SPRING 2018

President’s IntroductionWelcome to the Spring newsletter, and my first as President, of theAssociation of Laparoscopic Surgeons of GB and Ireland, incorporatingRobotics and Technology Assisted Surgery! I was greatly honoured to betaking over the reigns from Mr Peter Sedman and wish to thank himwholeheartedly for his contribution in office. He leaves the Presidency witha new vision and an exciting future for the Society. His ultimate task though,was to write the conference report for our excellent and enjoyable AnnualScientific Meeting (ASM) in Cardiff, which you’ll find within these pages.

The content of this newsletter highlights the enormous enthusiasm fortraining within ALSGBI. The range of training experiences either set up orfacilitated by the Society is notable, and there is always an atmosphere oftraining support within every Council meeting. I have already had a numberof opportunities to visit training days organised for registrars, and there isuniversal appreciation by junior surgeons for such additional training andeducational experiences.

The opportunity to have a formal assessment in practical surgical skills isunique to LapPass, which is going from strength to strength. It is importantto continue rolling it out to regional meetings as we need trainers as well astrainees to appreciate the level of skill required to pass. The credibility ofpassing should translate to the operating room, as trainers are provided witha benchmark of ability for their trainee, as alluded to by Mr Rikesh Patel inhis report.

Another area of support for our trainees are the bursaries, which aregenerous and help to contribute in no small measure to the high quality of,usually overseas fellowships that have been taken. The opportunity to visitcentres of excellence can be very instrumental in shaping one’s own practiceand ambition and is a valuable resource for senior trainees before taking upconsultant duties.

The trainees reports of their overseas experience provides something of ashopping list of fellowships available for those planning similar trips and Iwould urge our trainees to review the back catalogue of such reports.

During my recent trip to India I was very impressed by the sheer volumesand quality of surgery being undertaken in many Indian centres of excellence,

and it struck me that there should be some excellent opportunities for seniortraining there. This size of the country though makes it difficult for someonewithout prior knowledge to have a sense of where the world class expertiseis to be found and what might be on offer. Likewise some of our ownexpertise, particularly in the areas of surgical education and accreditation,could be of benefit to the Indian Surgical Societies. I have initiated discussionsto explore a mutual relationship with the Association of Surgeons of Indiawith such issues in mind and have secured 2 bursaries from ALSGBI tosupport members of the Indian Association to attend our own meeting andto undertake a short observership in a UK hospital.

We have an exciting year ahead with plans well underway for our ownASM in Manchester in December and of course the EAES Congress in Londonat the end of May. The EAES is always an excellent meeting and London 2018looks to continue that trend. There is an extensive programme withsomething for everyone. Check out the details at https://eaes.eu/eaes2018/

Manchester 2018 is being organised locally by Mr Chelliah Selvasekar andwill showcase the incorporation of robotics and technology assisted surgeryinto the ALSGBI. I would encourage all of you to start preparing some qualityabstracts and videos for the meeting, which is shaping up to be an excellentevent, with the usual registrar’s training day on the Tuesday.

Finally, the robotic subcommittee are well underway with drawing up acurriculum for the first robotic Training the Trainers course which is scheduledfor later this year. This underlines our commitment to embracing thechanging face of surgery and being proactive in technological developments.

My thanks to Mr Neil Keeling for another comprehensive newsletter andto all the individual contributors for their efforts.

I am excited to be able to represent you as President of your Assoicationso please don’t hesitate to approach me with ideas, comments or feedbackwhich I can bring forward for discussion and action where appropriate.With best wishes

Mr Simon DexterPresident, ALSGBI

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 306, 3rd Floor, 35-43 Lincoln's Inn Fields, London WC2A 3PERegistered Charity Number: 1058455

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

ALSGBandI#ALS2018

ALSGBI newsletter

ALSGBI COUNCIL 2018

ALSGBI Executive

PresidentMr Simon Dexter

Past PresidentMr Peter C Sedman

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

INC. ROBOTIC & TECHNOLOGYENHANCED SURGERY

ASSOCIATION OFLAPAROSCOPIC SURGEONS

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Editor’s IntroductionHopefully Springhas now sprungand the snow isgradually clearingfrom most of thecountry and wecan look forwardto the excitingevents planned forthis year.

Before that we must congratulate Mr SimonDexter for being voted in as the new ALSGBIPresident, taking over the reins from Mr PeterSedman. As many of you will already know Simonis a resectional oesophago-gastric surgeon inLeeds and his appointment maintains theYorkshire dominance of the Presidency. I shouldalso point out that Simon has been awarded amost prestigious Honorary Fellowship of theAssociation of Surgeons of India.

In this edition we have articles reviewing ourvery successful ASM in Cardiff, the flourishingManchester MASNOW meetings, Mr TanArulampalam reports on the EAES Winter Meeting

which hopefully serves as an appetiser for the bigmeeting of the year which is the 26th InternationalEAES Congress 2018 that will be taking placebetween 31 May and 1 June at London’s impressiveEXCEL. This is a combined meeting with the ALSGBI,the North American (SAGES), Japanese (JSES),Korean (KSEL) and Taiwanese (TAES) societies. As aconsequence there is expected to be most of theworlds finest minimally invasive surgeons and theprogramme has something for everyone and ishighly recommended.

