Welcome to the Department of Thoracic Surgery at University Hospitals Bristol NHS Foundation Trust.  These web pages are designed to provide an overview of our services for prospective patients, their families and carers.  If you are coming into hospital for surgery, they will give you an idea of what will happen during your stay, and how you can help contribute to your recovery.

The department deals with the surgical management of chest disease. Tumours, infections and other disorders of the lungs, the chest wall, the lung lining (the pleura), the mediastinum (middle of the chest) and diaphragm are investigated and treated.  Surgery for heart and oesophageal (gullet) disease takes place elsewhere in the hospital.

We have a particular interest in minimally-invasive surgery (also as video-assisted thoracic surgery, or VATS), including VATS lobectomy. Other areas of interest include endobronchial interventions for severe emphysema, airway stenting and  chest wall surgery.

Our catchment area is large and covers Avon, Somerset, Gloucestershire, Wiltshire and north Dorset. We also receive referrals from elsewhere.

In 2010 we adopted the principles of enhanced recovery for all patients undergoing thoracic surgery.  The key to its success is patient involvement, which we believe leads to better outcomes. Implementing enhanced recovery pathways is one of many improvements the NHS is undertaking. Modern surgical and anaesthetic techniques play a part but, more importantly, patients are encouraged to take an active part in their own recovery.  We hope that the better prepared you are the easier and more successful this will be. 

This website does not provide medical advice.  If you think you may require chest surgery, talk to your doctor in the first instance. 

Location

We are based in Bristol Royal Infirmary.  In-patients are looked after on Ward A700 (level 7 of the new Zone A ward block), with high dependency and intensive care provided on ward A600 (ICU) if required.

Children's thoracic surgery takes place at the Bristol Royal Hospital for Children.  Children are usually looked after on Ward 31, or in the adolescent unit on Ward 35.  This area is specially designed for patients aged 11-16.

Referrals

Most patients will be referred by a respiratory physician (chest medicine specialist), often through one of the lung cancer multi-disciplinary teams (MDTs) which we serve.  Some patients are referred directly by their general practitioner or by other specialists.  Currently, our surgeons routinely attend lung cancer team meetings at hospitals in Yeovil, Taunton, Weston, Bath, North Bristol (Southmead Hospital) and Gloucester, in addition to Bristol Royal Infirmary.

The department also welcomes referrals from hospitals and GPs outside our normal referral area. Please see the contact details section for how to make a referral.

Audit and quality assurance

The department sends data to several internal and external bodies to ensure the quality of our services. 

Data on our surgery for lung cancer is reported to the NHS England Lung Cancer Clinical Outcomes Publication, and is available through the SCTS.org website. 

Information on lung cancer care in our region is collected by the National Lung Cancer Audit.   You can access this data using the Roy Castle lung cancer smart map here.

We also send annual activity data to the UK Society for Cardiothoracic Surgery, for both our cancer and non-cancer surgery.

Enhanced recovery

This is based on the following principles:

• Patients are in the best possible condition for surgery
• Patients have the best possible management during and after their operation
• Patients experience the best post-operative rehabilitation 

We will talk to you about the operation beforehand, what to expect and how to aid your own recovery afterwards.  For major operations, this will include goals to aim for every day.  These are outlined in the patient diary (see useful information section).

The preoperative assessment team will discuss this with you and provide additional information.

Further information about the national ERAS programme can be obtained here.

New patients

We see most new patients at our Bristol Royal Infirmary clinics (level 4 of the BRI Queen's Building).  This allows most patients to see a surgeon, visit the preoperative assessment clinic (POAC) and meet with a nurse specialist in one visit.  If you might be eligible for a research trial, you may meet one of the surgical research nurses. 

The Preoperative Assessment Clinic by Video Link at Other Hospitals

We can now also provide this "one stop" assessment at Southmead Hospital for some patients.  Here, you will meet a surgeon and lung cancer nurse specialist in person, but will meet some of the other members of the team (assessment nurse and anaesthetist) via a video link to the pre-operative assessment team at Bristol Royal Infirmary.  This means that you can have your assessment closer to your home.  We are rolling this service out to other hospitals, starting at Gloucester Royal in late 2016.

You will not usually need to visit the hospital again until the morning of your operation. 

The Preoperative Assessment Clinic (POAC)

The purpose of this service is to ensure you are in the best possible health to undergo anaesthesia and surgery. You will be assessed by a nurse and reviewed by a member of the anaesthetic team if required. You may need to have some tests such as blood tests and possibly have examinations of your heart and lungs with additional tests as required. We aim to make this assessment as timely as possible, but this is a comprehensive assessment and we believe it is essential that you are assessed appropriately. You will be given the name of a preoperative assessment nurse, or 'case manager', who you can contact should you have any queries or further health concerns following this appointment and before your surgery.

POAC is located at A606 on level 4 of the BRI Queens' Building.   

