Associate Prof Peter Nottle is Director of Upper GI Surgery at The Alfred Hospital in Melbourne, Australia. His major areas of interest are Bariatric Surgery, Upper GI Cancers, Hiatus Hernia and Anti-Reflux surgery. He has been performing Bariatric Surgery for more than 30 years and Laparoscopic Gastric bands for past 15 years as well as a full range of other bariatric procedures. He is one of Australia's pioneers in Laparoscopic Surgery having introduced the French technique of Laparoscopic Cholecystectomy at The Alfred hospital in the early 1990's. Assoc Prof Nottle consults in Williamstown, Werribee, Sydenham and Windsor.

QUALIFICATION

UNIVERSITY:
M.B., B.S., (MONASH)
DECEMBER, 1970

POSTGRADUATE:      

  • FELLOW ROYAL AUSTRALIASIAN COLLEGE OF SURGEONS (F.R.A.C.S.) - FEBRUARY, 1978
  • DIPLOMA OF LAPAROSCOPIC SURGERY, UNIVERSITY OF STRASBOURG - 1997
  • GRADUATE CERTIFICATE HEALTH SERVICES MANAGEMENT, MONASH UNIVERSITY - 2009
  1. Associate Professor of Surgery Monash University, Department of Surgery, Alfred Hospital, Melbourne - 2007
  2. Unit Head, Upper Gastrointestinal Surgery Unit Alfred Hospital, Melbourne - 2007
  3. Director, Hobsons Bay Endoscopy ( Board Chairman) - 1999
  4. Member Commonwealth Clinical Casemix Committee - 2007
  5. Board Member Victorian Medical Insurance Agency  - 2000
  1. Senior Specialist Surgeon, Alfred Hospital, Upper GI Unit (1979 - 2001).
  2. Hon. Senior Lecturer, Monash University Department Surgery (1979 - 2001).
  3. AMA Branch Council Member (1988 - 1989).
  4. Member Board of Management Williamstown Hospital (1988 - 1995).
  5. President Board of Management Williamstown Hospital (1992 - 1995).
  6. Chairman Upper GI Section R.A.C.S (1997 - 1999).
  7. Chairman, Division of Surgery, Alfred Hospital (1998 - 1999).
  8. Member Victorian State Committee R.A.C.S. (1993 - 1998).
  9. Hon. Treasurer Victorian State Committee (1995 - 1996).
  10. Member Standards Committee Vic RACS (1995 - 2002).
  11. Chairman Medical Advisory Board Western Private Hospital (1999 - 2007).
  12. Visiting Surgeon, Werribee Mercy Hospital (1995 - 2007).
  13. Director Surgical Services, Werribee Mercy Hospital (1998 – 2007).
  14. Head, Laparoscopic and General Surgical Unit, Williamstown Hospital (2001 – 2010).
  15. Director, Western Private Hospital (1999 - 2011).
  1. R.M.O Royal Hobart Hospital (1971 - 1972).
  2. Surgical Registrar Royal Hobart Hospital - 1973
  3. Surgical Registrar Alfred Hospital (1974 - 1976)
  4. Surgical Fellowship R.A.C.S - 1978
  5. Surgical Registrar, Essex County Hospital, Colchester, England  (1977 - 1978)
  6. Senior Resident (S.H.O.) St. Marks Hospital, London  - 1978
  1. Australian Medical Association - 1975.
    (Branch Council Member (1988-9)
  2. Australian Association of Surgeons - 1980.
  3. Asian Surgical Association - 1980.
  4. Gastroenterological Society of Australia - 1985.
  5. International Hepatopancreatio-biliary Society - 1992.
  6. International Society for Diseases of the Oesophagus - 1999.
  7. Obesity Surgery Society of Australia & New Zealand - 2002.
  8. Australian & New Zealand Gastro-Oesophageal Surgery Association - 2007.
  1. Colonic Infarction and Pancreatitis - A Case Report. ANZ J. Surg.  Vol. 50  No. 2  Page 184-185  April, 1980.
  2. Cholecystectomy Without Routine Operative Cholangiography. ANZ J. Surg.  Vol. 52  No. 5  Page 484-487  October, 1982.
  3. Gallstones - Operative, Dissolve or Leave Alone? Drugs  Page 302-308  1981302-308  1981.
  4. Synchronous Carcinomas of the Large Intestine. ANZ J. Surg.  Vol. 53  Page 329-332  1983.
  5. Total and Subtotal Colectomy for Colonic Obstruction. Dis. Colon Rectum  Vol. 28  Page 162-163  1985.
  6. Percutaneous Laparoscopic Cholecystectomy - The First Fifty. ANZ J. Surg.  Vol. 61  No. 4  Page 254-260  April, 1991.
