Thursday, 10 August 2017

The forgotten male cancers: Public Lecture by Professor T. Clark Gamblin

Professor T.Clark Gamblin, visiting Fulbright Scholar, is giving
a public lecture 2 Nov 2017 at the Alfred Medical Research and
Education (AMREP) centre. RSVP here for catering purposes
You are invited to a public lecture by an internationally renowned surgeon, Professor T. Clark Gamblin, on the forgotten but lethal male cancers, including those of the pancreas, liver and oesophagus.

Details
  • Date: Thursday, 2 November 2017
  • Time: 5.30 pm drinks and canapes for 6.00 pm start. Lecture followed by Q&A session.
  • Venue: AMREP Lecture Theatre, adjacent to the Baker Institute at 75 Commercial Road, Melbourne 3004, 200 metres east of the main Alfred Hospital entrance. See map.
  • Cost: Free
  • RSVP: CLICK HERE. Please RSVP by Monday 30 October 2017 for catering purposes
  • Enquiries: Jacki.Sievers@monash.edu ph +61 3 9903 0190 or Daphne.Vogiagis@monash.edu ph +61 3 9903 30611

Wednesday, 9 November 2016

Message from the Chair of MUSAG - Professor Julian Smith

Surgery in the new Monash MD course

The March 2016 edition of The Cutting Edge outlined the proposed changes to the undergraduate medical course at Monash University and introduced the new Monash MD course. The curriculum framework in the new Monash MD course places Surgery throughout Year 3/B and also as a dedicated six week Surgery rotation in Year 5/D. The undergraduate surgical curriculum is currently undergoing review by the Surgery Discipline Reference Group, co-chaired by Mr. Peter Evans and Mr. Tristan Leech who have both been appointed the Curriculum Assessment Leads for Surgery. The surgical curriculum developed by the Group will be ready for delivery to the first Year 3/B cohort in 2018.
There will also be a significant research component in the new Monash MD course with an On-line Research Methods Module in Year 3/B and a six week Scholarly Intensive Project in Year 5/D. The Scholarly Intensive Project will include traditional research activities in the biomedical, social, educational and population sciences as well as quality improvement activities in clinical practice. As a there is likely to be a high demand for surgical research projects, there will be a need to identify suitable projects and supervisors to ensure that the agreed standard of academic rigour is applied to meet the various accreditation standards. All Departments of Surgery will need to contribute to this exciting new endeavor.
It is very pleasing that Surgery will continue to have a strong profile within the new Monash MD course and also that students will be introduced to aspects of surgical research, both of which may encourage students to pursue a career in Surgery and possibly with a significant academic component.

The Cutting Edge will continue to report on the above developments as they evolve.

Tuesday, 8 November 2016

What’s new in Research – across the campuses

Monash Health

Yi Ma recently won the best free paper by a junior doctor at the General Surgeons Australia (GSA) meeting for his paper on a Randomised Controlled Trial examining phone review vs traditional outpatient review following appendicectomy and lap cholecystectomy.

Julia Freckelton is continuing her PHD on the effect of body composition on outcome in pancreatic cancer.

Bill Berry is finishing his final year of his PhD examining the utility of Endoscopic Ultrasound and Fine Needle Aspiration (EUS FNA) to guide precision medicine in pancreatic cancer.

The Victorian pancreatic cancer biobank now has ethics and governance approval at Epworth, and the Austin hospital. Governance approval is in process at the Alfred and Cabrini.

Publication
Tranexamic Acid in Patients Undergoing Coronary-Artery Surgery
Published in the New England Journal of Medicine, 23 October 2016.
Authors:  Myles PS, Smith JA, Forbes A, Silbert B, Jayarajah M, Painter T, Cooper DJ, Marasco S, McNeil J, Bussieres JS, McGuinness S, Byrne K, Chan MT, Landoni G, Wallace S for the ATACAS Investigators and the ANZCA Trials Network.

Tranexamic acid reduces the risk of bleeding among patients undergoing cardiac surgery, but it is unclear whether this leads to improved outcomes.  In a trial of over 4600 coronary artery surgery patients this paper confirmed that the use of Tranexamic Acid reduced blood loss without increasing thrombotic complications.  This was a multi-centred international study run through Monash University with significant contributions from Alfred Health and Monash Health.
N Engl J Med 2016; DOI:10.1056/NEJMoal606424;@NEJM.org

Eastern Health

The Eastern Health Surgical Research Group has remained active in surgical research in 2016.  Junior doctors and medical students have been involved in various smaller projects, and two current Master of Surgery students are actively recruiting participants for their research projects.

