 Good evening. I'm John Fraser. I'm the Dean of the Faculty of Medical and Health Sciences and it's a pleasure for me to welcome you to this, our second of our inaugural lecture series for 2016. It's always a delight to see so many colleagues, friends and families here, from both inside and outside the faculty. The process of university inauguration serves two purposes. The first is an expression of acknowledgement and welcome, a reception for new professors joining the circle of esteemed colleagues within the professorial. The second and most important is to showcase the subject and the story of the new professor. They're made in lecture as an esteemed and eminent academic at the University of Auckland. The inaugural lecture series is a highlight of our academic calendar and this year we welcome three new professors into the professorial. So academic inauguration dates back to medieval times when it was unashamedly intended to impress upon the public and rich benefactors the need for their continued patronage. Indeed professors were chosen not only for their intellectual capacity but also their financial wuthiness. One tradition required new fellows to be willing and able to entertain all their new colleagues for the duration of the inauguration. Sort of an academic joiner's fee. Today's inaugural lecture you might argue are only slightly more evolved but are now a means of introducing our most eminent staff thankfully at the expense of the university. In all serious however elevation to the rank of professor is a very serious process since for many it represents the pinnacle of one's academic career. The process of selection is long and involved and requires intense scrutiny by other senior colleagues who then seek advice from international peers to confirm that the appointee is internationally eminent within their chosen field. The inaugural lectures are a wonderful opportunity for colleagues, family and friends to learn about the journey that has led to academic success, the milestones, the decisions and the mentors who have assisted and helped steer along the path. Tonight it is my very great pleasure to introduce Professor Peter Gilling. Peter is an eminent consultant urologist from Tauranga and the head of the university's medical program at Tauranga hospital. It is my pleasure now to invite Professor Alan Merrie head of the School of Medicine to provide a formal introduction to Professor Gilling. Professor Merrie will then invite Professor Gilling to deliver his inaugural address which will then be followed by some closing remarks from Professor Ian Bissett, head of the Department of Medicine. Professor Merrie. Thank you Professor Fraser. Good evening. It gives me very great pleasure to introduce Professor Peter Gilling. Peter is a busy specialist urological surgeon working in the Bay of Plenty and at the same time he is an acknowledged world authority in both the research and the treatment of benign prosthetic hyperplasia. In 2010 he received a doctorate of medicine from the University of Otago which is a higher doctoral degree recognizing his scientific contribution in this field and on the website expertscape he is ranked sixth in the world in this field. On Scopus which is a database that people like me use to figure out how our staff are doing Peter has over a hundred publications a very high proportion of which he is first author of. His work has been cited over 3,000 times and his age index is 32 the highest for a urologist based in Australasia. Peter was elected to the oldest and most influential society in the specialty of urology the American Association of Genital Urinary Surgeons. This organization has only 43 members from outside the US and only two from Australia and New Zealand. He chaired the committee on surgical therapies at the recent international consultation of urological disorders guidelines collaboration on benign prosthetic hypertrophy. He is on the editorial board of six international journals has been visiting professor or speaker at over 30 international institutions and given presentations at innumerable meetings around the world. He has been an examiner in urology for the Royal Australasian College of Surgeons and in 2015 was honoured with the Society international urology distinguished career award and the Royal Australasian College of Surgeons research award. This faculty amongst other responsibilities is charged through the three schools that administer its medical program with training a substantial part of the future medical health force of New Zealand. One of our priorities is to address the national shortage of doctors in rural areas and in primary health care. As one strategy to meet this goal we have placed great emphasis on the importance of sites like the Bay of Plenty. We have introduced a system of cohorting by which our students spend a year in places like the Bay of Plenty so that they extend their training beyond the walls of major hospitals in Auckland and so it's very important that Peter was instrumental in establishing the Bay of Plenty as an academic site for the university in 2009 and has been the academic lead there since then. Also he is a member of the steering committee and chair of the local advisory group for the university's rural health interprofessional immersion program based in Whakatane. As if that wasn't enough Peter personally teaches students during their fifth year specialty