Getting fit for surgery

The fitter you are before an operation, the better your chances of a good outcome.  There is a lot that you can do, even in just a few weeks, to get fit.

-If you are still smoking, try to stop as soon as possible. Your GP, local hospital or our clinic can help

-If you are on medications for emphysema/COPD, diabetes, high blood pressure or another long term condition, make sure to take them regularly.

-Be as active as you can.  Regular aerobic (fitness) exercise is ideal.  A half hour walk 3-4 times a week if you are able is a good start.

Children and teenagers

Children are usually seen in our general adult clinics.  Patients under 16 should bring a parent or guardian with them to clinic visits. Surgery for those under 16 will be performed at Bristol Children's Hospital.

Follow up clinics

Many procedures need follow up visits to check on your recovery and sometimes to discuss results and arrange further treatment.  For lung and other cancer patients, we will often follow you up in clinic for several years.  These clinics take place in your local hospitals to reduce travelling times when possible.  We currently undertake clinics in the following hospitals: 

Clinic locations and times

Location	Frequency	Day	Time
Bristol Royal Infirmary (BRI)	Weekly	Tuesday, Wednesday, Friday	9am-1pm
BRI nurse-led chest drain clinic Ward A700	Weekly	Monday	mornings
BRI nurse-led cancer follow up clinic	Weekly	Friday	9am-1pm
Southmead Hospital	Weekly	Wednesday	9am-1pm
Gloucester Royal Hospital*	Four per month	Thursday	2pm-4:30pm
Royal United Hospital Bath*	Weekly	Thursday	9am-11am
Weston General Hospital*	Two per month	Monday	9:30am-11:30am
Yeovil District Hospital*	Monthly	Tuesday	2pm-4pm
Musgrove Park Hospital, Taunton*	Weekly	Thursday	2pm-4:30pm

*clinics currently for post-operative visits only 

How often might I need to come back to clinic?

Most lung cancer patients come to clinic for five years following their surgery.  At the start this will be 2-3 weeks after surgery, then every 4 months for a year. If you remain well this will reduce to annual visits.  In particular cases we will vary this routine.  If another specialty (for example oncology) is involved, we may adjust your follow up to save unnecessary journeys.

For benign (non-cancer) patients, usually only one clinic visit will be needed after your surgery.  After some minor procedures we will just send the results to the doctor who referred you, and you don't need to come back to our clinic.

Going home after surgery

We will give you a plan for your follow up when you are discharged.  A written clinic letter will normally arrive within 1-2 weeks of going home.  If the date or location is inconvenient, please tell us and we will try to accommodate you.

Try and stay as active as possible when you get home.  Spend the day in a chair-not in bed, and keep doing the coughing and breathing exercise that the physiotherapist has shown you.  Take enough painkillers so that you can cough and breathe comfortably.   Try to get out the house at least once a day if you can, even if just for a very short walk.  Eat a healthy, balanced diet.  Keep taking our laxatives until your bowels have returned to normal, and wear the surgical stockings that you had in hospital for most of the day and night (its OK to take them off to clean them) until you are sure that you are fully mobile.

Once you are at home, any repeat prescriptions- for example for painkillers- and other routine issues are usually dealt with by your family doctor.  The practice nurse at your GP will normally be able to remove any stiches, if necessary.  If you are going home with a chest drain in place, or still need regular wound dressings, then we will involve your local district nurse before you go home.

If you have been smoking before surgery, do your best to stay off cigarettes now that you are at home.  Staying off cigarettes gives you the best chance of staying cancer free.  We will offer you smoking cessation support and nicotine replacement if appropriate before you go home.

The thoracic nurse specialist team is available if you have any specific questions about your surgery or follow up, at thoracicCNS@uhbristol.nhs.uk. 

Lung cancer patients are looked after by teams of professionals known as multidisciplinary teams or MDTs.  These include chest medicine specialists, radiologists, specialist nurses, oncologists and palliative care doctors, in addition to a chest surgeon.  This allows experts from many different areas to contribute to your care.

Before an operation for lung cancer, most patients will have undergone several tests and scans.  These are done to make a definite diagnosis (although sometimes this is not possible until the operation itself), to assess how advanced the cancer is (called staging) and to thoroughly assess your fitness before surgery.

Surgery is a very good treatment for early lung cancer, but it is not the best treatment for all patients, and is not the only treatment.  In fact, most lung cancer patients are not treated by surgery.  This may be because the cancer is too advanced to be removed by an operation, or because a patient's general health means that an operation is not possible.

Your own team will advise you on your situation and on which tests and treatment they feel are best for you.  Some excellent background information is available online from Cancer Research UK or from the Roy Castle Foundation.

Lung surgery nurse specialist support

You will usually meet one of the thoracic specialist nurses at your first clinic appointment, after you have seen your consultant. She will be able to answer or clarify any questions you may have and is there to offer help and support at what may be an anxious time for you and your family.

She will explain enhanced recovery to you, what to expect following your surgery and when you go home.

