Beyond the uniform: Mr Alfred Cutner


In the latest in a series about the people who make King Edward VII’s Hospital tick, we meet consultant gynaecologist Mr Alfred Cutner

Endometriosis can be an extremely painful condition. The tissue that makes up the lining of the womb also develops in other areas of the abdominal cavity, and this means that when a woman has her period, she bleeds outside the womb as well, which may cause endometriosis to develop. The condition can result in cysts, fibrosis and nodular areas, which can cause painful periods, pain during sexual intercourse, when opening the bowels or when passing urine.

On rare occasions, the endometriosis can lead to obstructions to the bowel or to the outflow of the kidney. It can also result in fertility issues. We don’t yet fully understand what triggers the condition, but it is hormone related. There is probably a predisposition to endometriosis in some women.

Things are different now
Fifteen years ago, a woman with endometriosis may have undergone a laparoscopy to diagnose it, then been prescribed pain relief and given the contraceptive pill to stop her ovulating: a cycle that would repeat several times.

But things are very different now. There have been real advances in the technology used in laparoscopic surgery— a form of keyhole surgery in which the surgeon uses a high resolution monitor to provide a magnified and enhanced view of the area. But it is not a one person show: it involves the surgeon, the surgeon assistant and the nurse assistant.

In our integrated theatres at King Edward VII’s Hospital, each member of the team has their own monitor, so they operate in the most comfortable environment. It means that there is less movement around the theatre, creating a calmer, more relaxed atmosphere.

The instruments we now use are also much better than ever before. They work by applying either heat or electricity to cut away or destroy unwanted tissue. Technological advances have significantly reduced the risk of electrical or heat spread. This makes them more efficient and haemostatic, which means that any bleeding caused during the operation stops more quickly.

Today, we would hope to bring the patient in, carry out a laparoscopic operation to remove the endometriosis, and then sometimes prescribe maintenance therapy to help prevent reoccurrence. This means more effective treatment, fewer interventions and quicker recovery times than in the past.

A multidisciplinary approach
The British Society of Gynaecological Endoscopy (BSGE) has created a model for endometriosis centres, based around a multidisciplinary approach. The core aspect of this is the creation of a team of clinicians dedicated to looking after all aspects of patient care. This approach is in the DNA of King Edward VII’s Hospital, and the facility we have set up here is the only approved private BSGE endometriosis centre in London.

When a patient has been referred, I will be the first person she sees to assess the situation, but our nurse specialist, Renata Marucha, will have been involved from the early stages. She will talk the patient through some of the wider issues and help us design a more holistic treatment path, taking into account the patient’s needs. Renata will also be there as a point of contact throughout the treatment, during what can often be a confusing and worrying time.

If the surgery involves the bowel to a significant degree, Mr Alastair Windsor, the colorectal surgeon, will become involved, and where there is a bladder or ureteric aspect, urologist Mr Darren Smith will be called in. Sometimes after their treatment a patient may have some residual pain, in which case Professor Andrew Baranowski, our pain management specialist, will join the team. The key thing is that our approach sees the whole team working together to provide the very best patient care.

One of the real satisfactions of our work comes from the fact that we tend to see women at the severe end of the endometriosis spectrum, who may have suffered a great deal for many years. When you see them on a follow-up visit, pain free, happy and functioning well, that is very rewarding.

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