Friday 27 August 2021

FINAL PROGRAM

ACT Annual Scientific Meeting 2021Advancing Operative Techniques – Improving Your Skills

We’ve gone virtual

ACT Annual Scientific Meeting 2021Advancing Operative Techniques – Improving Your SkillsFriday 27 August 2021

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Dr Hari BandiFRACS, Co-Convener

Dr David RangiahFRACS, Co-Convener

Dear colleagues,

In lieu of the recent COVID-19 border closures and lockdowns particularly in the ACT, the ACT Annual Scientific Meeting has been converted to a fully Virtual Meeting to be held on Friday 27 August 2021 via Zoom Webinar.

On behalf of the ACT Committee of the Royal Australasian College of Surgeons (RACS), we welcome you to the region’s premier annual surgical event, the RACS ACT Annual Scientific Meeting 2021.

As surgeons, we continuously look for more education, how to better our skills and how we will be operating into the future. The theme of the ACT ASM 2021 is to look at advancing our operative techniques and improving our skills. Throughout the program, keynote speakers will present on a range of topics from how to challenge boundaries, how to educate ourselves — particularly beyond gaining Fellowship and how to develop our skills into the future.

The ACT is fortunate to be hosting the Henry Windsor Lecture 2021 which will be given during the Virtual Meeting by Professor Michael Solomon.

Free paper presentations from local and interstate delegates will be interspersed throughout the Virtual Meeting to showcase junior surgical doctors’ research and audit activities. Poster presentations can also be viewed online and throughout this document.

Finally, we would like to acknowledge the support provided by our Gold Sponsor — W.L. Gore & Associates Pty, Ltd, Silver Sponsors — Avant, Medtronic Australasia Pty Ltd, MIGA and SANOFI, as well as our Supporting Partner — Bongiorno Group.

Warm regards,

Convener Welcome

Invited Speakers General InformationMS KATE BURGESSSenior Program Coordinator, responsible for the Continuing Professional

Development (CPD) program at the Royal Australasian College of Surgeons

PROFESSOR ANTONIO DI IEVA

Professor of neurosurgery and operates at the Macquarie University

Hospital (Sydney), and consults at Macquarie Neurosurgery, Dubbo and Camden with expertise in neuro-oncology, pituitary and skull base surgery, spine surgery and specialises in microneurosurgery, and pain treatment

MR STEPHEN HALCROW

A now retired surgeon who completed his Australian neurosurgical training in Sydney and was staff

specialist and VMO neurosurgeon in Adelaide and Canberra

PROFESSOR JEFFREY HAMDORF

Academic Surgeon (Upper Gastrointestinal and Bariatric) based at The University of

Western Australia and Hollywood Private Hospital in Nedlands, Western Australia

MS AMY GOFF

Training and Education Manager for da Vinci Surgery at Device Technologies and is involved in teaching

and training surgical technologies in minimally invasive surgery for 18 years

PROFESSOR PAUL SMITH AM

Professor of Orthopaedic Surgery at the Australian National University, Director

of the Trauma and Orthopaedic Research Unit at the Canberra Hospital and the John Curtin School of Medical Research, and Orthopaedic Unit Director at the Canberra Hospital

PROFESSOR MICHAEL SOLOMON

Consultant Surgeon and Academic Head of the Department of Colorectal Surgery

at the Royal Prince Alfred Hospital in Sydney and Professor of Surgical Research at the University of Sydney

MR DUNCAN STEVENSON

Worked for CSIRO for 27 years developing interactive computer systems for industrial

applications, and has a PhD in computer science and is currently an Honorary Associate Professor in the School of Computing at the Australian National University

CONTINUING PROFESSIONAL DEVELOPMENT (CPD) PROGRAMThis educational activity is accredited. Fellows who participate can claim one point per hour (maximum 8 points) in Education towards 2021 CPD totals.

CPD points will be automatically updated for all Fellows who have provided their RACS ID.

ACCESS TO THE VIRTUAL MEETINGAll registered delegates will receive a Zoom Webinar link to access the Virtual Meeting prior to the Meeting on Friday 27 August 2021.

If you have registered and have not received any details, please contact college.asm@surgeons.org

CERTIFICATE OF PARTICIPATIONA certificate of participation will be distributed after the Meeting.

ACT Annual Scientific Meeting 2021Advancing Operative Techniques – Improving Your SkillsFriday 27 August 2021

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GOLD SPONSOR

SILVER SPONSORS

Sponsors

Avant has a proud heritage of protecting the medical profession and is Australia’s leading medical defence organisation, representing over 75,000 healthcare practitioners and students across every state and territory.   We remain a mutual organization, serving members, not shareholders, ensuring they are always at the heart of everything we do.

As a global leader in medical technology, services and solutions, Medtronic improves the lives and health of millions of people each year. We use our deep clinical, therapeutic, and economic expertise to address the complex challenges faced by healthcare systems today. Let’s take healthcare Further, Together. Learn more at Medtronic.com.au

Gore engineers medical devices that treat a range of cardiovascular and other health conditions. With more than 50 million medical devices implanted over the course of more than 45 years, Gore builds on its legacy of improving patient outcomes through research, education and quality initiatives. Product performance, ease of use and quality of service provide sustainable cost savings for physicians, hospitals and insurers. Gore is joined in service with clinicians and through this collaboration we are improving lives.

Visit the W.L. Gore & Associates Pty, Ltd. Website

Visit the Avant Website

Visit the Medtronic Australasia Pty Ltd Website

SILVER SPONSORS (cont’d)

SUPPORTING PARTNER

Sponsors (cont’d)

MIGA is a specialist insurer offering a range of medical indemnity insurance products and associated services. We have been supporting and protecting the medical profession for over 120 years. Visit www.miga.com.au or call 1800 777 156 to find out why more and more doctors are discovering MIGA.

Sanofi Australia is part of a global healthcare organisation that employs over 100,000 people across 170 countries. Our purpose is to bring hope, relief and cures to patients with the medicines and vaccines that we make. Established in Australia in 1980, our heritage spans 100 years, pioneering medicine across broad therapeutic areas including diabetes, cardiovascular disease, influenza, oncology, immunology, rare diseases and rare blood disorders.

Visit the MIGA Website

Visit the SANOFI Website

Visit the Bongiorno Group Website

ACT Annual Scientific Meeting 2021Advancing Operative Techniques – Improving Your SkillsFriday 27 August 2021

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Posters Posters (cont’d)To view a poster presentation, click on the button below.

