When a second opinion can help
A second opinion is a normal and sensible step before a major decision about surgery. Women most often come to me when they have been told that:
- their operation, such as a hysterectomy or the removal of fibroids, can only be done through a large open incision
- their fibroids are too large or too numerous for anything other than a hysterectomy
- their endometriosis is too extensive to operate on, or affects the bowel or bladder in a way that cannot be treated
Complex cases of this kind are a large part of my practice, and I am often able to offer a keyhole operation (laparoscopic or robotic) instead. When endometriosis affects the bowel, I operate jointly with a colorectal surgeon. I cannot promise a keyhole operation, and sometimes my advice will be the same as the advice you have already been given. Hearing it from a second surgeon can be reassuring in itself. Other women come because the cause of their pain, bleeding, miscarriages or failed embryo transfers is unclear.
Since 2013, more than 99 in 100 of my abdominal operations have been keyhole rather than open, and around one in a thousand has needed to be changed to open surgery (about these figures).
For complex operations, such as a large womb or deep endometriosis, I prefer to perform the operation robotically, because the three-dimensional view, magnified up to ten times, and the wristed instruments allow precise work deep in the pelvis. The Royal College of Obstetricians and Gynaecologists concluded in 2022 that, for complex surgery, robotic surgery can be considered safe and a more effective tool than conventional keyhole surgery, with fewer conversions to open surgery, and for endometriosis at least as good, with a trend towards fewer complications, although much of the evidence is not from randomised trials [1].
How it works
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Get in touch
Contact my practice manager, Helen, by telephone or email, or use the request form. She will tell you what to send and book a consultation at the clinic that suits you, or by video if you live further away.
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Send your scans and reports
Helen will send you a secure link to upload your scan reports and, if possible, the images themselves, with any operation notes, letters from your current specialist and GP, and recent blood results. Please do not include detailed medical information in the online form itself. I review everything before we meet.
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Consultation
We go through your history and your symptoms, what you have been told and what matters most to you. With your permission I examine you, and at Parkside Hospital and the CRP Clinic I can scan you at the same visit.
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My advice, in writing
I explain what I think can be achieved, set out every reasonable option, including no surgery and no treatment at all, and give you my recommendation, and then we decide together. Where waiting is the right choice, we set a checkpoint, such as a repeat scan after six months and then a review. You receive a detailed letter swiftly after your consultation, which you are welcome to share with your current team.
What I can offer
- A careful review of your scans, sometimes with a further scan or an MRI if the existing images do not answer the question.
- A clear explanation of whether keyhole surgery is possible in your case, and what it would involve.
- An honest account of the risks and the likely benefits of each option, including the option of no surgery.
How I practise
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The same surgeon at every stage
You will see me at your first consultation, for your operation, when the results come back and at your review afterwards.
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A scan at the same visit
At Parkside and the CRP Clinic I can perform an ultrasound scan during your consultation, so we can usually discuss what it shows there and then.
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Every reasonable option, and the choice is yours
I set out every reasonable option, including the option of no surgery, and give you my recommendation. The decision stays with you.
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Everything in writing
You will receive a detailed letter swiftly after your consultation, and full written information well before any operation.
