Westmead Private Hospital

Cnr Mons & Darcy Road Westmead NSW 2145

Issue 1
February 2014

02 8837 9000

Message from our Chief Executive Officer: Tim Daniel

Welcome to the
inaugural issue
of our Westmead
Private Hospital
Update.
Our aim is to improve
our communication with
you by presenting topical
issues from our group of
leading Medical Specialists. I hope at the same time
we can also share with you some of the wonderful
things we are doing here at Westmead Private and
increase your level of awareness of our services, staff
and educational opportunities. Already, many of you
may have attended our G.P accredited education

New Accreditations

programs that we run 4-5 times a year, of which we

are very proud.

 r Joseph Chiha
D
Cardiologist

(02) 9687 0073

Each issue we will be presenting a different Specialty

group to you and I would certainly welcome feedback
if there are any particular issues / topics that you
would like us to cover as well.

 r James Chong
D
Cardiologist

(02) 9845 6795

 r Richa Rastogi
D
Psychiatrist

(02) 8833 2463

 r John Wehbe
D
Dental Surgeon

(02) 9636 7656

Over this last 2 years we have invested significantly

in new technologies and hospital infrastructure
to underpin what we believe is Western Sydneys
Hospitals of Surgical Excellence.
I hope you enjoy reading our first issue.
Yours sincerely

 r Eva Wong
D
General Surgeon/
Surgical Oncologist

(02) 9845 5200

Chief Executive Officer

 r Jyothi Marry
D
O
 bstetrics/
Gynaecology

(02) 8883 4952

Tim Daniel

NEWS FROM WPH

Westmead Private Hospital, owned by Ramsay Health Care, opened


in October 2000 so is now over 13 years old with a bed capacity
of 159. This year Westmead Private will be helping to celebrate
Ramsay Health Cares 50th anniversary since opening in 1964.

W
 estmead Private Hospital is pleased to announce the pending
arrival of the latest Zeiss Pentero 900 microscope, due to arrive late
February, with the 3D Imaging component to arrive in early April.
The PENTERO 900 microscope is a unique surgical visualization
platform that offers advanced functionality to meet the most
demanding microsurgical applications. This new microscope will
be equipped with all the latest technologies including foldable,
rotatable binoculars, integrated HD camera, and recording plus the
latest Infrared 800 and BLUE400 fluorescence technologies.

WPH Plastics and Reconstruction Surgeon Dr Thomas Lam co


authored an article published in the peak plastic surgery journal
and also in its online sister journal PRS global;

Publications

 am, T., Hsieh, F., Boyages, J. (2013), The effects of postL

mastectomy adjuvant radiotherapy on immediate two-staged
prosthetic breast reconstruction: a systematic review. Plastic and
Reconstructive Surgery. 132(3), 511-518.

 he BLUE 400 fluorescence will help in improving tumour

T
resection rates. It is used in conjunction with the Gliolan drug,
which accumulates at the glioblastoma site and fluoresces under
the blue light of the microscope.

Silicone implants are thicker than water. Plast Reconstr Surg Glob

Open 2013; X:e43; doi:10.1097/

GOX.0b013e3182a85b49; published online 23 September 2013.
Hsieh, F, Miroshnik M, Lam T.

Mr
 Sean Mungovan and Dr Andrew Hirschhorn of Westmead
Private Physiotherapy Services and The Clinical Research Institute
have recently conducted several research projects together with
A/Prof. Andrew Brooks and A/Prof. Manish Patel, Urological
Surgeons at Westmead Private Hospital. The focus of these was
on improving the perioperative (physiotherapy) management of
men undergoing radical prostatectomy, particularly in regards
to improving urinary continence. These three papers, published
internationally in 2013, are open access and available for download
at: http://sydneywestphysio.com.au/the-clinical-research-institute/
publications-presentations/

 he Infrared IR800 fluorescence is used to assist in vascular

T
Neurosurgery (most commonly to intraoperatively check how
effectively an aneurysm is clipped or to monitor the blood-flow
associated with an AVM.) Essentially the IR800 helps visualize the
blood flow so other applications of this may follow.
I
n addition to the microscope, Westmead Private Hospital are about
to become the first Hospital in Australia to adopt the new Trenion
3D camera system. Traditional video has always been limited in its
ability to show depth. The new Trenion 3D camera will give this
sense of depth. It has dual cameras on both light paths (left and
right), these signals are run simultaneously into the 3D screen and
with the assistance of the 3D glasses you will get an image clarity
like no other. The 3D recording is part of the Trenion system and
the videos taken with the Trenion will be world class videos for any
conferences, or live surgery sessions run at the hospital.