  7. Laparoscopic Cholecystectomy. Aust. Med. J.  Vol. 154  No. 6  Page 427  March, 1991.
  8. A Technique for Percutaneous Laparoscopic Cholecystectomy. Asian J. Surg.  Vol. 14  No. 2  Page 87-91  April, 1991.
  9. Percutaneous Laparoscopic Cholecystectomy - The Current Status. Chinese Med. Gazette  Vol. 1  October, 1991.
  10. Laparoscopic Vagotomy for Chronic Duodenal Ulcer. Aust. Med. J.  Vol. 155  No. 4  Page 648  4/11/91.
  11. Laparoscopic Cholecystectomy - An Australian View. ANZ J. Surg.  Vol. 62  Page 50  1992.
  12. Laparoscopic Cholecystectomy - Indications, Contra-Indications and Complications. ANZ J. Surg.  Vol . 62  Page 188-192  1992.
  13. Comparison of Selective Endoscopic Retrograde Cholangiography with Intravenous Cholangiography as Common Duct Imaging Techniques prior to Laparoscopic Cholecystectomy. H.P.B. Surg.  Vol. 5 (Supplement)  Page 83  1992.
  14. Laparoscopic Cholecystectomy - One Surgeon's Experience. Alfred Surg.  Page 26-29  1992.
  15. Carbon Dioxide, Temperature and Laparoscopic Cholecystectomy. S. Bradfield, P. Nottle & J. Monagle. ANZ J. Surg.  Vol. 63  No. 3  Page 186-189  1993.
  16. Cholecystokinin (CCK)-HIDA Scintigraphy in Patients with Suspected Gallbladder Dysfunction.  A. Watson, N. Better, V. Kalff, P. Nottle, M. Scelwyn, M. Kelly. Aust. Radiology  Vol. 38  Page 30-33  1994.
  17. Laparoscopic Cholecystectomy:  What National Benefits Have Been Achieved and At What Costs?  S.D.S. Woods, P.D. Nottle, C. Christophi, P.J. Labb, I. Lindsay. Aust. Med. J.  Vol. 164  No. 8  Page 507  15/4/96.
  18. Laparoscopic Abdominal Surgery:  An Update. Med. Observor  CME  Page 4, 6 & 8  16/8/96.
  19. Pre-Operative Screening for Common Bile Duct Stones with Infusion Cholangiography: Review of 1000 Cases.  I. Lindsay, P. Nottle, N. Sacharis. Annals of Surg.  Vol. 226  No. 2  Page 1-5  28/5/97.
  20. Laparoscopic Management of Small Bowel Obstruction Caused by a Retrocaecal Hernia. I. Lindsay, P.D. Nottle. J. of Surg. Laparoscopic and Endoscopy.  Vol. 7  No. 4  Page 349-350  July 1997.
  21. Laparoscopic Management of Blunt Diaphragmatic Injury. I. Lindsay, S.D.S. Woods, P.D. Nottle. ANZ J. Surg.  Vol. 67  No. 9  Page 619-621  Sept. 1997.
  22. Venous Haemodynamics During Laparoscopic Surgery.  A Case for Caution. Scott, Wyld, Paige, Lent, Nottle, Wale, Christophi, Rosengarten. Minimally Invasive Surgery.  1997.
  23. Laparoscopic Cholecystectomy, Bile Leaks and Routine Drainage. P.D. Nottle. ANZ J. Surg. No. 71 (Suppl.) Page A62  2001.
  24. Management of Colorectal Cancer patients in Australia: the National Colorectal Cancer Care Survey.  P.D. Nottle. ANZ J. Surg. Vol. 75  Page 85-86 March, 2005.
  25. Extrahepatic Biliary Anatomy at Laparoscopic Cholecystectomy: Is Aberrant Anatomy Important?  M. Larobina & P.D.  Nottle. ANZ J. Surg. Vol. 75  No. 6  Page 392-395 June, 2005.
  26. The Complete Evidence regarding Access Injuries in Laparoscopic Surgery.   Surgical Laparoscopy, Endoscopy and Percutaneous techniques. Larobina & Nottle.  Vol. 15 No. 3 June 2005.
  27. Laparoscopic Management of Iatrogenic Colonic Perforation. Surgical Laparoscopy, Endoscopy and Percutaneous Techniques. 2007 June;17(3):215-7.
  28. Small Bowel Obstruction Creates a Closed Loop in Patients with a Laparoscopic Adjustable Gastric Band.  Campbell NA, Brown WA, Smith AI, Skinner S, Nottle P. Obes.Surg Oct 18 2008(10):1346-9.Epub 25 Jul 2008.
  29. Longterm Follow-up of Laparoscopic Hellers Myotomy for Achalasia. K. Heggie, W. Brown, A. Smith, P. Nottle. ANZ Journal of Surgery. Vol. 79 Sup 1, May 2009.
  30. Surgery for Morbid Obesity – Framework for Bariatric Surgery in Victorian Public Hospitals: Michael Grigg, Wendy Brown, Jennifer Conden, David Castle, John Dixon, Margaret Grigg, Veronica Kirchner, Martin Lum, Ann Magnus, Peter Nottle, Ibolya Nyulasi, Leonard Sumil Piers, Joe Prioetto, Peter Sloan, Boyd Swinburn, Terry Symonds, Pam Williams. Vic. Govt. Dept. Human Services Publication. March 2009. www.health.vic.gov.au
