urgicalVol: 11 No:9 October 2010 Sthe royaL Australasiannews College of Surgeons

Our largest paediatric team helps children in PNG page 8

[12] [22] [34] PACIFIC ISLAND 80th ANNUAL BREAKTHROUGH IN NATIONS SCIENTIFIC CONGRESS TUMOUR TREATMENT Optimism for improved Milestone Congress College scholarship aids The College of health care across scheduled for four days research that could revolutionise Surgeons of Australia and Pacific region. in Adelaide next May. treatment of tumours New Zealand professional President’s Perspective development 2010 workshops Workforce planning – always at sea The year is coming to an end but professional development There will certainly be a greater demand for health professionals opportunities go on! We’d like to invite you to attend the following workshops that support you to strengthen your abilities in arenas such as communication, business, leadership and management.

Surgical Teachers Course 21-23 October 2010, Adelaide The Surgical Teachers Course, consisting of two and a half days of challenging and interactive activities, enhances the educational skills of surgeons responsible for the teaching Ian Civil President and assessment of surgical trainees. Experienced faculty members employ a range of teaching techniques and presentations to deliver the curriculum including Adult Learning, professional Teaching Technical Skills, Feedback and Assessment and Change and Leadership. development n the health sector there appears to be no topic workshops that creates more debate and outcry than From the Flight Deck: Improving Team Performance DATES: oct – nov 2010 Iissues of health workforce planning. What 29-30 October 2010, Melbourne are the correct number of health professionals, This two-day workshop is facilitated by an experienced doctor and pilot. It examines the NSW 29-31 October, Sydney how should they be educated and trained and lessons learned from the aviation industry and applies them to a medical environment. Process Communication Model where should they spend their professional The program combines rigorous analysis of actual airline accidents and medical incident 5 November, Sydney careers are questions that fill newspapers and case studies with group discussions and an opportunity to use a full-motion airline Polishing Presentation Skills conferences. The theme creates position papers, training flight simulator. You will learn more about human error and how to improve 19 November, Sydney individual and team performance. Proudly supported by Kimberly-Clark Australia Occupational Medicine: Industry site visits policies and government departments to enact 20 November, Sydney them. Depending on your perspective there Polishing Presentation Skills Writing Reports for Court can be too few health professionals creating 5 November 2010 Sydney QLD shortages and waiting lists, too many health Want to develop an attention grabbing presentation to deliver your message more 17-19 November, Brisbane professionals creating excessive self generated effectively? Whether you are a beginner or an experienced presenter, join this whole day Process Communication Model demand, maldistribution creating subsidised workshop to advance your presentation skills. You will learn a step-by-step presentation SA training and bonded career paths or a ’glut’ planning process and practical tips for delivering your message. It is equally applicable to 21-23 October, Adelaide threatening restrictions in health insurance Surgical Teachers Course presentation sessions in hospitals, conferences and international meetings. coverage or managed care. Yes, there will always Proudly supported by Kimberly-Clark Australia VIC be controversy. 29-30 October, Melbourne Process Communication Model (PCM) From the Flight Deck, Melbourne 29-31 October 2010, Sydney, 17-19 November 2010, Brisbane 11 November, Melbourne Haunted by bad policies Patient care is a team effort and a functioning team is based on effective communication. PCM Supervisors and Trainers for SET (SAT SET) However, there are a few facts that can be 12 November, Melbourne understood and are agreed. There is no is one tool that you can use to detect early signs of miscommunication and turn ineffective Occupational Medicine: Industry site visits President, Ian Civil presents wakarongoa (a vessel used to hold the healing plants of the Maori) to President of the College of Surgeons of Sri Lanka, Ranjith Ellawala. communication into effective communication. PCM can also help to detect stress in yourself 13 November, Melbourne doubt that the policies of the 1980s and the and others, providing you with a means to re-connect with those you may be struggling Communication Skills for Cancer Clinicians restriction on medical school intake have now to understand. The College is investigating how PCM can assist surgeons to improve their 19-21 November, Melbourne created health systems very dependent on the budget cuts or capped budgets where surgical communication skills. Two courses for rural Fellows, trainees and their supervisors are Leadership in a Climate of Change importation of medical graduates trained in Public Activities capped activity is seen as the most easily constrained planned for later this year. Proudly supported by the Dept of Health and Ageing WA overseas countries. Australia and New Zealand by budget controls service, the result is demonstrable public 20 October, Perth are the two countries with the highest rate of From a surgical perspective, another constant tension. The political excuses vary between Leadership in a Climate of Change Supervisors and Trainers for SET (SAT SET) imported overseas trained health professionals is the capped nature of surgical work that Australia and New Zealand. In New Zealand 19-21 November 2010, Melbourne – both nurses and medical practitioners – to is undertaken in the publicly funded health where there is political acceptance of waiting This 2½ day workshop aims to develop your understanding of how to be an effective 19-21 November, Melbourne LEADERSHIP IN A CLIMATE OF CHANGE sector. The nature of the clinical case load lists, scoring systems are used to define those leader in the 21st century. It focuses on leadership styles, establishing and maintaining alleviate self induced shortages. Change provides an ongoing challenge to Into the future, there will certainly be a and the necessity for training the various who fall below a threshold for treatment. In effective working relationships, managing the performance of others and managing surgical leaders. Understanding your own healthcare groups also creates an environ- issues effectively in a vibrant work environment. You will complete an online behavioural style of leadership and adapting it to the greater demand for health professionals. Two Australia, where waiting lists are less accepta- inventory called the DiSC profile that will generate a specialised report on your leadership situation and personalities of others in the strong drivers of this are that fact that the ment in which organisational inefficiency is ble, there are many attempts to hide the num- attributes which is the basis for interactive debrief session. Behavioural preferences for a workplace is crucial in today’s dynamic world. aged population, particularly above 65 years, commonplace. Waiting lists are rarely due to bers – either in the actual lists themselves or range of leadership styles are explored and you’ll be offered challenging insights about This workshop encourages a journey of is increasing and this population requires a shortage of surgical expertise. They are due by refusing to accept people onto the waiting your leadership attributes. NB: This workshop is stand alone or one of three entry points for self-discovery by undertaking a psychometric to constraints on access to operating theatres behavioural profiling exercise, indicating an interventions and advanced technologies to lists in the first place. Depriving people of ac- the Advanced Diploma of Management individual’s preferred leadership style. Group stay fitter for a longer period of time. ‘Life saving that occur in multiple ways. The challenge cess to surgeons in outpatient clinics or refus- discussions identify alternative leadership surgery‘ is now almost commonplace and the to obtaining access to routine surgical beds, ing to allow surgeons to place more than a Further Information: Please contact the Professional Development styles, the value of emotional intelligence and surgical intervention in chronic diseases now intensive care beds, and staffed operating certain number of patients on the waiting list Department on +61 3 9249 1106, by email [email protected] a range of appropriate management styles theatres at reasonable hours are folklore in appear two of the more common practices in or visit the website at www.surgeons.org - select Fellows then click that can enhance workplace relations. routine and expected. In short, there is more on Professional Development. work to do on a larger number of people. the surgical community. Be it through overt the various states of Australia. u

[Surgical News] Page 3 October 2010 President’s Perspective Relationships & Advocacy

“There is no doubt that the policies of the 1980s and the restriction on medical school intake has now created We live in interesting times health systems very dependent on the importation of medical graduates trained in overseas countries ” Should the rebate come under threat the College No guarantees for the increased Multiple contradictions role of the College is vital. Providing high qual- medical graduate numbers What a contradictory pickle this is. The need ity surgical services to the community is the Keith Mutimer “will remind government and voters that Australian In the meantime, the universities are now pro- for a growing surgical workforce in the future core of our activities. Vice President public hospitals, already hard pressed and under ducing medical graduates in far greater num- is self evident and the College and the various Key to our immediate actions must be to funded, will come under significantly greater pressure bers. So many that New South Wales can no specialty societies need to respond to this. The engage the private sector, because of both the s I write this article a minority Aus- longer guarantee intern positions to the gradu- training path from entry into medical school to volume of surgical work being undertaken tralian Government is being sworn in, as hundreds of thousands of people desert private ates from universities in that state. And other the graduation of a surgeon can easily exceed there and the scope of that workload. With some 24 days after polling took place. health funds and again rely on the public system.XX this workload coming within the training A states are not far behind. Six years of education 15 years. The requirements that we respond to An improbable ‘rainbow’ coalition of the ALP, going ‘up in smoke’ with often only debt left for workforce planning have long lead-in times umbrella, the future surgical workforce could Greens and independent MPs of conflicting ” be trained more flexibly and the potential for behind is an unconscionable position for our and do not align with the political imperatives ideologies are likely to find it difficult to agree The Greens are on the record as having that Australian public hospitals, already hard training could be significantly expanded. health system to find itself in. Surgeons often of the next election or six second media grabs. on policy, let alone the fine detail of legislation. consistently opposed the private health pressed and under funded, will come under Regardless of the nuances of workforce anal- cannot obtain public hospital positions when Safe hours and limited increases in throughput To complicate matters further, the government insurance rebate, viewing it as a vote buying significantly greater pressure as hundreds of ysis, Australia and New Zealand both have an they are establishing practices and move to full in the public sector mean that there is little will have to negotiate with a Senate that will extravagance. So fundamental is their thousands of people desert private health unsustainable reliance on International Medi- time practice in the private sector. The various room to reduce this. Inefficiencies and frustra- be controlled by a Family First senator until 30 opposition to the rebate, the Greens may try to funds and again rely on the public system. Any cal Graduates. The World Health Organisation departments of health in Australia seem unable tions in the public systems where we work can June next year and thereafter by the Greens. include it in the price of their ongoing support compromise arrangement, involving a lower- wants our governments to be signatories to doc- to comprehend the requirements for not only only increase the appeal and attraction of pri- What is the likely effect of this state of af- for a minority Labor Government. If not ing of the rebate, will be vigorously opposed. uments which highlight the moral dilemmas of continuity of clinical service, but for the critical vate sector careers. fairs on health policy generally and the deliv- immediately, then down the track. The extraordinary deal-making that culmi- active recruitment of nurses and medical practi- task of establishing our younger surgeons in a ery of surgery in particular? The Labor Gov- Labor, who know full well that the next nated in a minority Labor Government puts tioners from other countries. Before we can do career where they can contribute to education Where to from here? ernment’s first term saw considerable attention election will be decided not in the regions, one thing beyond doubt: that public money will this we need to make positive progress locally on and research in the public sector, which is the While there will always be debate on workforce paid to health policy and, while many of the but in the outer suburbs of Australia’s major soon be flooding into regional Australia. This addressing our pressing workforce needs. lifeblood of ongoing education and training numbers the overarching consideration at this reforms it initially promised were subsequently cities, will surely resist this push as doggedly as should see unprecedented funding for regional I look forward to your ongoing comments. for all health professionals. time is workforce shortage. In that regard the watered down, some significant changes and they will resist any push by the Greens to cut health services and represents an opportunity substantial investment have been promised. subsidies to, say, private schools. The Greens’ for the College to redouble its advocacy efforts Given the likely difficulty in getting anything argument – that money saved by abolishing on behalf of regional and rural surgeons. new through the parliament, I suspect this the rebate will be invested in the public system We have a proud record of reminding gov- will be a period of consolidation in which the – will fail to convince middle class constituents ernment that it is in regional and rural Aus- 2011 Younger Fellows Forum health reforms of the first term are implement- struggling to pay health insurance premiums tralia where surgical workforce numbers are ed and bedded down. Having said that, there and justifiably sceptical of government’s approaching the point of crisis. A considerable Barossa Valley SA, 29 April – 1 May 2011 are likely to be two health-related issues on the capacity to deliver services efficiently. portion of the College’s election manifesto sent new government’s agenda, one driven by the Should the rebate come under threat the to the major political parties during the cam- Greens, the other by the regional independents. College will remind government and voters paign was devoted to this very issue. u 2020 and Beyond: Future Challenges for Surgical Practice

The 2011 Younger Fellows Forum (the Forum) is to be held in South Australia. The Forum offers a Who? All Younger Fellows of the Correspondence to Surgical News should be sent to: Surgical News Editor: David Hillis [email protected] unique opportunity for a diverse and representative group of Younger Fellows to share ideas and College (within 10 years of gaining © 2010 Royal Australasian College of Surgeons experiences and debate issues that they believe affect their professional and/or personal lives. Letters to the Editor should be sent to: All copyright is reserved. Fellowship) are eligible to attend. [email protected] During the Forum you can explore future challenges for surgical practice as the program The College privacy policy and disclaimer apply – www.surgeons.org How? Please complete a nomination explores medico-legal implications, the business of surgery and healthcare delivery in the 21st Or The Editor, Surgical News The College and the publisher are not responsible for errors or consequences form and return by fax, email or mail to Royal Australasian College of Surgeons from reliance on information in this publication. Statements represent the century. You will have the chance to socialise with your peers and engage in robust discussion views of the author and not necessarily the College. Information is not the College Younger Fellows Secretariat College of Surgeons Gardens with College councillors and international guests. The Younger Fellows Committee invites you to 250-290 Spring Street intended to be advice or relied on in any particular circumstance. have your say, relax and be involved in your College! [email protected] East Melbourne, Victoria 3002 Advertisements and products advertised are not endorsed by the College. T: +61 3 9249 1200 F: +61 9249 1219 The advertiser takes all responsibility for representations and claims. Cost? This is a College sponsored Applications close Friday 29 October 2010. W: www.surgeons.org event; delegates are required only to Published for the Royal Australasian College of Surgeons by RL Media Pty Ltd. For further information visit the College website www.surgeons.org ISSN1443-9603 (Print) ISSN 1443-9565 (Online) ACN 081 735 891, ABN 44081 735 891of 129 Bouverie St, Carlton. Vic 3053. or call +61 3 9249 1122. cover their travel expenses.

[Surgical News] Page 4 October 2010 [Surgical News] Page 5 October 2010 Relationships & Advocacy sURGICAL sERVICES SURGICAL RESEARCH SOCIETY ANNUAL MEETING Poison’d Chalice The Surgical Research Society Bit like herding those famous cats. Dangerous job, but someone needs to do it.

47th Annual Scientific Meeting Professor U. R. Kidding will be held in Adelaide on How do gently rested my head in my hands. you get the Friday 19th November 2010 “ The meeting had been going on and outcomes that at the Basil Hetzel Institute, Ion. It felt like forever. Again I reflected on my school studies of Hamlet and the you need and Queen Elizabeth Hospital long windedness of Polonius. Indeed at the same the medical connection was strong. Freud had described him as “the old time have This meeting is open to all chatterbox” in his text Jokes and their people involved those involved in or interested Relation to the Unconscious. and actively in research, including surgeons, He made famous the words, surgical or medical trainees, “Therefore, since brevity is the soul participating? xx of wit. And tediousness the limbs and researchers and scientists. ” outward flourishes, I will be brief.”

Commonwealth funding for the Where possible, increased resourcing (Hamlet Act 2, scene 2). Ah brevity, do you stop them talking…endlessly? I knew JEPSON LECTURER: College’s Rural Surgical Training Program of regional and rural hospitals should I would so appreciate it now. I lifted I should have done that course on running Professor Michael Solomon was terminated in 2009 and funding include personnel to recruit surgeons my head. Yes, it was another meeting meetings effectively. “Surgical RCTs: Past, from a new Specialist Training Program and help manage their transition into the of the Operating Theatre Management I smiled. “Great point”, I said vaguely Present and Future” commenced in 2010. The amount of money hospital and their family’s transition into Committee. Who was it who said a wondering what they had said. We will need available to nurture the development of the local community. committee of more than six members was to carefully consider that as we review the new rural surgical capacity under the STP The accreditation of base hospitals incapable of making a decision? implementation. Now we are starting the GUEST SPEAKER: is quite inadequate and it is imperative for as registrar training posts would have a Why should the Director of Surgery have checklist next Monday. They looked at me. Professor Herb Chen, past President, people living outside our major cities that beneficial effect on surgeon numbers in to chair this committee I keep on asking Opened their mouths and then just nodded. Association for Academic Surgery the Commonwealth Government support regional and rural areas. Experience sug- myself. Why do anaesthetists need to explain Sometimes you just need to start doing things. “Targeting Notch in Neuroendocrine programs that bring new surgeons to the gests that surgeons trained in a regional things in such detail? Why do the nursing Maybe that is what the leadership tag is about. Cancers: Bench to Bedside” regions. or rural hospital are more likely to remain staff need to remind me how difficult some We were walking out of the meeting. My Our manifesto pointed out that sup- there once their training is complete. of my colleagues can really be? And we were deputy director who was the head of the port for the further development, career Enhanced interaction with really only discussing the introduction of orthopaedic unit said, at long last. Why did coaching and mentoring of International metropolitan hospitals, and in particular the Surgical Safety Checklist. you let them talk so long? It should just have CALL FOR ABSTRACTS: Medical Graduates working as surgeons the adoption of hub and spoke It should have been simple. The happened. If it was just the surgeons we would The call for Abstracts has now closed.. in regional and rural Australia is essential arrangements, would facilitate the delivery checklist has been introduced around the have sorted it out in no time. CONVENOR: if they are to be a sustainable resource. The of surgical care in regional and rural areas. world. It has been validated in numerous Yes, sorted it out in no time. The glass of Professor Guy Maddern Commonwealth should facilitate access The provision of locum services to en- hospitals and health systems. There is now red wine was in my hand that evening. Nice by IMGs to educational up-skilling op- sure leave relief must be encouraged. Hos- ample documentation in how it improves approach of the management members. Easy, PRESIDENT: New Zealand shiraz again. I reflected on the teamwork, decreases adverse events and can Professor John McCall portunities either through existing College pital administrations should be given the I thought. However, it was different ‘in the hot meeting. Surgical Services bring together so training programs or specifically developed latitude to fund more locally based initia- be locally adapted with advantage. However, it seat’. Now, chairing a meeting is a different many competing perspectives and views on FOR FURTHER INFORMATION IMG education/up-skilling programs. tives, ensuring funding flexibility for local does need to be carefully implemented locally ball-game. I had always moaned when the issues. The joy of managing multidisciplinary CONTACT: It was also noted in the election mani- services during periods of peak demand. so the uptake will be successful. Engagement, Chair of various committees let people talk on groups − bit like herding those famous cats. Sue Pleass, festo that there must be greater provision When these points on rural and that is the key. That is why we were discussing and on and on. Mind you, I had given them Dangerous job, but someone needs to do it. Scholarship Co-ordinator of services, such as nursing, anaesthetic, regional healthcare were made in the it at our regular committee meeting. a serve when they did not give time for that Maybe after I have done that “Managing T: +61 8 8363 7513 pathology and radiology in rural and re- College’s election manifesto in August, the Committees should be so easy. I had always essential clinical input. Got to keep them on Meetings Effectively” course, I can think about F : +61 8 8362 2077 gional areas. Some areas need to recruit government’s response was courteous, but thought that, when I had attended my first few their toes you know. E: [email protected] “Managing Diversity”. That would shock them. resident radiologists, anaesthetists and pa- predictably pro forma. When we next raise meetings. The occasional touch of wit; the How do you get the outcomes that you Hmmm, for now another glass of red sounds thologists in order to attract the interest of these matters I suspect the government clinical perspective that was so desperately need and at the same time have people the way to go. Maybe I should take a bottle to younger surgeons. will be much more engaged. needed to balance the bean counting involved and actively participating? But how the next meeting? [Surgical News] Page 6 October 2010 [Surgical News] Page 7 October 2010 Fellows in the News 2

