Applied programme of the subspecialty in Coloproctology in the Unit of Coloproctology of the Department of General and Digestive Surgery, Hospital Clínico Universitario of Valencia, Spain.

1. Objectives.

   The aim of this programme is to extrapolate the Coloproctology training system already present in other countries (mainly USA) to the European and Spanish medium. The objective is to start a pilot programme for training in this subspecialty with a logbook of procedures which can be recognised by other accredited centres. The programme will be exportable to other centres and will shortly be approved by the scientific community. The beginning of the development of the subspecialty in Spain will be through the Areas de Capacitación Especifica as specified by the current laws (BOE 22-11-2003) and the National Specialities Commission.

2. Characteristics of the bursary.

   • Income: 32.000 € (8.000 €/ trimester). This income will be subject to the current Spanish taxation laws. The scholarship funds are subject to income taxation of 33%.

   • Sponsors: COVIDIEN.

   • Organising body: Research Trust of the Hospital Clínico Universitario, Valencia.

   • Period: One year (From the 1st October 2008 to the 30th September 2009).

   • Annual call for applicants.

   • Regulations: The applicant must be a citizen of the EU and licensed in General Surgery. The degrees obtained outside Spain must be officially recognised in Spain when the application is made.

   • Applications should be accompanied by:

     • Photocopy of the National Identity Card or Passport (for foreigners).

     • Photocopy of the specialist degree in General and/or Digestive Surgery.

     • Curriculum Vitae.

   • The successful candidate will have to comply with Spanish requirements regarding recognition of prior medical training and certification of good standing from their own national medical governing body. This involves:

     • Achieving mutual recognition of academic and surgical professional titles by the Spanish Ministry of Education and Science. The documents (translated into Spanish by a sworn translator) required for this recognition are highlighted in Appendix H and Appendix I. These documents should be submitted either directly to the Ministry of Education and Science in Spain or Spanish Consulates or Embassies in the applicants own country.

     • A ‘Certificate of Good Standing’ (also translated into Spanish by a sworn translator). This must be forwarded to the ‘Fundacion para Investigación del Hospital Clínico Universitario’ (Avda. Blasco Ibañez, 17 - 46010 Valencia, Spain).

   • The candidate is advised to undertake these administrative responsibilities promptly following notification of success at interview. They will also have to register with the Official Medical Association in Valencia and will be assisted and advised in taking an annual malpractice insurance policy.

   • At the end of the programme, the candidate will be awarded a certificate by the Department of General Surgery and the Research Trust of the Hospital Clínico Universitario.

   • Applications should be presented in person or sent by land or email to the address below NO LATER THAN THE 30^th JULY 2008:

   Servicio de Cirugía 5º C
   Hospital Clínico Universitario
   Avda. Blasco Ibáñez, 17
   46010 Valencia
   Spain
   cirugia@telefonica.net
   
   

   • Criteria for the evaluation of merits:

     • Previous scientific publications.

     • Doctoral thesis.

     • Prior clinical activity.

     • Introduction letters or reports (maximum of three) from the mentors/ tutors, regarding training, merits of the aspirant and above all future perspectives for progress and work in the area of Coloproctology.

     • Possible personal interview.

     • Knowledge of languages.

     • The bursary cannot be granted twice to the same person.

   • The bursary will be granted by an evaluation committee with a COVIDIEN representative.

   • Commitment on behalf of the candidate:

     • Finish the period of the bursary.

     • To sit at the end of the year, the EBSQ-Coloproctology exam performed annually by the ESCP.

3. Activities to be carried out by the applicant.

   • Clinical activities as a specialist doctor tutored by the staff from the unit. Table I specifies the minimum number of procedures which the Subspecialist in Coloproctology candidate must perform, according to those established by the American Society of Colon and Rectal Surgeons (ASCRS) (Tables I and II). The candidate will have a logbook of surgical activities performed.

   • Educational activities: Participation in the educational activities of the unit: courses and meetings.

   • Research: Incorporation to the research projects.

   • Presentation of abstracts at the: Reunión Anual de la Asociación Española de Coloproctología, Congreso/Reunión de la Asociación Española de Cirujanos, Annual Meetings of the ASCRS or ESCP.

   • Participation in scientific publications.

4. Characteristics of the Coloproctology Unit.

   • Background: The Coloproctology Unit of the Hospital Clínico Universitario (Dr. Eduardo García-Granero), Valencia, is integrated together with another 3 units, within the Department of General and Digestive Surgery, chaired by Dr. Salvador Lledó, the current past-president of the Asociación Española de Cirujanos. The unit was founded in 1993 and has ample experience in the treatment of patients as can be seen by over 6.000 surgical procedures performed and registered in the Unit’s database. It also has prestigious research experience which is reflected in the scientific publications, together with a consolidated tradition in postgraduate training in Coloproctology for General Surgical residents and also for over 100 doctors who have visited the unit to improve their theoretical and practical knowledge in the subspecialty.