I hope that you will approve of our newbanner logo which represents the increasedapplication of robotics in minimally invasivesurgery and the Council believes is a significantmove for the Association.

The 77th Association of Surgeons of India(ASI) Annual conference was held at the BM BirlaScience and Technology centre, Jaipur, Indiabetween 26-30 Dec 2017. Our current ALSGBIPresident, Mr Simon Dexter was awarded one ofthe three prestigious honorary fellowships by theAssociation for his work in minimal access upperGI surgery over the last decade.

The Association of Surgeons of India is thelargest surgical association in the world with themembership over 18,000. Over 7,000 delegatesattended this conference and Mr Dexter gave aninvited lecture on 'Revolutionary development inupper GI surgery in the last two decades'. This waswell received and there was an internationalforum where Simon participated and explored theopportunities for the Association of Laparoscopicsurgeons of Great Britain and Ireland to workclosely with the ASI to produce high qualitysurgical trainees in the UK and in India.

Mr Neil Keeling Newsletter Editor

3

ALSGBI Annual Scientific Meeting 20179-10 November 2017, Cardiff City Hall

The 2017 ALSGBI AnnualScientific Meeting washeld in Cardiff in earlyNovember. This was thesecond meeting we haveheld in Cardiff (the firstbeing in 2011) and onceagain we had the benefitof the magnificentCardiff City Hall as theconference venue.

The feedback fromthose who were able to attend was extremely good and the meeting wasthoroughly enjoyable with many highlights. It is a shame that we are seeing atrend towards fewer and fewer delegates (in keeping with most other nationalsocieties) but despite this over 300 people registered and enjoyed two or threedays of stimulating discussion and top quality educational content.

The theme of this meeting was “Innovation” in line with the reputationCardiff enjoys as a leading centre for new surgical developments and ourguest speakers were chosen to exemplify this theme.

The meeting followed our traditional format and again the training daywas held at the Welsh Institute of Minimal Access Training (WIMAT). We striveto make this training day the best training day of the year in the British Isles.Under the leadership of Mr Paul Leeder, a motivated faculty of Councilmembers and local trainers, the outstanding technical facilities and modelsof the WIMAT, together with the sponsorship of Medtronic, there is noquestion we achieved this goal comfortably. Feedback was excellent and wethank all those involved for making this possible.

Professor Jared Torkington led a live operating day from our host hospitalat Cardiff University Hospital. From here three operating theatres relayed liveminimal access operating in a combination of 3D, 4K imaging and roboticplatforms demonstrated the technical skills and technological platformswhich make our specialty possible, increasingly safe and so rewarding forpatient and surgeon alike. Our live operating day is always a highlight of themeeting and this year was no exception. The standard of the surgery was topclass and informative and the images we enjoyed in the conference centrewere breath taking. Special thanks go to Olympus for coordinating this withIntuitive and Karl Storz.

The conclusion of the live operating day was a drinks reception and anarousing live performance from the Cardiff Arms Park Male Voice Choir. Thisyou might imagine would be difficult to “top” but then we were entertainedin the conference dinner at Cardiff Castle. What a venue, what food and

what company. For all thosefortunate enough to attend inthis majestic room with suchhistory (the G7 leaders met anddined in the same room theprevious year) a truly memorablenight was had and no one therewill ever watch an orthopaedicsurgeon perform arthroscopy inthe same way again after hearingMr David Scott-Coombes’ brilliantafter dinner speech.

The concluding day had muchto live up to but live up to it, itdid. Our thanks go to our guestlecturers: Dr Dominic King fromGoogle’s Deep Mind project, Dr Romain Pizzi who is a veterinarian withspecialist expertise in exotic species and in the laparoscopic treatment of themand most especially to Professor Sir Alfred Cuschieri whose pioneering workin the development of laparoscopic surgery has directly shaped the way weall practise our surgery today. Professor Cuschieri was knighted for his servicesto laparoscopic surgery and with very good reason. He told us of the very early

days of the technological developments, of his meetings with Harold Hopkins,George Berci and Karl Storz from which the prototypes evolved and some ofthe pitfalls encountered along the way. For those who were unable to attendI would recommend watching his talk on the ALSGBI website.

Our congratulations go to Mr Damien Mayo who won the David Dunnmedal for his oral abstract presentation.

Throughout the meeting we continued to hold sessions on LapPassassessments and I strongly urge those of you who have not done so to masterthese clinically highly relevant skills. They are difficult but frankly I would notwish a laparoscopic operation to be performed on me by a surgeon who didnot have this level of skill. In future I will insist on my trainees having thembefore they undertake any advanced procedure.

My final role was to hand the Chains of Office onto our new President, MrSimon Dexter, who I know will lead us with distinction for the next two years.

It was my privilege and honour to chair the ALSGBI for this Cardiffmeeting and my thanks go to all who made it possible and so successful, inparticular to Mr Neil Warren and the WIMAT team, to Jared and the Cardiffteam, to Professor Sir Alfred Cuschieri, Dr Romain Pizzi and Dr Dominic Kingand to our Sponsors to name just a few.

