Abdominal Organ Transplant & Hepatopancreaticobiliary Surgery Fellowship

The HPB / Transplantation Surgery Fellowship Program at Western University has a strong tradition of more than 30 years of training transplant surgeons that have gone on to practice around the world. The Fellowship Program is currently a TACC (Transplant Accreditation and Certification Council)- accredited Kidney Transplantation Surgery Fellowship.

The Fellowship Program at Western University also has a significant focus for training in Liver Transplantation and HepatoPancreatoBiliary Surgery. We have a very busy liver transplant service as well as a high volume HPB oncology practice serving the entire Southwestern Ontario region. We have one of the highest volume of MIS-HPB cases in Canada and are committed to training fellows in MIS approaches to major HPB procedures including laparoscopic Whipple procedure and major hepatectomies

Fellowships are two years in duration. The fellowship is focused on achieving clinical competence in and out of the operating room for HPB oncology and liver/kidney transplantation surgery. More formal aspects of teaching include fellows' seminars, grand rounds and journal clubs. Involvement in academic aspects of fellowship training are expected and include quality improvement projects as well as clinical or basic science research. There is opportunity to pursue a Master's Degree in Surgery through Western University but would likely require prolongation of the training period.

The fellowship application process is administered through the SF match.

Educational Objectives:

Abdominal Organ Transplant Surgery

Become competent in all aspects of liver, kidney and pancreas transplant recipient care including:
- transplant evaluation
- selection
- pre-transplant care
- post-transplant care in the inpatient and outpatient settings

Liver transplantation:

Become competent at all aspects of liver transplantation including
- donor liver evaluation
- organ procurement
- liver recipient procedure including hepatectomy and implantation of the donor liver
Become familiar with ancillary procedures and technical variations of liver transplant surgery
- living donor transplantation
- indications and setup of veno-venous bypass
Gain exposure in technical and clinical aspects of transplant oncology including
- hepatocellular carcinoma
- perihilar cholangiocarcinoma
- neuroendocrine tumours
Become competent in the longitudinal care of the liver recipient including
- percutaneous liver biopsy
- interpretation of liver histology including rejection, CMV infection, post-transplant lymphoproliferative disorder, recurrent hepatitis
- biliary obstruction and indications for revision or endoscopic management

Kidney transplantation:

Become competent in all aspects of kidney transplantation including:
- organ procurement procedures
- laparoscopic live donor nephrectomy
- kidney recipient procedure
- allograft nephrectomy
- native nephrectomy for polycystic kidneys

Pancreas transplantation:

Gain experience in all aspects of donor pancreas evaluation and organ procurement procedures.
Donor pancreatectomy
Back table preparation of pancreas allograft
Implantation of the donor pancreas
Learn all aspects of modern immunosuppression including dosing, side effects, and complications

Hepato-Pancreato-Biliary Surgery

LHSC is the tertiary referral center for HPB in Southwestern Ontario
Become competent in all aspects of evaluation, selection, pre-operative planning, technical performance and post-operative care of hepato-pancreatico-biliary (HPB) conditions
Become familiar and competent with minimally invasive surgery

Liver:

Become competent in open and minimally invasive surgery
- multi-disciplinary care of primary and secondary hepatic malignancies
  - operative planning and indications for resection including
    - major hepatectomy
    - ablation
    - parenchymal sparing approaches
    - indications for minimally invasive approaches
      - competence in laparoscopic major and minor hepatectomy
  - post-operative care

Pancreas:

Become competent in open and minimally invasive surgery
- major pancreatic resection
  - pancreaticoduodenectomy including:
    - major vascular resection and reconstruction
    - totally laparoscopic pancreaticoduodenectomy
  - distal pancreatectomy, laparoscopic and open
  - total pancreatectomy
  - surgery for benign pancreatic disease

Biliary:

Become competent in
- management of biliary malignancies
- management of biliary injuries
- management of complex benign biliary disease
Opportunities exist for additional training in ERCP

Procedure Volumes:

Transplant: 60 liver, 10 pancreas, 140 kidney transplants (40 living donor) per year
HPB: greater than 120 HPB cases per year (60 major pancreas, 50 major hepatectomy, 25 biliary; 75% minimally invasive or MIS assisted)

Academic and Research Responsibilities:

The fellows will be encouraged to carry out clinical investigation on mutually agreed upon topics, prepare the data and present the findings to the MOTP at University Hospital. They are strongly encouraged to submit abstracts to national or international meetings.
The fellows will participate in the on-going clinical trials of patients during their rotations and become familiar with the conduct of clinical trials, including the interpretation of results.
Attendance at all MOTP Educational Forums is expected.
For all MOTP supported fellows there is an expectation that a minimum of 24 months clinical service be provided by each fellow.
All MOTP supported fellows are expected to attend Journal Clubs, plan and present a research idea and maintain their own log, as required, for accreditation.