SPRING 2017

ALSGBI newsletterPresident’s Introduction

Welcome all of you to the 2017Spring edition of the newsletterand once again our thanks go toMr Neil Keeling for bringing thistogether so expertly; we hope youenjoy reading this.

As I write we are still in theafterglow of the Annual ScientificMeeting held at the ILEC inLondon last November whichattracted the largest number ofattendees to date, with nearly300 registered delegates and 28companies represented. Thefeedback has been very gratifyingand thanks are due to so manypeople whose individual andcollective contributions wereimmeasurable.

The meeting followed thefamiliar format with the trainingday on the Wednesday, liveoperating on Thursday and theScientific day on the Friday.

We held the training day atthe Training Unit in St Mary’sHospital which many of you who

work in the South East will be very familiar with. It was established underthe leadership of Professor George Hanna who kindly allowed us to use thefacilities and his team for the day. For those who have not visited this is abespoke training unit through which one quarter of all our UK surgicaltrainees gain technical skills training on a rotating programme. With thesefacilities Mr Paul Leeder was able to deliver, with his “A” list faculty, a trainingday which must rate as the best laparoscopic training day in the UK; nowonder it is routinely oversubscribed (as it was again this year). Our thanksgo to Medtronic for generously sponsoring the training day ensuring thatthis was free for those trainees participating.

For those of you interested in this year’s training day, it will be held in theequally impressive Welsh Institute of Minimal Access Therapy (WIMAT) andplaces will again be free to registered delegates on a strictly first come firstserved basis. Early applications are strongly advised.

During the main meeting the live operating always provides a frisson ofanxiety for the organising team and this year was no exception. For a littlewhile the Croydon tram crash threatened to also derail Professor Tim Rockall’scareful preparations but, in the event, the hurdles were overcome, all thetechnology worked perfectly and the operating was inspirational. Our thanksgo to Tim and the team at the Royal Surrey County Hospital and to Karl Storzand Olympus for providing the live links and the best quality images I have

ever seen. This was Europe’s first ever demonstration of a live 4K link and thequality of the operating which matched the jaw dropping quality of theimages will be remembered for a long time to come. The day concluded witha session of procurement which was a first for us and one which we plan tobuild and expand upon in future conferences.

Our guests at the Scientific meeting were Professor Luigi Boni from Italywhose topic was the use of ICG therapy in laparoscopic surgery and ProfessorMichael Kendrick from the USA who gave the BJS lecture on the topic ofpancreatic resections but who also led our symposium on haemostasis withcandid videos and helpful practical advice which we all crave.

Our congratulations also go to Mr Philip Pucher who won the David Dunnmedal for the best oral abstract presentation.

This year’s Annual Scientific Meeting will be held in Cardiff and judgingby the success of our last meeting in Cardiff may well prove bigger than eventhe London meeting. Our local organiser is Mr Jared Torkington who is knownto many of you and plans are already well underway. For now please reservethe dates in you diary – 9th and 10th November 2017. The theme will bebased around improvisation and innovation in laparoscopic surgery with anemphasis on novel thinking and practice.

Looking forward to 2018 London will be hosting the EAES meeting on31st May and 1st June. The venue is the Excel Centre and we would urge asmany of you to attend as you can. It will be an excellent meeting and the UKopportunity to showcase our skills to our European neighbours. It will be abig meeting with potentially 1,500 to 2,000 delegates and we need to bethere. Those who regularly attend the EAES will testify to the consistentlyhigh standard of the meeting and an opportunity to see a different way ofoperating from both Europe and, increasingly, from delegates from the Far-East. There will be more to say on this meeting in future bulletins.

Our other major project for 2017 will be the continued roll-out of the“LapPass” programme and the setting up of regional training days which weplan to provide free of charge. In these meetings we will be providing skillstraining for passing LapPass and there will be assessment opportunities aswell, but it is unlikely the standard required to pass will be achieved in onesession and independent practice is encouraged.

2017 will also see the closure of the RCS building in Lincoln’s Inn Fieldsand with it our home for the last 18 years of our existence. We shall maintaina base in the Nuffield building in the short term and all contact details willbe unchanged but as a Council we will become more nomadic in the venuesfor our forthcoming meetings. Future arrangements for the Association arebeing discussed but will become the responsibility of Mr Simon Dexter whoI am delighted is the person we have chosen to assume the Presidency fromNovember.

We wish you all an enjoyable 2017 and look forward to seeing as manyof you as possible in Cardiff. Best wishes

Mr Peter SedmanPresident, ALSGBI

SAVE THE DATE

2017 ALSGBI Annual Scientific Meeting | Cardiff

Thursday 9 & Friday 10 November

ALSGBI Laparoscopic Surgery Training Day | Cardiff | Wednesday 8 November

Mrs Sarah WilliamsDirector of Fundraisingswilliams@alsgbi.orgTel +44(0)20 7869 6940www.alsgbi.org

Association of Laparoscopic Surgeons of Great Britain & Ireland @ The Royal College of Surgeons, Room 505, 5th Floor, 35-43 Lincoln's Inn Fields, London WC2A 3PE (until August 2017)Registered Charity Number: 1058455

Mrs Jenny TreglohanExecutive Directorjtreglohan@alsgbi.orgTel +44(0)20 7869 6941www.alsgbi.org

ALSGBandI#ALS2017

2

ALSGBI Industry Partners for 2017-2018

PLATINUM GOLD

SILVER

ALSGBI COUNCIL 2017

ALSGBI Executive

PresidentMr Peter C Sedman

President ElectMr Simon Dexter

Honorary SecretaryMr David Mahon

Honorary TreasurerMr Donald Menzies

Director of EducationMr Paul C Leeder

Members ofALSGBI CouncilMidlandsMr Ewen GriffithsTrentMr Altaf Khan AwanIrelandMr Colm O’BoyleOxford & WessexMr Nicholas DaviesNorthern & YorkshireMr YKS Viswanath