METHOD Retrospective data collection of all multi trauma. Pts with BST from June 2008 - June 2013 at TCH. Data review included pts admission notes, CT result, management technique, and pts outcome. PATIENT COHORT A total of 161 patients with BST 124 (77.01%) male, 37 (22.98%) female. AAST-Splenic Injury by Grading:

- Grade 1-2: 73 (45.3%) - Grade 3: 33 (20.6%) - Grade 4-5: 55 (34.2%)

The median ISS scores were adults: 17.78, male: 15.10, female: 18.00, paediatrics 12.30.

MECHANISM OF INJURY

MVA 66 40.9% MBA 34 21.1% Fall 15 9.3% Snowboarding 14 8.6% Rugby 7 4.3% Miscelllaneous 25 15.5%

NOM

NOM(26) 100% Paediatrics sNOM 100% NOM(135) 73.3% Adult sNOM 97.8% fNOM(4) 2.2% Adult fNOM 2.2%

fNOM failed NOM ,sNOM successful NOM ICU Admission - 54.65% Angiographic Embolization - 2.9% (One active blushing, 2 with no blushing) One fNOM required delay laparotomy OPERATIVE MANAGEMENT

Urgent laparotomy

36 26.6%

- Splenectomy 33 24.4% - Laparotomy 3 2.2%

Delay laparotomy

3 2.2%

MORTALITY

Morality: multi trauma, multi organ failure

5 (3.7%)

Morality: isolated splenic injury

0 (0%)

Median ISS 24 Median age 51

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Dr. Mirwais Khan Hotak ,Supervisor Dr Ailene Fitzgerald

AIM To evaluate the management of Blunt Splenic Trauma (BST) management in multi injured trauma Pts at TCH. Non operative management (NOM) for hemodynamically stable pts & operative management (OM) for unstable patients. The queries to consider angioembolisation (AE) for all grade 4-5 SI and to reduce failed NOM.

CONCLUSION: - Hemodynamically unstable Pts with diffuse peritonitis should be taken urgently for laparotomy.

Hemodynamically stable Pts with high grade SI should be consider for NOM. - The severity of SI, neurologic status, age >55 and/or the presence of associated injuries are not

contraindications to a trial of NOM in a hemodynamically stable Pts. - The query to answer that AE should be considered for all patients with (AAST) grade 4-5 who are

hemodynamically stable to reduce rate of fNOM - A need for randomise control study to answer query regarding AE role in fNOM

Towards early identification and management of CSF leak by Trauma Teams in Temporal Bone fractures

Experience from a Level 1 Major Trauma Centre Dylan Tully1, Lorne Green1, Jennifer Wang1, Christine Li1, Kellie Gumm1, Katherine Martin1, David Read1, Claire Iseli2

1Department of Surgery, The Royal Melbourne Hospital, Victoria, Australia2Department of Otolaryngology Head and Neck surgery, The Royal Melbourne Hospital, Victoria, Australia

RESULTS 77 CSF leaks from 421 TBFs (18.6%) Majority male, predominant mechanism fall (Table 1) Associated with traumatic brain injury in 55.8%, and with concurrent CNVII injury and carotid

artery injury in 16.9% and 9.09% respectively (Tables 1 and 2) CSF leak most common in fracture of the petrous portion of the temporal bone, in a

longitudinal pattern and with concurrent sphenoid and/or occipital bone fracture (Table 2) Otorrhea was the typical presentation (84.4%; n=65) and 22.1% had pneumocephalus on

imaging Beta-2 transferrin confirmation utilised in 45.5% (n=35) Only 18.2% underwent dedicated temporal bone imaging (Figure 1b, Table 2) Over two thirds were managed conservatively, overall 35.1% (n=27) received targeted

antibiotics (Figure 3 – division of intervention) One quarter of CSF leak patients died (Table 3)

INTRODUCTION More than two thirds of Temporal bone fractures (TBF) occur with high energy blunt head

trauma (1) Cerebrospinal fluid (CSF) leak occurs in 17% of temporal bone fractures (TBF) and may

manifest as otorrhea or rhinorrhoea (2,3) It poses a risk of meningitis, may herald more severe injury to the otic capsule or complex

adjacent anatomy (figure 2a), and may be a sign of insidious open skull fracture (1) Early detection often obscured by unclear presentation and significant comorbid injury Conservative management includes bed-head elevation, monitoring and osmotic diuretic

therapy. Intervention techniques include use of antibiotics, lumbar drainage and surgical repair, but use of these and timing is controversial (1,2,3)

There is no consensus currently on early management, particularly by trauma and general surgical teams

METHODS Retrospective analysis of TBF patients from The Royal Melbourne Hospital Trauma Registry

between 2015-2020 501 temporal bone fractures identified from registry, exclusion criteria based on record

availability and fracture pattern (Figure 1a), giving a total of 413 TBFs including 77 with CSF leak

Computed tomography scan was analysed including original report (Figure 1b) Demographic and injury-related data obtained from electronic medical records, recorded in

redcap database and descriptive analysis undertakenLIMITATIONS A retrospective descriptive study without the ability to measure outcomes against

implementation Relying on electronic records with varying clarity and completeness of documentation. For

example as there are no protocols in place, nursing staff may not always record CSF leak daily

CONCLUSION This study outlines presentation, identification and current management patterns of CSF leaks

in TBFs encountered in a Level 1 Major Trauma Centre in Australia Utilising these characteristics may contribute towards trauma team guidelines to aid in:

Risk-stratification based on fracture pattern Early identification Confirmation and investigation protocols Initial management

This would be particularly useful in smaller centres without specialist Ear/Nose/Throat and Neurosurgical services and may be beneficial in risk mitigation

REFERENCES1. Kanona H, Anderson C, Lambert A, Al-Abdulwahed R, O’Byrne L, Vakharia N, Motter D, Offiah C, Adams A, Seymour K, Wareing MJ. A

large case series of temporal bone fractures at a UK major trauma centre with an evidence-based management protocol. J Laryngol Otol. 2020; 134: 205–212. https://doi.org/10.1017/ S0022215120000419

2. Patel A, Groppo E. Management of temporal bone trauma. Craniomaxillofac Trauma Reconstr. 2010; 3(2): 105-113. doi:10.1055/s-0030-1254383

3. Brennan JA, Holt R, Connor MP, Donald PJ, Eusterman VD, Hayes DK, Kellman RM, Morehead JM, Packer MD, Pafford WA, Ramsey MJ, Salinas NL, Sniezek JC, Stallworth CL, Stevens MS, Thomas RW. Resident Manual of Trauma to the Face, Head, and Neck.American Academy of Otolaryngology-Head and Neck Surgery. 2012. Alexandria, VA.

4. Gladwell M, Viozzi C. Temporal bone fractures: a review for the oral and maxillofacial surgeon. J Oral Maxillofac Surg. 2008; 66(3): 513-22. doi: 10.1016/j.joms.2007.08.039. PMID: 18280386.

