European Hernia Society Travel Grant 2022
From 23.05.2022 to 27.05.2022
Life Memorial Hospital – Medlife, Bucharest, Romania Dr. Victor Radu is a well-known Hernia expert. He is an Advanced Laparoscopic Surgery Master in Hernia Surgery and the director of the Center of Excellence in Hernia Surgery in Life Memorial Hospital – Medlife in Bucharest, Romania. By visiting him in his working environment, I had the chance to get a closer look at his approaches and to observe how he treats his patients. During the week I spent with him, I observed several eTEP and eTEP-TAR operations, as well as (recurrent-) Inguinal hernias repairs. In the same week, Dr. Radu hosted other collogues from Norway, Belgium, U.K. and Czech. This allowed a wide range of discussions and exchanges of experiences.
On the first day, I observed dr. Radu doing a TAPP in a recurrent inguinal hernia. Using glue to seal the peritoneum in one case and taking the decision to convert from laparoscopic to open approach in another challenging case, were something interesting to see and discuss.
On the second day, I was joined by colleagues from Norway and we attended a presentation by Dr. Radu about the eTEP approach. In this presentation, he explained some anatomical and theoretical aspects and the evidence behind the eTEP approach. Then we went together to the O.R. and we observed his structured approach in eTEP, from choosing the places of the trocars and the first entry with the optical trocar, to the dissection of the retro-muscular space, and placing the mesh. The Patient had a swiss cheese 9×10 cm hernia, which subsequently was covered with a 19×30 mesh in a good overlapping. It was very engaging and informative to have instant intraoperative discussions, including comparing and contrasting against other techniques like e/MiLOS and Intraoperative Fascial Traction.
On Day 3, We joined Dr. Radu in the clinical round to visit the patient he operated on the previous day. The patient was doing well, walking around with no pain, and was ready to be discharged. Then we joined him again in the O.R for another eTEP operation. We observed here the TAR done endoscopically with clear preserving and sparing of the neurovascular bundles. This patient was also doing fine the next day and was ready to go home. As the new head of the educational wing of the EHS, Dr. Knut Borch, was also there, we had the chance to discuss some educational plans and projects of the wing, and how to actively contribute to them.
On the 4th day of my stay, another group of interested surgeons from the Czech, U.K., and Belgium arrived. We observed another nicely done eTEP in a suprapubic (M5) incisional hernia. After that, we attended a presentation about Mesh properties and mesh selection. This led to a rich discussion with Dr. Radu and the other colleagues.
On the last day, we observed a TAPP Operation in a patient with a PM3 inguinal hernia. We saw how Dr. Radu closed the medial defect with a straight needle through a small local inguinal incision.
In addition to his elegant approach in hernia operations, we experienced with Dr. Radu his wild approach in exploring Bucharest on scooters! This tour -guided by Dr. Radu himself- ended with a nice dinner in one of the finest restaurants in the city.
During my stay, I also met the head of the Advisory Committee of Quality, Dr. Barbora East. We had the chance to get updated about the ongoing activities of the committee, and the incisional hernia guidelines group. In summary, I achieved my intended learning outcomes of this scientific visit. I increased my knowledge about a variation of laparoscopic retro-muscular approaches to treat ventral hernias. I compared and contrasted it with my current approach in similar cases, and I engaged in direct intraoperative discussion with the expert, exploring the advantages and limitations of eTEP and eTEP-TAR.
It was a wonderful experience. I learned a lot from Dr. Radu, and I am intending to apply some changes in my current practice according to his tips and advice.
Dr. Zaid Malaibari
Fellow in Abdominal Wall and Hernia Surgery
Hamburg Hernia Center – Germany