surgical attachment assesses their sixth years following their electives and leads the student pastoral care in Taro. Delivering our medical program across many sites is actually quite a challenge and depends on collaborative teamwork. I'd like to acknowledge the extremely positive relationship that Peter maintains with me and all the many academic and professional staff who work with you to this end Peter. Thank you. More than that, producing future doctors who are fit for practice in New Zealand goes far beyond academic education. It requires active and credible clinicians who are also researchers and above all are great role models for our medical students. Professor Peter Gilling meets all these criteria but in fact as a role model he goes further and importantly demonstrates by example that you don't need to work at a major centre to be all of these things to the highest possible standards. I'm looking forward immensely to his inaugural lecture tonight which is entitled only men dog and chimpanzees. Professor Peter Gilling. Thank you very much. Only men dogs and chimpanzees refers to my research interest which as Alan has said is BPH benign prostatic hyperplasia but I'm pleased to see John Windsor in the audience because the other two titles of my talk can I can directly sheet home to him. He asked me to speak five years ago on how to succeed in academic surgery from the provinces and I spoke at a course for him five years ago and I called my talk salutary experiences and immutable laws to do with becoming an academic in the provinces. So I've stolen slides from back then and then added the prostate stuff and luckily there are a few urologists in the audience so at least some of you will understand what I'm talking about. But of course if you're in the provinces you've got it all anyway. You've got the lifestyle and we increasingly have the education without the house prices but that's changing and if we can add academic associations to that then we cover all the bases. So I'd just like to first of all just back up a bit and give you some idea of some of the research experiences I had in my early career which led me to this sort of pathway and the first salutary experience was when I was a house surgeon and I was gifted the topic of reviewing upper GI hemorrhage for the previous 20 years by one of the well-meaning general surgeons in Christchurch and myself as a house surgeon and a young registrar whose name is Dr Stephen Munn were charged with this task. Interestingly after 18 months and two and a half thousand case notes and all our lunch times completely destroyed we did come up with a publication but sadly it was turned down for the two journals we the only two journals who would have had any interest in it whatsoever and so we came away with nothing to really show for that time so my first law to those budding academics from that talk was beware the meaningless research project which masquerades is research because and I try quite hard not to send my registrars down that same pathway. My second brush with research was when I was a full-time research fellow during my urological training and it was basic science we got little strips of bladder muscle and hooked them up in an organ bath and stimulated them with drugs and electricity and things and then tried to link it back to the patient's condition and and that was all very well and another registrar followed me and then we came to writing this thing up for our theses and the supervisor decided that all the methodology was fatally flawed and we should cease and desist at once and so that ground to a halt as well I got a couple of publications out of it but that was as far as it went so my advice to the registrars is that research is our good but the topic and the supervisor has to be locked down be given a lot of thought otherwise you'll come away empty-handed as I did. The third experience that I'd like to mention was when I was in Dallas I did two years as a clinical fellow there and did a research program did a research project once again it was basic science but in this time it was more molecular and looking at the structure of the smooth muscle and various things and it was a large academic institution and I was part of a number of projects over that time but interestingly these were published but equally interesting my name wasn't on any of the publications so I came away again empty-handed and so I would say that these research fellowships and fellowships in general are absolutely invaluable in terms of the collegial stuff but once again it doesn't always work out for the best and lastly I'd just like to mention at this stage the fact and the support that I've had in Tauranga to do the work that I've done I arrived into a three-man practice and my partners Harry Watson, Mark Froundelfer, they were very commercial and I learned a lot from them commercially they didn't have an academic bone in their bodies but we had a unique funding arrangement which started the year after I got there it's a capitated contract whereby the urologists had control of the entire budget and we paid the hospitals for the services that our patients had and it's still 23 years later it's still in existence and it's really a seed and soil they were really they really facilitated the stuff that I was doing didn't care too much for it but facilitated it nonetheless and so I would say that your surgical