Auckland City Hospital

Oesophagogastric and Bariatric Surgery Unit, Auckland City Hospital

The Oesophagogastric and Bariatric surgery unit is part of the Department of General Surgery at Auckland City Hospital. There are three Upper GI consultants performing a full range of Oesophagogastric surgery for benign and malignant conditions. The unit works closely with the HPB unit, wherein one of the senior HPB surgeons continues to have an active interest in Oesophagogastric surgery, principally for cancer.

The team consists of three consultants, a fellow, a registrar, a house officer (RMO) and a nurse practitioner. Team Health psychologists and dieticians provide additional input.

The fellow is involved with all major Oesophagogastric, bariatric and other benign UGI surgery. Over the course of a 12 month fellowship, approximately 30 major upper GI resections are performed (both open and minimally invasive), in addition to 75-100 bariatric procedures (Sleeve Gastrectomies, Gastric Bypasses and revision cases), and other benign upper GI operations. It is expected that the fellow will be primary operator for most if not all of the procedures by the end of his or her fellowship.

The fellow is integrally involved in perioperative care, clinics, and both UGI and bariatric multi-disciplinary meetings. The fellow will take a major role in acute Upper GI surgery cases as well as acute general surgery on a roster with the wider department. Call is coordinated with the UGI team, and is led on site by the fellow with consultant back up.

As the University of Auckland Department of Surgery is located within Auckland City Hospital, there are ample opportunities to become involved with high quality surgical, clinical and laboratory research, in addition to surgical education. Honorary clinical lecturer positions are available and applications are encouraged.

Austin Hospital

Austin Health – Upper Gastrointestinal and Bariatric Surgery Unit

Overview

The Upper Gastrointestinal and Bariatric Surgery Unit is part of the Division of General Surgery at Austin Health, a quaternary referral centre across two campuses, co-located with the University of Melbourne, Department of Surgery. The unit comprises 9 surgeons (all AANZGOSA members), including 3 university surgeons, who work across 2 campuses – Austin Hospital and the nearby Heidelberg Repatriation Centre. Oesophago-gastric, bariatric and general surgery as well as endoscopies are undertaken across both campuses. The oesophago-gastric and bariatric surgery fellows operate electively across these two campuses. Whilst emergency on-call work is undertaken at Austin Hospital.

 

Members of the Unit

9 consultant surgeons
– A/Prof Ahmad Aly (Head of Unit)

– Dr Tom Sweeney (Deputy Head)

– Dr Kiron Bhatia

– Dr Kiat Lim

– Dr Chek Tog

– Dr Krinal Mori

– Dr Ben Keong

– Dr Alex Craven

– Dr David Liu

2 Senior nurse coordinators: Ms Jarryd Walkley, Ms Linda Watson

1 Research nurse: Ms Amanda Dalyell

1 Oesophago-Gastric Surgery Fellow

1 Bariatric Surgery Fellow

2 General Surgery Registrar (SET trainee)

3 Interns

 

Key clinical activities

The Unit is one of the busiest oesophago-gastric and bariatric surgery units in the state. Per month there are:

– 28 public operating sessions

– 8 endoscopy list

– 4 Upper GI/General Surgery outpatient clinics

– 4 Bariatric Surgery outpatient clinics

– 2 Upper GI Cancer MDT meetings

– 1 Upper GI Benign disorder MDT meeting

– 1 Bariatric Surgery MDT meeting

– 4 Radiology meetings

– 4 Grand rounds

– Additional learning and teaching are undertaken during private operating lists

 

Elective operative experience/Case mix

– Oesophago-gastric resection (thoracoscopic, laparoscopic, open, and transgastric laparoendoscopic)

– Antireflux surgery and hiatus hernia repair

– Achalasia surgery (Heller’s myotomy and Peroral Endoscopic myotomy)

– Bariatric surgery (sleeve gastrectomy, gastric bypass, band removals, revisional surgery)

– Diagnostic and interventional endoscopy (POEM, dilatation, stenting, BOTOX injection, endoscopic mucosal resection, enteric access, foreign body retrieval, clipping, drainage, argon, laser, HALO, endoscopic management of bariatric complications)

– Abdominal wall reconstruction for complex hernias

– Cholecystectomy with trans-cystic choledochoscopy

– Elective General Surgery

– Both fellows participate in all public operating list at Austin and Repatriation Hospitals

– Fellows can expect 150-200 major Upper GI and bariatric cases per year, with more than 50% as the principal operator

– The Fellow will also access some work undertaken by consultant staff in various private hospitals including experience with the Da Vinci Robotic system

 

Emergency commitments

– Emergency General Surgery on-call: 1 in 4 rosters with the other General Surgery Units

– The Fellow takes second call, supporting a general surgical trainee on the on-call roster

 

Outpatient Experience

– 4 Upper GI and General Surgery clinics per month

– 4 Bariatric Surgery clinics per month

– Clinics are attended by consultants, fellows and registrars

– These sessions provide opportunities for assessment and management of individuals with UGI cancers, motility disorders, obesity, metabolic syndrome, and general surgery related pathologies

– The Unit views clinics as opportunities for teaching, discussion and cross-pollination of ideas

 

Perioperative Evaluation

– Preadmission and pre-op anaesthetic assessment clinics are coordinated by our senior nurse coordinators Ms Jarryd Walkley and Ms Linda Watson

– These clinics are attended by the Unit’s interns and the anaesthetic team, and is supported by the Unit’s Fellows

Prehabilitation and enhance recovery for UGI cancer and Bariatric Surgery

– Our unit is developing enhanced prehabilitation and recovery programs for UGI cancers and bariatric surgery

– The oesophago-gastric fellow will play a key role in facilitating these programs for UGI cancer surgery

– The bariatric fellow will play a key role in facilitating these programs for bariatric surgery

Multidisciplinary Interactions

There are regular clinical meetings involving interaction with multidisciplinary specialists. These include:

– Weekly radiology meetings

– Fortnightly UGI cancer multidisciplinary team meeting

– Monthly bariatric surgery multidisciplinary team meeting

– Monthly UGI benign disorder multidisciplinary team meeting

– The Unit views these meetings as highly educational, and all Fellows are expected to facilitate, attend, and contribute to these meetings

Education and Audits

In addition to clinical meetings, there are:

– Monthly Unit research meetings

– Weekly Surgical Forum hosted by the Division of Surgery, Anaesthesia and Procedural Medicine

– Weekly Austin Health Department of Surgery and Therapeutic Interventions audits

– Monthly Austin Precinct, University of Melbourne Department of Surgery Research meetings

– Monthly DOSTalks hosted by The University of Melbourne Department of Surgery

– Annual Unit audit

 

The Unit’s fellows are also expected to participate in teaching SET registrars on a formal basis. This includes:

– ‘Shock and Awe’ pre-fellowship exam tutorials

– Austin Surgical Education Program

– Annual UGI Surgery Saturday Surgical Seminar

 

The Fellows are provided with a workstation, computer, internet and printer access within the Clinical Surgical Unit. Fellows have full access to the onsite Austin Health Medical library which provides an extensive electronic literature database access.

