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”

10. EBSQ Examinations in HPB Surgery

11. ……at least 50 major HBP procedures

13. The Hepatobiliary Institute’s objective :
.ihb2.org www
The Hepatobiliary Institute’s 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
VIOREL SCRIPCARIU

18. Ord. 418/2005 – liver surgery and liver transplantation fellowship
Ref /2007 – hepato-bilio-pancreatic surgery fellowship (one-year duration)
Ord. 183/2012 – new curricula and duration according to UEMS

19. 983 HBP SURGICAL PROCEDURES
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? Letter of intention Letters of recommendations
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 Liver Resections Biliary Tract Surgery
Liver Vascular Reconstruction
Pancreatic Surgery
Multidisciplinary Oncological Approach of HBP Pathology
Organ Transplantation - LT 24

25. A typical day for HBP fellow
Morning ward round - begin at 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