  31. Transoral incisionless fundoplication 2.0 procedure using EsophyX for gastroesophageal reflux disease.  Hoppo T, Immanuel A, Schuchert M, Dubrava Z, Smith A, Nottle P, Watson DI, Jobe BA. J Gastrointest Surg. 2010 Dec; 14(12):1895-901. Epub 2010 Sep 28.
  32. An approach to the assessment and management of the laparoscopic adjustable gastric band patient in the Emergency Department.  Freeman L, Brown WA, Korin A, Pilgrim CH, Smith A, Nottle P.  Emerg Med Australas. 2011 Apr;23(2): 186-94. Doi:10.1111/j. 1742-6723.2011.01396.x. Epub 2011 Apr 7.
  33. Long –Term Outcomes of 2288  Laparoscopic adjustable gastric bands over 15years   PD Nottle   I Bringman   S Caiirns   Obesity Surgery Vol 22 No 9 September2012   p1332.
  1. May, 1979.  "The Surgeon Endoscopist". R.A.C.S., Young Surgeons Forum.
  2. February, 1980.  "Cholecystectomy with Routine Cholangiography". World Congress in Gastroenterology, Auckland, New Zealand.
  3. March, 1980.  "The Incidence of Recurrent Bile Duct Stones". Symposium Biliary Disease 1980, Repatriation General Hospital, Heidelberg, Victoria, Australia.
  4. May, 1981.  "Is Every Lump a Cancer Until Proven Otherwise?" Breast Cancer Symposium, Alfred Hospital, Melbourne, Victoria, Australia.
  5. May, 1981.  "The Epidemiology of Breast Cancer" Breast Cancer Symposium, Alfred Hospital, Melbourne, Victoria, Australia.
  6. May, 1982.  "Surgical Anatomy of the Vagi" Peptic Ulcer Symposium, Alfred Hospital, Melbourne, Victoria, Australia.
  7. May, 1982.  "Intraoperative Testing for Completeness of Vagotomy" Peptic Ulcer Symposium, Alfred Hospital, Melbourne, Victoria, Australia.
  8. November, 1983.  "Emergency Upper Gastrointestinal Endoscopy" Update on Gastrointestinal Bleeding, Alfred Hospital, Melbourne, Victoria, Australia.
  9. February, 1985.  "Endoscopic Predictability of Recurrent Gastrointestinal Bleeding" Scientific Meeting, Association of Surgeons of South East Asia, Singapore.
  10. August, 1986.  "Technique of Upper Gastrointestinal Endoscopy" Update in Endoscopy Symposium, Alfred Hospital, Melbourne, Victoria, Australia.
  11. May, 1988.  "Continuous vs. Interrupted Mass Wound Closure using Polydiozanone Sulphate" R.A.C.S., Annual Scientific Meeting, Brisbane, Queensland, Australia.
  12. August, 1990.  " Laparoscopic Cholecystectomy" R.A.C.S., Young Surgeons Forum.
  13. November, 1990.  "Laparoscopic Cholecystectomy" Guest Speaker, Launceston General Hospital, Launceston, Tasmania, Australia.
  14. November, 1990.  "Laparoscopic Cholecystectomy" Guest Speaker, Royal Hobart Hospital, Hobart, Tasmania, Australia.
  15. December, 1990.  "Laparoscopic Cholecystectomy" Live demonstration Laparoscopic Cholecystectomy performed Convenor Workshop on Laparoscopic Cholecystectomy, Monash University, Dept. of Surgery, Alfred Hospital, Melbourne, Victoria, Australia.
  16. 12th March, 1991.  "Percutaneous Laparoscopic         Cholecystectomy - A Simple Technique" 8th Congress Asian Surgical Association, Fukuoka, Japan.
  17. 26th February, 1991.  "Percutaneous Laparoscopic Cholecystectomy - The French Connection" Austin Hospital National Conference, Melbourne, Victoria, Australia.
  18. 21st February, 1991.  "Percutaneous Laparoscopic Cholecystectomy"  Poster Display Alfred Hospital Clinical Society, Melbourne, Victoria, Australia.
  19. 20th April, 1991.  Live demonstration Laparoscopic Cholecystectomy performed. Convenor Workshop on Laparoscopic Cholecystectomy, Monash University, Dept. of Surgery, Alfred Hospital, Melbourne, Victoria, Australia.
  20. March, 1991.  "Percutaneous Laparoscopic Cholecystectomy" Guest Speaker, Victorian Chinese Medical Association, Melbourne, Victoria, Australia.