 

Funding

The position is funded by the Austin Hospital. This is a form of a fixed annual salary covering both elective and emergent work. Additional income is generated from conjoint cases in private institutions. This will be on a regular schedule

Research Program

Most consultants within the Upper Gastrointestinal and Bariatric Surgery Unit have higher research degrees and ongoing interests in clinical research. The Unit is also intimately affiliated with the General and Gastrointestinal Surgery (GEGIS) Research Group embedded within the University of Melbourne Department of Surgery. Research from the Unit is regularly published in the field of Oesophago-Gastric and General Surgery. Undertaking research/audit project(s) is highly encouraged. The Fellows are expected to be involved in and submit for publication 1 or more manuscripts during his/her 12 month appointment.

Further information contact

A/Prof Ahmad Aly

aaly@outlook.com.au

Bankstown-Lidcombe Hospital

Upper GI Unit

The Upper GI unit is part of division of general surgery at Bankstown-Lidcombe Hospital. It provides UGI services for South-Western Sydney Local Health District (SWSLHD). This is part of the wider UGI, HPB and Bariatric service across SWSLHD encompassing Liverpool (Liver service) and Campbelltown hospital (Bariatric service).

Bankstown Hospital serves as the Oesophago-gastric and Pancreatic Centre for this LHD. All Oesophagectomies, most Gastrectomies and all Pancreaticoduodenectomies (unless vascular reconstruction is required) are performed in Bankstown Hospital. The unit comprises of four consultants in clinical role with two of them working across both Bankstown and Liverpool campuses.

 

Members of the Team:

Professor Neil Merrett – Professor of Surgery and District Head of UGI

Dr Manjunath Siddaiah-Subramanya – AANZGOSA Supervisor of Training

Dr Amitabha Das – Head of UGI Liverpool Hospital

Dr Yasser Farooque – AANZHPBA Supervisor of Training

Dr Aldenb Lorenzo

2 UGI fellows

• One AANZGOSA
• Second: Could be AANZHPBA or unaccredited

1 SET registrar

2 Interns/ JMOs

 

Elective Operative Experience:

Six full day lists in 4 weeks. (Opportunities exist to attend lists at Liverpool Hospital – 6 full day lists in 4 weeks)

• Oesophago-gastric resections: 20 – 25 cases
  • Approaches include minimally invasive, open and transgastric laparoendoscopic.
• Hiatal surgeries: 20-30 cases
  • Antireflux, hiatal hernias and revisional surgeries
• Motility surgeries (Achalasia cardia): Laparoscopic Heller Myotomy
• Biliopancreatic:
  • Pancreaticoduodenal resection: 20-30
  • Other pancreatic surgeries: 10-15
  • Laparoscopic cholecystectomy and bile duct explorative surgeries
• General surgery: Inguinal and ventral hernias

 

Elective Endoscopic experience:

3 half day lists in 4 weeks

• Diagnostic OGD and colonoscopies: 250-350 procedures
• Therapeutic: Dilatations, insertion of stents and feeding tubes, and polypectomies

Emergency Operative Experience and On-call commitments:

Daily emergency operating list shared with other units depending on case load.

On-call is shared between two fellows with the second fellow (if unaccredited) carrying out on-call duties mostly with general surgery consultants

Frequency: 1 day/ night in a week and 1 weekend in a 4-week cycle

Case mix: All abdominal / general surgery pathologies with some minor trauma cases (All major traumas are transferred to Liverpool Hospital)

Outpatient Clinics:

Private Consulting rooms – As per arrangements with individual consultants.

(As per NSW MOH policy, surgical outpatient clinics are not supported in facilities apart from preadmission clinics and post op follow/ wound clinics).

 

Preadmission clinic – Twice a week. Attended by interns and anaesthetic team. Provides an additional opportunity for registrars and fellows to review the patients.

Post – Operative/ wound clinic – once a week

Clinical Meetings:

Upper GI MDT meeting – weekly. Fellows are expected to facilitate, attend and actively take part in these meetings.

Audit meeting (M&M) – once in 4 weeks.

Department of surgery meeting – once in 4 weeks

Teaching and Research:

University Teaching:

• The unit is affiliated with Western Sydney University (WSU) and University of New South Wales (UNSW). Students from both universities rotate through UGI unit. Fellows are expected to take opportunities to teach students on the wards and in theatre.

General surgery teaching sessions:

• Once in 2 – 4 weeks
• Includes Journal clubs, topic reviews and SET registrar teaching and training for FRACS exam preparation.
• Organised by the fellow from general surgery unit, UGI fellows assist in arranging sub-speciality related talks.

NSW UGI Journal Club:

• 3 in a year. It is recognised and supported by AANZGOSA.
• AANZGOSA fellows are expected to attend and present in at least one of the three journal clubs.

Research:

• Clinical research opportunities exist with the unit’s association with various research organisations and Universities.
• The AANZGOSA fellow is encouraged to participate and publish or present the research outcome in their 12-month training period.

Fellow room and library:

• Fellow room is equipped with computers, printer and laparoscopic training box. This room also serves as a place for breaks.
• On site library provides access to extensive electronic database of journals

 

Unit Contact Information

Dr Manjunath Siddaiah-Subramanya

Manjunath.siddaiahsubramanya@health.nsw.gov.au

Box Hill Hospital

Overview

The HPB/Upper GI Unit at Box Hill Hospital is a combined unit as can be seen from its title.

It has 3 fellows – 1 ANZHPBA, 1 ANZGOSA, 1 Research

The consultants are

• R Cade
• A.S. Hassen
• S. Banting
• A Fox
• S Mackay
• S Ward
• MA Johnson

Operating sessions per week: 7 operating theatre 3 ERCP/OGD

Private operating list: 1 weekly each fellow

Outpatients weekly

Unit meeting, audit, ward round weekly

MDT meeting fortnightlyResearch meeting 7.00am each Tuesday; fellows expected to conduct a research project

Funding by the public hospital

Christchurch Hospital

Christchurch Hospital is a tertiary referral hospital in Christchurch, the biggest population centre on the South Island of New Zealand. A new acute services building has opened with around 400 beds. The general surgical unit has sub-specalised units including, oesophagogastric, hepatobiliary, colorectal and breast. Activities include 24/7 general surgery emergency cover, 24/7 trauma cover and elective operating 5 days a week, including outplaced lists at associated hospitals.

Members of the Unit

Oesophagogastric

• Mr Ross Roberts
• Mr Grant Coulter
• Mr Richard Flint
• Mr Steven Kelly
• Mr Matthew Leeman
• Mr Rukshan Ranjan

HPB

• Mr Saxon Connor
• Mr Todd Hore

They are mixed in teams with other subspecialties across 5 units, each with a SET trainee registrar, a junior registrar, a house officer and a trainee intern.