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Opposite page: 1. Attendance was popular at the Mount Hagen General Hospital paediatric clinic. this page: 2-3. Patients recover after surgery. 4. A patient and his parents were very happy with the surgery (with Dr Cooper, left and Dr Shun). 5. Back Row , from L to R: Michael Cooper, Benjamin Yapo and Okti PoKi. Front Row (seated), from L to R: Jack Mulu, Albert Shun 5 4 and Mclee Mathew

Copus-Campbell, Minister-Counsellor of to undertake the most complex cases not only He said this would include providing AusAID, came as a welcome respite from the because if we get it right the first time when funding for two visits per year to upgrade and Paediatric team works in PNG arduous workload. operating on a child they have the opportunity enhance the skills of Anaesthetic Scientific Fortnight in Papua New Guinea highlights needs of our nearest neighbour “It was a great honour to be asked to meet of living a wonderfully normal life, but also Officers and Registrars. with the High Commissioner and the Minister- because we can use the cases to train the local Dr Cooper is also in the process of arranging Counsellor of AusAID and it was a delightful paediatric surgeons.” for a number of Boyles anaesthesia machines evening,” Dr Shun said. that are no longer being used in Australia to chieving a record number of surgeries “It can be a wild place the highlands of Working out of Mount Hagen hospital first “The High Commission residence in The needs are great be donated to PNG with funding for transport and dinner with the Australian High Papua New Guinea,” Dr Cooper noted dryly. and later moving to Port Moresby, the team Port Moresby makes for a lovely setting for Dr Shun described seeing the increasing provided by Rotary and other charities. ACommissioner to Papua New Guinea “But the staff members up there are performed more major cases in one visit than entertaining, looking over the harbour as it skills and expertise of the local surgeons as “The work done by the RACS through (PNG) and the PNG Minister-Counsellor amazing. We walked in on the Sunday morning had ever been achieved to date in the 10 years does, and we had an excellent, informative and a highlight of the visit but said the country AusAID funding has had a major impact on of the Australian Agency for International following and it was as if nothing much had that Dr Shun and Dr Cooper have been visiting stimulating evening.” would only be self-sufficient in the surgical the surgical services offered to the people of Development (AusAID) made for a memorable happened.” PNG. Dr Shun said that while the post-operative care of children when there were 15 such PNG, but that has not flowed through so much two-week visit for the latest paediatric team to The July PNG visit (funded by AusAID death of one child had cast a shadow over surgeons located across the country rather into anaesthetic support,” he said. visit PNG. through the Health Education and Clinical Ser- Thirty-five children treated the trip, he believed it remained in the best than the three now working there. “There are only nine specialist anaesthetists Headed by Dr Albert Shun of Sydney’s vices (HECS) Program and the RACS) repre- Both hospitals opened their theatres to the interests of the children and the local paediatric “There is such great need in PNG,” he said. in the whole country, they have problems with Children’s Hospital at Westmead, the team sented the largest paediatric surgical team ever team, at times allowing all five surgeons to surgeons to allocate the visiting team the most “They need specialist paediatric nurses, the availability of reliable drugs and monitoring arrived at the Mount Hagen General Hospital assembled to treat some of the country’s sickest be operating simultaneously while local staff difficult cases. specialist anaesthetists, specialist ICU facilities equipment, at times they run out of oxygen and on July 17 to conduct an initial consultation children, many of whom had been specifically worked long into the night and on a public “The death of the child was upsetting for babies and neonates, but I can’t really the power can be less than reliable. clinic after news of the visit was broadcast selected for treatment by the team not only for Dr holiday to provide assistance, allowing 35 but in some ways just illustrates the constant see that happening probably until the PNG “Yet with all these limitations, the surgeons, widely over the “tok save” radio. Shun’s expertise, but also for that of Dr Cooper. children to be treated. limitations affecting surgery in countries such community at large fully appreciates the fact nurses and anaesthetists do an amazing job The night before, however, violence erupted With no specialist paediatric anaesthetist With more than 80 per cent of patients as PNG,” he said. that babies and children have a right to be in the care they provide and I would like to in the Emergency Department after a man was currently working in PNG, some children with younger than five years of age, the surgeries were “The pathology was more complex than treated with equal although limited health specially acknowledge the enthusiasm and brought into hospital having been critically in- congenital heart disease or those who had often extremely complex including Swenson’s anticipated, which relates to the lack of resources. hard work of Dr Rachel Paiva, the anaesthetic jured in a car accident, with the victim’s family previously experienced anaesthetic-induced operations for Hirschsprung’s disease, midgut diagnostic facilities there while there is no Dr Shun said that as such, specialist team registrar from Port Moresby General Hospital, blaming a group of workers for his plight. cardiac arrhythmias were selected as requiring malrotations with volvulus, the excision of a specialist paediatric ICU unit in the country visits such as the July trip would continue who worked closely with me during this visit. According to visiting team member, his paediatric anaesthetic expertise. large abdominal teratoma, anorectoplasties for postoperative care. to be required while Dr Cooper, also from “It is a privilege to work with such paediatric anaesthetist Dr Michael Cooper, the Along with the two paediatric specialists and hypospadias and fistula repairs. “That means that no matter how good the the Children’s Hospital at Westmead, is in dedicated people and because PNG is our Emergency Department staff simply ducked from Sydney, the team comprised local The invitation and opportunity for the surgery and anaesthetic support, you still confront the process of driving changes within the nearest neighbour with such close historical and dodged the bullets from the shootout, paediatric surgeons Dr Mclee Mathew, Dr Ben team members to dine with His Excellency, Mr limitations in infrastructure, skills and expertise Australian and New Zealand College of ties to Australia, we should train the specialists regained a measure of calm and continued Yapo, Dr Okti Poki and general surgeon and Ian Kemish, the recently-appointed Australian that we take totally for granted in Australia. Anaesthetists (ANZCA) to develop a more co- they require and provide the assistance that treating the patient. paediatric trainee Dr Jack Mulu. High Commissioner to PNG and Ms Stephanie “Yet still it is the job of such visiting teams ordinated aid program for PNG. they need.”

[Surgical News] Page 8 October 2010 [Surgical News] Page 9 October 2010 New To Council 2010 Sydney Colorectal Surgical Meeting 13 November 2010 Sofitel Sydney Wentworth All will be revealed… The first time we do something will always be the first time, but the last time may not always be the last time as we may decide to do it again

understanding of the complex creature that is retirement – they can ‘wind down’ rather than the College. Have I succeeded? I don’t know. stop suddenly. Many employed positions are Who are Mr Nit Picker and Professor such that a date looms and retirement occurs Dead Certain and Mr Pot Stirrer? All will – from top of the heap to another Old Age I.M.A Newfellow be revealed next month. Do I hear some Pensioner; from surgeon to former surgeon; Councillors stirring and wondering if one from rooster to feather duster. The College of these characters may be them – do I hear has held workshops for several years to assist nd the winner is… Ivan Thompson, the them calling their lawyers in case a defamation in the end of professional life. It is interesting WA Councillor. Now what competition action is needed? that they were once called “Winding down Ahas Ivan won? He was the first person As I draw to the end of these articles it from Surgical Practice”, but are now called Peter Loder Chair, Sydney Colorectal Surgical Meeting to work out who I.M.A Newfellow really is. It occurred to me that the end of eras in our lives “Building towards Retirement”. I am not sure Pierre Chapuis Chair, Scientific Program Committee must have been apparent for some time that is sometimes quite distinct and sometimes not which name I prefer – they both transmit Newfellow is not my real name. A quick look at quite so clear cut. All surgeons recall the first a useful concept of both decreasing the Further information and sponsorship opportunities contact: Royal Australasian College of Surgeons the list of Councillors tells you that. operation they ever did. Is the last operation surgical work, but not leaving a vacuum. E: [email protected] T: +61 3 9249 1248 F: +61 3 9276 7431 Now Ivan was pretty smart as he asked as readily recalled? In my case – no. The first Many surgeons in their years of busy me point blank about three months after time we do something will always be the first practice do not have time for doing College these articles started four years ago if I was time, but the last time may not always be the things. The senior years does offer the Mr Newfellow. How did he work this out? I last time as we may decide to do it again. I opportunity to be involved in such activities College Conferences and Events Management had hoped that it would have been from my hope the reader (and the censor) will allow a as teaching in the College courses, serving Contact Lindy Moffat / [email protected] / +61 3 9249 1224 incisive input, my clarity of expression or my slightly risqué comment; I am reminded of on committees and boards, being involved knowledge of the College, but it was my sense the clever line in the film “Elizabeth” where in organising meetings, mentoring young of humour that gave me away. Cate Blanchett as Elizabeth says to a bunch trainees and even writing impudent articles This will be my second to last article as I am of startled and incredulous courtiers “I have for Surgical News. leaving Council next year. Now that is a clue as decided to become a virgin”. The last operation At the Adelaide ASC in May 2011, the Senior to who I am. I have given clues at various times, may be the last operation of that particular Surgeons Group is holding several sessions, Austrauma - 11th but they have gone un-gathered and ignored. retirement and, like Dame Nellie Melba, there which I note has such topics as Prostatic Annual Trauma, Critical Care & http://asc.surgeons.org Why have I written these articles in a rather may be many other retirements ahead. Health, Changes to Superannuation and even see page 22 impudent manner? I have been cheeky and a session called “Secret Men’s’ Business”. I Emergency Surgery Conference for full possibly outlandish to get your attention. I have Rooster to feather duster could not see anything about how to become a Sydney Convention details written these articles to try to transmit some Surgeons are in a special situation in regard to feather duster with dignity. & Exhibition Centre Darling Harbour, Sydney 17 - 19 February 2011 LEADERSHIP IN A CLIMATE OF CHANGE Conference Convener: Dr Valerie Malka 19-21 November, Melbourne

Change provides an ongoing challenge to surgical According to Prof Clifford Hughes FRACS, CEO of leaders. Understanding your own style of leadership and the Clinical Excellence Commission who enrolled in adapting it to the situation and personalities of others in the diploma and helped facilitate this workshop, “I the workplace is crucial in today’s dynamic world. was mightily impressed with the way the presenter Annual Scientific Congress This workshop encourages a journey of self- worked with a group of clinicians, not known Adelaide Convention Centre, Adelaide, Australia discovery by undertaking a psychometric behavioural for their ready acceptance of some of the issues 2 – 6 May 2011 profiling exercise, indicating an individual’s preferred raised. It was great fun…. The informal discussions leadership style. Group discussions identify alternative illustrate the way in which the presenter engaged leadership styles, the value of emotional intelligence each member of the group and developed their Further info & sponsorship opportunities: Royal Australasian College of Surgeons and a range of appropriate management styles that enthusiasm, including me. More importantly, I think E:[email protected] can enhance workplace relations. there is still a lot to learn.” Royal Australasian T: +61 3 9249 1139 F: +61 3 9276 7431 College of Surgeons Please contact Professional Development Department. T: +61 3 9249 1106 F +61 3 9276 7432 E: [email protected]

[Surgical News] Page 10 October 2010 [Surgical News] Page 11 October 2010 Fellows in the News

“The role of the association is to bring people together and inspire them to work for the future of the Pacific Islands people”

The administration team and trainees Mr Maoate worked with. The conference in Vanuatu with the Pacific surgeons.

Surgeon optimistic about future Kids often disadvantaged “The kids from the Pacific are often disadvan- NZ paediatric surgeon Mr Kiki Maoate foresees a dramatic change in taged and don’t have the same opportunities medical services in the Pacific Island nations to perform at the same level as others so we are actively working to bridge that divide while hen NZ paediatric surgeon Mr “Yet as I travel back and forth to various coun- will see a dramatic change in ownership of helping them to attain the skills that will in Kiki Maoate speaks of the need for tries in the Pacific and get continual exposure to medical services provided. turn be of assistance to their own people. surgeons to take a higher profile their way of life – the lack of money, the lack of “Now the choice of health services offered is “It’s a long-term strategy aimed at solving W Hon Viliami Tangi, Minister of Health, Deptuy PM, Tonga, Sir Terepai Maoate, Retired general surgeon, in public health debates and the formulation facilities, even the lack of social opportunity – I get predominantly driven by available resources and some of the workforce issues confronting the Cook Islands and Kiki Maoate at a WHO Regional meeting, Hong Kong 2009. of health policy, it is clear that his opinions are a bit frustrated when I come back to New Zealand also the funders, Australia, New Zealand and the Pacific Islands, but it is an exciting one. grounded in both action and experience. and see how little we appreciate what we have. World Health Organisation to name a few. “The role of the PMA is to bring people As the son of the former Prime Minister of “I don’t think some people realise how easy “But I think the discussion is now starting together and inspire them to work for the the Cook Islands, Sir Terepai Maoate, himself it is in a first world country and how much from the people themselves about what they future of the Pacific Islands people.” Public health advocacy who have embraced this role of public advocate, a doctor, the twin notions of the public good money we have at our disposal, even though want, what they can do and what they can When not focused on the future of the “That is why I am also such a strong believer in but as a profession I don’t believe we are there yet.” and public service infuse much of his work we always think it is never enough.” afford to do. That may still be a way off, but Pacific Islands, Mr Maoate works as a Paediatric the role of the surgeon as a public health advo- Having recently returned from the and world view. I can see it.” Surgeon and Urologist at the Christchurch cate and in some ways the surgeons now work- Vanuatu meeting of the Pacific Islands Each year he makes up to 10 surgical and A healthy future To help bring forward that day of greater Public Hospital and Children’s Specialist ing in the Pacific are leading the way,” he says. Surgical Association Meeting, Mr Maoate training visits to various countries in the Yet while many Pacific Island nations continue self-determination, Mr Maoate, as president of Centre and is a Senior Clinical Lecturer in “We understood some time ago that all noted dryly that, given the tsunamis that Pacific while he is also an Advisor on Paediatric to struggle to find the resources and the man- the Pasifika Medical Association (PMA), has Paediatric Surgery at the University of Otago, our trainees needed to be aware of and able have devastated some islands in recent years, Surgery at the Fiji School of Medicine, acts as power needed to provide vital health services, helped design and implement an education- Christchurch. to manage issues relating to public health disaster management courses were being held the College’s paediatric specialty coordinator Mr Maoate sees the future with optimism. based initiative known as the “Students are our Yet still he can’t get the islands out of his even if they are neurosurgeons, plastic or there during the meeting. At the same time, the for the Pacific and is the President of the He claims that the surgeons working across Future Programme”. blood for he also acts as an advisor to the reconstructive surgeons. September earthquake hit Christchurch. Pasifika Medical Association. the Pacific region now and the trainees coming A New Zealand-wide initiative with the Ministry of Health on Pacific Island issues. “They need a strong voice in these countries He says the damage caused both to the He says that while he has little interest in through represent the best health workforce secondary schools and the Ministry of Health, He lists the major health issues confronting to argue for the necessary funding, to determine central city and in outer regional areas had participating in the notoriously volatile politics ever provided. the program aims to inspire Pacific Island Islander people as diabetes and obesity, both of and lobby for national health priorities and the been extensive and that only the fact that it had of the Cook Islands, the politics of health “The commitment, skills and maturity of students to pursue a health-related career. He which raise the need for surgeons to participate School of Medicine in Fiji has established a occurred in the small hours of the morning equity and provision, particularly for Pacific the Pacific surgeons and trainees now coming also hopes to implement this program in the vigorously in public health debates, given the curriculum to teach such leadership skills. limited the number of accidents and trauma. Islander people, is a core passion. through the system, compared to ten years ago, Pacific countries. chronic nature of the diseases. “I think New Zealand and Australian “The damage on the ground is quite “Absolutely, I was brought up to believe is absolutely fantastic to see,” Mr Maoate says. “We start with school kids from Year 10, to “This is not just about arguing over money surgeons could learn from this, that our role amazing, but in terms of accidents and injury that those of us who have the opportunity, also “We have a number of local surgical try and capture their imagination with a life for health services, but about discussing wider is not one of just thinking about hospital it’s all about timing because it happened in the have a responsibility to other people, to make specialists now working throughout the region, in the health sciences and provide mentors to issues such as how we live, what we eat, even systems or hospital funding, but engaging with middle of the night. If people had been driving a difference where and when we can,” Mr all of whom have tremendous leadership skills those already beginning their tertiary training,” how food is manufactured, costed or provided,” the community about pivotal health issues. on some of the buckled roadways there would Maoate says. and I believe over the next ten years that we Mr Maoate says. he says. “There have been some surgeons and others have been multiple casualties.”