  21. June, 1991.  "Laparoscopic Cholecystectomy - The First 200" Guest Speaker, Calvary Hospital, Adelaide, South Australia.
  22. 28th June, 1991.  "Laparoscopic Cholecystectomy - Indications & Techniques" The Application of the New Technology in Surgery, Melbourne, Victoria, Australia.
  23. 18th October, 1991.  "Laparoscopic Cholecystectomy – Where Are We Now?" City Scientific Meeting, R.A.C.S., Melbourne, Victoria, Australia.
  24. 16th November, 1991.  "Laparoscopic Cholecystectomy" Current Issues in Gastroenterology – Gastroenterological Society of Australia, The Regent Hotel, Melbourne, Victoria, Australia.
  25. 27th February, 1992.  "Laparoscopic Surgery" Alfred Hospital Clinical Society Annual Meeting, Melbourne, Victoria, Australia.
  26. 4th March, 1992.  "The Difficult Cholecystectomy" Centre of the Study of Endosurgery, Course on Advanced Laparoscopic Surgery, Melbourne, Victoria, Australia.
  27. 6th March, 1992.  "Laparoscopic Vagotomy" Centre of the Study of Endosurgery, Course on Advanced  Laparoscopic Surgery, Melbourne, Victoria, Australia.
  28. 26th March, 1992.  "Bile Duct Imaging in Laparoscopic Cholecystectomy" Melbourne Gut Club, Melbourne, Victoria, Australia.
  29. 28th April, 1992.  "Laparoscopic Vagotomy" St. Luke's Hospital, Advanced Endoscopic Workshop, Sydney, N.S.W., Australia.
  30. 14th May, 1992.  "Comparison of Pre-operative Selective E.R.C.P. vs. Pre-operative IVC for Duct Imaging in Laparoscopic Cholecystectomy" R.A.C.S., G.S.M., Canberra, ACT, Australia.
  31. 14th May, 1992.  "Laparoscopic Vagotomy - A Technique" R.A.C.S., G.S.M., Canberra, ACT, Australia
  32. 15th May, 1992.  "Laparoscopic Vagotomy – Preliminary Report of Cases" R.A.C.S., G.S.M., Canberra, ACT, Australia.
  33. June, 1992.  "Comparison of Selective Endoscopic Retrograde Cholangiography with Intravenous Cholangiography as Common Duct Imaging Techniques prior to Laparoscopic Cholecystectomy" World Congress of Minimally Invasive Surgery, Bordeaux, France.
  34. August, 1992.  "Laparoscopic Vagotomy" Invited Speaker, Graeme Copland Memorial Meeting, Royal Northshore Hospital, Sydney, N.S.W., Australia.
  35. September, 1992.  "A Technique for Laparoscopic Vagotomy" Gastroenterological Society of Australia, Annual Meeting, Canberra, ACT, Australia.
  36. November, 1992.  "A Simple Method for Managing the Common Duct Stone in Laparoscopic Cholecystectomy" R.A.C.S., Country Scientific Meeting, Moe, Victoria, Australia.
  37. November, 1992.  "Pre-operative Intravenous Infusion Cholangiography vs. Intra-operative Cholangiography in Laparoscopic Cholecystectomy" R.A.C.S., Country Scientific Meeting, Moe, Victoria, Australia.
  38. February, 1993.  "Avoiding Common Bile Duct Injury in Laparoscopic Cholecystectomy" Advanced Meeting in Hepatobiliary Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
  39. April, 1993.  "The Place of Infusion Cholangiography in the Management of Choledocholithiasis at Laparoscopic Surgery" R.A.C.S., G.S.M., Adelaide, South Australia.
  40. April, 1993.  Debate with Professor a. Cushieri. The Case Against Routine Cholangiography at Laparoscopic Cholecystectomy. R.A.C.S., G.S.M., Adelaide, South Australia.
  41. April, 1993.  "Bile Leaks Following Laparoscopic Cholecystectomy" R.A.C.S., G.S.M, Adelaide, South Australia.
  42. July, 1993.  "Infusion Cholangiography and Laparoscopic Cholecystectomy" Endosurgery - The State of the Art, Hamilton Island, Queensland, Australia.
  43. July, 1993.  "Laparoscopic Vagotomy.  A Technique using Anterior H.S.V. Combined with Posterior Truncal Vagotomy" Endosurgery - The Start of the Art, Hamilton Island, Queensland, Australia.
  44. 17th October, 1993.  "Laparoscopic Surgery" Australian Association of Surgeons, Victorian State Committee Seminar, Healesville, Victoria, Australia.
  45. 8th April, 1994.  "Laparoscopic General Surgery" Victorian Medical Postgraduate Foundation (VMPF), Country Education Programme, Latrobe Regional Hospital, Traralgon, Victoria, Australia.