• Operative Experience /Case mix – The ANZGOSA fellow would expect to get exposure to both benign and malignant oesophagogastric and hepatobiliary disease. There are a significant number of major upper GI cases per year with about 15-20 oeosphagectomies and 20 gastrectomies, 20 Whiples and 20 major liver cases. Benign operative cases include hiatus hernia, reflux, achalasia, complex biliar disease, bariatrics, benign liver and pancreatic lesions. Malignant operations include oesophageal and gastric cancer, prophylactic total gastrectomy for CDH1, malignant pancreatic and liver cancers. There are also endoscopy lists including upper and lower endoscopy with interventional endoscopy as required. The upper GI fellow is also expected to cover some emergency on call as the senior in the hospital one Saturday 8am – 11pm per month and one Friday afternoon per month. They will also at times be expected to cover the consultant call (with a backup consultant normally available as well) – that will be on average one weekday every two weeks.
• Outpatient’s Experience – There are 1-2 outpatient clinics each week that the fellow is expected to attend. This included upper GI and HPB clinics.
• Multidisciplinary Interactions – There is an Upper GI MDT every 2 weeks and a HPB MDT every week. There are department meetings most Fridays and M&M on Friday mornings. There is a cancer coordinator nurse.
• Education and Research Programs – The fellow is expected to participate in teaching the junior staff and medical students in a casual and a formal manner. There is an Upper GI Journal club that meets several times a year.
  The department is interested in research with access to Otago University and electronic databases. -Private hospital commitments There are no
• Private Hospital Commitments – except for outplaced public hospital lists which are usually registrar appropriate lists (gall bladders, hernias etc).
• Funding for the position – The position is funded by the local health district. This is a fixed salary with superannuation (Kiwisaver) or the option of another similar fund.

Further information contact Ross Roberts – email ross.roberts@cdhb.health.nz

Concord hospital

Overview

upper gastrointestinal surgery unit at Concord Hospital is composed of six surgeon’s both with HPB and OG practice focus. The unit covers at least one third of the hospital urgent admissions in surgery. There is a range of complex and urgent surgery above and beyond the elective upper gastrointestinal. There are two fellows within the unit and an advanced trainee and six all day elective operating lists. Fellows are encouraged to gain experience in the private hospital when time permits. The fellow is responsible each subsequent week for total organisation and on call for the unit and on call for appropriate general surgical emergency from home. Both fellow positions are fully funded and long standing. There is accreditation for ANZGOSA and OSSANZ with these positions. This unit is renowned for advanced laparoscopic surgical training. The hospital is a major tertiary referral in situation offering most services.

Operative Experience

During the 12 months within the public hospital alone there would be 80 laparoscopic hiatus hernia operations, 20 gastric cancer, 15 oesophagectomy, 200 sleeve gastrectomy, 20 gastric bypass and general surgery comprising 200 cholecystectomy, bile duct exploration 20, and acute general surgery. Liver resection , pancreatectomy and bile duct carcinoma surgery is performed frequently. There is a strong focus on therapeutic endoscopy of the upper gastrointestinal tract. There is a Department of surgery oesophageal physiology laboratory associated with the unit.

Ancillary Aspects

There is a unit audit meeting each week and a unit x-ray meeting, an MDT where public and private unit patients are discussed, surgical grand rounds weekly, surgical outpatients for preoperative and post-operative evaluation weekly.

Clinical Research

Numerous consultants in the unit publish frequently on bariatric and upper gastrointestinal surgery. It is expected that each fellow will do a clinical research project during the 12 months leading to presentation and publication internationally. There is a long-standing database of antireflux surgery and hiatal hernia surgery, oesophageal cancer, with ongoing ethical approval for maintenance of these database.

Surgery

It is expected that the fellow will be the primary surgeon in the majority of complex cases and is required to assist the advanced trainee with case is suitable to the individuals level of experience and mindful of appropriate numbers being available for training. The senior consultants consider the service to be strongly focused on development of tertiary level surgical skills and clinical experience.

Flinders Medical Centre

OESOPHAGO-GASTRIC UNIT

Overview

The Oesophago-Gastric Unit is part of the General Surgery service at Flinders Medical Centre, a tertiary referral hospital co-located on an integrated campus with the School of Medicine at Flinders University. The unit comprises 7 surgeons (all ANZGOSA members), including 3 university surgeons, who work across 2 campuses – Flinders Medical Centre and the nearby Noarlunga Hospital. Upper GI work is undertaken predominantly at the Flinders Medical Centre site, with some day stay surgery and endoscopy undertaken at Noarlunga Hospital. The Oesophago-Gastric fellow is expected to spend the majority of his/her time each week at the Flinders Medical Centre site.

The Unit is one of the busiest oesophago-gastric units in Australia. It has access to 20 public hospital operating sessions each month, and performs approximately 60 oesophago-gastric resection procedures each year (thoracoscopic, laparoscopic and open), as well as a large volume of antireflux surgery, hiatus hernia repair, surgery for achalasia, pharyngeal pouch procedures, and bariatric surgery. Members of the unit also undertake the majority of the complex interventional upper GI endoscopy work in Southern Adelaide, including endoscopic ultrasound, endoscopic mucosal resection, and oesophageal stenting.

Members of the Unit – Head of unit, surgeons, number of registrars

• 7 consultant surgeons
  – Professor David Watson (academic head)
  – Dr Tim Bright (unit head)
  – Dr Jonathan Shenfine
  – Dr Jacob Chisholm
  – A/Prof Sarah Thompson
  – Dr Lachlan Dandie
  – Dr Susan Gan
• Oesophago-Gastric Fellow
• General Surgical Registrar (SET trainee)
• General Surgical Resident Medical Officers
• 2 Interns
• Oesophago-Gastric Cancer care coordinator (Mr Jeff Bull – Senior Nurse)

Operative Experience/Case Mix

The Fellow participates in all public operating lists at Flinders Medical Centre, and can expect to be involved in 100-150 major upper GI cases, with more than 50% as the principal operator. Significant exposure and training in cancer resectional surgery, antireflux surgery, hiatus hernia repair and bariatric surgery is anticipated. Additional general surgery work will be undertaken as the unit contributes to the general surgery on-call in a 1:4 roster. The Fellow takes second call, supporting a general surgical trainee on the on-call roster. Opportunities are available for upper GI endoscopy training, including complex interventional upper GI endoscopy.

The clinical workload is such that the Fellow participates in all of the major Upper GI surgical cases at Flinders Medical Centre, and can also access some work undertaken by the consultant staff in various private hospitals. The General Surgical Registrar (SET trainee) is also expected to do more than 150 major cases with more than 50% as the principal operator during any 6 month rotation. Two Resident Medical Officers (pre-SET) support the Fellow and SET trainee.

Outpatient Experience

The unit conducts outpatient clinics at Flinders Medical Centre, the Flinders Cancer Centre and at Noarlunga Hospital. The Fellow usually alternates between the Upper GI Cancer Clinic at the onsite Flinders Cancer Centre and a benign outpatient clinic one half day each week. This provides opportunities for assessment and management of individuals with oesophageal and gastric cancer, and also benign disease, including participation in preoperative evaluation and assessment and treatment planning.

Perioperative Evaluation

The unit conducts outpatient clinics at Flinders Medical Centre, the Flinders Cancer Centre and at the Repatriation General Hospital. The Fellow usuallyattends the Upper GI Cancer Clinic at the onsite Flinders Cancer Centreone half day each week. This provides opportunities for assessment and management of individuals with oesophageal and gastric cancer, including participation in preoperative evaluation and assessment and treatment planning.

