Clinical Exchange in Japan

I was very privileged to be able to work with Dr. Nagino, a world renowned surgeon and professor and the leading expert in hilar cholangiocarcinoma resection through hepatopancreaticoduodenectomies. We were introduced to each other over a cup of green tea and he felt that it was important enough to know what my goals were from participating in the student exchange program with Nagoya University. Scrubs were provided to me as well as a selection of shoes that I could wear into the OR suites. I was pleased to find that in each OR, there is a high definition camera that is used over the surgical field to record the procedure. Furthermore, for a highly specific and small surgical field such as those used in HPD surgeries, there was also a high definition TV that showed, live, what was happening in the field so that even when I was not scrubbed in, I could see whatever the leading surgeon and the first assist saw.

Because of Dr. Nagino’s expertise in HPD surgery, he had many visiting professors at Nagoya come see his procedures as well as assist him. There were 4 other surgeons from Thailand, Taiwan and Singapore who watched the procedures with me. I was also given the privilege of having them explain to me in English what was happening. It was because I showed an interest in oncological surgery that they felt it was beneficial to teach me tips and techniques that could be useful in my career. There were a few times in the month that I was asked to scrub in on cases.

After the HPD surgeries were done, I was allowed to go through the various 20 or so other OR’s to see how other procedures were performed (such as colon reanastomoses, hernia repairs, abdominal tumor resections, laproscopic cholecystectomies, hepatic resections due to hepatocellular carcinoma, lymph node biopsies, pancreaticoduodenectomies). What I took away was the difference in not only Japanese culture through my time outside the hospital, but also the culture within the OR. Surgeons are very much more meticulous in exposing as much as they can in the surgical field than in the US. It was interesting to also see the different approaches that Japanese surgeons use for the same procedures. If I could, I would absolutely do this international elective again. If I were to change anything, I would have chosen to do this international elective for longer than just 4 weeks.