North West & MerseyMr Chelliah R SelvasekarScotlandMr Ahmad NassarNorth ThamesMr Tan ArulampalamAngliaMr Neil KeelingSouth ThamesMr Andrew DayWalesMr Graham Whiteley

South & WestMr Nader Francis

AUGIS RepresentativeProfessor Giles Toogood

ACPGBI RepresentativeMr Mark Chapman

ASiT RepresentativeMr Adam Peckham-Cooper

ALSGBI Representative at EuropeanAssociation of Endoscopic SurgeonsProfessor George Hanna

ALTS ChairpersonMrs Debbie Gooch

Deputy ALTS ChairMs Alice E JonesEditorial SecretaryMr Neil KeelingAudit DirectorMr C Richard B WelbournResearch DirectorProfessor George HannaWebsite DirectorMr David Mahon

Editor’s IntroductionWelcome to the 2017 Spring ALSGBINewsletter. It is both an opportunity tolook back on some of the events of2016 and to look forward to manyexciting things happening in 2017.

The Annual Scientific Meeting atthe ILEC in London was a tremendoussuccess and we hope that the CardiffMeeting being organised by Mr JaredTorkington for 9th and 10th Novemberwill surpass this.

I would like to bring to yourattention the EAES Congress in Frankfurt on 14th-17th June and at the endof August (29th to 2nd September) the IFSO meeting.

As you may already have heard there has been a major new projectannounced for the RCS England which is going to undergo a major

refurbishment and the official briefing is attached.Please make note of the announcement of the CORESS charity appealing

for contributions, the web address and e-mail details are on page 4.Once more I urge you to take a look at the excellent ALSGBI website

maintained by Mr David Mahon http://www.alsgbi.org. There you willalso find the application forms for ALSGBI funding assistance for localand regional skills and training meetings.

If you have articles that you would like to have considered for thenext Newsletter please send them to me neil.keeling@wsh.nhs.uk or toJenny jtreglohan@alsgbi.org

Please do not forget to submit your answers for the captioncompetition on page 7, entirely at the expense of our President Mr PeterSedman!

Mr Neil Keeling Newsletter Editor

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ALSGBI North West and Mersey Regional Meeting29 September 2016, Sai Spice, Chorlton

The 8th Minimal Access Surgery North West(MASNoW) meeting took place on the 29thSeptember 2016 at Sai Spice, Chorlton. Thebiannual evening event was hosted by MrSajal Rai, Consultant Colorectal Surgeon atStepping Hill Hospital, Stockport NHSFoundation Trust. The attractions of well-respected speakers from the region and thepromise of good curries have proved to be abig draw for audiences in recent meetings. OurSeptember meeting was well attended by 53consultants and trainees.

The evening consisted of consultant andtrainee presentations from Upper GI,Colorectal and HPB subspecialties. Mr BartDecadt (Consultant Upper GI Surgeon,Stepping Hill Hospital) gave a well-received

presentation on the surgical management ofoesophageal perforation with the use of T-tube. Professor Aali Sheen (Consultant HPBSurgeon, Manchester Royal Infirmary) sharedhis experience on the operative managementof difficult gallbladders which was muchappreciated by many non-HPB colleagues inthe audience. We were very honoured towelcome our guest speaker Mr RaviMarudanayagam, Consultant HPB Surgeonfrom Queen Elizabeth Hospital in Birmingham.Mr Marudanayagam shared his experience onthe technique of laparoscopic majorhepatectomy and outcomes from his unit.The latter half of the evening saw traineepresentations by Shahin Hajibandeh (CT1), EvaVitovská (FY2) and Jennifer Clark (CT1).

The trainee presentation prize was awarded toHayley Fowler (ST3) for her talk on Endoscopicpilonidal sinus treatment (EPSiT).

The MASNoW ALSGBI regional meeting isnow a key educational and social event in theregion. Our next meeting is planned for April 2017and abstract submission will open from early2017. Please contact closurgeon@gmail.com forfurther information.

Ms Christina LoSenior Upper GI Trainee, North West DeaneryMr Chelliah R SelvasekarConsultant Colorectal Surgeon, The ChristieNHS Foundation Trust, ManchesterNorth West & Mersey Regional Representative,ALSGBI Council

SAVE THE DATESWEDNESDAY 8 NOVEMBER 2017

ALSGBI Laparoscopic Surgery Training DayWIMAT (The Welsh Institute for Minimal Access Therapy), Cardiff

THURSDAY 9 & FRIDAY 10 NOVEMBER 2017ALSGBI & ALTS Annual Scientific Meetings, City Hall Cardiff

Contact Us

Reporting

Contact us now via email: admin@coress.org.ukTelephone: 020 7304 4778

Who can report?

specialty.How do I report? Reports can be submitted online through the CORESS website. Simply visit: http://www.coress.org.uk/submitform.htm to download the Reporting Form, complete it online and return it automatically through the website.

CORESS is an independent charity, which aims to promote safety in surgical practice in the NHS and the

lessons to be learned. CORESS then publishes these reports alongside the Advisory Committee’s safety lessons in surgical literature to educate fellow surgeons, with the end goal of reducing the chances of a similar incident re-occurring in another theatre.

What is CORESS?

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5

Fifty-eight trainees attended the regional ALSGBIChapter Meeting in Taunton organised byMusgrove surgeon Mr Richard Welbourn, whichrepeated the theme of live operating by invitedregional experts interspersed with lectures.Regional SpR Miss Zoe Oliphant did an excellentjob of raising sponsorship to make the event freefor trainees.

