Surgery

Head of Discipline
Professor John Fletcher
Location
In the Clinical Schools

The Discipline of Surgery is the largest academic surgical discipline in Australasia. Units of the Discipline are established at the Royal Prince Alfred Hospital, Royal North Shore Hospital, Concord Repatriation General Hospital, Westmead Hospital, Nepean Hospital, Lidcombe Hospital and the Children's Hospital at Westmead.

The Discipline is at the forefront of research and clinical studies in a wide range of surgical disciplines.

Research facilities are available in each of the teaching hospitals and in the Medical School. The main areas are as follows:

Royal Prince Alfred Hospital and the Medical School at the University
Transplantation surgery; vascular surgery; surgical oncology; melanoma surgery; ear, nose and throat surgery.

Royal North Shore Hospital
Oesophagal and upper gastro-intestinal surgery; endocrine surgery; orthopaedic surgery and surgery of rheumatology; neurological surgery.

Concord Hospital
Vascular surgery; colorectal surgery; surgery of trauma.

Westmead Hospital
Upper gastrointestinal surgery, including liver and pancreatic studies and pancreatic transplantation; surgery of trauma; vascular surgery.

New Children's Hospital
Cardiothoracic surgery.

Nepean Hospital
UGI Hepato-pancreatico biliary; colorectal; orthopaedics.

Major areas and topics of research include:

Breast and Endocrine Surgery

• Epidemiology of thyroid cancer
• Development of surgical techniques for thyroid surgery
• Molecular genetics of thyroid cancer
• Epidemiology of breast cancer
• Natural history of breast cancer
• Surgical strategy and outcome statistics

Cerebrovascular Surgery

• Chronic cerebral ischaemia
• Cerebral arteriovenous malformations
• Central control of blood pressure and respiration

Colorectal Surgery

• Pathology, classification and staging of CRC
• Identification of prognostic indices in CRC
• Surgical management and outcome studies
• Palliation of advanced rectal cancer
• Early diagnosis
• Continence mechanisms
• Frequency of microsatellite instability, TGFbeta receptor II and IGFII receptor mutations in colorectal neoplasms
• Role of TGFbeta signalling in CRC
• Relationship between serum and tissue levels of TGFbeta and IGFII and prognosis in patients with CRC
• P53 and genetic mutation as prognostic predictors for rectal cancer
• Genetic mutations as predictors for hepatic metastases
• Transrectal ultrasound staging of rectal cancer
• Patient preferences for surgical therapies
• Laparoscopic controlled trials for CRC
• Patient preferences and adverse events with screeding for CRC

Centre for Values, Ethics and the Law in Medicine

• Reconceptualising outcomes of medical treatment

Hand Surgery

• Disorders of the distal radio-ulnar joint
• Arthritis of the basal joint of thumb
• Flexor tendon repairs
• Vascularised bone grafts for non union of scaphoid
• Torsional strength in ulnar osteotomy

Head and Neck Surgery

• Sensory recovery in free flap
• Quality of life following major head and neck surgery
• Larynegeal preservation in cancer of the larynx and hypopharynx
• Metastatic skin cancer
• Papiloma virus and head and neck cancer
• Molecular biology of differentiated thyroid cancer
• Clinical behaviour of mucosal SCC

Inflammatory Bowel Disease

• Aetiology of ulcerative colitis
• Surgical outcomes of Crohn's Disease in the elderly
• Surgical outcomes of pelvic reconstruction for ulcerative colitis

Melanoma

• Lymphatic mapping and selective "sentinel" lymph node biopsy for primary melanoma
• Lymphoscintigraphy for cutaneous melanoma
• Regional chemotherapy by isolated limb perfusion and isolated limb infusion for recurrent limb melanoma
• Automated instrumental diagnoses of melanoma
• Adjuvant immunotherapy with vaccinia melanoma cell lysate for high-risk melanoma
• Multi-disciplinary management of melanoma
• Psychosocial intervention
• Melanoma genetics
• Ultraviolet carcinogenesis
• Immunology of melanoma