Please note for your diaries the Manchester meeting taking place on 5 -6 December 2018 and the EAES Congress in London on 30 May – 1 June 2018.We should all support these meetings and be most excellent hosts to the2000 or so delegates who are expected.

Mr Peter SedmanALSGBI Past President

L-R: Mr Chelliah Selvasekar, Consultant General, Colorectal, Laparoscopic &Robotic Surgeon, The Christie NHS Foundation Trust, Manchester, ProfessorKeith Harding, Dean of Clinical Innovation (Cardiff); Professor Sir AlfredCuschieri, Scuola Superiore Sant’ Anna in Pisa and Chief Scientific Advisorto the Institute of Medical Science and Technology (IMSaT); Dr Dominic King,Senior Clinician Scientist at Google DeepMind, Honorary Clinical Lecturer atImperial College London

LapPass Stations

ALSGBI Laparoscopic Surgery Training Day

Professor Sir Alfred Cuschieri & Mr Peter Sedman

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ALSGBI Annual Scientific Meeting 20179-10 November 2017, Cardiff City Hall

My first Conference as Chair of ALTSproved a success! The venue waslovely and I had to stop myself fromhaving a quick go on the ice skatingrink in the Winter Wonderland justoutside the City Hall where we were.The live operating was very interestingwith a good variety of cases to watchand questions asked by the audienceto listen to. The industry exhibitionwas, as always, really good with lots of new innovations andinstrumentation to try and askquestions about. The virtual realitystand was absolutely fantastic andreally brought out the competitivespirit of many delegates. I had a go onthe robot too whilst there were only afew people around – I would really liketo try that again too.

As always, ALTS is very gratefulfor the sponsorship we have fromour Industry partners and thisresulted in over 200 delegates onour side this year. I am consciousthat the same people are not usually

allowed to come every year but forthose who did attend, please passon your thoughts to your colleaguesand encourage them to apply forplaces early.

The drinks reception in the CityHall was very well attended and theWelsh choir was absolutely brilliant– a very rousing start to theevening! Cardiff castle was anequally imposing and fascinatingplace to hold the conference dinner;I spent a lot of the time betweenmouthfuls and chat to examine themurals and the beautiful roof.

Friday morning started brightand early with the ALTS breakoutsessions. We kicked off with a whistlestop tour of Human Factors and theirplace in patient safety. Mr TanArulampalam and I ran this session.The aim of the session was toencourage thinking around thevulnerability of a human and the factthat even with the best technicalability in the world, we are all still

open to error, priming, distractionand biased thinking. It was anenjoyable session and the groupwere very vocal which was great.

Our second session was aSchwartz round facilitated by MsJackie McSweeney. The panelconsisted of Miss Tamsin Morrison,a surgical Core Trainee and Michelle.an ex theatre manager who kindlystepped in at the last moment. Thetopic was ‘a bad day at the office’and the conversations following thetalks were really interesting.

Next year, I hope even more ALTSmembers can join us. There may bea change to the breakout sessions sothey are in the first afternoon of theconference thus enabling delegatesto socialise and network a littlebefore the night. It will also meandelegates will be able to attend allthe educational sessions in the mainconference on the second day whichI know are always very informativeand thought-provoking.

This year our Conference will beheld in Manchester, 5 - 6 December2018. I believe it will be anotherexcellent conference. Please, if youhave any ideas on topics you wouldlike included or areas you would liketo discuss please let me know. I amopen to change and help at alltimes!!

Ms Debbie GoochChair, ALTS

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British Obesity and Metabolic Surgery Society(BOMSS) Annual Scientific Meeting25-26 January 2018, Telford International CentreThe British Obesity and Metabolic Surgery Society (BOMSS) held its 9thAnnual Scientific Meeting at the new Telford International ConferenceCentre on Thursday 25 - Friday 26 January 2018 under the presidency ofMr Shaw Somers. There was a training day beforehand attended by over100 Allied Health Professionals (AHPs) and surgical trainees with nearly200 consultants and AHPs attending the main ASM on Thursday andFriday, including 50 trainees.

In addition to presentations by trainees there were 4 prominentinternational speakers. We were privileged to have Michel Gagner (Montreal),speaking on sleeve gastrectomy, the operation he pioneered. In excellentlectures Alfredo Genco (Rome) spoke on endoscopic bariatric surgery, whichhe envisions as the future for revisional surgery. Francois Pattou (Lille) spokeon the extensive experience his centre has on improving NASH and NAFLDwith weight loss from bariatric surgery. Finally, another former guest ofBOMSS, Torsten Olbers (Gothenburg), spoke on the challenges of adolescentbariatric surgery and how to manage the problem in the clinic.

There were 7 presentations for the BOMSS Council prize which wasawarded to Safwaan Adam for his presentation on 'Novel insights intopotential mechanisms by which bariatric surgery reduces cardiovasculardisease risk'.

There was an excellent dinner dance held in the same venue with alive band and BOMSS member Mr Shehzad Latif from Wales recited hispopular annual 'Bariatric Poem': All well received by the attendees!

