| Refreshingly different |
| Probus Surgical Centre has been providing NHS specialist day case surgery under local anaesthetic in a primary healthcare setting since 1995. The centre, which undertakes approx 3,000 procedures a year, is colocated with Probus GP Surgery near Truro offering a lowkey, relaxed environment for surgical patients. |
| Click here to visit the GP practice's website, Probus and Grampound Surgeries (Dr Round & Partners). |
| Patient care is paramount |
| The way we look after our patients reflects the centre’s ethos that patient care is our paramount consideration. |
| Just because care is provided in a GP surgery setting, doesn't mean that the quality of care is sacrificed. The operations performed at Probus (and the satellite centre at Penzance) are low risk procedures which can be safely and effectively performed under local anaesthetic. See the low infection rates and high patient satisfaction as shown in our 'Quality of Care' section. |
| A great team |
| Our team of surgeons and nursing staff pride themselves in providing a personal service to all our patients, giving thorough aftercare advice and information on how to easily contact us if there are any queries. This advice is also available on this website by visiting the relevant procedure page or clicking on the right hand menu. |
| Kay and Sandra provide the essential and valuable administrative backup to the clinical team, handling patient appointments and medical correspondence as well as assisting patients and GPs on the telephone and other vital administrative support duties. |
| Innovation in primary care |
| Mr Raj Dhumale and Dr John Tisdale, both of whom have won national awards for their innovation in primary care, lead the clinical team providing this pioneering service. In association with three further surgeons and the surgical nursing team, they have enabled the appropriate transfer of a significant proportion of surgical work from secondary (hospital) care to primary care and now undertake 40% of the county’s local anaesthetic hernia operations as well as most carpal tunnel and vasectomy procedures. Other specialities include skin surgery and other hand surgery (such as trigger finger etc). |
| The Centre works closely with the local Primary Care Trust and NHS Hospital Trust to ensure that the development of services is appropriate and supportive of current health plans. |
| The quality of the service is monitored closely with high patient satisfaction, whilst the cost to the healthcare budgets in Cornwall is significantly less than elsewhere nationally. It is estimated that approximately £400,000 of the Cornish healthcare budget was saved in the financial year 2005/6 through the use of the Centre’s services. |
| National Demonstration Site |
| In Autumn 2006 the national importance of this service was recognised by the Department of Health as a National Demonstration Site, as part of the Care Closer to Home initiative, headed by the (then) Health Minister, Lord Warner. The Probus site is one of only five selected across the country for general surgery. |
| “We are thrilled to have received this recognition of the services now provided at Probus” said Mr Dhumale, “..which is fantastic for the staff who work so hard to maintain our high standards with a friendly welcome. The service is really a win:win scenario where patients receive high quality care in a relaxed environment, while the healthcare economy in Cornwall pays a lower than average price for it. We are also hoping to expand to provide urological and pigmented skin lesion services so the future is very exciting.” |
| Procedures |
| Probus Surgical Centre has been providing NHS specialist day case surgery under local anaesthetic in a primary healthcare setting since 1995. The centre, which undertakes approx 3,000 procedures a year, is colocated with Probus GP Surgery near Truro offering a lowkey, relaxed environment for our surgical patients. |
| In Autumn 2006, the national importance of this service was recognised by the Department of Health as a National Demonstration Site, as part of the Care Closer to Home initiative, headed by the (then) Health Minister, Lord Warner. The Probus site is one of only five selected across the country for general surgery. |
| A full list of our procedures can be viewed here, many of which are described in more detail under the headings in this section with links to the after care that we recommend. |
| If you have any questions that are not answered here, please do not hesitate to contact us. |
| Foot surgery |
| Ingrown toenail |
| When the toenail no longer fits inside the side groove, an ingrown toenail occurs. As the name suggests, the nail grows inwards and is extremely painful. |
| The ingrown nail can be surgically removed. The toe is numbed and the nail is cut to create a straighter edge in order for it to grow properly. As a result, the cells underneath the affected nail will attempt to grow a new one so they have to be destroyed. This will result in the nail being thinner than usual. |