New Western Sydney Private

Oncology & Infusion Centre

The new Western Sydney Private Oncology
& Infusion Centre that we have on-site
at Westmead Private Hospital not only
offers our patients treatment from highly
specialised and experienced doctors but
it provides them with top quality facilities
that are modern, comfortable, relaxing
and help take away some of the anxiety of
receiving these types of treatment.
Our beautiful Oncology and Infusion
Centre specialises in the care and support
of patients receiving infusion therapy,
including cytotoxic therapies (usually by IV

Address:

infusion), often used for the treatment or

management of chronic illness and cancer.
These new facilities allow us to hold double
the capacity of our previous oncology and
infusion services.
The centre is a purpose designed unit
offering bright and spacious modern
treatment areas. The room is bathed in
natural light and features spacious yet
discrete treatment bays, modern dcor,
comfortable reclining electric treatment
chairs, access to wireless internet,
Foxtel and flat TV screens. We absolutely

recognise the importance of our patients

surroundings when going through such
a challenging time in their lives. These
facilities combined with the wonderful
team of dedicated and caring clinical
staff, provides a top-quality service that is
expected.
Services available to our patients include:
Chemotherapy
haematological treatments
iron infusions
blood transfusions
specialist drug infusions

W
 estern Sydney Private Oncology & Infusion Centre
Westmead Specialist Centre, Level 2, 16-18 Mons Road
WESTMEAD NSW 2145

Phone: (02) 8837 9800 Fax: (02) 8837 9845

www.westernsydneyoncology.com.au

Hit Milestone of Management of Men and Women with Haematuria

One Year of
Robotic Surgery

TOP 5 TIPS FOR GPS

Most causes of microscopic and macroscopic haematuria are nonmalignant; however it is important to exclude malignant causes which
are prevalent in 25% of cases of macroscopic haematuria and 9% of
microscopic haematuria. This is a short guide to the evaluation of these
patients.

Westmead Private Hospital continues to provide

its patients with leading edge technology in all
aspects of our services. At the end of last year we
celebrated one year of robotic surgery surpassing
well over 150 robotic cases. The robotic services
at Westmead Private are strongly underpinned by
our Urology, Gynaecology and Colorectal teams
and we are extremely proud of our ability to
provide patients with these top-quality services.
The minimally invasive capabilities of our robot
provides patients with extraordinary benefits
including less pain, quicker recovery times and less
risk of infection. The staffs at Westmead Private
are absolutely committed to providing the best in
health care, offering surgical options that promote
the greatest outcomes.

1. 
Check all patients with haematuria for infection. If present,
treat appropriately and then check for haematuria again. If a
high percentage of dysmorphic cells are present on microscopy,
send for nephritis evaluation. Testing for malignancy on urine
cytology (X3) is also important.
2. 
Patients with macroscopic haematuria also need imaging by CT
or MRI urogram to evaluate the kidneys, ureters and bladder.

A/Prof
Manish Patel

3. 
Patients with microscopic haematuria should be categorised
for risk. Patients at higher risk for malignancy include age>50
years, smoker, previous urological malignancy, radiotherapy or
MBBS MMed PhD FRACS
cyclophosphamide exposure and occupational risk.
(Urology)
If
Urological Cancer 4.  the risk is high, they should be investigated as for
macroscopic haematuria. If the risk is low, the imaging can be
& Robotic Surgeon
replaced with a urinary tract ultrasound.

T: (02) 9687 8252 5.  patients with unexplained haematuria should undergo

All
F: (02) 9687 0707
cystoscopy, as bladder cancers smaller than 10mm can be
missed on imaging studies.