partners also play a big part of your ability to do research and here's where I'd like to acknowledge Mark Froundelfer the reason he's not here is because he's covering me as we speak back in Tauranga so he would have liked to have been here and yeah he sends his regards by the way but he really is he was fundamental in the assistance that I got with all my research in those early years as a facilitator and he was actively involved in the early years as well so moving on to the research itself the prostate is only is a small organ the size of a chestnut that sits at the base of the bladder and the urethra the water tube that you pee through that goes through the middle of it so as you age the prostate can enlarge and there's a condition called BPH benign prostatic hyperplasia which has been the focus of a lot of the research projects that I have been involved in and it affects the areas that we can see here the transition zone and the peri urethral zone and they are right close by the urethra and we can see the normal prostate here and then the glands overgrow and the and the supporting cells overgrow as well and we get this condition called BPH and this is what people most people think of when they think of prostate blockages they think of a big swollen prostate leading to blockages of the bladder and the bladder getting thick and irritable and causing a lot of these urinary symptoms that you're probably aware of and then that can lead to back pressure on the kidneys and ultimately kidney failure but fortunately that's rather uncommon and the prostate does grow there's no question in Western men it just steadily grows as you age and this is a collection of international studies that have looked at this this topic and it's thought to be sort of an imbalance between the death of cells and the growth of cells such that there's an overgrowth and a proliferation and there's a range of different factors that lead into that but really what brings the patients along to see us as urologists is a collection of symptoms called lower urinary tract symptoms and BPH is really only one of the causes that can be causes related to the blood supply to the nerve supply to the bladder muscle there's a range of things that can lead to these lower urinary tract symptoms such that we get this sort of scenario where the green circle is the patients who have BPH but only a proportion of them get enlargement and only proportion of those with enlargement and symptoms get blockages and it's really these ones that we're targeting when we offer them surgery and of course there's a whole raft of patients who don't have problems to do with the enlargement of the prostate but still have the lower urinary tract symptoms so you can see this is why urologists are paid so much because it's a very complex and tricky area but as you see the prevalence of BPH inevitably goes up so by the time you're 90 it's something like 90% of people have the histologic condition if you look down the microscope at the prostate but the symptoms don't quite follow the BPH as we've said and this is a graph of symptoms and age and we can see that basically by the time you're in your 70s about 50% of men will have either moderate or severe lower urinary tract symptoms and a proportion of those will be due to BPH and this is just to show you that we don't always reach for the surgical solutions when we're faced with these men with lower urinary tract symptoms we're often offering education and lifestyle advice and of course the inevitable drugs there's a range of drugs that we use the ones at the top you might use if you have a lot of irritation and then you might have the ones at the bottom you might use if you are having problems with storage but there's a range of different solutions and it doesn't always involve surgery but I was interested in surgery so let's talk a little bit about the surgical options this is a schematic from a good friend of mine who's now deceased John Fitzpatrick and this is the operation which really defines urology back in the early days this is what's called the open prostatectomy now if you can imagine that the patients feet are towards the top and the head is towards the bottom and we're looking down into the pelvis and that's the bladder and the prostate and so what we do is we open up the front of the prostate and we've got Russell McElroy here who's done more of these than you can shake a stick at and but I won't get you to talk today Russell and what we do then is we open up the space between the BPH tissue and it sort of forms sort of a benign tumor it's a sort of encapsulated growth it's a prostate within the prostate if you like and so you get in there with the index finger and scoop the prostate out or the BPH tissue out and then you control the bleeding and so the thing up and this served urologists well for many years but it does come at a bit of a price there's a 25% transfusion rate there's a five to seven day hospital stay in most series and it's a reasonably major sort of thing so urologists moved on to endoscopic techniques seventy-odd years ago and this is the bog standard operation that urologists do for smaller prostates for BPH and this is the so-called Turb and in this you can see that we remove small fragments of the prostate and the prostate chips if you like and this is the BPH tissue and then they are placed back in the bladder and then we could once we've