London surgeons complete record week’s worth of operations in one day

 (Guys and St Thomas NHS Trust)
(Guys and St Thomas NHS Trust)

Surgeons in a London hospital have performed a week’s worth of operations in a single day, pioneering a technique that could be used to help reduce the NHS backlog.

The team at Guy’s and St Thomas’ hospital performed eight robot assisted radical prostatectomy operations in under ten hours, the highest number performed in a single day in the UK in one hospital.

High Intensity Theatre lists (HIT) focus on one procedure at a time and seek to minimise the turnaround time between operations. Using two theatres, the surgeon can go between cases without having to wait for a patient to come in. This helps to cut the significant amount of time it takes for medics to anaesthetise a patient, set up equipment in the theatre and help them to recover – a process which sometimes takes longer than the operation itself.

The team at Guy’s assembled a large team for the HIT list, which took place on October 8. Each theatre had a team of around 1.5 times its usual size and staff were given very specific roles.

By the time the list had reached the third patient, the turnaround time between operations had dropped as low as 32 seconds. Behind the scenes, staff in the control room used Proximie software to monitor activity in the theatre in real time.

Dr Ben Challacombe, a consultant urological surgeon who performed the operations with his surgical consultant colleagues Paul Cathcart, Christian Brown, and Prokar Dasgupta, told the Standard that the success of the HIT list had given staff a “huge” morale boost.

“Everyone pulled together to do the job, it really helped to energise the team. Morale has been hit by Covid and other issues, but people feel galvanised by doing something different.”

The surgeons who performed the HIT list (Guys and St Thomas NHS Trust)
The surgeons who performed the HIT list (Guys and St Thomas NHS Trust)

The HIT list took around two months to plan, but the hospital is already hoping to beat its record later this year. At the moment, the lists are only taking place on the weekend as the hospital does not want to disrupt its other elective activity.

Dr Imran Ahmad, a consultant anaesthetist who led the organisation of the list, said his team had sought to drastically shorten turnaround times between when an operation is finished and when the next case begins.

“The surgical time remained the same but, because of the planning, we managed to make huge gains in the turnaround time when the surgeon isn’t operating. As soon as one case was finished, the team would clean up and the next patient would immediately come through.”

Dr Ben Challacombe (left) and Dr Imran Ahmad (right) (Guys and St Thomas NHS Trust)
Dr Ben Challacombe (left) and Dr Imran Ahmad (right) (Guys and St Thomas NHS Trust)

He said that his team would usually perform three operations in a day and finish around 7.30pm but were able to finish eight cases by 5pm. “Our efficiency was pretty phenomenal,” he said.

“With each HIT list we are getting better and better. It was like an F1 pit stop where the car is the theatre: you don’t want it to be standing still for too long and everyone is going at full tilt to get it back into action again.

“All of the staff involved will be buzzing for weeks, and hopefully we will do more here and other hospitals will try something similar.”

Mick Jennings, one of the patients on the list, said: “It was really well-organised. There was a lot of staff around, they were all were very on it and you really notice the team cohesion.

“I felt very comfortable after the surgery. Even though it was fast, I didn’t feel rushed. It was clear that staff were focused on doing the right thing rapidly rather than hurrying. If anything, the experience of it being quick and controlled made me feel more confident.”

Mr Jennings, 59, was diagnosed with prostate cancer in early September.

“It was a bit of a shock... I wasn’t expecting to have cancer at all, but having had the diagnosis and the treatment at Guy’s I am feeling confident.

“Hopefully I shouldn’t need any further treatment. From the low after my diagnosis, I feel very positive about it now. I’ve been through an efficient process with a team who have done a great job.”

It is hoped that the HIT lists, if rolled out more widely, could help the NHS to reduce the backlog in care caused by the Covid-19 pandemic. There were 7 million patients waiting for routine hospital treatment at the end of August, according to NHS Digital data.

However, there are early signs that NHS staff in London are making strides in tackling London’s elective backlog.

The latest figures show the NHS in London has reduced the number of people waiting more than 18 months for treatment by 80 per cent over the past year.