August 2018
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Non NTN Ionescu Fellowship 2017-18 This Fellowship gave me the opportunity to visit the two European centres for advancing my knowledge and exposure to the Video Assisted Thoracoscopic Surgery and advanced thoracic oncological procedures in Copenhagen and Paris. Lakshmi Srinivasan MBBS, FRCS (Surg-in-Gen), FRCS (Cth)
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visited the state of the art facility for Video Assisted Thoracoscopic Surgery (VATS) and had the opportunity to work, for over a month, with Dr Rene Petersen and Dr Henrik Hansen who run the sub-specialist service in VATS at the Rigshospitalet in Copenhagen. This is a tertiary referral thoracic unit in Denmark and serves a population of 2.1 million including some of the other Scandinavian islands. It is highly accredited for popularising the anterior approach and has an established mentorship programme for the senior trainees and consultants at all levels to train in VATS techniques. It is a high volume centre with a throughput of 1200 major cardiac cases 75% of which are by VATS and 54% of the lobectomies done by VATS. I had the opportunity of watching 25 major VATS cases of which 23 were VATS anatomical lung resections including two segmentectomies and two thymectomies. The techniques were reproducible and standardised for the Unit. This gave me the opportunity to watch the techniques closely and learn how to plan, anticipate, avoid, and in some cases, manage intra-operative complications. Since my visit, I have developed my abilities further to be able to become independent operator in this technique. I am currently using VATS for lung resections in my current practice as Consultant in Thoracic Surgery in Stoke on Trent, UK.
During my stay I witnessed a wide variety of open surgery ranging from redo sternotomies for recurrent thymectomy with pericardial reconstruction to double sleeve resections and also pleurectomy and decortication for mesothelioma. I also had the opportunity to see trauma and bilateral lung transplantation with the on call team. This is the only centre for mesothelioma referrals in all of Denmark. Lead by Dr Jesper Ravn and Dr Bodil Brandt, they have a vast experience over the years in extrapleural pneumonectomy and now pleurectomy & decortication for epithelioid mesothelioma.
tracheal sleeve resections. I also was part of major resections of sarcomatous deposits in the supraclavicular region and advanced lung cancer resection for upper lobe tumours involving the chest wall using the anterior Dartevelle approach and the Shaw Paulson posterior approach. The inclusion of thoracic surgeons in the retrieval of donor organs (lungs), chronic pulmonary endarterectomy for pulmonary hypertension (CTEPH) and peripheral vascular operations being performed by the thoracic surgeons gives the trainee versatility in surgical skills and the holistic approach to the speciality. The advanced oncological resection skills are put to use less frequently but are useful in the surgeon’s armamentarium faced with locally advanced tumours which would otherwise have good results with R0 resection in combination with neo-adjuvant and adjuvant therapy. I thoroughly enjoyed my visit to the two hospitals and would like to thank the SCTS committee for having chosen me to be the recipient of the Non- NTN Ionescu Fellowship 2017. This Fellowship has broadened my knowledge in thoracic surgery and taught me advanced skills in minimally invasive surgery, advanced oncological surgery and management that I am able to apply to day-to-day practice as a thoracic consultant in the United Kingdom. n
“My visit to the MarieLanne Longue Hospital in southern Paris lasted two weeks and I had the valuable experience to attend the pulmonary hypertension MDT and the regular lung cancer MDTs.� My visit to the MarieLanne Longue Hospital in southern Paris lasted two weeks and I had the valuable experience to attend the pulmonary hypertension MDT and the regular lung cancer MDTs. I had the opportunity to work and learn from Professor Elie Fadel and his team. The hospital is dedicated to cardiovascular and thoracic surgery and is the tertiary referral centre for all pulmonary diseases from the peripheral hospitals. In addition to routine lung cancer surgery, I witnessed chronic thrombo-embolectomy for the chronic pulmonary hypertension and