BOMSS is indebted to local organiser Mr Manel Riera, consultant UpperGI & Bariatric Surgeon in Shrewsbury, for an extremely well organisedmeeting. He was extremely capably assisted by BOMSS administratorsSarvjit Wunsch and Nichola Coates, with further help on the financialorganisation from Mr Chandra Cheruvu (Stoke) and the BOMSS Council.

Next year's meeting is to be held in Belfast, NI, on 23 - 25 January 2019.

Mr Richard WelbournALSGBI Audit Director

EAES Winter Meeting London 201819 January 2018, Excel, London

The Winter Meeting of the EAES was held in London’s EXCEL in mid January.This meeting was conceived by the late Gerhard Buess and is both anaspirational and translational science meeting. Recent advances in soft andcompliant robotics, rapid manufacturing, collaborative robots, autonomousreasoning, and artificial intelligence powered by deep learning are enablingrobots to work side-by-side with humans. In endoscopy and surgery, roboticsis nowadays well established as a tool to augment a surgeon’s performanceby transparently mapping the operator’s intent. It can be debated whetherin the very near future, surgical robots will have the capability to performautonomously specific tasks of a procedure, relieving the surgeon from theburden of performing repetitive and tiresome actions. Certainly, this is anarea of great potential in the field of human health.

The 2018 EAES Winter Meeting focused on translational research inrobotic endoscopy and surgery. There were talks by innovators in the fieldshowcasing a number of new platforms that are ready to enter the marketor to start clinical trial. It was encouraging to see so many UK based academicinstitutions leading in this field. The meeting was opened by Guang ZongYang from Imperial College demonstrating the rapid advances in robotic

Transanal Endoscopic Microsurgery. Of great interest was the demonstrationon robotic colonoscopy, which conceptually required lateral thinking tounderstand the means to perform this complex task. Professor AndreaPietrabissa, President-elect of the EAES, gave a masterclass on 3D printingin surgery and surgical planning. Finally, there was a presentation byCambridge Medical Robotics, a clinically-led start-up in the robotic fieldshowing us how far robotics has come and where we are going.

The terminology used in this meeting alone was fascinating to try andunderstand. This field is on the move with enabling technologies such as featureextraction from endoscopic imaging, soft robotics to reach deeper inside thehuman body, plus automation of specific tasks during a clinical procedure.

The EAES has given an excellent taster for the forthcoming main Congresson 31 May - 1 June 2018 in Excel, which will bring together global leaders inthe various fields of surgery to debate current thinking, the futuretechnologies and how we should train our young surgeons.

Mr Tan ArulampalamALSGBI North Thames Regional Representative

5

6

Simulation training has been demonstrated tobe an excellent way to develop laparoscopic skillsand this led to the development of LapPass. Itwas first rolled out at the ALSGBI AnnualScientific Meeting in Southport in 2015 and Iwas very interested in attending the meeting totake up this training opportunity. Although I had attended several laparoscopic courses and training days prior to this these were not assessed and I was unable to formallydemonstrate my proficiency.

Throughout my career I have encounterednumerous rotations where I have had my assessordetermine my competence before being able toperform procedures. This has almost felt like a stepback and I feel that this did not fully utilise thelimited training time available. Therefore theopportunity to obtain a certificate confirming mylaparoscopic competence that would be nationallyrecognised was something of great appeal.

The technical tasks assessed by the LapPassinvolved jigs that were straightforward to set

up in laparoscopic box trainers, using materialsthat were relatively easy to acquire. However,despite their relative simplicity, these skills weretranslatable to those used in clinical practice.

Although I had practiced several of theseskills on previous laparoscopic courses andalso in preparation for ST3 interviews, it wasevident that these skills would require practiceto be able to complete them successfully inthe allocated time.

At the Annual Scientific Meeting I was ableto practice these tasks prior to undergoingassessment on the final day. Having been able tofamiliarise myself with the tasks I was able topass three of the assessments. I did howeverrecognise that my laparoscopic suturing wouldtake further practice to ensure I would be ableto complete two secure sutures adeptly in the sixminutes available. Although the main purpose ofthis was assessment, the faculty was also able toprovide me with very helpful tips and tricksincluding how to mount the needle and creating

my loops with rotation of the instruments. This spurred me on to take up further

opportunities to practise and develop atechnique that worked for me. I found thelimitation however was the restricted availabilityand access to box trainers and laparoscopicinstruments, particularly needle holders. Afterattending the Royal College of Surgeon’sIntermediate Laparoscopic Skills Course I feltconfident with my suturing and I was able tofinally pass the assessment.

I recognise that continual practice of theseskills is required in order to maintain them. Asa result of LapPass, I have been able to improvemy confidence to perform laparoscopic skillscompetently. My supervisors who are familiarwith LapPass have allowed me to train at anenhanced rate and I look forward to furtherdeveloping my skills.

