Our calling is helping patients suffering from the effects of surgical endocrine disorders. We work in both the public and private health systems and ensure that we provide safe and effective treatment of thyroid, parathyroid, adrenal and other neuroendocrine conditions (see the section on the conditions we treat).
In our practice there is a supportive and respectful collaboration between our office and clinical staff and we have a patient centred work ethic. We find that our long working relationships mean we can shepherd our patients through the complexities of the health system. Our staff have enjoyed working together for between 5 years and more than 20 years so it is likely we have collectively seen and dealt with most problems and circumstances. When we accept your referral we are determined to see your problem through to its conclusion.
Successful surgery depends on thorough assessment and preparation of patients with careful attention to detail so that when a procedure is performed the scope for surprise discoveries and unplanned changes in treatment is minimised. We aim to have our patients fully informed and confident of the treatment plan. As a result we place a strong emphasis on the pre-operative work-up and education of patients when they first see us. Central to this is a detailed medical history and examination. We use nasendoscopy (vocal cord examination) and ultrasound in our rooms to assist in the examination.
We work closely with our medical endocrinology colleagues who have particular diagnostic and therapeutic skills and a range of other imaging and diagnostic specialists to make sure that we offer a useful surgical procedure that will realistically deal with the clinical problem and improve the patient’s quality of life
As the population ages we need to place their surgical procedure in the perspective of other illnesses and similarly in the younger population think about the impact of treatment on work and family life. We endeavour to provide safe and lasting surgical solutions to surgical problems, and carefully follow up and support our patients during recovery, and in the case of cancer during post treatment surveillance. When a patient has other medical problems we make sure that these conditions are stabilised and that the risks are acceptable for surgical treatment. We will often advise against operating when we feel the benefits of surgery are outweighed by other risks, or if surgery is not the correct treatment.
We are very dependent on our working relationship with our anaesthetic colleagues, and the scope of what we can achieve with an operation is often only possible due to their high level of expertise. They can in many cases make anaesthesia which was previously a bad experience for a patient very much more pleasant this time around. They make the post operative experience much less troubled by pain.
We provide the most modern technology when we know it will help treat your condition, but avoid adopting new techniques until we know they are useful and safe in our practice. When an established surgical technique achieves the same result with less risk we choose proven results over novelty. We continue to review and fine tune our techniques to remain current. As a result we consider education and retraining both here and overseas to be critical to the success of our practice.
Since I commenced consultant general surgical practice in 1991 we have progressively limited the scope of the conditions that we treat to exclusively endocrine surgery, so we are familiar with a very wide range of unusual variations and presentations of endocrine disorders, and with the problems that might arise following surgery. When we have a very unusual case we consult with our network of trusted local and overseas colleagues before making decisions regarding management.
We see and treat patients referred from other surgeons, and from around the state, interstate and overseas. We provide second opinions on difficult cases, and perform technically challenging revision surgery.
When a condition impacts on other areas of expertise such as thoracic surgery, vascular surgery, gastrointestinal surgery or head and neck reconstructive surgery we consult and work closely with the right person in that specialty to deal with difficult and advanced cases. We enjoy a close working relationship with our preferred colleagues in cytology and pathology to ensure that the microscopic diagnosis is accurate.
When it assists in planning and co-ordinating cancer therapy we consult with our nuclear medicine, radiotherapy and medical oncology colleagues at Multidisciplinary meetings. We are indebted to our medical endocrinology colleagues in the challenging areas of stabilising and replacing hormonal imbalances in thyroid, bone metabolism and adrenal hormonal dysfunction.
We consult regularly with our endocrine genetics colleagues when there is a genetic component that might affect more than just the one person in a family, and contribute to the research effort that is rapidly changing the management of inherited illness.
We see the pervasive nature of "spin" in personal, political and commercial life. Our surgical results are very good and rank with similar highly specialised services around the world, but we avoid superlatives and "never" or "always" when we describe complications and cure rates. We do have complications and not every problem is solved; we would delude ourselves if we thought we were perfect. We are pleased with the results of our work in this practice.
