my stay, I was able to attend several laparoscopic and robotic colorectal resections for malignant as well as benign diseases. The procedures were very well taught to the colorectal fellows by the supervising surgeons. They were able to use a drawing feature during the robotic procedure to give the fellows instructions. The surgeons had a lot of patience and pretty much operating time was available for teaching. It was quite evident that this is really a teaching hospital. The large pathological lab performing frozen sections of almost all specimens after surgery was impressive to see as I had never seen this before. I was also able to attend the morning rounds at 6AM and the outpatient clinic. Both Mayo Clinic, Rochester, Minnesota. were very well and efficiently organized giving me the impression of excellent patient care. I was also impressed by the size of this clinic with more than a total of 100 OR suits and eight DaVinci robots. On Wednesday morning, I was also able to attend the CREST education session on rectovaginal fistula offered by the American Society of Colorectal Surgeons, and on Thursday morning I attended the multidisciplinary tumor board. On my last day, I was also able to attend a teaching session in the cadaver lab for the Dr. Robert Cima colorectal fellows which was very good. I really had a great time at the Mayo Clinic and I would like to thank Dr. Robert Cima and the other staff members for the great opportunity to visit this world famous clinic.
Clinical Congress American College of Surgeons, San Diego, 22 26 October My next stop was the clinical congress of the American College of Surgeons in San Diego. The Convention Center was really impressive for me as I did not have the chance to visit such a big American meeting before. I attended the Convocation Ceremony on Sunday evening with a great reception afterwards celebrating the new fellows, honorary fellows and new president of the American College of Surgeons. The opening ceremony on Monday was also a great experience as I was, together with the other International Guest Scholars, personally welcomed by the president of the American College of Surgeons, Dr. Barbara Bass. This event really touched me. The Clinical Congress was very well organized and I was able to attend several very good and nice sessions during the meeting. On Tuesday, we had the International Scholars Luncheon with all 2017, but also with some of the previous year s scholars. This was absolutely a very nice meeting with a delicious lunch. Later that day, we had a great evening during The Board of Governor s Dinner with very good food and nice live music. On the last day of the Clinical Congress, the Scholars had the opportunity to present their current research work. It was really nice to hear the research work all Scholars are doing all over the world. It was also International Scholars Luncheon during the American Colleges of Surgeons Clinical Congress. very nice to meet all the scholars from all over the world and I really hope to stay in touch with them. After the Congress, I had one day to visit some touristic spots in San Diego, like the Old Town State Historic Park, Mission Beach and Cabrillo National Monument, and to enjoy the very sunny and warm weather in Balboa Park, the Gaslamp Quarter and Seaport Village in this very nice and relaxing city. University of Illinois at Chicago (Host: Dr. Anders Mellgren), 30 October 3 November My second clinical visit was the Department of Colorectal Surgery at the University of Illinois in Chicago. My main reason to visit this unit was to learn advanced techniques in the diagnosis and treatment of pelvic floor diseases, proctology, rectal prolapse and fecal incontinence. On Monday, I was very kindly received by my host, Dr. Anders Mellgren. During my first day, I attended some outpatient clinics, ward rounds and a colonoscopy program in the afternoon. The other days, I had the opportunity to observe several interesting operations in the field, including a LIFT procedure for an advanced peri anal fistula, sacral nerve stimulation for fecal incontinence and an Altemeier sigmoidectomy for rectal prolapse. This exactly touched the purpose of my visit and it was very useful to learn new tips and tricks for these procedures. The outpatient clinic and especially the pelvic floor clinic, including anal manometry and endo anal ultrasound, was also very instructive as I was able to learn new surgical and conservative approaches in patients with these types of disorders. I also had great discussions with Dr. Mellgren on the organization of the US health care system and especially the insurance coverage of Dr. Anders Mellgren
patients as these are completely different from the one in my own country. It was very interesting to experience these differences during the outpatient clinics. I was excited that Dr. Mellgren invited me for dinner at his place on Wednesday evening. I had a wonderful night with Dr. Mellgren and his wife, enjoying a delicious dinner with a great view from his apartment. I was very grateful that Dr. Mellgren also invited me to attend a meeting of the Chicago Surgical Society on Thursday night. This was absolutely a wonderful event with very nice scientific talks and a very tasty dinner at a great place downtown Chicago. It was absolutely a great pleasure to visit this colorectal unit of the University of Illinois at Chicago and I would very much like to thank Dr. Mellgren for his kindness and all the opportunities he offered me during my stay. Dr. Mellgren was absolutely a fantastic and outstanding host. Before traveling to my next stop, I had some spare time during the weekend to visit some touristic attractions downtown Chicago, enjoying the fabulous skyline of this great windy city and wonderful Lake Michigan views from one of the skyscrapers. Cleveland Clinic Florida (Host: Dr. Steven Wexner), 6 10 November The next stop was Dr. Steven Wexner s colorectal unit at Cleveland Clinic Florida. Monday started with a meeting with many interesting colorectal case presentations by the residents and fellows. After lunch, I was able to attend the colorectal cancer MDT followed by a very good and interesting lecture on low anterior resection syndrome (LARS) by a visiting professor from Cleveland Clinic Ohio. In the afternoon, I had the opportunity to follow Dr. Wexner in the outpatient clinic with a lot of interesting cases on IBD, colorectal cancer and functional disorders. Especially Dr. Wexner s approach in these complex cases was very instructive to me. During the rest of the week, I attended several colorectal Cleveland Clinic Florida operations as Dr. Wexner is used to run two operating rooms at the same time. Especially the transanal TME with colo anal J pouch reconstruction was very interesting to observe as I did not have the opportunity to see this type of reconstruction after transanal proctectomy before. On Thursday, I had another day to follow Dr. Wexner in the outpatient clinic. It was also very interesting to attend the ward rounds at 615AM and to experience how efficiently this is organized. During my visit, I also attended several meetings after the ward rounds, including the morbidity and mortality and Dr. Steven Wexner colorectal research meeting. I have really learned a lot of different tips and tricks and approaches in the area of colorectal surgery during my stay at Cleveland Clinic Florida. It was absolutely an honor and great pleasure to visit this colorectal unit and I would like to thank Dr. Wexner for his hospitality and this great opportunity.
