Training Regulations Handbook
Curriculum & Syllabus
Applicant Guidelines
Padbury Trophy

APPLICATIONS ARE NOW CLOSED

If you have applied this current year successful applicants will need to be available for interviews on Saturday June 18th

Interviews will be conducted in person in Melbourne (details will be given to those invited to interview).

Applications for 2024 will open in February 2023.

For further information please contact the Executive Officer at info@anzhpba.com

Hospital Units

Hospital Units Seeking Accreditation

Hospital Units can seek accreditation at any stage. Applications must address all required hospital criteria as detailed in the “ANZHPBA Fellowship in HPB Surgery” document. Please post your application to:

Chair,
ANZHPBA Training Committee
24 King William Street,
Kent Town SA 5067

ANZHPBA Accredited Hospital Units

 

 

 

 

 

 

 

 

Auckland City Hospital HPB Fellowship

Overview

Auckland City Hospital is the largest hospital in New Zealand with about 750 beds.  A full range of tertiary HPB activities is provided, with referrals from around NZ. Liver transplantation is a separate but interlinked service. Inpatient facilities and some clinical activities are shared with the Upper GI service, which is separately staffed. Paediatric HPB work is carried out alongside the Paediatric Surgeons. The HPB service works closely with oncology, radiology including interventional, trauma, intensive care, and endoscopy, and shares some clinical work with Middlemore Hospital in South Auckland. Referral practices in complex pancreatitis and liver trauma contribute to the unit’s scope.

Team structure: 6 consultants, 1 Fellow (one year position), 1 SET trainee, 2 House Officers, 1 clinical nurse specialist.

Team

Peter Johnston, HPB, Upper GI and Transplant Surgeon, Unit Head

Professor John McCall, HPB and Transplant Surgeon

Professor John Windsor, HPB Surgeon

Adam Bartlett, HPB Surgeon

Peter Carr-Boyd, HPB and Transplant Surgeon

Louise Barbier, HPB and Transplant Surgeon

 

Clinical activities

MDMs: HBP/Upper GI, HCC, NET (all weekly)

Operating lists: 12 full days/4 weeks

Clinics: 3-4 half days/week

On-call commitments: the Fellow participates in the General Surgery on call roster, supported by a junior registrar or SET trainee, and is welcome to contribute to HPB emergencies and liver transplant work as time allows.

Case load: liver resections and operative ablations, 90/year; pancreas surgery 60/year; complex biliary 25/year. The liver transplant service carries out 50-60 cases/year (adult + paediatric) with a similar number of multiorgan donor procedures.

Some interchange with the liver transplant Fellows can be arranged, to give the HPB Fellow access to HCC cases, portosystemic shunt surgery, transplant and donor procedures.

Research facilities and opportunities exist at the adjacent University of Auckland campus.

Contact Details

For further information, please contact the unit lead, Peter Johnston pjohnston@adhb.govt.nz

 

 

 

 

 

 

Hepato-Pancreato-Biliary and Transplant Unit
Austin Hospital Victoria

The Austin Hospital is a tertiary referral centre in Heidelberg Victoria with approximately 500 beds. The unit includes the Victorian Liver Transplant Unit. Staffing includes seven surgeons, two fellows, 3 registrars and 3 interns.

Activities of the unit comprise elective operating sessions five days per week, HPB and general surgery emergency on call and on call for organ retrieval and liver transplantation. There is also a surgical ERCP list per week available for fellowship training.

The approximate annual numbers include: 60 adult and paediatric liver transplantation cases; 80 multi organ retrievals, 40 liver resections, 30 pancreas resections and 150 ERCP’s performed within the unit. Opportunities exist for both clinical and basic science research enrolment for higher degrees.

Number of Fellows: 1/year. One year fellowship.

Minimum requirements: FRACS or equivalent. Post accredited by ANZHPBA for post-fellowship training in HPB Surgery.

Unit structure: 6 supervising HPB surgeons – Mark Brooke-Smith, Janina Kaczymarczyk, John Chen, Eu Ling Neo, Lilian Kow, Susan Gan. Rob Padbury (Divisional Director)

Unit Activity: 2-3 operating sessions spread over a week; One half-day outpatient session per week. Involvement with Private HPB cases in adjacent and nearby hospitals. Also involved with liver transplantation activity. 5 of the consultants perform and supervise ERCP. 3 Surgeons are also employed at the Royal Adelaide Hospital.

On-call: Acute surgery unit admitting all general surgery patients. The unit is on call one in four, with the fellow covering the registrar half of the time. There is flexibility with the other units fellows and registrars involved in the acute care of the HPB patients and vice versa.