Multidisciplinary Interactions

There are regular clinical meetings involving interaction with multidisciplinary specialists. These include a dedicated Upper GI radiology meeting held each week, a monthly pathology review meeting, a weekly Statewide Upper GI Cancer multidisciplinary team meeting which engages all public hospital sites in South Australia (surgeons, medical oncologists, radiation oncologists, dietitians, gastroenterologists and radiologists), and a monthly benign disorders multidisciplinary meeting.

Education and Research Programs

The Fellow attends all clinical and teaching meetings within the Unit and the Dept. of Surgery at Flinders Medical Centre. This includes a fortnightly surgical “Grand Round”. The fellow is expected to present at this meeting, and also to manage the units formal annual audit presentation.

The Fellow is provided with a workstation, computer, internet access and printer access within the Department of Surgery. The Fellow has full access to the onsite Flinders University Medical library which provides an extensive electronic literature database access.

Most consultants within the Oesophago-Gastric surgery unit have research higher degrees and ongoing interests in clinical and laboratory-based research. Work from the unit is regularly published in the field of Oesophago-Gastric surgery. Access to a research project(s) is feasible, and completion by publication is supported and encouraged.

The Fellow is expected to be involved in, and submit for publication 1 or more manuscripts during his/her 12 month appointment. An active laboratory research program is integrated with the unit, and opportunities to contribute to this research may also be possible.

Private hospital commitments

As the position is fully funded by the public hospital, and the unit provides a large volume experience with both benign and malignant disease, regular private hospital commitments are not scheduled. However, attendance at private hospital lists to enhance learning and to access less common procedures is facilitated.

Funding for the position

A fulltime salary is paid by Flinders Medical Centre.

Further information contact

Professor David Watson
Flinders University Discipline of Surgery
Room 3D211, Flinders Medical Centre
Bedford Park, South Australia 5042, Australia
Ph: +61 8 8204 6086
Email: david.watson@flinders.edu.au

Fiona Stanley Hospital

Upper GI Unit Summary

Introduction

The Fiona Stanley Hospital (FSH) Upper Gastrointestinal Unit is a high-volume facility offering extensive services for both benign and malignant oesophagogastric conditions. We provide comprehensive training in advanced surgical and endoscopic techniques, and a multidisciplinary, patient-centered approach. Our unit is an excellent choice for fellows seeking an enriching operative and educational experience.

 

Unit Leadership and Team Composition

Head of Unit: Prof. Mohammed Ballal

Upper GI Surgeons: Dr. Sanjeeva Kariyawasam, Dr. Andrew Hardley, Dr. Matthew Henderson

Hepatobiliary Surgeons: Dr. Mayank Bhandari, Dr. Laurence Webber, Dr. Mandivavarira Maundura, Dr Joshua Salim

Three Fellows: Oesophago-Gastric Fellow, Hepatobiliary Fellow, Transplant Fellow

One General Surgical (SET) Registrar

One surgical resident medical officer

Four interns

Nurse Specialists: Two UGI/HPB cancer nurse coordinators

 

Operative Experience

Every year, we undertake a substantial number of surgeries for oesophageal and gastric cancers, giving fellows a chance to build their surgical skills under the guidance of our experienced upper GI surgeons. Fellows have access to eight all-day elective lists per month and can expect to be the primary operator in the major cases. Oesophageal and gastric cancer surgery is performed using minimally invasive techniques with ERAS protocols.

 

We perform both primary and revisional bariatric surgery and are involved in the management of bariatric complications admitted through the Acute Surgical Unit (ASU). The elective bariatric surgical workload primarily consists of revisional procedures, but a small volume of primary procedures are performed each year.

 

Our unit manages benign upper GI conditions, including gastroesophageal reflux, paraesophageal hernias, achalasia, esophageal motility disorders, and gastroparesis (gastric pacing).

 

We also perform endoscopic surgery for Achalasia (POEM), gastroparesis (G-POEM), and benign tumors (POET). Fellows have access to a weekly interventional endoscopy list, providing opportunities to learn dilatation, stenting, endoscopic suturing (Overstitch), and the insertion of feeding tubes.

 

Case Volume

Minimally invasive oesophagectomy: 25/yr

Gastrectomy: 20/yr

Hiatus hernias: 40/yr

Primary and revisional bariatric surgery: 30/yr

Interventional endoscopy: 50/yr

Endoscopic surgery: 10/yr

 

On-Call Responsibilities

Fellows will participate in an on-call general surgery roster at FSH which includes 1:4 weekends and will be attached to the Acute Surgical Unit (ASU). On-call commitments also include 1:7 weekdays.

 

Outpatient Clinics

Fellows are expected to attend weekly outpatient clinics and are involved in the pre and post-operative management of patients.

 

Multi-disciplinary Approach and Collaboration

We conduct Upper GI Multidisciplinary Team (MDT) meetings every two weeks, where fellows are tasked with reviewing and presenting each case. In our unit, there’s a strong collaboration with oncology, gastroenterology, and radiology to deliver integrated, multidisciplinary care.

 

Research and Educational Opportunities

We invite our fellows to participate in a research project as part of their fellowship training. They are required to attend multidisciplinary audit meetings, which are held every quarter. Fellows are expected to present at quarterly tri-hospital journal club meetings. Fellows will be also required to present unit audit data at an annual tri-hospital meeting.

 

Educational material is available through the South Metropolitan Health Service Library providing access to online literature. Fellows also have access to unique teaching material, presentations, and operative videos.

 

Location and Facilities

Fellows will be based at Fiona Stanley Hospital and attend a fortnightly list at Fremantle Hospital. They have access to a shared workroom, computer, and printer facilities.

 

Contact Information

For more details, please contact Dr. Sanjeeva Kariyawasam at sanjeeva.kariyawasam@health.wa.gov.au

John Hunter Hospital

Overview

JHH is the tertiary referral hospital for the Hunter New England Health network. It is located in Newcastle, NSW. The hospital has 800 beds and the population of the area is around 900 000.

Seven surgeons specialise in upper GI surgery, including hepatobiliary and oesophagogastric work. The hospital also has a high emergency workload.

The upper GI surgeons are divided over two teams, each with their own SET registrar and JMO. The fellow can work with all surgeons, but is expected to focus on areas of most interest to them. Team 1 is Stan Chen , Kalpesh Shah, Tim Wright. Team 2 is Jon Gani, Vanessa Wills, Adeeb Majid and Costa Karihaloo.

The position offers a wide range of opportunity which includes(per annum)

• 12-15 oesophageal resections
• 20-25 gastric resections
• 35 pancreatic resections
• 35-40 hepatic resections
• 10 Heller myotomies
• 30-40 hiatal hernia repairs and fundoplications

Many other types of complex upper GI and emergency surgery, including revisional bariatric surgery.
There is some opportunity to experience bariatric surgery in the private system.

Interventional endoscopy is also available with 500 ERCPS per annum, EUS, and weekly lists involving EMR, oesophageal and duodenal stents, PEGs and PEG-Js and dilations.