Westmead Private Hospital

ONCOLOGISTS Profiles
Professor Paul Harnett
MB, BS, FRACP, PhD

Professor Paul Harnett is a Senior

Staff Specialist in Medical Oncology,
specialising in breast and gynaecological
cancers. He is a Clinical Associate Professor
of USyd and is the Director of Crown
Princess Mary Cancer Centre in Westmead. Dr Harnett has
been in practice in the West of Sydney for
25 years and he is actively involved in clinical and laboratory
research into both breast and gynaecological cancers.
Crown Princess Mary Cancer Centre, Westmead,
Hawkesbury Roads, WESTMEAD, NSW, 2145

Phone: (02) 9845 6432

Fax: (02) 9845 6391

Dr Rina Hui
MB BS, PhD, FRACP

Dr Rina Hui is a Senior Staff Specialist in

Medical Oncology at Westmead Hospital
and a Clinical Senior Lecturer at the
University of Sydney. After completing
her medical degree at University of Sydney
and specialist training at Royal North Shore Hospital, Dr Hui
undertook basic laboratory research in molecular biology
of breast cancer at the Garvan Institute of Medical Research
and was awarded a PhD degree. Her major clinical interests
are breast cancer and lung cancer management. Dr Hui sees
over 400 new patients each year and is principal investigator
for many clinical trials in lung and breast cancers.
Crown Princess Mary Cancer Centre, Westmead,
Hawkesbury Roads, WESTMEAD, NSW, 2145

Phone: (02) 9845 5162

Fax: (02) 9845 6391

Dr Nicholas Wilcken
MB BS, PhD, FRACP

His clinical interests are in breast cancer

and colorectal cancer. Research interests
include translational oncology, systematic
reviews and breast cancer clinical trials.
Dr Wilcken is currently Director of
Medical Oncology at the Westmead
Cancer Care Centre and the coordinating Editor of the
Cochrane Collaboration Breast Cancer Group. He is also
closely involved in the ANZ Breast Cancer Trials Group and is
Chair-Elect of its Scientific Advisory Committee.
Crown Princess Mary Cancer Care Centre, Westmead
Hospital,
Hawkesbury Roads, WESTMEAD, NSW, 2145

Phone: (02) 9845 5200

Fax: (02) 9845 6391

Dr Richard Kefford
AO MB BS, PhD, FRACP

Dr Richard Kefford graduated in medicine from

the University of Sydney then trained in medical
oncology at Royal Prince Alfred Hospital, and at
the Ludwig Institute for Cancer Research, Sydney,
where he gained a PhD in purine biochemistry.
His post-doctoral period was spent at the
Laboratory of Molecular Biology in Cambridge, UK, on a Howard
Florey Fellowship. He founded the Department of Medical Oncology
at Westmead Hospital in 1986 and continues clinical practice in the
medical treatment of melanoma and breast cancer.
He has conducted research into molecular genetics of melanoma
continuously since 1985, playing a major role in the mapping of the
melanoma susceptibility gene p16 and in characterising hereditary
mutations in this gene. He is a member of many Medical groups, a
few being the Medical Oncology Group (Australia), the American
Society of Clinical Oncology, the American Association for Cancer
Research and the Australian Medical Association. He has been an
invited plenary speaker at many world-wide conferences and is the
author of over 140 papers in the peer-reviewed medical literature.
Division of Medicine, Westmead Hospital,
PO Box 533, WENTWORTHVILLE, NSW, 2145

Phone: (02) 9845 8089

Fax: (02) 9687 2331

Dr Howard Gurney
MB BS (Hons), FRACP

Professor Howard Gurney is a medical oncologist

and head of the Clinical Trials Unit in Medical
Oncology at Westmead Hospital. His subspecialty
interests are in lymphomas, prostate cancer and
other genitourinary cancers (bladder, testis and
kidney cancer).
He is involved with the introduction of new drug therapies in cancer
patients, particularly for prostate and kidney cancer.
Western Sydney Private Oncology & Infusion Centre
Level 2, 16-18 Mons Road, WESTMEAD, NSW, 2145

