Consultant Colorectal Surgeon

Portsmouth is accredited with the British Society for Gynaecological Endoscopy as the Southern Endometriosis Centre. This is a multidisciplinary team with dedicated Gynaecologists, Colorectal Surgeon , Urologist and Endometriosis Specialist Nurse. This centre is one of the busiest in the UK with 64 cases of rectovaginal endometriosis treated in 2018. A dedicated endometriosis MDT meets once a month and surgical input is expected alternate weeks. Part of the PAs for this job will include attending endometriosis MDT and being available for surgical assistance in appropriate cases. This joint surgery is done with a robotic platform. Similarly, the gynae-oncology centre is one of the two training centres in Wessex. Mr Richard Hadwin is the cancer lead and there are a team of four surgeons offering both minimally invasive surgery and radical open surgery. Mr Filippos Sagias and Mr Paul Sykes are the colorectal surgeons currently involved in twice monthly complex MDT discussions and joint operating. They also have the dedicated radiologists and urologist involved in appropriate cases. The new appointees will be expected to be able to provide colorectal assistance to the gynaecological team when needed. With the availability of two DaVinci X systems there are plans to do them robotically giving opportunities for new appointee to be mentored and establish a robotic practice. The care of patients with Inflammatory Bowel Disease is coordinated by a dedicated multidisciplinary team. There is excellent working relationship with the Gastroenterology team with bi-monthly IBD MDT, which the current appointees will be expected to attend. IBD Surgery results are constantly audited, and a high-volume practice has been developed in recent years. There is a high volume of complex Crohns disease surgery, including recurrent and fistulating disease with results consistently above national standards with more than 95% of the Crohns disease resections being completed laparoscopically and a stoma rate of 4% in the last three years. The unit provides a regular service in minimally invasive ileoanal pouch surgery and has attracted referrals from elsewhere. Robotic proctectomy and IPAA is another area, appointee can be mentored into. Complex abdominal wall reconstruction +/- Intestinal failure Complex abdominal wall reconstruction is an area we would like to see developed by the new appointments and is supported by our onsite plastic surgical team as and when needed. We have established radiology support in using pre op Botox injections to support CAWR. If the appropriate candidates have an interest in intestinal failure that would also be supported, as we currently manage a small but continuing number of patients with intestinal failure due to ischaemic bowel or surgical complications. An excellent nutrition service is led by Gastroenterology including a virtual clinic for managing patients with complex or high fluid needs in the community and we have close ties with University Hospital Southampton as our regional IF centre. All of the current consultants manage patients with pelvic floor and associated disorders, but we do not have a lead in pelvic floor disorders and the service needs to be coordinated. We have excellent radiology support with conventional and dynamic MR proctography and pelvic floor studies including endoanal and endorectal US scanning. We offer management of prolapse by Delormes, Altmeiers and VMR. We have participation in the regional MDT with Southampton to provide a modern pelvic floor service for our population. A specialist interest in this area will also be beneficial.

Emergency work

Our emergency surgery service is very busy and therefore this will constitute around 30 % of the DCC workload for the successful applicant. In the last year we did about 300 NELA cases out of which 70% were attempted laparoscopically. We have also successfully implemented a traffic light system to identify and offer emergency DaVinci robotic surgery for selected cases. We have published our emergency Robotic colonic resection case series. Occasionally emergency patients are transferred from the Isle of Wight, for services unavailable at their site. Appointees will have a broad training in general surgery and will be able to provide an on-call service in general surgery. Vascular emergencies, head injuries and surgery for children under 5 years are provided separately and would only be covered by the appointee under exceptional circumstances. There is an interventional radiology service almost 7/7 for management vascular emergencies and drainage of collections / abscesses etc. There is an endoscopy rota for upper GI bleeds. On take the consultant will be supported by a team of StR, CT and two FY1 doctors. The trainees work shifts to meet with doctors hours regulations. Currently the general surgeons provide on call services for a period of up to 7 days alternating 1st on call with second on call. Weekday nights are covered separately; weekend days are worked in 24-hour shifts. At weekends the first on/second on system continues but with added responsibility for ward rounds on the colorectal wards and other colorectal patients. The Colorectal Unit does not yet provide an on-call specialist service 24/7. We currently have access to two CEPOD theatres between 0800 and 1700 hours most days including weekends. There is a separate trauma list but sometimes we share the list with other specialities like transplant, Maxillo- Facial surgery, ENT and gynaecology.