Team structure: One fellow. One advanced training registrar. One service registrar. One resident medical officer. Three interns.

Operative case-load in 12 month:Liver resections: 20-30 per yearPancreatic operations: 25-40 per yearLiver Transplantation: 25-30 per year

Areas of interest: Major liver and pancreatic caseload. Laparoscopic liver resections. Laparoscopic pancreatic procedures. Percutaneous pancreatic necrosectomy. Liver Transplantation. ERCP.

Employment arrangement: Employed by Southern Area Health Service (SA Health) as 1 year temporary full-time employee. Benefits include superannuation, payment for overtime, paid recreational and professional development leave.

TeachingIn addition to weekly clinical meetings there are bi-monthly journal club meetings discussing relevant and topical clinical issues.

Adelaide: Adelaide is the capital of South Australia and has a population of around 1.8 million. The city is easy to navigate and there are plentiful good restaurants in the city and suburbs. The world class wine districts of the Barossa Valley, McClaren Vale, the Clare Valley and the Coonawarra are within easy driving distance. The Flinders Medical Centre is a quaternary referral hospital associated with Flinders University with 580 beds, and the adjacent Flinders Private hospital has 130 beds. Extensive recent redevelopment is now complete with new theatre suites and day surgery facilities, a new cancer centre and research facilities.

Further information contacts: Mark Brooke-Smith (Head of Unit and ANZHPBA supervisor), Rob Padbury (Divisional director and past president of ANZHPBA) on 08 8204 4253 or via gisurgerysecretary@health.sa.gov.au

 

 

 

 

 

 

 

 

MONASH MEDICAL CENTRE: DEPARTMENT OF UPPER GI AND HPB SURGERY

Overview:

Monash Health is Victoria’s largest healthcare service, we are a multi site service with more than 2000 beds. The HPB unit is located at Clayton which has 640 beds and consists of three streams – HPB service, OG service and an Acute Surgical Service. We perform a wide range of complex HPB operations as well as bariatric procedures. We run a HPB Molecular Tumour Board once a month for precision medical treatment of HPB cancers. We have weekly HPB and UGI Cancer MDT’s, fortnightly Hepatoma MDT and fortnightly HPB Radiology meetings.

Number of Fellows: 1/year. 12 month position.

Minimum requirements: FRACS or equivalent. Post accredited by ANZHPBA for post-fellowship training in HPB Surgery.

Team Structure: There are 13 supervising consultants.
HPB- Roger Berry, Dan Croagh, Mark Cullinan, Dean Spillias, Mithra Sritharan, Travis Ackermann
UGI- Paul Cashin, Liang Low, John Gribbin, Zdenek Dubrava, Hamish Shilton, Dan Foley
There is one registrar and 2 interns on each of the HPB and UGI streams and 3 registrars, 1 resident and 2 interns on the Acute Surgical service.
The unit is supported by a surgical liaison nurse, quality improvement and data manager and cancer care nurse.

Unit Activity: The unit is very busy providing both elective and acute surgical inpatient services plus outpatient services. There are 8-9 UGI/HPB theatre lists per week plus a dedicated afternoon ASU Operating Theatre 6 days a week. The fellow also regularly assists with HPB  surgical  procedures  in the private sector.

On-call: The fellow participates in the consultant on call roster covering 1 weekday per week and 1:7 weekends.

Operative case-load: Over the 12 month attachment the expected caseload would be
• Pancreatic resections- 40
• Liver resections- 50
• Complex biliary procedures- 20

Endoscopy: Training in endoscopy including ERCP and EUS is potentially available. 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. Approximate case-load per year performed by surgical endoscopists is
ERCP 150
EUS 250

Teaching: Key teaching activities include a weekly multidisciplinary cancer meeting, weekly clinical meeting, fortnightly HPB radiology meeting, weekly gastroenterology meeting and monthly journal club.

Research: Extensive research opportunities exist in both clinical and basic sciences. There are also opportunities at the completion of the fellowship year for research leading to higher degrees for those with an interest. We currently have 1-2 PHD students on the unit as well Medical Science and Masters students.

Training not offered: No transplant experience.

Further information contact: Mr Roger Berry ph (03) 85730001 email roger.berry@surgicalconsulting.com.au

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 6 surgeons on the unit. There is one fellow who works for all consultants on the unit.
Two surgeons have a predominantly HPB workload, one hepatic surgeon, two with a mixed practice of both oesophago-gastric and pancreatic surgery, and the 6th 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 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.