Mr Rikesh Patel ST5, MASNoW deputy trainee representative

LapPass–The Laparoscopic Passport–My Experience

LapPass Regional Training Day and ALSGBI North Westand Mersey Meeting Report 20 October 2017, Christie Hospital, Manchester

Minimal Access Surgery North West (MASNoW)is the regional chapter of ALSGBI in the NorthWest and Mersey area. The group has continuedto welcome trainees and trainers from all GIspecialties since its inception in 2012. We hostedour second regional ALSGBI LapPass training dayat the Education Centre at Christie Hospital,Manchester on 20 October 2017. The training day gave 18 trainees from FY2 to ST6 theopportunity to practise laparoscopic skills underthe supervision of experienced laparoscopicconsultant surgeons and senior trainees.

The LapPass competencies requireddemonstration of proficiency in a defined set offour laparoscopic tasks in allotted time framesusing simulated jigs. Based on experience fromour previous course, we decided to concentrateon development of the skills, rather than testing.The trainees were able to practice tasks includinggrasping and manipulation of polo mints, tyingextracorporeal Roeder’s knots to perform a

simulated appendicectomy, precise cutting ofcircles and finally laparoscopic suturing. We weredelighted to receive very positive feedback fromthe trainees and we plan to host our nextregional LapPass training day in April.

Following the training day Mr Usman Khan,Consultant Colorectal Surgeon at MacclesfieldDistrict General Hospital, hosted our 10thMASNoW meeting in the evening. This biannualevent has proven to be very popular amongstconsultant and trainee delegates to showcasetheir work and also enjoy an informal catch-upwith colleagues over a curry.

Our first presentation of the evening wasfrom Mr Yirupaiahgari Vishwanath, ConsultantUpper GI surgeon from South Tees Hospital, onSEMS in malignant and benign oesophagealstrictures. Following this Mr Chelliah Selvasekarfrom The Christie and Mr Ioannis Peristerakisfrom Royal Preston Hospital presented on therole of robotics in colorectal surgery and theirexperiences in their individual trusts.

Finally, four trainees delivered the followingpresentations: ‘Laparoscopic synchronous leftlateral sectionectomy and right hemicolectomy –a video presentation’ by Anthony Chan;‘Laparoscopic and open anterior resection forrectal cancer’ by MA Gok; ‘Diaphragmatic rupturefollowing robotic-assisted radical prostatectomy’by Temoor Naeem and ‘Unplanned readmissionsfollowing minimal access surgery’ by Tom Riley,who was awarded the MASNoW trainee prize.

The whole day was a fantastic success and welook forward to the 11th MASNoW meeting andLapPass regional training day on 20 April 2018 tobe led by Mr James Anderson (Arrowe ParkHospital, Wirral).

Mr Rikesh Patel ST5, MASNoW deputy trainee representativeMiss Christina Lo ST8, MASNoW trainee representativeMr Chelliah SelvasekarConsultant Colorectal Surgeon, Christie Hospital& ALSGBI North West Regional Representative

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Scottish Laparoscopic Passport Training & Assessment Event28 February 2018, Royal College of Surgeons of Edinburgh

An ALSGBI Scottish Laparoscopic Passport training& assessment event was held on 28 February at theRoyal College of Surgeons of Edinburgh. Despitecoinciding with the arrival of ‘the Beast from theEast’ into the capital the majority of participantsmanaged to battle through the snow to enjoy ahighly rewarding session. The small afternoon eventwas primarily aimed at core surgical trainees withsome of the local trainees having formed acollaborative group to build towards competency ineach of the LapPass tasks over the preceding months.

The event was entirely skills focused, structuredaround the Laparoscopic Passport simulated tasks.Participants had opportunity to practice each task:Basic manipulation, tying and applying endoloops,precision cutting and laparoscopic suturing.Feedback was provided from Mr Graeme Wilson,

consultant colorectal surgeon, before the option oftaking a formal assessment. Scottish regionalcouncil member Mr Ahmad Nassar was on hand toassess each task. Mr Nassar also provided a veryhelpful masterclass on Laparoscopic suturing,guiding participants through different techniquesand approaches.

Participants were hugely enthusiasticthroughout the afternoon and demonstratedexcellent skills for their career stage. Feedback fromthe event was very positive. Participants reportedthe competency targets for each of the Lap

Passport tasks were challenging to meet as juniortrainees but these targets had acted as significantmotivators to practice their skills over thepreceding months. Passing the assessments felt likea significant achievement. All 6 participantsmanaged to pass at least two of the tasks with twoparticipants managing to achieve sign-off on all 4.

The event was a resounding success despite thechallenging weather. The Laparoscopic Passporthad provided an excellent framework for simulatedpractice for this cohort of junior surgical trainees,with the challenging targets working as asignificant motivator for practice.

Mr Alistair GeraghtyScottish Clinical Leadership Fellow, RCSEd/NHSEducation for ScotlandColorectal TraineeALSGBI Member

8

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ALSGBI Trent Regional Meeting 26 September 2017, East Midlands Radisson Blu Conference Centre

The 6th Annual Trent Regional eveningsymposium took place at the East MidlandsRadisson Blu conference centre. The eveningsymposium was attended by 30 delegates whoincluded consultants and trainees from theregional hospitals. The meeting, as previous years,was generously supported by Karl Storz andMedtronic. I am grateful for their ongoingsupport for this educational event.