   • Human resources: 5 staff surgeons with complete dedication to Colorectal Surgery, two of them qualified with the European Board Surgical Qualification in Coloproctolgy (EBSQ-C). A stoma therapy nurse with complete dedication to the Unit.

   • Clinical activities and resources:

     • Surgery: The Unit performs around 225-250 Colorrectal surgical procedures and 125-150 Proctology procedures every year. There are 8-10 major operations per week.

     • Intelligent operating room for advanced Colorectal laparoscopic surgical procedures.

     • Clinics: two weekly clinics with four simultaneous completely equipped offices.

     • Anorectal ultrasound performed by the Unit which has studied over 750 rectal cancers from 1996.

     • Surgical ward with programmed and emergency admissions.

   • Available specialities related to the Unit: Gastroenterology, Gastrointestinal motility unit, Endoscopies, Conventional radiology, CT and MRI, Intensive Care, Urology, Gynaecology, Pathology, Oncology.

   • Coloproctology Functional Unit: The unit is organised for assistance and research, together with some of the previously mentioned specialities and is made up of the following multidisciplinary groups:

     • MDT of Colorectal Cancer.

     • MDT of Inflammatory Bowel Disease.

     • MDT of Pelvic Floor.

   • Activities in the teaching unit:

     • Annual practical course in Colorectal Surgery since 1995, (week’s duration) & directed towards specialist surgeons (programme).

     • Annual course in Coloproctology for residents promoted by the Asociación Española de Cirujanos.

     • Doctorate courses in Advances in Coloproctology.

   • Research activities.

   • Publications in the last 10 years (see Bibliography).

5. Activities in other Coloproctology Units of Valencia.

   To ensure the candidate meets the minimum number of surgical procedures established by the ABCRS (Tables I and II) the programme foresees that when a particular technique is performed infrequently, the candidate can attend the Coloproctology Units of the Hospital de Sagunto and the Hospital General Universitario de Valencia, directed by Drs. Alós and Roig respectively, with whom a close scientific relationship exists. Both of them qualified with the European Board Surgical Qualification in Coloproctology (EBSQ-C).

Lledó Matoses S. Colorectal surgery: justification for a specific area of knowledge. Cir Esp 2007;82:137-8.

Ivorra P, Sabater L, Calvete J, Camps B, Cervantes A, Bosch A, Plazzotta C, Cassinello N, Arlandis P, Lledó S. Effect of neoadjuvant chemotherapy on the results of resection of colorectal liver metastases. Cir Esp 2007;82:166-71.

Martín Arévalo J, García-Granero E, García Botello S, Muñoz E, Cervera V, Flor Lorente B, Lledó S. Early use of CT in the management of acute diverticulitis of the colon. Rev Esp Enferm Dig 2007;99:320-4.

Ballester C, Sarriá B, García-Granero E, Morcillo EJ, Lledó S, Cortijo J. Relaxation of the isolated human internal anal sphincter by sildenafil. Br J Surg 2007;94:894-902.

Alfonso R, Herrero MJ, Dasí F, Aliño SF, Lledó S. Effects of anti-K-ras and anti-telomerase phosphorothioate antisense oligodeoxynucleotides on colorectal cancer growth. In Antisense Elements (Genetics) Research Focus. A. G. Hernandes. Editor Nova Science Publishers. Inc. Hauppauge, NY. 2007. ISBN: 1-60021-491-6.

Codina-Cazador A, Espín E, Biondo S, Luján J, de Miguel M, Alós R, García-Granero E, Echeverría-Balda A, Ortiz H. Audited teaching program for the treatment of rectal cancer in Spain: results of the first year. Cir Esp 2007;82:209-13.

Alfonso-Ballester R, López-Mozos F, Mart-Obiol R, Garcia-Botello SA, Lledo-Matoses S. Laparoscopic treatment of endoscopic sigmoid colon perforation: a case report and literature review. Surg Laparosc Endosc Percutan Tech 2006;16:44-6. Comment in: Surg Laparosc Endosc Percutan Tech 2007;17:68-9; author reply 69.

Garcia-Granero E. Surgeon-related factors and surgical quality in rectal cancer outcomes. Implications for specialization and organization. Cir Esp 2006;79:75-7.

Garcia-Botello SA, Garcia-Granero E, Lillo R, Lopez-Mozos F, Millan M, Lledo S. Randomized clinical trial to evaluate the effects of perioperative supplemental oxygen administration on the colorectal anastomosis. Br J Surg 2006;93:698-706.