 

North Shore Hospital

Overview:
North Shore Hospital is a tertiary referral and university-affiliated teaching hospital with 663 beds located in Takapuna, in the northern part of Auckland city. The HPB/Upper GI unit provides care for a population of 800,000 and outreach services to Whangarei Hospital, 100 miles to the north. Patients are also referred from regional hospitals around the country for management of complex HPB/ UGI problems. The ethos of the unit is to treat the incoming fellow as the 5th consultant on the service.

Number of Fellows: 1/year. Fully funded 12 month position with employment benefits including a generous CPD allowance
Minimum requirements: FRACS or equivalent. Post accredited by ANZHPBA for post-fellowship training in HPB Surgery.
Team Structure: There are 4 supervising consultants. Jonathan Koea, Universe Leung, Michael Rodgers and Sanket Srinivasa. There are 2 registrars, 4 house officers and 1 intern on the unit, as well as 1.4 clinical nurse specialists.
Unit Activity: The unit provides both elective and acute surgical inpatient services plus outpatient services.

Operating lists: 7 half day lists /week

Outpatient clinics: 2 half day clinics per week

Multidisciplinary meetings: 2 meetings per week with access to national HCC and NET MDM weekly. As the year progresses, the Fellow is expected to present his/ her own cases at these meetings and be a participating colleague in the management of HPB diseases.

On-call: The fellow participates in the consultant acute general and trauma surgery on call roster covering 1 Friday per month. The Fellow is supported by a senior and junior registrar as well as house officers. A nominated consultant is also available for support if required. The expectation is that the Fellow function as an acute General Surgeon for this day rather than at registrar level.

During normal working hours in the weekday, the Fellow is contacted with new inpatient HPB referrals.

The fellow is not expected to provide secondary on call for the consultants on the service.

Operative case-load: The annual HPB caseload is 40 pancreatic resections, 70 hepatic resections and 30 complex biliary procedures. The unit has a strong UGI and surgical oncology focus and the fellow will also learn oesophagectomy/ gastrectomy and sarcoma surgery. The management of benign disease is also emphasised with the fellow having the opportunity to lead the difficult cholecystectomy service, endoscopic management of pancreatitis and common bile duct exploration. The Friday on call also provides the fellow with acute general surgery experience (e.g. colectomy, strangulated hernia). The overall caseload is 300 major HPB/upper GI cases over the 12 months. For elective HPB cases, fellows are given increasing autonomy over the year and leave being able to perform open pancreatectomy and hepatectomy independently. The unit has a strong focus on minimally invasive surgery (incl MIS whipple and major hepatectomy) and advanced laparoscopy and as well as formal teaching in intraoperative diagnostic and interventional ultrasound (e.g. laparoscopic ablations). Robotic surgical training and experience is available in an adjacent private facility.

Endoscopy: North Shore Hospital has a large endoscopy department. Exposure and training is available in colonoscopy, gastroduodenoscopy, ERCP and endoscopic ultrasound as well as advanced interventions (e.g. Axios stent placement)

Teaching: Regular teaching activities include a weekly morbidity and mortality meeting, weekly multidisciplinary cancer meeting, weekly clinical meeting, monthly journal club and weekly teaching on Friday mornings. The unit is proud of a constructive teaching culture in the operating theatre.

Research: The unit has a strong clinical research, outcomes research and indigenous health focus. The unit has published 62 papers in the last 5 years and has significant international collaborations in the areas of neuroendocrine tumours, indigenous health and surgical outcomes. Research is supported by a dedicated research nurse and opportunities exist for study towards higher degrees (MD; PhD) with the University of Auckland.

Further information contact: Prof Jonathan Koea ph (64) 21 401 901, email jonathan.koea@waitematadhb.govt.nz

Prince of Wales Hospital Upper GI/HPB Unit
ANZHPBA/ANZGOSA 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 cancer services. The Upper GI unit is a mixed unit encompassing both HPB surgery and upper GI/oesophago-gastric surgery. There are 4 surgeons on the unit. There is one fellow who works for all consultants on the unit.
One surgeon has a predominantly HPB/transplant workload, two with a mixed practice of both oesophago-gastric and HPB surgery, and the 4th who has a predominantly oesophago-gastric and bariatric focus.
The team also includes at SET trainee registrar, a resident medical officer, and an intern.

Workload
In terms of HPB workload the unit performs approximately 50 pancreatic resections per year including both venous and arterial resection and reconstruction. The unit also performs approximately 80 hepatic resections per year, including many trisectionectomies, re-do resections, second and third stage resections, as well as laparoscopic resections and microwave ablations.
The oesophago-gastric workload involves approximately 10-15 oesophago-gastric resections on top of approximately 40 major procedures for benign disease.
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 in both Prince of Wales Public and Prince of Wales Private Hospitals.