5. Frey C, Hazenfield JM. Essentials of Head Trauma Imaging. Semin Ultrasound CT MR. 2018; 39(5): 469-480. doi:10.1053/j.sult.2018.01.004. Epub 2018 Feb 8. PMID: 30244761.

6. Case courtesy of Dr Maxime St-Amant, Radiopaedia.org, rID: 55609. Accessed at: https://radiopaedia.org/cases/temporal-bone-divisions-annotated-ct

413 Temporal Bone Fractures

77 (18.6%) with CSF Leaks

Conservative management (n=55, 71.4%)

Antibiotics given for leak(n=20, 36.4%)

No antibiotics given for leak(n=26, 63.6%)

Intervention (n=8, 10.4%)

Antibiotics given for leak (n=6, 75.0%)

No antibiotics given for leak (n=2, 25.0%)

No management (n=19, 24.7%)

Antibiotics given for leak (n=1, 5.26%)

No antibiotics given for leak (n=12, 94.7%)

336 without CSF leak

Table 3. Outcome markers of TBF patientsAll TBFs TBF with CSF leak

Facial nerve palsy 39 (9.44) 13 (16.9)Grade (House-Brackmann)[median (range)] 4 (1-6) 5 (2-6)

Carotid artery injury 21 (5.08) 7 (9.09)Grade (Denver)[median (range)] 1 (1-4) 1 (1-2)

LOS (Days)[median (range)] 7 (0-107) 8 (0-70)ICU admissionYes 214 (50.8) 48 (62.3)Length of ICU admission (Days) [median (range)] 5 (0-59) 5 (1-28)Discharge destinationDeath 76 (18.4) 19 (24.7)Rehab 165 (40.0) 27 (35.1)Home 148 (35.8) 28 (36.4)*TBF=temporal bone fracture, CSF=cerebrospinal fluid, ICU=intensive care unit, LOS=length of stay; all values are expressed as number (%) unless otherwise specified

Table 1. Demographic and presentation features of TBF patientsAll TBFs TBF with CSF leak

SexMale 333 (80.6) 65 (84.4)AgeMedian (range) (Years) 40 (13-103) 39 (16-88)<18 18 (4.36) 6 (7.79)18-30 122 (29.5) 23 (30.0)31-49 110 (26.6) 16 (20.8)50-65 67 (16.2) 10 (13.0)>65 96 (23.2) 22 (28.6)MOIFall 211 (51.1) 36 (46.8)Pedestrian vs car 41 (9.93) 9 (11.7)MVC 48 (11.6) 10 (13.0)MBC 37 (8.96) 11 (14.3)Assault 38 (9.21) 4 (5.19)ISSMedian (range) 22 (4-75) 26 (9-59)<29 288 (69.7) 48 (62.3)30-45 104 (25.2) 21 (27.3)>45 21 (5.08) 8 (10.4)Intracranial injuryYes 376 (91.0) 72 (93.5)TBI severityMild 53 (12.8) 3 (3.90)Moderate 149 (36.1) 28 (36.4)Severe 196 (47.5) 43 (55.8)*TBF=temporal bone fracture, CSF=cerebrospinal fluid, ISS=injury severity score, TBI=traumatic brain injury, MVC=motor vehicle collision, MBC=motorbike collision; all values are expressed as number (%) unless otherwise specified

Table 2. Imaging characteristics of TBF patients on CTAll TBFs TBF with CSF leak

LateralityRight 156 (42.2) 32 (39.5)Left 171 (46.2) 37 (45.7)Bilateral 43 (11.6) 4 (4.93)Affected portionPetrous 377 (91.3) 75 (97.4)Mastoid 237 (57.4) 35 (45.5)Squamous 134 (32.4) 19 (24.7)Tympanic 114 (27.6) 20 (26.0)Fracture PatternLongitudinal 268 (64.9) 59 (76.6)Transverse 86 (20.8) 9 (11.7)Mixed 58 (14.0) 9 (11.7)Fracture InvolvementNon-otic capsule sparing 21 (5.08) 5 (6.49)Ossicular chain involvement 28 (6.78) 7 (9.09)Involve facial nerve canal 30 (7.26) 7 (9.09)Involve carotid canal 125 (30.3) 28 (36.4)Associated portionFrontal 55 (13.3) 15 (19.5)Sphenoid 166 (30.2) 38 (49.4)Occipital 142 (34.4) 18 (23.4)OtherDedicated TB imaging 87 (21.1) 14 (18.2)Pneumocephalus 97 (23.5) 17 (22.1)*TBF=temporal bone fracture, CSF=cerebrospinal fluid, CT=computed tomography, TB=temporal bone; all values are expressed as number (%) unless otherwise specified; temporal bone portion as outlined in figure 2b and 2c

501 Temporal Bone Fractures

(TBFs)420 TBFs 77 TBFs with

CSF leak

7 TBFs with incomplete

data

81 TBFs excluded

Figure 1. (a) exclusion process of database recruitment. (b) dedicated temporal bone computed tomography showing TBFs (obtained from reference 5)

Figure 2. (a) the complex adjacent anatomy to the temporal bone (obtained from reference 4). (b) different segments/portions of the temporal bone (adapted from reference 2) (c) highlighted portions of the temporal bone on computed tomography (obtained from reference 6) Figure 3. Management patterns in TBFs. CSF=cerebrospinal fluid leak

Squamous portion

Tympanic portion

Mastoid portion

336 TBFs without CSF

leak

EARLY IDENTIFICATION AND MANAGEMENT OF CSF LEAK BY TRAUMA TEAMS IN PETROUS TEMPORAL BONE FRACTURES – EXPERIENCE FROM A LEVEL 1 VICTORIAN TRAUMA CENTRE

Dr Dylan Tully

View poster here

BLUNT SPLENIC TRAUMA, RETROSPECTIVE STUDY 2008-2013, THE CANBERRA HOSPITAL

Dr Mirwais Khan Hotak

View poster here

Breast reconstruction and mental health: How is quality of life affected?Rudduck, E., Prowse, P., Edwards, S. & Reid, R.

Figure 1: Multivariate analysis on change in BREAST-Q scores pre- and post-operatively as affected by depression or anxietyBreast cancer is the most common cancer in women worldwide1. Following therapeutic

mastectomy, breast reconstruction has proven to improve quality of life (QoL)2. The gold standardpatient-reported outcome measure (PROM) for QoL in this cohort is the Breast-Q which assessessatisfaction with chest, breast, abdomen, and psychosocial and sexualwell-being3. This study investigated whether pre-existing depression or anxiety negativelyinfluenced quality of life as determined by the Breast-Q post-reconstruction.

