The Medical and Surgical Department of Digestive Diseases and Minimally Invasive HPB Fellowship at IMM

Abstract

The Medical and Surgical Department at the Institut Mutualiste Montsouris combines all the medical and surgical specialists in digestive diseases to work together on the same team and in the same unit. It represents a novel approach to the care of the patient with pathology of the digestive system. A Minimally Invasive HPB Fellowship was created in 2006 because of the vast laparoscopic experience at this institution. It is the first such fellowship listed on the IHPBA website and appears to be the first of its kind. For surgeons interested in pursuing a career in minimally invasive HPB surgery, it is currently accepted that expertise in both laparoscopy and HPB surgery have been the only means to gain the ability to tackle advanced procedures in this complex field. However, as young surgeons continue to get an earlier exposure to more and more complex minimally invasive procedures during residency, the need to perform two fellowships may be eliminated and more centers like IMM may permit graduating residents to become experts in this field in 1 year.

Introduction

The Institut Mutualiste Montsouris (IMM) was incorporated in 1999 by fusing together two hospitals: the Medical and Surgical Center (Centre-Médico-Chirurgical) of the Port de Choisy, founded in 1963, and the Hospital of the International University of Paris (HIUP), founded in 1991. This new center was built on the old site of HIUP. HIUP gained international fame by being the first hospital to publish an article on the new field of minimally invasive surgery. IMM represents a unique approach to healthcare in France because it is a non-profit private hospital that works for the public healthcare sector, Participant au Service Public Hospitalier (PSPH). Professor Francois Dubois published the first experience with laparoscopic cholecystectomy in France in 1988 and IMM has continued to carry out pioneering work in the field of laparoscopy and hepato-pancreato-biliary surgery ever since.

Development

When Professor Brice Gayet became the Head of the Medical and Surgical Department of Digestive Diseases in 1992 before IMM opened its doors in October 1999, he created one department by bringing together all the medical and surgical specialists in digestive diseases to work together on the same team and in the same unit. He was a Professor of Anatomy before becoming a Professor in Digestive Diseases specializing in oncology. He has worked as a councillor for the French Ministry of Health under Dr Bernard Kouchner. He obtained a diploma in computer science from the Jussieu Faculty of Science of the University of Paris, and conducts extensive research on the use of robotics in the operating room. Professor Gayet has also helped Professor Guy Vallancien to set up the European School of Surgery, the first school of its kind created specifically for practicing surgeons. This school specializes in laparoscopic surgery on fresh cadavers and is based on close teamwork.

Over the last 15 years, he has used his expertise in gastrointestinal surgery and pioneering work in the field of minimally invasive surgery to further advance the last bastion of laparoscopy, hepato-pancreato-biliary (HPB) surgery. At the time of writing, he has performed over 240 laparoscopic liver resections, of which more than 145 have been for liver metastases and 65 have been major hepatic resections ¹,²,³. He has also pioneered work in pancreatic surgery and has successfully performed over 160 laparoscopic pancreatic resections, of which 35 have been pancreatic head resections for both benign and malignant disease, without a single mortality. As a pioneer in the field of minimally invasive surgery, Professor Gayet co-chairs a minimally invasive conference in France every year with Dr Jean-Louis Dulucq of Bordeaux.

The Department of Medical and Surgical Digestive Diseases consists of four gastrointestinal surgeons, five gastroenterologists who perform endoscopic retrograde cholangiopancreatography and ultrasound, and two radiologists with interventional expertise ⁴. There is a weekly inter-disciplinary oncology meeting when all of these experts discuss every patient with medical oncologists from the Hospital of Saint Antoine, pathologists, and radiation therapists. Recently, the operating rooms have been equipped with the newest laparoscopic and endoscopic towers by the Olympus Corporation and integrated operating rooms were due to open in August 2007 (HD Alpha OR, Olympus Corporation, Japan). IMM is one of the three European showrooms for this state-of-the art equipment.

Because of Professor Gayet's vast expertise and volume of minimally invasive HPB surgery, a Minimally Invasive HPB Fellowship began in September 2006 ⁵. Over a 1-year period fellows have the opportunity to operate on major hepatic and pancreatic head and tail resections, of which approximately 90% are done via minimally invasive techniques. In addition, the fellow has the opportunity to gain experience in other advanced minimally invasive procedures such as esophagectomies, colorectal resections, adrenalectomies, and splenectomies ⁶,⁷,⁸,⁹. The case loads follow the guidelines set forth by the International Hepato-Pancreato-Biliary Association (IHPBA) for HPB Fellowships.

The Minimally Invasive HPB Fellowship is the first such fellowship to be listed on the IHPBA website (www.IHPBA.org) and appears to be the first of its kind. For surgeons interested in pursuing a career in minimally invasive HPB surgery, it is currently accepted that expertise in both laparoscopy and HPB surgery have been the only means to gain the ability to tackle advanced procedures in this complex field ¹⁰. Because of the existing lack of a center where young surgeons could obtain the expertise in advanced laparoscopic HPB surgery, Professor Gayet agreed to start the fellowship. As young surgeons continue to get an earlier exposure to more and more complex MIS procedures during residency, the need to perform two fellowships may be eliminated and more centers like IMM may permit graduating residents to become experts in this field in only 1 additional year of training.