Dr Matley & Partners is the largest surgical partnership in the country. We are a full partnership of fourteen specialist surgeons covering the entire spectrum of general, vascular and specialist GI surgery. The practice has provided 24-hour surgical cover for the southern suburbs of Cape Town since 1976. We provide this at the three largest private hospitals: Vincent Pallotti, Kingsbury/Claremont and Constantiaberg. Care provided by experts working together as a team within first-rate facilities forms the basis for good surgical outcomes.
The practice has established a country-wide reputation for providing highly specialized vascular, GI and oncology care. Several of our partners have super-specialist qualifications and expertise in these areas. A large number of our patients are referred to us by other specialist surgeons. They recognize the value of a team of experts providing surgical care in a tertiary referral “Centre of Excellence”. In particular we provide this service for surgeons in the Eastern Cape, Namibia and Mauritius as well as the Western Cape. We have been assisted in this by the development of well-recognized specialist units within the hospitals were we work such as the Kingsbury Vascular Unit. Vascular care within the southern suburbs has been centralized there for more than a decade, creating a high-volume dedicated unit. There is very good evidence that high-volume specialized units are associated with better clinical outcome and reduced cost.
The practice has always taken a leadership role in surgery in this country. Currently Professor Baigrie is President of the Association of Surgeons of South Africa (ASSA) as well as past-president of the Society of Laparoscopic and Endoscopic Surgeons (SASES). Dr Matley is the immediate Past-President of the Vascular Society of Southern Africa (VASSA) and currently serves on the executive committee, as does Dr Tunnicliffe. Dr Matley is a director of Surgicom and Dr Oodit, a past director. Dr Ndhluni holds an advisory appointment to the Cancer Association of South Africa.
The practice has always maintained very strong links with the Surgery Department at the University of Cape Town. With the appointment of our youngest partner, Dr Maree we have increasing links with the University of Stellenbosch. In 2010 Robert Baigrie was appointed an Associate Professor of Surgery at UCT, a rare honour for an individual in predominantly private practice. Most of our partners have regular teaching or clinical commitments at Groote Schuur. In addition to undergraduate training the partners of the practice are very involved in post-graduate surgical training and are regularly asked to contribute to departmental academic programmes and in particular, to the annual UCT Surgical Update congress. These close links assist us in maintaining the highest academic standards within the practice as well as affording us the opportunity of contributing to the training of tomorrow’s surgeons. This process assists us in carefully selecting future partners by watching the development of surgical trainees over several years.
Within the practice, the partners keep up to date by attending several international and local congresses each year. Many of the partners are regular members of the faculty of such congresses and regularly contribute at international meetings. In addition to this we provide training for our staff and in particular our team of seven nurses.
The practice has always been involved in clinical research. This produces papers presented at local and international meetings, as well as publications in peer-reviewed journals. Our research project utilizing duplex doppler rather than angiography for peripheral angioplasty was presented in Paris in 2010. The practice conducted one of the few good randomized trails of laparoscopic anti-reflux surgery as well as an audit of laparoscopic hernia repair.
We keep the family practitioner closely involved in patient care and maintain good communication with them. Medical reports are rapidly generated and for new patients can be emailed or faxed usually within 24 hours of the patient being seen. In addition we are very involved in GP education. We regularly speak at family practitioner CME events and twice a year produce an “Update” publication which is distributed free of charge to 1200 doctors.
We have established regular morbidity and mortality meetings in our quest for surgical excellence. With very sophisticated IT systems we are able to specifically audit areas of interest. As an example we have recently concluded and presented an audit of all large bowel anastomoses within the practice to determine whether our complication rates are well within the expected norms (they are). In addition we have studied the question of whether laparoscopic colon surgery is associated with a higher anastomotic leak rate (it is not).
The twelve partners work together in four cohesive teams. We assist each other in all major surgical cases. There is a built-in peer-review process here as the conduct and performance of each of us is open to scrutiny and comment from our peers at all times as we strive for the highest ethical and academic standards. The twelve partners meet once a month at a formal partners meeting where both clinical and administrative issues are addressed.
We currently perform approximately 4500 endoscopic procedures per year in six well-equipped endoscopy suites within our rooms. We have highly trained and experienced endoscopy nurses. Endoscopic examinations in hospital tend to be reserved for the occasional critically ill patient who cannot be moved. Most of the in-patients are scoped within our consulting room environment. We have an outstanding safety record for this. Endoscopy outside of the hospital environment is associated with considerable cost savings for funders.
We have been the country’s leader in non-invasive vascular assessment for nearly 20 years. We currently employ three highly trained sonographers operating four colour-flow duplex units in three hospitals. The vast majority of our vascular assessments are based on out-patient ultrasound evaluation. We seldom have to resort to expensive investigations such as CT or MR angiography and virtually never perform diagnostic angiography. These latter investigations are standard practice throughout this country because of poor access to top-quality duplex scanning.
A brief history of endoscopy in our practice
In 1972 Prof Jannie Louw arranged with Dr Solly Marks, Head of the GI Unit at GSH, for a surgical registrar to have endoscopy training. In 1975, as Prof Louw’s senior reg, Peter Jeffery (our practice founder) ran a GSH endoscopy session that continued until 1988 when he turned to vascular surgery. They used a front viewing Olympus scope if a duodenal ulcer was suspected, and a side viewing scope if gastric pathology was more likely.
Later, angled front viewing scopes allowed visualisation of both the stomach and duodenum. In 1977 Syd Cullis joined the practice and he and Peter started private practice endoscopy. At this time Solly Marks was the only other private practitioner doing endoscopy. We could not afford a new Olympus scope (about R8000 at the time) and Solly Marks sold us his ACMI gastroscope for R1 300, which he had recently replaced with an Olympus. It employed a joystick control as opposed to a ratchet wheel and was 15mm in diameter as opposed to the 8mm of current scopes. We performed our first scope in the small kitchenette in our Wynberg rooms. Suction was provided with a manual foot pump.
In early 1980’s, we bought a new Fujinon scope for about R7500. At the time the scope fee was about R58.00, which meant only 150 scopes to pay off the instrument.
With the practice’s first Fujinon scope:
Peter Jeffery, Solly Marks, Syd Cullis, Philip Bornman
Confidence grew in the 1980’s and slowly we became the major endoscopy practice in the Southern Suburbs, Central Cape Town and Sea Point. We offered a service to the provincial hospitals using our own equipment, Somerset, Victoria, Woodstock, Conradie and Fish Hoek Hospitals. This entailed taking our scope and accessories with us. Syd used to make a monthly trip to Swellendam to do a scope list in the local hospital.
In the early 1980’s a colonoscopy service was introduced – initially at our City Park rooms, then at Constantiaberg, Vincent Pallotti and Wynberg. In the late 1980’s Syd started doing private ERCP’s n the radiology suite of Dr Levin & Partners (now Dr Tuft & Partners). The move to Harfield House enabled us to design our own endoscopy suite and this coincided with the introduction of video endoscopy. Subsequently the same happened at our Constantiaberg and Vincent Pallotti rooms.
Today, the practice is the largest private endoscopy facility in South Africa. We have three endoscopy suites, 7 scoping partners and 6 nurses. We continue to provide an ERCP service and in 2009 introduced Transanal Endoscopic Microsurgery (TEO) into the country. The current annual number of scopes across the practice is over 4000.