President of the ALSGBI, Mr Peter Sedman andPast-President Mr Mark Vipond moderated thefirst session in which Mr Simon Dwerryhouse(Gloucester) performed a beautiful demonstrationof laparoscopic Nissen fundoplication, assisted bylocal surgeon Mr Hamish Noble. This was followedby a presentation by Professor Mark Coleman(Plymouth) who eloquently mapped out traineepathways for the 'consultant-ready' trainees.

Keeping to topics important to trainees at alllevels Mr Sedman then demonstrated how to doa laparoscopic incisional hernia repair, with MrDavid Hewin (Gloucester) and Mr David Mahon(Taunton) moderating. Mr Dwerryhouse thenspoke about problems facing every hospital - thatis, how to deal with the challenge of acutegallbladder surgery and the evidence behind

algorithms for triaging patients with derangedLFTs and dilated ducts – with a focus on how todeal with bile duct stones and by whomaccording to the skills available locally.

At lunchtime there was a knot-tyingcompetition, a lively trade exhibition andsandwich buffet lunch at which delegatesmingled well with our sponsors - to whom weare very grateful for making the day anothersuccess.

Both training and certifying of demonstratedskills is key to good laparoscopic training and MrSedman updated us with the LapPass passportfor trainees. To finish the live operating ProfessorColeman then demonstrated right hemi-colectomy in a difficult case in combination withlocal colorectal surgeon Mr Paul Mackey. The dayended with a tour de force presentation by Mr Ian Daniels (Exeter) on how to repairdifficult incisional hernias and reconstructwhole abdominal walls when there is completemuscle failure.

Feedback on the day was excellent and therewas enthusiasm for repeating it again next year,hopefully encouraging trainees to join theALSGBI as well.

Mr Richard WelbournAudit Director, ALSGBI Council

9th SW Regional Laparoscopic Training Day 21 October 2016, Musgrove Park Hospital Academy, Taunton

Mr Mark Vipond, Mr Matthew Mason and Mr Hamish Noble Lunch with trade exhibition Mr Simon Dwerryhouse operating

Mr Peter Sedman and Mr David Hewin

Professor Mark Coleman operating with Mr Paul Mackey

6

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ALSGBI Annual Scientific Meeting10-11 November 2016, ILEC, London

Caption CompetitionHere is your chance to win a bottle of champagne.To the right you will see a picture of Mr Peter Sedmantaken at the last ALSGBI Scientific Meeting in London.

First to come up with a caption that is printable and not likely to be subject to legal challenge for defamationplease send your caption to jtreglohan@alsgbi.orgThe best answers will be published in the AutumnNewsletter.

Our 2016 Annual Scientific Meeting was held in November at the ILECConference Centre in London and was one of our most successful andstimulating meetings to date.

We had our highest ever number of registrations (nearly 300 delegates) and28 companies were represented. The conference centre proved to be the perfectsize; suitably cosy and intimate but without being cramped and the programmewas stimulating and flowed freely throughout. There were lots of highlights.

We adopted our standard format for the event with the teaching day on theWednesday, live operating on the Thursday and the Scientific session on the Friday.

The teaching day was held at St Mary’s Hospital and we thank ProfessorHanna for allowing us exclusive use of the outstanding surgical trainingcentre he has developed there. Many surgeons who work in the South Eastare very familiar with this bespoke training unit and approximately onequarter of all our UK surgical trainees gain technical skills training on arotational programme through it. The technical support team have expertiseand experience which impressed us all and we took new ideas away from theday. A special thanks go to Mr Steve Marchington who oversaw.

With these facilities Mr Paul Leeder was able to deliver, with his facultyof true experts, a training day which must rate as the best laparoscopictraining day we can possibly deliver in the UK; no wonder this training dayis routinely oversubscribed. Our thanks to Medtronic for sponsoring thetraining day which, once again, we were able to provide free of charge to thedelegates. For those of you interested in this year's training day it will be heldin the equally impressive Welsh Institute of Minimal Access Therapy (WIMAT)and places are available to registered delegates on a strictly first come firstserved basis. Early applications are strongly advised as places are routinelyoverbooked.

The live operating day always provides a frisson of anxiety for the organisingteam and this year was no exception. For a short while the Croydon tram crashthreatened to derail Professor Tim Rockall’s careful preparations but in the eventthe hurdles were overcome, the technology worked perfectly and the operatingwas inspirational. Our thanks go to Tim and the team at the Royal Surrey CountyHospital and to Karl Storz and Olympus for providing the live links and the bestquality images I have ever seen. This was Europe’s first ever demonstration of alive 4K link and the quality of the operating which matched the quality of theimages will be remembered for a long time to come. We were grateful to MrAdam Howard from Colchester who added to these live links with somefascinating video presentations on laparoscopy in the practice of a vascularsurgeon. The day was concluded with a session on procurement. This sessionwas a first for us but was started in response to the frustrations we all have inthe modern NHS where the hurdles to obtaining the equipment we so heavilyrely upon seem greater with each passing year. We need to become smarter inthis area and we intend to expand upon this theme in future meetings.

Our guests at the Scientific Meetingwere Professor Luigi Boni from Italy andProfessor Michael Kendrick from theUSA who gave the BJS lecture on thetopic of pancreatic resections.

Professor Boni’s topic was on the useof ICG therapy in laparoscopic surgerywhich he has been developing for someyears and we had been able to witnessuse of this in live operating the preceding day. None who saw thesedemonstrations or who heard the talk will be in doubt about the potential forthis approach in minimising operative complications in the future.