[Surgical News] Page 12 October 2010 [Surgical News] Page 13 October 2010 Fellows in the News education IAN & RUTH GOUGH SURGICAL EDUCATION SCHOLARSHIP 2011 Background: The Ian and Ruth Gough Surgical Education Scholarship was The virtues of examiners established by Ian and Ruth Gough The Court of Examiners represents a tightly-knit group to encourage surgeons to become ROYAL AUSTRALASIAN expert surgical educators. of dedicated and committed surgeons COLLEGE OF SURGEONS Eligibility Conditions: Applications are open to Fellows COURT OF EXAMINERS and Surgical Trainees of the Royal FOR THE FELLOWSHIP Australasian College of Surgeons. EXAMINATION Applicants must be a permanent Spencer Beasley examination is to be conducted at a Chair, Court of Examiners resident of Australia or New Zealand. high level. It also carries with it certain Applications from eligible Fellows responsibilities because the summative willing to serve on the Court should Applicants must provide: erhaps one of the most rewarding assessment provides the last opportunity be forwarded to the Department of > A Curriculum Vitae roles a Fellow can have in the Col- to confirm that a trainee is ready to > A Referee report Plege is as an examiner for the Fel- graduate from formal training. Examinations of the College no later > An outline of a program proposal lowship examinations. For many, it is the The Court of Examiners has been than Wednesday 1 December 2010 for that includes documentation ultimate achievement in their specialty, concerned to ensure that the examination appointment in 2011. of your acceptance of visits to and the importance of the role is widely process can reliably and consistently dem- specialist centres or into courses acknowledged throughout the College. onstrate achievement of pre-determined Fellows are asked to note the following that will enhance your ability Each of the nine specialties has a spe- standards, and that the whole process is fair to become an expert surgical vacancies on the Court, in the specialty of: educator. The Dean of Education cial court of examiners responsible for the and unbiased. To this end, the College is u Cardiothoracic Surgery is available to advise on suitable final assessment of its SET trainees at com- working towards providing greater support u General Surgery Work of a distinguished and training to examiners, and to develop the activities. pletion of their training before Fellowship u Neurosurgery of the College can be awarded; together tools each specialty needs to provide feed- > Details of the approximate cost of u Orthopaedic Surgery your program they form the Court of Examiners. back to its examiners on their performance. Fellow recognised again u Otolaryngology – Head & Neck > A statement that summarises your In earlier years, examiners learnt their Consequently, from 2011, all new exam- Surgery personal experience in obtaining The pioneer of the cochlear implant, Distinguished task on the job, mostly by osmosis. At their iners will undertake an examiners’ training and delivering surgical education first examination they were often paired course and have the opportunity of being u Paediatric Surgery programs and the anticipated Professor Graeme Clark AC, has become only the third with a senior examiner (but not always so). an observer for one examination before u Plastic and Reconstructive Surgery future contribution you will make Australian to be awarded the Lister Medal, the world’s As many components of the examination functioning as an examiner. This means u Urology to surgical education in Australia had a fairly unstructured format, it was as- that a Fellow who wishes to become an u Vascular Surgery and/or New Zealand. foremost honour for surgical research. sumed that all examiners intuitively ‘knew’ examiner can be confident that he/she will Value: the required standard – and for that, it was be provided with the necessary skills to The duration of this scholarship is 12 rofessor Clark, a Fellow of the Col- was awarded the Zulch Prize for his expected that the candidates should dem- function in this role at a high level. Should you wish to apply to be an Examiner/ months. The value of this scholarship lege since 1966, did his research into achievements in basic neurological onstrate that they were capable of safe clin- Being an examiner has many attrac- member of the Court of Examiners, please is $10,000. Pthe implant at the University of Mel- research, and in 2009 the Otto Schmidt ical practice, independent of supervision. tions and rewards: it is intellectually stim- forward your application form with your bourne during the 1970s. Since then more Award from the International Federation Now, the examination is a lot more ulating and challenging, and facilitates the curriculum vitae to: More Information: than 200,000 cochlear implants have been of Medical and Biological Engineering. structured, better aligned to the syllabus, maintenance (and expansion) of one’s own [email protected] Applications are now open and performed in over 100 countries. Celebrating his 75th birthday this year, and less subject to the vagaries of bias and knowledge. The collegiality and camara- or post to close at 4.00pm on Tuesday 30th He joins Howard Florey and Sir Professor Clark is currently working on personality. Advances in technology have derie of the Court is legendary and highly Department of Examinations November 2010. Peter Morris as the only Australians to the next generation of cochlear implants enabled introduction of new assessment valued by its members. While the Court Royal Australasian College of Surgeons have received the Lister Medal, named and hopes that by 2020 all deaf people will tools. Increasingly, the examination is based of Examiners is not exactly a ‘club’, it does 250 - 290 Spring Street Please read the important general for English surgeon Joseph Lister (1827- enjoy the gift of hearing. on defined standards and the demonstra- represent a tightly-knit group of dedicated EAST MELBOURNE VIC 3002 information and the scholarship 1912) whose work on antiseptics was Representing the College at a dinner tion of clinical competence. It focuses on and committed surgeons, genuinely inter- conditions prior to applying, these are on > Application forms are available for fundamental to the development of to celebrate Professor Clark’s birthday, and clinical judgment and operative decision- ested in the teaching, assessment and the the College website at www.surgeons. downloading via the College website org. Please follow the prompts from sterile surgery. The recipient of the award at which the announcement of the award making, rather than testing pure basic sci- maintenance of surgical standards. the Research and Audit menu to Travel is determined by the Royal Society, The of the Lister Medal was made, Professor ence. To this end, most specialties have Being an examiner involves much hard > The policy in respect to Appointments to Scholarship Opportunities. Alternatively, Royal College of Surgeons England, the Julian Smith said Professor Clark’s removed, or are in the process of remov- work and commitment. Nevertheless, it is contact our Scholarship Coordinator at the Court of Examiners and Conduct of the University of Glasgow, The Royal College achievements were of historic proportions. ing, the basic science components from this sort of person that the College hopes [email protected]. Fellowship Examination can be found on the of Surgeons in Ireland and The Royal “His work has enabled the deaf to their Fellowship examination and replac- to continue to attract so that the same high College website. Please submit applications by College of Surgeons in Edinburgh. hear. Few others can make a claim of such ing them with components assessing the quality of examiners may be maintained into 30th November 2010 to: Professor Clark’s work has been significance. Some 200,000 people have clinical application of this knowledge. Pure the future. If you, as a Fellow of the College, > For inquiries, please email The Scholarship Coordinator recognised by other distinguished bodies. had their lives changed for the better, and it basic science is now tested as part of the ge- are interested in becoming an examiner, and Royal Australasian College of Surgeons [email protected] PO Box 553, Stepney SA 5069 In 2005 he received the International is very appropriate that this be recognised neric and specialty-specific Surgical Science contributing to your profession in this way, P: +61 8 8363 7513 Speech Communication Association – by events such as tonight’s and by the Examinations earlier in SET training. please contact Narelle Hardware, Manager, www.surgeons.org F: +61 8 8363 3371 Medal for his contribution to speech awarding of the Lister Medal,” Professor Being an examiner now requires Examinations. Email narelle.hardware@sur- science and technology. In 2007 he Smith said. specific skills and expertise if the geons.org or telephone +61 3 9276 7471. [Surgical News] Page 14 October 2010 [Surgical News] Page 15 October 2010 Regional News

within this region), neoplasia and degenerative conditions. Access Disaster management to appropriate contemporary surgical advice and intervention is One of the meeting’s themes was disaster management. This Pacific Islands Surgeons meeting frequently delayed by transport difficulties and also the widespread appropriately reflected the recent tsunamis in Samoa and Tonga; and reliance upon local healers as the first point of care. Consequently, the importance of this was reinforced by the personal experiences August meeting in Vanuatu brought together representatives from across the region there is a much higher morbidity and mortality within this region. of every participant in the 7.5 magnitude earthquake that struck Professor Ikau Kevau, PNG School of Medicine, and Professor Port Vila late on the Tuesday afternoon. Aftershocks continued Eddie McCaig, Fiji School of Medicine, discussed developments in throughout the week (and after all but the local participants had the Masters in Surgery courses. These two programs have resulted left Vanuatu) and were an ever-present reminder of the instability in a significant number of locally trained surgeons who contribute of much of this region. John Kyngdon, At the opening ceremony, participants at the meeting were led to to the provision of surgical care in the region. Both programs are This was an outstanding meeting of immense value to all Chair, NZ National Board the venue by a ceremonial welcoming party. Delegates were welcomed of four years duration and cater to doctors from throughout the participants, both those from Pacific Islands and those from by Professor Eddie McCaig, President of the Pacific Islands Surgeons Pacific. Despite this valuable educational development, serious New Zealand and Australia. The strong collegiality, support and his meeting brought together Pacific Islands’ surgical leaders Association and myself as Chair of the New Zealand National Board. workforce deficiencies remain and these cannot be addressed in the leadership demonstrated within this group of surgeons and trainees and trainees to discuss issues of surgery provision and Keynote addresses were provided by His Excellency Jeff Langley, New short-term. It was a concern to hear that some countries are needing will undoubtedly play a significant part in the further development Tto hear numerous scientific papers. Representatives were Zealand High Commissioner to Vanuatu, and Mr Mark Bebe, Direc- to turn to places such as Cuba for undergraduate medical training of health services within this region. present from the Cook Islands, Fiji, Federated States of Micronesia, tor General, Vanuatu Ministry of Health. The meeting was formally (conducted in Spanish) to increase graduate numbers. Cuban and The meeting was made possible through the significant financial Kiribati, Nauru, Papua New Guinea, Samoa, Solomon Islands, opened by the Minister of Health, the Honourable Moses Kahu. Chinese surgeons are employed in many Pacific countries. This assistance of NZAID and the Pasifika Medical Association (PMA), Tonga, New Zealand, Australia and the host country, Vanuatu. does help the current workforce shortfall, but at times there are supported with assistance from AusAID (through the PIP and the The first day of the meeting was devoted to younger surgeon High demand for care both language and cultural difficulties. HECS programs) and sponsorship from Braune. The meeting was training. This offered visitors such as myself a valuable insight The region is vast with approximately 12 million inhabitants – more During the meeting a number of outstanding scientific papers extremely well-organised by Dr Richard Leona who was assisted by into the knowledge and judgement of surgical trainees from the than six million of these live in Papua New Guinea, approximately were presented. These included the Vanuatu Ministry of Health staff, in particular Mr John Tesserei, postgraduate programs at the Fiji and PNG Schools of Medicine. one million in Fiji and the remainder are spread over a vast area > Osteomyelitis Dr Basharat Munshi (Trainee Prize winner) and by Mr Kiki Maoate (Paediatric Surgeon in Christchurch and The trainees were at differing levels of experience and those in much smaller population groupings. This creates significant > Epidemiology of Lower Extremity Amputation Dr Rajeev Patel President of PMA) and staff from the College’s NZ Office. nearing the end of their Masters training demonstrated knowledge, difficulty for the provision of health services and surgical services > Blood Utilisation with Current Blood Ordering Practice at judgement and maturity comparable to that of similar level trainees can be provided in only relatively larger centres. Vaiola Hospital, Tonga Dr Saia Piukala in Australia or New Zealand. A Primary Trauma Care course for The ratio of surgeons to population is extremely low by Western > Congenital Diaphragmatic Hernia Dr Colin Brook nurses and other paramedical staff was run concurrent with the first standards, but there is a high demand for surgical care reflecting > Burnout in Fijian Surgeons Dr Rajeev Patel (Trainee Prize winner) two days of this meeting. injury, infection, the complications of diabetes (which is very prevalent Professor Sitaleki Finau (from Auckland) gave a public health perspective to the development of health care in the South Pacific The next Pacific Islands Surgeons Meeting and participated enthusiastically in much of the discussion is to be held in 2012 in either Tonga or Fiji. throughout the week. Dr Raj Singhal (a Rehabilitation Physician at Burwood Hospital) provided an excellent short paper on the conservative care of the patient with displaced cervical spinal injury. Dr Sammy Thomas’ (PNG) paper highlighted the importance of neurosurgery in PNG.

LEFT: The Minister of Health, Hon Moses Kahu, at the official opening of the Meeting. ABOVE: Professor Eddie McCaig (2nd from left) with surgical trainees from Fiji School of Medicine post graduate program.

[Surgical News] Page 16 October 2010 [Surgical News] Page 17 October 2010 Surgical Training

Snakes and Ladders (or Mentors and Role Models) Difficulty is, all surgeons I meet are usually my direct supervisors

Dr Ina Training or better, surgeon. However, I do I just don’t consider not feel that my relationship with “ raining is like a game of Snakes and any one of them is close enough it appropriate that Ladders. You throw the dice, get a lucky that I could actually admit to those responsible Tnumber and whoosh - up the ladder them my hopes, dreams, desires or to start your surgical training pathway. And fears. I tell them what I think they for your career then you throw another good role, and next want to know, or what they need progression should thing you know you’re up the next small set of to know. I listen attentively to their also be those to ladder rungs, past the primaries. At least, that’s operative discourses and manage- sometimes what it feels like. There are also ment plans, take notes and ruminate give you career times when you fail at something and before intently over the evidence for their advice.xx you know it, you’re down a snake and have to preferences. Any career advice I re- maximise the value of your start a whole section all over again. Drat! ceive, however, I take with a grain your progression through training.” I was pondering over a nice glass of sauv of salt. There is always a concern It does not pay to piss these people blanc and a solo dinner (yet again!) all those that what they tell me is partially off. And I strongly doubt that there is motor vehicle purchase, why snakes and ladders. Actually, I was really for their own (or someone else’s) much (or anything) to be achieved by thinking about the professional interactions we gain. I have very little trust that telling them what you really think of wouldn’t you? have and how they impact our training careers. the advice I receive is really for my your training. In particular, of the many supervisors I have benefit. Except maybe that of Ms Secondly, there is a huge There is more to financing a motor vehicle than looking at the had. Sometimes a Snake, sometimes a Ladder, Forthright, who just says it like it is, restriction on interaction with interest rate alone. It’s important to consider the after-tax costs, but from everyone of those experiences I have and calls the spade a ...... shovel. potential mentors due to time which could be affected by the finance structure, initial fees, learnt something that I believe will make me a constraints. Either they are too better surgeon. Yet to find a mentor busy working, or you are. dealership discounts and ongoing costs. Pander me, for a moment. This is going The College has tried to formalise Hence, I am mentorless. This is somewhere. the Mentor processes, with many not to say that the people I have had At Investec Experien, we help you select the finance structure Mr Eccentric, Mr Old-fashioned, Mr specialities and programs trying to exposure to do not wish to function that best suits your needs. Contact your local banker, call Younger Fellow (who is up-to-date with the match the trainees to a mentor. This in this capacity. I am convinced that 1300 131 141 or visit www.investec.com.au/professionalfinance. latest published data on their area of expertise has not worked for me, and after most, if not all, would like to see you and many others), Mr Family Man, Mr seven years involvement as a trainee progress and prosper (except maybe Unlucky, Mr Practical, Mr Sexy-but-doesn’t- of some description or another, I still Mr Controlling-Manipulative- seem-to-know-it (he may also be Mr Younger find myself mentorless. Why is this? Psychopath whose only pleasure is Fellow), Mr Re-assuring, Mr Controlling- For me, the difference between a to watch others suffer). It’s a Catch-22, a Manipulative-Psychopath, Mr Grumpy (but role model and a mentor is vast. First and conflict of interest. I just do not consider it really a Teddy Bear), Ms Forthright, Mr Cheeky, primarily, a mentor needs to understand me as appropriate that those who are responsible for Mr Gentle, Mr Unpredictable, Mr Grandpa, a human being and a person; what my back- your career progression should also be those to Mr Ladies-Man, Mr Manic, Ms Got something ground is, where I’m at, and where I’m going. give you career advice. Particularly when your to Prove and The Prof. And I need to have a reciprocal understanding of career aspirations can be so far off-stream to I cannot give their real names, but these them. They would need to be a friend and confi- their own; “Are you crazy? Why be a generalist? surgeons exist and have made a huge impact dante. Someone you have met and trust implic- You should specialise. Why would you want on my training. These role models have been itly. Where you can have a conversation about to go rural? There’s no future in it.” (This was mostly positive, with behaviours I have tried to what you really think, and there is no concern actually once said to me. Nice guy, no idea.) emulate. Occasionally, the lessons have been that what you say could ever be brought against Which brings me back to Snakes and Experien habits to try to avoid. They have been very you. Unfortunately, as a trainee, this is very dif- Ladders. Some of these role models are snakes, strong role-models. You may wonder, “Which ficult to find as all the surgeons you meet and some are ladders, but a mentor would give you one am I?” have exposure to are usually your direct super- a good overview of the board and where the But please note that I have stated here that visors at one stage or another. Therefore, they snakes and ladders lie. And sometimes you just they are role models, who model being a sur- have some (or much) direct input into your as- have to hit a snake that takes you down, but will Asset Finance • Commercial Property Finance • Deposit Facilities • Goodwill & Practice Purchase Loans • Home Loans Income Protection & Life Insurance • Professional Overdraft geon in ways that make me want to be a good, sessment, and hence some (or much) say into set you up for the ladder that brings you home. Experien

Investec Experien Pty Limited ABN 94 110 704 464 (Investec Experien) is a subsidiary of Investec Bank (Australia) Limited ABN 55 071 292 594 AFSL 234975. All finance is [Surgical News] Page 18 October 2010 subject to our credit assessment criteria. Terms and conditions, fees and charges apply. We reserve the right to cease offering these products at any time without notice. Investec Experien is not offering financial or tax advice. You should obtain independent financial and tax advice, as appropriate. ASC 2010

The 2010 Hamilton Russell Memorial lecture tients with end stage renal disease and, currently, polyethylene acetabulum and the qualities of many years been one of the surgical procedures three year patient and graft survival rates exceed this material, its excellent wear resistance, low I most admire. 90 per cent in most transplant centres. It has also friction and high impact strength have stood Over the past 30 years, there have been become clear that those patients who receive a the test of time. technical improvements in this surgery but un- “In Praise of Surgery” transplant early in the course of end-stage renal His next major requirement was to like the advances in most other subspecialties, disease experience the best outcomes. determine the means of securing these foreign these improvements are not based on techno- Continuation from September Surgical News of the lecture delivered The cost benefit of kidney transplantation materials to living bone. Methylmethacrylate logical progress, but have resulted from me- by Allan Skirving at the 79th Annual Scientific Congress, Perth compared to dialysis over a period of ten years, cement was borrowed from the dental ticulous thought and study of the embryology which is the median transplant survival time, community and in 1960, he produced and pathology of the deformity followed by the is approximately $500,000, which is approxi- a momentous publication entitled ‘The development of appropriate corrective surgical mately $50,000 per year for each year that the anchorage of the femoral head prosthesis to the technique. Suffice to say that these technical patient has a functioning transplanted kidney. shaft of the femur’ in which he demonstrated advances, linked to an interdisciplinary team Dr Thomas Starzl back in the 1960s, said the bone cement acted as a grout and not as that includes orthodontic surgeons and speech Allan Skirving that what is required in transplantation surgery a glue so that the fixation was achieved by therapists, have led to realistic goals of normal is ‘the courage to fail’ and progress since then interlocking and not by adhesion. appearance and normal function. ’ll move onto neurosurgery. It is, I think, suggests and I quote ‘looking back, the failures Charnley’s contribution, however, extended I know you are aware of the effort and fair to say that, as in many other surgical seem almost totally eclipsed by the successes’. far beyond what I have so far described: his commitment of many doctors and nurses in Ispecialties, progress has largely resulted Perhaps you should include that in your preoperative assessment and clinical and radi- many organisations from this country and from new technology which has expanded the next application for ethics approval. ological outcome measurements were meticu- around the world who are also committed to horizon and refined the precision of almost all lous. He recognised the value of laminar flow the challenge of providing these life transform- neurosurgical procedures leading to improved Orthopaedic Surgery clean air enclosures in operating theatres. His ing surgical corrections of these deformities to outcomes and reduced morbidity. Of course, eventually I have to come to ortho- operation was reduced to 149 well-described children in the developing world. I know if you These advances include frameless paedic surgery and you would have to concede and illustrated specific steps and for many could see these children, I would not for one stereotactic surgery, interventional imaging, the great difficulty I have in making just one se- years orthopaedic surgeons were not allowed moment insult you by posing the question as with MRI becoming the preferred modality lection from the many, which would easily ful- to insert a Charnley hip arthroplasty unless to whether the procedure is cost-effective. and Gamma knife surgery. fill most of my criteria. My task has been made they had visited and observed the operation I believe our medical community, perhaps Allan Skirving with College Councillor Dr Ian Dickinson at the 2010 Perth ASC. Frameless stereotactic surgery relies on easy because the selection has already been being performed at the Whittington Hospital. this College should resolve that no child in our fiducial markers, which are taped to the scalp performed by others. In The Lancet i n 2 0 07, There are many times when I wish that these region be denied access to this form of correc- before the brain is imaged. In the operating temporal lobe epilepsy typically are at the end in the Peter Bent Brigham Hospital in Bos- Total Hip Replacement was described as ‘the strict criteria were insisted upon today. tive surgery. room, the orientation of these markers is of the road, taking multiple medications, often ton, John Merrill and his team performed the operation of the century’, admittedly by three One further point I think illustrates Regrettably, at least for me, I have to draw used to register the computer containing the suffering severe side-effects, unable to work, first successful renal transplantation from one orthopaedic surgeons. The impact of this surgi- the stature of the man is that he had many to a close. Had I had time, and I assure you I brain images. Once registration is completed, unable to drive, socially isolated and desperate. healthy identical twin to his twin brother who cal solution to hip arthritis of various aetiologies instruments named after him, but he patented prepared the material, I would like to have pre- a digitising camera senses the position of the In one study, one-year post-surgery using was dying of renal disease. is undisputed, but it reaches even greater status none of them and nor did he patent his low sented my selections from all the other surgical surgeon’s instruments in space and indicates stereotactic techniques and interventional Of course, it was understood that the when it is appreciated that so much can be at- friction arthroplasty. specialties and I apologise for not being able the position of the instrument on the image MRI scanning resulted in 85 to 90 per cent of success of this operation was due to the tributed to one man – Sir John Charnley He was a special man and he deserved a to do so. displayed on the computer monitor in real patients being either free or having significantly absence of host rejection but, enormously Charnley made three major contributions to Nobel Prize. I have described just a little of the extraor- time, as the operation proceeds. reduced frequency of disabling seizures. In encouraged by the technical success of the the evolution of total hip replacement. Firstly, he Impressive though it is I would concede dinary progress which has been made in the Gamma knife surgery enables patients every respect, there was a marked improvement surgical procedure, attention became focused introduced the concept of low frictional torque that perhaps my three orthopaedic colleagues past half century or so and we can take, per- to undergo non-invasive brain surgery using in the patient’s quality of life especially in terms on the immunosuppression required for arthroplasty which he considered the basis of might have been a little more humble and haps, some vicarious satisfaction from these multiple beams of gamma radiation to focus of their social and occupational functioning. transplants from an unrelated donor or a living total hip arthroplasty design. There is a well described total hip arthroplasty as being ‘The achievements, but there is still a long way to precisely on the targeted lesion with markedly Morbidity from the surgery was minimal and family donor. There was a brief flirtation with known anecdote that this epiphany resulted orthopaedic operation of the century’ but, as go and, although some of this progress will be reduced surgical risks and faster rehabilitation. the procedure is very cost-effective. total body irradiation which achieved the from a serendipitous event when a patient whose you know, we orthopaedic surgeons don’t do made by seismic contributions from special in- The procedure is applicable to many forms of What an extraordinary achievement! desired immunosuppression, but at a cost of left femoral head had been replaced with an humble too well. dividuals, maybe from one or two or three del- benign tumours such as acoustic neuromas and profound marrow aplasia and overwhelming acrylic Judet prosthesis reported that his left hip egates attending this meeting, there is no doubt pituitary tumours; also for some metastatic Transplantation surgery infections. squeaked every time he bent forward. Charnley What about Plastic surgery? much of the progress will be Darwinian, that is, and primary intracerebral tumours as well as In this field, I have a personal reason for choos- In 1963, the introduction of azathioprine recognised the importance of low frictional It is, I know, unnecessary to describe to you the slow and incremental. vascular malformations. ing renal transplants. In 1950, my elder sister, and steroid combination therapy became the resistance at the articular interface and the devastating physical, psychological and socio- Some of you will make the appropriate ob- Although these extraordinary technological Avril, died of renal failure, having developed mainstay of immunosuppression until 1983 requirement to reduce the torque transmitted economic impact of a deforming birth defect servations, conduct the appropriate trials and advances have allowed improvement in post-streptococcal glomerulo-nephritis and when one of the most pivotal events in the his- from the metal femoral head to the socket to on the well-being of a child and this is equally experiments or perform the rigorous scrutiny almost all forms of neurosurgery it is in the nephrotic syndrome. My father, who was not tory of organ transplantation occurred with reduce the risk of loosening. He achieved this true for children in the developed world as in of clinical outcomes research. Many of you management of movement disorders and, a doctor, tried to persuade her treating doctors the introduction of cyclosporine followed by by reducing the diameter of the femoral head the developing world. The great difference, of will simply inspire your younger colleagues in particular the management of intractable to consider a renal transplant with himself as anti-T cell antibodies as well as other mainte- component to 22.2 mm in diameter. course, is that our children have access to effec- and students. No matter your role, your con- temporal lobe epilepsy which is, perhaps, most the donor. It was, of course, declined but I re- nance immunosuppressants. Secondly, after a disastrous trial of tive surgical solutions, which have the poten- tribution will ensure that the recent decades of impressive. member very clearly a few years later my father, Renal transplant is now vastly superior to di- polytetrafluoroethylene or Teflon in 1962, tial to be life-transforming. For this reason suc- innovation and progress will continue for the Pre-operatively, patients with intractable in tears, telling me that, on December 23, 1954 alysis and is the treatment of choice for most pa- he inserted the first high molecular weight cessful cleft lip and cleft palate surgery has for benefit of our patients and society.