You will be provided with written information about your condition and surgery.

Following your surgery, the thoracic specialist nurse, who is a key member of the daily ward round, is available for questions and advice.

You will be given her contact details at the initial meeting. You or your family can call for advice and support before or after your surgery.

Follow up after lung cancer surgery: specialist nurse-led care

At the Bristol Royal Infirmary, our long term lung cancer follow up service is now run by the nurse specialist team, in a system known as "nurse led" follow up.  Research has shown that patients prefer this.  Your nurse specialist will coordinate support from surgeons, oncologists and other doctors when needed.  We use a mix of clinic visits, structured interviews known as "holistic needs assessments", CT scans and x rays to help keep you well after surgery.

Smoking cessation

Smoking is a major risk factor for lung cancer and several other lung diseases.  The most effective way to reduce your risk of lung cancer is to quit as soon as you can.

For people preparing for lung surgery, stopping smoking can help reduce the risk of some complications of surgery.  Even after an operation for lung cancer, long term outcome seems to be improved in patients who manage to stop.

Stopping smoking can be very hard, but we are able to refer you to a dedicated smoking cessation service. Please ask any member of staff or the preoperative assessment team should you like to be referred. You can also refer yourself here. 

We can support you in stopping smoking by prescribing nicotine replacement therapy whilst you are in hospital and ensuring your GP or local smoking cessation service continues this when you leave.

Consultant thoracic surgeons

Mrs Eveline Internullo

Mr Rakesh Krishnadas

Mr Igor Saftic

Mr Doug West

Ms Laura Socci 

We have five consultant thoracic surgeons providing a team-based service. Clinics and operating sessions are shared between the surgeons. This reduces waiting times for patients, but can mean seeing a different surgeon in clinic before or after surgery than the one who performed your operation.

There is a daily consultant led ward round of all inpatients, seven days a week, 365 days a year.

Thoracic nurse specialists

Email: thoraciccns@uhbw.nhs.uk

Tel:  01173427648                    

Secretaries

Email: BristolthoracicSurgery@uhbw.nhs.uk

Tel:      0117 342 3132 / 0117 342 4211 / 0117 342 4210

Waiting list / admission coordinator

 Thoracic Waiting List Office ThoracicWaitingListOffice@uhbw.nhs.uk

Tel:      0117 342 3131

How to make a referral: from a lung cancer MDT

We are keen to receive MDT referrals on our referral forms whenever possible.  If we have a completed form (including results for PET scan and full lung function/transfer factor) we will endeavour to place that patient on our electronic waiting list within 24 hours of MDT. Copies of the form can be provided by the secretarial team on request by emailing BristolthoracicSurgery@uhbw.nhs.uk. 

We will copy and return referral forms to you as proof of delivery.

When using a form is not possible, please follow the email procedure below.

For emergency referrals and advice, the on-call team can be contacted via referapatient©. 

Email for non-urgent referrals 

The address for referrals is: 

BristolthoracicSurgery@uhbw.nhs.uk 

We are keen to receive referral letters in electronic format as attachments to an email whenever possible. This applies to urgent, cancer, benign and GP referrals. This allows us to respond to you as quickly as possible, is secure and provides you with proof of arrival, if the "read receipt" function is used. 

This account is monitored twice daily by the secretarial team, and referrals are triaged by a consultant as soon as possible. 

For emergency referrals, when immediate transfer or out-of-hours surgery may be required, the on-call team can be contacted via referapatient©. 

Urgent and in-patient referrals: use Referapatient©

Referapatient© is a secure cloud-based web application that is accessed via the internet. 

To make an urgent referral please go to www.referapatient.org.

This applies to urgent referrals and allows us to respond to you as quickly as possible, it is fully auditable and directly alerts the on-call team via SMS and email notifications. 

This can be used for urgent advice, emergency referrals and immediate transfer or out-of-hours surgery. 

For further information please go to www.bloomsburyhealth.org/referapatient. 

Email referrals and data security

Referrals should only be sent from nhs.net accounts, to ensure data security. This is the responsibility of referring teams.

How to make a referral: from a GP

Referrals must be made via eRS (Electronic Referral Service). UHBW is no longer accepting GP referrals sent outside of the eRS which is being implemented by NHS England in conjunction with NHS Digital. If a GP referral is not received via eRS, the referral will be rejected.

For further information, please contact ERSQueries@uhbw.nhs.uk.

Nursing team

Sister Emma Kirkland leads the nursing team on Ward A700.

Ward telephone: 0117 342 2779
Visiting hours: 2pm to 3.30pm

Links to local respiratory medicine departments and lung cancer team sites

Below are links to the web pages of some local lung cancer teams that we serve: 

- University Hospitals Bristol, based at Bristol Royal Infirmary  

- North Bristol NHS Trust, based at Southmead Hospital

-  Royal United Hospital Bath

-  Yeovil District Hospital  

-  Gloucester Royal Hospital

-  Musgrove Park Hospital