Operative Experience
The Fellow is involved in all public operating lists, and most private lists throughout the 12 month appointment. This involves on average 5 full operating days per week, with involvement in between 200-300 major cases. The expectation would be that the fellow would be primary operator in around 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.
The fellow is also expected to take second call on behalf of the unit consultants for weekend call shifts, and be involved in acute surgical emergencies admitted under the unit.

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 gastrointestinal malignancies involving Upper GI and colorectal surgical specialists, medical oncologists, radiation oncologists, radiologists, pathologists and palliative care physicians.
There is also a monthly departmental audit meeting with associated journal club. The unit presents all activity data, and morbidity and mortality statistics on a bi-monthly basis.

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 and unit meetings, and may be 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 ANZHPBA/ANZGOSA supervisor for the hospital Dr Koroush Haghighi via email at surgeon@koroushhaghighi.com.au

 

 

 

 

 

 

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.

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).

Royal Brisbane HPB Fellowship

Number of Fellows: 1/year. One year fellowship.

Minimum requirements: FRACS or equivalent. Post accredited by ANZHPBA for post-fellowship training in HPB Surgery.

Unit structure: 4 supervising surgeons – Richard Bryant, George Hopkins, Les Nathanson, Nick O’Rourke.

Unit Activity: Average of 5.25 half-day operating sessions spread over a 4-week cycle; Average of 2 half-day outpatient sessions per week.

On-call: Acute surgery unit admitting all general surgery patients. One 24 hour period/week and one weekend (48 hours)/month. Often required to assist other surgical teams with Upper GI/HPB emergencies during working hours, especially difficult cholecystectomy and bile duct stones.

Team structure: One fellows. Two registrars – 1 Senior (SET 5) and one junior (SET 1). 3-4 interns/residents.

Operative case-load in 12 month: 400 major cases (96% as primary operator or supervisor).
Liver resections: 35
Open liver resection: 20
Laparoscopic liver resection: 15
Pancreatic operations: 20
Pancreaticoduodenectomy: 10
Other pancreatic operations (distal pancreatectomy, necrosectomy): 10
Complex biliary cases: 10

Areas of interest: Laparoscopic surgery exposure particularly laparoscopic liver and pancreas resection, laparoscopic hiatus hernia surgery, laparoscopic bile duct surgery and revisional bariatric surgery (including Roux-en-Y gastric bypass).

Training not offered: No transplant experience. No ERCP experience.

Employment arrangement: Employed by Queensland health as 1 year temporary full-time employee. Benefits include superannuation, payment for overtime, paid recreational and professional development leave.

Brisbane: Brisbane is the capital of Queensland and the third largest city in Australia with a population of around 2 million. The city is cosmopolitan, multi-cultural and sophisticated. To the North and South are pristine beaches. The Royal Brisbane hospital has 950 beds and serves as a tertiary referral for areas as far as Cairns (1800km North). The Hospital is recently renovated with modern laparoscopic operating suites and a fantastic working environment.

Further information contacts: Nick O’Rourke (Supervising surgeon) nickoadmin@wesley.com.au; Jerome Laurence (Fellow 2012) jm_laurence@yahoo.co.uk).

Royal Melbourne Hospital

Overview

The Royal Melbourne Hospital and Peter MacCallum Cancer Centre are co-located in the Parkville Precinct, situated on the northern edge of the Melbourne CBD. The HPB Fellow works equally across both hospitals in the precinct. The two hospital share services such as the ICU, Emergency Department, and some endoscopy services (e.g., ERCP, EUS).

 

Number of fellows: 1 HPB Fellow, 1 UGI Fellow

 

Team structure

Royal Melbourne Hospital (RMH)
Dr Benjamin Loveday – HPB Surgeon, Head of Unit
Professor Benjamin Thomson – HPB Surgeon, Head of Department (General Surgery)

Dr Brett Knowles – HPB Surgeon
Dr Mary Ann Johnson – UGI Surgeon
Dr Daniel Foley – UGI Surgeon
Dr Nicole Winter – UGI Surgeon
Dr Rose Shakerian – Trauma and General Surgeon

Dr Katherine Martine – Trauma and General Surgeon
Senior SET Trainee
Interns x 2
Surgical Liaison Nurse x 1

 

Peter MacCallum Cancer Centre (PMCC)
Professor Benjamin Thomson – HPB Surgeon, Head of Upper GI Tumour Stream

Dr Brett Knowles – HPB Surgeon
Dr Benjamin Loveday – HPB Surgeon
Associate Professor Cuong Duong – UGI Surgeon
Dr John Spillane – UGI Surgeon
Senior SET Trainee
HMO x 1
Nurse Specialists x 2
Surgical Liaison Nurse x1
Patient Navigator x 1

 

Experience 

The HPB/UGI service at RMH/PMCC is mature, with all surgeons focussed either on HPB or UGI pathology. Fellows should expect to gain experience with open and laparoscopic pancreas surgery, open and laparoscopic liver resections, bile duct exploration, multivisceral resections involving the HPB tract, and ERCP. Fellows will gain exposure to the full range of HPB surgical oncology conditions, including borderline resectable and locally advanced pancreatic cancer (with vascular reconstruction), neuroendocrine tumours, HCC, cholangiocarcinoma, and liver metastases. We work closely with other specialties in our tumour stream to provide multimodal treatments for our patients. This includes access to endoscopic ultrasound, peptide receptor radionuclide therapy, selective internal radiotherapy and radioablation, stereotactic body radiotherapy, and percutaneous microwave ablation. We frequently collaborate with surgeons from other specialties for complex cases, such as combined liver and colon resections / cytoreductive surgery for metastatic colon cancer, and multivisceral resections for abdominal sarcomas. RMH is a Level 1 Trauma Centre, with one of the highest trauma workloads in Australia. The HPB/UGI Unit provides specialty support to the trauma service, which includes management of HPB/UGI injuries and complications. We work closely with the Emergency General Surgery Unit to provide specialty support for acute patients with HPB/UGI pathology. RMH has a Renal Transplant Unit, and there are potential opportunities for the HPB fellow to assist with organ retrievals from deceased donors.

 

Elective Operative Case Volume 

Liver: 60

Pancreas: 30

Biliary: 100

Spleen: 10

 

After Hours Cover 

The HPB/UGI service across RMH/PMCC provides on call and consultative services 24/7. The HPB fellow is on a 1:7 Emergency General Surgery roster as the “junior consultant” after hours, with senior consultant back up.

 

Research 

The surgeons in our HPB/UGI are dedicated to progressing meaningful research. In the last 5 years the unit consultants have produced >130 publications. Our unit collaborates with other centres in research projects and is involved in clinical trials. There are opportunities to complete a higher research degree within the unit. There is an expectation that our fellows participate in research and have outputs each year.

 

Further Information

Contact Dr Benjamin Loveday – Benjamin.Loveday@mh.org.au or Ben.Loveday@petermac.org

Royal North Shore Hospital NSW

The HPB Unit is part of the Upper GI Surgery Unit at Royal North Shore Hospital.  The unit has three surgeons with a predominant focus on HPB surgery. Approximately 60 liver resections and >100 pancreatic resections are performed annually.  This is a busy clinical rotation with a particular focus on major liver and pancreatic surgery.  The Unit undertakes a range of complex open and laparoscopic HPB and General Surgical procedures. The HPB Fellow is attached to three HPB consultants only. There is a separate Oesophago-Gastric Fellow working with two Upper GI surgeons whose main focus is Oesophago-Gastric and Obesity Surgery. In addition, there are two full time HPB research fellows, one of who oversees the research activities of the unit. The HPB Unit looks after patients in Royal North Shore Hospital (public hospital) and North Shore Private Hospital.

Anticipated Operative Experience

The Fellow participates in all public hospital and many private hospital operating lists throughout the 12 month appointment.  They can expect to be involved in more than 200 major HPB cases during the rotation including exposure to a large number of liver and pancreatic resections.  In at least 50% of cases the Fellow will be the principal operator.  The HPB Fellow also takes second call as a junior consultant for all acute gastrointestinal emergencies admitted under the HPB Unit.  At the end of the year, the Fellow would have had enough exposure to complex HPB surgery to confidently perform those procedures independently.

Multidisciplinary Interaction

There are regular clinical meetings involving interaction with multidisciplinary specialists.  These include a dedicated HPB radiology meeting each week, a weekly gastroenterology meeting (gastroenterologists, surgeons and radiologists), a weekly unit audit meeting (surgeons, junior medical staff, and nursing staff), a second weekly HPB MDT meeting (surgeons, medical oncologists, radiation oncologists, radiologists) and a monthly surgical Grand Rounds (sub-speciality surgical groups, medical students, junior medical staff, and nursing staff). These meetings involve structured presentations of selected cases and the HPB Fellow is expected to participate and present on a regular basis.

