Minimally Invasive Surgery Program

Program DirectorDr. Timothy Jackson

Program Description: 
The University of Toronto offers a one year clinical fellowship in advanced minimally invasive surgery providing high volume clinical exposure to laparoscopic bariatric, colorectal, foregut, and solid organ surgery. Our fellowship includes the participation of three large University of Toronto affiliated hospitals and over 10 full-time MIS faculty. We also offer a two year research/clinical fellowship where the first year is spent developing research skills in a focused area of interest to the fellow. Opportunities exist to obtain a master's degree as part of the two year fellowship. Positions are available for two 1-year clinical fellows and one 2-year research/clinical fellow annually. 

The primary goal of the clinical fellowship is to train excellent surgeons in advanced minimally invasive techniques. In addition to extensive operating room experience, fellows will have the opportunity to develop their endoscopy skills and participate in ambulatory clinics. The clinical fellowship also includes an active research component. Current research programs in clinical epidemiology, surgical education and telesimulation, quality improvement, and health technology assessment provide an opportunity for fellows to develop their research and academic skills. Fellows will be assigned a research mentor at the start of the fellowship with the expectation that they will complete at least one project throughout the year suitable for publication in a peer reviewed journal and presentation at a scientific meeting. 

As part of the program, fellows will also gain significant experience teaching residents in the operating room and in the surgical skills lab. Simulation facilities are available onsite at many of the affiliated hospitals as well as at the University of Toronto Surgical Skills Centre. Participation and certification in the SAGES Fundamentals of Laparoscopic Surgery (FLS) program is expected as part of the fellowship. Opportunities for fellows to participate in international teaching initiatives and electives are also available. More information about the program and application process may be found at  

Expected Case volumes: 
Bariatric: 150 cases 
Foregut: 40 cases 
Colorectal: 50 cases 
Solid Organ: 20 cases 
Abdominal Wall: 40 cases 

3 Sites for Clinical Activity: 

University Health Network – Toronto Western Hospital: site director: Dr. Allan Okrainec

OkrainecSite Director: Dr. Allan Okrainec, MDCM, MHPE, FACS, FRCSC 
Division of General Surgery 
Toronto Western Hospital 
University Health Network 
399 Bathurst Street 
Toronto, ON M8Y 1E8 
Tel: 416 603-5224 
Fax: 416 603-5991 

The University Health Network (UHN) MIS rotations occur at 2 hospital sites: the Toronto Western Hospital (TWH) and Toronto General Hospital (TGH). Fellows will perform a variety of clinical cases including colorectal, malignant and benign foregut, hernia, splenectomy, adrenalectomy, hepatobiliary pancreatic, and laparoscopic donor nephrectomy. Fellows at the 
UHN site are in the OR approximately 3 days per week, and spend 1/2 day per week in the ambulatory clinic and 1/2 day per week in endoscopy. In the clinic, fellows will learn the appropriate evaluation and management of GERD/benign foregut diseases and the endocrine evaluation of adrenal and pancreatic lesions. The MIS fellows function as associate faculty, 
supervising residents in the ward and ambulatory clinic, and taking call at the faculty level. Fellows will participate in the resident teaching program, teaching MIS skills and general surgical skills in the surgical skills laboratory. Each fellow is expected to complete one research project and present the results at a scientific meeting. There will be opportunities 
to spend time in the esophageal motility laboratory if desired. Fellows are expected to attend all academic activities including morbidity and mortality rounds, GI/general surgery rounds, journal club, and GI and endocrine tumor boards. 

David R Urbach MD MSc FRCSC FACS 

Dr. Urbach graduated from the University of Toronto Medical School in 1993. After finishing his residency in General Surgery and Master’s degree in Clinical Epidemiology and Health Care Research at the University of Toronto, he completed a clinical fellowship in minimally invasive surgery in Portland, Oregon in 2000. 
Dr. Urbach is Associate Professor of Surgery and Health Policy, Management and Evaluation at the University of Toronto, and Tyco Chair of Minimally Invasive Surgery at the University Health Network, specializing in minimally invasive oncologic gastrointestinal and endocrine surgery. He is currently appointed as a Scientist at the Division of Clinical Decision Making and Health Care, Toronto General Hospital Research Institute, and at Cancer Care Ontario. He is an Adjunct Scientist at the Institute for Clinical Evaluative Sciences. 
Dr. Urbach’s research interests include health services research, focusing on surgical procedures and cancer care, clinical epidemiology, and health technology assessment. His current research projects include: cancer-related health services research, development of a process for making decisions about the adoption of surgical technologies in Canadian hospitals, and evaluation of the effectiveness of surgical procedures for gastrointestinal diseases. He is a Career Scientist of the Ontario Ministry of Health and Long-Term Care, Health Research Personnel Development Program, and is also supported by Cancer Care Ontario. He holds research grants from a number of funding agencies including the Canadian Institutes for Health Research (CIHR), Canadian Institute for Health Information (CIHI), Physicians Services Incorporated Foundation, and the Society of American Gastrointestinal Endoscopic Surgeons. 

