Exhaustive Hours Provide Invaluable Knowledge In Healing

An Update on Dr. Fuchs’ E.U. Clinical Residency Fellowship at Université Paris-Saclay.

PARIS, FRANCE – Since July, Dr. Juri Fuchs, a resident at Heidelberg University Surgery Clinic and a researcher with Liver Surgery Research Heidelberg (LSRHD), has been participating in the 6-month E.U. Clinical Residency Fellowship of the Université Paris-Saclay at the Center for Pediatric Liver Transplantation and Hepatobiliary Surgery, Hôpital Bicêtre, Assistance Publique - Hôpitaux de Paris, Université Paris-Saclay in Paris France. There, he has been focused on clinical training in pediatric liver transplantation and hepatobiliary surgery and research in the field of rare liver diseases in children.

Going into this fellowship, the main objective was to gain experience in surgical techniques and perioperative care of children with surgical liver diseases. Dr. Fuchs has a specific desire to assist in the treatment of children with biliary atresia, liver tumors, bile duct cysts and other rare liver afflictions. These treatments are performed at high frequency at Hôpital Bicêtre. For example, Kasai portoenterostomy, split liver transplantation and major liver resections in small children, particularly in children under the age of one, are performed predominantly at Hôpital Bicêtre instead of being performed in many other hospitals, even those specialized in childcare.

The number of unique and rare liver disease cases and interventions are quite high at Hôpital Bicêtre. However, the number of surgical residents is relatively low in comparison. This provides Dr. Fuchs the opportunity to assist in many operations, and in some cases, he may even perform a small part of these interventions – under observation and mentorship of senior surgeons. Some of the surgeries Dr. Fuchs has assisted in are liver transplants, complex hepatobiliary surgery, oncologic operations, and neonatal surgeries. As an operating surgeon with guidance from his mentors, he has performed such surgeries as inguinal hernias and appendectomies.

Assisting in the OR (operating room) is only a fraction of the responsibilities expected from Dr. Fuchs during this fellowship. Besides assisting in surgery, Dr. Fuchs must do shifts where he manages the ER (Emergency Room) in the evenings and nights or be “on call” (off-work but ready to respond to emergency situations). In the ER he deals with various types of pediatric emergency care for wounds, fractures, postoperative complications and other traumas or ailments.

As well as assisting in surgery and ER operations, Dr. Fuchs is also tasked with managing wards within the hospital. This entails such duties as doing ward rounds every morning and evening, discussing incidents with senior surgeons, changing bandages, removing drains, and responding to patient health crises. Dr. Fuchs also sees new patients admitted for surgeries scheduled for the coming day. He must make sure that these patients are medically fit and ready for whatever surgery they are about to undergo. And, once a patient is ready to leave the hospital, he must make sure that they understand their recovery therapy and ensure the patient’s discharge information is in order prior to them leaving his ward. Administration and paperwork are a huge part of the job, and it is vital for the accurate tracking of patient medical care and therapy.

On top of this heavy workload, Dr. Fuchs continues to conduct research whenever time allows. Recently, his study, “Biliary Rhabdomyosarcoma in Pediatric Patients: A Systematic Review and Meta-Analysis of Individual Patient Data” was published in Frontiers in Oncology, Pediatric Oncology. Currently, he is investigating through retrospective analysis of single center clinical data and meta-analysis, topics in extended liver resection in pediatric patients, rare aggressive liver tumors affecting children, and a specific subgroup of patients with biliary atresia.

The workload has been quite intense for Dr. Fuchs, and his fellow residents, as vital responsibilities and tasks outnumber available residents and attendings. This is not a problem faced only at Hôpital Bicêtre, but it is a crisis felt universally by many hospitals worldwide as there is a widespread shortage of surgical residents and attendings. This crisis, being the cause of a heavy and diverse workload, and Hôpital Bicêtre being a specialized center, have allowed Dr. Fuchs to learn much in the areas of perioperative management of pediatric patients with a variety of liver diseases, operation techniques in split liver transplantation, surgeries for biliary atresia and portal hypertension, and liver resection in small children. Some of the skills Dr. Fuchs has gained over his fellowship include: evaluating indications for pediatric liver transplantation, assessing organ quality and eligibility of possible donors, preoperative planning of liver resection in extensive liver tumors, and surgical principles and techniques in pediatric liver surgery (transplantation, resection, biliary atresia, portal hypertension, porto-caval fistula).

Dr. Fuchs appreciates this opportunity to learn the surgical treatments and therapies for a wide range of rare live diseases in children, that only a center like Hôpital Bicêtre provides. More importantly, he hopes that with the knowledge and experience he gains during this fellowship, he can in turn positively impact the lives of many other sick children through assisting in the healing or improvement in the quality and length of life of these young people.

Between now and when the fellowship ends in December, Dr. Fuchs hopes to build upon the knowledge he has already gained, perfect learned surgical skills, while continuing to learn new techniques. He aims to perform even more complex operations under observation and engage with the highly experienced surgeons at Hôpital Bicêtre, not only in surgical areas, but in building cooperation in scientific endeavors as well.

After his return to Heidelberg University Surgery Clinic, Dr. Fuchs states that he will miss doing complex liver surgery in pediatric patients and interdisciplinary work with hepatologists in pre- and post-liver transplantation therapy in children.

This fellowship is providing some essential skills that can be applied at Heidelberg University Surgery Clinic, as Dr. Fuchs stated, “some of the specific techniques used by specialized pediatric liver surgeons might be useful in adults too. For example, a special technique of dissecting/clamping the vena cava.”

If the Heidelberg University Hospital re-establishes a pediatric liver transplantation program, Dr. Fuchs hopes to take an active part in the organization and development of such a project, contributing knowledge gained during this fellowship.

Though the workload is high, which has caused a work/life imbalance, Dr. Fuchs has had a few occasions to enjoy Parisian life. Additionally, immersion in French culture and language has allowed him to significantly improve his language skills.

The time at Hôpital Bicêtre has had its share of struggles, but as Dr. Fuchs stated, “The workload is quite challenging, but I have experienced and learned many things in pediatric liver surgery in a comparatively short span of time, which is extremely satisfying.” The momentary hardship is worth it when a personal goal is to be a healer for children suffering from liver disease.

Cancer is at the heart of the public health service mission of the Assistance Publique - Hôpitaux de Paris (AP-HP), with over one-third of all cancer patients in France being treated at AP-HP hospitals. AP-HP treats all cancers, at all stages, covering all ages of the population. This includes rare cancers that affect less than 6 people out of 100,000 people per year, in addition to childhood cancer, rare diseases that account for 1% of cancers. In 2018, 61,844 patients, including 38,975 new patients, were treated at AP-HP for cancer. To learn more, visit https://www.aphp.fr/pass-sanitaire-lhopital.

Liver Surgery Research Heidelberg is a research group located at Heidelberg University specializing in liver regeneration after hepatectomy (liver resection) and post-hepatectomy liver failure, HCC development and treatment (especially in the context of MAFLD [metabolically associated fatty liver disease]), and rare liver lesions and diseases. LSRHD is currently working on over 24 research projects, has 5 articles under publication review, and over 100 published authorships. LSRHD is also the founder of the RELIVE (RarE LIVEr) Initiative, a multidisciplinary project to establish evidence-based therapies for rare liver diseases. To learn more, visit www.liversurgeryresearch.com.

Author:

Nicholas Murtha is the Communications Manager at Liver Surgery Research Heidelberg. He holds a Bachelor of Arts in Political Science from the University of Minnesota.