OBGYN.net Editorial Advisor
Hysterectomy and Alternatives

Ellis Downes, MB, ChB - UK Articles and Interviews

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Clinical Experience:

Gynaecology Exeperience

I am a Consultant Obstetrician & Gynaecologist in a busy district general hospital on the edge on London. I have received extensive training in general gynaecology. I have a particular interest in urogynaecology and minimal access surgery. I enjoy vaginal surgery (a recent personal audit showed an 83% vaginal hysterectomy rate) and am collecting a personal series of vaginal hysterectomies and bilateral salpingo-oopherectomies (performed for menorrhagia) - 43 to date. I perform vaginal sacro-spinous colpopexy (using the Myia hook) for vault prolapse. I have also had widespread experience of outpatient hysteroscopy. I am able to contribute to counselling and treatment of women wishing medical or surgical termination of pregnancy. I have good experience of colposcopy and have attended BSCCP approved basic and advanced training courses.

Speciality Experience:

Urogynaecology

I have been extensively trained in urogynaecology by Dr C.R.Landon, Urogynaecologist at Leeds General Infirmary, initially on a full-time basis for two years, and subsequently attending urogynaecology clinics alone and under supervision. I am highly experienced in urodynamics and have an interest in patients with complex and intractable urinary incontinence.

I regularly undertake laparoscopic colposuspension, which we have found gives a reduced in-patient stay and good patient acceptability, and open retro-pubic bladder neck procedures including Burch colposuspension for genuine stress incontinence. I also perform Stamey procedures, Urethral implants (using bovine collagen and macroplastique) and vaginal approach repair operations. I am also develping experience in advanced pelvic floor surgery and have performed laparoscopic sacro-colpopexy (using a mesh approach), para-vaginal repairs and mesh procedures for complex anterior, middle and posterior compartment defects.

I am interested in, and have completed research studies evaluating new medical therapies for detrusor instability and chronic interstitial cystitis.

Minimal Access Surgery

Following extensive training in minimal access surgery I am an RCOG accredited level III hysteroscopic and laparoscopic surgeon. Experience was gained with Mr. A. J. Tyack in Nottingham in endometrial ablations, operative hysteroscopy and laparascopically assisted vaginal hysterectomies (LAVH's). Subsequently I have personally evaluated a variety of different modalities for performing LAVH's when a simple vaginal hysterectomy is impossible. I am participating in the multi-centre EVALUATE study.

I have helped develop and introduce outpatient hysteroscopy in two centres, Leicester Royal Infirmary and Nottingham City Hospital which led to excellent experience and several publications. I have also helped develop laparoscopic colposuspension at Leeds (pre and intra-peritoneal approaches), this is now part of our standard management for many patients with genuine stress incontinence. Leeds now has the third largest series of laparoscopic colposuspension after Manchester and Glasgow.

I have also undertaken training of junior medical staff in the laparoscopic management of ectopic pregnancy.

Obstetric Experience

I have received extensive experience in general obstetrics and have a busy obstetric practice. Our unit of four consultants delivers 3600 high and low risk women a year. During my training I have attended specialist pre-natal diagnosis clinics, diabetic clinics and genetic clinics. I have a basic ultrasound ability am competent to perform amniocentesis. I am highly experienced in the management of high risk pregnancies, antenatally and intra-partum. Experience has also been gained in critical care management of severe pre-eclampsia and eclampsia.

Information Technology

I am computer literate (Macintosh system preferred). I am able to use word-processing, database, graphics and statistical software. I am conversant with the internet.

Journalism

I have had an extensive training in journalism and have an active "second career" in freelance medical journalism. Previously a regular freelance for The Sunday Times (of London), I then became The Daily Mirror Doctor, reporting to the newsdesk and writing a weekly column. I have had extensive television experience for Central Television (Central Weekend) and appearances on many other current affairs "magazine" shows.. A member of the medical journalists association (MJA) , I am a former winner of the MJA Advancement award, a major award in UK medical journalism.

Teaching

I love teaching and was previously an academic lecturer in Leeds. I have extensive experience of organising courses, and teaching undergraduates and postgraduates. I have organised previous master-classes and I recently lectured at the recent RCOG meeting on "Teaching The Teachers" in Harrogate.

Administrative Experience & Audit

Apart from those aspects previously mentioned, I have had extensive experience of organising staff rotas, meetings and conferences. I have attended seminars & meetings on : Clinical Audit, Management Skills, the Changing NHS and Time Management. I am committed to the concept of clinical audit as underpinning the foundations of good clinical governance. I am the chairman of the departmental audit committee and regularly teach undergraduates, postgraduates and midwives. I regularly referee for the British Journal of Obstetrics & Gynaecology in the fields of urogynaecology and endoscopic surgery. I've recently organised with a colleague a highly successful two day international meeting in Leeds on "Recent Advances in Gynaecological Surgery".