| For ingrown toenail removal aftercare, click here. |
| Ganglion |
| A ganglion is a small cyst that feels and looks like a smooth lump under the skin. It is very common and is found near joints or tendons. The most common site is the back of the wrist but it may also occur in other areas such as the front of the wrist or the foot. |
| Many ganglia disappear on their own. For those that do not they can be aspirated (using a needle to draw out the material after numbing the skin) or, for recurring ganglia, surgery can be performed. The excision is performed under a local anaesthetic at Probus Surgical Centre. An incision at least as wide as the lump is made into the skin and the ganglion is then removed. |
| Circumcision |
| Adult circumcision, or removal of the foreskin, may be performed for religious, cultural or personal reasons. There are also certain medical reasons for circumcision to be performed. These include recurrent infections and inflammation or more commonly tightness of the foreskin known as phimosis. |
| Phimosis can cause problems passing urine, difficulty retracting the foreskin, pain on erection or discomfort during intercourse. |
| Circumcision involves removing the foreskin using local anaesthesia. Possible alternatives to surgery may include personal hygiene and antibiotic or steroid creams. |
| The technique involves injecting a quantity of local anaesthetic around the root of the penis. This will render the area numb for the surgery to take place. The foreskin can then be excised and the wound is closed with self dissolving stitches. These may take up to 2 weeks to disappear. A simple dressing is applied that can be removed after 24 hours. For details on post circumcision care, click here. |
| Vasectomy |
| The "vas deferens" carries sperm from the testes (where the sperm is made) to the penis. A vasectomy involves cutting the vas deferens so that the link is broken. |
| Most men decide to have a vasectomy for reasons relating to birth control. They no longer have to worry about contraception and a vasectomy is more effective than female sterilization. |
| The operation is usually done under a local anaesthetic which is injected just under the scrotum on either side. Once the skin is numb, a small incision will be made to gain access to the vas deferens. The cut is then made and the two ends are tied. The skin is then either stitched or stuck back together with tape. |
| There will be some discomfort after the surgery but this usually only lasts for a few days. |
| For full details on postvasectomy care, click here. |
| Hydrocele |
| A hydrocele is a collection of fluid around the testicle in the scrotum (the bag that holds your testicles). It is in no way dangerous and usually requires no treatment: many men have small hydroceles they are not even aware of. However sometimes it may reach a size where it becomes uncomfortable or awkward and in this case surgical treatment is best. Drainage of the fluid can be done but it always comes back again. |
| The operation is performed under local anaesthetic and a technique called the modified Jaboulay procedure is used. Essentially this involves an incision being made on the scrotum and the hydrocele being obliterated by folding it back around the testicle. This is a little like turning a bag inside out on itself. You will have some stitches in your scrotum which will be dissolving. |
| What is a Hernia? |
| A hernia is an abnormal protrusion (bulge) caused by a weakness in the muscle wall of the abdomen. If there is a weak point in the muscles or ligaments of the abdomen, part of the intestines push through allowing you to feel a soft lump under the skin. |
| The most common hernias, usually in men, appear in the groin as the groin is often the weakest point of the abdomen. However, hernias can be found sometimes at other sites eg. next to the navel (belly button or "umbilicus") or under an old operation scar. |
| Symptoms of a Hernia |
| Sometimes hernias are noticed after a strain, for example, lifting a heavy object or after a period of intense physical activity. Sometimes they come on for no good reason and a small lump may be noticed, usually in the groin area. Usually, at first, the lump can be pushed back, but may pop out after straining again coughing is a common strain that causes this. They are not usually painful, but many people feel an ache over a hernia. In time they might become bigger as the gap in their muscle or ligament tissue becomes larger. Sometimes in men they track down into the scrotum. |
| Inguinal or Femoral Hernia |
| Above the groin is a small hole in the muscle wall of the abdomen where arteries and veins pass to the testicle. A weakness may be caused in this area through heavy lifting or some other strain. This results in a part of the bowel bulging (called an inguinal or femoral hernia). You will feel discomfort when coughing, standing for long periods, or carrying out some vigorous activity. |