Professor Kendrick began his contribution to the meeting by showing somecandid videos as a backdrop to the symposium on haemostasis. The technicalquality of his surgery is sublime and to see how he copes with suddenhaemorrhage left us all with practical tips which bear rehearsing mentally inpreparation for the occasional moments where they are needed in a hurry.

The BJS lecture was later given and presented the results of his severalhundred laparoscopic pancreatic resections and video footage todemonstrate various technical points along the way. It was impossible toleave without feeling inspired and a little awed.

The scientific contributions were of a high standard reflecting theexcellent work being done up and down the UK and our congratulations goto Mr Philip Pucher who was awarded the Society’s most prestigious prize,the David Dunn medal for his presentation entitiled “The impact oflaparoscopy in emergency major abdominal surgery”. The presentation of themedal will take place at our next conference.

The meeting concluded with the announcement that our next Presidentis to be Mr Simon Dexter who will take over from me at the conclusion ofthe Cardiff meeting. Please make a note in your diary now of the dates:

Wednesday 8 November 2017Laparoscopic Surgery Training Day at the WIMAT

Thursday 9 November 2017Annual Scientific Meeting including live operating sessions at Cardiff City Hall

Friday 10 November 2017Annual Scientific Meeting including invited speakers &

ALTS Meeting at Cardiff City Hall

Mr Peter SedmanPresident, ALSGBI

8

ALSGBI Annual Scientific Meeting10-11 November 2016, ILEC, London

The 2016 ALSGBI conference was in London,which was obviously a great choice as we had thebest delegate numbers ever. More importantly wehad 48 ALTS members registered which is also arecord: We hope this will increase year on year.The ILEC conference centre was a lovely hotel andan excellent conference venue. As the conferencewas all in the same area it didn't matter what theweather was doing outside, as all we had to dowas to look at the weather and not experience it!

The local organising team did a wonderful jobarranging all the live operating which really wasfirst class with some very challenging surgerybeing performed.

The exhibition was up to the usual highstandard exhibiting a wide range of keyequipment required in laparoscopic surgery.Certainly our ALTS delegates enjoyed seeing allthe companies relevant to minimal accesssurgery under one roof. There were lots ofcompetitions to enter and prizes to win from apen all the way up to a Microsoft Surface Pro, aswell as other titbits and a variety of other prizes.All in all well worth attending.

After the live operating had finished on theThursday we adjourned to the exhibition for adrinks reception, followed by dinner at the

Queens Club in Palliser Road: What a greatvenue! The dinner was, as usual, extremely wellattended, with not a spare seat to be had! Thefood was excellent as was the wine and there wasno shortage of either! Our after dinner speakerwas Mr Gary Richardson who really was excellentand had us all laughing throughout.

After dinner the bus took us to the hotel andeveryone proceeded to the bar to ‘put the worldto rights’ before retiring to bed very late!

Friday is the day when we split up intoparallel sessions for all ALTS members (andanyone else that wanted to join in!). As we hadso many delegates registered the room was fullwhich was fantastic to see. Mr RichardLawrence from Olympus gave us an excellenttalk on getting the best out of our camerasystem – informative and light hearted in equalmeasure, and very enjoyable. The currentPresident, Mr Peter Sedman gave us some of hisvaluable time to talk about LapPass, what itentails and the purpose of the exercises. It is notexpected that our theatre practitioners willcomplete these tasks, but it is always fun tohave a go. It makes us appreciate how difficultit is for our trainee surgeons to make the grade.We then joined in with the main scientific

meeting for some more excellent presentations.We had managed to borrow some

laparoscopic stacks in the afternoon for anyonewho wanted to practise their camera holding, buteveryone wanted to attend the main meeting,which of course was absolutely fine as we do liketo offer our delegates choices.

This was my last meeting as ALTS Chairpersonas I have now been in the post for 10 years and Ifeel it is time someone else took over andinjected some new life into the role. The newALTS Chairperson will be Mrs Debbie Gooch,whom I am sure a lot of you will know already asshe has been involved with the organisation formany years and has been to all the meetings overthe last 8 years. She is well known to most of theCouncil members and will do a fabulous job, ofthat I have no doubt. So I would like to take thisopportunity to welcome her into the role andonto the Council. Please support her and sendher any ideas or themes you would like to seecovered in the ALTS sessions.

Good luck to all and I am sure our paths willcross in the future.

Mrs Jane P Bradley Hendricks ALTS Chairperson

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Position statement from Association of Laparoscopic Surgeonsof Great Britain and Ireland (ALSGBI) on Robotic SurgerySummary: The Association of Laparoscopic Surgeons ofGreat Britain and Ireland (ALSGBI) has been atthe forefront of development of minimal accesssurgery in the United Kingdom. ALSGBI providesa structure for training to promote safe practicein multi-professional minimal access surgery.Robotics in surgery has been in clinical use forsome time and the Association fully understandsthe need to embrace robotics. It does feelhowever a cautious approach is beneficial in theintroduction to clinical practice, based on theclinical and cost-evidence with training forsurgeons and the team to perform the procedurecompetently. There should be strong clinicalgovernance arrangements locally and the NHSshould adopt the technology appraisal guidanceprovided by National Institute for Health andClinical Excellence (NICE). The cost of currentrobotic systems is a huge financial challengehowever the ALSGBI believes that by establishinghigh-volume centres this will enable thedevelopment and sustaining of a high qualityservice. It will also provide centres of excellencewith high quality training. The training needs tobe team-based, structured and accredited.Clinical outcomes should be defined, measuredand recorded prospectively in clinical trials orthrough a national registry.

