Adam is a General Surgeon with sub-specialty training in liver, pancreas, biliary and transplant surgery.
After completing his medical degree at the University of Auckland and General Surgery training in New Zealand, Adam undertook a fellowship in HPB and Transplant Surgery at King’s College, London. He has also spent time at Centre Hepato-Biliaire Paul-Brousse, Paris; Leuven Hospital, Belgium; The Mayo Clinic, Rochester, Minnesota, USA and The National Children’s Hospital, Tokyo, Japan.
Adam is frequently invited to speak at international conferences and regularly attends courses to ensure that he is able to deliver first class care and techniques to patients with a variety of surgical needs. Adam is very passionate about his profession and has dedicated a large part of his life to surgery.
Adam's Areas of Practice
General surgery covers a wide spectrum of surgical conditions, including abdominal, skin and soft tissues, gastrointestinal, vascular and endocrine systems. While the name would suggest that the focus of general surgery is to perform operations, often this is not the case. Many patients are referred to general surgeons with conditions that do not need surgical procedures, but merely require counselling or medical treatment.
Gastrointestinal surgery is the branch of surgery that intervenes to treat or improve the prognosis of pathologies affecting the digestive system.
This includes conditions that affect the stomach, small and large bowel as well as the solid intra-abdominal organs; pancreas and liver.
Laparoscopy is a surgical procedure involving the use of small instruments introduced through keyholes to operate on organs inside the abdomen. It’s a low-risk, minimally invasive procedure that requires only small incisions.
Laparoscopy is often used to identify and diagnose the source of pelvic or abdominal pain. It’s usually performed when non-invasive methods are unable to help with diagnosis. It is also used as a means to perform a number of operations, including cholecystectomy, appendicectomy, hernia repair, colectomy, appendectomy, and resection of solid organs (pancreas, liver, spleen).
HEPATIC (LIVER) SURGERY
Most patients who require a liver resection have metastases from a colorectal (bowel) cancer. Less commonly other secondary cancers from neuroendocrine tumors (like carcinoid), renal cancer, breast or melanoma are resected. The most common primary liver cancer that is resected is hepatocellular carcinoma (HCC or Hepatoma). This is a cancer that originates in liver cells (primary), and is usually associated with underlying chronic liver disease. Primary cancers of the bile ducts, cholangiocarcinoma, are less commonly resected. There are a number of benign lesions that occur in the liver. Most don’t cause any symptoms or problems and can be monitored or left alone. Sometimes it is not possible to be sure of a diagnosis and resection is undertaken to establish the diagnosis. Biopsy of the liver is not routinely recommended as it has the potential to cause bleeding and spread of the cancer. The most common method of removing part of the liver is by an open operation (laparotomy). In some instances it is possible to undertake the operation laparoscopically (keyhole surgery). The open technique is the preferred method for major resections particularly and in those tumours that are difficult to access. Some liver resections can be performed laparoscopically. A camera, known as a Laparoscope, connected to a high intensity light is introduced through a small incision and a further three puncture wounds are made to allow the surgical instruments to be introduced. Once the liver has been resected a small incision is made low down in the abdomen to allow the tumour to be extracted. Irrespective of the method used the principals are the same: The liver is mobilized. The vessels to the portion being resected are isolated and controlled. A cut is then made through the liver substance (parenchyma) and care is taken to seal off the blood vessels and bile ducts that pass across the plane of transection.
The most common indication for gallbladder surgery is symptomatic gallstones. Gallstones are stones formed within the gallbladder out of the components of bile. Laparoscopic cholecystectomy is the surgical removal of the gallbladder using a laparoscope (a tube like instrument). This is commonly known as keyhole surgery and is safe and effective for most patients who have symptoms from gallstones. There are usually three or four small cuts (incisions) made in the abdomen, however the number of the cuts and their positions may vary between patients. The telescope (‘laparoscope’) is passed into one of the small incisions to allow the surgeon to see inside the abdomen. Hollow tubes called ports are inserted through the other small incisions. Carbon dioxide is then blown into the abdomen (insufflated) to lift the abdominal cavity away from the liver, gallbladder, small bowel, stomach and other organs. The surgeon then puts instruments such as forceps and scissors into the other ports to help remove the gallbladder (figure 3). Small clips are placed to block off the tube leading from the gallbladder to the other bile ducts (cystic duct) and the arteries leading to the gallbladder. These clips stay in your body and do not cause any problems. Once the gallbladder is taken out all the instruments are removed from the abdomen and the carbon dioxide gas is allowed to escape before the incisions are closed with dissolving sutures.
The pressure from inside the abdomen then pushes the lining of the abdominal wall, the peritoneum, out through this area of weakness, leading to a bulge under the skin. The hernia sac may start as a small lump, which disappears when the patient is lying down, and may be only apparent when standing or straining (coughing). Hernias are not always painful, they can be found incidentally. Over time hernias typically increase in size and can become quite large due to pressure from the abdomen pushing intra-abdominal fat and intestines (bowel) out, which can get stuck in the hernia sac (incarcerated) and potentially strangulate. For this reasons most hernias require surgical repair to alleviate symptoms and to prevent possible complications. Laparoscopic groin hernia repair is an operation performed to fix defects in the abdominal wall musculature using small incisions, a telescope (laparoscope) and a mesh patch. Compared to the traditional open approach, laparoscopic groin hernia repair offers a quicker return to work and normal activities, with less pain, for some patients. Many other types of hernia are best treated with an open, “traditional” approach. A/Professor Bartlett will discuss the risks and benefits of the various approaches to ensure that you chose the best approach for your hernia.
Pancreas is a vital gland, located behind the stomach just below the liver. It produces several digestive enzymes (exocrine function) and also plays a vital role in maintaining the blood glucose levels (endocrine function).
Any disease or injury to the pancreas may cause several problems. Pancreatic surgery comprises a wide range of surgical procedures performed on the pancreas. Most operations involve a resection or removal of the diseased portion of the pancreas. Depending upon the extent of the resection it may have an effect on the exocrine and endocrine function. The exocrine part produces enzymes that help in digestion and absorption of nutrients from food. The endocrine part of the pancreas secretes hormones involved in the metabolism of sugar and maintenance of blood sugar levels.Depending upon the indication for surgery, the type of operation will differ. A/Professor Adam Bartlett will explain this at the time of your consultation.