  46. 21st July, 1994.  "Laparoscopic General Surgery" VMPF, Country Education Programme, Portland & District Hospital, Portland, Victoria, Australia.
  47. 7th September, 1994.  "Advances in Laparoscopic Surgery" VMPF, Country Scientific Programme, Mildura Base Hospital, Mildura, Victoria, Australia.
  48. 9th February, 1995.  "Laparoscopic Abdominal Surgery" VMPF, Country Education Programme, Wimmera Base Hospital, Horsham, Victoria, Australia.
  49. 4th March, 1995.  "The Hidden Trauma of Laparoscopy" R.A.C.S., Annual General Meeting of Victorian Fellows, Melbourne, Australia.
  50. 9th May, 1995.  "Infusion Cholangiography in Patients Undergoing Laparoscopic Cholecystectomy" R.A.C.S., Annual Scientific Congress, Perth, Western Australia.
  51. 9th May, 1995.  "Diagnosis and Management of Bile Leaks Following Laparoscopic Cholecystectomy" R.A.C.S., Annual Scientific Congress, Perth, Western Australia.
  52. 15th October, 1995.  "Infusion Cholangiography in Patients Undergoing Laparoscopic Cholecystectomy – Cost Implications" Gastroenterological Society of Australia, Perth, Western Australia.
  53. 23rd May, 1996.  "Laparoscopic Abdominal Surgery" VMPF, Country Education Programme, Gippsland Base-Hospital, Sale, Victoria, Australia.
  54. 19th July, 1996.  "Laparoscopic Abdominal Surgery" VMPF, Country Education Programme, Hamilton Base Hospital Hamilton, Victoria, Australia.
  55. 7th August, 1996.  "Pain Without Stones and Stones Without Pain" Surgical Pot Pourri, Alfred Hospital, Dept. of Surgery, Melbourne, Victoria, Australia.
  56. May, 1997.  "Laparoscopic Fundoplication" The Avenue Hospital, Melbourne, Victoria, Australia.
  57. 4th June, 1997.  "The Ins & Outs of Laparoscopic Surgery" Caulfield General Medical Centre, Melbourne, Victoria, Australia.
  58. 4th May, 1998.  "I Always Drain My Cholecystectomies" R.A.C.S., Annual Scientific Congress, Sydney, N.S.W., Australia.
  59. 12th May 2000 "Expert Witness For the Defence" Seminar on Management of Bile Duct Injuries R.A.C.S. Annual Scientific Congress, Melbourne, Victoria
  60. July 2000.  Foundation visitor in laparoscopic/general surgery Royal College of Surgeons of Thailand Annual Scientific Meeting:
    • Prevention of bile duct injuries in laparoscopic cholecystectomy.
    • Management of bile leaks following laparoscopic cholecystectomy.
    • Evaluation of new technology in symposium or New Technology.
    • Laparoscopic surgery of oesophago-gastric junction.
  61. Laparoscopic update.  Live demonstration to auditorium audience. Laparoscopic gastric banding, Western Hospital Footscray May 2004.
  62. 2nd September 2005.   The Difficult Cholecystectomy. Benign Disorders of the Biliary Tract.   Annual course in hepatobiliary and pancreatic surgery. Langham Hotel, Melbourne.
  63. 2007   RACS Hong Kong: Laparoscopic Gastric Banding Costings in the Public Health System.
  64. 2007 RACS Congress Hong Kong    Day Care Laparoscopic Fundoplication.
  65. Sept 2008  Update Austin Hospital RACS:  The Difficult Cholecystectomy" Biliary Tract Disease.
  66. 2009   Alfred Hospital Update Course for Surgeons:   Laparoscopic Transluminal inguinal Hernia Repair.
  67. RACS Congress Perth:  2010  Laparoscopic Gastric Banding in the Public Health System
  68. 2010 OSSANZ Hobart Nov.  Endoluminal Bariatric Surgery.
  69. 2011 OSSANZ  Adelaide       Low BMI  Bariatric Surgery
  70. October 2011 The Alfred General Surgery Meeting, Langham Hotel, Melbourne, "Updates on Common Surgical Problems" Is There a Place For NOTES? Management of the Failed Lap Band
  71. OSSANZ  Darwin 2012 "Evolution of a public bariatric Practice"
  72. IFSO  2012 Delhi, India. " Long-term Outcomes of 2288 LAGB over 15 years". " Outcomes of Revisions and Reversals for LAGB"

