Expertise in general, abdominal, laparoscopic and colorectal surgery

Natural Orifice Surgery

There is a wealth of evidence to support better short and long term outcomes after laparoscopic surgery. However, we still see complications after this type of surgery and many of these such as pain, wound infection and incisional hernias are related to the abdominal wall incisions. Operating through the body’s natural openings such as the mouth, anus or vagina can allow access to the internal organs without cutting through the skin and muscles which have the most sensitive nerve supply. Many studies have now shown that there are further benefits in reducing the size or number of incisions in the abdominal wall during minimal access surgery. In 2011 I travelled out to Rio de Janeiro to learn more about advanced techniques in natural orifice surgery with Professor Ricardo Zorron (pictured with myself after a transvaginal cholecystectomy in 2011), a leader in the field. Although more still needs to be done to develop the right technology, I was impressed by the quick recovery of the patients. 

I am currently leading a study at Colchester to pursue my goal of introducing natural orifice surgery to our department. In 2012 I performed the first natural orifice specimen extraction for a patient with colon cancer. This eliminates the need for an extended incision in the abdominal wall to remove the diseased segment of bowel. It is likely that this study will show a further improvement in outcomes and result in less pain and a shorter hospital stay for patients. You can watch some of the important technical aspects of performing a natural orifice specimen extraction for colon cancer via this link:
In May 2013 I broadened the range of natural orifice surgery available to patients at Colchester by performing the first radical rectal cancer resection (total mesorectal excision) through a transanal port. You can watch some of the important technical aspects of performing a rectal cancer excision through the anal canal via this link:
I have now established one of the world's first training courses for transanal total mesorectal excision for senior surgeons and this has allowed many other surgeons to pass on the benefits of this procedure.