• Retrospective review of the breast cancer reconstruction database (n = 183) at Queen ElizabethHospital, Adelaide, Australia.

• Univariate linear regression and multivariate regressions performed• Patients who completed 1 pre-op and 1 post-op Breast-Q (n = 72)• Breast-Q domains analysed with respect to patient factors• Anxiety: n = 11. Depression: n = 23, No mental health history: n = 38

Background

Methods

Discussion & Conclusions

Results

Having a past history of depression did not significantly impact any PROM in our patient cohort but havinganxiety did across multiple domains. If using the clinically relevant minimally important difference, onunivariate analysis patients with depression were negatively impacted in the TE/Implant cohort in sexual well-being and in DIEP/TRAM reconstructions with satisfaction with breast and sexual and psychosocial well-being.Patients with known mental health diagnoses may require more psychological support, more intensive pre-operative counselling and extensive discussions around the benefits and risks of their reconstructive surgeriesto aim to equalize their satisfaction with their peers without mental health issues. Further studies are neededto better understand the influence of mental health issues on patient reported outcomes in order to improvetheir long-term quality of life with breast reconstruction after cancer.

References: 1. https://www.wcrf.org/dietandcancer/cancer-trends/worldwide-cancer-data (Published 2020. Accessed September 10th, 2020). 2. Nelson et al, Ann Surg, 270(3):473-483 (2019). 3. Pusic et al, Plast Reconstr Surg, 124(2):345-353 (2009). 4. https://breastcancernow.org/information-support/facing-breast-cancer/living-beyond-breast-cancer/types-breast-reconstruction (Published 2018. Accessed Feb 28th, 2021).

Latissimus dorsi (LD, n = 23)Tissue expander / Implant (TE/I, n = 34)4

Deep Inferior Epigastric Perforator flap (DIEP, n =4 )Transverse Rectus Abdominus Myocutaneous flap (TRAM, n = 11)

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Anxiety vs. No Anxiety Depression vs. No Depression

BREAST RECONSTRUCTION AND MENTAL HEALTH: HOW IS QUALITY OF LIFE AFFECTED?

Dr Emma-Leigh Rudduck

View poster here

J. H. T. Lee1, N. Busutil1, C Shean1, J. Balasooriya1, S. Chan2, T. Ncube1

1Department of General Surgery, The Canberra Hospital, ACT Health, Garran, Australian Capital Territory, Australia; 2 Intensive Care Unit, The Canberra Hospital, Garran, Australian Capital Territory, Australia.

Traumatic spleen injuries can be managed in various ways, generally guidedby grades of spleen injury. Low-grade spleen injuries are managedconservatively, but high-grade splenic injuries can be treated with either (totalor partial) embolization or surgically with splenectomy. In 2017, CanberraHospital changed the model of trauma care to multidisciplinary specialistservice since then the number of splenectomy decreased, but embolizationincreased. The object of this study is to compare the outcomes ofsplenectomy, embolization and conservative management that will aid andguide future management of traumatic spleen injuries.

Introduction

MethodsA. C. D.A retrospective review of patients with traumatic spleen injuries in ACT Healthsystem will be conducted by auditing medical records of traumatic spleeninjuries between the period of 2016 – 2021 with the below inclusion criteriainformation (Table 1). Groups: Conservative n=100, Embolization n=22,Splenectomy n=9.

E. F.

Conclusion / Discussion

Mechanism of Injury and GCS

Comparing Outcomes of Splenectomy, Embolization and Conservative Management after Traumatic Spleen Injuries

Inclusion Criteria Patients: adults, age ≥ 18 years old; non-pregnant; All grades of spleen injury managed by conservative, embolization or splenectomy; blunt and penetrating splenic injury

Exclusion Criteria Patients: age < 18 years old; pregnant; previous splenectomy or embolization; independent indication for laparotomy

Data Patient Demographics; Splenic injury (AAST) grade; mechanism of injury; Injury severity score; patient observations (vitals, initial BP, HR); presenting Glasgow Coma Score; shock; blood product transfused; DVT prophylaxis; indication and type of intervention (conservative, embolization, splenectomy); surgery length, intraoperative blood loss; Imaging

Outcomes Initial treatment success rate; in-hospital re-bleed rate; in-hospital mortality; hospital length of stay (LOS); ICU LOS; conservative, embolization and splenectomy failure rate, in-hospital complications (Hospital acquired pneumonia, infection, etc.); re-admission within 1 month; discharge disposition

Discharge Destinations and Complications

Demography

AAST Spleen Injury Grades and Other Injuries

Conservative Embolization Splenectomy Conservative Embolization Splenectomy

Conservative Embolization Splenectomy Conservative Embolization Splenectomy

Conservative Embolization Splenectomy Conservative Embolization Splenectomy

More Males sustain traumatic spleen injuries compared to Females. Therewere no difference in Age between the groups (43yo vs. 44yo vs. 44yo, p>0.05)

Embolization and Splenectomy groups have higher AAST scores (4 vs. 2).Majority of the patients in all the groups had concurrent injuries.

Motor Vehicle Accidents was the highest mechanism of injury in Conservativeand Splenectomy groups, whereas blunt force trauma was the number onecause in the embolization group. Splenectomy group had the lowest GCS =10at presentation significantly lower than the Embolization group (p<0.05).

Conservative Embolization Splenectomy Conservative Embolization Splenectomy

Most patient was discharged home followed by transfer to other hospitals.Splenectomy group had 11% mortality compared to the other groups of 4%.The number of in hospital complications such as infection, bleeding andrepresentation was highest in the Splenectomy group.

Embolization and Splenectomy groups have higher AAST injury grades,resulting from motor vehicle accidents, blunt force trauma injuries. Mostpatients discharged home; however, Splenectomy group had the highest in-hospital complications. Taken together, given that Embolization andSplenectomy groups have similar AAST grades, splenectomy patients presentwith more severe injuries and the outcomes of Embolization group is better. It isimportant to balance the benefits and complications before managing spleeninjuries with Embolization or Splenectomy in ACT Health.