Introduction:Robots have been used in assisting surgeonsperform surgical tasks in orthopaedics,neurosurgery and cardiac surgery for some time,however there has been an exponential increasein their use and popularity following theintroduction of robotic prostatectomy. Nowadaysrobotics are widely used in general surgery,gynaecology and head and neck surgery.

Clinical application:Despite the increased popularity of roboticprostatectomy, which is recommended by NICE asthe technique of choice, there is no unequivocalevidence to show its superiority over traditionallaparoscopic surgery in other surgical procedures.Further trials are required to ascertain the long-term benefits of robotic surgery in oncology,functional outcomes including QoL and to assessthe cost effectiveness. In other pelvic surgeries theuse of a robot has shown marginal benefit but hasinvolved greater costs and longer operating times.

In 2000, the Da Vinci robot was approved bythe FDA for use in laparoscopic surgery. The DaVinci system overcomes some of the limitationsof standard laparoscopy and allows for precisedissection in a narrow confined space, hence theincreasing application in robotic assistedlaparoscopic prostatectomy. The advantagesinclude stable operator controlled camera system,high definition 3-D magnified view, articulatinginstruments with seven degrees of freedom,

improved ergonomics, motion scaling and tremorfiltration. The short term benefits are mainlyrelated to reduced wound related complicationshowever robotic surgery is more expensive thanlaparoscopic surgery and open surgery. There issome evidence to suggest robotics may reducethe learning curve and may enable opensurgeons to take up minimal access surgery.Although the initial set up costs are high,increased competition from manufacturers andwider dissemination of the technology may drivethe costs down in future.

Robotic technology is rapidly evolving withthe development of new robotic prototypes forsingle incision surgery. Robots designed forspecific procedures rather than the currentgeneric system will enable procedure specificimproved outcomes with decreased complicationsalong with cost effectiveness in future.

Training in Robotics:Currently in the UK, the knowledge and skills areacquired through speciality training or on peri /post-CCT fellowships. Operative experience canbe gained by mentored practice or by the use ofsimulators. Trainees must have satisfactoryknowledge of the specific characteristics of therobotic platform and be taught by appropriatelytrained and experienced trainers. Equallyimportant in robotic surgery is that the team istrained with the robot. At present, apart from fewrobotic prostate fellowships, most of the robotictraining is provided by the manufacturer of thesingle currently commercially available and FDAapproved surgical robot. Ideally health careproviders should have the ability and theresources to train surgical teams in all aspects ofsurgical care, including robotics.

Training in laparoscopic colorectal surgery has been streamlined using a modular approach and through the LAPCO programme(http://lapco.nhs.uk/). Similar training modelsneed to be established for robotic surgery. Thereare some unique considerations such as portplacement, where collisions of the arms have tobe avoided, additional arms under the surgeoncontrol and increased reliance on visual clues dueto lack of tactile feedback with the currentsystems. In addition, team training with enhancedcommunication between various members isneeded as the surgeon is away from the patient,scrub team and the anaesthetist. There is a hugeamount of literature on calculating the learningcurve based on surgical competency and patientoutcomes in laparoscopic surgery. Similarmethodologies need to be adopted in achievingcompetency in robotic surgery. Using the cusumand operating time, appropriately 15-30 cases arethought to be required to achieve competency inrobotic rectal resections based on prior experiencein minimal access surgery.

The Association would recommend competencybased training in robotic surgery based on theEuropean robotic urological society fellowshipprogramme and the European academy of roboticcolorectal surgery. The training needs to be astandardised structured programme withassessment of knowledge by completing theIntuitive surgical online robotic training module,followed by training in the wet lab including animaland human cadaver training. Non-technical skillstraining for the team is important followed by teamobservation visits to a proctor site and then a fewproctored cases +/- assessment of technicalcompetence by video analysis, with ongoing auditof the clinical practice.

Quality assurance:As a new technology, robotic surgery should besubjected to all the currently defined qualityindicators for surgical practice includingmortality, oncological safety, complications, andquality of life assessments and follow the NICEapproved process of assessing clinical and costeffectiveness. Standardisation of surgical trainingand its application is vital to ensure that newertechnologies are validated appropriately.

Conclusion: Robotic surgery with the Da Vinci surgical systemis increasingly used in a wide range of surgicalspecialties. This technology aims to improveoutcomes when compared to open surgery and toovercome some of the limitations of laparoscopictechniques. Despite increasing use, apart fromprostatic surgery there is no unequivocal evidenceto show the superiority of robotic surgery over thetraditional laparoscopic technique. As there is agreater focus on early intervention and quality oflife, there is likely to be development of roboticplatforms for procedure-specific or platforms forspecific parts of the procedure, rather than thecurrently available single robotic system used inall specialities to cover the entire surgicalprocedure. At the same time there is advancementin laparoscopic surgery with 3-D technology andimproved instrumentation. An area of considerableinterest unique to robotic platforms, is the abilityto integrate electronic systems such as cross-sectional imaging and programmable parametersinto a robot, allowing 3-D lesion definition,plotting no-go anatomical danger zonesfacilitating dissection in the ideal plane inoncosurgery. In training, robotics lends itself totelementoring as a training tool. Establishing asmall number of accredited, adequately resourced,high volume centres of excellence with theadditional remit of delivering training wouldprovide a suitable framework for training inrobotic surgery in the UK similar to the modelsestablished for training in laparoscopic colorectalsurgery.

10

Report on the B Braun Aesculap Travelling Fellowship 2015

I was awarded the B Braun Aesculap travelling fellowship in November 2015enabling me to visit the world-renowned Karolinska Institute in Stockholm,Sweden. Subsequently I attended the Congress of the European Society forDiseases of the Esophagus held in Stockholm.

