Hi Richard Gallagher’s my name and I’m a head and neck surgeon at St Vincent’s. I work at St Vincent’s Private Hospital, St Vincent’s Public Hospital, and at The Kinghorn Cancer Centre. I’ve worked at St Vincent’s since 1998. I finished my surgical training in 1995 and following that I did further training in head and neck cancer surgery. At the present time my practice is mainly looking after patients with cancer and head and neck cancer and looking after patients with complex airway problems. In 2011 I went and did further training in the United States in Philadelphia at the University of Pennsylvania in transoral robotic surgery. So that surgery’s used mainly for patients who have cancers at the back of the throat and oropharynx and is particularly useful for patients who have cancers due to the human papillomavirus or HPV. So that’s a large number of patients at the present time. On the campus I am the Director of the Head and Neck Cancer Service at St Vincent’s.
Mission
My mission is to challenge the status quo of treatment of patients with head and neck cancer and complex airway disease. My vision is for a health system which provides world class care to both private and public patients regardless of whether they live in urban or regional parts of Australia. My strategy is build the most measurably robust Head and Neck Cancer Service in NSW which focusses beyond short term treatment outcomes to long term quality of life for patients and their loved ones. This requires a commitment to patient care, clinical excellence, research and clinical trials, and raising awareness of the HPV related oropharyngeal cancer epidemic.
Why the Head and Neck?
Head and neck surgery has always been my passion. To me the head and neck make up the most complex and beautiful anatomy in the human body. Head and neck disease can be incredibly confronting because it can affect our most basic functions – how we breathe, how we talk, how we eat and drink, and how we look. When I did my training it was the men and women coping with treatment for advanced head and neck disease who stayed in my memory.
Surgeon and Advocate
I call myself a head and neck oncologist because not all my patients require surgery. I am hugely proud to be part of the fantastic head and neck multidisciplinary team (MDT) which I chair at St Vincent’s. Our Head and Neck MDT has been running since the 1950s and is attended by a range of experts in surgery, radiotherapy, chemotherapy as well as our dentists, dietitians, speech pathologists, social worker, cancer care coordinators, and nurses.
One of the most rewarding surgeries I perform is complex airway surgery in adults. I am regularly referred patients with severe narrowing of the larynx and trachea (subglottic and tracheal stenosis). These require both endoscopic and open surgical management. To date I have performed over 60 cricotracheal resections for subglottic stenosis. The results for patients are life changing.
Head and neck cancer patients can have fantastic outcomes if they are treated early and in high volume centres. I am hugely frustrated when patients come to me with advanced disease or have been poorly managed. Sometimes all I can do is perform salvage surgery which buys time but at enormous cost to how patients look, talk, and swallow. Raising awareness of head and neck disease is what led me to taking on the role of Director of Cancer Services of St Vincent’s Health Network in 2015.
Apart from poor awareness, head and neck disease also faces the challenge of the emerging epidemic of human papillomavirus (HPV) oropharyngeal cancers. These are viral related cancers not due to smoking or drinking alcohol. They involve the lymphoid tissue of the tonsils and tongue base. The good news is that most HPV oropharyngeal cancers respond well to treatment and we are seeing excellent long term outcomes where patients are completely cured of cancer.
Operating Numbers
| Procedure | Private | Public | Total |
|---|---|---|---|
| Transoral Robotic Surgery (TORS) | 265 | 36 | 301 |
| Neck Dissection | 812 | 531 | 1343 |
| Laryngectomy | 143 | 110 | 253 |
| Cricotracheal Resection | 67 | 21 | 88 |
| Parotid Surgery | 354 | 137 | 491 |
| Thyroid Surgery | 215 | 58 | 273 |
| Microlaryngoscopy | 1864 | 608 | 2472 |
| Craniofacial Resection | 27 | 18 | 45 |
| Maxillectomy | 99 | 49 | 148 |
How I set my fees
There are two main areas that are taken into consideration when deciding surgical fees. Of course, simply running the practice must be taken into account. However, there are many factors that determine my part of the surgical costs. For each case the approach I will take and the experience I bring are carefully considered. I hope the following overview clarifies this process. Then for a more complete discussion about other financial matters that may be related to your treatment please visit this page.
My expertise
General head and neck procedures
- I am highly experienced in open, endoscopic and robotic surgical procedures of the head and neck. I trained for twelve years to be a head and neck surgeon, including specialist fellowships and self funded robotic surgery training.
- The anatomy of the head and neck is highly complex. My surgical skills include my ability to navigate and preserve as many functions as possible in the areas in which I operate. These functions include your ability to swallow, smile, kiss and speak.
- I perform head and neck surgical procedures on a weekly basis. There are very few Australian surgeons who can claim to do the same.
- I take on high risk procedures that other doctors are not skilled enough to handle. This is reflected in the extremely high number of referrals I receive from other head and neck and ear nose and throat surgeons.
Cancer head and neck procedures
- I am not only focussed on cancer survivorship, I am also focussed on preserving long term quality of life. I routinely perform partial laryngeal procedures, robotic surgery, and other forms of minimally invasive surgery (MIS) to maximise quality of life after treatment.
- The care of head and neck cancer patients is both complicated and complex. Many of my patients are in hospital for weeks. I can spend a huge amount of time managing their care in conjunction with my private practice staff, other doctors, allied health workers, and nursing teams.
- I make myself available to patients 24/7. My mobile phone runs non-stop after hours answering questions from the ward and answering questions from other surgeons and doctors involved in my patients’ care.
- I take on high risk procedures that other doctors are not skilled enough to handle. This is reflected in the extremely high number of referrals I receive from other head and neck and ear nose and throat surgeons.
- I have more than twenty years post training experience in the treatment of what is essentially a rare cancer. For example. NSW Cancer Institute projects 1,420 head and neck cancer diagnoses in NSW in 2021 compared to 6,466 breast and 6,881 prostate cancer diagnoses in the same period.
- I keep caring for patients long after their initial treatment period.
- I have excellent results – upcoming publications will validate this claim.
My practice
- Your fees do not just pay for me, they pay for my entire practice team.
- My practice offers patients five star service. We arrange many of your other appointments and ensure you are seen as quickly as possible. This is paramount if you have a suspected malignancy.
- In my private consulting rooms I use operating theatre standard equipment which is found in only a handful of Australian private practices. This includes a flexible video nasolaryngoscopy suite which includes video image capture. Flexible video nasolaryngoscopy allows me to store both video and still pictures in your medical record. These clinical images help me follow your progress and monitor for any changes.
Our office based infection control policies, procedures, and equipment are superior to the majority of Australian head and neck, and ear, nose and throat (ENT) practices. For example, many practices re-use disposable atomisation nozzles for anaesthetic spray or perform inadequate sterilisation of nasolaryngoscopes.
Teaching
Teaching is another of my major commitments. In 2016 I stepped down from my role as National Board Chair of Training in Otolaryngology – Head & Neck Surgery at the Royal Australasian College of Surgeons (RACS) after serving in the position for four years, after spending a total of eight years on the board. Prior to that I spent seven years on the NSW Board, and eight years as a RACS Examiner. Mentoring and teaching surgeons is one of the greatest rewards of my career and the reason for my appointment to the University of Notre Dame, Australia, as an adjunct associate professor. My commitment to teaching and to my public patients explains why the public health system is such an important part of my surgical practice.
Research and Publishing
A short list of recent publications follows, for the complete list please click here.