OUT PATIENTS: Many patients are seen at outpatient clinics providing an excellent opportunity to be involved in total patient care. Regular oesophageal oncology and hepato-pancreatic clinics are held.

ON CALL: The fellowdoes AGSU shifts (from 7pm to 7pm) in lieu of an upper GI consultant once every 2 to 3 weeks on a rotating basis. The nominated consultant provides back up and support.

RESEARCH: It is expected research be undertaken. Current areas being investigated are jejunostomies, preoperative scoring systems and improvement of patient fitness prior to major upper GI resection. Involvement in multicentre trials includes DOCTOR and TOPGEAR

CME AND MEETINGS:

• a weekly audit and CME
• 3 monthly dinner journal club
• 4 monthly oncology dinner
• Weekly GI oncology MDT
• Monthly endoscopy meetings

TEACHING

The fellow is expected to help teach medical students, JMOs and registrars. Formal teaching programmes exist for all these groups. Trial exams to assist fellowship candidates are arranged by fellows and the superintendent.

CONTACT

For further information email Dr Vanessa Wills Vanessa.wills@hnehealth.nsw.gov.au

North Shore Hospital – Auckland

 

Overview

North Shore Hospital in Auckland is a busy tertiary hospital that offers a wide range of services for benign and malignant oesophagogastric and bariatric conditions. North Shore Hospital serves the large and diverse population of Northern and Western Auckland and several districts in the North Island. The fellowship program is primarily based at North Shore Hospital, with occasional sessions at Waitakere Hospital and Southern Cross North Harbour hospital.

The unit has a well-established fellowship program that has been successfully running for over 10 years, attracting fellows from Australia, New Zealand, and the UK. The surgeons in the unit are Mr. Michael Booth and Mr. Jason Robertson. Together, they provide comprehensive support and guidance to the fellows.

The fellow is well supported by:

• A senior registrar (usually SET IV or V)
• A junior unaccredited registrar
• Dedicated house officers

The team also benefits from the presence of:

• Full-time specialist bariatric and oesophagogastric nurses, who play a crucial role in supporting the fellow and the rest of the team and coordinating weekly bariatric and Upper GI MDMs.

The unit places a strong emphasis on research, offering numerous opportunities for fellows to engage in research projects, including randomized controlled trials. Previous fellows have achieved notable recognition, with one winning the AANZGOSA research prize.

Operative Case Mix

• The fellow can expect to participate in two to three full-day operating lists per week at the public hospital, in addition to a regular private assisting lists.
• North Shore Hospital is a high-volume, multidisciplinary bariatric center with over 20 years of experience.
• The unit performs a diverse range of bariatric procedures, including:
• • Roux-en-Y gastric bypass
  • Sleeve gastrectomy
  • Single-anastomosis bypass
  • Laparoscopic duodenal switch
  • SADI-S procedure

• The unit has a significant volume of bariatric surgeries, with an average of 2-4 major cases on the public bariatric operating list per week. The unit strongly favours hand-sewn anastomosis, providing the fellow with ample opportunities to refine their laparoscopic suturing techniques
• The unit also performs a significant volume of revisional bariatric surgery, providing fellows with valuable expertise in managing complex cases and weight regain.

In terms of oesophagogastric surgeries, the unit performs:

• Approximately 20-25 gastrectomies
• Approximately 20 oesophagectomies
• Numerous gastric wedge resections (e.g., for GIST)
• Around 30-40 fundoplications per year

The unit strongly favours:

• Laparoscopic approaches for gastrectomies
• Hybrid approach for oesophagectomies

The fellow can also expect to participate in approximately one full-day equivalent list, or more, per week dedicated to oesophagogastric surgery.

While robotic surgery is not currently offered, the HPB unit has initiated robotic procedures, and plans are in place to adopt robotics into the oesophagogastric service.

The fellow can expect to have approximately one half-day per week dedicated to endoscopy, providing exposure to interventional procedures. Previous fellows have had sufficient case numbers to obtain GESA/Conjoint accreditation.

Regular Clinics

• The fellow will participate in regular outpatient clinics covering a wide range of upper GI conditions and providing continuity of care for patients.
• The fellow will have the opportunity to work in a multidisciplinary upper GI cancer clinic, collaborating with other specialists to provide comprehensive care for patients.

On-Call Responsibilities

The fellow has relatively few general surgery commitments, requiring approximately one weekend in five on-call cover and no mid-week cover. The fellow is given a fortnightly acute general surgery list, generally comprising laparoscopic cholecystectomy and other semi-acute cases.

The fellowship position is fully funded by the local health district. The fellow will receive a fixed salary, which includes superannuation. Additionally, continuing medical education (CME) activities are also funded to support the fellow’s professional development and ongoing learning.

North Shore Hospital is in the affluent and picturesque neighbourhood of Takapuna on Auckland’s North Shore, known for its beautiful beaches and stunning views of Auckland Harbour and Rangitoto Island. The area boasts a high density of restaurants, cafes, and schools, providing a vibrant and convenient lifestyle for fellows.

Nottingham University Hospital (UK)

Overview

The Trent Oesophago-Gastric Unit (TOGU) at Nottingham University Hospitals (NUH) manages patients with benign and malignant OG conditions for Nottinghamshire and surrounding areas. This is performed within a framework of a multi-disciplinary team where all individuals are encouraged to contribute effectively towards patients care. In addition to maintaining these high standards, there is a commitment towards research and the unit is committed to offer access to a clinic trial for every patient and and are currently recruiting in to 7 different clinical trials. Furthermore, TOGU is one of the largest contributors to the Oesophageal cancer clinical and molecular stratification (OCCAMS) study.

TOGU provides specialist tertiary referral OG services to a population of 2 million patients in Nottinghamshire and Lincolnshire. Between 2016 and 2019, TOGU performed 345 OG resections for cancer alone excluding GISTs and pharyngo-laryngo-oesophagectomy (PLOs), making us one of the biggest OG cancer centres in Europe. In the calendar year of 2019, 146 cancer resections were performed. The unit has one MDT meeting per week and a departmental planning meeting weekly. In addition, we have a supra-regional referral pathway for colonic interposition, complex benign OG surgery for hiatus hernias and achalasia, and endoscopic therapies e.g. stenting, endomucosal resections (EMR) and peroral endoscopic myotomy (POEM) and has begun a robotics practice for OG conditions.

Members of the Unit – Head of unit, surgeons, number of registrars…

Surgeons

• Mr NT Welch
• Mr JP Duffy
• Mr SL Parsons
• Mr J Catton
• Ms D Zanotti
• Mr F Yanni
• Mr RS Vohra (Head of Department)

Operative Experience /Case mix

It is anticipated that the post holder will teach more junior members of the team to do basic laparoscopic procedures. The post holder will take part in the delivery of an acute OG on call system under supervision of an experienced consultant surgeon (Mr NT Welch). The work intensity will vary depending on the number of clinics and lists running each week and a flexible approach is necessary in this situation. The successful candidate will be expected to undertake some clinical sessions (clinics, endoscopy and day surgery lists) independently or under supervision by one of the consultants. The successful candidate will be expected to participate in all aspects of the departmental research programme allowing enhancement of their CV prior to application for a substantive position as a consultant in OG surgery.