Healthcare in Sweden is largely tax-funded; a system that ensureseveryone has equal access to healthcare services. The responsibility for healthand medical care in Sweden is shared by the central government, countycouncils and municipalities.

I was especially impressed by the systematic organisation of the hospital.The Karolinska University hospital is set in a beautiful location a few milesaway from the city and has very strong research collaborations with theKarolinska Institute. The Karolinska University Hospital has 1,600 beds andadmits over 100,000 patients each year.

The Karolinska University Hospital is the largest university hospital inSweden and a national referral centre for specialised care. The Upper GISurgery unit is led by Associate Professor Magnus Nilsson and comprisesthree other consultant surgeons, two Specialist Registrars, a Senior JapaneseSurgical Fellow and a team of more junior trainees.

Having developed an interest in laparoscopic Upper GI surgery andminimally invasive cancer surgery during my training, exposure within a highvolume specialised centre observing a new method of performing minimallyinvasive oesophagectomy (MIO) was invaluable.

My decision to visit Karolinska followed a presentation delivered by DrIoannis Rouvelas (Senior Consultant Upper GI Surgeon) at a local meeting inChelmsford. Dr Rouvelas described his unit’s experience of performing MIOusing a linear stapled anastomosis in the thorax in the prone position. I waskeen to observe this technique and grateful to be invited by Dr Rouvelas andhis team to visit the unit for a week.

I observed the 2-phase MIO whereby the laparoscopic procedure wasperformed with the patient in the supine French position. The conduit wascreated in the abdomen but not completely divided from the specimen.

A 2-cm long proximal ‘bridge’ remained undivided, acting as an anchor to thespecimen, in order to facilitate the pull-up of the specimen into the chestduring the thoracoscopic phase. The thoracoscopic procedure is performed inthe prone position. The side-to-side anastomosis was fashioned using a linearstapler. All patients followed an enhanced recovery program. The patientsspent the first three days in HDU and were then transferred to the ward.Patients were allowed sloppy diet on post op day 6 and solid food on day 8.

The Upper GI cancer unit in Karolinska performs up to a hundredoesophago-gastric cancer resections (approximately 50-60 MIOs) a year.Operating sessions occur on Mondays, Tuesdays and Thursdays. Wednesdaycomprises an outpatients’ clinic and an interventional endoscopy list. Fridayis dedicated to MDT and for ensuring loose ends are tied prior to the weekend.The Upper GI unit assesses and treats oesophago-gastric and hepato-pancreatobiliary cancers and complex benign upper GI diseases. It does notperform primary Bariatric surgery but on occasions deals with complex post-operative problems. One of the most enlightening observations was theprofessionalism within the team, meticulous attention to detail and athorough, systematic approach when operating. I hope to use such lessonsand examples to benefit my own practice in future.

I was able to attend the Congress of the European Society for Diseases ofthe Esophagus. This had a unique scientific program with internationalexperts in the field of both Upper GI cancer and complex benign disease. DrRouvelas and his team demonstrated live surgery of MIO which enabled meto gain from their teaching adding to my prior experience and knowledge.

Following my visit, short term outcomes of this technique have beenpublished for 46 consecutive patients with distal oesophageal or gastro-oesophageal junction cancer.(1) This is the first report of an intrathoracic linearstapled anastomosis in the prone position in a Western population.

There is also a close twinning fellowship program between the NationalCancer Institute in Tokyo, Japan and a senior trainee surgeon spends up totwo years in Karolinska. I appreciated the warm welcome I received whenattending this unit and can understand why it is attractive for foreignsurgeons to visit.

Mr Khaleel R FareedWinner of the B Braun Aesculap Travelling Fellowship 2015

REFERENCE1. Irino T, Tsai JA, Ericson J, Nilsson M, Lundell L, Rouvelas I. ‘Thoracoscopicside-to-side esophagogastrostomy by use of linear stapler- a simplifiedtechnique facilitating a minimally invasive Ivor-Lewis operation. LangenbecksArch Surg (2016) 401: 315-322.

Professor Lars Lundell, Mr Khaleel Fareed and Dr Ioannis Rouvelas

11

The ALSGBI is funding a scholarship in memory of the late Mr David Dunn, a Past President ofthe ALSGBI. This scholarship is to the value of £4,000 and it is anticipated that this would enablea surgeon at the end of his/her training, or a consultant within 5 years of appointment, to makea substantial visit to a unit abroad to learn new skills in laparoscopic surgery, with a view tointroducing these skills into his/her practice for the benefit of patients.

B. Braun Medical Ltd in partnership with the ALSGBI is also awarding two Aesculap EndoscopyTravelling Scholarships of £2,000 each. The purpose of these scholarships is to enable surgeonsin training, or young consultants within 5 years of appointment, to extend their experience inminimal access surgery by short visits to one or more centres.

The successful applicants will be expected to give a report on their visit at an ALSGBI Annual ScientificMeeting and also write an article for the ALSGBI Newsletter.

Candidates for these scholarships should request an application form from Mrs Jennifer Treglohan,Executive Director, ALSGBI at The Royal College of Surgeons of England, 35–43 Lincoln’s Inn Fields,London WC2A 3PE or email: jtreglohan@alsgbi.org and be current members of ALSGBI. The deadlinefor receipt of applications is Friday 13 October 2017. The successful applicants will be announcedat the 2017 ALSGBI Annual Scientific Meeting on Friday 10 November.

DETAILS OF THE TRAVELLING SCHOLARSHIPS 2017

12

BOMSS Annual Scientific Meeting 26–27 January 2017, Alton Towers, Staffordshire

The 8th Annual BOMMS Scientificmeeting was held between the 26and 27 January 2017 at AltonConference Centre in Staffordshire,and it was a phenomenal success.

