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It is just after 11:30 on Wednesday 26 July and Dr Alana Heynes, a general surgeon at Groote Schuur Hospital and a team of specialised surgeons are performing a distal pancreatectomy and splenectomy in the theatre to remove a pancreatic neuroendocrine tumour from a patient.
On the day, a group of journalists had the opportunity to spend a day in the life of three surgeons at the Red Cross, Tygerberg and Groote Schuur hospitals.
About 55 000 surgeries are executed between these three hospitals annually.
The friendly 36-year-old doctor leaves the theatre room to greet the group of journalists that will be spending some time with her in the theatre as she helps with the operation of a 46-year-old patient.
“This is a rare type of tumour,” she tells the reporters as she explains the dos and don’ts in the theatre.
Bright lights, a robotic machine, cameras, medical equipment and a group of dedicated staff hard at work were the scene when Heynes opened the theatre doors. There is silence in the theatre. The only conversation is between the four surgeons as they discuss and glance at the camera screen every few minutes to best decide how to remove the tumour.
“We have it, it’s out,” exclaims one of the surgeons as they remove a bloody spleen, parts of the pancreas and the tumour.
The operation lasted just over three hours.
For the group of journalists, this was a fascinating experience. But for Heynes it was just another one of the many operations she was able to complete in her four years as a registrar in general surgery.
“I chose general surgery for various reasons. I love the practical aspect of the job; general surgery provides new challenges daily. It is not just one skill set required. I love the theatre environment, the tradition and the formality of it all,” says Heynes.
But she says this wasn’t always the case.
“I disliked surgery as a medical student. I found it intimidating and technical and as a student, I didn’t think I would end up here. Someone gave me the opportunities to do some minor procedures as an intern and motivated me to continue surgery. And I love the theatre environment, the tradition and formality of it all. Doing your job one patient at a time.”
Explaining the technicalities of the operation, Heynes says: “The cancer that was removed was growing inside the pancreas. We covered that entire part of the pancreas as well as the spleen that was nearby. We also looked for a liver lesion which we didn’t find during the operation. So, we then proceeded to remove the spleen and parts of the pancreas.
“This is a very rare type of tumour. It was a laparoscopic case, which is minimally invasive. It is what we try and do these days, keyhole surgery where we can. The patients recover much better with laparoscopic surgery. We have skilled surgeons as well who are well trained in laparoscopic techniques and minimally invasive techniques as well.”
According to Heynes, the operation was successful and the patient should be discharged soon. She says the benefit of laparoscopic surgery is that the patient will experience less pain after the operation.
Heynes says knowing that a surgery was successful is always worth celebrating. “Removing a big sarcoma from patients who survive afterwards is always victory. We celebrate every case that is a victory. You see the patient in the ward afterwards smiling and they are happy that they are able to go home at the end of the day with their problem fixed.
“It is the most satisfying thing to see a patient’s cancer is now out and she is cured from that cancer. To the patient it is a big deal and it’s really satisfying to us as well.”
When asked how she copes with every operation Heynes says: “It is difficult to hold on to a patient’s story when you are operating. When you are operating you are focussed on what you are doing and the task at hand. When it is a success, you celebrate in your own mind with the patient. But during the operation you separate yourself from and focus on the work.”
Heynes says working with a great team makes her job easier.
“Teamwork is essential in theatre. We have a variety of team members from anaesthetists to floor nurses and scrub sisters who all come together with a common goal.
“As surgeons, we all come with some experience. You can’t enter the general surgical registrar programme without surgical experience. We operate on general surgical conditions without seniors, depending on our skills level and you would do that with the help of junior staff.”
She says big surgeries or sub-speciality like the one they did on Wednesday are executed by senior staff.
“We wouldn’t do that as a general surgeon. In the operation room, we had Senior qualified surgeons who are sub-specialising in hepatobiliary. There was a visiting surgeon from Sweden and one of our senior sub-specialists that oversees everything.”
Like any other position, the doctor explains that her job does not come without challenges. “A few of the aspects I struggle most with are working in a resource-limited setting. Pre-Covid we already had a backlog of theatre cases and the pandemic has worsened the situation globally. We must prioritise the urgency of each case we do and deal with the patient’s frustration as well as our own when it comes to explaining this.”
Heynes explains that the future of surgery is ever-changing.
“AI (Artificial Intelligence) and Robotics will probably be a major factor in the fields where the need for surgery still exist such as acute and benign surgery, while advances in targeted oncological and immunotherapies will probably replace oncological surgery.”
When asked what still keeps her motivated, Heynes says: “With surgery, the improvement in quality of life is often significant and to be able to celebrate the wins with the patient is quite special.”