[Surgical News] Page 20 October 2010 [Surgical News] Page 21 October 2010 ASC 2011

College & Industry Scientific Conveners Sponsored Visitors Bariatric Surgery Dr Lilian Kow Assoc Prof Daniel J. Scott USA 80th Annual Scientific CongressDr Helmuth Billy USA Breast Surgery Mr David Walters Ms Fiona MacNeill UK CALL FOR ABSTRACTS Adelaide Conference Centre Monday 2 May to Friday 6 May, 2011 Prof J M Dixon UK asc.surgeons.org Burns Surgery Mr John Greenwood Mr Ken W Dunn UK Mr Peter Davenport UK Colon & Rectal Surgery Mr Andrew Hunter Prof Ronan O’Connell Ireland Prof Frank Frizelle NZ Campbell Miles, Prof Robin PhillipsAdelaide conferenceUK centre Annual Scientific Congress Co-ordinator Craniomaxillofacial (CMF) Assoc Prof Peter Anderson Prof David David Australia Dr Michael Buckley Australia he theme for the 2011 Annual Scientific Congress is extremely appropriateEndocrine – Surgery Mr James Kollias Dr Fiemu Nwariaku USA TUnity Through Diversity: Diversity Dr Herbert Chen USA as exemplified by the nine disciplinesGeneral and the Surgery Mr Trevor Collinson Prof Michael Bailey UK numerous special interest groups that work Prof Mehran Anvari Canada together under the unity of the Royal Australa- Dr Lee Swanstrom USA sian College of Surgeons. The year 2011Head marks & Neck Surgery Mr Darcy Economos Dr Marshall Strome USA an important milestone for the College – the Dr Nicholas McIvor NZ 80th ASC. Many western world surgical colleg- Hepatobiliary Surgery Dr Mark Brooke-Smith Mr Rowan W Parks UK es no longer convene a multi-disciplinary sci- entific conference, an exception being Internationalour sister Forum Mr Mark Moore – – College, the American College of Surgeons,Medico-Legal the Mr Erik Eriksen Assoc Prof Leigh Atkinson Australia College that had a significant influence on the Scientific and Plenary program lio, aMr Minister Anthony in theMorris House of LordsAustralia and is Pro- founding Fathers of our College. Military SurgerySince June 2009 andMr Craigonly weeks Jurisevic after the con- fessorMr of David Surgery McLeod at Imperial College,Australia London. clusion of the BrisbaneDr Robert ASC, Baird members of the Prof Grant Niemann Australia Convocation & Welcome reception Adelaide convening group have applied them- Congress faculty Neurosurgery Dr Stephen Santoreneos Prof Peter Wormald Australia The Convocation will be held at the Adelaide The entire program will benefit from an selves to planning the 2011 conference. Suren Prof Takeshi Kawase Japan Convention Centre at 4.30pm on Monday 2 Krishnan, Congress Convener, and Tom Wilson, outstanding invited faculty of 40 surgical Pain Medicine May. All delegates and associates are invited Congress ScientificAssoc Convener, Prof Andrew have led Zacest an out- leadersProf from Kim Australia, J Burchiel New ZealandUSA and from Prof Yucel Kanpolat Turkey to attend. Any Fellow who has received their standing group of Adelaide surgeons and the around the world – the US and UK, Canada, Fellowship in the past five years, andRural who Surgeryhas Rural Surgery ConvenerAssoc ProfMatthias Matthias Wichmann Wichmann EuropeDr Nadineand Turkey. Caron This impressiveCanada faculty of not previously convocated, is invited to register from Mt Gambier, and an excellent program CongressDr Lloyd Visitors Einsiedel is made possible Australiaby funding Dr Christian Mueller Australia to attend the ASC as a convocating Fellow. has resulted. The scientific program will be held to participating sections from the College’s own Annual Scientific Congress Convocating Fellows receive complimentarySenior Surgeons from Tuesday Group 3 MayMr toGlenn Friday McCulloch 6 May 2011. Visitor – Funding program and from our– industry registration for the conference and their family partners. The College visitor funding is sourced Surgical EducationThe plenary programAssoc Prof is a Mellick keystone Chehade of the Prof Richard Reznick Canada Adelaide Convention Centre, Adelaide, Australia members are welcome to attend the conferral Congress. The contentMr Adrian cannot Anthony be replicated in from Fellows’ annual subscription fees, and not of Fellowship. Further details regarding strictly sectional programs, which is a reflection from the College Foundation, as it was until 2002. Surgical History Assoc Prof Susan Neuhaus Ms Libby Stewart Australia convocating and College gown hire are of the breadth of interests represented at the ASC. Funding from industry is now used to enhance 2 – 6 May 2011 available from the ASC Executive OfficerSurgical Katie Oncology Dr Brendon Coventry the scientificDr Clifford program Ko of particular sectionsUSA rather Fagan at ‘[email protected]’. The plenary topics all address vital surgical than funding individual speakers to a program. Transplantation Surgery Dr Christine Russell Prof Peter G. Stock USA The Honourable Alexander Downer has matters related to training,Mr John politics Chen & standards. accepted the College’s invitation to present the Tuesday: The interface between surgery and Call for abstracts http://asc.surgeons.org George Adlington Syme oration duringTrauma the Surgerygovernment – for Assocbetter or Prof for Robertworse. Atkinson ThisDr issue Karim of SurgicalBrohi News containsUK the Call Prof Keith Willett UK Convocation. After a long career as a Federal Wednesday:Commercialisation of the surgical for Abstracts form – it is stapled in the centre politician and the long-serving MinisterUpper for GI Surgeryprofession – ownership,Dr Harsh ethics Kanhere and the law. pagesProf as Michael a pull-out Griffin section. TheUK Adelaide Foreign Affairs and Trade, Mr DownerVascular is now SurgeryThursday: TrainingProf the Robert tsunami Fitridge of new medi- programProf Stephenconveners Cheng have scheduledHong copious Kong 80 Years of the ASC an ambassador with the United Nations with cal graduates and training in the private sector. timeProf for Marioresearch Lachat presentations, anSwitzerland important special responsibility for Cyprus. Mr Downer Friday: Quality improvement in surgical featureProf of Matt the ASC.Thompson The Trainee ResearchUK Prize has an outstanding reputation as an erudite, practice – how are we doing as a profession? program has been expanded to 16 sections. Women in Surgery Dr Melissa Bochner – – entertaining public speaker. He follows in the Winning the prize is not just about the money, Royal Australasian footsteps of other political leaders who have Tuesday’s plenary will open the Congress. but the accolade in the winner’s CV. Full details College of Surgeons delivered ‘The Syme’. The first presentation will be the British Jour- regarding the Trainee Research Prize program The ConvocationRoyal Australasian is followed Collegeby the of Surgeons’nal of Surgery Gardens SocietyT: Visitor,+61 3 9249 Lord 1273 Ara Darzi are on the Call for Abstracts form and on the College of Surgeons 250-290 Spring Street F: +61 3 9276 7431 President’s WelcomeABN 29 004 167 766Reception at East5.30pm Melbourne, whose Victoria, lecture 3002 is titledE: ‘Innovation [email protected] and the in- abstract submission site: asc.surgeons.org. to which all delegates and the familiesAustralia of terface between surgeryW: andwww.surgeons.org government’. Lord Suren Krishnan and Tom Wilson look convocating Fellows are invited. Darzi has been a Minister in the Health portfo- forward to seeing you in Adelaide for the 80th.

[Surgical News] Page 22 October 2010 [Surgical News] Page 23 October 2010 Keep abreast of program developments on the conference website http://asc.surgeons.org Annual Scientific Congress 2 – 6 May 2011 Adelaide, Australia

Submission of Abstracts for 13. Please ensure that you indicate on the Abstract Adelaide ASC 2011 Program Overview (indicative only) Research and Invited Papers Submission site whether you wish to be considered for: Monday 2 May Tuesday 3 May Wednesday 4 May Thursday 5 May Friday 6 May Abstract submission will be entirely by electronic means. Section Prize Sponsor Breakfast session This is accessed from the Annual Scientific Congress Bariatric Surgery $500 Johnson & Johnson Medical Masterclasses Masterclasses Masterclasses Masterclasses 7.00am – 8.20am website http://asc.surgeons.org clicking on Abstract Breast Surgery $500 Covidien Session 1 Submission. Plenary Scientific Sessions Scientific Sessions Scientific Sessions Burns Surgery $500 8.30am – 10.00am Several points require emphasis: Craniomaxillofacial Surgery $500 Johnson & Johnson Medical 10.00am – 10.30am Morning Tea Morning Tea Morning Tea Morning Tea 1. Authors of research papers who wish to have their Colorectal Surgery Session 2 Scientific Sessions Plenary Plenary Plenary abstracts considered for inclusion in the scientific (Mark Killingback for Young $500 Covidien 10.30am – 12 noon programs at the Annual Scientific Congress must Fellows & Trainees) Edward ‘Weary’ submit their abstract electronically via the Congress Endocrine Surgery Dunlop Memorial website having regard to the closing dates in the $500 Covidien (Tom Reeve prize) 12 noon – 12.30pm Pre-Congress Keynote Lectures Lecture President’s Lecture Keynote Lectures Call for Abstracts, the Provisional Program and on Workshop the Abstract submission site. Abstracts submitted General Surgery $500 Covidien Program Keynote Lectures after the closing date will not be considered. Head & Neck Surgery $500 Johnson & Johnson Medical 12.30pm – 1.30pm Lunch Lunch Lunch Lunch 2. The title should be brief and explicit. Hepatobiliary Surgery $500 Covidien American College of Hamilton Russell Rupert Downes Neurosurgery $500 College Surgeons Lecture Memorial Lecture Memorial Lecture 3. Research papers should follow the format: 1.30pm – 2.00pm Keynote Lectures Surgical Education Purpose, Methodology, Results, Conclusion. $500 Section Keynote Lectures Keynote Lectures Keynote Lectures (Not exclusively for Trainees) 4. Non-scientific papers, eg. Education, History, Military, Session 3 Scientific Sessions Scientific Sessions Scientific Sessions Scientific Sessions Medico-Legal, may understandably depart from the Surgical History $500 College 2.00pm – 3.30pm above. Surgical Oncology $500 Novartis Oncology 3.30pm – 4.00pm Afternoon Tea Afternoon Tea Afternoon Tea Afternoon Tea 5. Excluding title, authors (full given first name and family Trauma Surgery $500 Johnson & Johnson Medical Session 4 4.30pm Scientific Sessions Scientific Sessions Scientific Sessions Scientific Sessions name) and institution, the abstract must not exceed Upper GI Surgery $500 Covidien 4.00pm – 5.30pm Convocation Ceremony 1750 characters and spaces (approximately 250 words). Vascular Surgery $500 Atrium Sectional Dinners In MS Word, this count can be determined from the and Younger 7.00pm – 11.00pm 6.00pm Sectional Dinners Congress Dinner ‘Tools menu’. Any references must be included in this The submitting author of an abstract will ALWAYS receive Welcome Cocktail Fellows & Trainees allowance. If you exceed this limit, email confirmation of receipt of the abstract into the Reception Dinner the excess text will NOT appear in the abstract book. submission site. If you do not receive a confirmation email 6. Abbreviations should be used only in common terms. within 24 hours it may mean the abstract has not been For uncommon terms, the abbreviation should be given received. In this circumstance, please email Binh Nguyen Research Paper Specialties at the Royal Australasian College of Surgeons to determine in brackets after the first full use of the word. Authors of research papers and posters are invited to submit abstracts for why a confirmatory email has not been received consideration and inclusion in the Scientific Program in the following areas: 7. Presentations (slide and video) will only have electronic ( [email protected] ) PowerPoint support. Audio visual instructions will be Bariatric Surgery Neurosurgery available in the Congress Provisional Program and in Breast Surgery Pain Medicine correspondence sent to all successful authors. Important Information TO SUBMIT AN ABSTRACT GO TO http://asc.surgeons.org Burns Surgery Rural Surgery 8. Authors submitting research papers have a choice AND CLICK ON ‘ABSTRACT SUBMISSION’. Colorectal Surgery Senior Surgeons Group of two specialties under which their abstract can be considered. Submissions are invited to any of the THE CLOSING DATE FOR ALL SCIENTIFIC PAPER Craniomaxillofacial (CMF) Surgical Education specialties or special interest groups participating ABSTRACT SUBMISSION IS 25 JANUARY 2011. Endocrine Surgery Surgical History in the program. PLEASE NOTE THAT PAPER OR FACSIMILE COPIES General Surgery Surgical Oncology 9. A 50 word CV is required from each presenter to WILL NOT BE ACCEPTED, NOR WILL ABSTRACTS Head & Neck Surgery Transplantation Surgery facilitate the Chairman’s introduction. BE SUBMITTED BY COLLEGE STAFF ON BEHALF Hepatobiliary Surgery Trauma Surgery OF AUTHORS. 10. The timing (presentation and discussion) of all papers International Forum Upper GI Surgery is at the discretion of the Convener of each Section. If there are any difficulties regarding this process, please Medico-Legal Vascular Surgery Notification of the timing of presentations will appear contact Binh Nguyen, for assistance on +61 3 9249 1279 in correspondence sent to all successful authors. or email [email protected] Military Surgery Women in Surgery 11. Tables, diagrams, graphs, etc CANNOT be accepted in the abstract submission. This is due to the limitations Scientific Posters Executive Organising Committee of the computer software program. All posters will be presented electronically during the Convener: Mr Suren Krishnan 12. Authors must be registrants at the meeting for their Congress and will be available for viewing on computer Scientific Convener: Mr Tom Wilson screens at the venue. Posters will be placed on the abstract to appear in the publications, on the website Member of Executive: Dr Michelle Lodge Virtual Congress in addition to the abstract. or the Virtual Congress. Member of Executive: Mr Greg Bain Important Dates ASC Co-ordinator: Mr Campbell Miles ASC Manager: Ms Lindy Moffat Abstract Submission opens 13 October 2010 Closure of Abstracts 25 January 2011 ASC Executive Officer: Ms Katie Fagan Closure of Early Registration 15 March 2011 SA Regional Manager: Ms Daniela Ciccarello Commentary