Millan M, Garcia-Granero E, Flor B, Garcia-Botello S, Lledo S. Early prediction of anastomotic leak in colorectal cancer surgery by intramucosal pH. Dis Colon Rectum 2006;49:595-601.

Millan M, Garcia-Granero E, Esclapez P, Flor-Lorente B, Espi A, Lledo S. Management of intersphincteric abscesses. Colorectal Dis 2006;8:777-80.

Garcia-Granero E, Munoz-Forner E, Minguez M, Ballester C, Garcia-Botello S, Lledo S. Treatment of chronic anal fissure. Cir Esp 2005;78 (Suppl. 3):24-7.

Lledo S, Alfonso R, Alino SF. Antisense gene therapy using anti-k-ras and antitelomerase oligonucleotides in colorectal cancer. Rev Esp Enferm Dig 2005;97:472-80.

Garcia-Armengol J, Moro D, Ruiz MD, Alos R, Solana A, Roig-Vila JV. Obstructive defecation. Diagnostic methods and treatment. Cir Esp 2005;78 (Suppl. 3):59-65.

Alos R, Solana A, Ruiz MD, Moro D, Garcia-Armengol J, Roig-Vila JV. Novel techniques in the treatment of anal incontinence. Cir Esp 2005;78 (Suppl. 3):41-9.

Garcia-Botello SA, Garcia-Armengol J, Garcia-Granero E, Espi A, Juan C, Lopez-Mozos F, Lledo S. A prospective audit of the complications of loop ileostomy construction and takedown. Dig Surg 2004;21:440-6.

Lledo SM, Garcia-Granero E, Dasi F, Ripoli R, Garcia SA, Cervantes A, Alino SF. Real time quantification in plasma of human telomerase reverse transcriptase (hTERT) mRNA in patients with colorectal cancer. Colorectal Dis 2004:236-42.

Garcia-Granero E, Garcia SA, Alos R, Calvete J, Flor-Lorente B, Willatt J, Lledo S. Use of photoplethysmography to determine gastrointestinal perfusion pressure: an experimental canine model. Dig Surg 2003;20:222-8.

Ortiz H, Armendariz P, DeMiguel M, Solana A, Alos R, Roig JV. Prospective study of artificial anal sphincter and dynamic graciloplasty for severe anal incontinence. Int J Colorectal Dis 2003;18:349-54.

Ortiz H, Armendariz P, DeMiguel M, Ruiz MD, Alos R, Roig JV. Complications and functional outcome following artificial anal sphincter implantation. Br J Surg 2002;89:877-81.

Minguez M, Herreros B, Espi A, Garcia-Granero E, Sanchiz V, Mora F, Lledo S, Benages A. Long-term follow-up (42 months) of chronic anal fissure after healing with botulinum toxin. Gastroenterology 2002;123:112-7.

Garcia-Granero E, Marti-Obiol R, Gomez-Barbadillo J, Garcia-Armengol J, Esclapez P, Espi A, Jimenez E, Millan M, Lledo S. Impact of surgeon organization and specialization in rectal cancer outcome. Colorectal Dis 2001;3:179-84.

Dasi F, Lledo S, Garcia-Granero E, Ripoll R, Marugan M, Tormo M, Garcia-Conde J, Alino SF. Real-time quantification in plasma of human telomerase reverse transcriptase (hTERT) mRNA: a simple blood test to monitor disease in cancer patients. Lab Invest 2001;81:767-9.

Hinojosa J, Bau I, Martinez B, Garcia Armengol J, Roig JV, Ferrando J, Moles JR, Gomez AB, Lledo S. Morphological, histochemical and immunochemical characteristics of the terminal ileum of patients with ulcerative colitis. Relationship with the development of pouchitis. Gastroenterol Hepatol 2000;23:263-8.

Garcia-Granero E, Esclapez P, Garcia-Armengol J, Espi A, Planelles J, Millan M, Lledo S. Simple technique for the intraoperative detection of Crohn's strictures with a calibration sphere. Dis Colon Rectum 2000;43:1168-70.

Minguez M, Melo F, Espi A, Garcia-Granero E, Mora F, Lledo S, Benages A. Therapeutic effects of different doses of botulinum toxin in chronic anal fissure. Dis Colon Rectum 1999;42:1016-21.

Roig JV, Buch E, Alos R, Solana A, Fernandez C, Villoslada C, Garcia-Armengol J, Hinojosa J. Anorectal function in patients with complete rectal prolapse. Differences between continent and incontinent individuals. Rev Esp Enferm Dig 1998;90:794-805.