Phone: (02) 9845 5200

Fax: (02) 9845 6391

Dr Mark Wong
BSc (Med), MBBS, FRACP, PhD

Dr Mark Wong is a medical oncologist at

Westmead Hospital and a clinical senior lecturer
at the University of Sydney. He was graduated
from the University of NSW and obtained his PhD
in pharmacogenetic research in 2008. His research
is focussed on therapeutic drug monitoring and
pharmacogenetics of targeted therapies. He is also specialising in the
management of patients with soft tissue sarcomas, nervous system
tumours and gastro-intestinal tumours.
PO Box 533 WENTWORTHVILLE, NSW, 2145

Phone: (02) 9845 5200

Fax: (02) 9845 6391

NEWLY ACCREDITED UROLOGIST

at Westmead Private Hospital
Dr. Tania Hossack

MBBS (Hon), MS (Surg), FRACS (Urology)

Dr. Tania Hossack undertook her medical training at the University

of Sydney, graduating with a first class honors degree. She was then
admitted as a fellow of the Royal Australian College of surgeons in
2010 and is also accredited by The Urological Society of Australia and
New Zealand. Dr Hossack is a general urologist, and trained in all
urological procedures including Endourology, Laparoscopy and Robotic
Surgery. She has experience with a vast array of urological problems,
however she does have specific interest in the following:
Specialties:
 tone disease and all stone procedures including Ureteroscopy, Pyeloscopy, Lasertripsy and
S
percutaneous Nephrolithotomy.
 oiding dysfunction and painful bladder syndrome. At Western urology they offer
V
uro-dynamics and have a urology nurse trained in caring for these patients.
 ll Urological cancers. From making the first diagnosis, to management and then follow-up.
A
 urvivor-ship following cancer treatment, including penile rehabilitation, is also a key focus of
S
her practice

Westmead Private Hospital, Suite 12, Corner Mons and Darcy Roads, WESTMEAD, 2145
Phone: (02) 9633 2088 Fax: (02) 9633 3785
Email: thossack@westernurology.net.au

Westmead Private Hospital: Specialist Urologists

Dr Tania Hossack joins the already very well established Urology team here at WPH.
Visiting Medical Officer

Sub-Specialty

Contact Number

Kidney Stones, Laser Surgery

(02) 9831 7400

Dr Andrew Brooks

Prostate, Kidney and Bladder Cancer,

Robotic Surgery, Kidney Stones,
Vasectomies and Vasectomy reversals

(02) 9633 2088

Dr David Ende

Renal calculi complex stone disease,

Prostate Disease (benign/malignant)

(02) 9831 5696

Dr Chi Huynh

Erectile Dysfunction, Robotic Prostate

Surgery, Prostate Cancer, Kidney Stones

(02) 64 92 1483

Prof Mohamed-Hassan Khadra

General Urology, Erectile Dysfunction

and Bladder Kidney and Prostate Cancer

(02) 4732 5599

Prostate and Kidney Disease,

Robotic surgery

(02) 9635 5377

General Urology

(02) 9643 1223

Urological Cancers
(prostate, kidneys and bladder)

(02) 9687 8252

Incontinence and General Urology

(02) 8061 6180

Dr Simon Bariol

Dr Howard Lau
Dr Andrew Mitterdorfer
A/Prof Manish Patel
Dr Audrey Wang

ROBOTIC SURGERY IN UROLOGY

Dr Howard Lau MBBS, FRACS (Urol)

