COLLEGE TRAVELLING FELLOWSHIP REPORT

                                       Mr S S Chaudhri

I was delighted to be awarded the College Travelling Fellowship last year. I had applied to to
visit the Karolinska University Hospitals in Stockholm, Sweden with a view to training in
undertaking extra levator abdominoperineal resections (eLAPE) for rectal cancer. My visit
was planned for October-November last year but had to be deferred to allow me to take up
my appointment as Consultant Colorectal Surgeon at Leicester General Hospital.

Photograph of the Karolinska University Hospital Solna

I visited the Karolinska University Hospitals at Solna and Huddinge in January-February
2010. The Colorectal unit at Solna specialises in the management of rectal cancer and
undertakes 40 resections annually for advanced rectal cancer. Dr Torbjorn Holm from the
unit has introduced the eLAPE technique and teaches the technique on the course at
Salisbury Hospital in the United Kingdom.

Photograph of self with Dr Torbjorn Holm and a resident doing an eLApe

The Huddinge site is the larger of the two Gastrointestinal Surgery units and has the Upper
GI and Hepatopancreaticobiliary departments and also a Colorectal Unit that specialises in
proctology with Professor Per-Olof Nystrom and abdominal wall hernias with Professor Ulf

During my visit I was able to scrub up and assist in three eLAPE and three anterior
resections for advanced rectal cancer (T4). I attended all the operating rooms every day and
scrubbed up for most cases. Prof. Nystrom taught me his perianal block which in
combination with intravenous sedation and Fentanyl allows him to undertake all his
proctology. I attended the multidisciplinary meetings (MDM) all of which were specially
conducted in English for my benefit. In addition I was able to visit the Colorectal Unit at Ersta
Hospital, Stockholm which is one of the centres of excellence for Enhanced Recovery after
Surgery in Europe.

I was impressed with the excellent audiovisual conferencing infrastructure which allows all
the hospitals in Stockholm to connect with the MDM at the Karolinska and refer or discuss
cases and including their imaging. The hospitals were spotlessly clean and the wards very
modern and uncluttered. I must not forget to mention the food in the Hospitals which was
appetising and delicious. Another interesting point was that all hospital doctors have to wear
a smartly tailored white uniform in all clinical areas.

Photograph of the patient dining hall on the ward at Huddinge

During my visit I was also able to study the training programme for Surgeons. To summarise
it comprises of a 5 year Residency programme following which one becomes a Specialist in
Surgery. The duration of time spent as a Specialist varies as this is essentially dependent on
obtaining surgical expertise and often includes time spent doing a PhD. Appointment to
Overlakare (Consultant) might be directly made or follow a period as Associate Consultant
and most Surgeons are in their mid 40s at the time of appointment. There are no exams
involved and all trainees are assessed locally by their departments.

To summarise I had a great trip and came back having had a chance to benchmark my
eLAPE technique and improve on in it besides learning a few other useful techniques. I
would like to thank the College for having made my trip possible.

Mr S S Chaudhri
March 2010

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