The first session of the symposium waslaparoscopic DVD presentations. The traineesfrom the region presented videos on advancedlaparoscopic surgery including SILS. The Storz‘2017 Trent ALS Best Laparoscopic DVD Medal’was awarded to Mr Chris Neophytou for hisvideo entitled ‘Laparoscopic management ofbenign biliary stricture’. Mr Neophytou is ClinicalFellow in Pancreatico-biliary surgery at DerbyTeaching Hospitals.

We had excellent talks on a variety of subjectsby invited speakers: Mr Nader Francis gave astimulating talk on ‘Training and assessment for

laparoscopic surgery’, Mr Nauman Zafar,Consultant Urological Surgeon, Derby TeachingHospitals, gave an inspiring talk on his trainingin Robotic surgery and its relevance to GIsurgeons and Dr Rajeev Singh, Consultantradiologist, delivered a lecture on ‘Salientradiological features in postoperative bariatricpatients presenting as an emergency to a non-bariatric centre’. Our ALSGBI Education Director,Mr Paul Leeder, apprised the delegates on‘LapPass’ and since the regional meeting I ampleased to report five of our trainees havesuccessfully passed the assessment at therecently held ALSGBI ASM in Cardiff.

We received an excellent feedback, from bothtrainees and consultants. Some of the commentsreceived included “Excellent regional laparoscopicsurgery meeting providing an opportunity fornetworking and updates on advances inlaparoscopic surgery techniques”, “brilliant lectureon assessment in laparoscopic surgery” and“Inspiring lecture on Robotic surgery training”.

This year’s meeting is planned for September2018. Based on delegates’ feedback the emphasisof the meeting will be on the role of laparoscopyin emergency abdominal surgery, laparoscopicparastomal hernia surgery and robotic surgery.

Mr Altaf AwanALSGBI Midlands Regional Representative

Third Northern Video Laparoscopic and RoboticSymposium17 November 2017, North Tees University HospitalMore than 110 delegates attended this year, the concluded ‘ThirdNorthern Video Laparoscopic and Robotic Symposium’ on 17 November2017. It was held in North Tees University Hospital convened by Mr Gopinath Bussa with Mr Talvinder Gill and organised by Mr A Gilliam,Mr A Reddy, Mr V Kanakala, Mr V Shanmugam and Mr YKS Viswanath. We had an accomplished and expert laparoscopic surgeon from Pretoria,Professor Heine van der Walt, who shared his vast experience via manyvideos covering anti-reflux, hiatal hernia and meshplasty complicationwith revisional surgery. That mellowed nicely with a presentation byProfessor Ahmed on CBD exploration along with a variety of other videotalks including thoracoscopic oesophageal resection, SILS colorectal

surgery and robotic pancreatic surgery.Mr Simon Dexter, ALSGBI President, attended the meeting and briefed

delegates about the future direction of the ALSGBI along with extending‘Lap Pass’ courses to North of England.

The meeting was a huge success and ended with 6 videopresentations from regional registrars with excellent feedback.

The 4th Northern Video Laparoscopic and Robotic Symposium will beheld on 17 November 2018.

Mr Viswanath YKSALSGBI Northern & Yorkshire Regional Representative

10

Report on the B Braun Aesculap Traveling Fellowship 2016

I was awarded the Traveling Fellowshipin November 2016 enabling me to visitProfessor Luigi Boni in Milan, Italy.Fluorescence or image guided surgeryhas gained more and more popularityover the recent years and Luigi Bonihas been one of the leaders in thisfield. The week before my planned visitin June 2017 I also attended the EAES meeting in Frankfurt where Iparticipated in the ICG Masterclass.Once in Milan, I hit the groundrunning..

The "Ca' Granda Ospedale MaggiorePoliclinico" Foundation in Milan,traditionally known as the Policlinicoof Milan, is one of the oldest hospitalsin Italy, founded in 1456. Today it is a modern hospital with 1000 beds located in the heart of thefabulous city of Milan. Ever since 2010 Policlinico has been under major development with impressiverenovation works throughout thehospital grounds. The surgicaldepartment is nearly finished andincludes completely new integratedoperating theatres.

The abdominal and emergencysurgical department consists of 25consultants and 6 specialty registrars.With 38 inpatient beds, they perform1300 surgical procedures a yearincluding 250 colonic resections andaround 300 cholecystectomies. ICG isused in every single one of those

procedures. I joined Professor LuigiBoni in theatres for 2 weeks, togetherwith a colorectal fellow from thePhilippines and a consultant colleaguefrom Palermo.

It was interesting to see thatProfessor Boni was present in all or atleast part of every case despite beinglead of the abdominal and emergencysurgical department and in charge ofthe renovation of the surgical unit. Henot only trains his juniors inlaparoscopic surgery but often hisconsultant colleagues as well. As ICG isused as standard, every member of theteam is well informed and involvedwhen it comes to this technique. It’sbeneficial value was well demonstratedduring intraoperative findings in manycases and in particular, a case involvinga cholecysto-duodenal fistula.

I would like to thank Luigi and histeam for their hospitality, the city ofMilan for looking after me and alsoextend my sincere appreciation to theAssociation of Laparoscopic Surgeonsof Great Britain and Ireland and B.Braun Aesculap for sponsoring myfantastic visit. This has inspired me touse ICG regularly and has providedclarity in some difficult situationsalready!

