When I was elected as a SOFJO travelling fellow, I asked to watch spine surgeries, especially, endoscopic spine surgeries. Prof. P.Merloz who is a chairman of AFJO introduced me CHU de A.Michallon in Grenoble, Bordeaux and Archet2 in Nice.
I visited three university hospitals from September to November in 2001.
Although the period in staying in France was very short, I could watch many operative cases. Outcome of most of these cases was excellent, however, there are some difficult cases such as nonunion and infection after arthodesis of spine and the treatment of discopathy, and their results were not always good. From these cases I realized the difficulty in the spine surgeries. It was a good experience for me that I could know the idea of each surgeon in France. If I had spoken French much better, I could have discussed these matters more deeply. As 30-50 operations were performed per week in each hospital, I have learned a lot of unexperienced methods.
It was fantastic for me to know both French orthopedics and French culture for three months.
CHU de GRENOBLE, HOPITAL A. MICHALLON
This hospital is situated along the Isere river at 10-minute drive by tram from Grenoble station. From the hospital we can see beautiful mountains at all directions. The hospital was 17 stories and possessed about 2000 inpatients. Prof. P.Merloz was in charge of department of orthopedics and traumatology where 7 doctors and 5 interns were working. Thirty-40 cases were operated every week and also there were many additional cases by trauma. All operations were performed only by one surgeon and one intern, while those were done by three or four doctors in Japan.
As you know, Prof. Merloz is very famous for the performance of computer-assisted surgery, especially for navigation system (Fig. 1a). He owns one institute for computer-assisted surgery inside the hospital. I could watch the surgery with navigation system there and I could luckily attend his lecture and also a symposium concerning the present state and the future of this system in the SOFCOT in 2001. I learned the concept and broad application to orthopedic surgery there.
At his outpatient clinic I saw a lot of cases of infantile orthopedic disease such as scoliosis, LCC, club foot, leg length discrepanthy and genu-valgum. It was very interesting and useful for me.
CHU de BORDEAUX
Next month I visited CHU de Bordeaux. It was also a large hospital with16 floors admitted 2000 patients. Its shape looked like three feet, then it was called Pellegrin tripodes.
Bordeaux is well known as city of wine making. On the weekend I took part in a tasting tour to St. Emillion.
At this hospital there were three orthopedic departments. I stayed at professor Chauveaux's department of which speciality was foot surgery. Another professor was Dr. J.C.Le Huec whose speciality was spine surgery and shoulder surgery, and 6 staff doctors and 5 interns were working at the same department. I learned standard spine surgery and endoscopic spine surgery under Dr. J.C.Le Huec. In this department there was 40 cases of spine, shoulder and foot surgeries every week.
Dr. Le Huec has a lot of experience of thoracoscopic and laparoscopic spine surgery on the disc herniation, trauma, tumor, and scoliosis etc. I saw thoracoscopic surgery to the scoliosis and disc herniation at his department(Fig. 2a,b).
Interestingly, I could watch the procedure of lumbar disc prosthese to the lumbar discopathy patients. He has been using the prothesis for 8 years. It was surprising for me that more than 80% of patients were satisfied with this prosthesis.
Every week I could see spine surgeries at the operation rooms and the results of surgeries at his outpatient clinic.
During my stay, Dr. Le Huec sometimes invited me to dinner and gave me a chance to participate in the meeting of degenerative lumbar disease in Biarritz. There I could learn the results of long term follow up study of MED and endoscopic spine surgery in Bordeaux area.
There was another spine surgery department by professor Vital. Dr. Aburakawa who came from Hirosaki University introduced me this department, then I could look at Dr. Vital's operations too.
I think doctors here tended to use instrumentations more frequently than I did on the degenerative spine diseases. It may depend on the limitation of hospitalization or the difference of the idea to the spinal instability and to the treatment of instability between France and Japan.
I had an impression that not only doctors but also paramedical staffs are very much accustomed to surgeries. Surgeons concentrated only on surgeries. All the surgeries were acted extremely systematically and they did not waste time. There was a wonderful circumstance for surgery in this place.
CHU de NICE, HOPITAL de l'Archet 2
I moved to Nice on November 1. When I looked at Nice from the window of the airplane, a coast of Nice was as blue as just like a Cotes d'Azur even in November.
HOPITAL de l'Archet 2 was placed at the middle of the hill in the west of the city-center. I went up there shaken by the terrible rolling bus every day.
Dr. Argenson, spine surgeon, had been a professor at this hospital three years ago. Now there were 4 doctors and 4 interns. Professor Boileau is in major of shoulder surgery. A lot of cases of arthroscopic shoulder surgeries and total shoulder replacements could bee seen here. Dr. Hovorka was the second in this department and mainly treated degenerative spine disease. I learned under Dr. Hovorka (Fig. 3). He started endoscopic spine surgeries from 1994. He published a lot of articles about minimal invasive spine surgery to the thoracolumbar spine and had profound experience of endoscopic spine surgeries. He operated anterior spinal fusion to the burst fracture at the thoracolumbar level with only 5cm skin incision by video assistance. He is young and he is one year senior to me. I could talk with him a lot and I could understand his strategy to the degenerative and traumatic spine disease. He was the only spine surgeon in this hospital but he accomplished difficult and up-to-date operations by himself. I was impressed by the high potentiality and the high quality of each surgeon.
While staying in France, I could see many interns from all over the world. During lunch or dinner time at the dormitory, I talked and chatted with many young doctors about daily life, habit and medical system of each country. It was another fan for me(Fig. 1b).
During three months I traveled about 20 cities in the weekend. I went to many historic cities and knew the European culture.
In conclusion. When I saw their treatment, they innovated their operation every year and devised their original instrumentation. When I stayed there, they did not insist on only laparoscopic spine surgery to the discopathy and spinal trauma but they chose mini-open ALIF and mini-open thorocoscopic surgery. To know and compare with the present medicine of France and Japan is very useful for each other. I hope to continue and expand this travelling fellowship program in the future.
I thank to the chairman of SOFJO and all the member of SOFJO and thank them very much for giving me an opportunity to join this program.
Especially Professor Merloz was very kind to help me to make a plan of this visit and advised me a lot in the period of my stay. And when I left Grenoble, he kindly gave me his book with writing "a mon ami Torikai" . it is my unfogettable treasure for me(Fig.4).