The Urology Fellowship at the Royal Melbourne Hospital specialises in pelvic uro-oncology and involves a well supervised program of clinical and research activities undertaken over 12 months.
This world renowned Urology Fellowship attracts high calibre urologists work under the supervision of Prof Anthony Costello, MD, FRACS, MBBS, Director of Urology.
The Royal Melbourne Hospital is affiliated with the University of Melbourne and is a tertiary referral hospital with a catchment area servicing more than one million people.
The Urology Department has ten attending urologists, one trainee urology registrar and two residents, three clinical fellows and one lab-based research fellow, a clinical psychologist, and both research nurses and nurse consultants. A neuro-urology and continence unit has been established within the department and is closely linked with the continence service based at the Royal Park Campus.
This Laparoscopic and Robotic Urology Fellowship focuses on the treatment of localised prostate cancer. Prostate cancer is one of the commonest cancers in men in Australia, accounting for 10,000 new diagnoses and 3,000 deaths per annum. For cancer confined to the prostate, there are a number of treatment options, of which surgery (radical prostatectomy) offers a high chance of cure.
However radical prostatectomy through a traditional open-surgery incision has a considerable impact on patients, not just around the time of surgery, but also in the long-term with regard to continence and potency. It is not uncommon for patients to require a blood transfusion, hospital stay averages 3-5 days, 3 months may be required before returning to work, and the majority of patients lose the ability to have erections.
As with many other surgical procedures, “keyhole surgery” techniques have been developed to minimize the impact of such surgery on a patient’s recovery. It is possible to perform robotic assisted laparoscopic radical prostatectomy (RARP) using the da Vinci™ Surgical System via 6 tiny incisions with a much faster recovery time than open radical prostectomy. The blood transfusion rate is less than 2% and over 80% of patients are discharged the day after surgery.
Robot assisted surgery
Robotic assisted laparoscopic prostatectomy was first established in Australia by Professor Costello at the Epworth Hospital in Richmond in 2003. Since then we have performed over 1400 RARPs, the outcomes of which have been scrupulously audited and the results published in several prestigious manuscripts internationally including the European Journal of Urology. Since its inception by Professor Costello in 2003, the training of other urologists around the nation has been undertaken and has led to the procedure being widely accepted for the treatment of localised prostate cancer in Australian men.
More recent developments within Melbourne has led to the instillation of Australia's first public robotic assisted laparoscopic prostatectomy service at the Peter MacCallum Cancer Centre. The program of robotic cancer surgery provision at the Peter MacCallum Cancer Centre as well as a program for training surgeons in robotic surgical techniques has been developed by Professor Costello and A/Prof Declan Murphy in close collaberation with the robotic service at the Epworth Hospital. The aim of this program of robotic surgery is to ensure that excellence in the provision of surgery for prostate cancer is maintained here in Melbourne.
Robot surgery theatre set-up at the Peter MacCallum Cancer Centre. The robot and patient with the assistant Dr Robin Weston can be seen on the left and the operating surgeon A/Prof Declan Murphy can be seen sitting at the console on the right.
Robotic prostectomy surgery is technically demanding and requires intensive training. At present, it is only offered in a handful of centres statewide, including the Epworth Richmond Hospital and the Peter MacCallum Cancer Centre here in Melbourne. Both of these hospitals along with the Royal Melbourne Hospital have close international links with other centres of excellence in robotic prostate surgery including Guy’s Hospital in London, UK. This Fellowship training opportunity provides the training of further surgeons to allow more patients to benefit from this type of “keyhole surgery”.
To achieve the skills necessary to deliver this surgical expertise at the highest level, a period spent in an overseas centre of excellence is highly recommended. The one year Urology Fellow posts at the Royal Melbourne Hospital in Australia provide excellent opportunities to obtain these skills in a highly supportive environment where the Fellows are supervised by world leaders in these forms of "keyhole" surgery. This training has led to our Urology Fellows developing their surgical skills in RARP to the level of independant practice.
Fellowship in Laparoscopic & Robotic Urology
Urology fellows' clinical activities include:
- two and a half days operating per week
- ward round (both daily business rounds and a weekly grand round)
- weekly uro-radiology meeting
- weekly uro-pathology meeting
- weekly urological seminar meetings
- weekly general outpatient clinic
- weekly specialist lower urinary tract symptoms (LUTS) clinic
- weekly uro-oncology clinic
- quarterly surgical forms
- on call duties as rostered (1 in 4 with prospective cover)
Surgical procedures include:
- major uro-oncological surgery
- open surgery including radical cystectomy and urinary diversion, radical nephrectomy and retroperitoneal lymph node dissection
- laparoscopic including radical prostatectomy and radical nephrectomy
- robotic assisted radical prostatectomy*
- general BPH surgery including "Greenlight" KTP laser prostatectomy
- stone surgery, in particular PCNL and semi-rigid and flexible ureterorenoscopy +/- Ho:YAG laser stone fragmentation
The Urology Fellowship at is a busy and challenging position with ample opportunity for clinical development and participation in clinical research activities.
* RARP surgical exposure is undertaken outside of the department. Arrangements for this are made around clinical commitments at the hospital.