College & Industry Scientific Conveners Sponsored Visitors Bariatric Surgery Dr Lilian Kow Assoc Prof Daniel J. Scott USA Dr Helmuth Billy USA Breast Surgery Mr David Walters Ms Fiona MacNeill UK CALL FOR ABSTRACTS Prof J M Dixon UK Burns Surgery Mr John Greenwood Mr Ken W Dunn UK Mr Peter Davenport UK Colon & Rectal Surgery Mr Andrew Hunter Prof Ronan O’Connell Ireland Prof Frank Frizelle NZ Prof Robin Phillips UK Craniomaxillofacial (CMF) Assoc Prof Peter Anderson Prof David David Australia Dr Michael Buckley Australia Endocrine Surgery Mr James Kollias Dr Fiemu Nwariaku USA Dr Herbert Chen USA General Surgery Mr Trevor Collinson Prof Michael Bailey UK Prof Mehran Anvari Canada Dr Lee Swanstrom USA Head & Neck Surgery Mr Darcy Economos Dr Marshall Strome USA Pre-anaesthesia consultations Dr Nicholas McIvor NZ Hepatobiliary Surgery Dr Mark Brooke-Smith Mr Rowan W Parks UK High quality pre-anaesthesia assessment practice benefits patients and assists surgeons International Forum Mr Mark Moore – – Medico-Legal Mr Erik Eriksen Assoc Prof Leigh Atkinson Australia Dr Andrew Mulcahy, What can be done? Mr Anthony Morris Australia Vice-President, Australian Society of Anaesthetists There is no question that ideal pre-anaesthesia assessment Military Surgery Mr Craig Jurisevic Mr David McLeod Australia practice benefits patients, but it is important to emphasise the tudies have repeatedly demonstrated the importance of Dr Robert Baird Prof Grant Niemann Australia fact that ideal anaesthesia practice also assists surgeons in their high quality pre-anaesthesia consultations in ensuring good efforts to provide best possible patient care. Neurosurgery Dr Stephen Santoreneos Prof Peter Wormald Australia outcomes from surgery and anaesthesia as well as the converse Prof Takeshi Kawase Japan S The solutions to this emerging problem will be multiple and – inadequate pre-anaesthesia assessment of patients leads to poor often location-specific, partially determined by the practice at Pain Medicine Assoc Prof Andrew Zacest Prof Kim J Burchiel USA patient outcomes. In fact inadequate pre-anaesthesia assessment has individual institutions. However, a key component in solving Prof Yucel Kanpolat Turkey been identified as a major contributing factor in adverse outcomes this dilemma will be good communication between surgeons Rural Surgery Assoc Prof Matthias Wichmann Dr Nadine Caron Canada in every triennial report into anaesthetic mortality published by the and anaesthetists. Dr Lloyd Einsiedel Australia Australian and New Zealand College of Anaesthetists (ANZCA) Improving communication will allow anticipation of Dr Christian Mueller Australia Annualsince these studies have begun. Scientificproblems Congress in advance and provide time for anaesthetists to invoke Senior Surgeons Group Mr Glenn McCulloch – – alternative pre-anaesthesia assessments where required. Health questionnaires used by either hospitals or referring surgeons to Surgical Education Assoc Prof Mellick Chehade Prof Richard Reznick Canada AdelaideWhy are anaesthetists Convention concerned? Centre, Adelaide, Australia Mr Adrian Anthony Providing a good pre-anaesthetic consult is proving a screen patients for health problems should be made available challenge because of: to anaesthetists well ahead of the operating list. The increas- Surgical History Assoc Prof Susan Neuhaus Ms Libby Stewart Australia 21> increasing– 6 May day surgery (>602011 per cent of all surgical procedures) ing utilisation of pre-hospital pre-anaesthesia consultations will Surgical Oncology Dr Brendon Coventry Dr Clifford Ko USA 2> day-of-surgery-admissions (another 20 per cent) minimise late cancellations, facilitate day-of-surgery admissions 3> the intervals between booking for surgery and Transplantation Surgery for major surgical procedures and provide improved patient Dr Christine Russell Prof Peter G. Stock USA admission to hospital is decreasing Mr John Chen satisfaction. Telephone consultations in advance of admission http://asc.surgeons.org4> the time between admission to hospital and arrival can also be used as both a screening tool and a means to address Trauma Surgery Assoc Prof Robert Atkinson Dr Karim Brohi UK in the operating suite is decreasing areas of concern for patients prior to the day of surgery. Prof Keith Willett UK 5> staggered admission times for patients 6> inadequate physical facilities for pre-anaesthetic assessment. Upper GI Surgery Dr Harsh Kanhere Prof Michael Griffin UK Staggered admission times? Vascular Surgery Prof Robert Fitridge Prof Stephen Cheng Hong Kong Whilst 80administratively Years of appealing, the ASC staggered admission Prof Mario Lachat Switzerland What is happening now? times necessarily create a situation of either an inadequate Prof Matt Thompson UK Anaesthetists are anxious not to interrupt the efficient flow of an pre-anaesthetic assessment or theatre list inefficiencies. Patients Women in Surgery Dr Melissa Bochner – – operating list. They therefore have to rush to the pre-op area or need to be informed why they are being brought in early and day-surgeryRoyal Australasian unit to conduct the pre-anaesthesia consultation in anaesthetists need to see them. whatCollege are of often Surgeons unsatisfactory conditions; they may have to consider To facilitate the most appropriate pre-anaesthetic treatment leaving an incompletely recovered patient in the recovery area. for patients, anaesthetists require the ongoing and continued Royal Australasian College of Surgeons’ Gardens T: +61 3 9249 1273 Of course, should the anaesthetist discover unexpected acute or College of Surgeons 250-290 Spring Street F: +61 3 9276 7431 support of their surgeon colleagues. Opening the channels of ABN 29 004 167 766 East Melbourne, Victoria, 3002 E: [email protected] chronic medical conditions (often unrelated to the surgical procedure) communication, particularly in healthcare institutions will Australia W: www.surgeons.org this will lead to a last-minute cancellation of the surgery. (Australian enable both the surgeon and the anaesthetist to provide the data reveal this occurs in up to 1 per cent of day cases.) highest level of quality care for the patient. [Surgical News] Page 27 October 2010 Keep abreast of program developments on the conference website http://asc.surgeons.org FOUNDATION FOR SURGERY u:CCTOTS CMC Pub:

Law Commentary

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the case of ANZASM, there is no opportunity of the College Continuing Professional The Fellow will then be required to submit this to obtain this consent. Development (CPD) Program? letter to the Department of Professional Stand- What is qualified privilege? In the face of an allegationQueensland or suggestion that ParticipationWestern in ANZASM Australia is now a require- ards for verification purposes. In this way Fellows Use of the term ‘privilege’ reflects the legal principle that enables a there was a failure in clinicalMr practices, J Lancaster it may at ment for FellowsMr I Thompson in operative-based practice selected to verify their CPD activities will consent first seem useful to refer toDr andT Porter rely upon the when a patient dies who has been admitted to the disclosure of the fact of their participation. person to resist disclosure of certain documents in a legal context. peer review assessment as an exoneration of under the surgeon’sVictoria care to a hospital partici- The details of the cases they have submitted to conduct. However, it mustNew be borne South in mindWales pating in theMr audit. B Dooley the mortality audits will not be disclosed to the that the disclosure for theseMr purposes G Coltheart could be Each yearMr 3.5 J Elderper cent of Fellows are ran- Department 41 Page: of Professional Standards. in breach of the legislation,Dr especially K Merten if the in- domly selectedScotchman’s to verify Creek their Golf CPD Club return. It is important to remember that a QAA formation from within the Mraudit K Prabhakaractivity relates These Fellows are required to submit docu- has as its core focus the identification of trends What is the purpose of qualified privilege? The general exception to disclosure – non- New Zealand Qualified privilege exists to encourage full and identifying information to a specific patient or incident, because it could mentation showing that their CPD obligations in clinical practice and the continued develop- Mr A Merrie frank disclosure and involvement in the QAA. This exception enables the audit to publish be taken to identify an individual. have been met in that particular year. ment and improvement in clinical outcomes. It Furthermore, the feedback received by The procedure for confirming whether or not is a forward looking process, designed to high- Professor Guy Maddern, The use of the term ‘privilege’ reflects the legal aggregated data which discloses trends in Singapore Total Chair, ANZASM Steering Committee principle that enables a person to resist the dis- the course of clinical practice, on a state- or a surgeon through the audit process is not a Fellow has participated in ANZASM is cur- light areas for improvement in clinical practice. Mr H Chng closure of certain documents in a legal context. territory-wide scale, on a de-identified basis. obtained in the medico-legal context, nor is rently being $6finalised. 6,720 It is anticipated that upon his article uses the Australian and New The Foundation for Surgery helps towns where these childrenit live available for analysis in the same way as selection for verification, Fellows will be required Zealand Audit of Surgical Mortality What is protected within the QAA? The nature of the protection ’normal‘ medico-legal opinion. As a matter to contact the project office of their state audit T(ANZASM) of the Royal Australasian There are three categories of information (and/ The protection effectively extends to everything of practice the College would recommend and request a letter confirming their participa- College of Surgeons as its practical example; or documents) which are protected: recorded in the course of the QAA activity. against disclosure for this purpose, as it tion in the audit. If a Fellow has had a reportable If you would like further information on however, the same principles apply to any audit • information which came to be known Therefore, everything from the information arguably offends the intended purpose of the death and has participated in the audit, they will ANZASM or on qualified privilege in general or activity (such as the morbidity audits), which solely as a result of the QAA created in the surgical case form submitted to legislation and the prerogative of the quality receive a letter confirming their participation. If a terms, please contact either Felicity England, is a declared quality assurance activity under the • documents brought into existence solely as the audit to a first- or second-line assessment YES, Iassurance would function.like to donate to our FoundationFellow has not for had Surgery.a reportable death, they will Project Contracts Manager (felicity.england@ Commonwealth Health Insurance Act 1973. a result of the QAA report is protected. With everyHow donation will over my $1000,privacy the be College protected is able now to support that Researchreceive &a Internationalletter confirming Outreach that Programs. they have met surgeons.org) or Mr Gordon Guy, PLEASE NOTE that this article is general in nature. It should be noted that it is only the participation in ANZASM is a requirement their obligations for the purposes of the audit. ANZASM Manager (gordon.guy@surgeons. Anyone requiring particular advice or seeking a considered • the participants in the QAA as long as they

opinion on the rights or obligations under qualified are acting in good faith (examples include information held within the QAA which 10-AUG-2009 Date: Name: Speciality: privilege should seek independent legal advice. the peer reviewers, surgeon participants is protected. Much of the information Qualified privilege is a generalised and patients). submitted to a QAA is accessible in other Address: description given to the protection of areas and in other forms, such as hospital Telephone: Facsimile: information and documents within a quality What are the consequences of disclosure? records. This information (in its original assurance activity. ANZASM operates as a The unauthorised disclosure of any informa- or alternative location) does not attract Your passion. My cheque or Bank Draft (payable to Royal AustralasianFundraising College of Surgeons) for $ Golf. Day quality assurance activity and is used as an tion held within a QAA is an offence under protection through the QAA activity, though example for the purposes of this article. the Act and carries a penalty of up to two years it may of itself be protected by other means, Please debit my credit card account for $ . & Gala Dinner imprisonment. However, under the Common- such as throughYour privacy skill. legislation. What are Quality Assurance Activities (QAA)? wealth scheme (as in many others), there are Mastercard Visa AMEX Diners Club NZ Bankcard Friday 1 April 2011 A QAA is an activity designed to monitor prescribed circumstances in which information Some issuesYour to keep in mind legacy. Huntingdale Golf Club and evaluate health services, with the goal can be disclosed. Unless the proposed disclo- The privilege is absolute in its nature. However, Credit Card No: Expiry / of improving the quality of health services sure meets the prescribed test, the information it is also possible to waive the privilege, either and Grand Hyatt Ballroom, Melbourne delivered to the Australian public. ANZASM (or document) cannot be disclosed. by intention or by implication. If, for example, is most notable because it includes the peer a person consents to identifying information Card Holder’s Name - Block Letters Play a round Card Holder’s of golf Signature at the exclusive Date Huntingdale Golf review component, in which nominated The test for permitting disclosure? being disclosed, then the privilege is waived Your I would like my donation to go to: reviewers give feedback on clinical practices There are three circumstances in which and cannot be regained. Club in Melbourne’s famous ‘sandbelt’ region. General College Bequests International Development Program

and performance. The peer review process information held in a QAA can be disclosed: Plate: Scholarship and FellowshipThen enjoy program a gala Internationalblack tie dinner Scholarship at the ProgramGrand Hyatt with world class entertainment, superb auction items enables clinical events (albeit with the benefit • Information (or a document) can be I am a surgeonFoundation. submitting to ANZASM and I have a potentialand contribution fantastic prizes. to the CulturalProceeds Gifts will Program assist the Foundation to provide surgical scholarships, expand medical research, of hindsight) to be analysed and reviewed for disclosed, as long as the disclosure does not receiving peer-reviewed reports. What can I I do not give permission for acknowledgementaddress indigenous of my gift in anyhealth College challenges Publication and deliver international surgical care. ongoing improvement of clinical services. identify, either expressly or by implication, a do with this information? C

In order to attract the qualified privilege particular individual or individuals. The fact that you are participating in the Please send your donations to: M Foundation for Surgery

protection, ANZASM is declared under the • A person who would be identified by a dis- audit means that you are protected. The Y

Health Insurance Act 1973. There are similar closure (either expressly or by implication) peer-reviewed reports are also protected. It is AUSTRALIA & OTHER COUNTRIES NEW ZEALAND K provisions in the various state and territory has consented to the disclosure. possible for you to consent to the disclosure Royal Australasian College of Surgeons PO Box 7451 GGSS College of Surgeons Gardens Wellington South New Zealand health legislation schemes; however, the • Information or a document can be disclosed of information, to the extent that it may 250 - 290 Spring Street Tel: +61 4 385 8247 EAST MELBOURNE VIC 3002 Fax: +64 4 385 8873 Commonwealth scheme has proved to be to the federal minister if it is necessary for identify you. Of course, once information is Support the Foundation for Surgery relatively static in its terms over time and has the disclosure to occur, for the minister to disclosed, the privilege of the protection of the benefit of being available for application determine whether certain conduct (detailed that information is lost. SURGICAL NEWS P41 / Vol:10 No:7 August 2009 in all states and territories. Hence, the in the disclosure) constitutes a serious offence It is also important to remember that you Proceeds will also support other worthy medical and children’s charities. Commonwealth scheme provides consistency against a law in any state or territory cannot disclose information which either for activities such as the College’s audits which A person may be liable to a penalty of up to expressly or implicitly identifies another Book now as places are limited. For more information or bookings email PM [email protected] or [email protected] operate in many (and in some cases, across) two years imprisonment if they disclose informa- person in the absence of their consent – this state or territory boundaries. tion outside of these prescribed circumstances. would include a patient or peer. Obviously in

[Surgical News] Page 28 October 2010 [Surgical News] Page 29 October 2010 Younger Fellows Grant calling creative surgeons...

Covidien Travelling Fellowship Grant Do you have an hobby An invaluable three weeks at the Chang Gung Memorial Hospital in Linkou, Taiwan ? Like painting, photography, glassa r blowing, ti s ti sculpture, c woodwork, ceramics or jewellery making. If so and you’d like to take Frank Wang (back right) with (front row) Professor Yi Yin Jan (Director of Department of Surgery), Professor Miin Fu Chen (Emeritus President of Chang Gung Memorial Hospital) and Professor Ta Sen Yeh (Director of Division of General Surgery) and other members of the department. advantage of this opportunity please contact Lindy Moffat Frank Wang [email protected]

his was not the first time I had been to Chang Gung Memorial Hospital Tin Linkou, Taiwan. I can still remem- ber the fascinating three weeks I spent there as We expect to repeat the very part of my sixth year elective term under the successful art exhibition held at supervision of the then Director of General the 2002 Adelaide ASC. Surgery, Professor M. F. Chen. Returning to the hospital some 11 years later to undertake one year of hepatopan- creatobiliary (HPB) and liver transplantation fellowship, I am still amazed at the sheer size of the hospital campus and the available medical technologies and infrastructures. Chang Gung Memorial Hospital is a privately owned, universityaffiliated, tertiary referral medical centre offering level 1 trauma service. The main campus in Linkou has 3,715 wards and operating theatres has been care- The other personal achievement has been beds across the adults’ hospital, the children’s fully streamlined to improve overall efficiency. the completion of my Master of Clinical Epi- hospital and the women’s hospital – 150 of Nursing specialists such as cancer care/ demiology (Biostatistics specialisation) with which are allocated to general surgery. It transplant co-coordinators and operating guidance from the academic professors in also possesses 90 operating theatres, with six assistants have been heavily relied upon to Chang Gung University. dedicated general surgical theatre rooms. In overcome the relative shortage of medical staff. What cannot be over-emphasised is the addition, there are four general surgical One thing that has been echoed by all invaluable support I have received from intensive care units, including one ICU for travelling Fellows is the fantastic opportunity the Younger Fellows Committee and the liver transplantation and the other for trauma to experience a different culture in surgical generous sponsorship from the Covidien patients. As one could imagine, getting lost in training. In contrast to the nation-wide SET Travelling Fellowship Grant. The financial the tangled maze of hospital corridors is not an selection, the surgical training in Taiwan is contribution from the travel grant has assist- infrequent event. entirely hospital-based. Advanced surgical ed me in paying for the accommodation and The Department of General Surgery has a training occurs in the last three years of the supported the cost of living in Taiwan and ena- particularly strong focus on HPB surgery and five year surgical residency program and each bled me to broaden my experience in HPB sur- liver transplantation, performing more than 75 trainee is assigned a mentor for the duration gery and liver transplantation. major liver resections and up to 75 pancreatic of the training to ensure high standards of resections annually. In addition, there are two References clinical and technical skills. liver transplantation lists per week, operating 1. Kuo IM, Wang F, Liu KH, Jan YY. Post-gastrectomy The trainees work six days a week and up to 70 liver transplants per year; the major- acute pancreatitis in a patient with gastric carci- the concept of safe working hours is virtually ity of which would be living related adult liver noma and pancreas divisum. World J Gastroenterol non-existent. There is a significant emphasis 2009;15(36): 4596-4600. transplantation. Space has been reserved at the Adelaide Convention Centre for Fellows on academia within the hospital and the de- 2. Wu TJ, Wang F, Lin YS, Chan KM, Yu MC, Lee partment, as attainment of higher degree and WC. Right hepatectomy by the anterior method with to display artworks for purchase or for display. Enormous caseloads research publication has a direct impact on liver hanging versus conventional approach for large The ASC returns to Adelaide in 2011 – a city with a fine reputation for the arts. A typical surgical outpatient clinic would see the progression along the surgical hierarchy hepatocellular carcinomas. Br J Surg 2010;97(7): 1070-1078. 60-80 patients in half the day between the and financial remuneration. I have been very consultant surgeon and the senior registrar fortunate to be involved with several clini- 2011 Younger Fellows Forum, (fifth year surgical resident). In order to cope cal research projects1 last year, among which Barossa Valley South Australia adelaide ASC & the arts with the enormous caseloads, surgical patient one original article has been published in the 29 April - 1 May 2011 Younger. journey from outpatient clinics to surgical British Journal of Surgery2 as co-first author. [email protected] [Surgical News] Page 30 October 2010 [Surgical News] Page 31 October 2010 Professional Development

Royal Australasian College of Surgeons Trauma Committee presents …

A revolutionary product, Alcohol and Injury Workshop the ultimate all-in-one medical facility. THURSDAY 18 NOVEMBER 9am – 5pm medical at 250 Spring Street, East Melbourne Occupational Medicine (Bridging) Course The annual Trauma Committee workshop is on Alcohol November workshops will engender better understanding of work practices suites and Injury. There will be a healthy forum for debate available from a wide range of speakers including researchers, now hotel and alcohol industry, politicians, health ministers Come on a tour. and government officials. We invite leadership and involvement from all parties involved in this area.

