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Nepean Upper GI/HPB Unit

ANZHPBA Fellowship Nepean Hospital, Kingswood, Sydney, Australia.

Overview:

Nepean Hospital is a busy tertiary hospital in Penrith in Sydney's western suburbs. The Upper GI unit is a mixed unit encompassing both HPB surgery, upper GI/oesophago-gastric surgery, ERCP and general surgery. There are 5 surgeons on the unit. There is one fellow who works for all consultants on the unit.

One surgeon has a predominantly HPB workload, one hepatic surgeon, two with a mixed practice of both oesophago-gastric and pancreatic surgery, and the 5th who has a predominantly oesophago-gastric and bariatric focus. All surgeons on the unit also have a mix of general surgery in their practice and contribute to the Acute Surgical Unit roster. The team also includes at SET trainee registrar, an unaccredited registrar and 2 junior medical officers.

Workload

In terms of HPB workload the unit performs approximately 15-20 pancreatic resections per year. The unit also performs approximately 40 hepatic resections per year, including many trisectionectomies, re-do resections, second and third stage resections, as well as laparoscopic resections, microwave ablations and complex benign biliary surgery.

The unit also provides the ERCP service for the hospital performing around 300 ERCPs per year combining elective and emergency procedures in addition to other therapeutic endoscopy including oesopgageal and duodenal stents. The trainee would be encouraged to undertake ERCP training while attached to the unit.

The oesophago-gastric workload involves approximately 10-15 oesophago-gastric resections on top of approximately 40 major procedures for benign disease.

The trainee is also expected to contribute to the fellow on call roster for acute surgery, and be involved in acute surgical emergencies admitted under the unit, or requiring sub-speciality involvement.

Operative Experience

The Fellow will be involved in all public operating lists throughout the 12 month appointment. This involves on average 3 full operating days per week, plus 2 half day ERCP lists and additional endoscopy lists. The expectation is that the fellow would be primary operator in around 50% of major resection 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 GI malignancies involving the 5 Upper GI surgeons, medical oncologists, radiation oncologists, radiologists, nuclear medicine physicians and palliative care physicians.

There is a monthly departmental audit/M&M meeting which the trainee will be involved in, with the assistance of the SET trainee. The unit also presents all activity data, and morbidity and mortality statistics on a quarterly basis at a unit journal club, where topical articles are also reviewed and discussed.

Education and Training

The fellow attends all departmental and unit meetings, and may be involved in presentations at monthly journal club meetings within the hospital. Attendance and presentation at the 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 Sydney Medical School, and opportunities for conjoint appointment are available, with associated clinical teaching roles.

Research opportunities are available within the unit. The unit has strong links with Sydney Medical School and the Whiteley-Martin Research Centre, and the fellow can expect to be involved in research projects within the unit. The opportunity to supervise junior trainees in their research projects is also encouraged.

Contact

Should you require further information please feel free to contact the ANZHPBA supervisor for the hospital Dr Andrew Ling via email at andrew.ling@health.nsw.gov.au.

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