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Surgery will be affected by coronavirus outbreak but staff wellbeing remains the top priority

Mark Taylor


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Health Minister Robin Swann is shown around the Covid-19 centre at Altnagelvin Hospital in Londonderry by Dr Tom Black.

Health Minister Robin Swann is shown around the Covid-19 centre at Altnagelvin Hospital in Londonderry by Dr Tom Black.

Health Minister Robin Swann is shown around the Covid-19 centre at Altnagelvin Hospital in Londonderry by Dr Tom Black.

Over the coming weeks, we will face the inevitable surge of patients with Covid-19.

All areas of the Health & Social Care system have been involved in training and re-training and we are rapidly changing the way we work in preparation for managing those patients who will require ventilation and critical care management.

The practice of surgery will be very much affected over the next number of months. Stories emanating from Europe and China highlighting the death of front-line health care staff have heightened anxiety levels. This virus does not discriminate, and its unpredictability poses a threat that the NHS and its clinicians have never seen before. As such, it is imperative that those of us in medical leadership ensure that we listen to the concerns of our colleagues.

With this in mind, the four Royal Colleges of Surgeons and three surgical specialist societies have issued guidelines to protect not only surgeons, but anaesthetists, nurses and all personnel within theatre complexes. In order for us to deliver care to the sick, we need to remain well to fulfil our duties.

The general public should note that irrespective of Covid-19 or indeed guidelines, healthcare staff will continue to do everything in their ability to treat the sick.

However, in the days and weeks ahead, staff will be challenged to work outside their comfort zones, adapt to a rapidly changing environment, whilst being mindful of their own physical and mental wellbeing.

Technical and managerial aspects of surgery will change to minimise the risk of contamination of healthcare workers and their patients as a result of aerosol particles.

For example, in my own area of hepatobiliary surgery, the practice of laparoscopic surgery (keyhole surgery) is one such change. In laparoscopic surgery, carbon dioxide is inflated into the abdomen and has, by many authorities, been highlighted as a potential risk of dissemination of the virus into the atmosphere by aerosol spread.

The aerosol that is produced on deflation of the abdomen, even with controlled mechanisms cannot be fully guaranteed to ensure the safety of the theatre personnel. Therefore, we will use different methods to manage some surgical conditions.

Patients with appendicitis may be treated by antibiotics rather than surgery. The patient who presents with a very inflamed gallbladder, may have a tube placed by the x-ray doctors into the gallbladder to drain it rather than the standard way of carrying out a laparoscopic operation to remove it.

The use of diagnostic camera tests for evaluation of the stomach and colon will be restricted and priority given depending on clinical need.

We are prepared to face challenges that we never believed we would face in our medical careers. The training involved in becoming a doctor, a nurse or an allied health professional is based on achieving the very best, if not the perfect outcome. And as we move ahead, we will continue to do our very best for every patient we see.

And that is the commitment from everyone involved in health care, from the Minister, the Chief Executive of the HSCNI, the Chief Medical Officer to all the health and social care staff. But we need our public to understand that the delivery of all services will be different, whether it be a telephone outpatient review or a video consultation with your GP. We do not want to put you or your family at any unnecessary risk.

There have been many calls from statesmen, celebrities and clinicians asking for our public to listen to the public health messages. This cannot be over emphasised.

It is critical that people stay at home, practice safe social distancing if they need to go out for essential shopping or work, engage in regular handwashing, keep in contact with their loved ones who are in isolation, and be mindful of the ways in which they can help the most vulnerable members of our society. All of this is so important over the coming weeks.

Mark Taylor is Director for Northern Ireland at the Royal College of Surgeons

Belfast Telegraph