scooped out a channel in the through the prostate then we flush these fragments out and it gives us a wide open channel and usually the patient can have the catheter out in a couple of days and head off home so this is the environment that we were faced with in the late 80s and early 90s and then arrived lasers lasers really what I've been interested in as far as BPH is concerned for the last 20 odd years the original laser procedure which was pioneered by my friend and mentor Tony Costello who's professor of surgery at University of Melbourne he first published an operation involving a wave length called neodymium yag nd yag which you'll see the second bar on the left there and the nd yag laser penetrated quite deeply into the prostate if you look at that on the right side there we can see that we're down around this sort of range because the prostate is mainly 70 or 80% water so this is the this is the absorption if you like the laser we use by the way is this one here where the penetration is only a millimeter or two but it penetrated quite deeply and what he did with this using a side firefighter he sort of cooked the prostate from the inside and he might have done four burns if you like circumferentially to the prostate and maybe did that twice the whole thing would only take a minute per burn and so the patient might have only been in theater for five ten minutes and then away they go and that was fine they often went home the next day but it did take a month or six weeks before they really started to feel any better and often they were quite miserable throughout this experience and that was the so-called V lap procedure so we had the fortunate circumstance that a mutual friend of ours this is myself and Mark by the Mike Peterson who was who was a distributor a local distributor of medical products here in Auckland he had a relationship with a large laser company in Silicon Valley called coherent coherent medical just happened to be the world's largest laser company and most of their lasers were for light shows and for industrial uses and so forth and they just started to make a foray into surgical endeavors and they'd had great success with the CO2 laser for skin and that was Mike's main interest but they developed this laser called a Holmium laser which they had developed and we we bought the first one they ever sold so we had a high-powered Holmium laser and a neodymium laser in the same box and basically we used the neodymium laser to cook the prostate and then use the Holmium laser because it didn't penetrate very deeply to actually make a channel and that allowed the patients to recover a lot quicker but it was still pretty inefficient and time-consuming so that's this procedure then evolved to a procedure analogous to the term where you just chopped out little fragments and we called that Holmium laser resection of the prostate and that's the next technique that we evolved and that really caught on around the world or a lot of people who were interested in laser moved from the V-Lap procedure to this procedure which was the Holmium laser resection and it was still a bit tedious and a bit inefficient compared to TURP but it was actually better for the patient in terms of their perioperative or the time and time around the operation but it did really cement the Holmium laser as a viable wavelength and around this time we were developing a relationship with some of the big instrument surgical instrument makers and two of the German companies Stortz and Olympus started developing prototype instruments for us to allow us to do this procedure because it did require slightly different tools so we developed this relationship as well all for a lot of it was facilitated by Coherent who were it was good to be associated with in those early days so my next salutary experience would be to say that we had new technology we had innovative ideas and we had backing of a large American corporates but randomized controlled trials are really the lifeblood of medical technologies and so we had to start producing the science to actually make any sort of meaningful headway with laser techniques that we were pioneering and my mutable law from this was basically the quality research is is essential if you want to carve out an academic career and the randomized controlled trial for the medical devices is the way forward so the first randomized controlled trial that we did was comparing our section technique to the V lab which was the standard laser technique that was used in the early 90s and we pretty much showed that in every respect other than the actual time they spent in the operating room it was superior and we showed that even in terms of the blockage the relief of the blockage that the patients had that the home in resection was better than the V lab and this was an important first step for us the next randomized controlled trial we did compared the home in resection versus the term which was the standard procedure and still is the predominant procedure worldwide that in many jurisdictions that's changing and this also was the FDA study for this home in laser it's it wouldn't happen now because now the FDA to get a 510k approval you need at least 50% of the patients to be done in the continental us but this study was entirely done in Tauranga these were all patients who had blockages and we basically showed that it was identical to TURP in terms of