Upper gastrointestinal surgery, Box Hill Hospital, Melbourne

I was welcomed as part of the Surg B team at Box Hill hospital during my elective. The team consisted of three interns, two registrars, one fellow and numerous consultants.

I was invited to participate in the team in an intern role as well as observing and assisting in procedures and clinics.

The most common procedures I observed included: ERCP, gastroscopy, Whipple’s, gastrojejunostomy, Ivor-Lewis, cholecystectomy and hepatic resection.

The nature of the team’s specialisation meant that the scope of illness ranged from gallstones causing cholecystitis and pancreatitis to malignancies (gastric, oesophageal, pancreatic, hepatic).

As I had not previously observed most of these procedures, I gained insight into their indications and common complications.

In particular, I was able to refine my knowledge of ERCP, which is commonly used to identify and remove obstructed gallstones in the pancreatic duct using a flexible endoscope. The options for remediating obstructed gallstones included sphincterotomy with or without a temporary stent and the routine use of indomethacin (per rectum) to prevent post-ERCP pancreatitis in patients who had previously undergone ERCP.

My knowledge of relative anatomy in the upper GIT improved significantly and I refined my knowledge of the vasculature supply.

As well as refining my knowledge of the upper gastrointestinal system, the placement allowed me to experience the practicalities of working both in a different hospital and within a different state.

These differences were subtle in some cases, such as with hospital policies and charting systems, however, the presence of a theatre tech assigned to each operating theatre enabled immediate assistance with operating equipment that is not available in ACT.

During my placement, I had the opportunity to take detailed histories from patients presenting to the outpatient clinic for an initial appointment with a surgeon to discuss the possibility of surgical management or patients requiring review following a procedure.

This enabled me to refine my history taking skills and identify issues that would require further discussion with the surgeon. I was also invited to observe the pre-procedure anaesthetic clinic, where patients were referred to assess their suitability for surgical procedures from an anaesthetic perspective.

This gave me a unique insight into the particular areas of interest that anaesthetists use to assess surgical suitability compared to surgeons.

The most valuable experience I obtained was assisting in a Whipple’s procedure, where I was guided by the surgical fellow in delicate handling of liver and intestine to allow her optimal access for resection of pancreas and gallbladder.

This placement provided me with the opportunity to observe procedures I would not have had the opportunity to see in my placements in ACT hospitals as well as the experience of the differences in a new hospital and clinical team.

Overall, I achieved refinement of skills gained in my previous placements and new knowledge of management of malignancies in the upper gastrointestinal system.