| Umbilical Hernia |
| A weakness (which will have been present since birth) exists in the navel area in the region where blood vessels of the the umbilical cord disappear as a baby, leaving just the dimpled bellybutton scar. The weakness or gap in the muscle may persist and hernias can occur in this area of weakness at any time from birth through to late adulthood. As the weakness progressively bulges and opens, it allows abdominal contents to protrude through. In addition to some deformity in the navel area and an associated bulge, the signs and symptoms of a hernia include pain at or around the navel area. |
| In general, umbilical hernias should be repaired though the risks of it causing a more serious problem (such as obstruction or strangulation of bowel or abdominal contents) are rare. Pain and discomfort in the navel region after strenuous activity as well as increasing hernia size are some of the usual reasons patients undergo a hernia repair procedure. |
| Hernia Repair at Probus Surgical Centre |
| Hernia repairs can be undertaken under general or local anaesthetic but at Probus Surgical Centre, all procedures are performed under local anaesthetic which is injected into the area of the hernia site. The operation involves an incision in the affected area and the hernia is pushed back. The weak spot is then reinforced with a patch of synthetic mesh. This is sewn over the area and the wound is normally closed with stitches or glue/staples. The procedure normally lasts between 30 and 45 minutes. |
| Trigger finger/thumb release |
| A trigger finger or thumb is locked in position after being flexed making it difficult to straighten. It can be straightened out by using the other hand to pull on it at which point a 'click' is often heard. There may also be some pain and swelling around the base of the finger/thumb. It is a condition which is caused by a thickening of the tendon there is a mismatch between the size of the tendon and its sheath making it difficult for the tendon to pass through a pulley in the palm of the hand. |
| The procedure is performed under local anaesthetic and through the use of a tourniquet on the upper arm which numbs the site. A small incision is made at the base of the finger/thumb and the tendon sheath is expanded. The wound is then closed with stitches that need to be removed subsequently. The hand is then bandaged and rested in a sling to minimise swelling. The whole procedure takes approximately 3045 minutes with the operation itself taking 15 minutes. |
| Carpal tunnel release |
| Carpal tunnel syndrome is quite common and occurs when there is too much pressure on a nerve in the wrist and it becomes trapped. |
| In particularly bad situations, an injection or surgery will be performed to improve the problem. |
| If surgery is required, local anaesthetic is injected and a cut is made in the wrist which allows access to the carpal tunnel. The surgery involves cutting the carpal ligament which will then make more space for the nerves and tendons within the carpal tunnel. |
| For carpal tunnel release after care, click here. |
| Dupuytren's / Fasciectomy |
| Dupuytren’s Contracture is a fairly common disorder of the fingers. It most often affects the ring or little finger, sometimes both, and often in both hands. The disorder may occur suddenly but more commonly progresses slowly over a period of years. The disease usually doesn’t cause symptoms until after the age of 40. |
| What Part of the Hand is Affected? |
| The palmar fascia lies under the skin on the palm of the hands and fingers. This fascia is a thin sheet of connective tissue shaped somewhat like a triangle. It covers the tendons of the palm of the hand and holds them in place. It also prevents the fingers from bending too far backward when pressure is placed against the front of the fingers. The fascia separates into thin bands of tissue at the fingers. These bands continue into the fingers where they wrap around the joints and bones. Dupuytren’s Contracture forms when the palmar fascia tightens, causing the fingers to bend. The condition commonly first shows up as a thick nodule (knob) or a short cord in the palm of the hand, just below the ring finger. More nodules form and the tissues thicken and shorten until the finger cannot be fully straightened. |
| What is the Goal of Surgery? |
| Many cases of Dupuytren’s Contracture progress to the point where surgery is needed. The goal of surgery is to remove the diseased fascia, allowing the finger to straighten out again. By removing the tight cords and fascia, the tension on the finger is released. In some cases, grafting extra skin in the area close to the incision gives the finger more flexibility to straighten. |
| Ganglion |
| A ganglion is a small cyst that feels and looks like a smooth lump under the skin. It is very common and is found near joints or tendons. The most common site is the back of the wrist but it may also occur in other areas such as the front of the wrist or the foot. |