COMPARING OUTCOMES OF SPLENECTOMY, EMBOLIZATION AND CONSERVATIVE MANAGEMENT AFTER TRAUMATIC SPLEEN INJURIES

Dr Jae Lee

View poster here

ID: 18

A EXACERBATION OF HASHIMOTO’S THYROIDITIS WITH SYMPTOMATIC HYPERTHYROIDISM FOLLOWING ELECTIVE PARATHYROIDECTOMY IN A

PREVIOUSLY EUTHYROID PATIENTLauren M. Turner, PhD., MChD.,1 Martin Varley, MBBS,1 Klaus-Martin Schulte PhD, FRACS,1-2

1 Department of Surgery, Division of Critical Care, Canberra Hospital, Garran, ACT2 ANU Medical School, Canberra, Acton, ACT

Parathyroidectomy-induced Thyroiditis• Thyroiditis occurs secondary to intraoperative thyroid gland

manipulation during parathyroidectomy• Incidence 42.3-76.9%• Manipulation causes isolated follicle rupture, impaired

follicular basement membrane, induction of inflammation• Peri-operative stress factor not measurable• Reported in 1⁰, 2⁰ and 3⁰ hyperparathyroidism

• Effect is transient in nature• fT3/fT4 maximum post operative day 1-3, TSH day 5• Spontaneous resolution within 40 days

• Only 2 studies have reported pre-operative thyroid Abx (-ve)• Problematic because leads to expectations thyroiditis will be

transient and self-limiting in nature

Table 1. Thyroid function and antibodies pre-operatively, post operative days 11 and 66.

• 26 y/o F presented to her GP with 3/12 hx of lethargy and diarrhoea• Nil other PMH/FH• Regular medications: COCP• No Hx of thyroid dx, neck irradiation, amiodarone/lithium

• Hypercalcemia 2.69-2.73 (2.10-2.60mmol/L)• Hyperparathyroidism 10.5-12.9 (1.6-7.2pmol/L)• Elevated 24 urinary calcium 9.1 (2.5-7.5mmol/24h)• Thyroglobulin antibodies 503 (<5kU/L)• Thyroid Peroxidase Antibodies (TPO Ab) 61 (<6kU/L)• Euthyroidism:

• Thyroid Stimulating Hormone (TSH) 1.96 (0.34-3.40mU/L)• Free thyroxine (fT4) 13.5 (10.7-17.0pmol/L)• Free triiodothyronine (fT3) 5.1 (3.4-5.4pmol/L)

• Abnormal Thyroid on ultrasound (Figure 1):• Heterogenous echotexture (normal vascularity)• Right lobe 10.9; left lobe 6.6 (4-12cc)• Multiple colloid nodules right lobe (largest 6x5mm)

• Sestamibi scan (Figure 2):• Early images - increased activity right thyroid gland• Focal retained activity level of right mid/inferior pole,

SPECT/CT localised 12x7mm nodule deep to thyroid• Bone DEXA scan normal (not shown)• Referred for elective right superior parathyroidectomy

Figure 2. Positive 99m Tc sestamibi scan. Early (A; 10 min washout) and late (B; 2 hour washout) anterior coronal views. Delayed images demonstrate focal retained activity consistent with parathyroid adenoma deep to the right thyroid lobe at the mid/inferior pole level (12x7mm).

Post-Operative Management• Resected without complication• Histopathology:

• Histological dx – parathyroid adenoma• Flow Cytometry – mixed T-cell and polyclonal B cell

population (inflammation)• Reviewed in clinic 11 and 66 days later, respectively

• Day 11 post operative • Pt breathless, with palpitations and tachycardia (110 bpm)• Hyperthyroid, TSH suppression, Ab +ve (TPO and

thyroglobulin)• Not treated

• Day 66 post operative • Euthyroid• Thyroid Ab remain +ve (TPO and thyroglobulin)

• Palpation thyroiditis first described by Carney in 1975• Mechanical trauma induces inflammatory changes

(autoimmune thyroiditis)• In our case trauma exacerbated pre-existing thyroid antibodies• Bi-phasic presentation of post-surgical hyperthyroidism:

• Mechanical disruption of follicles resulting in early excess hormone release, abating within a week

• Delayed hyperthyroidism due to inflammation upon mechano-immunological induction

• Relevant as hyperthyroidism has a number of complications including AF and peri- and post-operative stroke

• Antibodies should be included in pre-operative workup for thyroid/parathyroid resections

Pre-

operative

Post-operative

Day 11

Post-operative

Day 66

Normal

Range

Heart rate 56 110 < 100 60 - 80 bpm

Thyroid Stimulating Hormone (TSH) 1.96 < 0.03 3.26 0.34 - 3.40 U/L

fT4 (free thyroxine) 13.5 18.4 12.3 10.7 - 17.0 pmol/L

fT3 (free levothyroxine) 5.1 6.1 4.8 3.4 - 5.4 pmol/L

Anti-thyroglobulin antibodies 503 464 402 < 5kU/L

Anti-thyroid peroxidase antibodies 61 61 76 < 6kU/L

TSH Receptor Antibodies (TRAB) < 0.8 - < 0.8 < 0.8IU/L

Corrected serum calcium 2.73 2.22 2.17 2.10 - 2.60 mmol/L

Parathyroid hormone 12.9 6.3 9.4 1.6 - 7.2 pmol/L

Initial Presentation

Discussion

Pre-operative BiochemistryFigure 1. Thyroid Ultrasounda. Ultrasound transverse view of the isthmus.b. Ultrasound view of left neck demonstrating multiple colloid nodules.

Imaging

Post-operative Biochemistry

EXACERBATION OF HASHIMOTO’S THYROIDITIS WITH SYMPTOMATIC HYPERTHYROIDISM FOLLOWING ELECTIVE PARATHYROIDECTOMY IN A PREVIOUSLY EUTHYROID PATIENT

Dr Lauren Turner

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ID: 5

Royal Australasian College of Surgeons

Hydrocephalus as a Delayed Presentation of Klebsiella Pneumoniae VentriculitisRasouli Mohammad, MD, Rasoulimd1983@gmail.com Honeybul Stephen, FRCS (SN), FRACS, Stephen.Honeybul@health.wa.gov.auDepartment of Neurosurgery, Sir Charles Gairdner Hospital, Nedlands, Western Australia, 6009, Australia

• A new hypervirulent variant of Klebsiellapneumoniae (hvKP) has emerged over last few yearsinitially in the Asian Pacific Rim and it is beingincreasingly reported in Western countries.

• In contrast to classic Klebsilella Pneumoniae, it cancause serious, life-threatening community-acquiredinfection in younger healthy hosts who present withliver abscess, pneumonia, meningitis.

• It has a high morbidity and mortality, with mortalityrates range from 3% to 42%, CNS involvement has areported mortality ranging from 38% to 91%. [1, 2]

• This reports a patient who developed delayedobstructive hydrocephalus secondary to hvKPventriculitis in the context of urosepsis.

• An 80-year-old female was admitted withobstructive urosepsis on background of knownkidney stone.

• A ureteric stent was inserted.

• Klebsiella Pneumoniae was grown in the urine andblood culture.

• She was commenced on Piperacillin-Tazobactam

• On the third day of admission, she became confused(GCS E4,V4, M6).

• A CT scan of the brain was normal.