Surgical Career

Following completion of my surgical training at Alfred Hospital in 1977, I continued my training at

The Essex County Hospital and St. Marks Hospital, concentrating on Gastrointestinal surgery and

Endoscopy.  Early in my career I recognised the importance of surgeons performing Gastrointestinal endoscopy and gave a lecture at the Young Surgeons Forum R.A.C.S on "The Surgeon Endoscopist".  I have always been a strong advocate for the inclusion of endoscopy training in the Surgical training programme and I was appointed as a Surgeon to Alfred Hospital in 1979 and the emphasis in my practice was Upper GI and HPB surgery.

My main achievement in surgery has been the pioneering of Laparoscopic Surgery.  In June 1990 I was the first surgeon to perform a laparoscopic cholecystectomy at Alfred Hospital using the French technique, skills for which were developed whilst studying under Professor Francois Dubois in Paris at L'Hospital International de l'Universite de Paris.  Following that, I performed a number of live demonstration laparoscopic cholecystectomies during teaching courses at Alfred Hospital for other surgeons.  I have also visited several other centres in Victoria and Tasmania and Thailand in July 2000 performing demonstration laparoscopic operations.

I have continued to provide leadership in the development of laparoscopic techniques, updating my knowledge and skills by regular presentations at scientific meetings and several visits to the University of Strasbourg laparoscopic teaching unit where I obtained a Diploma in Laparoscopic Surgery in 1997.

In July 2000, I was honoured to be invited as the Foundation Visitor in Laparoscopic and General Surgery to the Royal College of Surgeons of Thailand Annual Scientific Meeting and gave lectures on :

  1. The management of bile leaks following laparoscopic cholecystectomy.
  2. The prevention of bile duct injuries during laparoscopic cholecystectomy.
  3. Laparoscopic surgery of the oesophago-gastric junction.
  4. Clinical assessment of the new technology.

