Nottingham is becoming one of the leading centres in the country for keyhole surgery. Health Correspondent Claire Carter watched the team in action.
TWO gall bladders and a liver operation are a typical day's work for consultant surgeon Adam Brooks and his team.
"Sometimes, a gall bladder operation can take two-and-a- half hours, sometimes 20 minutes," said Mr Brooks.
Much of the team's work is done using a form of keyhole surgery known as a laparoscopy – where the operation is carried out through small incisions in the abdomen – but this isn't always possible.
While we were in theatre we witnessed both keyhole and open surgery.
Mr Brooks said: "Most of what we do as open surgery is because we can't do it laparoscopically. We might need to feel the liver for example and check the other side is OK.
"Laparoscopic surgery is higher-risk work for us as a team, as if something goes wrong it's very different from open surgery, where you can access the problem more easily."
Keyhole surgery is carried out where possible, though, as it reduces the time a patient has to be in hospital, and cuts their recovery time.
Nottingham's hospitals are becoming one of the specialist centres in the country for keyhole surgery and, as I watched the team remove a gall bladder, it was easy to see why.
The patient had been having persistent problems with gallstones. With just two small cuts in his stomach, and one through his navel, the team were able to insert a microscopic camera to project an image of the man's internal organs on to a large screen.
Zooming in and out of this projected image, Mr Brooks was able to use two tools to remove fat surrounding the gall bladder, isolate it from the blood supply and put it into a small bag with the utmost precision. This was then removed through the navel in a procedure that took around 40 minutes and left the man with just three tiny cuts. The team said he would probably be sent home the next day.
With an hour's break to get the next patient ready and under anaesthetic, it was time for the next operation – a liver resection. This operation, where Mr Brooks estimated he would have to remove about 20 per cent of the liver, was more complicated.
The 58-year-old woman had previously had bowel cancer but an ultrasound had shown some of this had spread to her liver and tumours had developed. There was a 2 per cent risk she would not survive the surgery – but this is relatively low for a team used to operating on patients with a 20 per cent risk.
The preparation for open surgery is a lot more involved. Tongs, scissors, thread and swabs are laid out in precise lines and two scrubbed nurses are ready to hand any equipment to Mr Brooks and his assistant. Masks are worn and there are numerous runners in the theatre who are able to get fresh supplies and operate some of the monitors.
As with all operations, the anaesthetist was also present.
Liver operations are tricky because of the amount of blood that flows in and out of the liver. This procedure is possible to carry out using keyhole surgery but Mr Brooks wanted to do open surgery to check for more tumours.
About ten minutes into the surgery, it was clear he was right, as he found more disease and specimens were taken and sent off to be analysed.
"We can safely remove about 80 per cent of the liver, as it re-grows," added Mr Brooks.
"Last week, we had a lady who on her 80th birthday had 80 per cent of her liver out. The liver regenerates. In about three months, it will be back to about 80 per cent of its original volume and we can re-operate probably four times more if we need to."
Mr Brooks and his team are in theatre from about 8.30am until 6pm five days a week to ensure they can work on the maximum number of patients.
Nottingham University Hospitals Trust (NUH), which manages the QMC and City Hospital, is also part of an on-call duty service for cancer patients who need urgent operations, which means they can end up operating on patients from Notts, Derbyshire, Lincoln and Boston – a catchment area of around 2.2million patients.
Mr Brooks is also the clinical lead at the hospitals for trauma or serious emergency cases.
"My two big interests are trauma and the liver. Major trauma is what I grew up doing and the liver fits in with this – it's technically challenging."
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