Baird News

Professor Paul Bannon, Chairman of The Baird Institute, talks to the ABC News about the opening of the country’s first robotic surgery training facility called the “RPA Surgical and Robotic Training Institute” at Royal Prince Alfred Hospital.

The facility will have the ability to train up to 400 surgeons each year in the use of the robot and as a result, more patients will have access to these less invasive procedures on the operating table.  The robot used to train the surgeons at the Institute cost around $4 million.

Robotic surgery allows us to perform complex procedures at a distance, with great precision and great control”, says Professor Bannon.  With this technology, surgeons make less invasive incisions which result in better outcomes and improved recovery times for the patient.  A quicker recovery means less time in hospital which in turn means a lower cost.

The robots have been used for several years in Australia, largely in private hospitals. However, Australian surgeons have had to travel overseas to develop their skills and this has been difficult due to the costs involved and a surgeon’s busy schedule.

Now, with the opening of the new training institute, the surgeons will be able to advance their knowledge in Australia, without the necessity to travel overseas.  This in turn will allow more public patients access to the less invasive procedures that robot allows.

Robotic surgery allows us to perform complex procedures at a distance, with great precision and great control.

We want to know how to teach robotic surgery and how to teach it better and we want to know exactly what the benefits to the patients are.

A robotics surgery symposium will be held in late June where doctors will discuss having a national register for surgeons who provide robotic treatment. The meeting will also address discretionary surgeon fees for such procedures.

View the original ABC News story here

KEY POINTS

• For more than a decade, robotic machines have largely been used in private hospitals for procedures like robotic prostatectomy to treat prostate cancer and robotic mitral valve surgery for heart failure patients.
• Nepean Hospital has been using robots for four years in the public system, however surgeons still had to travel to the United States for some of their training.
• A 2016 Australian study published in prestigious journal The Lancet questioned the value of using expensive robotic technology to treat prostate cancer patients.
• The Surgical and Robotics Training Institute will also collect patient outcome data and present its findings to state and federal governments.

Two of The Baird Institute’s Cardiac Surgeons, Prof Paul Bannon and Prof Michael Wilson, issue a warning over government policy on the ABC’s 7.30 Report.

The warning relates to government policy on a revolutionary keyhole heart surgery procedure called TAVI (Transcatheter Aortic Valve Implant) where the aortic valve is replaced without the need for open-heart surgery.  A surgeon inserts a new aortic valve into an artery with a very small wire, usually through the groin. The wire is then carefully manoeuvred up to the heart and inside the existing valve.

The government’s policy mandates that for this type of valve implant surgery, there is only the need for just one principal operator at the table, despite repeated warnings by both the Cardiology Society and the Surgical Society that this could result in dire consequences for the patients undergoing this procedure, even death!  The surgeons and cardiologists’ recommendation is for there be two operators – a cardiac surgeon and a cardiologist – working side by side and they would like the government to make this mandatory.

In the Unites States of America, the government has listened to the advice of the professional societies as well as the surgeons and cardiologists performing the procedure, that both a cardiologist and a surgeon – the “Heart Team” – be involved in operations involving the technique of Transcatheter Aortic Valve Implants.  In order to ensure that this happens, the government has made this a condition of payment.  Professor Michael Mack from the Bayler Heart Hospital in Texas who is a pioneer of the TAVI technique, said that he really believes that the government in the United States have got it right this time.

The surgeons explain that cost is not the issue as they are prepared to split the fee with the cardiologists so this will not cost the government any more than a single operator model.  Professor Bannon says that once the government rolls this out in November of 2017, they “would be morally and ethically bound not to allow the patients through to a single operator model”,

Experience has told us that we need to have cardiac surgeons and cardiologists at every step of the way;  at the decision making step, all the way through to the care of the patient and at the operating table.  You need both skill sets there from beginning to end.

If something goes bad with the heart and the heart stops beating, you’ve got about five minutes until you have irreparable brain damage … so you don’t have a lot of time to muck around and find a solution and get somebody into the room [to assist, therefore] we both need to be here and work collaboratively.

KEY POINTS

• Government advisory committee recommends single principal operator for procedure
• Surgeons say two principal operators are needed — a surgeon and a cardiologist
• Surgeons warn they may boycott the procedure if two principal operators are not used

View the original story featured on the ABC here

The Baird Institute’s Annual “Cocktails & Conversation” was held on December 7, 2016 at the Wooloomooloo Bay Hotel, Sydney.

For more details from the evening, including photos, please view the follow-up news item here: A Year of Achievements Celebrated at the Annual Baird Institute Christmas Party.

Inaugural Cardiac Nurses Education Conference

The Baird Institute’s first Cardiac Nurses Education Day focused upon the surgical care of patients requiring cardiac intervention with four rotating workshops to enable small group learning in conjunction with patient-centred care. The day was designed to provide practical and informative updates on the management and care of patients in the perioperative and post-operative period.

The event was held on Saturday 28th November 2015 through the support of The Baird Institute and Strathfield Private Hospital. Nurses from Strathfield Private and Royal Prince Alfred Hospitals participated in the event. Major sponsors for this occasion were Strathfield Private Hospital and St Jude Medical.