Dr. Todd Penner, MD, FRCSC 
Assistant Professor University of Toronto 

Dr Penner completed his surgical residency in Toronto and was the 1st ever graduate of the University of Toronto MIS fellowship. After a brief stint in New Zealand at a private laparoscopic hospital, he returned to Staff at the Toronto Western Hospital. His clinical practice includes all areas of minimally invasive surgery within the abdomen. 

Dr. Allan Okrainec 
Assistant Professor University of Toronto 

After completing his surgical residency Dr. Okrainec completed a fellowship in minimally invasive surgery at McGill University. He has both clinical and academic interests in minimally invasive surgery. His research interest is in surgical education and simulation. 

St. Joseph's Health Centre: site director – Dr. Paul Sullivan

SullivanSite Director: Paul Sullivan B.Sc., MD, FRCSC   
General and Laparoscopic Surgery
St. Joseph's Health Centre
30 The Queensway, Sunnyside Building, Suite 220
toronto, ON  M6R 1B5
Tel: 416-530-6030
Fax: 416-530-6520

St. Joseph’s Health Centre is a 387 bed community teaching hospital within the University of Toronto. There are 6 members in the Division of General Surgery, all with University appointments, with a wide range of clinical expertise including Thoracics, Head and Neck, Hepatobiliary, and Bariatric surgery. The group also enjoys a high volume of more common general surgical procedures, of which, each member of the division is comfortable performing laparoscopically. 

The centre is fully staffed with general surgery residents at all levels, including 3 senior residents (PGY 4 or 5) at any given time. There is often a clinical associate in general surgery, and at various times Thoracic Surgery/Respirology fellows. We have long been considered one of the most sought after sites for the residents. In part this is due to our philosophy of training both residents and fellows. The primary goal of the faculty is the training of the general surgical residents – and fellowship training is done in this context. Fellows will often share advanced cases with the senior resident, with a goal to have the fellow take the senior through the case. The only current exception to this are the bariatric cases which the fellow will likely do with the staffman facilitating. 

The clinical responsibility of the MIS fellows at St Joseph’s will primarily be in the Operating Room, as the clinical volume of laparoscopic cases can easily support this. Fellows will be expected to follow their post-operative patients on the wards, but the formal rounding and decision making will be done by the resident house staff in conjunction with the attending. Input from the fellow is obviously welcome. Fellows are expected to take part in the formal educational rounds within the division. Fellows are asked to take call, as acting staff, with the residents, at least one weekend every other month, and the occasional weekday. Attending staff ‘back-up’ will be made available. 

The academic/research component of the fellowship will be mentored by one of the academic surgeons within the fellowship, and appropriate time will be allowed for these exercises. In addition, the fellows will be responsible for inputting data into the St Joseph’s Laparoscopic Database, primarily for the Bariatric patients. 

Dr. Lloyd Smith, MD. FRCS(C) 
Associate Professor, University of Toronto 
Surgeon in Chief, Department of Surgery, St Joseph’s Health Centre 
Former Program Director U of T MIS Fellowship 

Dr. Smith graduated from University of Saskatchewan Medical School to complete a general surgical residency at the University of Toronto. He completed a fellowship in Pancreaticobiliary Surgery at Middlesex Hospital in London, England, followed by a Surgical Nutrition fellowship at the University of Pennsylvania. 
He has been active staff at St Joseph’s hospital since then, with a brief spell at the University Health Network. He has been a pioneer in minimally invasive surgery at the University of Toronto, and founded the MIS fellowship in 2000. He has lectured widely, and given courses on advanced laparoscopic procedures across the country. 
His clinical practice includes hernia, solid organ, colorectal, bariatric, and benign upper GI surgery. 