• During next few days, she improved clinically after asecond cystoscopy and removal of stone butremained confused (E4M6V4).

• Around two weeks into her admission, shedeveloped a right sided hemiparesis to a stage herbest motor score was localising (E2,V3, M5).

• A repeat CT scan of the brain showed asymmetricalhydrocephalus with layering of debris within theoccipital horns indicating ventriculitis. (Fig 1)

• A left frontal external ventricular drain (EVD) wasinserted uneventfully. Postoperatively she improvedand she was commenced on Ceftriaxone.

• Subsequent MRI brain confirmed features ofventriculitis (Fig 2)

• The EVD was removed after 2 weeks

• On outpatient review after 4 weeks, she was GCS 15without any neurological deficits.

• It is important that clinicians to be aware of the newhypervirulent variant of Klebsiella pneumoniae(hvKP) because it can spread to other organs andcan be a life-threatening condition

• It should prompt a search for other sites of infectionwhenever this microorganism is grown on culture.

Figure 1: Axial CT Brain

• Shon AS et al, Hypervirulent (hypermucoviscous) Klebsiellapneumoniae. Virulence, 2013. 4(2): p. 107-118.

• Tang LM et al, Klebsiella meningitis in Taiwan: an overview.Epidemiol Infect, 1997. 119(2): p. 135-42

Fig 2:Axial MRI Brain

showing layering of debris within the occipital horns

Introduction Case Presentation

Conclusion

References

ACT ASM 2021 HYDROCEPHALUS AS A DELAYED PRESENTATION OF KLEBSIELLA

PNEUMONIAE VENTRICULITIS

Dr Mohammad Rasouli

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ID: 3

Introduction

THE ALFRED EXPERIENCE ON THE USE OF THE MEDTRONIC APTUS ENDOSYSTEMS HELI-FX GUIDE FOR COMPLEX ENDOVASCULAR AORTIC INTERVENTION

ZAFREEN RAHMAN MBBS, THODUR VASUDEVAN FRACS (VASC), FRACS (GEN), FRCSTHE ALFRED HOSPITAL, VIC

Discussion

Conclusion

Creating a stable platform with the purpose of accessing mesenteric or renal arteries for complex endovascular aortic interventions such as Fenestrated or Branched endografting, is a long-standing operative challenge for any proceduralist involved. There are many different techniques described to over-come this hurdle such as upper limb access, modifying existing sheaths to become steerable, and the use of robotic endovascular systems.

In this short case series, we describe The Alfred Hospital’s experience in using the Medtronic Aptus Endosystems Heli-FX Guide as steerable sheath to access mesenteric arteries during Branched endografting in complex aortic intervention. Since October 2020, The Alfred Hospital has utilised the Heli-FX Guide in a total of four endovascular operative interventions. All fours cases involved mesenteric vessel access for either the purpose of mesenteric stenting in endovascular thoracoabdominal aneurysm repair with a branched endograft, or treatment of endoleaks leading to secondary sac rupture in previous endovascular aneurysm repair.

Case 1: 28M with 6.8cm type II thoracoabdominal aneurysm in thesetting of Marfan’s syndrome and previous aortic arch debranching.A custom made branched endograft was designed for endovascular repair of this thoracoabdominal aneurysm which included a total of four branches, one into each mesenteric/renal vessel. During the repair, the Heli-FX guide was introduced via the sheath of the graft’s main body component, and used to cannulate each branch, creating a stable platform for stent deployment

(Top row left to right): Reconstructed imaging of thoracoabdominal aneurysm with superimposed graft plan. (Bottom row left to right): angiographic images demonstrating cannulations of the Right renal artery, Left renal artery, superior mesenteric artery, Coeliac artery.

Case 2: 78M with 8.3cm type V thoracoabdominal aneurysm. A custom made endograft was designed with branches in to thecoeliac and superior mesenteric arteries, and fenestrations for therenal arteries. During the repair, the Heli-FX guide was again introduced via the sheath of the graft’s main body component, and used to cannulate the branches for coeliac and superior mesenteric artery stenting.

(left to right): Reconstructed imaging of thoracoabdominal aneurysm with superimposed graft plan, and centreline sagittal view demonstrating the origins of coeliac and superior mesenteric artery.

(left to right): angiographic images demonstrating cannulations of the Coeliac artery andsuperior mesenteric artery.

Case 3: Previous 28M with repaired type II thoracoabdominal aneurysm with branched endograft, developed a 1c endoleak leading to secondary sac rupture. In this case, the Heli-FX guide was used as a primary access sheath from the Left common femoral artery. The Heli-FX guide was then used to cannulated the superiormesenteric artery to assist in creating a stable platform for deeper access into the secondary artery branches. A further covered stentwas deployed to treat the type 1c endoleak.

(Left to right): angiographic images of type 1c endoleak from the distal end of the superior mesenteric artery stent. Access into the superior mesenteric artery with the Heli-FX guide

(Left to right): angiographic images of Heli-FX guide into the superior mesenteric artery, with a covered stent graft in position. Covered stent graft being deployed, and subsequent completion angiographic image demonstrating resolution of type 1c endoleak from the distal end of the superior mesenteric artery.

Case 4: Previous 28M with repaired type II thoracoabdominal aneurysm with branched endograft, developed further secondary sac rupture given the fragility of his vessels in the setting of Marfan’s syndrome and chronic graft infection. This time it was due to a combination of type IIIc endoleak from the superior mesenteric artery, and type II endoleak from the inferior-pancreaticoduodenal artery. The Heli-FX guide was again used as a primary access sheath from the left common femoral artery. The tip was then deflected to access the superior mesenteric artery for deployment of another covered stent to treat the type IIIc endoleak, and then into the coeliac artery for coil embolization of the inferior-pancreaticoduodenal artery to treat the type II endoleak.

(left to right): angiographic images demonstrating cannulations of the Coeliac artery and superior mesenteric artery with the Heli-FX guide

The increasing nature of complex endovascular interventions hasled to an increasing demand for devices that can provide a range of manoeuvers with ease of use. The Australian market for a variety of endovascular components, such as steerable sheaths, is quite limited. The Medtronic Aptus Endosystems Heli-FX guide hasprovided a useful option to assist in accessing graft components and native vessels for endovascular interventions.

With respect to the Alfred Hospital’s experience, the Heli-FX guide has been used in a total of two cases of primary endovascular repair for complex thoracoabdominal aneurysms. As outlined in Case 1; a four-branched endograft was utilised for the repair. The total operative time for this case was 5 hours and 35 mins. As for Case 2; a two-branch + two-fenestration endograft was utilised, with a total operative time of 4 hours and 10 mins.

