01 April 2019

I am very grateful to the Association of Coloproctology of Great Britain and Ireland (ACPGBI) for the award of this travelling fellowship scholarship. This facilitated me in undertaking a one year colorectal surgery fellowship between February 2018 and February 2019 at the Peter MacCallum Cancer Centre, Melbourne, Australia.

The Peter MacCallum Cancer Centre (Peter Mac) is one of the world’s leading cancer research, education and treatment centres globally and is Australia’s only public hospital solely dedicated to caring for patients affected by cancer. There are currently 4 colorectal surgery consultants. The main reasons for undertaking this fellowship were to gain specific experience in the following:

1. Robotic Colorectal Surgery
2. Cytoreductive Surgery & Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for peritoneal metastases or Pseudomyxoma Peritonei
3. Pelvic Exenteration Surgery for locally advanced or recurrent pelvic malignancy
4. Transanal Total Mesorectal Excision (TaTME) Surgery for rectal cancer
5. Perioperative management of complex colorectal cancer patients

The hospital is fortunate to have a da Vinci Xi robot with a dual console, which facilitates teaching for robotic cases. This has a simulator with multiple workshops to practise and develop your surgical skills on the robotic console. In the year I was involved with 75 cases including a mixture of anterior resections, colectomies, transanal procedures and incisional hernia repairs. The hospital very kindly sponsored me to attend the da Vinci System training laboratory for console surgeons at the Royal Prince Alfred Surgical and Robotic Training Institute in Sydney. I also underwent the necessary proctored cases and I am now recognised by da Vinci as suitably trained to undertake robotic surgery in colorectal. The Peter Mac is a tertiary referral centre for peritoneal metastases and pseudomyxoma peritonei (PMP) with a dedicated fortnightly multidisciplinary meeting. This provided an invaluable experience in the discussion and management of these complex cases. I was able to participate in 80 cytoreductive surgery and HIPEC cases for a mixture of pathology. It is also a major referral centre for pelvic exenteration for locally advanced or recurrent pelvic malignancy with a weekly dedicated multidisciplinary meeting. Particular interests in the year included sacrectomy and lateral pelvic sidewall dissection. I was present for 35 cases in the year for a variety of underlying pathology, but the majority were total pelvic exenterations. I also had the opportunity to be part of the first robotic pelvic exenteration performed at the hospital. The hospital also performed its first robotic TaTME case whilst I was there and I got to participate in a further 12 TaTME cases for low rectal cancers. This was a great opportunity to implement the theory and skills I had acquired on a TaTME course at the VUmc in Amsterdam prior to starting my fellowship. I found this experience in a different healthcare system and hospital setting, with exposure to alternative surgical techniques and methods of research was truly invaluable. The opportunities afforded to me by this fellowship have helped expand my understanding of diseases we treat and the infrastructure required to optimise patient outcomes. This focused period of training will inform my approach to patient management, which I hope will be beneficial to the patients I treat in the future. Without the support of the ACPGBI, this experience would not have been possible.

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