Guy’s and St Thomas’ Hospital in London has performed three months’ worth of breast cancer surgeries in five days in a potential blueprint for clearing the NHS backlog.
Plastic surgeons performed complex reconstruction surgery on 22 breast cancer patients back-to-back using an innovative approach called a high-intensity theatre (HIT) list over a five-day stretch, including the weekend.
The blueprint, devised by consultant anaesthetist Dr Imran Ahmad from the same trust, allows the hospital to run theatres “like Formula One pit stops”.
It involves using up to two theatres at a time with clinical staff operating both in tandem, maximising capacity and time.
It allows surgeons to move from patient to patient without waiting for them to be anaesthetised and theatres to be set up, and means more patients can be treated daily than would otherwise be possible.
Waiting for over a year
The surgeons operated on patients who had been diagnosed with breast cancer, were breast cancer gene carriers, or both.
The majority had been waiting for reconstructive surgery for over a year.
Nine of the patients had a new breast created using tissue from their abdomen or upper thighs in a procedure called microsurgical reconstruction.
It involves disconnecting and then reconnecting the blood vessels of the skin and fat from those areas to the chest to create a naturally reconstructed breast.
Pari-Naz Mohanna, consultant plastic surgeon and breast surgery lead, said: “We wanted to safely tackle the backlog of reconstructive surgery, while continuing to operate on patients with newly diagnosed breast cancers.
“We were inspired by the HIT list model, but we needed to adapt it for longer, more complex procedures while ensuring that the highest quality of care was maintained throughout the patient’s journey.”
Dealing with pandemic delays
Guy’s and St Thomas’ first used the HIT list method in February 2021 to carry out 20 hip operations that had been delayed due to the pandemic.
It has since run 23 HIT lists in total but this was the first one involving breast reconstruction.
The initiative pioneered by Dr Ahmad, who is the deputy clinical director for anaesthesia and theatres at Guy’s and St Thomas’, has now treated 410 patients across various surgical specialities, including gastrointestinal, gynaecology, ENT and urology.
He said: “We started the HIT list model with relatively straightforward procedures which would be done in one day. Through time this has developed to now operating across multiple days for complex, longer and bespoke procedures, which has allowed us to expand the types of patients and procedures benefitting from the HIT list programme.”