Ms Nienke WarnaarWinner of the B Braun AesculapTraveling Fellowship 2016

11

DETAILS OF THE TRAVELLING SCHOLARSHIPS 2018

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 £a 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.

and it is anticipated that this would enable4,000

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 scholars are also requested toshare their experience with the B. Braun Endosurgical team upon completion.

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 Thursday 1 November 2018. The successful applicants will be announced at the 2018 ALSGBI Annual Scientific Meeting on Thursday 6 December.

urgery, with a view to

Aesculap Endoscopy

12

Report on the David Dunn Travelling Fellowship 2016

I was awarded the ALSGBI David Dunn Travelling Scholarship in November2016, which allowed me to visit the renowned liver resectional unit underProfessor Luca Aldrighetti, in Milan.

Following his kind offer of a placement within his unit we met at the inauguralEuropean Guidelines Meeting on Laparoscopic Liver Surgery. ProfessorAldrighetti’s expertise and experience in the fieldof laparoscopic liver surgery is well recognized.Furthermore, as a past President of the ItalianGroup of Minimally Invasive Liver Surgery(IGoMILS) and Coordinator of the Italian Registryof Laparoscopic Liver Resections, he is significantlyinvolved in surgical training and was an idealmentor for my fellowship.

In Italy healthcare is provided to all citizensand residents by a mixed public-private system.The public part is the national health service,Servizio Sanitario Nazionale (SSN), which isorganized under the Ministry of Health and isadministered on a regional basis. San RaffaeleHospital was originally founded as a privatehospital by Don Luigi Maria Verze, a spiritualMilanese entrepreneur, who also established amedical school in 1998. It is a remarkablyimposing combined hospital and universitycampus, linked to the main city metro by amonorail, with an on-site hotel, shopping centre and, as I later found out, anaging zoo! Verze sought a place for reflection and well-being for both patientsand students and features such as the zoo and sculpted grounds and fountainsare typical of the man’s vision for the hospital. The trustees running San Raffaelewent into liquidation in 2011 and Verze died later that year but his legacy liveson and the trainees would regularly speak of howthey enjoyed such an open and accessiblecampus combined with state-of-the art facilities.

Having developed an interest in laparoscopicliver resection and minimally invasive cancerinvestigation, diagnosis and surgery during mytraining, exposure within a high-volumespecialised centre performing 80% of liverresections laparoscopically was invaluable. Mydecision to visit was based partly on my owntraining experience that laparoscopic majorhepatectomy was not yet common practice,although it was also driven by the fact that Iwanted more intensive exposure and experienceof laparoscopic resections to develop my

practice as a consultant. On arrival, my occupational health clearance initially proved a challenge

when I was unable to explain in Italian the UK policy of BCG immunisation andmy subsequent weakly positive tuberculin test. This was resolved when ProfessorAldrighetti liaised with the team specialist infectious disease physician, who

administered the correct screening test and I wassubsequently allowed into theatre.

Even before attending the operating room, itwas clear that the Chirurgia Epatobiliare teamwas very tight. The hospital supports this indifferent ways. Firstly, all HPB patients arelocated on one ward; it is exceptionally rare fora patient to be ‘boarded out’. With the exceptionof Professor Aldrighetti, the 6 team consultantsshare an open plan office at the end of the HPBward and there is a waiting room and office formeeting relatives next door. The hospital alsosupports the team’s ethos with initiatives suchas asking each specialist team to design a logofor their overalls to wear outside theatre whenin ‘scrubs’. These have proven popular withpatients as they can clearly identify teammembers on the ward round. This is even moreimpressive when you see the full repertoire ofdesigns in the canteen at mealtimes.

The surgical team held a daily team brief before distributing clinicalcommitments according to the difficulty of the operative cases, ward issues andoutpatient commitments. The most challenging cases for resection were discussedat a fortnightly MDT (held on alternate weeks with the pancreatic surgical team)and, for example, those requiring detailed hilar imaging and preoperative

staging underwent echo-endosonography).Professor Aldrighetti was particularly supportiveof my prior echo-endosonography training and Iwas encouraged to follow operative patients to theHPB EUS unit during pre-operative work up. Again,this was particularly rewarding as many of thepatients with hilar pathology would often havebiliary stents in situ and observing the staging byProf Arcidiacono’s team with the artifact of in situstents was an added educational experience.

When I first observed a major righthepatectomy what struck me the most was thewell-established team roles, regimentedreproducible set-up in theatre (1 theatre, locatedimmediately above the HPB ward and consultant

Ospedale San Raffaele Ospedale San Raffaele

Anaesthetic team top

Echoendosonography

13

offices, with 5 days per week operating).Furthermore, the quality of the equipment wasimpressive. I had never seen such a large 4Kmonitor; it felt like I was standing in the middle ofthe transection plane.

