Robotics has taken the surgical community by storm and is increasingly being adopted in IBD surgery. While many see true technological advancement in robotics, by virtue of its ability to facilitate complex procedures in Crohn’s Disease and Ulcerative Colitis for the good of the patient, there remains scepticism as to whether robotics really represents a relevant game changer in IBD surgery compared to advanced standard laparoscopy. And, as always, there are two sides to the coin.

Are we measuring postoperative outcomes that reflect the success of surgical intervention? Are those outcomes sufficiently sensitive to measure the success of surgical intervention? Complication rate, quality of life and disease relapse are frequently used outcome measures but they have drawbacks that must be taken into consideration. Combining these outcomes with objective measurements will provide the best account of the success of a surgical intervention. Why is this important? Because the greater the number of successful surgical interventions, the lower will be the threshold for accepting surgery as part of the treatment strategy in IBD. Lowering the threshold for acceptance of surgical intervention will convince more gastroenterologists to refer patients to surgery and will eventually enable more patients to benefit from early surgery.

Caroline Nordenvall has recently joined the S-ECCO Committee. She works at the Karolinska University Hospital as an IBD surgeon and is head of the research group in colorectal surgery. She is an Associate Professor within the University.

Peter Kienle © ECCO

The 13^th S-ECCO IBD Masterclass within the 19^th ECCO Congress completed a return to normality, this being the second time in a row that we were able to meet in person with colleagues focusing on IBD surgery without the ghost of COVID hovering above us. Pär Myrelid, having successfully and calmly steered S-ECCO through a challenging year, opened the first session and welcomed us heartily in his home country.

The increasing complexity of care for patients with Inflammatory Bowel Disease (IBD) has driven the need for multidisciplinary care.  This has led centres and practices to hold regular multidisciplinary team meetings (MDTs) at which specialists in gastroenterology, surgery, radiology and pathology discuss patients. It has also led to joint clinics where practice environments allow patients to be seen by specialists in both gastroenterology and surgery, and even in some cases by experts in stoma therapy, nutrition and psychology, all on the same day. This allows for greater cross-disciplinary dialogue and more consistent messaging to the patient, which improves the quality of care and overall patient experience.

How do you make a surgeon? Not by the preliminaries, the 6-7 years of medical college and the years that follow in residency training, but by the six or seven years subsequently spent after medical school learning the surgical trade. Exactly what happens in this apprenticeship that transforms him\her from a helpless, frightened medical school graduate into a (hopefully) capable and confident surgeon?

Pär Myrelid © ECCO

In many countries, cancer patients have had structural pathways for a number of years. Regardless of whether these are called two-week referrals, urgent referrals or cancer pathways, they have improved the care for many patients with a suspected malignancy. In a society with limited access to medical care, however, an improvement like this may come at a cost. Unfortunately, patients with chronic disease may be among those paying the price for the structural pathways within Oncology. This price comes in many different forms, but for our Inflammatory Bowel Disease patients it particularly involves prolonged waiting times for radiology, endoscopy and surgery. Thus the improvement achieved for patients with, for example, suspected colorectal cancer may at the same time represent an impairment for patients with an increased risk of developing the same type of cancer as intervals between endoscopic surveillance sessions tend to increase.

Pär Myrelid © ECCO

The 18th ECCO Congress and 12^th S-ECCO IBD Masterclass provided many of us with the opportunity finally to meet in real life and delivered much new knowledge and numerous new insights. This year’s Masterclass was opened by Christianne Buskens, who in a very distinct manner showed us what kind of effect the pandemic and all virtual meetings have had on us by showing a picture from last year’s virtual meeting (we all looked terribly concerned and sad). This can be compared with a picture from this year’s meeting, where good old friends reunited to discuss IBD.

This week my dishwasher broke down. I hadn’t ever been in this situation before, so I called my plumber. He laughed at me and told me that he didn’t do stuff like that anymore. Instead, he gave me a number for a ‘kitchen appliance repair guy’. Since when have we developed specialists in the repair of kitchen appliances? I didn’t even know that such specialists exist. How the world around us has changed in the last 25 years! I called the number and the receptionist who answered my call was direct and to the point. She asked what the appliance was. ‘A Zanussi’, I said. ‘Why?’ ‘Well, it’s because we have different engineers for the different makes’, she said in her south London patois. Anyway, I spoke with the engineer who ‘ran a diagnostic check’ over the phone by instructing me remotely to push various buttons on the machine under his instruction. In doing so he demonstrated an ability to drive at the same time as guiding me around, from memory, the control panel of my model. He clearly has the patience of Job! When he promptly arrived a day later, he laid out his tools neatly in a semi-circle on the kitchen floor. He had brought specific ‘parts’ with him that he thought he might need. After about 20 minutes the task was complete – the washer was back in working order. He asked me to sign his form and within an hour of his leaving I received electronically a feedback form to comment on his promptness, manner and efficacy. As far as kitchen appliance repair guys go, he was awesome! A true master craftsman.

Optimisation is the action of making the best or most effective use of a situation or resource (Oxford Dictionary) but in the medical world it is preparing the patient (and the surgeon) for surgery and postoperative recovery.

The goal of “optimising” patients’ health prior to surgery is to minimise the risk of postoperative complications, decrease the length of hospital stay, reduce unplanned re-admissions and enhance overall health and surgical experience.