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