Publications:

Papers & Letters

1. Downes E, Anwar, M. Failure Of Condoms. BMJ;1991; 302 : 1400
2. Downes, E., Crosier, S., Ferrari, B., Fletcher, A., Al-Azzawi, F. Assessment Of Endometrial Explant Hypoxia By Electron Microscopy & Biochemical Methods. J. Reprod. Fert. Abstract Series No. 8, December 1991, 55
3. Downes EGR , The Sexuality Of The Menopausal Woman (Editorial), BJHM, 1992, 47,6, 409-410
4. Downes, E., HRT: Non-compliance and education, BJHM, 1992, ,48, 5, 265
5. Downes E, Too deep or not deep enough ?, BMJ, 1992; 305:365
6. Downes EGR, Goodbye D & C, Welcome Hysteroscopy (Editorial), BJHM, 1992, 48:2, 75-77
7. Downes EGR, Al-Azzawi F, Randomised placebo controlled trial to assess the role of intra-cervical lignocaine in outpatient hysteroscopy. BJOG, 1993, 100(5), 501-2
8. Downes EGR, Al-Azzawi F, How well do perimenopausal women accept outpatient hysteroscopy ? Visual analogue scoring of acceptability and pain in 100 women ? Eur Jnl Obstet Gynae 1994, 1: 37-41
9. Downes E and Al-Azzawi, F. "The predictive value of outpatient hysteroscopy in a menopause clinic. A prospective study of 254 patients. BJOG, 1994, 100:12, 1148-9
10. Downes, E, Rushman, N and Tyack, A. The Role Of Outpatient Hysteroscopy In The Conservative Management Of Placenta Accreta. GynEnd, 1995, 4, 147-148
11. Downes, E. A memorable patient - My Little Girl. BMJ, 1995,
12. Downes, E, Al-Azzawi, F., Hysteroscopic Views & Endometrial Behavior, AmJOG, 1994, Dec, 1673-4
13. Downes, E & Tyack, A. Long-Term Follow Up After Hysteroscopic Endometrial Laser Ablation (HELA).A Study of 124 Patients, Proceedings of ISGE, 1995
14. Downes, E, Bogod, D & Tyack A, Successful Pregnancy Following Surgical Repair Of A Woman With A Univentricular Heart , Jn O & G, Jan 1996, 264, 53-54
15. Downes E. Urinary Incontinence, British Journal Of Sexual Medicine, 1997, 24,3, 23.
16. Downes E & Vail A. Trocar Insertion At Laparoscopy, Gynae Endoscopy, 1997,6, 251-2.
17. Downes E & Prendeville W. Hot Water Ablation To Treat Menorrhagia : Preliminary Results of a New Technique. Journal AAGL, 1998, In Press
18. Downes E, Landon C, Urodynamic and Cystoscopic Findings In Sensory Urgency - A Prospective Study. Br Jnl Uro, 1998, In Press.
19. Downes E & Prendeville W. Hot Saline Endometrial Ablation To Treat Menorrhagia : Preliminary results if a new technique. 1997, Gynae Endoscopy 6 (suppl 2) 23
20. Downes E, Rogerson L & Landon C. Initial Experience of laparoscopic colposuspension. 1997, Gynae Endoscopy 6 (suppl 2) 19
21. Downes E., Rogerson L., Gannon G., How Do Gynaecologists Manage Endometrial Carcinoma ?. Eu Jnl Gynae Onc, 1998, In press

Books

• Drife, J, Walker, J & Downes, E, De Bono, M . "Clinical Obstetrics & Gynaecology : An Undergraduate Text ". Balliere Tindall Publishers, 1998, In Press I've co-edited this textbook and contributed four chapters.
• Ellis Downes & Peter O'Donovan , "Recent Advances In Gynaecological Surgery", Allan Publishers, In preparation for publication in 1999.

Membership of Institutes, Associations and Learned Societies

• The International Continence Society
• The Pelvic Floor Club
• The British Society of Gynaecological Endoscopy
• The International Society of Gynaecological Endoscopy

Interests

My main relaxations are playing with my young children, gardening and ski-ing. A committed Francophile, I enjoy recreating classical French dishes and increasing my knowledge of Bordeaux wine with good friends. I also attempt to keep fit by playing squash and am an enthusiastic weekend golf hacker.