Hepato-Bilio-Pancreatic Surgery Specialty - Current Trends and Perspectives - PowerPoint PPT Presentation

1 / 31
About This Presentation
Title:

Hepato-Bilio-Pancreatic Surgery Specialty - Current Trends and Perspectives

Description:

Current Trends and Perspectives Irinel Popescu, MD, FACS, FEBS Professor of Surgery Center of General Surgery and Liver Transplantation Fundeni Clinical Institute ... – PowerPoint PPT presentation

Number of Views:235
Avg rating:3.0/5.0
Slides: 32
Provided by: sim8192
Category:

less

Transcript and Presenter's Notes

Title: Hepato-Bilio-Pancreatic Surgery Specialty - Current Trends and Perspectives


1
Hepato-Bilio-Pancreatic Surgery Specialty
-Current Trends and Perspectives
Irinel Popescu, MD, FACS, FEBS Professor of
Surgery
Center of General Surgery and Liver
Transplantation Fundeni Clinical Institute,
Bucharest, Romania
2
  • We need a system, and we shall surely have
    it, which will produce not only surgeons, but
    surgeons of the highest type, men who will
    stimulate the first youths of our country to
    study surgery and to devote their energies and
    their lives to raising the standard of surgical
    science.
  • William Stewart Halsted, MD

3
From General Surgery to HBP Surgery
  • Many large academic institutions now deal with
    many of the diseases historically managed by
    general surgeons in organ- based specialty
    units or discipline-specific units
  • ..the move toward specialization has a lesser
    degree in nonacademic and geographically remote
    areas

4
From General Surgery to HBP Surgery
  • The operations on the liver and pancreas have
    fallen within the domain of the general surgery
  • The number of complex HBP procedures increased
    dramatically
  • The experience of general surgery residency is
    limited in the HBP domain

5
From General Surgery to HBP Surgery
  • THE NEED FOR HBP TRAINING
  • Surgeon training
  • was associated with improved outcomes after
    hepatic resections
  • significant predictor of postoperative
    complications,
  • no impact on in-hospital mortality

6
How should we train the HBP surgeon?
and
What Is the Current Status of Postgraduate
Training in HBP Surgery?
7
. By definition, HBP surgeons had to have one
full year of training in HPB surgery with or
without training in liver transplantation
8
(No Transcript)
9
(No Transcript)
10
EBSQ Examinations in HPB Surgery
11
at least 50 major HBP procedures
12
(No Transcript)
13
henri.bismuth_at_pbr.aphp.fr .ihb2.org www
  • The Hepatobiliary Institutes objective
  • to set up a HBP specialty and
  • to train specialized surgeons through a 12-month
    or 24-month program.
  • The program is open to surgeons trained in
    digestive surgery with a minimum of two years
    experience in this field  six years of Residency
    and Senior Residency.

14
What Is the Current Status of Postgraduate
Training in HPB Surgery?
University of Toronto model
  • The two-year HBP Fellowship is designed as
    follows
  • Year 1 Combined HPB Surgery and Liver
    Transplant Year
  • Year 2 HBP Surgical Oncology Research

15
Romanian Model of the Hepato-Bilio-Pancreatic
Surgery Training
16
Aims
  • Increase of training time dedicated primarily to
    HBP surgery
  • Increase the sample size of the HBP procedures
    performed by HBP fellows in a high-volume hospital

17
  • The fellowship was set as two-year duration
  • 6 Training Centers

BUCHAREST Institutul Clinic Fundeni IRINEL POPESCU
Spitalul Clinic de Urgenta MIRCEA BEURAN
CLUJ Spitalul Clinic Judetean C-TIN CIUCE
Institutul Regional de Gatroenterologie si Hepatologie Prof. Dr. O. Fodor CORNEL IANCU
IASI Spitalul Clinic Judetean de Urgenta Sf. Spiridon EUGEN TARCOVEANU
Spitalul Clinic Judetean de Urgenta Sf. Spiridon VIOREL SCRIPCARIU
18
  • Ord. 418/2005 liver surgery and liver
    transplantation fellowship
  • Ref. 102224/2007 hepato-bilio-pancreatic
    surgery fellowship (one-year duration)
  • Ord. 183/2012 new curricula and duration
    according to UEMS

19
Fundeni Clinical Institute
High volume center
983 HBP SURGICAL PROCEDURES
20
Surgical Training Model
6 years medical school
6 years residency in general surgery
Inadequate exposure to HBP surgical procedures
Attending surgeon
Large academic institutions
2 years fellowship in HBP surgery
nonacademic and geographically remote areas
21
Who Should Attend?
  • The applicant- Board Certified General Surgeon
  • - Board Certified Pediatric Surgeon
  • CANDIDATE SELECTION by
  • Letter of intention
  • Letters of recommendations
  • Oral interview

22
The way of training
  • KNOWLEDGE
  • lectures/course/didactic conferences
  • case reports presentation
  • discussion of relevant papers
  • CLINICAL SKILLS WARDS, OR
  • EXPERIMENTAL SKILLS pig model
  • EDUCATIONAL TRAINING

23
Educational training
  • proficiency in medical knowledge
  • patient care skills
  • self-reflection and assessment
  • interpersonal skills and communication
  • professionalism
  • ability to practice

24
TOPICS
  1. Liver Resections
  2. Biliary Tract Surgery
  3. Liver Vascular Reconstruction
  4. Pancreatic Surgery
  5. Multidisciplinary Oncological Approach of HBP
    Pathology
  6. Organ Transplantation - LT

24
25
A typical day for HBP fellow
  • Morning ward round - begin at 08.00 am
  • OR- attending HBP surgery
  • Hepatic resections, Whipple procedure, Distal
    Pancreatectomy, Hepaticoenterostomy
  • Minimally Invasive HBP Surgery ( laparoscopic,
    robotic)
  • Liver Transplantation
  • Afternoon attending ward round
  • Weekly multidisciplinary board meeting
  • Liver transplantation
  • Oncology


26
CLINICAL RESEARCH
  • Many available opportunities to become involved
    in clinical research in HBP field
  • Patient recruitment into existing trials
  • Access to new therapy / clinical trials
  • The fellow participate in publication work
    abstract and manuscript submission

27
Liver Transplantation
  • closely related to HBP surgery detailed
    understanding of the local anatomy, biliary
    surgery and techniques of reduced or split liver
    transplantation
  • different modules concerning
  • organ procurement
  • recipient hepatectomy
  • graft implant

28
2005
Romanian Association of Hepato-Bilio-Pancreatic
Surgery and Liver Transplantation
  • main objectives
  • training in HBP surgery
  • CME in HBP surgery
  • collaboration with similar associations
  • national and international conferences
  • support and publication of HBP articles

29
4 HBP Romanian Fellows attended the 2008-2009
courses for
30
30
31
Take home message..
  • learning by doing the best approach
  • the HBP subspecialty is the way for improving the
    outcomes in HBP surgery
  • the national HBP surgery program must follow the
    UEMS rules
Write a Comment
User Comments (0)
About PowerShow.com