limitations in most studies and the lack of
prospective randomised trials. The reviews also
demonstrated similar cancer resection margin
results comparing RARP and OPR, RARP may also
be used in patients with high-risk prostate cancer
where extensive lymph node dissection is required.
Biochemical disease-free survival after RARP
seems to be equivalent to other approaches. When
appropriately performed, RARP is not associated
with an increased risk of patients needing adjuvant
therapies.
Development of technology has greatly influence
the evolution of surgery. Robot assisted surgery
is a classic example of this relationship which is
ultimately aimed at improving patient outcome.
However, the introduction of robotic surgery in
the treatment of prostate cancer was not without
controversy. Early reports showed significantly less
blood loss and shorter hospitals stay in prostate
cancer patient received robot-assisted Radical
prostatectomy (RARP) when compared with Open
Radical prostatectomy (ORP). Other benefits were
less clear. Some early reports even raised concerns
with cancer resection margins, urinary incontinence
and erectile dysfunction with RARP while other
authors reported improvement in continence and
ED in patients treated with RARP. A European
report in 2008 showed a higher rate of regret of
treatment choice among patient receiving RARP.
These somewhat surprising finding may to some
extent be related to the extensive experience in
ORP, which had been practiced for more than three
decades when RARP was first introduce. In all the
reports, importance of the surgeons experience
is highlighted. The robot after all is a slave to its
master where every move is controlled and planned
by the surgeon.
Fast forward to the 2010s the benefit of RARP
is less controversial. Systematic reviews indicate
superiority of RARP for preservation of continence
and potency following Prostate cancer surgery;
however, the authors noted methodological

With the hype of advanced technology such as

the Da Vinci surgical robot, it is important to
remember surgical technique is only one of the
factors that influence outcomes. In the case of
radical prostatectomy, patients pre-morbid function
(bladder, erectile and general), obesity, age,
prostate size, presence of bladder outlet obstruction
as well as the level of surgeons expertise have
a significant impact on functional outcomes.
With RARP showing reduction in blood lost,
lower transfusion rate, shorter hospital stay, less
pain, faster recovery and return to work, likely
earlier return of urinary continence and erectile
function as well as lower risk of wound infection
and scarring it is not surprising to see a rapid
uptake of RARP worldwide. In 2006 over 40% of
radical prostatectomy in the US is by RARP. That
percentage increased to over 80% in 2008 and now
over 95%. Currently in Australia approximately
half of the radial prostatectomies are by RARP.
This percentage is expected to increase with more
robot availability and increased expertise of local
surgeons together with likely reduction in cost.
At Westmead Private Hospital the latest generation
Da Vinci Surgical Robot was installed over twelve
months ago. In that time our surgeons have
successfully performed well over 100 RARP; we
have also carried out robot assisted cystectomy for
bladder cancer, partial nephrectomy included used
of Firefly (Fluorescent enhanced vision for improved
segmental control of renal artery),

a first in Australia. Other applications of the robot

include hysterectomy, bowel resecions, pelvic floor
repair which are all available at Westmead Private
Hospital. We are also proud to report the first two
successful single port robot assisted hysterectomies
in Australia recently performed in our hospital. In
the coming year we are looking forward to building
on out experience and expertise and to continue to
provide state of the art treatment to our patients.
We look forward to your continual support.
Dr Howard Lau.

Dr Howard Lau is among the worlds

most experienced surgeons in the
field of minimally invasive kidney
surgery. His work on laparoscopic
kidney surgery has changed the
practice of Nephrectomy (radical and
partial) in Australia and overseas.
He specialised in renal, adrenal and
prostate (RAP) surgery, including
diagnostic and treatment for both
benign (stone, BHP, PSA) and
malignant diseases. Dr Lau is also a
qualified robotic surgeon and trainer
for other robotic surgeons.
Phone: (02) 9635 5377
E-mail: info@ howardlau.com.au

Other Specialist Urological

Robotic Surgeons at WPH
A/Prof Andrew Brooks (02) 9633 2088
A/Prof Manish Patel (02) 9687 8252
For a more comprehensive list of our
robotic surgeons please visit our
website.

Diary Dates: UPCOMING GP EDUCATION EVENTS

(CPD points available with proof of attendance)

Tuesday 4 March Necklines

Tuesday 22 July Women & Robots

Thyroid nodules, melanoma and soft tissue tumours.

New offerings in gynaecology; robotic case presentations,

adolescent and post-menopausal problems.

Saturday 17 May Heart Break Ahead!

(6 hours in afternoon - 40 Category 1 points achievable)

Tuesday 9 September Back Up

An active learning module in practical GP cardiology

and neurosurgery comprising workshops, practical
demonstrations, thought provoking round table discussions &
case studies, ECGs (again!) and a CPR certificate.

GP assessment and interventions of back and neck pain, spinal

nerve compression and upper limb conditions.