During that visit to Thailand, I also performed demonstration operations (laparoscopic cholecystectomy and laparoscopic hernia repair) at the Lerdsin Hospital in Bangkok.

In 2008, because of my interest in public patient access to bariatric surgery and  because of the number of these procedures that I perform in the public system, I was invited to join the subcommittee that developed guidelines for bariatric surgery in the public health system in Victoria. This resulted in a publication which is currently in use through the Victorian Public health System.

Since returning to The Alfred in 2007 as The Unit Head of Upper GI Surgery, I have focused the unit in the key areas of :

  1. Upper GI/HPB  cancer - A  data manager has been appointed to the unit ( funded through unit activities ) which has enabled the unit to establish and maintain  data bases in oesophago-gastric, pancreatic and  liver cancer.
  2. Bariatric Surgery – Bariatric procedures have increased from 50 per year to 300 per year and the range of operations broadened from Gastric banding to Roux-Y bypasses , Sleeve gastrectomies and  BPDs. A Data base has also been established and maintained and  outcomes of the procedures  performed in this setting have been presented in scientific meetings and several papers have been published. Multidisciplinary bariatric outpatient clinics have been established to assess new patients and to  follow up patients post surgery. For patients who are to undergo bariatric procedures , information nights have been commenced and an on-line education tool has been developed I have continued to emphasise that bariatric surgery is an important part of upper gastrointestinal surgery and must be taught in  a major teaching hospital setting.
  3. Antireflux and Hiatus hernia surgery.
  4. Laparoscopic biliary surgery
  5. Trauma and emergency surgery
  6. Improvement in Quality outcomes by introducing a method of standardising the documentation of post operative complications ( Clavian-Dindo) presented at our 2012 Audit

During my time as unit head, the surgical workload of the unit has doubled

My current skills in laparoscopic surgery include:

  1. Laparoscopic-hepato-bilary surgery (cholecystectomy, exploration of CBD, cholecyst-jejunostomy) and hepatic cyst marsupialisation.
  2. Laparoscopic oesophago-gastric surgery, fundoplication for G.O.R.D., cardiomyotomy for achalasia, repair of para-oesophageal hiatus hernia, gastro-enterostomy, pyloroplasty, total gastric mobilisation (for oesophageal replacement), laparoscopic partial gastrectomy.
  3. Bariatric procedures including laparoscopic gastric banding and laparoscopic sleeve gastrectomy , BPD , Roux-Y gastric bypass and laparoscopic reversal of bariatric procedures.
  4. Laparoscopic splenectomy.
  5. Laparoscopic bowel surgery – right hemicolectomy, sigmoid colectomy, anterior resection, reversal of Hartmann's procedure, colostomy, repair rectal prolapse and small bowel resection.
  6. Laparoscopic appendicectomy.
  7. Laparoscopic hernia repair – inguinal hernia, femoral hernia and incisional hernia.
  8. Diagnostic laparoscopy with biopsy procedures ± lymph node excision.

My principal goals in this field are to ensure that laparoscopic surgery is performed safely and that laparoscopic procedures become the preferred technique for most abdominal operations.

Elected member of the R.A.C.S. State Committee for 1994-1998 being Honorary Treasurer in 1998.  During that time I was Co-Ordinator for the second part course (at that time organised by the State Committee) and a member of the Standards Subcommittee and Victorian Council Casemix Committee.

Member of the Upper GI Committee of the R.A.C.S. in 1993 and was Chairman of that group in 1998 and 1999 and was the clinical  Co-Ordinator for the Upper GI Training Program.  As a member of that committee, guidelines were developed for several laparoscopic procedures.

Alfred

I spent five years on the executive of the then Division of surgeryfrom 1994 and was chairman in 1998. I am currently on  multiple Alfred hospital committees in my role as unit head.

Williamstown

Appointed to the Board of Williamstown Hospital in 1989 and continued in that role until individual hospital boards were replaced by network boards in 1994.  I was Chairman of the Board from 1992-1994 inclusive.  During that time the Board oversaw the successful introduction of Casemix funding.  The Board also developed the plans for the construction of the wards, operating theatre and rehabilitation unit, all of which were completed in 3 years.  I spent many years on the executive of the Williamstown Hospital Medical Staff Group and was  Chairman of that group in 1987 and 1988 and again from 1998-2007.

