Surgical Operations
For information on specific operations and treatments visit our medical information page.
this page last updated 02 January, 2008
Informed consent
A recommendation to undergo a surgical operation is only arrived at after a careful history, examination, and consideration of all the treatment options. This includes full discussion of the aims, risks and benefits, and a best estimate of the likely outcome in your particular case. Remember that
- Effective medical treatments are available for many ENT conditions
- Surgery does not always deliver the desired outcome
- General statistics regarding outcomes may not appy in your particular case
- Only a small minority of patients referred to us receive a surgical operation
Even when patients are referred by medical colleagues with a view to carrying out a particular operation, the same process of careful history, examination, consideration of all treatment options, and full discussion of aims, risks and benefits applies. This follows on naturally from our guiding principle, which is to treat patients as we would like members of our own family to be treated. Clinical excellence means more than just getting the diagnosis right and being up to date with the latest treatment guidelines. It means finding out what you hope for and expect from treatment, dovetailing our clinical expertise with your values and preferences. Having explained treatment options in terms we hope you can understand, we check you have understood. Our policy is complete openness and honesty. We give copies of our GP letters to patients and parents as a matter of course. We do not want snap decisions, we prefer you to have the chance to consider things carefully, with the written report at home. On the other hand, we do not expect you to shoulder the burden of treatment choices alone, we are there to help. If the best choice of treatment is clear, we will tell you so.
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Ethics of the surgeon - limits of competence
As a surgeon, there are ethical considerations regarding which operations I am prepared to carry out, and under what circumstances. There are limits to what I can do, and limits to what the hospitals can do. To know these limits, I have a very simple test. I just ask myself whether I would be happy to be doing this operation in this hospital on a member of my own family. I know my own strengths and limitations. I don’t hesitate to discuss difficult problems with colleagues, and refer on when necessary. Though lucky enough to have “a good pair of hands” I always strive to improve my surgical skills. In theatre, I am a meticulous operator, though not one of the quickest.
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My experience and current practice in sub-specialised areas of ENT
Otology
I have carried out over 1,000 major middle ear operations including tympanoplasty, mastoidectomy (both canal wall up and canal wall down techniques, including cholesteatoma surgery in children) labyrinthectomy, saccus decompression and stapes surgery. I use the Causse LASER stapedotomy technique and my audited results are on a par with the best published internationally. Since 1995 I have carried out over 100 Bone Anchored Hearing Aid implants.
Nasal and Sinus surgery
Besides several thousand routine nasal procedures, I have carried out successful lateral rhinotomy, fronto-ethmoidectomy, transantral ligation of the maxillary artery, and radical frontal sinus obliteration with osteoplastic flap. I have twenty years experience using the techniques of functional endoscopic sinus surgery and have carried out around two thousand such procedures with only one CSF leak which was recognised and repaired at the time. I have had no cases of blindness as a complication of FESS
Head and Neck Surgery
Although fully trained in this area, I made a decision on being appointed a consultant in 1993 to refer patients requiring major head & neck cancer surgery (laryngectomy, pharyngectomy, commando and radical neck dissection) to my colleagues, who now form mulitdisciplinary teams. I still carry out a great deal of diagnostic work (laryngoscopy, pharyngo-oesophagoscopy, biopsies, fine needle aspirations) and have also continued to perform parotidectomy, submandibular gland, branchial cyst and thyroglossal cyst excisions, and radical sinus surgery.
Facial Plastic Surgery
I am experienced in both internal and external rhinoplasty techniques, functional and cosmetic. I regularly carry out pinnaplasty and attain good results.
Endoscopy
I am skilled with both rigid and fibreoptic instruments. I use both macroscopic and microscopic techniques in laryngoscopy, including vocal cord augmentation injections. I regularly use the rigid Storz-Hopkins rod system for functional endoscopic sinus surgery. Although fully trained in paediatric bronchoscopy including emergency work, such cases are relatively rare in our catchment population and we now tend to refer to tertiary centres in London.
Laser surgery
I have used the carbon dioxide laser since 1986 and the KTP laser since 1995, and am familiar with both micromanipulator and hand-held fibreoptic delivery devices. I am an accredited LASER user.
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Our hospitals
We operate on adult patients at St Saviours Hospital Hythe, including
- cosmetic and functional rhinoplasty
- septoplasty
- functional endoscopic sinus surgery (FESS)
- tonsillectomy
Operations for adults and children age three years and over are at the Chaucer Hospital, Canterbury, including
- tonsils
- adenoids
- grommets
- laser turbinates
- sinus washouts
We can operate on children aged from 12 months at Benenden Hospital.
At the Chaucer Hospital we carry out
- Complex middle ear surgery for cholesteatoma and perforated eardrum
- Combined approach laser mastoidectomy and tympanoplasty
- Causse laser stapedotomy with vein graft and teflon loop piston ossiculoplasty for deafness due to otosclerosis
For information about specific operations and treatments visit our medical information page.
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