The Baird Institute wishes to extend its thanks to Ms. Cassandra Broad who helped organise the day and to the key speakers who made the day such an exciting and informative event. These experts included The Baird Chairman and Board members speaking from their cardiothoracic and research expertise, The Baird Institute doctoral fellows and Registered Nurses with expertise in patient care, management and critical problem-solving.

Guest speakers from The Royal Prince Alfred Hospital, Concord Repatriation General Hospital and from St Jude Medical helped make the day a successful and productive event.

Presentations discussed major surgical procedures, complications from cardiac and lung disease encountered during the perioperative and post-operative period and current treatment modalities.

Subject matter ranged from the latest in robotic surgery, use of innovative materials to improve surgical outcomes and advances in technology that improve cardiac surgical techniques.

Four workshops were presented for all attendees to experience smaller group discussion and to have input from radiology, surgery, nursing and trade company specialists. A wet lab was held for pig heart dissection and anatomy and physiology review, as well as chest x-ray interpretation, management of emergent chest re-opening in critical care and the use of intra-aortic balloon pump for patient survival.

The patient voice was heard with a discussion of unanticipated psychological effects of surgery, including the management of depression despite a successful surgical outcome. Mr. Phillip Koperberg spoke about his own personal experiences after cardiac surgery – a discussion which resonated with operating theatre, intensive care and cardiac ward nurses.

Sixty-three delegates were registered for the event from Perioperative Nursing, Critical Care and Cardiothoracic Surgical departments. This presented a challenge for the organisers to ensure that the sessions appealed to the three different areas of expertise in cardiac nursing. Forty-three survey responses were received at the conclusion of the day; a response rate of 73%.

Continuing Professional Development certification (CPD) was obtained through the Australian College of Nursing, providing a professional and documented approach to acknowledging the content delivered to participants. Overall the Cardiac Nurses’ Education day was deemed a success by both participants and organisers. It is anticipated that a biennial event will be held and that it will be open to perioperative, intensive care and ward-based nurses.

The 8th Annual Cardiothoracic Seminar

JOHN HUNTER HOSPITAL, NEWCASTLE, 19 AUGUST 2016

The topic addressed was:

Cardiac surgery complications

The Baird institute is committed to the education of doctors and nurses in the field of cardiothoracic medicine and as such, recently funded six nurses to attend the 8th Annual Cardiothoracic seminar in Newcastle. The conference was aimed specifically at nurses and allied health professionals.

One of the sponsored attendees at the conference – Francesca Rowshanzadeh, Clinical Nurse Educator at Royal Price Alfred Hospital – commented that the seminar discussed common and lesser known post-surgical complications which she felt better prepared her to support the patient and to educate clinicians in the ward environment.  See below her feedback on the seminar:

“I am the Clinical Nurse Educator of ward 6E2, the cardiovascular ward at RPAH, and I was extremely impressed with the quality of this seminar as the content was extremely applicable to the care we provide to our patients on a day to day basis.  Education in nursing care is very often reactive in nature, waiting for a complication to occur for an opportunity to educate on the management & treatment. I feel this seminar provided my nurses and I with the knowledge to be adequately prepared for any complications post-operatively which would directly  impact on our patient’s journey. The presentation regarding sternal wound dehiscence is extremely applicable to my role on the ward, and is an area I have a special interest in. It was extremely beneficial to follow the patient journey post pec flap advancement surgery and see the wound’s journey via photographs. The topic of tamponade was also extremely valuable as it is a complication which occurs to our patients every so often and which requires preparation and  knowledge of the signs and symptoms, as well as the treatment options, to manage adequately. Finally, the presentation on post-operative  arrhythmias was perhaps the most pertinent topic as it is managed by myself and my nurses on a daily basis. I believe it reinforced our prior knowledge whilst also adding to it. All up, it was an excellent opportunity for my staff and I and I really appreciate the opportunity that the Baird Institute gave each of us to attend.”

One of the presentations at the seminar was  “Prolonged Bypass – Myocardial Protection” by Perfusionist, John Dittmer. Below is a summary of John’s presentation.

“Cardiac surgery remains unique in that most procedures require Cardiopulmonary Bypass (CPB) to allow the surgeon to operate on a motionless and relatively bloodless heart. Cardiopulmonary Bypass is the most invasive procedure performed on the human body and unfortunately it is not without its consequences. Each time the blood passes through the bypass circuit it passes over between 2 and 3 square meters of non-endothelial surfaces. As the blood traverses the circuit, it is subject to rapidly changing pressures, sheer forces and comes in contact with foreign surfaces and with air. The blood is therefore subject to various stresses not normally experienced within the body. The longer the patient is on CPB there is an increased likelihood that its effect on the blood and the inflammatory response will cause coagulopathies and increased vascular permeability. Reducing the effects of CPB will bring about better outcomes for our patients. This requires a team effort. Already this year there are positive results from changes in our practice. Firstly, using the results of anaemia screening, patients have a higher pre op Hb. This has reduced the volume of hemodilution during bypass. Secondly there has been a reduction of the use of blood product used intraoperatively. This has been done by determining which products are needed by analysing the patients clotting profile, using the TEG monitor. During cardiac procedure, the heart is stopped by giving Cardioplegia directly into the coronary arteries and or coronary sinus. There are several techniques involved in preserving the heart for longer cases. We have been using three different types of Cardioplegia and are undertaking a small study to look at the efficacy of each formula.”