Memorial Sloan Kettering Cancer Center, NYC (Host: Dr. Julio Garcia Aguilar), 13 17 Nov My last stop was Memorial Sloan Kettering Cancer Center in New York City. My main aim to visit this unit was to observe robotic colorectal resections. This center was a very good choice, because the surgeons are used to perform almost all colorectal procedures by using the robot. I was able to observe several right and left sided colectomies, rectal resections, and even a trans anal resection of a rectal cancer (TAMIS) by using the robot. It was very instructive to see these procedures performed by the experienced surgeons from this center and to experience the differences, advantages and drawbacks, of robotic surgery compared to laparoscopic colorectal surgery. In addition, I was excited about the setup of the OR in this center with a lot of screens showing all the necessary information of the patients, including radiology imaging, history/ allergies, time out procedure and anesthetic details. I also had the opportunity to follow the surgeons during some Dr. Julio Garcia Aguilar outpatient clinics. It was very valuable to learn how they are used to treat patients with colon and rectal cancer, and to experience the differences in treatment in my own country. It was also very useful to hear how the colorectal surgeons in MSKCC are used to treat patients with a complete response after chemo radiation for rectal cancer as I am currently writing the protocol for this patient population in my own hospital in the Netherlands. Also, it was very interesting to observe how well the outpatient clinic is organized with a lot of fellows and physician assistants supporting the colorectal surgeons. Additionally, I had the chance to attend the monthly research meeting of this unit and the weekly cancer MDT, including very interesting and complex cases. I was excited that Dr. Garcia Aguilar invited me to have dinner with him, his wife and Professor Eric Rullier from Bordeaux who was also visiting MSKCC for some days. We had a great time in a very nice Italian restaurant downtown Manhattan, enjoying a delicious meal. I really had an excellent and very instructive time at Memorial and I would like to thank Dr. Garcia Aguilar for his time and effort. I am also very grateful Dr. Weiser took care of me during the last days of my visit as Dr. Garcia was visiting a meeting elsewhere. Conclusion This International Guest Scholarship of the American College of Surgeons was really a great and inspiring experience for me. It was a tremendous privilege to attend the Clinical Congress of the American College of Surgeons, visit several high quality colorectal units throughout the United States and to be exposed to the state of the art surgical expertise. I was able to expand my knowledge, discuss several different surgical techniques with the experts and learn new approaches in the treatment of patients with surgical colorectal diseases. This will absolutely be very helpful to implement changes and improvements in techniques, organization and decision making in patients with diseases within the colorectal area in my own hospital in the Netherlands. In addition, to get to know the US healthcare system and the differences with the one in my own country was also a very interesting part of my experience. I was delighted to meet the international recognized and dedicated colorectal surgeons and observing their work was a main achievement from this Scholarship. I truly
hope to stay in touch with those inspiring people to be able to meet each other again in the future and to collaborate in several clinical, educational and research activities. In addition, I have also very much enjoyed and appreciated all the social activities during my trip. Altogether, this International Guest Scholarship of the American College of Surgeons has absolutely been of great additional value for me and will definitely enable me to improve the quality of my own clinical practice and patient care. I would very much like to thank the International Relations Committee of the American College of Surgeons for awarding me this Scholarship, I am tremendously grateful for this great and inspiring opportunity, this is really a memory for life. Edgar Furnée, MD, PhD Colorectal surgeon University Medical Center Groningen The Netherlands November 2017 NTvH: Prestigious Scholarship of the American College of Surgeons