Dear EHS community,
My name is Lawrence Nip, and I am a surgical resident in London, UK, with a strong interest in abdominal wall surgery. I recently had the pleasure of spending one week at Virgen del RocĂo University Hospital in Seville, where I observed the abdominal wall reconstruction team led by Dr Luis Tallon Aguilar.
I was initially awarded the extended stay travel grant by EHS. However, due to unforeseen work commitments in London, I was unable to complete a longer visit. I am extremely grateful to the EHS for their flexibility in allowing me to convert this into a short stay travel grant, as it meant I did not miss out on what proved to be a fantastic and invaluable opportunity.
During my time in Seville, it was truly inspiring to see how the workload of an expert abdominal wall centre is organised. The Department of Complex Abdominal Wall and Outpatient Surgery consists of five surgeons and four residents, delivering both simple day-case hernia procedures and highly complex abdominal wall reconstructions. The unit serves a direct population of approximately 550,000, while also acting as a tertiary referral centre for complex cases across the wider AndalucĂa region, covering several million people.
Each morning began with a large multidisciplinary surgical meeting involving approximately 50 members from various specialties, including colorectal, oesophagogastric, abdominal wall, emergency surgery, HPB, and transplant teams. These sessions provided an excellent platform for reviewing emergency cases from the previous day, discussing patients ready for discharge, and engaging in educational presentations and learning projects. It was impressive to witness such a collaborative and structured approach to patient care and education.
Following the meeting, the teams divided into their respective specialties, and I primarily observed the elective workload within the abdominal wall service. I was fortunate to be exposed to a wide range of operative procedures, with detailed pre- operative discussions that included reviewing CT scans for each case. This greatly enhanced my understanding of case planning and anatomical considerations.
The variety of cases I observed was exceptional, including complex open abdominal wall reconstructions for giant midline and off-midline hernias, preoperative progressive pneumoperitoneum (PPP), laparoscopic ventral TAPP, robotic ventral TAPP, robotic eTEP, rTARUP/rTARM procedures, inguinal TAPP, inguinal TEP, and open umbilical hernia repairs.
One of the highlights of my visit was observing robotic abdominal wall surgery. In my current training in London, I have not yet encountered robotic AWR, so this was a
particularly valuable experience. Dr Tallon Aguilar and his colleagues were incredibly generous with their time, providing clear explanations of each procedure. They discussed in detail aspects such as robot docking, operative steps, preferred anatomical planes, and specific considerations including the “classic” Belyansky and Carolinas crossover techniques. It was fascinating to see how robotic technology enhances visualisation of tissue planes and facilitates precise suturing.
Overall, this experience has been incredibly educational and has significantly broadened my perspective on abdominal wall surgery. I have gained insights and techniques that I hope to incorporate into my own practice in the future. I would also like to highlight how welcoming and supportive Dr Tallon Aguilar and his team were throughout my stay. They actively involved me in discussions and created an environment in which I felt comfortable and engaged from the outset.
I would highly recommend this institution to other aspiring abdominal wall surgeons. The team’s extensive experience across a wide range of techniques, combined with their willingness to teach and explain their decision-making processes, makes it an outstanding place to learn.
Finally, Seville itself was a wonderful city to visit. The weather was consistently sunny, and I stayed in a hotel just a 15-minute walk from the hospital and a short 15-minute Lime bike ride to the city centre. Even after full operating days, there was ample daylight until around 8pm, allowing me to explore the city, enjoy its culture, and experience the local cuisine.
In summary, this was a fantastic experience and undoubtedly one of the most rewarding and memorable weeks of my career so far.
Kind regards, Lawrence Nip
