Minor Surgery on the NHS

GPs are ably assisted in theatre by our experiences Nurses and Health Care assistants.

All patients have a pre-op consultation with the operating GP first. If the doctor feels it necessary to operate the patient will be booked in to the minor ops clinic. The doctor will explain the procedure to the patient and why it is necessary. The patient will have the opportunity to ask any questions to reassure them about the procedure and when they are happy they will be asked to sign a consent form.

Most patients will be able to go about their normal business the following day but they are advised to ask somebody to drive them home.

All operations are performed under local anaesthetic (numbing of the affected area while the patient remains awake) and there is a recovery room for patients to rest for a while after having had their operation.

Procedures

At Thornhills Surgery we provide a wide range of surgical procedures, from simple excisions to complex operations such as carpal tunnel decompression. We are the largest surgical service provider in Maidstone and Weald district. Up until now patients referred to Thornhills have to be assessed by one of the GP surgeons prior to their operation. We appreciate that patients may have to travel long distances to Thornhills for their pre-operative assessment and to return on another date for the operation. This is time consuming and inconvenient for some patients. Therefore, as from May 2006, we will start to provide a ONE STOP MINOR SURGERY CLINIC for many cases. Patients will have to be referred to Thornhills Surgery by their own GP as usual. Once we receive the referral, we carefully select patients with a condition that could be treated in this clinic, patients will then be offered an appointment. During the appointment, the Patient will be assessed, consented and operated on.

Joint Injections

Joint injections or aspirations (taking fluid out of a joint) are usually performed under local anaesthesia. After the skin surface is thoroughly cleaned, the joint is entered with a needle attached to a syringe. At the point, either joint fluid can be obtained and sent for appropriate laboratory testing or medications can be injected into the joint space. This technique also applies to injections into a bursa or tendon to treat tendonitis and bursitis, respectively.

Ingrowing Toenails

For a recurrent ingrowing toenail, a doctor may need to remove a portion of your toenail along with the underlying tissue (nail bed) to prevent that part of your nail growing back.

To help prevent an ingrowing toenail:

Trim your toenails straight across. Don't curve your nails to match the shape of the front of your toe. If you have circulation problems in your feet from disorders such as diabetes or peripheral vascular disease, see a chiropodist regularly to have your nails professionally trimmed.

Keep toenails at a moderate length. Trim toenails so that they're even with the tips of your toes. If you trim your toenails too short, the pressure from your shoes on your toes' tissue may direct your nails to grow into the tissue.  

Wear shoes that fit properly. Shoes that place excessive pressure on your toes or pinch your toes may cause your nails to grown into surrounding tissue. If you have nerve impairment to you feet, you may not be able to sense if your shoes fit too tightly. Take care to buy and wear properly fitted shoes, preferably from a shoe store specialising in fitting shoes for people with foot problems. Wear protective footwear. If your work puts you at risk of injuring your toes, buy footwear such as steel-toed shows, which protect your toes.

Carpal Tunnel

The median nerve passes through a tight space at the wrist called the carpal tunnel - occasionally it becomes compressed in the tunnel causing pins and needles in the fingers, and pain which can extend up the forearm. Some settle with splinting, others with tablets, and others following a steroid injection into the tunnel itself. However, when symptoms persist despite three medical measures, it is necessary to de-compress the nerve surgically. This will offer the definitive sure to the condition.

The procedure will be done under local anaesthetic supplemented by a pre-medication injection of a mild sedative and analgesic, and the operation will take about 30 minutes in all. After the operation, patients will be kept in the recovery room for 30 - 45 minutes to recover. Patients will not be able to drive home, and therefore need to be accompanied home by a partner of a relative. Patients are usually advised to take two weeks off work following this operation.

Excision

This is a long and well established method of treating many conditions such as skin cancer, lipoma, sebaceous cyst, naevus. Primarily, skin is infiltrated with local anaesthetic to numb the operating site. Skin is then incised and the lesion is removed  and sent for histopathological examination. Wound is then closed by sutures (stitches). Sutures are usually removed by a Practice Nurse at your surgery within 5 to 14 days depending on the site of the wound. Most of the patients who undergo this procedure will be able to drive home on the same day unless specifically asked by the operating doctor otherwise. 

The majority of patients who have this procedure do not have a lot of time off work. However, it does depend on the type of work that the patient does and the site and size of the lesion.

Basal Cell Carcinoma

A basal cell carcinoma (aka Rodent Ulcer or BCC) is a type of skin tumour which is increasing in frequency in this country. It is thought to arise from previous repeated exposures to sever ultraviolet light causing sunburn up to forty years previously. They are locally invasive skin cancers (i.e. they do not spread to other parts of the body producing secondary tumours), but slowly grow, and if not treated, become larger and larger, slowly invading deeper tissues beneath the surface.

Small basal cell cancers can be treated in a various number of ways - some are excised surgically and the wound stitched, others are treated with radiotherapy, and others by removing with a steel spoon (curettage) and cauterising the base several times with a diathermy or electrocautery.

Whichever method is chosen depends on the site, size of the lesion. During the pre-op consultation our doctors will be able to advise you the appropriate type of treatment.

Electrocautery / Radiowave Surgery

Many warts, moles, naevi and keratoses can be removed with a scalpel or curette and the base cauterised with the electrocautery. Alternatively the mole can be removed entirely by radio-wave surgery from a high frequency electrosurgical unit. Radio-surgery is a new method of treating many skin lesions using high frequency radio-waves (4 million herz) which both cuts through the skin and also seels odd any small blood vessels simultaneously thus avoiding the need for any stitches, and in many cases give a neater scar. This tends to give superior cosmetic results to conventional surgical excision or electrocautery.