Garcia-Armengol J, Hinojosa J, Lledo S, Roig JV, Garcia-Granero E, Martinez B. Prospective study of morphologic and functional changes with time in the mucosa of the ileoanal pouch: functional appraisal using transmucosal potential differences. Dis Colon Rectum 1998;41:846-53.

Garcia-Granero E, Sanahuja A, Garcia-Armengol J, Jimenez E, Esclapez P, Minguez M, Espi A, Lopez F, Lledo S. Anal endosonographic evaluation after closed lateral subcutaneous sphincterotomy. Dis Colon Rectum 1998;41:598-601.

Buch E, Alos R, Solana A, Roig JV, Fernandez C, Diaz F. Can digital examination substitute anorectal manometry for the evaluation of anal canal pressures? Rev Esp Enferm Dig 1998;90:85-93.

Lledó Matoses S. Classifications of perianal Crohn disease. Rev Esp Enferm Dig 1997;89:581-2.

Garcia Armengol J, Hinojosa J, Lledo S, Roig JV, Garcia-Granero E, Garcia SA, Alos R, Minguez M. Evolutive study of the functional results after restorative proctocolectomy for ulcerative colitis. Rev Esp Enferm Dig 1997;89:685-98.

Hinojosa J, Garcia Armengol J, Martinez B, Bau I, Moles JR, Roig JV, Lledo S. Reservoiritis: acute inflammation of the ileoanal reservoir (and II). Natural history and treatment. Gastroenterol Hepatol 1997;20:432-6.

Garcia Armengol J, Hinojosa J, Lledo S, Roig JV, Minguez M, Garcia-Granero E. Reservoiritis: acute inflammation of the ileoanal reservoir (I). Etiopathogenesis and diagnostic criteria. Gastroenterol Hepatol 1997;20:426-32.

García Armengol J, Solana Bueno A, Roig Vila JV, Hinojosa del Val J, Blasco Segura T, Lledó Matoses S. The mucosal electrosensitivity of the anal canal following restorative proctocolectomy for ulcerative colitis. Gastroenterol Hepatol 1997;20:339-43.

Garcia-Granero E, Alos R, Uribe N, Sala C, Lledo S. Intraoperative photoplethysmographic diagnosis of ischemic colitis. Am Surg 1997;63:765-8.

Sala C, Garcia-Granero E, Molina MJ, Garcia JV, Lledo S. Effect of epidural anesthesia on colorectal anastomosis: a tonometric assessment. Dis Colon Rectum 1997;40:958-61.

Espi A, Arenas J, Garcia-Granero E, Marti E, Lledo S. Relationship of curative surgery on natural killer cell activity in colorectal cancer. Dis Colon Rectum 1996;39:429-34.

Solana A, Roig JV, Villoslada C, Hinojosa J, Lledo S. Anorectal sensitivity in patients with obstructed defaecation. Int J Colorectal Dis 1996;11:65-70.

Uribe N, Garcia-Granero E, Belda J, Calvete J, Alos R, Marti F, Gallen T, Lledo S. Evaluation of residual vascularisation in oesophageal substitution gastroplasty by surface oximetry-capnography and photoplethysmography. An experimental study. Eur J Surg 1995;161:569-73.

Garcia Armengol J, Roig JV, Alos R, Solana A. Perianal cutaneous metastasis of rectal adenocarcinoma. Rev Esp Enferm Dig 1995;87:342-3.

Solana Bueno A, Roig Vila JV, Villoslada Prieto C, Segarra Gomar D, Ramirez Muñoz D, Hinojosa del Val J, Lledó Matoses S. Sensitivity of the anal canal: study techniques and results in normal subjects. Rev Esp Enferm Dig 1995;87:298-304.

Roig JV, Villoslada C, Lledo S, Solana A, Buch E, Alos R, Hinojosa J. Prevalence of pudendal neuropathy in fecal incontinence. Results of a prospective study. Dis Colon Rectum 1995;38:952-8.

American Board of Colon & Rectal Surgery (ABCRS) Operative Procedure Standards Policy

The Board instituted a Standards Policy with regard to acceptable operative performance by residents in colon and rectal training programs. It states:

“Minimum requirements within each of the 17 operative categories have been established. Accordingly, residents displaying insufficient numbers in five or more categories will not be allowed to enter the certification process until they are able to finish sufficient case numbers to meet the requirements”.

Residents should consult with their Program Directors for specific details about reaching the required numbers within his/her own institution. The Board recommends a periodic evaluation prior to the conclusion of training to ensure that the expected numbers are being meet.

Operative Procedure Guidelines

* When considering what the “Minimum Requirements” are, it should be stressed that theses figures do not reflect what the board considers to be the ideal number of cases.

American Board of Colon & Rectal Surgery (ABCRS) Operative Procedure Category List