The three prior complex endovascular repairs performed at The Alfred involved a total of 8 vessel cannulations over 10.5 hours (approximately 1.31 hours per vessel). With the use of the Heli-FX guide, there were 8 vessel cannulations over 9.5 hours (approximately 1.19 hours per vessel). When comparing this to the other similarly complex endovascular aneurysm repairs performed at The Alfred, the operative time with the cases involving the Heli-FX guide, is slightly improved relative to the degree of complexity associated with the procedure itself. This in turn, has positive implications of the total amount of radiation and contrast used.

Despite these positive findings, it is important to note that commercially available steerable sheaths can be associated with increased expense and may not be readily available to use at short notice.

The Alfred Hospital’s experience in using the Medtronic Aptus Endosystems Heli-FX Guide for complex endovascular aortic intervention has yielded many positive outcomes. These include creating a stable platform for repeated access into mesenteric vessels with avoidance for supplementary upper limb access, and potential for reduced operative time and lower doses of radiation.

Furthermore, with the anticipated Australian approval for the use of the low-profile system (Medtronic TourGuide Steerable Sheath 6.5Fr-8.5 Fr), primary access of native vessels for varyinginterventions, and potential mitigation of the need for using closure devices becomes increasingly achievable with the scope for fewer intervention related complications.

References:1. Medtronic, Heli-FX Endoanchor Components (Image), June 2020, Available from Medtronic Europe, https://europe.medtronic.com/xd-en/healthcare-professionals/products/cardiov0ascular/aortic-stent-grafts/heli-fx-endoanchor.html, (20 Aug, 2021)2. Medtronic, Heli-FX Guide (Image), Aptus Endosystems. 7 August 2013, Available from Wikimedia Commons, https://en.m.wikipedia.org/wiki/File:Heli-FX_Guide.png, (20 Aug 2021)3. Heli-FX and EndoAnchor Systems, comprising the Heli-FX Guides, Heli-FX Appliers, EndoAnchor implants, and EndoAnchor Cassettes, Medtronic Instructions for Use Manual, 2020 M967540A001, Pages 6-74. Case Book: Endoanchor TM Fixation, Medtronic, Germany, 2017, Page 16

Technique

The Medtronic Heli-FX guide is the first component of the complete Heli-FX Endoanchor System

Figure 1 (Left): Medtronic Heli-FX Endoanchor system Figure 2 (Right): Image of Heli-FX guide Aptus Endosystems, GNU Free Documentation License

The Heli-FX guide is compatible with Australia’s most frequently utilised abdominal aortic endografts (Medtronic Endurant™, Cook Zenith™, and Gore Excluder™)3. Furthermore, the 16 Fr outer diameter Heli-FX Guides is available with a working length of 62 cm, and deflectable tip lengths of either 22 mm or 28 mm. Since October 2020, The Alfred Hospital has been employing the Heli-FX guide as a steerable sheath for assisted mesenteric and endograft branch access.

Figure 3 (left): Heli-FX guide with two deflector tip lengths. Figure 4,5,6 (right): Various deflection angles

THE ALFRED EXPERIENCE ON THE USE OF THE MEDTRONIC APTUS ENDOSYSTEMS HELI-FX GUIDE FOR COMPLEX ENDOVASCULAR AORTIC INTERVENTION ZAFREEN RAHMAN MBBS, THODUR VASUDEVAN FRACS (VASC), FRACS (GEN), FRCS, THE ALFRED HOSPITAL, VIC

Dr Zafreen Rahman

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ID: 12

A PEDUNCULATED SMALL BOWEL GASTROINTESTINAL STROMAL TUMOUR (GIST) MASQUERADING AS AN OVARIAN TUMOUR.

Lauren M. Turner, PhD., MChD.,1 Phillip Jeans, MBBS, FRACS,1-2 Stephen Robson PhD, FRANZCOG,2-31 Department of Surgery, Division of Critical Care, Canberra Hospital, Garran, ACT

2 ANU Medical School, Canberra, Acton, ACT3 Department of Obstetrics and Gynaecology, Centenary Hospital for Women and Children, Garran, ACT

Initial Presentation• 42 y/o F posted to a developing nation experienced sudden

onset, acute, severe lower abdominal pain• 2/52 history of preceding episodes of vague pain• Abdo U/S - right-sided cystic pelvic lesion (75 x 58 x 56mm)

appearing to arise from the ovary • DDx – ? endometriotic/haemorrhagic cyst ? primary

(mucinous) ovarian neoplasm ? partial torsion of lesion

Figure 2. Intraoperative photograph - large cystic lesion appearing contiguous with right ovary.

Figure 1. Abdominal ultrasound - 75 x 58 x 56mm heterogeneous solid and cystic lesion.

• Further episode of pain concerning for complete torsion• Laparoscopy – large cystic lesion ? contiguous with right

ovary, densely adhered to small bowel and sigmoid colon

Figure 3. Histopathology of resected specimen:a. Resected specimen (100x) stained with Hematoxylin and Eosin (H&E) demonstrated

epitheloid type cells composed in nests.b. Adjacent infarcted small bowel mucosa/muscularis. c. Positive immunohistochemical staining for DOG1.d. Positive immunohistochemical staining for KIT (CD117) - 10% cells positive. Other immunohistochemistry (not shown) – negative staining for CD68, SMA and desmin, which coupled with positive DOG1 and CD117 (sensitivity ~97%), is consistent with a histopathological diagnosis of GIST.

• Repatriated to Australia due to concerns for resectability and bowel involvement

• Ca-125 level 15kU/L (NR < 36)• Repeat laparoscopy – large round mass with

adhesions to right ovarian, fallopian tube, small bowel, anterior rectum and sigmoid colon

• Conversion to laparotomy – dissection of mass arising from a small bowel pedicle, 90cm from the ileo-caecal junction

• Large-infarcted solid lesion • Clear margins• High-grade GIST/stage pT3• Adjacent small bowel normal

Repatriation to Australia

Histopathology

a. b.

c. d.

The General GIST• GISTs - most common non-epithelial tumours of the GIT:

• 1% of GIT tumours, ~80% of all non-epithelial tumours• Arise oesophagus>anus, majority stomach/small bowel• 10% extra-GIT: pancreas, retroperitoneum, mesentery etc.

