SCTS Ionescu – NTN Travelling Fellowship – The Barts Experience Tom Combellack

Lung transplantation

The unit has a robust lung transplantation service which, to date, has performed in excess of 500 transplantations. It is a close collaboration between the transplant surgeon and the transplant Pulmonologist. The unit’s work has been internationally recognised. During my visit, I got to experience the in-hospital post-operative care of lung transplantations. In addition, the department has a strong culture of clinical and experimental research embedded in their practice. Active areas of interest include malignant mesothelioma, lung transplant and pulmonary hypertension. Quality research meetings and symposiums are held regularly.

Overall, this was an enlightening and self-expansive experience for me. A debt of gratitude is owed by myself to the SCTS Ionescu Fellowship for affording me this opportunity and my unit, Glenfield Hospital, Department of Thoracic surgery for allowing me time off to make this trip.

Finally, I would like to extend my wholehearted appreciation and thanks to Professor Schmmit-Opitz and her team for making my stay worthwhile and indeed memorable. n

SCTS Ionescu – NTN Travelling Fellowship – The Barts Experience

Tom Combellack

Ihad the good fortune to undertake a fellowship in Barts under the supervision of Mr Stamenkovic, who is Director of Robotic Surgery and founder European proctor for Intuitive – the company that makes the Da Vinci robot. There is another robotic fellowship opportunity in Guys under the supervision of Mr Routledge.

What is unique about the Barts robotic programme is that it has the most advanced Da Vinci – 4th generation Xi. It is a dedicated thoracic robot with access five days per week for use by all five consultant surgeons including two European proctors, effectively delivering a standardised training experience. In addition, there is a large volume of segmentectomies with full use of robotic adjuncts such as ICG (indocyanine green), exposure to innovative procedures and ideas and involvement in high quality research.

My fellowship was for three months prior to gaining a substantive consultant post in Cardiff but the fellowship usually lasts for 6-12 months. My typical week involved one clinic/MDT day, two days in theatre and one in six non-resident on call with relatively light intensity.

Prior to my arrival I completed the Da Vinci online learning modules. Once at Barts I dedicated myself to the simulation training package that comes with the robot. I completed these modules within my first week. The first two weeks I watched on the second console, immersed in the operation, learning the set up and tips and tricks for thoracic robotic operating. In my third week I was signed off on Da Vinci in-service and emergency undock training by one of the Intuitive representatives and performed my first case the same week.

Within three months I had performed 23 independent cases supported both by Mr Stamenkovic and my registrar colleagues on a range of lung resections including advanced segmentectomies and mediastinal procedures. I felt incredibly well supported throughout my learning curve especially with such a slick theatre team. Personal highlights include a robotic lung and chest wall resection and a hybrid robotic procedure with cone beam CT fiducial insertion and localisation.

The whole thoracic team was very welcoming and I was invited to learn in other theatres too. For example, I performed robot procedures with Ms Wilson (European proctor), an extended pleurectomy decortication with Mr Waller and navigational bronchoscopy with Mr Lau. The robotic experience alone was fantastic but the opportunity to see and perform some of the other most innovative and advanced techniques has taken my development to a whole new level. My only regret is that I wish I could have stayed longer!

I think the Barts Robotic Fellowship is a phenomenal opportunity, especially as a post FRCS finishing school. Not only will it be stimulating and broaden your professional network with some of the highest profile surgeons in the country but it will also put you in a very strong position for any consultant post. I cannot rate it highly enough.

I would like to offer my sincere thanks to Mr Ionescu for giving me this fantastic opportunity to learn new skills. n