Perioperative Evaluation

There are two formal public outpatient clinics at Royal North Shore Hospital.  These include a wound clinic and a pancreatic exocrine deficiency clinic. Also, as required, the Fellow can participate in the liver and pancreatic cancer clinics conducted out of the private consulting rooms of the HPB surgeons. This will involve participation in preoperative evaluation and assessment and treatment planning.

Training Program

The HPB Fellow attends all clinical and teaching meetings as appropriate within the Division of Surgery.  The surgical Grand Rounds involves alternating between a journal club format and didactic lectures on Upper GI, Colorectal, Vascular and Endocrine surgical issues.

Members of the Upper GI Surgical Team include:

  • HPB Clinical Fellow
  • HPB Research Fellows (x 2)
  • Oesophago-Gastric Fellow
  • SET 3 General Surgical Registrar
  • SET 1 General Surgical Registrar
  • Resident Medical Officer
  • Intern

The clinical workload of the Unit is such that the HPB Fellow and the Oesophago-Gastric Fellow participate in all major Upper GI surgical cases at Royal North Shore Hospital as well as many in the private hospitals.  The General Surgical Registrars (SET trainees) only work at RNSH but can still expect to do more than 100 major cases and in 30% of these cases they will be the principal operator during any 6 month rotation.

Funding for this Position

The Fellow is part funded (0.5 FTE) salary from Royal North Shore Hospital with the remainder of the salary made up from private assisting and supplemented from an Upper GI Surgical trust fund.

Education Facilities Available for the HPB Fellow

The HPB Fellow is provided with a workstation, computer, internet access and a printer within the Upper GI Surgical Department.  The HPB Fellow also has basic administrative support and is allocated a defined amount of time each week (1.5 days) to undertake clinical or laboratory-based research.  The HPB Fellow has full access to the Royal North Shore Hospital library as well as to the University of Sydney library which provides an extensive electronic literature database access.

Director of the HPB Program/Mentors

The Director of the HPB Fellowship Program is Prof Thomas J Hugh, a board member of the ANZHPBA.  All consultants within the HPB surgery unit have higher degrees and have a major interest in both clinical and laboratory-based research.  All consultants regularly present and participate in National surgical meetings. They also regularly publish in the field of HPB surgery.  There are formal prospective liver and pancreatic databases within the unit as well as a dedicated Data Manager. The HPB Fellow is able to use these resources for clinical research.  The HPB 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

Royal North Shore Hospital and the Northern Sydney Area Health Service are fully supportive of both the HPB Fellow and the Oesophago-Gastric Fellow positions.  In recognition of the contribution these senior trainees make to our hospital they are provided with substantial base funding.

Research Training

The HPB unit runs a monthly research meeting with over 50 active participants including two PhD students and numerous MD students from the University of Sydney.  We publish 10-15 clinical and basic science papers per year and have active collaborative relationships with several laboratories.  The clinical fellow will be expected to conduct a limited number of clinical research projects while the research fellow will take the bulk of the research responsibility.

Royal Prince Alfred Hospital, CAMPERDOWN, SYDNEY, NSW
HPB and Transplant at RPAH:
Royal Prince Alfred Hospital is a Tertiary referral Hospital associated with the University of Sydney. Fellows predominantly work in the Department of Upper GIT surgery with five specialist surgeons. There is a predominantly HPB focus to the Department with four of five surgeons performing hepatic surgery, and all performing pancreatic and biliary surgery. There are operating lists running every weekday (9.5 sessions per week). The unit also partakes in the general surgery and trauma roster. Apart from the HPB Fellow, there is currently a SET trainee, a surgical senior resident and three interns covering the service. Two surgeons perform ERCP, making it one of the few centres able to provide ERCP training to surgeons. There is a large workload of advanced HPB surgery, utilising the more aggressive approaches to oncological clearance including; vascular reconstruction, portal vein embolisation, 2-stage hepatectomies and isolated hypothermic liver perfusion. Three out of 12 months are spent working as the transplant surgery fellow, with exposure to Liver and kidney transplantation and donor surgery. There are good opportunities for clinical research, and fellows can participate in the Master of Surgery offered through the University of Sydney. The fellow position at RPAH is ideally suited to a second year fellow, who is already proficient in routine resections and management of gallstone disease, so that they can fully benefit from exposure to advanced techniques.

TAN TOCK SENG HOSITAL
SINGAPORE HPB Fellowship

Number of Fellows: 1/year. One year clinical fellowship.

Minimum requirements: FRACS or equivalent.
Post accredited by ANZHPBA for post-fellowship training in HPB Surgery.