As well as taking an active role in all activities within the department, the successful candidate will also be expected to have a strong commitment to undergraduate and postgraduate teaching, including the teaching/training of junior registrars and nursing staff in OG related activities. Participation in the ongoing audit and governance activities within the unit is also expected.

Outpatient’s Experience
1 session per week

Multidisciplinary Interactions
1 session per week

Education and Research Programs
1 session per week

Private hospital commitments
None

Funding for the position
Funded by TOGU

Further information contact Mr RS Vohra by email

Prince of Wales Hospital

Upper GI/HPB Unit
ANZHPBA/AANZGOSA Fellowship Prince of Wales Hospital, Randwick, Sydney, Australia.

Overview

Prince of Wales Hospital is a busy tertiary hospital in Sydney’s eastern suburbs with a strong focus on oncological services. The Upper GI unit is a mixed unit encompassing both Hepatobiliary, pancreatic and Oesophagogastric surgery.

There are 4 surgeons on the unit:

• Dr Koroush Haghighi – HPB, Upper GI oncology, transplant and general
• Dr Greg Keogh- Oesphagogastric, HPB and general
• Dr David Links – Oesphagogastric, bariatric and general
• Dr Robert Gandy – HPB, Bariatric/UGI and general

 

The unit is a mixed Oesphagogastric and HPB surgical unit. The focus of this position is training future Upper GI surgeons in a range of procedures to set them up for a career in either HPB, oesphagogastric or mixed upper GI practice. The consultants in the unit have mixed practice with two predominantly oesphagogastric and two predominantly HPB. Of the 4 surgeons 2 have a specialist interest in Bariatrics with the opportunity to participate in these cases (mainly at the co-located private hospital)

There is two fellows (one accredited and one unaccredited) who works for all consultants on the unit. The team also includes a SET trainee registrar, a resident medical officer, and an intern.

Workload

The oesophagogastric workload involves around 20-30 oesophagogastric cancer resections on top of approximately 40 major procedures for benign disease in the public hospital.

The unit HPB workload consists of around 80 pancreatic resections per year including both venous and arterial resection and reconstruction. In addition, around 100 hepatic resections are performed each year, including many trisectionectomies, re-do resections, second and third stage resections, as well as laparoscopic resections, microwave ablations and Nanoknife procedures.

In addition to this the unit also performs a large volume of general surgical procedures.

There are on average 2 endoscopy lists per week comprising both gastroscopy and colonoscopy and interventional endoscopic work including PEG tube insertion and stenting.

There is further opportunity to be involved in approximately 20 renal transplantations performed each year, with a mixture of living related and cadaveric donors, and both adult and paediatric recipients.

The unit is involved in the care of patients across both Prince of Wales Public and Prince of Wales Private Hospitals.

The position includes ‘1 in 2’ fellow level on call for the upper GI team and share cover for general surgery with the second fellow (1 in 6)

Reimbursement

The position currently attracts a level 1 staff specialist award (see NSW state award and confirm with term supervisor prior to term commencement). Income from assisting at operations in the private hospital is in addition.

Operative Experience

The Fellow is involved in all public operating lists, and most private lists throughout the 12-month appointment. This involves on average 4.5 operating days per week, with involvement in between 300-400 major cases across the board. The expectation would be that the fellow would be primary operator in over 50% of these cases, depending on the level of experience of the individual. The fellow is also expected to supervise and train the SET trainee registrar on the team in appropriate surgical cases.

Multidisciplinary Interaction

The unit is also involved in a robust MDT process allowing discussion of these patients and further learning opportunities. This is a weekly meeting to discuss all upper gastrointestinal malignancies involving surgeons, medical oncologists, radiation oncologists, radiologists, pathologists, geneticists and palliative care physicians. There is also a fortnightly liver MDT involving HPB surgeons, hepatologists, radiologists, pathologists and oncologists.

A monthly departmental audit meeting is run with associated journal club. The unit presents all activity data, and morbidity and mortality statistics monthly.

Perioperative Evaluation

The unit runs a weekly public outpatient clinic which has a wide referral base. This encompasses both simple general surgical presentations, and complex upper GI and HPB referrals. Post operative and long term follow up patients also attend this clinic. The clinic provides opportunity for the pre-operative assessment and work up of upper GI/HPB malignancies under the supervision of the involved consultants.

Education and Training

The fellow attends all departmental/unit meetings and MDT’s. They are often involved in presentations at monthly journal club meetings within the hospital. Attendance at quarterly ANZHPBA journal clubs is also encouraged.

Administration facilities are available with access to an office, computer, internet access and printer. The unit has strong ties with the University of NSW Medical Faculty, and opportunities for conjoint appointment are available, with associated clinical teaching roles.

Research opportunities are available within the unit, and the fellow can expect to be involved in presentations at national and international conferences, as well as in publication of projects completed during the fellowship year.

Contact

Should you require further information please feel free to contact the AANZHPBA/AANZGOSA supervisor for the hospital Dr Koroush Haghighi via email at haghighi@hpbsydney.com

Queen Elizabeth Hospital Birmingham (UK)

Overview

Our hospital is a large tertiary service (1000 beds) which currently has 7 Upper GI consultants. Our current consultants include: Mr J Dmitreski, Mr E Griffiths (Upper GI Cancer Lead), Mr J Whiting (EGS Clinical Service Lead), Ms S Puig, Mr B Tan , Ms O Tucker and Mr Raj Nijjar (Upper GI and Sarcoma Clinical Service Lead). All do major OG cancer resections. Currently the unit does about 100 – 120 major OG resections per year. Our unit also does complex benign and revisional surgery (such as anti-reflux, hiatus hernia, achalasia, colonic interposition) and helps in complex reconstructive surgery for Head and Neck cancer such as free jejunal flap reconstruction and gastric pull up. Bariatric surgery is not provided at our hospital, but provided at Heartlands Hospital apart of our hospital network. The hospital is a Level 1 trauma unit and is the main military hospital for repatriated injured service men. The Upper GI unit works closely with the West Midlands Sarcoma Unit and shares junior staff and registrar trainees. The unit contributes to the emergency general on-call rota. We have excellent links with Gastroenterology / Interventional Radiology who provide Endoscopic Ultrasound, Endoscopic Mucosal Resection and HALO ablation service. The unit also has excellent ICU and interventional radiological support. We also have close links with the University of Birmingham, Academic Department of Surgery and the West Midlands Surgical Research Collaborative. Regular therapeutic and diagnostic endoscopy lists are available. The HPB / transplant unit is separate, but the Upper GI unit performs a significant number of laparoscopic cholecystectomy as emergency and elective procedures.

Outpatient’s Experience
There are 3 Upper GI clinic sessions per week

Multidisciplinary Interactions
1 session per week (Wednesday PM) with a zoom link to Heartlands Hospital

Education and Research Programs
The unit has an active research program and we try to get fellows involved in publications and research activities.