The forum will: Edward Schutz, FRACS BlueScope Steel >expand on the issues surrounding alcohol-related injury, Course Convenor and member of Medico Legal Committee Friday, 19 November, Wollongong particularly in the young This site produces steel from the blast furnace through to milled >review latest evidence on alcohol & injury urgeons have an important role to play in assisting patients >review alcohol policy reform product and many distinct processes. It is a huge site and we will be to successfully return to work. An understanding of a pa- .fully furnished medical suites. >develop recommendations to reduce alcohol related injury transported by bus to several sections of the plant and ‘kitted up’. It is .hospital with 7 operating theatres. on behalf of the Royal Australasian College of Surgeons Stient’s working environment is vital in order for surgeons a noisy site and we will have speaker headphones. Participants must .doctor concierge & chauffeur service. to advise on restrictions and alternatives to their work practices. be fit enough to climb stairs in order to see workers operating all the .most advanced technology in Australia. Knowing more about workplaces can also help to improve com- processes and machinery. munication between all stakeholders involved in the return to .staff lounge with complimentary meals. For further information, or a copy of the registration form This is a opportunity to see the equivalent of four factories in one: work process. Ceilidh McGrath contact Lyn Journeaux, Trauma office, Royal Australasian • Blast furnace, Located on the corner ph. 02 8904 1500 College of Surgeons, Tel: 03 9276 7448; Fax: 03 9276 7432; The Occupational Medicine (Bridging) Course incorporates • Basic oxygen steelmaking, of Queens Rd and m. 0412 772 048 CONTACT whole day factory visits. Previous courses have proved to be a very • Continuous slab casting, and Dora St, Hurstville e. [email protected] email: [email protected] w. www.medicacentre.com.au $165 full registration, $150 FRACS members and efficient way for Fellows to see many commonly performed jobs, • Hot strip mill. EARLY BIRD rate (registration before 8 October) which are of significant benefit in case assessment and in providing These activities have activity has been approved in the College’s CPD return to work advice. Fellows who participated in visits in early 2010 Program. Fellows who participate can claim 5 points per hour in Cat- to the Ford Assembly Plant, Melbourne, and to the Coal Mine Train- egory 7: Other Professional Development /Category 8: Medico Legal. ing Facility, Woonona, found the experience very rewarding and were For more information visit www.surgeons.org and click on amazed at what they saw and learnt. Fellows or contact the Professional Development Dept on Two more workshops are planned for 2010. Each workshop will +61 3 9249 1106 or email [email protected] have: • an introduction to the industry, • case presentations of successful return to work events by recovering workers and treating doctors, School of Public Health • a tour of the operations, and Community Medicine • information about each site’s Return to Work program, and Faculty of Medicine University of New South Wales • a question-and-answer session.

Graduate study in Public Health & Health Management Established since 1977 Future workshops In2Store and Sutton Tools Improve your career prospects through postgraduate study Friday 12 November, Melbourne with the School of Public Health and Community Medicine.

Morning: In2Store in Somerton, a northern suburb of Melbourne. We are a leading educator in Public Health and Health This is the largest undercover distribution centre in Australia. It Management, providing high quality and flexible programs to suit busy professionals, either part-time or full-time, by handles the Coles distribution centre and also several other major distance, face-to-face or intensive workshop mode. We offer: logistics operations. The operations we will see include transport, • Master of Public Health storage, forklifts, conveyors and assembling of orders using both With optional specialisations in: mechanised and manual handling processes. Part of the visit will - Infectious Diseases Epidemiology and Control include interactive case presentations. - Aboriginal & Torres Strait Islander Health (proposed) - Health Promotion Specialist Consultants in permanent Afternoon: Sutton Tools in Thomastown, close to In2Store. - Primary Health Care and temporary medical staff placements. This is a large precision engineering company which has been - International Health manufacturing cutting tools over four generations, including • Master of Health Management Contact Carol Sheehan • Master of International Public Health medical drills. The company is actively training apprentices and • Masters by Research and PhD Telephone 03 9429 6363 engaging with the community. You will see workers operating a Opportunities are also available to fast-track Facsimile 03 9596 4336 wide range of machinery and packaging and distribution aspects. your career by completing our combined Part of the visit will include interactive case presentations with Email [email protected] Masters degrees. the expectation of seeing workers in their return to work jobs. Website www.csmedical.com.au Programmed maintenance activity is also planned to coincide Address 22 Erin St Richmond 3121 with the visit so you will see the replacement of grinding wheels, www.sphcm.med.unsw.edu.au Enquiries: Tel. (61) (2) 9385 2507, Email: [email protected] which is a more complex operation.

[Surgical News] Page 32 October 2010 [Surgical News] Page 33 October 2010

Journal Ads.indd 1 20/08/2010 4:56:12 PM Successful Scholar College Awards

Findings could revolutionise tumour treatment Congratulations on your achievements Scholarship aided investigation that could drive cancer research for the next 100 years We salute two worthy recipients of College Awards Trainees Association Chair Matthew Peters Christine Allsop Dr Tinte Itinteang medicine, the news of the award The John Corboy Medal 2010 Gordon Trinca Medal 2010 presented in Belgium was kept quiet for atthew Peters is a fitting inaugural recipient his award is presented to 15-year-long investigation into some months as intellectual property Mof the first John Corboy Medal, given that he Tan individual who has the causes, behaviour and treat- rights were registered. succeeded John Corboy as the Chair of the Royal excelled in any of the following A ment of strawberry birthmarks Dr Itinteang, originally from Kiribati, Australasian College of Surgeons Trainees’ Association criterion (haemangioma) has culminated in findings conducted his research through Victoria (RACSTA) upon John’s tragic passing in late 2007. 1. An outstanding contribution to that could revolutionise the treatment of University’s School of Biological Sciences Matthew Peters is a leader among Trainees and the Early Management of Severe certain tumours. under the supervision of Dr Darren Day is highly respected by his peers. He has served the Trauma (EMST) program. The research, headed by internation- and Professor Tan at the Gillies McIndoe college for five years in several roles and capacities with 2. A major contribution to ally-renowned New Zealand Plastic and Research Institute, and in collaboration intelligence and dedication. trauma education or research Reconstructive Surgeon Professor Swee According to Dr Itinteang that great leap for- with pathologist Dr Helen Brasch from Matthew was first elected to the RACSTA committee in 2005. He served as Chair 3. Demonstrated leadership in the management of the in- Tan, discovered not only the genes that con- ward came with a surprise discovery that beta the Hutt Hospital. Matthewof the Queensland Peters committee for two years and as Chair of the RACSTA Board for jured patient. Christine has contributed in all these areas of trolled both the growth and remission of the tu- blockers could cause the tumour to regress, yet He said the team had recently received ethi- two years. During his tenure, he has represented Trainees at the Board of Surgical trauma care. mours, but also isolated the stem cells involved. even then the mechanisms were unknown. cal approval to begin a clinical trial using ACE Education and Training, Education Board, the Surgical Leaders Forum, and as a The EMST program celebrated its 20th year in Australia That discovery in turn led to the eureka Looking into that part of the puzzle became inhibitors for the treatment of haemangioma, Council Observer for two years. and New Zealand in 2008. Christine was a pivotal member of moment when the team, working out of the the basis of his PhD. which they believe could result in even lower SoHe what continues tocan serve the you College doas a member about of the RACSTAit? Executive. He the team that nurtured its beginning. In September 1986, she Gillies McIndoe Research Institute based at “We discovered that it was the Renin- doses, less side effects and faster regression. is an active participant of the Academy of Surgical Educators Advisory Committee, accompanied Gordon Trinca, Stephen Deane, John Graham Hutt Hospital in collaboration with scientists Angiotensin system that was governing the He wished to thank not only the College and is a co-opted member of the Younger Fellows Committee. and Peter Danne to San Francisco to a special Advanced at the School of Biological Sciences at Victoria behaviour of the stem cells, which was a for its support through the scholarship, but In all of these representative roles, Matthew has been a consistent and forthright Trauma Life Support (ATLS) training course for overseas University of Wellington, uncovered the system considerable surprise given that it was thought also the financial assistance provided by advocate of Trainees. His views are widely respected, and as a result he has increased participants. Their task was to adapt and introduce the controlling the behaviours of the stem cells. only to regulate blood pressure,” he said. the Surgical Research Trust, the Wellington the profile of RACSTA and afforded it significant credibility. course to Australia and New Zealand. The American College Part of that research was undertaken “Now we have found that using the beta- Regional Plastic Surgery Unit Research & Matthew has madeAnyone major contributions who to the establishment, growth and insisted from that the the course bullyingbe rebadged as the legal aspects of by Plastic and Reconstructive surgical blocker Propranalol to block renin, stops stem Education Trust, the Reconstructive Plastic success of the Trainees’ Association. Thanks to his effectivehas leadership, suffered RACSTA has copyright had not been secured. EMST was born. trainee Dr Tinte Itinteang (pictured above cell multiplication which causes these cells to die, Surgery Research Foundation and Victoria evolved into a mature behaviourand well organised body of that contributesothers strongly should to surgical be Christine’soffered role was to recruit, develop and train the course with colleagues), the 2009 recipient of the meaning that we can shrink the tumour within University of Wellington’s Internal Fund. training. He has played an integral role in improving the relationship between co-ordinators in order directfor the program to begin. Course co- Foundation for Surgery Scholarship. days and have it disappear within months.” “The nature of such research into cell surgical Trainees and the College. During his and tenure, RACSTAif needed initiated several mediation ordinators are theor backbone of the program. They have .to “Haemangiomas develop shortly after The findings of the research have met with and molecular biology is very expensive with significant projects includingsupport a survey of trainee working hours, and a training term structure the course, managecounselling the logistics, run all aspects of birth and affect up to one in 10 children, such admiration the team has already been the cost of consumables quite high and these feedback form. Matthew’s service in these initiatives will help to ensure that the the course and keep everyone on side and liaise with directors, growing rapidly in the first year of life and then awarded the prestigious John Mulliken Prize organisations funded most of it for which I am quality and safety of surgical training posts in Australasia is maintained. instructors and participants. She took on the task with great diminishing over the next decade,” he said. for the best basic science paper presented in greatly appreciative,” he said. Matthew’s astuteness and diplomacy skills have been great assets in helping the enthusiasm and dedication with an attitude that nothing “However, for 10 per cent of these children, Brussels at a conference of the International Dr Itinteang is now in the process of writing College to negotiate several challenges. Matthew had significant representation in was unachievable or impossible. She led by example. It was the tumours can grow so aggressively they can Society for the Study of Vascular Anomalies in up his PhD Thesis and will return to the Plastic the transition to the SET scheme, and his input and insights helped to ensure that essential for courses to be run in regional and remote areas. compromise the child’s airway, eyesight and April of this year. and Reconstructive surgery training program this was a smooth transition for most Trainees. Christine had an ability to set up a course in any environment, hearing and can ulcerate causing intense pain In June, Dr Day and Dr Itinteang gave three in December. • Trainees Say, haveSTOP! appreciated ThisMatthew’s is consistent often focus the on mosttransparency effective and no matter and how powerful under-resourced ormeasure. difficult. Soon she had a and bleeding for the infant. presentations on their work at the annual meet- “I have always wanted to be a surgeon sci- fairness, in such areas as Trainee interviews and selection criteria. He has been willing group of committed co-ordinators who followed her “Until recently there was no satisfactory ing of the International Society for Stem Cell Re- entist and was greatly honoured to receive the proactiveSay in thethat College’s you response fi nd to bullying this and behaviour harassment. unacceptableexample. She set the standard and the attitudinal personality treatment for these children, and doctors resort search in San Francisco while Professor Tan has Scholarship from the College, but still when Matthew has fostered good relations between the College and several external of our course co-ordinator group. to high dose steroids or even in severe cases been invited to address the American Society of I began this research I didn’t expect to be in- •parties. Document On Matthew’s initiative,threats an internationalor actions collaboration taken of Trainees’ by the bullyChristine has made many other contributions to trauma chemotherapy. Plastic Surgeons’ Meeting in Toronto in October. volved in such exciting discoveries,” he said. Associations was established, with Trainee representative groups from the US and education and research. An intensive care trained nurse; she Professor Tan has been quoted in New “Yet the enigma and mystery presented by the UK. He was awarded the Hugh Johnson Travel Grant for 2010, which he used is currently the Trauma Review Project Manager for the New Tumour ‘suicide’ Zealand publications as saying the research the behaviour of the haemangioma presented a •to foster Discuss this collaboration. concerns He initiated and with presented your a joint internationalsupervisor trainees’ or Southsomeone Wales Institute equivalent of Trauma and Injury like Management. your “Yet while such problematic haemangiomas into the haemangioma has the potential to great challenge that was hard to resist. perspectivementor paper on if working the hours supervisor in surgical training is at thethe last Americanproblem College She has been a committee member of the NSW Death Review affect only a small proportion of children, what drive cancer research for the next 100 years “Like all PhD students there were mo- of Surgeons’ Clinical Congress. Committee, the Trauma Services Committee and the Trauma made them a fascinating subject for research is through the search to find methods to force ments I felt a lot of doubt about my work, Matthew is regarded as an excellent and compassionate doctor. He has selflessly Network Committee. that they obviously had internal systems that tumour stem cells to die themselves rather wondering if I had gone down the right path •devoted Consider his time to the making College while maintaininga complaint his family commitmentsunder theas a Employer’sChristine has published harassment and presented nationallyand and caused the tumour to grow and then spontane- than finding ways to kill them. of investigation, but then we picked up this husbandbullying and devoted policy father of two, and continuing his training in plastic surgery. internationally on trauma care. Her contribution has been ously regress and if we could understand that clue about the beta-blockers and then it just The four criteria for the John Corboy medal are outstanding leadership, selfless recognised by this College by the awarding of the Merit system we could perhaps find a way to make Intellectual rights steamrolled, making this research a hugely service, tenacity, and service to the Trainees of the College. Matthew Peters has award in 1991. She is the first woman and the first nurse co- the tumour cells die faster or, as we say, com- So significant are the implications of the satisfying experience.” •fulfilled Consider all of these criteria making with excellence, a complaint and he fully deserves under the Award theof the College’sordinator to receive harassment this award. and mit suicide.” research for cancer treatment and regenerative With Karen Murphy inauguralbullying John Corboy policy Medal. With Gregory O’Grady With Phil Truskett [Surgical News] Page 34 October 2010 [Surgical News] Page 35 October 2010 • Seek support from the Royal Australasian College of Surgeons Trainees Association (RACSTA), your peer network, colleagues or Human Rights Commission. Email [email protected] about the issue or give the Support & Advocacy Portfolio Chair of RACSTA a call • Seek support from the Dean of Education or Executive Director of Surgical Affairs (Australia & New Zealand) at the College

The fact that the harassment and bullying was not intentional is no defence!

08

RACS_Bullying_A5.indd 8 3/12/2009 9:54:59 AM surgical training RACS Member Advantage your ultimate benefit experience 1300 853 352 www.memberadvantage.com.au

Short-term specified training An IMG can now be assessed by the College in three different ways

College. While IMGs applying for an AoN their country of training at the end of the assessment are generally also assessed short-term program, which shall not be for RACS Fellows and Trainees are saving everyday! for comparability, an AoN assessment on a period of longer than two years. its own does not lead to Fellowship. Based on a position description and details Simon Williams The Specialist or Specialist in Training IMG of the training program, the College’s role our service Your Benefit Your savings p.a. Chair, Board of Surgical Education undertaking a short-term specified training in this assessment is to determine if a) the and Training position assessment is not as well known as the position offers valid educational experience Gold Credit Card Save on fees and extra benefits $170.00 n 2008, a uniform process for assessing other assessments performed by the College. and b) if the IMG nominated for the position Car buying service Save up to 15% off dealer price $3,000.00 International Medical Graduates (IMG) This assessment is available to IMGs who may has the appropriate skills and experience was developed as a Council of Australian not have a specialist qualification, but wish to to undertake the educational program. At a I Home loans Save up to 0.75% off variable rates $2,625.00 + Governments (COAG) initiative and implemented undertake a period of practice to Australia to minimum the position must provide: to provide nationally consistent alternative acquire specific skills and knowledge. IMGs • an appropriate scope of work Accommodation Save up to 15% off at 60,000 hotels in over 134 countries $190.00 pathways to conditional registration. These were are required to apply directly to the Medical • adequate clinical and academic the Competent Authority pathway, the Standard Board of Australia for conditional registration, supervision and Qantas Club Save with corporate rates $340.00 pathway and a revised Specialist pathway. with support from the relevant College. • a designated supervisor The College has a role in the Specialist Prior to submitting an application for With the implementation of the Medical Private health insurance 5% discount on current health products $285.60 pathway. There are three different ways an IMG assessment, it is essential that the employer/ Board of Australia (MBA) there is an can now be assessed by the College of Surgeons. sponsor and/or institution has assessed and expectation that the IMG or their agent will Magazine subscriptions 8% off already reduced prices on subscriptions $146.60 • Advanced standing towards comparability verified that the applicant: provide information to the MBA to satisfy the (substantially or partially comparable • is an overseas-trained specialist or is an requirements for limited registration for post- and much more Enjoy savings on over 1700 products and services all year round Endless to an Australian trained specialist – the overseas specialist-in-training, having graduate training or supervised practice as a specialist assessment pathway); either passed the relevant specialist medical practitioner. The College assessment total saving $6,757.20 + • Area of Need (AoN) assessment (based examinations or is no more than two years will form part of the application to the MBA. on an assessment of qualifications and from completing specialist training in their call Member advantage on 1300 853 352, or visit www.memberadvantage.com.au/login/racs experience against an AoN position country of training; The savings in the above table are calculated based on an estimate of an average family use in 2010. Actual circumstances will vary. Credit Card savings based on no annual fee, no rewards program fee, and no supplementary card fee on take up of two extra cards. description); and • will be undertaking this position (which Private Health Insurance calculated on HCF current products, QLD Family Top Plus Cover nil excess and Super Multicover excluding the government rebate. Accommodation saving (off publicly listed price) based on 7 nights stay in Byron Bay (NSW), subject to location and night stay. Car hire calculated on excess on Damage Liability fee. Qantas Club corporate rates based on 2 year membership (new member).Home Loan calculated on $350,000 mortgage. Magazine subscription saving off 52 week subscription on BRW magazine. • Specialists in Training (for overseas trained may include such opportunities as exchange Further information, including Specialists or Specialists in Training who wish fellowships) for the purpose of specific the Endorsement of Short-Term to undertake specified training in Australia). training or upskilling in their specialty or Training Positions in Australia TRAVEL BENEFITS The Specialist Assessment pathway for obtaining experience in their specialty not Policy, is available on the registration is the only one that also provides available in their country of training; College’s website IMGs with a pathway to Fellowship of the • has the stated intention of returning to www.surgeons.org. EscapE to paradisE and savE savings for racs Fellows and trainees: Treat your loved ones to a tropical get-away this summer. Plan an unforgettable trip to the Daintree Rainforest or the white, sandy beaches of Broome, and FLY Qantas - Fly in style and be rewarded enjoy great discounts on travel through Member Advantage. Access exclusive benefits through the Qantas Club Airline Are you a flying surgeon? Lounge membership at corporate rates. New 2 year membership $815* (save $340) Have you ever thought of combining your surgical career with your love of flying?

Do you already provide a flying outreach service? DRIVE avis - competitive rates & reduced excess Enjoy a stress free car rental experience with Avis’ superior customer service for both business and leisure. > I am trying to identify surgeons who have, or are interested in obtaining, a pilot’s licence. > The aim will be improving outreach services in Australia and education of remote practitioners through information HotEL cLUB - Exclusive deals STAY sharing and collaboration. Enjoy savings of up to 15% off the publicly listed prices > The initial proposal is to establish an on line chat group and organise an annual conference. at 60,000 hotels in over 134 countries.