Mr Andrew Hardley is coming towards the end of his 2nd year of post-fellowship Upper GI Surgical training at Eastern Health. He will soon complete his surgical Masters project which has been to design, construct and run his own randomised controlled trial in the latest question to be asked in endoscopic bile duct stone management. Balloon dilatation of the lower bile duct sphincter has revolutionised ERCP stone management. This allows the exit of the bile duct to be opened widely, enabling large or multiple stones to be extracted with ease. The question of which type of stones, which type of patient, to which type of lower bile duct anatomy this procedure is applicable and whether this can be combined safely with existing techniques, is the underlying substance of his surgical masters. This randomised study will complete recruitment this month and then Andrew will concentrate on finalising this project before the end of his time with us.

Ms Sheryn Cheah is completing her first twelve months as the Upper GI Surgical Research Fellow in the Eastern Health Surgical Research Group. This position provides her with about 50% clinical workload and patient contact.  She has experience with upper gastrointestinal surgery and hepatobiliary surgery, and a healthy experience of ERCP training.  More importantly, this position has scope for regular teaching of medical students and surgical trainees, and wide exposure to the active academic department of the Eastern Health, Monash University affiliated, research division.  Her current research project is part of a Masters in Surgery study on the interface between blood vessel walls and the blood flow known as the glycocalyx.  Her research which utilises state-of-the-art portable video microscopy with patented software called 'GlycoCheck', is used to study these changes in vivo in the awake non-anaesthetised patient.  The project looks at the glycocalyx for the first time in obesity, metabolic syndrome and in the event of significant weight loss from bariatric surgery.  She is actively recruiting normal subjects, subjects with obesity without metabolic syndrome, subjects with obesity and with metabolic syndrome, and patients who have had bariatric surgery and lost at least 50% of their excess weight.  Recruitment will continue into 2017 when she will remain a surgical fellow at Eastern Health, joining the bariatric surgical unit.  Early data was recently presented at a local surgical research meeting in Melbourne.

The junior members (HMOs, interns and medical students) of the Research Group have also been active, presenting three papers at the recent 2016 Victorian Annual Surgeons’ Meeting in Melbourne.  One paper was presented at the national OSSANZ conference which took place in Sydney.

These papers included:
Effectiveness of chemical thromboprophylaxis in obesity: A cross-sectional study of post-operative surgical patients.  Presenter: Matthew Wei.

Efficacy of very low calorie diet in reducing liver volume and body weight prior to laparoscopic bariatric operations: a systematic review.  Presenter: Raphael Park Chae.

Role of Percutaneous Cholecystostomy and the subsequent management of cholecystostomy tubes in high-risk patients with Acute Cholecystitis.  Presenter: Adele Lee.

The Eastern Health Surgical Research Group thanks many contributors and supporters of our group and its research activities, and hopes to increase surgical research activity at Eastern Health next year and beyond.

Cabrini Health

Accepted paper:
Suturing in small-group teaching settings: A modification to Peyton’s four-step approach. Medical Science Educator. (2016) In Press
Raymond Yap, Alayne Moreira, Simon Wilkins, Fairleigh Reeves, Michele Levinson, Paul McMurrick. 

Published abstracts
1. Au, L., Grant, M., Haydon, A., Oliva, K., Wilkins, S., McMurrick, P., Shapiro, J. (2016) Use of chemotherapy and mismatch repair deficiency testing in resected stage-II colon cancer: a retrospective cohort study. Asia-Pacific Journal of Clinical Oncology 12 (Supp. S4) 51.
2. Wilkins, S., Yap, R., Oliva, K., Staples, M., McMurrick, P.J., Carne, P. (2016) Oncological outcome in standard abdominoperineal resection-Do we need to change technique?  ANZ Journal of Surgery 86 (Supp. 1): 28.
3. Wilkins, S., Yap, R., Oliva, K., McMurrick, P.J. (2016) Colorectal cancer surgery in the new extremes of age: nonagenarians ANZ Journal of Surgery 86 (Supp. 1): 31.
4. Yap, R., Moreira, A., Wilkins, S., Reeves, F., Levinson, M., McMurrick, P.J. (2016) Suturing in small-group teaching settings: A modification to Peyton’s four-step approach.  ANZ Journal of Surgery 86 (Supp. 1): 150.