The laparoscopic procedure was performedwith the patient in the supine ‘French position’.The San Raffaele HPB Surgical team perform 25right hepatectomies per year. I was particularlykeen to observe the 3 approaches to hepatocavalconfluence during laparoscopic righthepatectomy as described by Professor Aldrighetti

in his Surgical Endoscopy paper in 2017. In thepicture you can see the laparoscopic CUSA (left-hand) and Thunderbeat (right-hand). This carefulselection of the best transection device,combined with excellent visibility and resolutionof the monitors, all helped to minimize blood lossand was impressive to observe.

Overall, my time at San Raffaele was aninvaluable educational experience and one thatwould not have been possible without theALSGBI travelling fellowship funding. I made agreat number of new friends during my time atthe San Raffaele, such as new contemporariesDot.ssa Federica Cipriani and Dot.ssa FrancescaRatti, with whom I hope to collaborate in thefuture. Importantly, I have an expert mentor inProfessor Aldrighetti who has kindly offered tohost me, should I be visiting Milan in the future.During my time in Milan I was appointed to a UKConsultant HPB post and I am sure theexperience acquired during my fellowship playeda significant part in achieving this. I hope thatmy time at the San Raffaele will help to continueto foster relations that will benefit more trainees(both Italian and British) and help to establish myown advanced laparoscopic resectional practice.

Mr Andrew HealeyWinner of the David Dunn TravellingScholarship 2016Theatre set-up

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ALSGBILaparoscopic Surgery Training DayTuesday 4 DecemberThe Christie | Manchester M20 4BX

ALSGBIAnnual Scientific MeetingWednesday 5 & Thursday 6 DecemberCharter 1 | Manchester Central M2 3GX

ALTS Meeting(for theatre staff)Wednesday 5 DecemberCharter 4 | Manchester Central M2 3GX

THE THEME OF THIS MEETING IS AVOIDING COMPLICATIONS IN SURGERYFeaturing live HD Laparoscopic, Robotic & Technology Enhanced Surgery including...

• A selection of live colorectal and upper GI laparoscopic operations• Demonstration of the use and the role of fluorescence withindocyanine green

• Safe use of various energy devices• Safe techniques in minimal access surgery

• Robotic pelvic oncology includes rectal, uro-oncology and gynae-oncology procedures

• Demonstration of the advantages and benefits to patients havingrobotic pelvic surgery

• Safe techniques in robotic surgery

PROCEDURES DIRECT FROM THE CHRISTIE | MANCHESTER

Visit www.alsgbi.org for up-to-date information on the Live Operating & OperationsWorld Class Speakers | Laparoscopic Surgery Training Day | LapPass | ALTS Meeting | Awards & BursariesAbstract, Poster & DVD Submissions | CPD Points | Poster Exhibition | State of the Art Industry Exhibition

Lively Social Programme | Travelling Scholarships | Hotels & Travel Information | Registration

DATES & DEADLINESFRIDAY 1 JUNE

• Online abstract submission opens

WEDNESDAY 1 AUGUST• Online registration opens

MONDAY 1 OCTOBER• Deadline for Abstracts, Posters & DVDs to be submitted

THURSDAY 1 NOVEMBER• Deadlines for applications for Training Day Bursaries, ALTS Bursaries,Premier & Procurement Passes

• Deadline for applications for Travelling Scholarships

• ‘Early Bird’ Conference Rates end

CONTACT DETAILSGENERAL ENQUIRIES | Mrs Jennifer Treglohan | T: +44 (0)20 7869 6941 | E: jtreglohan@alsgbi.org

INDUSTRY EXHIBITION ENQUIRIES | Mrs Sarah Williams | T: +44 (0)20 7869 6940 | E: swilliams@alsgbi.orgAssociation of Laparoscopic Surgeons of Great Britain & Ireland

@ The Royal College of Surgeons of England | 35-43 Lincoln’s Inn Fields | London WC2A 3PE

ALSGBandI#ALS2018

Register @ www.alsgbi.org/manchester2018

1 Benchtop testing in porcine stomach tissue. Mean peak load required to pull tissue from the clamped jaws of ECHELON FLEX™ Powered Plus Stapler (PSEE60A) and ECHELON Reload with GST vs ENDO GIA™ ULTRA

Handle (EGIAUSTND) and Endo GIA™

Reload with Tri-Staple™ Technology

(GST60B 6.496lbf & GST60T 7.789lbf vs EGIA60AMT 1.325lbf & EGIA60AXT 1.920lbf, all p<0.001).

2 System components include ECHELON FLEX™ Powered Plus Stapler and ENDOPATH ECHELON™ Reloads with Gripping Surface Technology

ECHELON FLEX™ Powered Plus Stapler (PSEE60A) and ECHELON Reload with GST vs ENDO GIA™ ULTRA Handle (EGIAUSTND) and Endo GIA™ Reload with Tri-Staple™

Technology at 1.5, 2.5, 3.3 and 4.0mm tissue thicknesses (1.5mm; GST60B 1.067mm vs EGIA60AMT 2.452mm p<0.001; 2.5mm: GST60G 1.148mm vs EGIA60AMT 3.261mm p<0.001; 3.3mm: GST60T 0.642mm vs EGIA60AMT 4.806mm p<0.001; 4.0mm: GST60T 0.654mm vs EGIA60AXT 5.116mm p<0.001).

PO 0253 UK ©Johnson & Johnson Medical Limited 2015

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