Curriculum

Our fellowship program follows the AHPBA recommended curriculum.

By the completion of the two-year HPB fellowship, the fellow will:

1. Be able to independently perform the following operations with an appropriate first assist: open pancreatoduodenectomy, laparoscopic or open distal pancreatectomy/splenectomy, laparoscopic or open targeting and ablation of a liver tumor, laparoscopic or open left lateral segmentectomy, laparoscopic or open wedge resection, laparoscopic or open radical cholecystectomy (4b/5 partial hepatectomy), laparoscopic or open portal lymphadenectomy, laparoscopic or open choledochoduodenostomy, open bile duct resection with roux-en-Y intra-hepatic hepaticojejunostomy, open major hepatectomy (right hepatectomy, left hepatectomy, right trisegmentectomy, left trisegmentectomy, segment selective major hepatic resection)
2. Understand the complexity of incorporating the following minimally invasive techniques into their future clinical practice with appropriate mentorship: laparoscopic or robotic pancreatoduodenectomy, laparoscopic or robotic major hepatectomy (right or left hepatectomy), hepatic artery infusion pump placement.
3. Understand the pre-operative clinical assessment, intra-operative considerations, and post-operative management necessary when planning a major hepatic resection.
4. Understand how to calculate liver volumes when planning surgical resections and calculate estimates of future liver remnant and kinetic growth rate. Understand the pathophysiology and clinical indications for selective portal vein embolization.
5. Independently perform a thorough intra-operative ultrasound of the liver, pancreas, porta hepatis, and adjacent lymph nodes.
6. Have a thorough understanding of the anatomy and physiology of the liver and its relationship to adjacent structures, how to interpret and utilize hematologic and biochemical tests which correlate with liver function and hepatocellular injury.
7. Have a thorough understanding of the options for liver imaging (including CT, MRI, PET, and ultrasound) their costs, implications, and indications for clinical use and pre-operative planning.
8. Have a thorough understanding of benign and congenital liver, biliary tract and pancreatic lesions, including their imaging characteristics, indications for intervention, treatment options, and risk of post-surgical complications and/or clinical sequelae.
9. Have a thorough understanding of malignant and neoplastic liver lesions, including a broad differential diagnosis that includes both primary liver and biliary malignancies (including hepatocellular carcinoma, cholangiocarcinoma, gallbladder cancer) as well as metastatic lesions, including their pre-operative, intra-operative, and post-operative considerations, appropriate staging work-up and the role of neoadjuvant and adjuvant systemic, regional, and radiation therapy options.
10. Have a thorough understanding of the anatomy and physiology of the gallbladder, biliary tract, and ampulla of vater, be able to diagnose congenital and acquired biliary tract disorders and develop a multi-disciplinary treatment strategy incorporating surgical, endoscopic, and interventional techniques where appropriate
11. Have a thorough understanding of the options for biliary imaging (including CT, MRI/MRCP, HIDA, and ultrasound) their costs, implications, and indications for clinical use and pre-operative planning.
12. Diagnose and work-up common bile duct injuries following cholecystectomy, understand the pre-operative, intra-operative, and post-operative management strategies, perform an appropriate operative bile duct reconstruction
13. Have a thorough understanding of malignant and neoplastic lesions of the ampulla and pancreas, including a broad differential diagnosis that includes pancreatic adenocarcinoma, mucinous cystic neoplasms and IPMN, extra-hepatic cholangiocarcinoma, peri-ampullary cancers, neuroendocrine tumors, and solid pseudopapillary tumors, including their pre-operative, intra-operative, and post-operative considerations, appropriate staging work-up and the role of neoadjuvant and adjuvant systemic, regional, and radiation therapy options.
14. Have a thorough understanding of the anatomy and physiology of the pancreas, understand the implications of pancreatic endocrine and exocrine functions, be able to diagnose and treat pancreatic insufficiency and perform an adequate assessment of risk for development of diabetes following surgical pancreatic procedures.
15. Have a thorough understanding of the options for pancreatic imaging (including CT, MRI, PET, and ultrasound) their costs, implications, and indications for clinical use and pre-operative planning. Understand the role of EUS and ERCP in the evaluation of pancreatic, biliary, and peri-ampullary lesions.
16. Understand the multi-disciplinary approach to the management of hepatocellular carcinoma in patients with underlying cirrhosis and liver insufficiency. Understand when to incorporate surgery, liver-directed therapies (including bland embolization, TACE, and Y90), and systemic treatments.
17. Understand the multi-disciplinary approach to the management of metastatic neuroendocrine tumors, including pre-operative work-up, staging, use of selective imaging modalities (DOTATATE Ga68 PET), role for systemic treatments, liver-directed therapy, and PRRT, and understand the role of surgical management of liver metastases in both functional and non-functional tumors.
18. Have exposure to the multi-disciplinary management of complex malignancies including gastric and esophageal cancer, soft tissue sarcoma, gynecologic malignancies requiring complex upper abdominal debulking, metastatic melanoma, renal cell carcinoma, locally advanced colon cancer, and adrenal cell carcinoma.
19. Have exposure to complex vascular reconstructions, including portal vein and inferior vena cava resection and reconstruction

Research

Fellows have some dedicated research time during their first year and it becomes a primary focus during their second year. They participate with post-doctoral researchers and research fellows in weekly research meetings and in the administration of a variety of clinical and lab-based research efforts. They have unlimited access to state-of-the-art basic science labs and our animal/cadaver procedural investigation lab.

Fellows are supported by their Program Director, faculty mentors, and a clinical research nurse.