Conference Presentations:
Royal Australasian College of Surgeons Annual Scientific Meeting Brisbane 2-6 May
Oral presentations by Mr Stephen Bell (x2) and Dr Simon Wilkins
Poster presentation by Dr Simon Wilkins (x2)

Several researchers from the Cabrini Monash University Department of Surgery successfully presented new research findings and the latest in surgical technique advancements at the recent Royal Australian College of Surgeons (RACS) Annual Scientific Congress held in Brisbane 2 – 6 May 2016.

Cabrini surgeon Stephen Bell presented at this year’s international scientific congress with an overview of the equipment and techniques involved with the latest surgical procedure, trans-anal Total Mesorectal Excision. He also presented at the video session on “taTME – How I do it”. He was also invited faculty in the educational workshop on taTME, and course director of the workshop: “For Advanced Laparoscopic Solutions in Colorectal Resection Surgery”. Finally, he hosted a meeting for the surgeons and researchers involved in the ADIPOSe clinical trial, an Australian and New Zealand surgical trial investigating the benefits of weight loss prior to rectal cancer surgery in obese patients.

Dr Simon Wilkins presented on a retrospective data review of patients who underwent a particular surgical resection technique (abdominoperineal resection, or APR). To help improve outcomes in cancer treatment, the APR standard technique has been purportedly superseded by a more radical extra-levator abdominoperineal excision (called ELAPE) while patients are in a prone position.

However, Dr Wilkins concluded that the data does not in fact provide justification for change in respect to the technique of APR and that the ELAPE technique is unnecessary. The positioning of a patient in the Lloyd-Davies or the left-lateral position is adequate.

Yap, R., Moreira, A., Wilkins, S., Reeves, F., Levinson, M., McMurrick, P.J. (2016) Suturing in small-group teaching settings: A modification to Peyton’s four-step approach. Royal Australian College of Surgeons Annual Scientific Congress, Brisbane, Australia 2-6th May 2016.

Wilkins, S., Yap, R., Oliva, K., McMurrick, P.J. (2016) Colorectal cancer surgery in the new extremes of age: nonagenarians. Royal Australian College of Surgeons Annual Scientific Congress, Brisbane, Australia 2-6th May 2016.

Association of Coloproctology of Great Britain and Ireland, Edinburgh, UK 4th-6th July
Oral Presentation by Dr Simon Wilkins

“The relationship between the degree of T3 mesorectal invasion in rectal cancer and the complete pathologicval response rate after neoadjuvant long-course chemoradiotherapy”
Poster presentations by Dr Simon Wilkins

Wilkins, S., Yap, R., Oliva, K., Staples, M., McMurrick, P.J., Carne, P. (2016) Oncological outcome in standard abdominoperineal resection-Do we need to change technique? ACPGBI 2016 Annual Meeting, Edinburgh, UK 4th-6th July 2016

Wilkins, S., Yap, R., Oliva, K., McMurrick, P.J. (2016) Colorectal cancer surgery in the new extremes of age: nonagenarians. ACPGBI 2016 Annual Meeting, Edinburgh, UK 4th-6th July 2016

Abstracts in Press
Wilkins, S., Haydon, A., Porter, I., Oliva, K., Staples, M., Carne, P., McMurrick, P., Bell, S. (2016) Complete pathological response after neoadjuvant long course chemoradiotherapy for rectal cancer and its relationship to the degree of T3 mesorectal invasion.  Colorectal Disease In Press

Wilkins, S., Yap, R., Oliva, K., Staples, M., McMurrick, P.J., Carne, P. (2016) Oncological outcome in standard abdominoperineal resection-Do we need to change technique?  Colorectal Disease In Press

Wilkins, S., Yap, R., Oliva, K., McMurrick, P.J. (2016) Colorectal cancer surgery in the new extremes of age: nonagenarians. Colorectal Disease In Press

Grants
Dr Simon Wilkins a recipient of a $2000 Cabrini Travel Grant towards the costs of the UK conference attendance and presentation.