Unit structure: 3 supervising surgeons –

Mr. Terence Huey

Mr. Low Jee Keem, MD, FRCS(UK)

Mr. Sameer Junnarkar, MD, FRCS(UK)

Adj A/P Vishalkumar Shelat

Unit Activity:
Operating sessions: 3 full day lists / week
Endoscopy sessions: 1 full day list / week
Clinic sessions (for fellow): 1/ week
HPB multidisciplinary meeting: 1/week
GI tumor board: 1/week

On-call:

General Surgical On call:
Two registrars, four medical officers and three house officers – all on site. Consultant on call – off site.
Fellow would be expected to do on-calls as a senior registrar with Consultant cover.
We are an acute surgery unit and admit all general surgery patients.
One 24 hour period/week

HPB on call:
HPB team provides 24/7 complete and comprehensive cover for the hospital.
Fellow may be escalated to independent HPB calls depending on level of seniority and training adjudged.

Team structure:
3 Consultants
1 Fellow
3 Registrars (1 Senior and 2 Junior)
4 Medical Officers
3 House Officers
1 HPB nurse clinician

Supporting services (all 24/7):
Gastroenterology service
ERCP/ EUS/ FNA etc
Interventional radiology service
PTC, RFA, TACE etc
Diagnostic radiology service including CT and MR scans

Operative case-load of HPB unit in 12 month:

Liver resections: >50
Open liver resection: 40
Laparoscopic liver resection: 10
Pancreatic operations: >35
Pancreaticoduodenectomy: 25
Other pancreatic operations (distal laparoscopic pancreatectomy etc): 10
Complex biliary operations: 15-25

Areas of interest:

Laparoscopic surgery exposure, particularly laparoscopic liver, pancreas and bile duct surgery.

Others – Laparoscopic Hernia Surgery

Training not offered:
No transplant experience.
No ERCP experience.

Employment arrangement:
Employed by Tan Tock Seng Hospital as 1 year temporary full-time employee.
Extra benefits include payment for emergency on call duty, annual/training leave, conference support and others.

Singapore:
Singapore is an island city country with a population of around 5 million. The city is multi-cultural, extremely safe, clean and modern.
Singapore is one of the best places in Asia to live, work and play. It offers the best of shopping and dining. Tan Tock Seng Hospital is a 1400 bed tertiary university affiliated hospital. The hospital has all the world class modern laparoscopic operating suites and a fantastic working environment.

Further information contacts:
Terence Huey (Fellowship programme director)
Email: cheong_wei_huey@ttsh.com.sg

 

 

 

 

 

 

 

The Alfred Hospital: Department of HPB Surgery

Overview:
The Alfred is a tertiary referral and university-affiliated teaching hospital with 640 beds located in Prahran, in the inner south east of Melbourne. The Alfred has one of Australia’s busiest emergency and trauma centres, the state’s largest Intensive Care Unit and is home to multiple state-wide services.

The unit provides an HPB service as well as an Acute General Surgical and Trauma Surgical service. A range of complex hepatobiliary and pancreatic procedures for benign and malignant disease, including advanced laparoscopic surgery are performed.

Number of Fellows: 1/year. 12 month position.

Minimum requirements: FRACS or equivalent. Post accredited by ANZHPBA for post-fellowship training in HPB Surgery.

Team Structure: There are 4 supervising consultants. Marty Smith, Charles Pilgrim, Kaye Bowers and Val Usatoff. There is 1 registrar, 1 resident and 1 intern on the unit
Unit Activity: The unit provides both elective and acute surgical inpatient services plus outpatient services.

The unit averages 4-5 HPB theatre lists, plus 1 acute surgical/trauma list per week. There is also an opportunity for the fellow to assist with HPB surgical procedures in the private sector.
HPB outpatient clinics are run weekly and are attended by all unit staff.

On-call: The fellow participates in the consultant acute general and trauma surgery on call roster covering 1 weekday evening per week and approximately 1:5 weekends.

Operative case-load: Over the 12 month attachment the expected caseload would be in excess of 200 majors with a mix of hepatobiliary, pancreatic, general surgical and trauma cases.

Teaching: Key teaching activities include a weekly morbidity and mortality meeting, weekly multidisciplinary cancer meeting, weekly clinical meeting, and weekly gastroenterology/HCC meeting.

Research: Extensive research opportunities exist in both clinical and basic sciences. There are also opportunities at the completion of the fellowship year for research leading to higher degrees for those with an interest.
Training not offered: No transplant experience. No ERCP/EUS experience.

