Mr Small trained in general surgery in Scotland undergoing basic training in and around Edinburgh. His final years were spent in Dundee, one of the founding centres of laparoscopic surgery. He was privileged to train under the guidance of Prof Cuschieri, one of the pioneers of laparoscopic surgery in the UK. He was appointed as the first consultant general surgeon with an upper GI interest to Sunderland Royal Hospital on 1st January 1998 where he introduced laparoscopic surgery for reflux disease and obesity surgery.
He has a particular interest in minimal access surgery and was quick to recognise the benefits of keyhole surgery in the management of obesity, establishing a North of England NHS referral service at Sunderland serving a population in excess of 3 million. He performs laparoscopic gastric banding, bypass and sleeve resection in my NHS practice and carry out over 100 obesity procedures a year. This number continues to grow.