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Royal Adelaide Hospital(RAH)
Hepato-Pancreato- Biliary (HPB) Surgery Unit

Royal Adelaide Hospital(RAH)

The RAH is South Australia’s largest accredited teaching hospital. It has well-advanced training in a range of specialty areas. The General Surgical Service is comprised  of  sub-specialised  HPB, Colorectal, Upper  Gastointestinal  and  Breast/ Endocrine Surgery Units. All  units support  a  General Acute  Surgery Unit (ASU).

Centre for Digestive Diseases (CDD):

The gastrointestinal General Surgical units work closely with the Gastroenterology and Clinical  Hepatology Units, so forming a Centre for Digestive Diseases. This  facilitates combined endoscopic training , clinical research projects and clinical meetings.

Consultant staff:

The consultant surgeons currently attached to the HPB Surgery Unit include : Chris Worthley (Head of Unit), Paul Dolan, CP Tan  and Eu Ling Neo.  John Chen and Mark Brooke-Smith  are  seconded  to the RAH from the Flinders Medical Centre (FMC).

Unit activities:

Clinically, the HPB Surgery Unit provides Acute Inpatient and Outpatient services. There are two all-day operating lists and a weekly surgical ERCP list. The gastroenterologists provide a further 3 ERCP lists each week, including an endoscopic ultrasound service. Each  General Sugery  unit  is  rostered  for ASU duty an average of 1 day in 4. There is a dedicated ASU Operating  Theatre  available  daily from 0900-1600 hours.  The HPB Surgery Fellow  has a weekly outpatient clinic which includes mainly patients with HPB problems. Patients with undifferentiated General Surgical problems are spread across the General Surgical service.

HPB Surgery Unit Activity:

In 2012 the Unit  performed  370 major operations. These  included  17 pancreatic resections (15 Whipple’s), 10 other pancreatic procedures, 19 major  liver resections and  8  other hepatic  procedures. There were 216 cholecystectomies and 16  bile duct operations.
HPB consultative support  is  provided  to the other General Surgical units.
There is an option to assist with  HPB  surgical  procedures  in the private sector, when not committed to the RAH.

Surgical  ERCP service:

Approximately 200 inpatients per year on the HPB Surgery  Unit  undergo ERCP-related procedures along with a similar number of outpatients. The HPB Fellow is able to attend  the weekly  surgical  ERCP  list.  (They will not however be able to become accredited in ERCP  during a 1 year  attachment  to  the Unit.) The Fellow should be accredited in upper gastrointestinal  endoscopy  by the Conjoint Committee  of the RACS and GESA prior to  obtaining  hands-on ERCP training.

Major Trauma:

The RAH is a Level 1 Major Trauma   hospital which includes a commensurate volume of patients with major HPB Trauma.

MDT’s and Surgical Audit:

The HPB Surgery Unit  runs  a weekly  MDT  meeting  and also participates in a fortnightly Hepatoma  MDT and weekly Colorectal MDT. The HPB Unit has a web-based semi-automated  Surgical Audit  database  which can also be a  useful tool  for clinical research projects and presentations.

Liver Transplantation:

Several surgeons on the unit are affiliated with the SA Liver Transplantation Unit. Livers are implanted at FMC, but many donor livers are harvested at the RAH and many potential liver transplant  patients  are sourced from the RAH patient population.
 
Tutorials:

There is a  quarterly  South  Australian ANZHPB Trainee journal club and also a quarterly journal club  at  the HPB/Upper GI/Bariatric Surgery  dinner meetings.

Trainee Medical Officer staffing  on HPB Surgery Unit:

HPB Fellow - 1 ANZHPBA post-fellowship training position (1 year attachment).
Accredited SET 3-5 General Surgical trainee – 1 position.
Interns/ RMO’s – 2-3 positions (variable).

 

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