If you are interested in pursuing this concept then please contact Neil Meulman FRACS PPL. [email protected] call Member advantage on 1300 853 352 or visit www.memberadvantage.com.au/login/racs [Surgical News] Page 36 October 2010 *Rate quoted includes a once off Qantas Club joining fee of $230 and Member Advantage management fee of $55. Correct as at 1 May 2010 and subject to change. Terms & conditions apply. Traveling Fellow

For more than 20 years, the College has welcomed a Fellow of the American College of Surgeons (ACS), to participate in the Annual Scientific Congress (ASC). As well as participation in the ASC the Travelling Fellow visits hospitals and research institutions for further professional exchange. The College has recently established the Hugh Johnston ANZ Chapter of the ACS Travelling Fellowship, which provides support for an annual visit by an Australian or New Zealand surgeon to the ACS Congress. The first RACS Fellow is expected to travel to the ACS Congress in 2011.

Sydney several of the trainees and registrars who had their academic pursuits. However, while pre- fter the RACS meeting, my wife and I prepared several short talks. I was joined there viously, most trainees in Australia had to go Atravelled to Sydney, where our children by Fellow Cuong Dong, an upper GI surgeon oversees to pursue additional research training, Forming ties with USA joined us. We had the opportunity to see many in Melbourne and also MSKCC alumni. It there has been tremendous growth in several of the sights. We were hosted there by several was a pleasure spending the afternoon with centres of research excellence, providing high- friends including Dr Richard Hanney and Dr them and discussing their thoughts about quality training for young surgeons. Stan Sidhu. Dr Hanney took us to Cottage their training as it compared to training in the Another revelation I encountered visiting Dr Nipun Merchant, Perth my arrival, Dr John Buckingham, President Point which, while within the Sydney city US and also their aspirations of and concerns different parts of Australia was fierce regional MD, FACS, the ANZ Chapter Travelling y journey began as my wife and I trav- of the ANZ Chapter of the ACS, had helped limits, feels like an oasis that would be found about pursuing an academic career. pride and passionate people. Debates persist Fellow for 2010 writes of his experience. Melled to Perth where the 2010 Annual facilitate my trip by putting me in touch miles away from a major urban city. In Melbourne, I also visited several other as to the best sport – Australian Rules Football Scientific Congress of the Royal Australasian with several of the convenors responsible for While in Sydney I spent time with Dr Sid- colleagues and medical centres. I met with versus Rugby League. Australians are also very t was indeed an honour to College of Surgeons (RACS) was held. Perth is a organising the various scientific programs of hu, Professor Ross Smith and Doctors Jaswind- Tony Burgess, PhD from the Ludwig Institute, passionate about their wines and I sampled serve as the 2010 Ameri- beautiful city along the Indian Ocean and I was the meeting. They, in turn, arranged for my er Samra and Tom Hugh at the Royal North with whom we have an ongoing collaboration some excellent vintages. can College of Surgeons I fascinated to learn that it is perhaps the most participation in their respective sessions. I was Shore Hospital. While there, I attended their of our colorectal cancer genetic profiling work. I would like to thank the American College Australia and New Zealand remote metropolitan area in the world. involved in several aspects of the program HPB Tumour Board and Multi-disciplinary I was hosted by Fellow Ben Thomson, of Surgeons and the Australian and New (ANZ) Travelling Fellow. This One day prior to the commencement of including the Breast Cancer session of the GI conference, spoke at their Surgical Grand HPB and upper GI surgeon at the Peter Zealand Chapter for providing this once-in- was truly a memorable expe- the Congress, the 2nd Annual “Developing Surgical Oncology program, the Colorectal Rounds and spent time with them in the op- MacCallum Cancer Centre (the ‘Peter Mac’) a-lifetime experience for my family and me. rience. Travelling to the ‘Land a Career in Academic Surgery” course, run Session, the Hepatopancreaticobiliary (HPB) erating room, discussing our research and ex- where I attended the HPB Tumour Board My trip to Australia was full of professional Down Under’, meeting col- jointly between the Association of Academic session and of course had the privilege of changing ideas. My time at Royal North Shore and toured their facilities. I also spent time and personal development. It allowed me to leagues, Trainees and surgical Surgery (AAS) and the Academic Section of delivering the ACS Keynote lecture. Hospital highlighted the quality, depth and with Wayne Phillips, one of their leading establish important clinical and basic science leaders from Australia and the RACS, was held. Spearheaded by Fellow Following the lecture, Professor John breadth of the clinical work being done there. scientists, discussing our respective research collaborations, and promoted an intense New Zealand and exchanging Richard Hanney in collaboration with Buckingham hosted the luncheon of the ANZ I then spent time at Bankstown Hospital and understanding the differences in research exchange of ideas. I know many of the friends ideas in scientific and social members of the AAS, this course has been a Chapter members. The year 2010 marked the with Dr Andrew Biankin. I participated in and funding between our two nations. that I met during this trip will be lifelong settings was unparalleled. tremendous success. 25th anniversary of the ANZ Chapter. I had the spoke at their GI Tumor Board and participated One of the most memorable meetings I had colleagues. I am indeed indebted to the ACS for Perhaps as important, I had It provided an ideal forum for interaction opportunity to address the Chapter members, in their ward rounds. It was interesting to was with Professor Robert Thomas, previously this generous opportunity. the opportunity to develop and motivation for young, aspiring academic Professor Ian Gough, RACS, President of the note that early discharge management is the Chief of Surgical Oncology at Peter Mac what will hopefully be- surgeons particularly as there is no pure Royal Australasian College of Surgeons and Dr more difficult there as they do not have a and who now works for the Department of come lasting friendships model for academic training or promotion in Lamar McGinnis, President of the American formal system for skilled home nursing care. Health for the Victorian State Government. The Presentations by the and collaborations for the Australian health care system. The course College of Surgeons during this session, express Therefore, patients tend to stay in the hospital state and federal government have committed ACS Travelling Fellow future interactions. focuses on providing young surgeons’, trainees’ my gratitude for their support of this fellowship until they are more fully recovered. almost $1 billion to create a comprehensive at the 2010 RACS ASC and students’ insights into careers in academic and highlight the importance of this wonderful Dr Biankin also took me to the Garvan cancer centre in Melbourne, a combined effort “Molecular Imaging and Prediction of surgery and provides them with an opportunity professional interchange. Dr Buckingham then Institute, a free-standing facility of biomedical between several institutions including Royal Tumour Response” – based on some of made an exciting announcement. Starting next research, currently undergoing a multi- Melbourne, Royal Women’s, Peter Mac and the to directly interact with more established our research on in vivo imaging of cellular Ludwig Institute, among others. A stimulating surgeons in an effort to help inspire and recruit year, in addition to an ACS member travelling million dollar expansion, where he runs the proliferation, apoptosis, and drug delivery potential academic surgeons. During the course, to the RACS meeting, an Australian Fellow will Pancreas Cancer Genome Project. I spoke discussion following our meeting about the to tumours. also be selected as a travelling fellow to the US change that had to occur in the mindset and I gave a talk entitled, “Building an Academic with several members of his laboratory and “An Experimentally Derived Metastasis Career Pathway: Opportunities, Obstacles and and the ACS meeting, further enhancing the gave a talk based on my laboratory research culture of some of these institutions to bring Gene Expression Profile Predicts Getting Past Them.” vibrant association between the ANZ Chapter in “Src Signaling in Pancreas”. This was truly their important resources together for the Recurrence and Death In Colon The ASC began the following day. Prior to with the ACS. a premier group of researchers who stimulated benefit of a greater good. Cancer Patients” – based on some of inquisitive interaction. After a whirlwind tour of Perth, Sydney and our recent work in which we identified Melbourne, it became quite apparent that clini- a 34 gene profile derived from a liver Melbourne cal care and research in Australia is second-to- metastasis mouse model and advance human colorectal cancers that is highly rom Sydney, my family and I travelled none. Despite many similarities to the US, there Homestay Accommodation for Visiting Scholars predictive of good or poor prognosis in Fto Melbourne where we were hosted by are also dramatic differences in the way our Aus- Stage II and III colon cancer patients. Through the RACS International Scholarships Program and Project China, young surgeons, my good friend, Fellow Dr Bruce Mann, of tralian colleagues practice surgery – particularly nurses and other health professionals from developing countries in Asia and the Pacific “Current Approaches to Management the Royal Women’s Hospital. Dr Mann and I the two-tier, ‘public’ and ‘private’ system. are provided with training opportunities to visit one or more Australian and New Zealand If you would like to help or of Pancreatico-enteric Neuroendocrine have known each other for more than 14 years The worldwide economic downturn has af- hospitals. These visits allow the visiting scholars to acquire the knowledge, skills and require further information, Tumors.” ACS Keynote lecture contacts needed for the promotion of improved health services in their own country, and can please contact the International since our time together as Surgical Oncology fected many public hospitals leading to signifi- – “Progress in Pancreas Cancer Scholarships Secretariat: range in duration from two weeks to 12 months. Due to the short term nature of these visits, Fellows at Memorial Sloan-Kettering Cancer cant cuts in resources. Therefore, most academ- Management: Not an Oxymoron” - described some of the significant it is often difficult to find suitable accommodation for visiting scholars. If you have a spare Royal Australasian College of Surgeons Center (MSKCC). He, his lovely wife, Fellow ic surgeons engage in a parallel private practice College of Surgeons’ Gardens advances made in the understanding of room or suitable accommodation and are interested in helping, send us your details. We are Dr Julie Miller, and their three children were to supplement their income. As in the US, with Spring St, Melbourne Victoria 3000, Australia the molecular and genetic progression most gracious and opened up their home to us these added clinical responsibilities, many aca- seeking people who are able to provide a comfortable and welcoming environment for our T: + 61 3 9249 1211 F: + 61 3 9249 1236 of pancreas cancer resulting in potential overseas scholars in exchange for a reasonable rental and eternal appreciation. E: [email protected] during our stay in Melbourne. demic surgeons continue to struggle with the novel therapies. Dr Mann had arranged for me to meet with time and financial constraints associated with

[Surgical News] Page 38 October 2010 [Surgical News] Page 39 October 2010 Fellows in the vines

commercially successful ventures, others have In Western Australia, at Margaret River, on the Christie’s market. More importantly a sad end (drought, overproduction, world glut Dr Kevin Cullen, a paediatrician, planted his 1787 was etched onto the glass bottle with Wine is poetry in a bottle - R.L. Stevenson and financial crisis). vineyards in 1966. At Vasse Felix the initial the initials Th. J, denoting Thomas Jefferson. The techniques of wine production are basic, cut and dry like a surgical mind Wayne Stott’s prestigious and commercially plantings by Dr Cullen were followed by the A German wine collector Rodenstadt made successful winery Wild Wood has fallen victim establishment of a vineyard by Dr Tom Cullity, the discovery fortuitously in a house in Paris, to such an outcome. The Victorian Government a cardiologist. in the Marais district, where the bottles were will forcibly acquire this marvellous vineyard cellared and hermetically sealed between 50- in 2020 for infrastructure development, as Medicine and vines 57°F since the time of the French Revolution. reported in The Age some months back (I hope Thus one can appreciate a long standing He had the knack of making discoveries the price reflects the value). connection exists between the medical of rare wine which was the subject of wine gentle crushing, open fermentation, extended In South Australia, Richard Hamilton, from profession and the product of the vine. Is it tastings for the elite that he often conducted. yeast lees contact for the Chardonnay and dis- a family lineage of successful vintners, produces the reversion to an open air environment creet exposure to French oaks (Margaret, my among others, Old Vine Shiraz, of a quality that with one’s hands in the soil? Is it the complete Was it a good year? assistant had to explain the meaning of lees to ranks with the best in my experience. Another separation of lifestyle from the commitments From the circumstantial evidence, Broadbent me – you can appreciate I’m a beer drinker). The colleague Gwyn Morgan is yet another wine of the medical profession and the impositions argued overwhelmingly for the wine’s vineyard epitomises the ingredients for its suc- MUNCHAUSEN producer, whose Merlot was given to me one of hospital politics which are left behind on authenticity. I love the quote from the Christie’s cess, embracing the grape varieties chosen, vine SYNDROME evening when I enjoyed his family’s hospitality. Friday afternoon? Is it the element of a high catalogue “Estimated value – inestimable”. The location, pruning for low production with high It is an Australian wine with the Bordeaux disposable income (formerly) among the auction attracted the attention of collectors quality and trellising for flavour concentration. characteristic (colour, texture and aroma). You medical profession? But most importantly, from around the world, particularly American Enviable reputation appreciate I avoid descriptors of wine experts like every person loves a cellar where his wine is (before the 1987 crash). The price volleyed

K blackcurrant, chocolate and cassis etc, which as stored, selected on merit with the dust as a between £20,000 to £40,000 and when the Various wine experts have praised the fruits Y we know often reflect the oak factor in the casks). bonus and the cobwebs adding to the mystique. bidding reached £75,000 a new record was of the vineyard over the years. In 1973 Len M In a recent publication of Surgical Life, I If Grange is expensive, let me conclude set for a bottle of wine. It was bought by an

C Evans says the quality of the wine is such that came upon some more historical information. with a brief story that appeared in the financial American. The rest of the book I leave you to Factitious disordersits importance greatly outweighs its size. Dan The first Australian wine doctor was Dr Pen- pages of The Age some months back. It was peruse and enjoy but when certain elements Murphy placed it in the “very great” category. fold. Having trained at Bart’s, he settled outside about a book called The Billionaire’s Vinegar, came to light such as modern printing of Halliday in the Australian Wine Guide states

Plate: Musings about Munchausen Syndrome, are there three types? Adelaide in a place called Magill. His medical documenting the litigation and possible fraud labels in the old style, but attached with this vineyard has the enviable reputation for practice was conducted from his cottage called surrounding the most expensive bottle of modern glue, allegations of fraud surfaced. quality and style. The 2000 vintage he rates the Grange. His wife Diana used French cut- wine ever sold at auction at Christie’s in 1985. The American buyer thinks he has been short “as close to perfection as the real world will tings to produce the Mary Penfold wine – an Michael Broadbent was the world renowned changed and the matter is now the subject of Felix Behan Leonard was the same, both enjoying a long allow”. In his 2006 Wine Companion, he sees ideal treatment for anaemia at the time. wine connoisseur, establishing Christie’s wine legal proceedings; but really it is as exciting as Victorian Fellow life – be it genetics, wine or both? only four Hunter Valley wines making the I visited the Lindemann’s winery department. The book was written by Benjamin a Sherlock Holmes mystery. When Max was about to establish the best of the best three from Lake’s Folly. What museum years ago. It was established by Dr Wallace and reached the top of the New York In conclusion I must quote from another was pleasantly sur- vineyard in 1963, the first planted in the Hunter a rewarding thing to say about a vineyard later that evening discharged herself. This clin- As we know musing is gazing meditatively Henry Lindemann, another Bart’s graduate, Times best-seller list. famous American also a consul in Paris in prised recently when Valley in the 20th century, Atkins was doing started by a surgeon and I am sure his surgical ical history stimulated me to recount the story and refl ectively in a literary context. This led producing table wines and fortified wines, Lot 337 was the first item on the program the late 18th century, Benjamin Franklin who Val Usatoff, a wine con- most of the on-call work for Bankstown at the ethos of simplicity and technical refinement OPXIV I of some of my other Munchausen experiences me to ponder the Munchausen syndrome. the latter being the basis of the apothecary and Chateau Lafite from 1787 was the oldest once said “time is money” – which is really a OPXIII noisseur (with cellar), gave time (when Max was not available). Leonard would have contributed to its success. over the last three and a half decades, and three Whether by proxy or direct involvement mixtures he formulated. authenticated vintage of red wine ever to come synopsis of this liquid tale. me a bottle of Lake’s Folly unhesitatingly suggested ‘Lake’s Folly’ when Wineries in Australia have a long association Felix Behan cases in particular spring to mind – I wonder in the public or the private sectors, this wine from the Hunter Valley. It prompted me asked by Max what to call the produce. Later with the medical profession. It prompted me Victorian Fellow if this is the statistical average (one every ten psychiatric disorder is classifi ed as a facti- to explore the history on this prestigious bou- on, when the winery was well-established, they to phone my colleague Phil Slattery, another years and I would welcome other comments). tious sequence of clinical episodes - fancied, tique vineyard. I gleaned that the founder, Dr entertained William Dobell, another Hunter international hand surgeon of repute whose n a recent theatre list I had an inter- The second case makes an interesting feigned or self-infl icted-. It is interesting how For further information please Max Lake (who passed away in 2009) estab- Valley local whose studio was at Wangi. While winery lies in the Yarra Valley in Victoria. I esting clinical experience even at narrative, in the 1980’s. In those days the medi- this eponym arose: Richard Asher in 1951 was SUGSS COVIDIEN call (02) 8382 6671. There is no lished the vineyard in 1963. My late friend John enjoying the fruits of this boutique vineyard, asked for a one-liner of his experiences and application form. Hueston,my pre-eminent age. In the in Anaestheticthe international room field a cal administrator allowed us to transfer insur- the fi rst to describe such self-harm, recall- Date: 27-SEP-2009 O it prompted Leonard to whisper in Max’s he said “never again!” He mentioned various TRAVEL GRANT 2011 patient was awaiting surgery. My registrar was ance patients to the private domain. Over a two ing Baron Munchausen in an article in the as a hand surgeon first acquainted me with ear sotto voce “looks like Lake’s Folly was a surgeons around Australia who had explored not there with me to present the details on his month period a general surgeon and I operated Lancet. He mentioned how the Baron had a Applicants are invited for the Sydney Upper Gastrointestinal Surgery Society this label in 1974. Max Lake and John had met success”. This story reminds of the quote from this hobby not only to enjoy some profits, line of management. He had mentioned before- on this young man a number of times. He had list of fantastic stories, beyond belief, refl ect- COVIDIEN Travel Grant for 2011. The purpose of this grant is to support Closing date: Friday through their mutual interest in hand surgery the Queen Mother saying to her daughter one but also more importantly to have a tangible hand that this lady had presented for removal sustained abdominal injuries in a motor vehi- ing daring exploits, quite unbelievable. In his younger upper gastrointestinal surgeons or trainees to undertake a period of November 12th 2010 and subsequently with the establishment of day over lunch “perhaps, darling, you shouldn’t end-product to hold, to feel, to taste and to of something off her leg. cle accident, a perfectly credible story until I obituary in the British Medical Journal, it was at 12 midnight. the Australian Hand Surgical Society. have that second glass of wine. You have to rule enjoy (of course, I’m talking about a glass of training or study in another country. The grant has a value of $5000, When I addressed the patient in this later questioned the multitudinous mature mentioned how Asher respectfully dedicated There is another interesting connection this afternoon.” Wine quotes usually have an wine). He recalled an episode that occurred at thanks to a kind donation from COVIDIEN. context, my question was “now what am I abdominal wall scars – another warning sign. this syndrome to the Baron with the surgical fraternity. My former registrar, element of lubricated spontaneity. the Australian Hand Surgery Society Meeting removing today?” She said “I have a scar on the Applications should include: Please send application to SUGSS Ramin Shayanm, is the grandson of Leonard Ownership of this boutique vineyard is in the Clare Valley in South Australia in 1999. leg at a skin graft site and I was told you could • cover letter Executive Committee, c/o Suite 606, Atkins. Leonard was a close friend of Max now in the hands of Peter Fogarty (since 2000). A show of hands indicated that almost 80 possibly fi x it”. Previous attempts at serial scar “As one of my mentors and later colleagues said • curriculum vitae St Vincent’s Clinic, 438 Victoria Street, Lake, both being on the staff at the Bankstown It concentrates on two wine varieties – Caber- per cent in the group were associated with revision had been unsuccessful. People knew • an outline of the proposed travel including location or locations to be visited Darlinghurst NSW 2010 or by email to Hospital in the ’60s. Ramin’s grandfather, now yearsnet and Chardonnay.ago “Plastic The techniques surgeons of wine arevineyards sometimes either commercially described or recreationally. [email protected] I have successfully closed similar defects in • the skills or knowledge that will be acquired 95 years of age, revealed the origin of the title production are basic, cut and dry like a surgi- When you see an outcome like the Max • an estimate of the costs Email application must be followed by a melanoma patients with the usual keystone as psychiatrists with knives” – but not always.” for the vineyard. Max Lake was a bon vivant cal mind, and the terroire is superb. I liked the Lake story, we all yearn for the rewards at • two written references hard copy version within 4 working days. technique. and epicurean with a perennial love of life. simple summary of production – hand-picked, the end of the rainbow. While some are Like any experienced surgeon, I exposed Three days before discharge he asked a The Baron served in the Russian mili- the[Surgical whole lowerNews] limb Page to 40 examine October it2010 and found, young nurse for $15 so that his clothes could tary forces against the Ottoman Empire and [Surgical News] Page 41 October 2010 to my horror, she had a donor site dressing on be dry-cleaned. I asked the young lady some acquired a reputation for witty and exagger- her upper thigh. On further questioning, it months later whether she had ever received her ated tales and became the subject of numerous Page: 40 transpired, this had been there for six months. money. She was never paid. texts published in 1862 by Gustav Doré, from I then glanced at her notes on the anaesthetic Some years later, I was doing Monday balloon fl ights, to taming wolves to shooting bench. There were fi ve volumes, each about fi ve morning rounds when I encountered the fl ocks of ducks and being mauled by bears (en. inches thick – “a warning sign”. At this stage the same individual, recently admitted again wikipedia.org). alarm bells were ringing and I asked her “why with abdominal trauma. Needless to say he However the idea occurred to me that have you been in hospital so often?” suspect- signed himself out within the hour when I this recollection had a similar ring to another ing some major clinical catastrophe like neph- confronted him. particular person who also wrote about rotic syndrome. She gave a history of repeat A further story relates to a nursing aide fi ctional and fanciful adventures. He was far overdose needing ICU admission. It transpired who burnt her fi nger on a steriliser. The regis- more readable and he became the second most she was seen in our unit six months earlier and trar in the Emergency Department referred translated author of all time, (second only to it was found that she has been putting oven her to me for grafting (which failed), which Agatha Christie). Having written Journey to cleaner on the skin graft donor site. was repeated and failed a second time before the Centre of the Earth in 1864, then 20,000 I took her into theatre and manually debri- doing a cross fi nger fl ap. The resultant stiff Leagues Under the Sea in 1869, and Around the ded the wound under general anaesthesia and fi nger years later resulted in a ray amputation World in 80 days in 1873 – none other than the dressed it with the usual donor site techniques, of the middle fi nger, by another specialist, as great Jules Gabriel Verne (1828-1905) reinforced with soft topical non-removable I discovered when she came back to me for a He lived along the Loire Valley. At the Pub: CMC TOTS dressings, and signed it “not to be removed medico legal report seeking compensation for school of St Donation College, one of his without my permission”. I heard that she had this work related injury. tutors in drawing and mathematics was possi-