the effects but the patients did much better around the time of surgery but while we were doing that of course we were rediscovering the prostate anatomy the old nucleation that we were talking about it occurred to us that it was much more efficient to remove these whole lobes intact and we were starting to see the surgical planes endoscopically and if we have a look what we then started doing rather than chopping these lobes this is looking down this is a bladder eye bladder's eye view of the prostate and if we're looking down towards the prostate we might see two or three lobes to the prostate and what we then moved on to was to remove the whole prosthetic lobe by getting into this what's called a surgical plane that we knew from our open prostatectomy experience and we were trying to enucleate just like you did with the index finger with the old open prostatectomy and this is a procedure that we termed Holmium laser enucleation of the prostate and we first described it in 1998 and this is what you see when you're doing the Holmium enucleation this is the BPH tissue here here and here and you can see this is the capsule of the prostate which is the compressed prostate and we're finding our way into this plane and the lobe peels away from the capsule and this becomes a very efficient way of getting rid of this tissue and I'll just show you the short video just to show you this plane because the plane itself when you see it you can see how obvious it becomes this whole enucleation thing that was we were looking into the bladder there now we're making an incision into the prostate and now we're the lobe the lateral lobe is here and we're moving down and this is the plane between the compressed prostate and the adenoma and you see how it peels see that a nucleation and this is the plane that we're in and we do Holmium enucleation and this was a bit of a revelation to the urology world though it did take a long time before people really started to become interested in it but this is basically the left lateral lobe of the patient and what we're doing is we're in the plane here again and the laser really it provides a bit of cutting but it's really there just to quarter eyes those little bleeders and you can see it just peeling away so this is the whole a nucleation concept and this is what you might have done with your index finger when you were doing an open prostatectomy so then we had a problem we had big chunks of prostate sometimes as big as your fist sitting in the bladder we had to develop a way to get those fragments out so we started humbly and this thing top left is an arthroscopic shaver and so this is something that an orthopod and I know Sue Stott's here an orthopod might use in a knee put in the knee and it nibbles away at the cartilage well we put it through the tummy and nibbled away at bits of prostate and bladder it was a bit of a messy business because there was quite a lot of leakage around the cannula and so forth but that's how we started and then we convinced the company we were working with luminous based in Palo Alto to produce for us a morcelator and this is the handpiece these are the reciprocating blades so it's sort of the blades sort of reciprocate and then with the high-powered suction suck the fragments out and this is the motor in the handpiece and this is the controller blocks which control the motor and there's a foot pedal of course which controls all this we also formed an alliance with an Auckland company to produce a pneumatic one which we plug into the to the compressed air so we're using all these good orthopedic props Sue and this was a little bit jerky though didn't really hold the fragments too well and this was quite a bit smoother so we went with this design and with the company that manufactured the laser though they were a little bit out of their comfort zone these mechanical devices interestingly a few years later we came across the patent for this device and unsurprisingly we weren't listed on the patent even though it was our idea and we developed and of course there wasn't a royalty to be seen as you would expect and the engineers that we were working with were all featured large in this and at this point my commercial partner Markey threw his toys out of the cotton said he wasn't going to work with the member again and he never did and but I sold it on so this is the commercial more slated that coherent developed from that that one that you saw before and this was the one that they produced in 1998 and this is the high-powered homium laser and this is the this is the modern more slater which we use we still use the coherent one but we use this other one and there's probably four or five of these in the market now which have been spawned directly by the homium and nucleation procedure so then we went on to study the nucleation procedure so HOLEP compared to TURP we started off working with and funded by the laser company but as soon as they realized they didn't need this for FDA approval of the more slater they dropped us like a hot cake and we had to we carried on and we self-funded this procedure with our ill-gotten gains from pharmaceutical trials and and that's a model for funding that that you know you always need to consider for surgical device trials because they're notoriously poorly funded but anyway we studied it versus TURP and looked at the durability at seven years and so did many other