Innovation
option enhances patient dignity and privacy. Mr Abou-Chedid, who launched the project as part of Prostate Cancer UK’s Clinical Championship Programme, said: “We have had very positive feedback from our patients and are pleased with the success of this project. “The team at Royal Surrey is constantly thinking of ways to improve patients’ care and experience and we were keen to come up with ideas to reduce waiting times for patients who had catheters in after their surgery. This is a simple but safe and effective solution. It not only saves clinic time, but during a period of high fuel prices, it’s very helpful for patients. “My father, who is a Gynaecology Consultant, made the decision to remove the catheter himself at home after his prostatectomy in 2011. I always remembered that, and I thought why not show our patients that they can do this, too? We started trialling the option and found that our patients had no problems with it.” Last year, the results of a study of self-
removal of catheters were reported by the Trust – in an award-winning poster presentation at the British Association of Urological Surgeons’ annual conference,2
and in a published paper in
The Journal of Robotic Surgery.3 The study included 129 consecutive RARP performed at the Trust for the self-TWOC (trial without catheter) programme. The exclusion criteria were: patient preference, surgeon preference, due to difficult anastomosis or patients suffering from poor manual dexterity. The men who opted in were explained about self TWOC pre-operatively, and contacted after TWOC to fill out a questionnaire. Among the 129 who opted in, 112 filled out the follow-up questionnaire and therefore were included in the final analysis. Self TWOC was successful in all the 112 men
included in the study and patient satisfaction was high. The distance of travel avoided per patient was 79.6+/-36.72 km (Mean+/-SD) and
Diesel car (£)
Cost of TWOC clinic per patient
Parking cost for 4 hours
Travel cost to and from hospital Carbon Offset Total savings
85 5.6
15.99 0.28
106.87 Petrol car (£) 85 5.6
16.18 0.28
107.06 Table 1: Savings achieved through self-removal of catheters.
the average travel time saved per patient was 77 minutes. The move to self-removal also reduced waiting time in hospital by four hours per TWOC appointment. The study showed fuel cost savings of £9.87 to £15.99 per patient depending on car engine size/ type. The carbon footprint calculated was 0.02 tonnes of CO2
assuming average engine sized
(<2.0 litre capacity) diesel/petrol cars and 0.01 tonnes of CO2
for an average UK petrol hybrid
car. The calculated carbon offset per patient for diesel/petrol cars was £0.32 or for petrol hybrid £0.16 (see Table 1). Mr Abou-Chedid et al concluded that self TWOC after RARP is feasible, safe and cost effective for the hospital and patients. With 7913 robotic prostatectomies in UK per year, if the programme was expanded to other units, 158 tonnes of CO2
emissions could be saved per
year. The study also suggested that 30 patients that self-TWOC would save 30x 0.02 tonnes (= 0.6 tonnes), which is the emissions of a passenger on a London to New York flight (0.59 tonnes of CO2
). This carbon saving contributes to the
Trust’s sustainability efforts, as part of the NHS’s commitment to achieving Net Zero. “Some patients would have to travel from as far as Worthing or Chichester to Surrey if they were to have their catheter removed at the hospital. It is also saving time. Furthermore, prostate cancer nurse specialist TWOC clinics
New Cancer and Surgical
Innovation Centre Work has now started on Royal Surrey’s new Cancer and Surgical Innovation Centre, bringing state-of-the-art facilities to Royal Surrey and increasing the Trust’s surgical capacity. The £41.5m development, which is expected to be completed at the end of 2025, will house six new operating theatres and help to build on Royal Surrey’s world-class services in robotic and non- robotic surgery. The new Centre will enable an additional 7,000 patients to receive surgery every year, helping
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www.clinicalservicesjournal.com I July 2024
Royal Surrey respond to increasing demand for cancer surgery and bring down waiting lists for all elective (planned) surgical procedures. The building will be situated at the back of Royal Surrey County Hospital, accessed by car from Egerton road. The new two storey building will serve as the main entrance for surgical patients coming to the hospital with the exception of paediatric patients and day surgery, which will remain as a separate unit in its current location.
now have 88% less patients,” Mr Abou-Chedid explained. “Our patients have now carried out hundreds of self-removals (528 up to 1 November 2023), with no major issues and less than 1% complications. These were detected by the nurses when the patients were phoned, and no patient was put in any danger or had any unpleasant experiences.” Self TWOC is also resulting in significant cost
savings: the savings per case for the Trust was £82 per patient and the total saving was £43,296. In addition to the cost benefits, the approach is also increasing patient satisfaction: <1% said that they would have preferred to have had the catheter removed at the Trust. Following the results of the study, the Trust has been sharing its best practice with other Trusts; self-removal of catheters has now been adopted by many major Trusts in London, including The Royal Free, Guy’s and St. Thomas’, UCL, and Imperial. It has also been adopted by hospitals in Southampton, Maidstone and Eastbourne. The programme continues to receive interest from other healthcare providers across the UK.
Reducing bleeding The Trust has pioneered other improvement initiatives and carried out a pilot study to investigate the effect of topical microporous polysaccharide haemospheres (Arista) on outcomes following robot-assisted radical prostatectomy.4
Controlling bleeding without
disturbing the anatomy and function of the structures in the prostate bed remains a significant challenge during radical prostatectomy. Five grams of powdered microporous polysaccharide haemospheres (MPH) was applied to the prostate bed at the end of RARP in 422 consecutive patients. Continence was defined as no pads and potency as the ability to have penetrative sex with or without PDE5 inhibitors in previously potent, non- diabetic men aged <70 years following bilateral intra- or inter-fascial neurovascular bundle (NVB) preservation. In total, 95.3% of patients had nerve
preservation and the mean operating time and blood loss were 142 minutes and 200ml,
Petrol hybrid car (£) 85 5.6
9.87 0.14
100.61
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