Surgical Services

Who is in the room

You will meet your surgeon before the operation, and it is the surgeon you have been seeing who performs it. You will not be alone with one person.

An operation is done by a team. Besides the surgeon there are surgical assistants, an anaesthetist, theatre nurses and technicians. In the modular theatres one nurse works at a central control console and sets the equipment, the lights and the cameras from there, so the rest of the team stays at the table.

The anaesthetist does not leave. From the moment you are anaesthetised until you are awake in the recovery unit, an anaesthetist stays with you and watches your breathing, your heart and your blood pressure continuously.

Will I be asleep?

That is decided with you, not for you. Before a planned operation an anaesthetist sees you for a pre-anaesthetic check, goes through your medical history and any heart, lung, kidney or liver problem you already have, and plans the anaesthetic around it.

The hospital gives general anaesthesia, where you are fully asleep, and spinal and regional anaesthesia, where one part of the body is numbed and you may be awake or sedated. Which one suits your operation and your health is what the pre-anaesthetic check settles. Ask the anaesthetist anything you are worried about at that visit. It is the right time and they expect it.

Pain relief after the operation is part of the same plan, made before you go to theatre rather than after you wake up.

Before the day

You will be given an instruction about when to stop eating and drinking, and about which of your regular medicines to take on the morning of the operation and which to stop. Follow the instruction your surgeon and anaesthetist give you, not a general rule you have read somewhere. Blood thinners, diabetes medicines and blood pressure medicines are each handled differently.

If you take any medicine at all, including anything bought without a prescription, tell the anaesthetist at the pre-anaesthetic check.

One attendant should stay with the patient. What to bring and the passes you are given at admission are on /ip-processes/.

The operating theatres

There are eleven modular operating theatres, each laid out for the speciality that uses it: cardiovascular surgery, neurosurgery, orthopaedic surgery, bariatric surgery and transplant surgery. A minor theatre and seven procedure rooms take shorter cases. There is a separate pre-operative area, and a post-anaesthesia care unit for the hours after surgery.

• Laminar airflow through HEPA filters, which take out particles down to 0.3 microns, so the air over the operating table is filtered continuously
• Stainless steel panelling and epoxy flooring, which have no joints or corners to hold dirt and can be cleaned down fully between cases
• The sterile supply department, the theatre pharmacy and the counselling rooms in the same cluster as the theatres
• An anaesthesia workstation in every theatre
• Motorised operating tables and shadowless LED lights, set from the surgeon's control panel
• HD cameras that send the view from inside the body to large monitors placed where the surgeon can see them, used in keyhole surgery
• A C-arm for X-ray images during the operation, and electrocautery and other energy sources

Keyhole surgery

Many operations here are done through small cuts rather than one long one. Whether yours can be is a decision for your surgeon and depends on what is wrong and on your own anatomy. The equipment for it includes:

• A 3D Karl Storz laparoscopic system
• Minilaparoscopy instruments of 3 mm
• Video endoscopic equipment for treating anal fistula (VAAFT)
• Vessel sealing systems: Force Triad (Ligasure) and Enseal

Where you wake up

You will not wake up in the theatre. You are taken to the post-anaesthesia care unit, where nurses and an anaesthetist watch you until the anaesthetic has worn off, your breathing is your own again and your pain is controlled.

From there you go to your ward bed, or to the surgical intensive care unit if the operation was a major one or your condition calls for closer watching. The surgical intensive care units are next to the theatres, so a patient who needs intensive care does not have to be moved across the hospital to reach it. The intensive care units are described at /intensive-care-service/.

Some operations are done as day care and you go home the same day. Those are booked through the short stay care unit, and you will be asked to come in early in the day. See /short-stay-care-services/.

Operations done here

These are operations the hospital's own records show being carried out. The list is not a menu. Which operation suits you, and whether an operation is the right answer at all, is decided by the treating surgeon.

• Heart and chest: coronary artery bypass grafting, including with balloon-pump support, and mitral and aortic valve replacement
• Abdominal and keyhole surgery: laparoscopic removal of the gallbladder, laparoscopic appendicectomy, and hernia repair
• Urology: PCNL for kidney stones, ureteroscopy with stone removal, DJ stenting, TURP for the prostate, and TURBT for bladder tumour
• Orthopaedics: knee replacement including revision, hip replacement, arthroscopy, ACL reconstruction, and fracture fixation by plating, nailing and internal fixation
• Eye: cataract surgery by micro-incision and small-incision techniques with a lens implant, and intravitreal injection
• Obstetrics and gynaecology: caesarean section, and hysterectomy by open and laparoscopic routes, with removal of tubes and ovaries where needed
• Neurosurgery: craniotomy, for example to drain a brain abscess
• Plastic and reconstructive surgery: nerve repair and grafting, flap cover, skin grafting, and debridement of diabetic and other large wounds
• Ear, nose and throat: endoscopic sinus surgery with septoplasty
• Endoscopy under anaesthesia in the procedure rooms: ERCP with stenting, sphincterotomy and stone removal, and banding of oesophageal varices

Risks, and what to ask

Every operation carries risk, and the risk is particular to the operation and to the patient having it. Nobody can give you a number from a website. The two people who can are your surgeon, who will go through what the operation involves and what can go wrong with it, and the anaesthetist at the pre-anaesthetic check, who will go through the risks of the anaesthetic for someone with your medical history.

It is reasonable to ask both of them: why this operation, what happens if I wait, what are the alternatives, how long will I be off work, and what will recovery feel like in the first week. Ask before you agree, not afterwards.

How the date is fixed

A planned operation is not put on a waiting list. When your doctor advises the operation, a Guest Relation Executive goes through the costs with you and your attendants and records the date and time, and the operating doctor books the theatre in the hospital's information system at that point.

The day before, the theatre coordinator confirms the day and time with your doctor and the theatre team calls you. That call is a good moment to ask what time to arrive, how long the operation is expected to take, and where your family should wait.

The estimate, insurance pre-authorisation, package billing and discharge are all on /ip-processes/.