Werribee

Appointed as director of Surgical Services, the Werribee Mercy Hospital in 1998 until 2007

Other Institutions

I founded Hobsons Bay Endoscopy  at the site of the old Altona  hospital in 1999. After its initial success, I  was joined by another General Surgeon and a Gastroenterologist as partners and a new facility was built in Werribee. More recently we have opened a new facility in Sydenham. All three centres are presently performing endoscopies, Upper and lower GI and pillcam examinations.

I was one of six partners who built and managed Western private hospital and was on the board of management until 2012 . During my time on the Board, an accredited training post in general surgery was established

Undergraduate

Since 1978, as a member of the Alfred Hospital Surgical Staff, was an Honorary Lecturer in the Department of Surgery, Monash University.  This involved active participation in the student teaching programme for 5th and 6th years and has included the formal lecture programme, regular tutorials and teaching in outpatients and the operating theatre.

In 2002, I obtained final year Melbourne University medical student attachment to the General Surgical Unit at The Williamstown Hospital.  They participated in all unit activities and had a formal tutorial program.  Undergraduate students are attached to the Alfred Upper GI Unit and regular teaching sessions are carried out.

Postgraduate

Registrar Level

Actively participate in the Registrar Surgical training programme with regular tutorials and operating theatre demonstrations and assistance.  Whilst a member of the Victorian State Committee, I was also responsible for the organisation of the Second part course which is now run by the Board of General Surgery.  I was also, as curriculum co-ordinator for the Upper GI section committee of the R.A.C.S., responsible for the development of the curriculum for advanced training in Upper GI Surgery.  I have established, and have had accredited by the College ,  four general surgical registrar positions, two at Williamstown Hospital, one at the Werribee Mercy Hospital and one at Western Private Hospital.

Formal tutorial sessions are given as part of the Alfred teaching programme.

Surgical Colleagues

As a pioneer in laparoscopic surgery, I have taught many of my colleagues laparoscopic surgical procedures.  This has been at a formal level during courses run at the Department of Surgery, Monash University, Alfred Hospital where demonstration operations were performed along with a formal lecture programme.  It has also been at an informal level with visits by colleagues to operating sessions.

I have also produced several video tapes at the Monash Teaching Services Unit which are used for teaching purposes.  (Also at undergraduate and registrar levels.)

As head of the General Surgical Unit at the Williamstown Hospital and Director of Surgical Services at the Werribee Mercy Hospital, I introduced regular Death and Complication meetings and a Surgical Audit programme in both institutions.

Research Activities

I have published more than 30 scientific articles in various journals, most resulting from clinical research activities (see list).  Since rejoining The Alfred, I have appointed a Data Manager to the Upper GI Unit to aid the collection of data for follow up and research papers.

  1. A leader in the field of laparoscopic surgery pioneering the introduction of laparoscopic cholecystectomy and other laparoscopic techniques.
  2. Extensive clinical surgical experience at a senior level with knowledge and experience in laparoscopic surgical procedures, particularly upper GI cancer, antireflux  and bariatric procedures which is one of the largest in Australia.
  3. With a graduate diploma in health services management ,a knowledge of hospital management and systems including :
    • Budget management
    • Human resources
    • Quality Improvement
  4. Long experience with surgical teaching at undergraduate and postgraduate level.
  5. Significant experience with clinical research projects.

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Your BMI is below 20. You may be perfectly healthy at this BMI, but if you have lost weight recently we suggest you visit your general practitioner for a check-up.

Congratulations your weight is in the ideal range. You do not need to consider a weight loss procedure.

You are overweight but not to a degree which is likely to lead to major medical problems. You may wish to consider an appointment with our Dietitian or consider use of the Orbera Intra Gastric Balloon.

We suggest a consultation to discuss your options.

You are significantly overweight and may be a candidate for a weight loss procedure, particularly if you have other problems such as diabetes and hypertension. Options include Orbera Intra-Gastric Balloon and LapBand.

We suggest a consultation to discuss your options

Your weight is now at a potentially dangerous level and you are at high risk of developing major conditions such as Type 2 Diabetes, Hypertension, Stroke, Heart Attack and some cancers. Options include Lapband, Laparoscopic Sleeve Gastrectomy and Laparoscopic Gastric Bypass.

We suggest a consultation to discuss your options.

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