Neurosurgery

• Cerebral blood flow and transcranial doppler measurements
• Cerebral oxygen measurement
• Subarachnoid haemorrhage – CBF and TCD measurements
• Drug trials for delayed vasospasm
• Head injury
• Epilepsy
• Bioethics
• CSF circulation
• Biomechanics of CSF pathways
• Computer modelling CSF pathways
• Neurotrauma, especially in sport
• Acute cerebral ischaemia and neuroprotection
• Cervical myelo-radiculopathy
• Rheumatology and Orthopaedic Surgery
• Studies on mesenchymal cells concerning their metabolism of matrix components during degeneration and ageing process
• Identifying metabolic response of chondrocytes to effects of mechanical loading using animal models of osteoarthritis
• Establishing importance of mechanical factors and annular injury on metabolism of components of intervertebral disc and cartilaginous end-plate
• Evaluation of novel therapeutic agents and post-operative strategies which influence the above
• Demography, epidemiology and long-term outcomes in spinal deformity (kyphosis and scoliosis)
• Design and information technology
• Revision joint replacement and surgical fixation

Otorhinolaryngology

• Cochlear implant program
• Menière's Disease research program
• Risk factors in age-related hearing loss
• Radiology of the ear
• Intra-operative monitoring of cochlear potentials

Paediatric Surgery

• Cardiac surgery
• Myocardial protection in congenital heart disease surgery
• Hirschprung's Disease
• Oesophagal atresia and tracheo-oesophagal fistula

Pelvic Floor Disorders

• Aetiology of faecal incontinence in the elderly
• Use of biofeedback for faecal incontinence
• Anal sphincter reconstruction for faecal incontinence

Surgery Education

• Role of the operating theatre as a learning environment
• Use of multimedia in surgery education
• Surgical Oncology
• Regional chemotherapy by isolated limb perfusion and isolated limb infusion for bone and soft tissue sarcomas
• Pre-operative ‘induction' intra-arterial chemotherapy for soft tissue sarcomas
• Regional chemotherapy for locally advanced and recurrent malignancies
• Minitory responses to induction chemotherapy for soft tissue sarcomas by sequential PET scanning

Transplantation Surgery

• Bioartificial liver support systems
• Mechanisms of tolerance
• Immunosuppression
• Organ preservation
• Xenotransplantation
• Experimental tissue and organ transplantation
• Characterisation of inbred pig colony
• Evaluation of xenoimmune response
• Islet cell transplantation – clinical and experimental
• Effect of normglycaemia on secondary complications of diabetes

Upper Gastrointestinal Surgery

• Reflux disease and hiatal herniation
• Laparoscopic bile duct exploration
• Gastric cancer project
• Ampullary tumour
• Barrett's oesophagus – pathophysiology and new therapies
• New laparoscopic operations for reflux disease
• Modelling to define pathophysiology of hiatus herniation
• Pre-operative systemic chemotherapy in gastric cancer
• Management of colorectal cancer liver metastases
• Albendazole in treatment of disseminated and localised hydatid disease
• Radical pancreatectomy with vascular reconstruction for advanced islet cell tumours

Urology

• Neurophysiology of bladder
• Neuromodulation of incontinence and urological pain
• Use of isoflavones in prostate cancer
• Efficacy of PET scanning in detection of pelvic metastases
• Quality-of-life outcomes measures in incontinence
• MRI in prostate cancer
• Molecular biology of prostate cancer
• Genetic markers in familial carcinoma of prostate
• Electron microscopy changes in detrusor muscle
• Detection of prostate cancer with enhanced ultrasound
• Alternative therapy for BPH

Vascular Surgery

• Prevention of vascular graft infection
• Inhibition of intimal hyperplasia after vascular interventions
• Cellular mechanisms of intimal hyperplasia
• Endovascular repair of abdominal aortic aneurysms
• Endoluminal vascular surgery for abdominal aortic aneurysm
• Non-invasive diagnosis of peripheral vascular disorders
• Surveillance after peripheral arterial reconstruction
• Vascular applications of ultrasound
• Endoscopic surgical sympathectomy
• Surgical management of extracranial arterial disease
• Surgical management of thoracic outlet syndrome
• Renovascular hypertension
• Plaque structure, unilateral occlusions and restenosis in carotid artery disease
• Angioplasty and stent procedures in ileofemoral artery disease
• Graft survival in infra-inguinal disease

Other

• Soft tissue biomechanics and instrument-tissue interface

Professor John Fletcher
Head of Surgery

Department of Surgery
Westmead Hospital

Email:

Associate Professor Ross Smith

Postgraduate Research Program
Department of Surgery
Royal North Shore Hospital

Email: