14 December 2021

Despite wanting to be a colorectal surgeon ever since training under Royal College of Surgeons President Professor Neil Mortensen in Oxford and a stint at a centre of excellence in Ohio, it’s probably fair to say that Nicola wasn’t exactly rushing to be at the front of the queue when it came to taking part in the popular BBC TV documentary series: Surgeons: At the Edge of Life.

‘Alex [Colquhoun, a urologist and her regular surgical partner] and I were initially reticent about appearing on camera and it did take a little persuading to get us to sign up,’ explains Nicola. ‘Alex has a leadership role within the Trust [Cambridge University Hospitals] and she was clear about the benefits of our involvement so that got me over the line.’

‘But we’re both very glad we did. Our main reason for taking part was demonstrating diversity – we wanted to showcase more women surgeons at work and there hadn’t been that many previously seen on the series – so we both felt we had a duty to help bring on the next generation.’

In Episode 4 of Series 4 which aired last week, we saw Nicola and Alex performing a ‘total pelvic exenteration,’ which in lay terms is the removal of all the organs in the pelvis.

If you haven’t seen the episode, Nicola and Alex were operating as a team on bowel cancer patient Stuart. For Stuart, who had already had surgery, chemotherapy and radiotherapy for his cancer, it meant he would need to lose his rectum, bladder, prostate gland and surrounding lymph nodes, as well as having a large tumour on his kidney taken out, an operation that was performed by a separate team of surgeons on the same day.

Needless to say, a total pelvic exenteration while life-saving is also profoundly life-changing. It left Stuart with two permanent stomas; one for waste from his bowel and the other for urine, and the complete loss of his sexual function.

Although the operation took place over two gruelling days, it was actually technically less challenging than some other surgeries Nicola regularly performs.

She comments:

“When we’re trying to save organs like the bladder or the rectum it can be much more challenging. For the whole team of medics involved it was very important we save as much of Stuart’s kidney as possible because there is a long-term risk of kidney failure after this sort of surgery. Stuart still had around two thirds of functioning kidney left after the tumour had been removed. This was a very good outcome for him and us.”

While still a very complicated procedure, it was far from the first time that Nicola had performed this type of operation.

‘We do around 15 extensive resections every year, many with Alex, and I must have done well over a hundred in my career. But it’s important to stress that every operation is different, and they all take extremely careful planning. I think it came over in the film that Alex and I spend many hours meticulously planning our operations, which was illustrated by the steps you saw listed on the whiteboard in the theatre. We’ve had a lot comments about that whiteboard after the episode went out.’

As a reluctant on-screen surgeon, how did having cameras in the operating theatre change her normal theatre routines and did they make her self-conscious?

‘A lot of the cameras are remotely operated from a gantry directly above the operating tables, so most of the time we could work as usual. That said, there was always one, sometimes two, camera operators in the theatre at any one time, and occasionally we did have to shift positions to give them a better view of what we were doing.

‘You might not have noticed it, but we were also wearing headcams. Mine was initially strapped on with a headband, but after a couple of hours this became really uncomfortable, so I switched to a clip-on version which was a lot easier to deal with.’

‘One thing we had to constantly remember was that we were wearing microphones that were hidden under our scrubs. This meant it could’ve been quite easy to forget about them when leaving theatre for a break. It was also quite odd to hear how loudly we spoke. Alex and I speak quite softly to each other while operating, but our voices really sounded loud during the broadcast.’

‘It also felt very strange to watch the film and see the focus on us as Consultants when actually we are part of a much bigger team when operating on patients like Stuart, including specialist nurses, anaesthetists, theatre staff and trainees. It was a pity that it did not come through that a lot of surgical training happened throughout the case. With no training today, there will be no surgeons tomorrow, so it is a really important part of our role as surgeons.’

And were there other differences to normal routines from having the film crew and production team on site?

‘There were. One major thing is the amount of time filming takes. This wouldn’t be obvious to anyone except the participants, but simple things like being filmed walking down a corridor often took three or four shots. My talking heads pieces to camera, which I must admit I found difficult, also took a few times each to film.

‘There were also a lot of other people around out of shot to get used to, such as producers with clipboards getting permissions signed on the spot by other patients and colleagues agreeing to appear on screen. Outside theatre, we had a director permanently in situ watching the live feeds, and then feeding back comments and questions to their team.’

Aside from the inconveniences during filming, there were other benefits from taking part in the series. She is keen to talk about the differences Bowel Research UK’s research programme has and will make to her job, in particular the bowel disease projects it is funding.

‘One is our IMPACT study which is ready to launch internationally next year (2022). The IMPACT study is about improving the management of patients with advanced colorectal tumours, and is running alongside a separate quality of life study Bowel Research UK is also funding for patients with recurrent bowel cancer.’

Nicola is also keen to lend her support to Addenbrooke’s Charitable Trust’s bid to raise money to buy a new robot for the hospital.

Currently the Trust has only one robot dedicated to kidney, bladder, and prostate cancer patients. ACT’s appeal is helping to fund another surgical robot, revolutionising patient care across six specialities in the hospital including urology, gynae-oncology, gynaecology, lower GI (gastrointestinal tract), ENT (ear, nose and throat) and HPB (Hepato-Pancreatico-Biliary – diseases of the liver, pancreas and biliary tree) and improving outcomes for many more patients every year. She would love any readers of this piece to donate to both organisations and support their work.

And how’s it been since the episode went out? We leave the last word to Nicola.

‘People have been incredibly kind; we’ve had some very encouraging comments. It’s been lovely to have such a positive reaction. Most importantly, Stuart is doing well, has returned to his family life and is currently cancer free. His courage in allowing his operation to be filmed to help others is simply amazing.”