We had a training day onWednesday 25 January 2017 andthis was attended by nearly 80delegates (we expected 50). The

bookings for the training day hadto be closed after this number. Theday consisted of an excellentprogramme of lectures, hands onworkshops, and in addition, aBariatric MDT, where complex caseswere discussed by surgeons,dieticians, psychologists, nursespecialists and anaesthetiststhroughout the Country. Thefeedback highlighted that the MDTwas especially interesting this timearound as it was attended byanaesthetists for the first time. Theday concluded with a sumptuous

training day dinner at the AltonTowers Resort.

The main conference inviteddignitaries from around the world,including the 2017 IFSO PresidentDr Kelvin Higa from Fresno inCalifornia, Dr Bruno Dillemansfrom Belgium, Dr Hjortur Gislasonfrom Sweden, Dr Simon Nienhujis

from Eindhoven, Dr Anthony Ianellifrom France, Dr John Dixon fromAustralia and Professor CarelLeroux from Ireland.

The 1st session was on themedical aspects of bariatricmetabolism. We went on to atopical session on the bariatriccommissioning process for 2016-17 as there have been severalinteresting changes in tariffs andguidelines, and this proved a veryuseful discussion for all the teamsin Centres providing the service.This was followed up by a session

on fast tracking in bariatric surgerywhere evidence of high volumework was provided by Dr Gislason,supported by Dr Nienhujis, both ofwhom provided a comprehensiveoverview of current fast trackingmechanisms, increasing productivityand long term follow up based onclinical evidence. An e-platformwhich would help manage servicefollow-up in the longer term wasalso presented.

We had a special session onmetabolic surgery for type IIdiabetes focusing on indicationsand the optimal timing of surgery,expertly provided by Dr Higa andProfessor Rubino. The finalscientific session on Thursdayconcluded with a free oral papersession followed by an update onthe by-band-sleeve study from theUK. The day ended with the AGMand with Mr Roger Ackroydhanding over the BOMSSpresidency to Mr Shaw Somers. Inthe true spirit of BOMSS, theconference dinner was sold outand a memorable night was had bynearly 300 people who attendedand enjoyed some excellententertainment and dining.

On Friday 27 January 2017, theday started with a free oral papersession and a DVD session followedby a special talk about staplereinforcement, with literaturereview by Professor AntonioLannelli. Professor Higa providedthe main Guest Lecture of theentire conference with a veryspirited discourse on “50 years on

is Gastric bypass still the goldstandard operation?”, whichreceived a phenomenal reception.

Later in the day a specificupdate on “BOMSS nutrition anddiet guidelines” was presented byMary O’Kane. Finally, Mr RichardWelbourn, as IFSO LOC President,presented an update on IFSO 2017which is being hosted by BOMSS inLondon between 29 August and 2 September 2017. BOMSS 2018 is planned at Telford, Shropshire. The organising committee wasdelighted by how well the BOMSSconference was attended andappreciated. May I thank all thosewho joined us this year, and for theexceptionally good feedback as oneof the best BOMSS meetings ever.

Mr Chandra CheruvuBOMSS 2017 - OrganiserBOMSS Council Member

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Planning permission granted for redevelopment of theRoyal College of Surgeons’ historic London building

The redevelopment of the Royal College of Surgeons’ (RCS) historic Londonbuilding has been given the go-ahead by Westminster City Council.

The approved plans, which will refurbish and maintain the building’sprestigious façade and library, will see the site transformed into a landmarkbuilding with modern and light facilities to provide the best education,examination and research resources for the nation’s surgeons.

The world class Hunterian Museum, which currently resides on the first floorof the RCS building, will be expanded to occupy the majority of the ground floorallowing more of the museum’s collection to be displayed.

Miss Clare Marx, President of the Royal College of Surgeons, said:

“This is an important step in the transformational journey for thewhole College and the many thousands of visitors who visit usand our museum every year.”

“We have taken on board the feedback from the public, localcommunity and our membership. We believe that these planswill transform the building into a home for surgical excellencein Britain and across the world.”

A large atrium inspired by the museum’s original large halls destroyedduring the Second World War will form a breathtaking centrepiece to thebuilding. The Hunterian Museum will be immediately accessible on theground floor to visitors along with new café facilities.

The new building will also include a Surgical Skills Centre, an exams suite, anAnatomy & Pathology Study Centre to support medical trainees in theirunderstanding of the human anatomy, and three floors of office space witha dedicated sixth-floor conference suite.

The redeveloped building has been designed by the leading architectsHawkins\Brown. The firm, whose clients include University College Londonand the British Council, were chosen to lead on the project for theircommitment to developing innovative and socially sustainable buildings withpeople at the heart of their projects.

Morag Morrison, Partner at Hawkins\Brown, said:

“The new Royal College of Surgeons at Lincoln’s Inn Fields willprovide an outward-facing headquarters that will refresh theway the College is able to engage with society.

“Our design celebrates both the past and future of the College,preserving and celebrating its extraordinary 19th century fabric.We will replace the tired post-war portion of the building withsensitively designed, high-quality facilities that will locate theRoyal College of Surgeons at the heart of the healthcare debatein the 21st Century.”

The redevelopment will begin in autumn this year with the projectexpected to be completed by Christmas 2020.