Dr. David Lindsay, MD. FRCS(C) 
Lecturer, University of Toronto 

After completing his General Surgery Residency at University of Toronto, Dr. Lindsay did a one year clinical fellowship at St. Joseph's Health Centre and The Hospital for Sick Children. His laparoscopic interests include colorectal, bariatric, hernia, and solid organ surgery 

Dr. Paul Sullivan, M.D., FRCS(C) 
Lecturer, University of Toronto 
Former Program Director, U of T MIS fellowship 

Dr Sullivan is a graduate of the U of T MIS fellowship after completing his general surgery training at U of T. He recently moved to St. Joseph’s Health Centre to become part of the fellowship program and took over as program director in 2005. His clinical practice includes colorectal, bariatric, benign upper GI, hernia, and solid organ surgery. 

There are three other surgeons within the division, with expertise in Thoracic, Hepatobiliary, and Head and Neck surgery. The fellows will have access to some advanced laparoscopic procedures with each member of the division. 

Humber River Regional Hospital

HagenSite Director: John Hagen, MD, FRCS(C)
Humber River Regional Hospital
960 Lawrence Ave. W., suite 504
Toronto, ON M6A 3B5
Tel: 416-782-2616

Humber River Regional Hospital is a community hospital in the Northwestern part of Toronto. At present, laparoscopic fellowship training has been centered at the Finch site of Humber River regional hospital. There are three main surgeons, Dr. Laz Klein, Dr. John Hagen, and Dr. Quoc Huynh involved with the laparoscopic fellowship program, but all the surgeons are happy to have fellows help with their laparoscopic surgeries. The scope of practice for all of the surgeons is similar. There are approximately 300 laparoscopic gastric bypass operations, 200 laparoscopic colon resections, 15-20 laparoscopic gastrectomies, 60 laparoscopic ventral hernia repairs, 150 laparoscopic inguinal hernia repairs, and 400 laparoscopic cholecystectomies done on a yearly basis. All surgical emergencies, such as perforated viscus, bowel obstructions and incarcerated hernias are usually approached laparoscopically. 
There will generally be a senior level general surgical resident rotating through HRRH. The fellow’s primary clinical responsibility is in the OR. Fellows are expected to attend all divisional rounds. The fellows will be expected to take call at the staff level, with an attending available for back-up. 

Dr. John Hagen, MD, FRCS(C) 
Medical Director of Bariatric Surgery, Humber River Regional Hospital 
Lecturer, Division of Surgery, University of Toronto 
Dr. John Hagen is the past Chief of General Surgery at Humber River Regional Hospital and current Medical Director of Bariatrics. He is a pioneer in advanced minimally invasive surgical techniques (MIS). 
Dr. Hagen has extensive experience in advanced laparoscopic procedures and is a faculty member of the University of Toronto's MIS fellowship training program. 
Dr. Hagen is also one of the lead surgeons for the Cancer Care Ontario mentoring program which is designed to train surgeons around the province in the most current minimally invasive techniques for the treatment of colon cancer. 

Dr. Laz Klein, MD, MSc, FRCS(C) 
Staff Surgeon, Humber River Regional Hospital 
Assistant Professor, Divison of Surgery, University of Toronto 
Dr. Klein completed the residency program in General Surgery at the University of Toronto. He then went on complete fellowship level training at U of T in advanced Minimally Invasive Surgery (MIS). 
Since coming to Humber River Regional Program, he converted the existing bariatric program from an "open" program to a "laparoscopic" program. Gastric bypass and gastric banding are now performed laparoscopically by Drs Klein, Hagen, Starr and Huynh. The bariatric program is independently funded by the MOH. 
Dr. Klein is a faculty member of the University of Toronto's MIS fellowshp training program with an appointment of Assistant Professor, Department of Surgery. He is primarily interested in the application of minimally invasive techniques to intra-abdominal pathology such gastric and colorectal cancer, benign esophageal disease, adrenal surgery and abdominal wall hernias. 

Dr. Quoc Huynh, MD, FRCS(C) 
Staff Surgeon, Humber River Regional Hospital 
Dr. Huynh is the most recent MIS surgeon to join Humber River. He completed the University of Toronto MIS fellowship in June of 2007 and has now begun practice at HRRH. Dr. Huynh’s practice is almost exclusively laparoscopic. He is part of the bariatric surgery team and is the newest staff member of the University of Toronto’s MIS fellowship training program.