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Highlights of the Fellowship:
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As a quaternary care academic practice in the public health system of Canada, we enjoy a centralization of referrals which creates a very clinically busy Endocrine section in our Division. Further, our section is located in a highly prolific academic milieu involving 6 teaching hospital networks and the University of Toronto campus, which harbors a vast amount of scientific and academic opportunities with respect to clinical, educational, basic science, translational and ethics research.
Our staff surgeons include 4 academic fellowship trained endocrine surgeons (Rotstein, Devon, Pasternak, Madani) and affiliated HPB faculty who are very active clinically, and are highly engaged in the endocrine oncology academic community. Our HPB-Endocrine Faculty (Dr Chaya Schwaartz) performs robotic and minimally invasive liver and pancreas surgery for neuroendocrine tumors. Our surgeons work at 4 affiliated hospitals located in the downtown core in the City of Toronto including Toronto General Hospital, Princess Margaret Cancer Centre, Toronto Western Hospital and Women’s College Hospital. We expect fellows to complete between 300 and 350 cases per year including thyroidectomy (with central and lateral neck dissections), parathyroidectomy, adrenalectomy (including laparoscopic transabdominal, retroperitoneoscopic, and open approaches), as well as resection of GI/pancreatic neuroendocrine tumors. Further, We perform TOETVA and RFA of thyroid nodules on a regular basis. Fellows will have large volume exposure to outpatient clinic patients and will routinely perform neck ultrasounds, fine-needle aspirations and flexible laryngoscopy.
According to their learning objectives, the fellow may attend several multidisciplinary tumor boards including 1) Thyroid/Parathyroid Tumor Board (2 per month), 2) Adrenal Tumor Board (1 per month), 3) GI/Neuroendocrine Tumor Board (1 per month), 4) Province-Wide Neuroendocrine Tumor board (1 per month), as well as 5) weekly Quality-Improvement Rounds and Endocrine Teaching Conference.
They will gain skills to ultimately become leaders in the field of Endocrine Surgery both technically in the operating room and with regards to the perioperative management of complex surgical endocrinology. The fellow as well as the entire team will interact regularly with various non-surgical team members who are leaders in their field, including endocrine oncology, endocrinology, radiology, genetics, nuclear medicine, medical oncology, radiation oncology and pathology. There is especially a high volume of exposure to rare endocrine disorders given the quaternary care nature of this endocrine surgery section, and management of these patients as a multidisciplinary team will be stressed.
Depending on the career plans of the clinical fellow, there will be opportunity for funding in an additional year for a research fellowship with potential for obtaining an advanced degree (MSc or other) from the University of Toronto.
Average Thyroid Case Volume: 125
Average Parathyroid Case Volume: 100
Average Adrenal Case Volume: 75
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Neuroendocrine Tumors (NET)
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Number of evaluation and management of NET (enteric and pancreatic only) cases per year: 25
Number of operative NET (enteric and pancreatic only) cases per year: 10
Number of NET case discussions per year: 50
The fellow has an opportunity to participate in a Multidisciplinary NET (enteric and pancreatic only) Tumor Board which meets three times a month (2 Panc/liver, 1 GI-NET).
If the fellow desires, there is an internal opportunity to engage in a more robust NET experience. Our HPB-Endocrine Faculty has a referral practice for pancreas/liver HPB. She can take the fellow depending on learning objectives on the service. Currently our fellow participates in cases requested.
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