Alfred Health

RACS Scholarship Success
Congratulations to Mr James Lee who was awarded the prestigious RACS Senior Lecturer Fellowship.  This provides funding for 2 years, with funding matched by the Faculty and CCS. Congratulations also to Dr Geraldine Ooi was awarded a RACS Surgeon Scientist Scholarship.

MIME Grant Scheme
The MIME Seed Fund was established to accelerate the development of new medical technologies that address significant unmet clinical needs. 
Congratulations to A/Prof Jeremy Grummet, Prof David McGiffin and Dr Heather Cleland, for being part of the top sixteen successful project teams awarded seed funding by MIME in 2016.


Title of Project

Clinical Champion

Collaborators
Robotic transperineal prostate cancer biopsy
A/Prof Jeremy Grummet
Urologist
Lead CI Dr Chao Chen (eng)
Surface modifications prevent driveline infection
Prof David McGiffin
Director Cardiothoracic Surgery & Transplantation
Alfred Health
Lead CI A/Prof John Forsythe (eng)
Additional Team Prof Laurence Meagher (eng), Dr Yue Qu (eng), Dr. Helmut Thissen (CSIRO)
Burn wound management: Bioactive technology
Dr Heather Cleland
Director, Victorian Adult Burns Service
Alfred Health
Lead CI Dr Jess Frith (eng)
Additional Team Prof Laurence Meagher (eng), Prof Neil Cameron (eng) Dr Rebecca Lim (med), A/Prof Mikaƫl Martino (med)

Central Clinical School Public Lecture:  Innovative systems for improving trauma care
Speaker:  Professor Mark Fitzgerald, Director of Trauma Services at The Alfred and Director of the National Trauma Research Institute (NTRI).

This lecture took place on 12 October 2016 and was attended by 130 people.
Injury causes 5.8 million deaths per year with 90% in low- and middle-income countries. It also causes a significant amount of disability and economic loss. Much of this burden could be decreased by improvements in the care of the injured (trauma care).
Professor Fitzgerald gave an overview of trauma system research and development, how we’re using it here, and how we’re helping other countries, both in the developed and developing world, to either build or improve their own systems of trauma care.

http://ccsmonash.blogspot.com.au/2016/03/ccs-public-lecture-innovative-systems.html

Peninsula Health

Peninsula Health clinical school (PCS) continues its strong commitment to surgical research across all disciplines.

The annual surgical symposium will be held on Friday the 9th of December at the Frankston campus.  Registrars, resident and trainees will present their research and we are fortunate to have Professor Wendy Brown as this year’s keynote speaker. Mr. Ian Young will present his experience in the ADF, drawing on his vast experience in the Middle East.

The Jonathon Serpell prize for surgical research endeavor and excellence will be awarded to the best researcher for 2016.

The Peninsula Health clinical school is fortunate to have Dr Vicky Tobin PhD, as its full time
coordinator/manager of surgical research. We run weekly research meetings and monthly
formal presentation sessions with the aim to foster surgical enquiry at every level of the
surgical career.

This year we have Dr Michael Chae in his second year of PhD research titled ‘Biomedical 3D
modelling in surgery’. Ru Dee Chung and Mitchell Pryce are completing BMedSci projects on
‘Process mapping in Surgery’ and ‘3D upper limb anatomy for surgeons’ respectively.

We have published over 15 peer review papers in 2016, a couple of book chapters and have
presented widely, which is a credit to the team at PCS.

In addition, we have recently been successful in winning the highly competitive seed funding
($50,000) through the Monash Institute of Medical Engineering (MIME) for a project “3D
bioprinted scaffold of trapezium in basal thumb arthritis management”, a project that brings
together basic stem cell science, engineering, biotechnology and surgeons.

Post graduate surgical students

Mr Michael Zhu
Working towards prevention of acute kidney injury in patients undergoing cardiac surgery


Acute kidney injury (AKI) after cardiac surgery is a common, yet difficult problem to tackle. New clinical research at Monash Medical Centre and Monash University may allow clinicians to detect the real-time risk of AKI intraoperatively, offering an opportunity to predict AKI up to 1-2 days earlier than current methods of diagnosis.
The latest research has been conducted by Bachelor of Medical Science (Honours) student Michael Zhu under the supervision of Professor Julian Smith, Associate Professor Roger Evans and Associate Professor Andrew Cochrane. Michael has also been supported by a Monash University Honours scholarship.
The prospective study used a feasible and relatively non-invasive technique, involving a fibre optic oximetry probe deployed in the urinary catheter, to evaluate the relationship between urinary oxygen tension (PO2) and the development of AKI after cardiac surgery requiring cardiopulmonary bypass (CPB).
The study is ongoing, with a current sample-size of 35 subjects. The data indicate that patients who later developed AKI experienced significantly longer and more severe periods of urinary hypoxia intraoperatively; with a median of 14 min per hour of surgery in the AKI group, compared to just 30 seconds per hour of surgery in the non-AKI group.

The promising study has shown that real-time monitoring of risk of AKI during cardiac surgery is feasible and may be prognostically useful. This may in-turn offer clinicians the opportunity to intervene in the operating theatre to minimise the risk of AKI.

The next step will be to investigate, in a large animal model, whether intraoperative interventions (e.g. during CPB) can result in changes in renal and urinary oxygenation. Subsequently, this may translate to strategies to reduce the risk of AKI in patients having open-heart surgery.

Michael wishes to thank his dedicated supervisors for their tremendous support throughout the Honours year. He will present his research at the upcoming Annual Scientific Meeting of the Australia and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) in Cairns.

Surgical careers after PhD

What happens after doing a PhD – does it impact on your career as a Surgeon?  Each edition we will feature a surgeon who has completed a PhD and how this has impacted on their subsequent career.

Mr James Lee

Combining a clinical and research career in Endocrine Surgery


James Lee is a consultant endocrine surgeon at The Alfred and Monash Health. In 2014, he successfully completed a PhD on microRNA biomarkers of thyroid cancer at The University of Sydney. He currently holds the position of Adjunct Senior Lecturer at the Central Clinical School Department of Surgery, through which he continues to advance his interest in surgical research and education.

Upon completion of clinical fellowships at Austin Health (Melbourne) and Royal North Shore Hospital (Sydney), James embarked on a laboratory-based PhD to study the potential role of miRNA in the management of thyroid cancer. In his studies, James investigated the miRNA expression profiles of papillary thyroid cancer in subgroups of patients. The thesis also examined the potential utility of circulating miRNA molecules as a biomarker of recurrence. His studies showed that both tissue and circulating miRNAs have the potential to be biomarkers of thyroid cancer recurrence. James’ doctoral work also suggested that thyroid cancer cells seem to use miRNA-containing exosomes as a form of inter-cellular signaling.

Through his doctoral studies, not only was James able to gain a deeper understanding of the thyroid cancer disease process, he was also able to enhance his appreciation of the rigours of the scientific methods. As a result, his skills and understanding in the pre-clinical research fields, combined with his clinical training, put him in an ideal position to lead translational research projects. With close collaboration between clinicians and scientists, a translational research team can implement bench research findings to improve patient care, as well as take clinical problems from the bedside, and solve them in the laboratory. James is currently in the process of setting up a thyroid cancer research group to conduct further translational studies in the fields of miRNA and exosomes.

Another one of James’ passions is surgical education. He has recently established and run a very successful Monash University short course “An Introduction to Surgical Research”. It is hoped that this course will become an annual event. James is currently the Younger Fellows Representative in the RACS Section of Academic Surgery Committee, and is the convener of the Annual Academic Workshops in November. At the Alfred, James enjoys mentoring surgical trainees and residents who have an interest in research, and helping them with their clinical research projects. This year, James has joined the organising committee of the Biannual Alfred General Surgery Meeting.

In recognition of his work, James has recently been awarded the prestigious Royal Australasian College of Surgeons Foundation for Surgery Senior Lecturer Fellowship. One such fellowship is awarded each year to a Fellow of the College who is deemed by their peers to have made, and is likely to continue to make, significant contributions to academic surgery. James is excited and humbled by the award, which will help him further his career in academic surgery.
More information on James’ research and publications at:
http://www.mrjameslee.com.au/research.html

Teaching Update

Undergraduate teaching

Surgery is one of the pillars of the Monash University medical degree. Monash students are fortunate to have access via their clinical schools to a world class surgical education, thanks in the most part to the commitment, experience and enthusiasm for teaching of hundreds of surgeons throughout Melbourne, regional Victoria and Malaysia. Elements of surgery are taught across all years of the program and at almost twenty clinical sites.