Notes to editors1. The Royal College of Surgeons of England is a professional membershiporganisation and registered charity, which exists to advance surgical standardsand improve patient care.2. Hawkins\Brown is an architecture practice based in London and Manchester. It was founded more than 25 years ago by Partners Russell Brown and RogerHawkins, the firm works across a range of types and scale, bringing a collaborativeapproach to its projects.Hawkins\Brown is one of the UK’s leading architects in the higher education sectorand is currently working on a number of academic buildings throughout thecountry, including the Beecroft Theoretical and Experimental Physics Building forthe University of Oxford.The practice has completed work on a number of significant arts and cultureprojects around the UK, including the Henry Moore Foundation’s site at Perry Greenin Hertfordshire, The Roald Dahl Museum and Story Centre in Great Missenden,Bucks and the New Art Exchange in Nottingham. 3. For more information, please contact the RCS Press Office on: 020 78696052/6047 (or 079 6648 6832 for out of hours enquiries) or email:pressoffice@rcseng.ac.uk

Mr Owen TaylorSenior Press Officer

14

European Associa�on for Endoscopic Surgery (EAES) www.eaes2017.eu

Thursday, 15th June 2017

• Face to face HPB:CBD / ALPPS• Unedited videos: Radical oncological resec�on

for rectal cancer: How far can we go?• Unedited videos: Robo�c esophagectomy &

MIA gastrectomy• Face to Face Emergency: urgent surgery

revisited• Unedited videos bariatric; How I do it• Face to face Bariatric: sleeve vs plica�on and

surgical REDO vs alterna�ve op�ons

Friday, 16th June 2017

• Face to Face: Advanced rectal cancer and Neoadjuvant radio chemotherapy

• Keynote lecture: 25 Years of EAES• Sir Alfred Cuschieri technology lecture: The

death of surgery (as we know it)• Consensus Conference SILS• Unedited videos: Laparoscopic ventral hernia

and Minimal invasive component separa�on • Best EAES videos sessions

Saturday, 17th June 2017

• Free paper oral and video sessions• Treatment of early Barre� cancer (joint

session ESDE and EAES)• Spotlight on colon cancer• Moving the mesh to extraperitoneal

posi�on: future of ventral hernia repair?• Benign UGI disorders: how to deal with

complex problems

Highlights

KEYNOTE AND SYMPOSIA TOPICS INCLUDE:• Lars Påhlman memorial lecture• War, austere environment and natural

disaster surgery• What’s new in the world of research?• International trial / guideline updates• Lessons learned and shared• BJS lecture SPECC• IBD reconstructive surgery• International Nursing Congress• Controversy debates in colorectal disease

• Peri-operative management• Managing the obese patient with

colorectal disease• Living with colorectal disease• Video abstract sessions• SNS - is it all in the brain?• Prehabilitation of the colorectal patient• Evidence-based enhanced recovery• Updates on oncology, pathology and

radiology

Extracurricular activities include:

• 1st EBSQ exam in UK• Charity Fun Run in aid of BDRF• 4th July Celebration gala event• Charity / Patient day session

ACPGBI ANNUAL MEETING Bournemouth 3-5 July 2017

Register before June 23rd for the best available prices!Registration is OPEN NOW on the conference website - www.acpgbiconferences.org.uk

Follow us on twitter - @acpgbi #acpgbi2017

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COURSES

15

simulation@gstt.nhs.uk

COURSES

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http://www.ifso2017.com/

http://www.ifso2017.com/registration

COURSES

17

h�p://www.ifso2017.com/information/travel-information

h�p://www.ifso2017.com/accommodation/hotel-information

h�p://www.ifso2017.com/launch-video

www.ifso2017.comenquiries.ifso2017@�igroup.com

https://www.facebook.com/IFSO-2017-614486062044738/

https://twitter.com/IFSO_2017

https://www.linkedin.com/groups/8572540

COURSES

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riday 29th September 2017for Applications:

riday 29th September 2017

riday 29th September 2017

5th International Controversies in Rectal Cancer ConferenceWednesday 4th & Thursday 5th October 2017Radisson Blu Hotel, Stansted, UK

A star-studded international faculty from the USA, Europe and the UK will address the current issues in early and late rectal cancer management, with debates on outcome data, Trans-anal TME and high-risk rectal cancer.

Early bird rates available until 1st July 2017

Book now at www.icenicentre.org

ICENI Centre, Colchester Hospital, Turner Road, Colchester,Essex C04 5JL Tel: 01245 686791 Email: iceni@anglia.ac.uk

Invited Faculty from USA, Europe and the UK:

Simon Bach (UK)Aman Bhargava (UK)Gina Brown (UK)Conor Delaney (USA)John Burns (UK)Hugo Ford (UK)Nader Francis (UK)Ashley Groves (UK)Najib Haboubi (UK)Ian Jenkins (UK)

Søren Laurberg (Denmark)Tony Miles (UK)Vivek Misra (UK)James Read (UK)John Schofield (UK)Fraser Smith (UK)Diana Tait (UK)Charles Wilson (UK)Des Winter (Ireland)

ICENI faculty

Tan Arulampalam (UK)Darren Boone (UK)Jan Edwards (UK)Roger Motson (UK)Bruce Sizer (UK)Neil Smart (UK)Matt Tutton (UK)Greg Wynn (UK)

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Introducing the Brand New for 2017Stryker ‘1588 AIM’ Camera System Solution

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Next level visualisation is here. The Stryker 1588‘Advanced Imaging Modalities’ platform isdesigned to help surgeons see more, do more, andto help safeguard critical anatomy.

See and Do More in General SurgeryThe 1588 AIM platform consists of five imagingmodalities in ENV, IRIS, DRE, DESAT and Claritywith nine dedicated surgical camera specialtysettings. The 1588 AIM platform delivers thehighest definition, within a standardised multi-specialty solution, designed to improve patientoutcomes. Its unique advanced imaging modalitiesallow for visualisation in near infrared and infraredwavelengths. The 1588 is designed to give youcustomised control over the surgical devices in theoperating theatre.

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ureters with an infrared lighted fibre

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