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In Memoriam Statutory Protection Cowlishaw Symposium Dear Editor, 8th I refer to the article on Mandatory Reporting (Surgical News, Vol 11, No 7, August The speakers are: 2010) by College Solicitor Michael Gorton with particular reference to the section Mr Wyn Beasley, headed “Protection”. In that section, Mr Gorton indicates that Section 237 of the Health Mr Felix Behan, Practitioner Regulation National Law Act 2009 provides statutory protection for health professionals who report notifiable conduct provided that the report is made in “good Information about Mr Geoff Down, faith”. Section 237 applies not only to mandatory notification of conduct as defined in Hon Prof Sam Mellick, Section 140 of the Act but also to voluntary notifications made under Section 144. The deceased Fellows Ms Elizabeth Milford grounds for voluntary notification are wider than those for mandatory notification, but Our condolences to the family, Prof John Royle, the statutory protection remains the same. friends and colleagues of the Mr Phillip Sharp, Fellows of the College should be aware that this statutory protection does not The Royal Australasian College of Surgeons Prof Donald Simpson prevent a professional about whom a complaint has been lodged from instituting following Fellows whose death invites nominations of worthy individuals for Prof Alan Thurston, proceedings in defamation. MIPS has had one recent case where this occurred when has been notified over the a SURGEONS INTERNATIONAL AWARD { { not only was the action brought in defamation but it was also brought for “injurious past month: Mr Sharp has been invited to deliver the eponymous falsehood” and additionally for “misleading or deceptive conduct” under the NSW Fair The Award provides for doctors, nurses or other address (the Russell Memorial Lecture). Trading Act. After a number of days of legal argument the court struck out the action Donald Wallace Fleming, WA General surgeon health professionals from developing communities in defamation, the two other causes of action remain on foot. The plaintiff has lodged to undertake short term visits, usually of 4-6 weeks Sat 6 November 9:30am an Appeal with respect to the action in defamation. All this indicates that while there is Andrew Brian Fagan, SA Orthopaedic surgeon duration, to one or more Australian hospitals to Royal Australasian College of Surgeons, 250-290 Spring St, some statutory protection for health professionals who report other practitioners, they Douglas Trevor Beetham, NZ General surgeon acquire the knowledge, skills and contacts needed East Melbourne (Level 2 Training Area) are not necessarily protected from legal actions being brought even though some of Sir Randal Elliott KBE GCStJ, NZ for the promotion of improved health services in the recipient’s country. those may well fail. Ophthalmologist Fee: $120.00 inc. It is for the reporting practitioner to establish that the report was made in good The Award may cover a return economy class GST per person covers morning tea, lunch, airfare, necessary accommodation costs and living faith and to do so may present a considerable challenge where the practitioners are Gaston Napoleon Arthurs, NSW Neurosurgeon afternoon tea and cocktail reception expenses for the recipient. The value of the award from the same branch or specialty of their profession. It is MIPS’ view that where the Alan Geoffrey Watt, WA General surgeon Contact [email protected] +61 3 9276 7447 varies up to a total amount of AU $12,000, depending question of good faith in mandatory reporting is raised that that should be a matter Ian Reid, NSW paediatric surgeon on the requirements of the candidate’s programme. treated as a disciplinary rather than a legal question. Rowland Norman Gale, TAS vascular surgeon More than one award can be made in any one year. Failure of a healthcare practitioner to report in accordance with the legislation 8TH COWLISHAW SYMPOSIUM NOMINATION CRITERIA does not constitute an offence but may result in a finding that they have engaged in Barrie Russell Jones, NZ ophthalmologist > Surgeons participating in the RACS International PLEASE RETURN THIS SECTION WITH PAYMENT TO: professional misconduct by not doing so. It is important to ensure that any Fellow when We would like to notify readers that it is not the Development Program are encouraged to nominate ROYAL AUSTRALASIAN COLLEGE OF SURGEONS making a notification, mandatory or voluntary, makes it in good faith, and ensures that practice of Surgical News to publish obituaries. worthy individuals they have identified while Megan Sproule, Resources Division they have formed a reasonable belief of the alleged misconduct when undertaking When provided they are published along with undertaking international development activities. College of Surgeons Gardens, 250-290 Spring Street, East Melbourne, VIC 3002 mandatory notification. the names of deceased Fellows under In > Surgeons who nominate worthy individuals with Yours faithfully, Alternatively fax completed form to +61 3 9249 1219 Memoriam on the College website whom they have had contact must be willing to accept RWL Turner LLB FRCS FAORthaS the responsibility for arranging a suitable program www.surgeons.org go to the Fellows page and Chairman and acting as a personal host to the award recipient. DELEGATE INFORMAtiON (Please print in BLOCK LETTERS) click on In Memoriam. Title Given Name: NOMINATIONS MUST INCLUDE (Prof/Dr/Mr/Mrs/Ms) > Personal and professional information concerning Surname: the nominee; > Objectives of the proposed visit; Mailing Address: P ostcode: Informing the College > Anticipated benefits to the nominee and their home College response Ph: E-mail If you wish to notify the College of the country; Dear Editor, > Names of the International Development Program Dietary Requirements: death of a Fellow, please contact the I have reviewed the correspondence from Mr Turner. team members responsible for organising the visit Guests: I am aware of the case in New South Wales to which Mr Turner refers. That case is Manager in your Regional Office. (including accommodation, training program and based on the NSW legislation, which does not offer as extensive protection as is afforded They are travel within Australia); PAYMENT OPTIONS by Section 237 of the National Law, which now applies to mandatory reporting. > An outline of the proposed training program and 1. Cheques/bank drafts payable to the Royal Australasian College of Surgeons (payable $AUD) The particular case in NSW is based on a more limited protection to those who make a ACT [email protected] activities; and 2. The following Credit Cards are acceptable and complete details required – mandatory report in NSW under the former NSW legislation. NSW [email protected] > Letters of recommendation from the nominee’s hospital and/or Health Department with an The protection afforded under the new National Law is broader and provides: “A NZ [email protected] Amex Diners MasterCard Visa card indication of the local importance of any person is not liable civilly, criminally or under an administrative process for giving the QLD [email protected] upskilling resulting from the Award. Card No: information.” SA [email protected] The protection under section 237 for a mandatory report, or a voluntary report, is far TAS [email protected] FORWARD NOMINATIONS TO: Expiry Date more extensive than the protection given under NSW legislation. VIC [email protected] International Scholarships Officer There have been a number of reports in the general media about the case in NSW. It Royal Australasian College of Surgeons WA [email protected] Card Holder’s Name – Block letters is important to note that it is a case only referrable to the previous NSW legislation, and College of Surgeons’ Gardens NT [email protected] not the new National Law. 250 – 290 Spring Street, East Melbourne VIC 3002 Card Holder’s Signature E: [email protected] Cancellations must be received in Yours faithfully, Amount (inc. GST) $ writing prior to Friday 15 October 2010 T: +61 3 9249 1211 F: +61 3 9276 7431 and will incur a 20% cancellation fee. Michael Gorton Date……… /……… /………… Cancellations received after this date College Solicitor (ABN 29 004 167 766) will not be refunded. [Surgical News] Page 44 October 2010 [Surgical News] Page 45 October 2010 iNVENTORS CORNER FOUNDATION Covidien Travelling FOR SURGERY Fellowship Grant

The Younger Fellows Committee in partnership with Covidien TOTS CMC Pub: Healthcare, is pleased to offer two Travelling Scholarships (value $7,500 AUD each) to assist Younger Fellows who are travelling overseas in 2011 to further post Fellowship studies Grafting in the 1950s and diversify their surgical experiences. The applicant must be a Younger Fellow of the College Experimentation was the name of the game in the 1950s (within ten years of gaining Fellowship) at the time of submitting theirThank application, who you is planning for to travel donating overseas within to the Foundation for Surgery the next 12 months to further post Fellowship studies prior to TRAUMA/RURAL SURGICAL FELLOWSHIP returning to Australasia to practice. ROYAL DARWIN HOSPITAL Bernard Catchpole, New type of tube Application requirements QueenslandA position exists for a paediatrics,Western urology Australia and thoracic However, shortly into suitably qualified candidate surgery, both electively and in West Australian Fellow Meanwhile, our young weaver had got to work. Please attach a short CV in addition to the information below. Mr J Lancaster Mr I Thompson “the series of aneurysm Drfor T12 monthsPorter in 2011 with a acute care /trauma. He made a new type of tube from nylon. It All applicants are required to flexible commencement time. t was about 1956 that an interest in mak- ThisVictoria position would be of interest to consisted of a coiled monofilament covered by replacement, the grafts provide details of planned visit (approximately 1 page) The position is funded by the those interested in rural surgery, or NewNational South Critical CareWales & Trauma workingMr B Dooleyas a surgeon in remote ing arteries was born, in the Department of a fine braid of multifil, both of nylon. This gave including proposed itinerary, details of work and/or study to Surgery, the University of Sheffield, England. began to rupture. MrResponse G Coltheart Centre (NCCTRC) and there environmentsMr J Elder such as humanitarian 41 Page: I strength to the tube by providing the weft as it be undertaken and envisaged benefits of this activity. Details of is opportunity for planning and or military situations. There is Dick Jepson was Foundation Professor in charge, Dr K Merten Scotchman’s Creek Golf Club ran around the tube, multifil nylon being used The material was any financial support or funding already secured (e.g. personal participating in disaster response, extensive exposure to Indigenous later to be also appointed Foundation Professor Mrand Kopportunities Prabhakar for trauma health issues. for the warp. This tube was flexible and was funds, research grants, sponsorship and/or other grants) and research. abandoned! We did This position is excellent preparation in Adelaide. Many new materials were becom- 1 New Zealand studied experimentally. the proposed use of the Grant funds should also be included. The position is based at Royal Darwin for anyone interested in a rural or ing available and a liaison was established with Mr A Merrie Dacron (the polyester fibre brand of Du- not know that PVAl is The Covidien Travelling Fellowship Grant is each valued at Hospital in the Northern Territory, but regional surgical career. Courtaulds, the fibre and fabric conglomerate involves outreach work to regional pont) or Terylene (the brand name of ICI’s fi- slowly, but inexorably AUD$7,500 each. hospitals in Katherine and Gove, as Total and with a young man with interest and ingenu- Singapore Enquiries and further bre) were available, and Courtaulds was pro- For an application form and further information, please well as visits to isolated Indigenous ity in weaving tubes. water soluble.xx Mrcommunities. H Chng information can be ducing Courlene, a polyethylene fibre which contact the Younger Fellows Secretariat on +61 3 9249 1122 or $6 6,720 About that time, Charles Rob, Professor As a ‘General Surgeon’ you will have obtained from: our weaver wove into tubes. We worked on The [email protected] for Surgery helps towns where these children live of Surgery of St Mary’s Hospital in Lon- ” the opportunity to definitively [email protected] or these. A problem was how to make these Applications close 5.00pm Friday 29 October 2010. manage subspecialty areas such as [email protected] don, began to use polyvinyl alcohol (PVAl) neurotrauma, burns, vascular, tubes kink free and not too porous. Eventu- of the nylon which left a coating without sponge for aortic replacement. We followed ally we solved this by using a finely threaded strength, but which was waterproof. Thus suit. The hospital engineers made a set of brass rod, which fitted into the polyethylene the monofil was protected, but the process formers in brass. Each was a solid rod to tube. A length of thin wire was then wound seeped right through the fine multifil fibre, which was screwed at one end two smaller 3 YES, I would like to donate to our Foundation for Surgery. round the graft (to be) driving it into the causing their failure. calibre rods to represent the aorta and the With every donation over $1000, the College is able to support Research & International Outreach Programs. two common iliac arteries. Three sizes of depths of the thread. It was then boiled for five minutes, cooled, and the brass rod re- Vascular valves these bifurcations were made. To make a While experimenting with polyethylene tubes, moved. This left a crimped flexible tube. Its 10-AUG-2009 Date: PVAl aorta, numerous pieces of foam about Name: Speciality: fibres had been compressed by the wire and we developed some valves. If the end of a fabric six to eight millimetres thick were wrapped tube is inverted to form an intraluminal cuff, heat, but was still too porous. A finer poly- Address: around the former. The strips of uniformly and is then stitched to the wall in the long axis ethylene fibre would have been better to re- Telephone: Facsimile: applied foam were then bound in place by in three places 120 degrees apart, a crude tri- duce fabric interstices size. The material was cotton tape wrapping the entire bifurcation. cuspid valve is formed. A suitable former with inert in the tissues and looked promising.2 Your passion. My cheque or Bank Draft (payable to Royal Australasian College of Surgeons) for $ . When the time came to replace an aortic an- three circumferential bulges could be used to At about this time, we realised that how eurysm, the appropriate sized preparation develop a ‘sinus’ behind each cusp during the various fibres behaved in the tissues was not Please debit my credit card account for $ . was autoclaved. heat calendering process of the tube. Your skill. very clear. Did they lose strength in the tis- This heat treatment bonded the PVAl Our weaver made for us a woven tube sues and did they stir up a reaction? So we Mastercard Visa AMEX Diners Club NZ Bankcard foam to produce a soft white smooth bifur- with heavier monofilaments at three posi- measured the breaking strengths of a range Your legacy. cation which would hold sutures well and tions 120 degrees apart. By teasing these of fibres of both natural and synthetic ma- Credit Card No: Expiry / could be cut without any fraying of the cut from the fabric which was then cut away, we terial, buried lengths of them in the Rectus edges. These grafts went in exceptionally well. could form chordae tendinae from the centre Charles Rob made a film for BBC Television abdominis sheath of animals for six months, of each cusp, fusing their ends to their par- Card Holder’s Name - Block Letters Card Holder’s Signature Date and re-examined them. We found that silk, demonstrating an aortic replacement. Howev- ent monofilament just proximal to the cusp which contains a good deal of the protein Your I would like my donation to go to: er, shortly into the series of aneurysm replace- margin. ment, the grafts began to rupture. The mate- keratin, lost all strength and fragmented. General College Bequests International Development Program

Would these have worked? Experimenta- Plate: Scholarship and Fellowship program International Scholarship Program rial was abandoned! We did not know that Linen thread being largely of cellulose lost tion was the name of the game in the 1950s. Foundation. PVAl is slowly, but inexorably water soluble. almost all of its strength within the six I have a potential contribution to the Cultural Gifts Program I do not give permission for acknowledgement of my gift in any College Publication Nylon was being used and grafts became months. Polyester, polytetrafluorethylene References C commercially available. The woven fabric (PTFE) and polyethylene lost virtually none 1. A new type of arterial prosthesis. Catchpole, B.N. Please send your donations to: M tubes were crimped to make them flexible of their strength, but not so nylon. The fine and Curran, R.C. Surgery, 44,1958, 994-1007. Foundation for Surgery Y without kinking and ‘calendered’ or heat 2. Polythene fabric as an arterial prosthesis. Catchpole, fibrils of a multifil thread rapidly broke up in AUSTRALIA & OTHER COUNTRIES NEW ZEALAND K rolled to reduce bleeding through the fabric’s the tissues although the thicker monofil re- B.N. and Curran R.C. Angiology, 10,1959, 99-108. Royal Australasian College of Surgeons PO Box 7451 3. Durability of suture materials. Catchpole, B.N. GGSS College of Surgeons Gardens Wellington South New Zealand interstices. The results were usable, but rather tained much of their strength. This proved to 250 - 290 Spring Street Tel: +61 4 385 8247 stiff and the cut ends tended to fray. Not ideal. be due to a chemical change on the surface and Winn S.A. Lancet, 2,1960, 236-240. EAST MELBOURNE VIC 3002 Fax: +64 4 385 8873 [Surgical News] Page 46 October 2010 [Surgical News] Page 47 October 2010 SURGICAL NEWS P41 / Vol:10 No:7 August 2009

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