Private hospital commitments
Occasional private assisting for complex private cases is possible, but not mandatory.

Funding for the position
Further information contact Mr Ewen Griffiths ewen.griffiths@uhb.nhs.uk by email

Note to applicants

Applicants would have to secure their own GMC registration: http://www.gmc-uk.org/doctors/registration_applications/routeG.asp. Our medical staffing / international fellow office can help with the requirements for this. In addition, UHB can sponsor a Tier 2 visa to provide them with their Right to Work. The sponsorship for this is only valid for 3 months so they need to apply for their visa 3 months before the start.

Contact Details

Department of Upper Gastrointestinal Surgery,

Queen Elizabeth Hospital Birmingham

Mindelsohn Way

Edgbaston, Birmingham

B15 2GW

 

Tel: 0121 627 2000

https://www.uhb.nhs.uk/

Royal Adelaide Hospital (RAH)
Upper GI Surgery Unit

Sir Charles Gairdner Hospital

Overview

Sir Charles Gairdner Hospital is a major public tertiary hospital in Perth, Western Australia.

The Upper GI and Bariatric surgery unit is part of the Department of General Surgery and the Unit has four consultants, two of whom perform around 75 Bariatric Surgery cases a year, covering the full gamut of laparoscopic adjustable gastric band, laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass, including revisional surgery. In addition to surgery for treating benign and malignant diseases of the oesophagus, stomach and duodenum, the Unit also performs 20-30 pancreatic resections a year, including laparoscopic distal pancreatectomies. There are around 10-15 oesophageal resections per year, including minimally invasive oesophagectomies. There is no crossover with the hepatobiliary unit and as the Upper GI ANZGOSA Fellow there is no sharing of cases or workload with any hepatobiliary Fellow.

Western Australia in renowned for providing excellent operative experience for its trainees and our Unit is no exception. It would be anticipated that the Upper GI Fellow would be the primary operator in 50-60% of major cases by the end of the year.

There are regular combined Oncology, Gastroenterology and Radiology MDT meetings once a week and there is a close working relationship between the Unit and these specialties within the Hospital.

Public outpatient bariatric and upper GI clinics are run in the hospital once a week. This provides the opportunity for pre and post-operative evaluation and management of patients without any need to travel off-site.

On the ward, the Upper GI Fellow is expected to be responsible for the day to day management of inpatients as well as being second on call for on-take days. These occur once a week, on a Wednesday, and one in four weekends. The Fellow is well supported with a SET Registrar, an RMO, and two Interns. There is also a 24 hour a day, 7 days a week, dedicated acute surgical unit registrar to deal with calls from the Emergency Department.

Remuneration is 100% funded by the Hospital/Health Department of WA, and is commensurate with all other Fellows within the Hospital, at probably one of the best rates in Australia.

There is secretarial support with 3 secretaries within the Department of General Surgery and there is one day a week set aside for administrative, research and educational activities.

St George Public/Private

UGI and BARIATRIC SURGERY FELLOWSHIP

Overview

St George hospital is a tertiary referral hospital with a drainage population of approximately a million people. There are 4 surgeons on the Unit which covers both campuses, and the Fellow positions are cross campus also.

St Vincent’s Hosptial Melbourne

Overview

The hepatic, pancreatic and biliary (HPB) and upper gastrointestinal (UGI) unit consists of ten surgeons and is accredited for post-fellowship training by both the Australian and New Zealand Hepatic, Pancreatic and Biliary (ANZHPBA) and Gastric and Oesophageal (ANZGOSA) surgical societies. All of our surgeons are committed to excellence in patient care and adhere to a robust audit process. We closely monitor patient outcomes following surgery to ensure that we are achieving the best possible results for our patients and that they are consistent with international best practices. We believe in a patient centred, multidisciplinary approach to patient care and work in close collaboration with the departments of oncology and gastroenterology. Our surgical team is supported by a cancer nurse specialist, waiting list and unit support nurse, research coordinator and research assistant in addition to a large complement of junior medical and allied health staff. Our surgeons also offer specialist support to a number of regional centres including Bendigo, Goulburn Valley and Gippsland.

In addition to its role within the hospital, our surgical team also maintains an active involvement within the Royal Australasian College of Surgeons (RACS). Our surgeons instruct on numerous courses such as ASSET, EMST, Foundation Skills for Surgical Educators and GSA training days and serve of numerous committees, such as the Victorian Regional Committee and the Academic Surgical Committee.

Members of the Unit

• Upper GI Surgeons
  – Mr Michael Hii
  – Dr Salena Ward
  – Dr Mary Ann Johnson
  – Mr Matthew Read
  – Dr Nicole Winter
• Hepatobiliary Surgeons
  – Mr Simon Banting (Head of Unit)
  – Mr Adrian Fox
  – Mr Brett Knowles
  – Mr Dan Crough
  – Mr Luke Bradshaw
• Oesophago-Gastric Fellow
• Hepatobiliary Fellow
• 2 General Surgical Registrar (SET trainee)
• 2 General Surgical Unaccredited Registrars
• 2 General Surgical Resident Medical Officers
• 3 Interns
• Oesophago-Gastric Cancer care coordinator (Nurse)
• Research Team

Operative Experience /Case mix

The HPB & UGI unit perform a range of procedures for the treatment of both benign and malignant conditions affecting the liver, pancreas, bile duct, stomach, oesophagus, spleen and bariatric surgery. The Upper GI Fellow participates in both public operating lists with the Upper GI Surgeons as well as private operative lists. The fellow can expect participation in over 300 major cases, including minimally invasion resectional surgery and public bariatric surgery. Our unit participate in a 1:3 general surgery oncall. This is shared with the hepatobiliary fellow.

Gastric & Oesophageal Surgery

• Hiatus Hernia Repair
• Anti-reflux surgery
• Surgery for Achalasia
• Gastrectomy
• Oesophagectomy
• Bariatric Surgery
• Revisional Bariatric Surgery

Outpatient Experience

Consultant outpatient clinics occur every Monday afternoon after MDT. Registrar clinic occur every Thursday afternoon. Cancer Care Nurse run clinic occur every Thursday morning.

Multidisciplinary Interactions

All meetings occur on Monday

• Weekly research meeting
• Weekly radiology meeting
• Multidisciplinary team meeting
• Unit audit meeting

Multidisciplinary team meetings occur weekly on Monday. This begins with a UpperGI/HPB radiology meeting, the malignant MDT, then benign MDT. This meeting invites surgeons, medical oncologists, radiation oncologists, gastroenterologists, radiologists, pathologists, nursing staff, dietitians and research team. Unit meeting occur weekly following the Monday outpatient clinic.

Education and Research Programs

The Fellow attends all weekly research meeting and combined meetings with Gastroenterology. The fellow is expected to present at this meeting. The fellow is expected and encouraged to be involved in the publication of at least one manuscript during their 12 months appointment.

Private hospital commitments

Private hospital commitments are scheduled to 1-2 sessions a week. Experience in private is mainly bariatrics and hiatal disease.