Further information contact: Ms Kaye Bowers ph (03) 85730022, email kaye.bowers@monash.edu

Westmead Hospital

Westmead Hospital is one of the major teaching hospitals of the University of Sydney.
At Westmead Hospital, the Hepato-biliary/Gastro-intestinal service comprises five Consultant Surgeons, one Fellow, two trainee Registrars and two Residents. We also have a Clinical Nurse Consultant.

We work closely with the Gastro-enterology service at Westmead Hospital which has a large workload which includes 1000 ERCP’s per year and more than 300 endoscopic ultrasound assessments. There is strong interventional radiology support.

We as a group are mainly interested in the treatment of hepato-biliary and upper gastrointestinal oncology, but we also run a co-ordinated gallbladder service for the hospital and we provide a large amount of general surgery on-call.

The Fellow’s position is an outstanding opportunity to have exposure to a large amount of complex hepato-biliary and upper gastro-intestinal surgery as well as acute general surgery over a 12 month period. We perform as a group in the public hospital somewhere between 50 -75 liver resections a year, 25-30 major pancreatic resections and approximately 300 laparoscopic cholecystectomies per year. We also operate on about 30 gastro-oesophageal cancers per year and we have a strong interest in the management of neuroendocrine tumours.

Westmead Hospital is the national Pancreas transplant service and for those fellows who are interested there is the opportunity to have exposure to solid organ pancreas transplantation and renal transplantation as well as about 50 multi-organ retrieval procedures per year.

The Unit has a major academic involvement and all five Consultants have an appointment with the University of Sydney and are actively involved in undergraduate and postgraduate teaching as well as supervision of higher degrees. Fellows would be expected to participate in publications and presentations during the year.

Further information can be obtained from the Head of Department, Associate Professor Arthur Richardson arthurr@arthurrichardson.com.au.

Western Health Footscray

Upper GI / HPB and General Surgery (UGIG) Unit

Overview

The Upper GI / HPB and General Surgery (UGIG) Unit is part of the Division of Surgery based as Western Health, Footscray. The hospital is a major tertiary centre in Western Melbourne and part of a health network with a catchment population of 900,000 in one of the fastest growth corridors in Victoria. A new Footscray Hospital campus is expected to be completed in 2025. The unit is a combined hepatopancreaticobiliary / oesophagogastric service and accredited for both ANZHPBA and ANZGOSA Fellowship training positions. We alternate between hosting a HPB fellow one year and oesophagogastric fellow the following year. Irrespective of their primary training program, the Fellow is expected to fully participate in all of the unit’s activities.

Number of Fellows

1 Fellow per year, one year clinical fellowship

Minimum Requirements

FRACS or equivalent

Team Structure

There are 8 supervising consultants;

HPB : A/Prof. Val Usatoff, Mr Julian Choi, Mr Nezor Houli, Mr Frederick Huynh

UGI : Mr Rodney Jacobs, Mr Hai Bui, Mr Ramez Bassari, Mr Yahya Al-Habbal

The Fellow works with 2 registrars, 1 HMO and 3 interns.  The unit is supported by a departmental secretary, a theatre booking manager, an outpatient liaison nurse, allied health staff and will be expected to work closely with interventional radiologists and interventional gastroenterologists.

Unit Activity

The unit has 6-8 elective operating lists and 1 endoscopy list per week. There is a weekly upper GI / HPB multidisciplinary meeting, unit meeting and a fortnightly hepatoma MDT. The Fellow will be expected to attend the weekly General outpatient clinic and the fortnightly Gallbladder clinic.   There is a quarterly Academic Day where the Fellow and other unit junior staff will present updates on contemporary surgical literature. The unit has a well-established clinical database and research opportunities exist through the strong relationships between the Upper GI Surgical Unit and the Department of Surgery, University of Melbourne.

On-Call

The Fellow participates in the consultant acute general surgery and Upper GI / HPB roster with a 1 in 3 on-call with close support from the consultant team.

Operative Caseload

The Fellow will have an opportunity to gain experience in a large volume of complex oesophagogastric and hepatopancreaticobiliary operations for both benign and malignant disease, as well as acute general surgical operations. The Fellow will be involved in between 200-300 major operative cases, including 30 hepatic resections and 20 pancreatic resections.  Although the bulk of the work is at the main Footscray campus, there may be an occasional need to help out at the Sunshine or Williamstown campuses.  There may be some opportunity to assist in the private sector also.

Training not offered

No transplant experience. Limited ERCP experience.

Further Information

For further information, contact Mr Frederick Huynh, email : frederick.huynh@wh.org.au