Choosing a Surgeon?

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Have you found the right surgeon?

This may seem a strange question to pose if you are having your operation as an NHS patient as you are normally expected to take what is offered locally.  However, via the  NHS patient choice initiatives you do have a greater choice, especially when you live in a city where there are a number of surgeons practicing.

The patient on the left thinks that they have had a laparoscopic operation and yet has a large midline cut and a transverse bikini incision!  The operation was also recorded as a laparoscopic operation by the NHS trust!

The decision to have major surgery can often be stressful. Patients interested in Laparoscopic Surgery for colon, prostate disease and weightloss should find a surgeon who is experienced in this type of surgery. When meeting with the surgeon, the patient should consider bringing a friend or family member to take part in the discussion with the surgeon and to help take notes.


The private option will enable you to seek a surgeon who is more skilled in the operation you wish to have and for it to fit in more easily with your own time frame.

So, you've found the names of several surgeons and you need to decide which one to consult.  Here are some pointers to guide you through this decision making process.

How conveniently located is your surgeon?

In the event that something goes wrong, you need to be able to get in contact with your surgeon immediately for advice and if necessary treatment.

If you have chosen a private surgeon 200 miles away because the price of the operation was cheaper, this may become a problem if you need help urgently.

If you underwent an operation that is not available locally, the staff in your local hospital may not know how best to help you should you run into difficulties

It is thus very sensible to choose a laparoscopic surgeon, provided that they have all the skills that you require close to where you live.


What operations does your surgeon do most often?

Common sense would dictate that any surgeon will achieve greatest technical expertise in the operation they perform most often.

Beware of the surgeon who says they will "have a go" and if you are one of the first patients to undergo this surgery locally, ask if your surgeon is planning to have a more experienced surgeon to supervise him/her.
 
Q: How many colon cases do you treat annually?

(The Society of American Gastrointestinal Endoscopic Surgeons (SAGES) recommends prerequisite experience should include performing at least 20 laparoscopic colorectal resections for benign colon disease or metastatic colon cancer before using the technique to treat curable cancer.)

Q: Have you received advanced training in minimally invasive surgical techniques? Have you  been trained/accredited via Lapco (National training programme for colorectal surgeons)?

Q: How many minimally invasive operations have you performed overall?
How many per year?

Q: What is your conversion rate?

What are the results of your local surgeon?

Most sensible and forward thinking surgeons will maintain a database of all patients undergoing Cancer, advanced laparoscopic and minimal access surgery and undertake regular audits of their practice. 

He/she should be able to tell you their short and medium term results and also how many have had side effects etc.

Q: What have you seen in terms of patient outcomes with this procedure?

Q: What is the most common complication you have encountered with this procedure?

Has your surgeon undergone National Cancer Peer review?

Is his/her choice of private hospital an accredited provider for colorectal and urological cancer services?  Does it have high dependency facilities?  How many bariatric operations are carried out each year?  What is the rate of C Difficile infection?

Does your surgeon work in a multidisciplinary team?

Avoid a surgeon who does not work in a multidisciplinary team - works with colleagues where appropriate (urologist, gynaecologist & coloproctologist, endocrinologist),  specialist nurses, dietician, specialist radiologist, oncologist and physiotherapist etc.

Remember, some of the best results are obtained when your surgeon has a close working relationship with an individual anaesthetist. 

Cancer and pelvic floor problems can be quite complex!
Bariatric surgery when it goes wrong quickly becomes life threatening!

Does your surgeon operate laparoscopically?

Laparoscopic surgery can take longer than open surgery (and in some instant costs a little more) but has huge advantages for the patient in terms of less scarring and a quicker recovery, return of function and resumption of normal activities, work etc.

Ask them how long they have been doing laparoscopic surgery, where were they trained and how many operations have they performed.

 

Is there a local support group?

A sensibly structured support group eg BOS (Bristol Ostomy Society) can make a huge difference and the better ones have the input of a local surgeon in them.  Support is especialy important in weight-loss surgery

The support group should do more than meet socially for a chit chat (there is a lot of good that will come from such a meeting, don't get us wrong) but a group that has guest speakers and a proper education–based agenda will be much more useful to you.

Do you like your surgeon?

This may seem like a silly question but remember, you are entering into a professional relationship and you will need to be completely open and honest with them.

If you don't like your surgeon, you are unlikely to trust and respect him/her and you will find it harder to comply with the post–op instructions, disappointments etc.

If you have an experience that leaves you concerned, make sure you have not just met him/her on a bad day - speak to your GP, the nurses or other patients if you are at all concerned.

The new NHS patient choice initiatives should make it easier for you to seek out a surgeon who you trust and feel more comfortable with.


It is not Bristol Laparoscopic Associates role to address complaints about individual surgeons. However, if you are experiencing difficulties finding a local laparoscopic surgeon please feel free to use our resources to get in touch with someone who might be able to help you.

If they are not able to sort you out, aske them to referr you on to someone who can.


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SPIRE Hospital, Bristol. 
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Contact: Claire Trenberth - 0117 9804051
claire.TRENBERTH@spirehealthcare.com
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