For further information please contact Mr. Michael Hii – michael.hii@svha.org.au

The Alfred Hospital

Overview

The Alfred Hospital is a 638-bed, tertiary referral centre located in metropolitan Melbourne, approximately 5 km from the CBD. The hospital is adjacent to Faulkner park, vibrant Chapel St as well as St Kilda road boulevard and Albert Park Lake.

An ANZGOSA fellow can expect significant exposure to and training in oesophago-gastric and bariatric surgery which consists of 80-90% of the elective workload. Oesophago-gastric cancer resections are performed with an emphasis on minimally invasive approach, with 40-50 resections annually. Bariatric surgical cases are 300 per year with 45% being revisional. There is a significant exposure to hiatal surgery including a specialised interest in reflux occurring in association with lung transplantation.

Other Unit interests include surgery for median arcuate ligament syndrome and a gastro-intestinal physiology laboratory incorporating high resolution manometry, pH and impedance.

Unit Team

The oesophago-gastric and bariatric Unit consists of 5 consultant surgeons all with subspeciality interests across benign and malignant oesophago-gastric disease as well bariatric surgery. Two surgeons have significant commitments to the University Department of Surgery. Quality audit, clinical and basic science research, incorporating collaborative research, clinical trials and usually 6-8 enrolled research students are considered integral to the Unit.

The clinical team is supported by a senior SET registrar, a junior registrar (HMO 3), two interns and frequently (post FRACS) research fellows who participate in the oncall roster. Other support staff include a data manager and dedicated OG Cancer coordinator nurse. There is close overlap with the University department of surgery, including dedicated research nurses and administrative staff.

The fellow is expected to act as interface between the consultant and junior staff and demonstrate leadership in the management of the more complex OG cases. There is a commitment to training and upskilling the fellow.

There are weekly multidisciplinary oesophago-gastric cancer meetings and close collaborations with medical oncology, radiation oncology and gastroenterology. Busy outpatient clinics (one clinic attended by the fellow) occur twice weekly. Department morbidity and mortality meetings and a Unit meeting are scheduled weekly.

Operative Workload

Opportunities for elective operating sessions average three full days a week. One afternoon per week is available as protected research time There is a fellow endoscopy list every second week. Other sessions are frequently occupied with additional operating lists or urgent cases.

Oncall commitments are off-site once per week overnight (Wednesday) and usually one weekend day (24 hours) every 4 weeks. Consultant back up for oncall is provided and responsibilities are dependent on the experience level of the fellow. Oncall is provided to the trauma service, which is one of the largest in Australasia. Emergency general surgery admissions are only of moderate volume commensurate with the population and state service focus of the hospital.

There is no requirement for regular private assisting, and it would be unusual for a fellow to achieve free time for this to occur regularly.

Contact

For more information, please contact Roxana Ruiz (Personal assistant to Professor Wendy Brown, Director Oesophago-Gastric and Bariatric Unit)

E Roxana.Ruiz@monash.edu

T +61 3 9903 0190

https://www.alfredhealth.org.au/services/hp/oesophago-gastric-and-bariatric-surgery-service/

https://www.monash.edu/medicine/ccs/surgery-alfred/home

Western Hospital

Overview

The Upper GI unit is part of the Division of Surgery based at Western Hospital, Footscray (WHF). The unit alternates between hosting an Oesophago-gastric Fellow one year and an HPB fellow the next and Fellows, irrespective of their primary training program fully participate in the units mixed activity. Currently, there are eight surgeons in the unit, with four surgeons having Oesophago-gastric surgery their main focus and four HPB. The Unit on average manages about sixty patients with Oesophagogastric malignancy a year, performing 25 – 30 gastric resections and 6 – 8 oesophagectomies a year, as well as anti-reflux and achalasia surgery. We also undertake a range of other complex, endoscopic, open and laparoscopic Upper Gastrointestinal procedures. The Fellow will have access to a dedicated endoscopy list. There is access to Bariatric surgery although not in the Public hospital. As the Fellow is attached to all consultants they will be involved in the management and surgery of complex HPB problems. Furthermore, the unit undertakes complex abdominal wall reconstruction.

Anticipated Operative Experience

This is a single fellow job, so the Fellow participates in all public and some private operating lists throughout the twelve months appointment. They can expect to be involved in more than thirty major oesophago-gastric cases. In most of these cases they will be the principal operator. The Fellow also takes first call as a junior consultant for all acute emergencies admitted under the Unit. In addition, in conjunction with the Gastroenterology unit, the Unit provides surgical cover for upper gastrointestinal tract bleeding.

Multidisciplinary Interaction

There are regular clinical meetings involving interaction with multidisciplinary specialists. These include a weekly unit audit meeting (surgeons, junior medical staff, and nursing staff), a weekly MDT meeting (surgeons, medical oncologists, radiation oncologists, radiologists), a weekly radiology meeting, a weekly M&M meeting and a three-monthly unit “Academic Day” (Journal Club). These meetings involve structured presentations of selected cases and the Fellow is expected to participate and present on a regular basis.

Perioperative Evaluation

There is a weekly public outpatient clinic at WHF. This will involve participation in preoperative evaluation and assessment and treatment planning. Participation in these outpatient activities occurs for one half day each week.

Training Program

The Fellow attends all clinical and teaching meetings within the Division of Surgery.

Other Members of the Upper GI Surgical Team

• Accredited General Surgical Registrar
• Unaccredited General Surgical Registrar
• Intern x 3

The clinical workload of the Unit is such that the Fellow will participate in all of the major Upper GI surgical cases at WHF and assist where practical in the private hospitals. The Fellow has a regular general surgical list at the Williamstown Hospital. The General Surgical Registrar only works at WHF but can still expect to do more than 100 major cases and in 30% of these cases he/she will be the principal operator during any six months rotation.

Funding for this Position

This position is funded through Western Health at the appropriate pay scale for Fellows, extra income from private assisting is available where there is no clash with Western commitments.

Education Facilities Available for the Fellow

The Fellow is provided with a workstation, computer, internet access and a printer within the WHF Department of Surgery. The Fellow also has basic administrative support and is allocated a defined amount of time each week to undertake clinical or laboratory-based research. The Fellow has full access to the WHF library as well as to the RACS Library, which provides an extensive electronic literature database access.

Director of the Oesophago-Gastric Program/Mentors

The Current Director of the Fellowship Program is Mr. Rod Jacobs a member of the AANZGOSA. The Upper GI consultants present and participate in local, national and international surgical meetings. There is an esophagogastric database within the unit that is run by one of the consultants and the OG Fellow is able to use this for clinical research. The Fellow’s progress will be carefully monitored and formally evaluated during the appointment. There will be 3 monthly feedback sessions with the program director.

Support from the Institution

Western Hospital, Footscray is part of Western Health, with campuses at Footscray, Sunshine and Williamstown. Western Health are fully supportive of the Fellow.

Research Training

The Fellow can be involved in clinical research and submit for publication manuscripts during his/her twelve-month appointment. All the unit surgeons support and encourage clinical research and there is even an opportunity for laboratory-based research given the strong relationships between the Upper GI Surgical Unit and the University of Melbourne, Department of Surgery based at Sunshine Hospital.