Tuesday 11 November Robots & Stones

Stone disease, urological oncology and impact of robotic
surgery on patient outcomes.

Register online or download a registration form and fax to 02 9687 9095

or email Sandra Southwell at southwells@ramsayhealth.com.au

Westmead Private Hospital and

Embarrassing Bodies Down Under
Plastics and Cosmetics: Dr Barnouti FRACS, RACS, ASPS, ASAPS
Dr Laith Barnouti is one of Sydneys leading plastic surgeons specialising in Plastics and
Reconstruction Surgery. He is best known for rejuvenation and recontouring of the
face, breast and body with the focus on minimal scarring and invasion with maximum
improvements.

Phone: (02) 9561 0222

Website: www.plasticsurgery-sydney.com.au

Westmead Private Hospital recently featured in the well-known television program

Embarrassing Bodies Down Under where Dr Barnouti, a Specialist Plastic Surgeon at
Westmead Private Hospital, carried out drastic surgery on a patient. The patient, underwent
radical abdominoplasty and liposuction after massive weight loss. The surgery took a total
of six hours to complete and Dr Barnouti managed to remove 16k of her. This is the first time
ever that Embarrassing Bodies has filmed in Australia.

Dr Barnoutis Top Tips For GPs:

 ome patients can only loose up to
S
a certain amount of weight before
they need to be addressed surgically.
It is crucial to recognise that in the
case above, the patient had lost 90K
preoperatively by exercise and change
of life style however she ended up
having massive skin redundancy, and
stubborn fat. She stopped exercising
after a while as there was no visible
improvement. This is because fitness will
improve your muscle tone and decreases
your fatty tissue areas; however it will
do nothing to the excess skin and some
stubborn fatty areas.
 urgery is sometimes the only option for
S
certain patients to kick start a lifestyle
change. Obesity is epidemic in our society,
you need to know that weight loss is
extremely difficult in this life-style and
patients often need help to resculpture
their body to encourage them to re-start
a healthy life style and recommence
exercise. Abdominoplasty, Body lift and
Liposculpture is a very powerful tool to
deal with such problems.

 sing the correct item numbers

U
for procedures makes surgery
more affordable. The correct item
number to use for Abdominoplasty
is 30177 and for excess fatty tissue
excision is 30171. These numbers
indicate that at least part of the
hospital, surgical and Anaesthetist
fees will be re-imbursed by
health insurance. With respect to
Gynecomastia surgery for male
obesity, medical item number 31527 x2
should be used.
 ariatric surgery patients should be
B
reviewed post-op and referred for postweight plastic surgery where applicable.
Many patients having gastric banding,
sleeve and other type of bariatric
surgery end up requiring plastic surgery.
However, only about 5% of patients
make it to the plastic surgeon for post
weight reduction surgery.

New Surgical Oncology Accreditation: General Surgeon/Surgical Oncologist

Dr Eva Wong BDS (Hons), MBBS (Hons), FRACS

Dr Eva Wong is a Head & Neck Surgeon and Surgical Oncologist in
Westmead Private Hospital. She joined the Surgical Oncology Unit in
2013. She graduated with Bachelor of Dentistry in 1994 and underwent
Oral and Maxillofacial training in 1996. She completed her medical
training in 2002 and undertook general surgical training in Westmead
Hospital. Upon obtaining her surgical fellowship in 2010, she spent
her psot fellowship training in Head & Neck, Surgical Oncology Unit
in Westmead Hospital in 2011, Prince of Wales Hospital in 2012. She

recently returned from London after completing her

fellowship training in the Sarcoma and Melanoma
unit at The Royal Marsden Hospital where she acquired experience in
the management of limb and retroperitoneal sarcoma. She was also
training in isolated limb perfusion for patients with advanced limb
malignancy. Dr Wong has a special interest in the management of Head
and Neck malignancy, in particular skin cancer, thyroid, parathyroid
and salivary gland neoplasm.

Westmead Cancer Care Centre, PO Box 533 WENTWORTHVILLE NSW 2145 Phone (02) 9845 5200

Mobile: 0415 488 323

Fax (02) 9845 6391