In 2016 Monash University appointed Mr Peter Evans and Mr Tristan Leech, both practising surgeons, to the position of Curriculum/Assessment Leads for Surgery.

We have embarked on a project to update and document the surgical curriculum into a format more useful to students and surgeon/teachers, review and develop assessment materials and develop new online learning modules accessible to all students to reduce the amount of doubling up on didactic teaching required at individual sites currently

 This project is a collaboration between surgeons at all Monash University Clinical Schools and campuses, from Box Hill to Bendigo, Johor Bahru and beyond.

We are proud to announce the formation of the Surgery Discipline Reference Group (S-DRG) who will act as site-based curriculum and assessment advisors. In turn, they are inviting input from surgeons of all specialties at their sites to provide recommendations and content in specific areas of the curriculum. We have the full support of the Monash University and the Departments of Surgery at the various sites.

If you are passionate about surgical teaching and want to know more or get involved in this exciting and overdue modernisation of the curriculum content and delivery, please get in touch with us, or your local S-DRG representative. We’d love to hear from you!

The Monash University Surgery Discipline Reference Group (S-DRG)

Central Clinical School

  • The Alfred Hospital – Mr Simon Grodski
  • Cabrini Hospital – Ms Kaye Bowers
  • The Epworth – A/Prof Martin Richardson
  • Frankston Hospital – Mr Tristan Leech

 Clinical School Johor Bahru

  • Johor Bahru – Mr Suneet Sood

Eastern Clinical School

  • The Angliss, Box Hill Hospital, Maroondah Hospital - Mr Nigel Sacks

Rural Clinical School

  • Bendigo Base Hospital - A/Prof Beth Penington
  • La Trobe Regional Hospital - Mr Neil Jayasuriya
  • Mildura Base Hospital – Mr Rotimi Afolabi

School of Clinical Sciences at Monash Health

  • Dandenong Hospital – Mr Stephen Rodgers-Wilson
  • Monash Medical Centre – Mr Mark Cullinan

MUSIG 2016

The Monash University Surgical Interest Group (MUSIG) is a not-for-profit, student run organisation, dedicated to promoting the profession of surgery to medical students at Monash University. Since the last edition of the Cutting Edge, MUSIG has been busy with several key events.

Surgical Careers Symposium  

In April, MUSIG held a Pathways into Surgery Symposium, where each of the nine RACS Surgical Specialties were represented by a distinguished Consultant Surgeon or current surgical Trainee. The event was keenly attended by students across all year levels and was streamed live to regional Clinical Schools. Surgeons highlighted the fascinating world of their chosen specialties, discussed personal career pathways, and covered topics ranging from advice on becoming a competent and proficient surgeon, to involvement in research and academia, and the importance of mentorship.

MUSIG would like to thank the Victorian Regional Office of the Royal Australasian College of Surgeons and each of Monash University’s Departments of Surgery for their wonderful support of this event.

Surgical Skills Workshops

Across May to August, MUSIG held four surgical skills workshops (Alfred, MMC, Gippsland and Preclinical), reaching over 200 medical students. Stations ranged from basic suturing and hand-tying, to more advanced skills such as laparoscopic simulation, airway management, chest-tube insertion, bowel anastomosis, cyst removal, z-plasty and tendon repair. Guided by outstanding surgeons and trainees who generously volunteered their time and expertise, students wetted their appetite for surgery, brushed up on their surgical anatomy and gained a greater understanding of the intricacies and dexterity involved in surgery. At each of the workshops, surgeons gave very positive feedback and praised students for their enthusiastic attitude and learning abilities.

MUSIG and attending students would like to extend another heart-felt thanks to all Surgeons who assisted as tutors, and to the Departments of Surgery at the Central Clinical School, the School of Clinical Sciences (Monash Health), the Gippsland Clinical School and the Department of Anatomy & Developmental Biology for their ongoing support and backing.

How can you get involved?

Many doctors and surgeons tirelessly share their knowledge and passion for surgery at our events. If you, or staff in your Department are interested in teaching medical students with a keen interest in surgery, please feel free to contact our chairs Michael Zhu and Matthew Lam at musig@mumus.org.