It is a good idea to make some preparations before your appontment
This is a faily intense and sometime stressful visit
You might be worried about what illness you have and what it means to your well being
Pit is a good idea to have thought about the questions we will ask to get a clear picture of your illness and your general health and the effects of thenadvic we will be gI in about your life
It may surprise you to learn that despite all the advances in imaging and blod tests that the main way to get to the bottom of a health proem is to talk in a very structured way about your problem and how it is affecting you. If we don't know that the all he tests in he world won't assist in making the right decision in your case. It may seem redundant after seen you GP and perhaps another specialist thatbe o vet the things ou have already told them. This serves two purposes; one is that his is like the two pilots on a lane runingver the safety check list together and the second is to clear the histories f he last patients from my mind so hat the full picture of your life and health is foremost n my mind
We will sport by finding out what the main reason to come to see me is and what symptoms this is causing you so we build. A picture of the natur of your illness and the effect it has n your life. After hat we ask abut life style and family risk favors that might predispose you to he illness
After that we perform an examination and review your tests so that we have as much knowledge the problem as possible. After hat wexamine look at your general health work family life and heritage to ind clues about the impact of all hese factors which will guide the diagnosis and treatment plan we will wantoo know of any allergies and the medicatioouyou ar on. If there are more than two or three hen bro ging a Luis a good idea. If you or get something dn worry as we can often chase these results by fax while are talking
We will want to not only read all reports bu also look at he films from any X-rays or ther imaging, as a lough we are not radio hosts we have specific surgical owl edge to bring to the review of your tests
After that
the key to thyroidectomy is the dissection of the upper pole of the thyroid and the key to that dissection is the anatomy of the Superior thyroid artery. If you know the branches of this artery and its relationships you know the steps to mobilising the upper pole.
There are 13 branches.....
- superior thyroid artery origin
- internal laryngeal
- infra-hyoid
- crico-thyroid
- crossing branch
- sternomastoid branch
- strap muscle branch
- thyroid and parathyroid capsular branches
- anteromedial thyroid artery proper
- anterolateral thyroid artery
- posterior thyroid artery
- inferior thyroid artery connecting branch
- superior parathyroid branch
Generally the order in which you encounter these is the capsular branches from the strap muscle branch, the antero-medial branch to the thyroid propria, the crossing branch in the cave of Reeve connecting the crico-thyroid and the antero-medial branch, the antero-lateral branch and the posterior branch with the artery to the superior parathyroid. At this point the dissection turns to finding the termination of the recurrent laryngeal nerve as it enters the larynx below the small wedge of the inferior constrictor. The connecting branch from the antero-lateral or sometimes the posterior branch to the inferior thyroid artery may extend over the lobe of Zuckerkandl at this point and make the mobilisation of this area difficult, but it must not be divided until all the branches of the recurrent laryngeal nerve are found, as the artery and nerve run nearly in the same direction, and rarely the recurrent laryngeal nerve runs superficial to the lobe of Zuckerkandl
We like to see all our patients within the first week of discharge. This gives us the opportunity to report on the results of pathology which might not be available after a short in-hospital stay, If this leads to further treatment then this can be organised. Also if there is a complication which is developing we can deal with that in a timely manner. Patients and their family often have further questions which we can answer at that time. Wound swelling is common and most does not require treatment if mild but we can diagnose the common causes for this symptoms at this visit; sometimes fluid might be aspirated with a needle and syringe. We sometimes need to start antibiotics.
Many patients will ring the ward and their GP but during this time I am keen that you ring me or one of my team. We want to know if there is a problem and deal with it promptly; this might speed up recovery
If we have operated near the nerves to the vocal cords this is a time when my Nurse practitioner or I would perform a nasendoscopy to check the vocal cords; we like to do this on all our patients to ensure that there are no problems; even if the voice sounds normal there can still be an issue, and in only 50% of cases where the voice is hoarse is there a problem with the cords moving properly; the rest are due to swelling, and minor local trauma from having a breathing tube for the anaesthetic
Usually my anaesthetist will ring you a few days after going home to ensure that his side of things is going well and they will let me know if there is a surgical issue
We will be able to gauge how your are progressing and provide a work certificate or carer's certificate at this visit.
We will arrange blood tests to check thyroid hormone and calcium levels if needed, and other procedures have specific investigations to ensure that we are on track for recovery
Sometimes we will arrange one of our paramedical colleagues to see you such as a speech therapist
If there are bills to be paid then my secretaries will present you an account and assist with expediting payment and we have a separate section that deals with the somewhat complex arrangements we have in place in Australia to sort out Medicare Health fund and out of pocket expenses
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