people so we did the first randomized controlled trial comparing homium and nucleation to TURP but there are now at least 10 randomized controlled trials in the literature confirming our original findings which were that the procedure was more efficient that it was less morbid you got rid of more tissue and it gave a better relief of the blockage than TURP and it was more fun to do and more cost effective we carried on studying this thing we looked at large prostates we did a couple more randomized trials looking at small prostates looking at other energy sources so the randomized controlled trial has been very good to me over the years and if you look now in the literature you'll find over 500 papers on homium and nucleation and every conceivable patient subgroup has been studied and the randomized controlled trials comparing Holep with all manner of other things still keep coming through and it's very well studied to the point that it's now in all the guidelines and all the textbooks in urology and it has been called by many authors the new gold standard for the treatment of BPH and that's an American publication Indian and Canadian publication and and this of course all came from our endeavors in Tauranga and if you look at the current inventory of laser techniques in the prostate and once again vaporization and we developed homium ablation resection we developed homium resection and nucleation we developed Holep and these were the first in each of the classes and all these others are basically well they're not cheap knockoffs but they are knockoffs but some of them are okay but essentially apart from PVP which we'll see there on the which is the green light laser on the vaporization front I think that's a better vaporizer than Holep there is no better a sector or a nucleator in my view so the first the next salutary experience in my wife my long-suffering life duty is in the audience you do have to do the hard yards you do have to go to the international meetings sit on the advisory panels do the workshops go to the meetings be that do the visiting professor things if you want to succeed in academic medicine visibility is very important and you do need to publish you don't actually perish if you don't publish but you don't do particularly well so that's enough of lasers I'd just like to give you a little a brief inkling of the research that we're currently doing in BPH and that's probably over half the publications that I've done are BPH related we've looked at medication we've been involved in multi-centres studies we've looked at prostatic injections these are enzymatic substances which shrink the prostate we've currently trialling a different sort of laser for a nucleation we're looking at stents we've looked at biodegradable stents in the past and we're looking now at some permanent stents on the back of some success that other companies have had with implantable devices for BPH and the one I'm most interested in is the water jet technology and this is called aquablation and this is where we use a water a water blaster on the prostate essentially and we've linked up with another Silicon Valley startup to do this which does involve a lot of the heavy hitters in the medical device world and they support this research and I'd like to mention that just briefly this is the stent that we're looking at and this can be done in an outpatient environment through a flexible telescope and we place this little three layered stent in the prostate and essentially patients who wouldn't be fit for surgery might well be treated this way as a standard and they wouldn't have to keep a catheter but without the risks of anesthesia but anyway moving on to the aquablation now water jets have been used a lot in industry and when you use water jets in air you're using quite high pressures up to 90,000 psi and you can use it on metal stone and wood and there's a range of uses but we're interested in submerged water jets and of course there hasn't been much done on submerged water jets there's the non-cavitating type which might be what you might find in your spa pool and fortunately that doesn't cause you any harm but cavitating when the pressures get up they are they can be quite destructive in an aqueous environment you do use lesser pressures 50 to 500 to 10,000 psi the maximum our device goes up to about eight and a half thousand psi and that really for the prostate and for the depth that we need is what we need for developing a channel in the prostate gland it does use robotics and once again robotics are going to replace a lot of our jobs in the future and this is a property in inkling and there's at least a half a dozen urologists in the audience and this is an example of how of how robotics might be replacing your jobs in the future but most of us won't be caring will we but this is the robotic component there's a couple of micro motors in the handpiece one that controls rotation and one that controls longitudinal extension and retraction and this moves the water jet from side to side and from front to back and then we use this very precise high-pressure pump which very accurately delivers pressures up to 10,000 psi and there's another motor for active aspiration the actual so-called aqua beam comes through a sapphire nozzle which is only 150 micron in diameter so it's only the size of a human hair but 150 microns sapphire is used because it's very accurate