• Symptoms variable, location dependent – bleeding, obstruction, perforation, dysphagia, pain, abdominal/pelvic mass

• Variable - hyperechoic central areas, or large hypoechoic masses with peripheral rim of residual echogenic parenchyma

• Hypoechoic regions (haemorrhagic necrosis/colliquation) • Usually no acoustic shadowing nor calcific degeneration• Pelvic/abdominal trace-free fluid - diagnostic clue (perforation)

Figure 4. Differential appearances of GIST on ultrasound:a. A well-defined solid mass lesion (85x70x70mm) with central cystic areas posterior to stomach, anterior to

pancreas.b. 15cm, well circumscribed, homogenously hypoechoic pelvic mass with low-level echos and a thick hyperechoic

irregular wall.c. A large homogenous, hypoechogenic mass growing exophytically in the epigastrium. Central area of cystic

appearance (arrow), and surrounding ascites

• 5 cases of bowel/stomach GISTs metastasising to the ovary• 24 GISTs misdiagnosed as gynaecological neoplasm prior to OT

• Origins: bowel, stomach, rectovaginal septum, uterus/ovary• Radiologic behaviour variable – CT/US heterogeneous• In above cases (including ours), CT/US did not identify origin

• CT assess invasion in adjacent structures/GI wall, resectability• MRI/PET delineation of necrosis/haemorrhage, useful for

evaluation of larger lesions (>6cm)• Not available at all centres

• Combination of imaging may not provide diagnostic certainty• Detection of a pelvic mass should raise consideration of non-

gynaecological tumours including GIST

Challenges

Features on Ultrasound

Utility of CT/MRI/PET

b.a. c.

A PEDUNCULATED SMALL BOWEL GASTROINTESTINAL STROMAL TUMOUR (GIST) MASQUERADING AS AN OVARIAN TUMOUR

Dr Lauren Turner

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ID: 16

ID: 21

ID: 23

ID: 30

ACT Annual Scientific Meeting 2021Advancing Operative Techniques – Improving Your SkillsFriday 27 August 2021

8

Program Correct at time of release (August 2021).

9:15am Welcome and outline of proceedingsDr David Rangiah

9:20am Presentation provided by the Bongiorno Group

9:40am - 10:30am SESSION 1Chair: Dr David Rangiah

9:40am Free paper — Serum biochemical markers in complicated appendicitis and the impact of obesity

Dr Daisy Frankcombe9:50am Free paper — Is routine intraoperative

cholangiography necessary in patients undergoing cholecystectomy? A systematic review and meta-analysis

Dr Catherine Hall10:00am HENRY WINDSOR LECTURE 2021 Decisional conflict: Bias, equipoise and the

interpretation of trial results in colorectal cancer surgery

Professor Michael Solomon

10:30am - 10:40am BREAK

10:40am - 11:45am SESSION 2Chair: Dr Laura O’Connor

10:40am Welcome backDr Laura O’Connor

10:45am Free paper — An evaluation of the clinical utility of proximal bone chips in the treatment of diabetic foot infections

Dr Longhai Jin10:55am Free paper —Computed tomography

assessment of residual vascular pedicle length following colon and rectal cancer surgery: A marker of extent of lymphadenectomy and surgical quality

Dr Krishanth Naidu11:05am After retirement: Can surgeons approaching

retirement still continue to improve their skill sets and knowledge? If so, then how?

Mr Stephen Halcrow11:25am Improving surgeon outcomes – The influence of

a national registryProfessor Paul Smith

11:45am - 11:55am BREAK

11:55am - 1:00pm SESSION 3 Chair: Dr Ruth Wieland

11:55am Welcome backDr Ruth Wieland

12:00pm Free paper — Preventing carcinoid crisis in surgical patients with neuroendocrine tumours. A case report

Dr Phillip Whiley12:10pm Free paper — Subtotal cholecystectomy; Is it a

substandard operation?Dr Xin Yi Goai

12:20pm From the anatomical to the computational lab: An academic surgical journey

Professor Antonio Di Ieva12:40pm Continuing Professional Development – The

benefits and how your College supports youMs Kate Burgess

1:00pm - 1:30pm BREAK

1:30pm - 2:40pm SESSION 4Chair: Dr Hari Bandi

1:30pm Welcome backDr Hari Bandi

1:35pm Presentation provided by W.L. Gore & Associates Pty, Ltd.

1:40pm Free paper — Why is diversity in surgery a priority?

Dr Jennifer Green1:50pm Free paper — Quality assurance in melanoma

sentinel node biopsy in the ACTDr Lauren Turner

2:00pm Surgical simulation: Advancing operative skills acquisition and retention

Professor Jeffrey Hamdorf (CTEC)2:20pm Mastering new technologies in surgery; A da

Vinci Surgery perspective Ms Amy Goff

2:40pm - 2:50pm BREAK

2:50pm - 3:30pm SESSION 5Chair: Dr David Rangiah

2:50pm Welcome backDr David Rangiah

2:55pm Robotic interfaces for training simulatorsMr Duncan Stevenson

3:15pm What’s coming up for TraineesDr Hazel Serrao-Brown – RACSTA

3:25pm Awards PresentationDr Lawrence Malisano FRACS, RACS President

3:30pm Summary and closeDr David Rangiah and Dr Hari Bandi

LEAVES NOTHING BEHIND, BUT A STRONG REPAIR

GORE® BIO-A®

Tissue Reinforcement

Visit goremedical.com/products/bioatissue to learn more.

10years

positive clinical results

Better AWR Outcomes Reinforced by Data

W. L. Gore & Associates, Inc. goremedical.com

Asia Pacific +65 6733 2882 Australia/New Zealand 1800 680 424 Europe 00800 6334 4673 United States Flagstaff, AZ 86003 800 437 8181 928 779 2771

Refer to Instructions for Use at eifu.goremedical.com for a complete description of all applicable indications, warnings, precautions and contraindications for the markets where this product is available.

Products listed may not be available in all markets.

GORE, Together, improving life, BIO-A and designs are trademarks of W. L. Gore & Associates. © 2021 W. L. Gore & Associates GmbH 21195450-EN JUNE 2021

* Data on file 2018; W. L. Gore & Associates, Inc; Flagstaff, AZ.

3D bioabsorbable mesh that is an alternative to longer-term resorbable and permanent meshes.

Seroma Bowel obstruction

Hematosa SSI Fistula SSOs: wound complications/

wound dishicence

Mesh removals

6% 2% 1‒6% 18‒24% 1‒16.1%ZERO complete mesh removals due to infection

2%

LITERATURE SUMMARYFollow-up 6–24 months | 382 patients, Gore devices Study population includes high risk, complex patients

Proven LOW complication rates in ventral hernia repair*

RACS ACT OfficeRoyal Australasian College of SurgeonsSuite 31/2 King StreetDeakin ACT 2600E: college.act@surgeons.orgP: +61 2 6285 4023

RACS Registration TeamRACS Conferences and Events Royal Australasian College of SurgeonsCollege of Surgeons Gardens250 - 290 Spring Street, East Melbourne, VIC 3002E: college.asm@surgeons.orgP: +61 3 9249 1260