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Bariatric Training is now SORTED

As a surgical registrar with a specialist interest in Upper GI and Bariatric surgery, I was frustrated by the lack of a formalised training programme in Bariatrics in the UK. I was also a little disappointed that courses in bariatric surgery were slightly confused about their target audience, with delegates ranging from junior trainees to senior consultants. I decided to address these problems and designed SORTED!

S.O.R.T.E.D (Surgery for Obesity – Registrar Training and Educational Development) is a unique modular course, designed specifically for senior trainees within two years of a consultant post. Its aim is to provide operative training in addition to enhancing multidisciplinary skills necessary to practice in this specialty. Full sponsorship was generously offered by Ethicon Endo-Surgery after a “dragon’s den” style pitch at head office and the pilot course was setup in the South West region.

Six delegates were selected from open competition using a combination of CVs, letters of support from trainers and personal statements. The course programme was as follows:

Module 1 (Feb18th/19th2010)

European Surgical Institute, 
Hamburg, Germany.

Faculty: Mr David Hewin, Mr David Mahon, Mr Peter Sedman

This two day module was held at the state-of-the-art facility in Germany, owned and run by Ethicon Endo-Surgery. The programme included:

Simulator session – using computer simulation to revise basic laparoscopic skills such as knot tying and suturing. Hand-eye coordination and manipulation exercises were included with time trials to encourage competition between the delegates and faculty. The faculty were not always the fastest! Each delegate and faculty had their own individual simulator.

Dry laboratory session – each delegate had their own laparoscopic station with a porcine prosection. This was excellent as all the organs were in their correct anatomical positions and was a welcome change to a dried out stomach and bowel pinned out on a corkboard. We then trialed a new perfusion prosection model (unique to Ethicon Endo-Surgery) in which red liquid was continuously pumped through a cannula in the splenic artery. This meant that the tissues were engorged and “bled” if you made a mistake. A truly excellent experience for all and great preparation for the wet labs.

Supervised sleeve gastrectomy in the dry labs, Hamburg


 Wet laboratory session – uniquely we had a full day in the wet labs with two delegates per station. The delegates had the opportunity to perform gastric banding with the Swedish Adjustable Gastric Band (Ethicon Endo-Surgery), followed by band removal, followed by a sleeve gastrectomy and finishing with a Roux-en-Y gastric bypass. We were able to use the state-of-the art staplers, such as the Echelon Flex and equipment which enhanced the whole experience.

Module 2 (Mar 23rd 2010) 

Southmead Hospital, Bristol, UK

Faculty: Ms Sally Norton, Mr Justin Morgan, Ms Sharon Bates, Dr Mike Darby

This one day module allowed the delegates to get up close and personal with gastric banding. They were all cleared by occupational health in advance and scrubbed up in pairs to undertake a supervised gastric band, under the careful supervision of Miss Sally Norton and Mr Justin Morgan. 

The afternoon involved meeting a real patient in a question and answer session, facilitated by the superbly enthusiastic and knowledgable nurse specialist, Ms Sharon Bates. This was hugely valuable as it allowed the delegates to ask those questions that can’t be found in textbooks. This was followed by a radiology tutorial to allow recognition of slips and pouch dilatations. The delegates found this to be very useful.

The last part of the day was attendance at a “live” MDT meeting so that delegates could see the process of patient selection and get input from dieticians, psychologists and endocrinologists. Definitely, an eye opener and gave a unique insight into the bariatric surgery pathway which is usually a “behind close doors” affair.

Module 3 (Apr 12th 2010)

Musgrove Park Hospital, Taunton, UK

Faculty: Mr Richard Welbourn and Mr David Mahon

This one day module was the third and final chapter of SORTED. It was a day of live operating via video links. We witnessed two gastric bypasses, a band and VBG (Vertical Banded Gastroplasty) conversion to a bypass. The operations were fantastic with two way interaction between surgeon and delegates via microphone. 

The natural “gaps” between cases were utilised to the full. We had a short presentation from Chloe Ibrahim (Dendrite) about the National Bariatric Surgery Database and a talk from Mark Davidson (Ethicon Endo-Surgery) about commissioning bariatric services in the NHS. The delegates were given presentation topics in Hamburg to prepare for this meeting and each delegate delivered a well researched, ten minute presentation on a topic of controversary in bariatric surgery.

From left to right:  John Loy (Delegate), Simon Monkhouse (Course Director), David Mahon (Faculty), Hamish Noble (Delegate), Simon Higgs (Delegate), David Hewin (Faculty), Allwyn Cota (Delegate), Somaioh Aroori (Delegate), Peter Sedman (Faculty), James Rink (Delegate).

Examples included “Which operation for which patients”, “When to remove a band” and “Nutritional consequences of the gastric bypass”. This was particularly useful as the delegates drew out information from the most up to date literature and gave an evidence–based overview of their topic.

The delegate feedback was uniformly excellent and I am hugely grateful to all the faculty and in particular Paula Thomas, Mark Thomas and Paul Griebel from Ethicon Endo-Surgery who facilitated this pilot course from conception to delivery.

The plan for the future is to nationalise SORTED. Local trainees, local faculty in local centres. Keep your eye out for a SORTED near you!