it doesn't expand or contract so if you deliver a certain flow rate to that all other things being equal it will always deliver the same water flow and essentially if you can control the flow rate very accurately you can actually control the depth of destruction and this is what the water jet looks like when it's attacking a piece of liver and you can see when we slow up you can see that the tissue close to the water jet is destroyed completely and the further away you get from the tissue is denatured but not necessarily destroyed and obviously the flow can affect the destruction so on the touchscreen you can turn up the flow and that deepens the level of destruction and of course this can be done in the urethra there is very little penetration into the tissue itself at the limits of the destruction so you do have to still control the bleeding at the end of it but here I'll show you a quick animation which shows the procedure you place the handpiece the handpiece is disposable you attach the motor pack which has got those two little motors in it and then using the touchscreen you've got a transrectal ultrasound probe in there which is the imaging and then the technology marries up the device and you light up the device in relation to the ultrasound and it's all touchscreen stuff and I can tell you engineers do that better than urologists by and large but the urologists still have to come in at the end and control the bleeding but typically it only takes one pass of this and it can penetrate up to seven centimeters in depth and so it basically takes out a channel in the prostate quite simply takes about three or four minutes and then the job is done in prostates we're testing up to 80 grams in size which is about three times the normal size and so we reported the first demand cases of aqua ablation earlier this year and I'm one of the two principal investigators from the water trial which involves 20 sites around the US and two in Australasia ourselves and interestingly Tony Costello's group in in Melbourne and it's another randomized controlled trial so thank you all for coming and my wife and my three sons my three sons couldn't be here because they were too lazy but no but they don't live in Auckland so that's their excuse so thank you and it's a great honor to be a new professor at the University of Auckland thank you thank you very much Peter what a remarkable career and to think that you've produced all of that in Bay of Plenty with it seems really minimal support from outside is truly remarkable and it demonstrates some of your characteristics perseverance is clearly one of them you start with being knocked back again and again in terms of research you start some basic science and you don't stop despite failing if you like and you innovate so you I would have thought once you'd made one of those steps that might have been enough to think we've we've got there but it's never enough sounds like and now we've got the the water jet technique I I just have to take my hat off to you and the way you do it your innovation has not just been in in your research your innovation obviously is in the way you work with others most people who are involved in such a dramatic number of randomized controlled trials are in a very big group and they have research students who work with them for years and you've generated that by your own hard work and particularly your organization and that's that's clearly showed your leadership and taking taking that forward the other key thing that that speaks to me is your ability to build relationships and to maintain them even when in a sense you're not recognized when you ought to be you continue to put in the hard yards and in a sense forgive what's happened and keep going for the sake of producing a better result for your patients so it's been it's been wonderful here tonight hearing you say these things and hearing the journey much of it is completely new to me I've learned a lot about urology um for a while I was the urologist but the main operation I did was the one with your finger so to see now that we can do with water that's amazing um two years ago I was in Nepal and went to one of their urology meetings and two or three of the surgeons came up to me and they said do you know Peter Gillan and I was able to put out my chest and say he's in my department and my reputation went up like that so Peter thank you congratulations it's been wonderful hearing this it's a great example of perseverance innovation relationship building and including other people so thank you come forward for the plaque for tonight wonderful Peter what a fantastic lecture I think all the men in the audience can now uncross their legs that was an eye opener and I think it's a testament to your as Ian was saying your perseverance and your dedication to discovery and innovation while at the same time always considering seeking new and improved ways for patients is the sort of work that this university acknowledges and recognises as being fit for a professor at the University of Auckland so once again congratulations on your election to the professoriate and thank you all for coming tonight just to remind you that the last of our three inaugural lectures Professor Janie Sheridan is on Thursday night Janie is from the School of Pharmacy so thank you all again for coming thank you Alan and Ian and especially thank you Peter for a wonderful lecture