10 Questions to ask to get the best liver and pancreas surgeon for you
1. Do you enjoy what you do and why?
This might seem like an odd question to ask your surgeon but most of us do our job because we love it. A passion for the vocation is what drives most of us to do our best. There are many aspects to being a liver/ pancreas (HPB) surgeon but the most important is the privilege of looking after people.
2. Where did you train and do you have a specialised fellowship in liver and pancreas surgery?
In order to become a specialist liver/ pancreas surgeon, your surgeon has had to complete medical school (4-6 years), then get registration from the Medical Council of New Zealand (2 years) (www.mcnz.co.nz) and then complete Surgical training (5-7 years) administered by the Royal Australasian College of Surgeons (www.racs.org) before doing a period of further specialisation in Liver/ Pancreas surgery (~ 2 years). It is these final years of subspecialist Fellowship training that qualifies a surgeon to be able to operate safely on the liver and pancreas. Most of us love talking about our “fellowship” so feel free to ask. At our rooms, you will also see some clues as to our locations of training!
3. Are you involved in teaching liver and pancreas surgery – to whom?
There are very few liver/ pancreas surgeons in NZ. Thus, it is our responsibility to teach this field to surgical trainees, medical students, doctors in the community and other colleagues in Nursing etc. Many of us also have formal roles in the University and Medical School.
4. Are you involved in research in liver and pancreas surgery – have you published your results?
The international expectation is that surgeons and units involved in liver/ pancreas surgery be transparent with their experience and outcomes. Our outcomes are on a public website (www.waitematadhb.govt.nz/hospitals-clinics/clinics-services/upper-gastrointestinal/ugi-hpb-team) and also published in the peer reviewed literature. Since the outcomes from liver and pancreas cancer are not as good as some other cancers, it is imperative that clinicians looking after people with these diseases are research active. As a result, we run an active research lab supervising PhD students, junior doctors and medical students.
5. What audit and quality improvement programs do you participate in?
Surgeons are expected to be reflective and honest as they engage in a process of constant self-improvement. This is both self-driven and a pre-requisite of most institutions. We undergo weekly audit of outcomes and work in a multi-disciplinary environment where every patient is discussed with all colleagues (not just surgeons) to ensure a balanced, personalised approach to care.
6. What is the most demanding part of the surgery and how do you manage it
Every operation has phases that can be anticipated as difficult. Despite this, due to the level of training and experience of your surgeon, most operations proceed completely uneventfully- akin to a flight. The most demanding part of surgery is when patients experience an unanticipated adverse outcome (a “complication”). All surgeons have patients who have complications and most of us judge our colleagues based not on whether they have complications (a statistical inevitability) but rather on how they manage these situations.
7. Can you tell me about the surgical and patient care team you work with?
The most important person in the operating theatre is always the patient. But it might surprise you to know that there may be many people (8-10 and sometimes more) in the operating theatre during your operation. The teams of people looking after you include Surgeons (including a qualified assistant), Anaesthetic teams and nursing teams. We work with the same people to ensure an experienced team that are familiar with one another.
8. How many liver and pancreas operations do you personally perform every year
There is good evidence in the international and national literature that liver and pancreas surgeons need to be performing these operations regularly to ensure the best possible outcomes. Moreover, the entire team and institution needs to be familiar with liver/ pancreas surgery. It is a reasonable expectation that your surgeon be performing these operations on a weekly/ fortnightly basis.
9. Do you practice both open and minimally invasive (laparoscopic and/or robotic) liver and pancreas surgery – which way would my operation best be performed
Liver/ Pancreas surgery can be performed via the traditional open (via a large incision) approach. This remains appropriate in many cases. However, laparoscopic and robotic (keyhole) approaches are often possible and lead to earlier recovery (less time in hospital, less time off work, less pain, shorter time before chemotherapy etc). It’s important to enquire whether a keyhole approach is possible and if not, important to enquire why not.
10. What can I expect in the days and weeks after surgery
After liver and pancreas surgery, recovery can be thought of as both in and out of hospital. Most people are in hospital for about a week unless they have a complication. Once out of hospital, recovery can be steady with ongoing improvements in diet, activity and energy levels. A good rule of thumb is to think of progress in terms of weeks rather than days.