| Many ganglia disappear on their own. For those that do not they can be aspirated (using a needle to draw out the material after numbing the skin) or, for recurring ganglia, surgery can be performed. The excision is performed under a local anaesthetic at Probus Surgical Centre. An incision at least as wide as the lump is made into the skin and the ganglion is then removed. |
| A variety of skin procedures can be carried out at Probus Surgical Centre, including: |
| Lowrisk Basal Cell Carcinoma ¹ |
| Benign Skin Lesions |
| Lipoma large and small |
| Sebaceous Cysts |
| Lumps & Bumps |
| Abscesses |
| ¹ Low risk BCC includes small, superficial tumours at sites away from the central face and ears and excludes BCC’s with aggressive histology such as morphoeic BCC. |
| If you have any queries over what is appropriate to be referred to Probus (as a referring GP), or if you wish to know whether Probus is an option for you (as a patient). |
| Haemorrhoids, Chalazion and NasoLacrimal Duct Washout |
| Haemorrhoids (Banding/Injection) |
| There is a network of small veins (blood vessels) in the lining of the back passage (anus and lower rectum). It is thought that these veins become wider and swollen with blood if the pressure in and around them is increased. The veins and the overlying tissue may then form into one or more small swellings called haemorrhoids. |
| About half the people in the UK develop one or more haemorrhoids at some stage. Many develop for no apparent reason. |
| After examination, the surgeon will decide whether treatment would be helpful. If so, the haemorrhoid may be injected with a hardening agent that triggers the creation of scar tissue in the base of the piles. Injections can be uncomfortable but not painful. Alternatively, 'banding' of the haemorrhoids may be recommended which effectively involves a 'rubber band' being placed at the base of the haemorrhoid using a device. This cuts off the blood supply to the haemorrhoid which then 'dies' after a few days. |
| Chalazion cyst |
| A chalazion cyst is a small fluidfilled sac in the edge of the eyelid. Persistent cases may require chalazion surgery. |
| The operation is done under a local anaesthetic which is administered via an injection into the eyelid. Anaesthetic drops are also used. An incision can be made in the back of the eyelid to remove it. The area is the pressed down to stop any bleeding and the hole will heal up without needing stitches. |
| For chalazion surgery after care, click here. |
| NasoLacrimal Duct Washout |
| Appointments |
| Our systems are flexible and our administration team will always endeavour to make appointments at a time and date to suit you. |
| Access is easy with plenty of free patient parking. Disabled patients will find designated parking bays and easy access within our onestorey building. |
| The Centre is only approx 8 miles away from either Truro or St Austell main line train stations and is also well served by local bus routes. |
| Paying for treatment |
| Probus Surgical Centre is an NHS facility committed to the underlying principle that treatment is free to patients. Over 90% of the work undertaken at the centre is provided under the NHS. |
| However, we recognise that some patients may choose to pay privately for their procedure and such treatment is available directly or via medical insurance. Probus Surgical Centre is recognised by a number of UK private medical insurance companies and we recommend that you confirm your level of cover with your insurer before arranging treatment. For those without insurance cover, our fees are transparently fixed upfront so you will always know what you will need to pay with no hidden extras. Payment can be taken by cheque or credit/debit card (in person sorry no American Express). |
| Charges are not inflated for private patients and represent the true cost of undertaking the procedures. The Primary Care Trust and GP Practices who refer patients to us under the NHS can also be sure that they are receiving a high quality and valueformoney service. |
| Probus Surgical Centre prides itself in its friendly, relaxed approach with patients. Our team of surgeons, nurses and administrative support staff are all committed to helping to make each patient's visit as comfortable and stress-free as possible. |
| The team's commitment to your care does not end when you walk out the door. |
| In addition to the written aftercare sheet they will have given you already, patients are encouraged to pick up the phone and raise any queries or concerns they may have after their procedure - a doctor or member of the nursing team will always be available or will ring you back that day. After hernia procedures our nurses will specifically telephone you later that day to see how you are and offer any further advice and guidance. |
| Specific information on the background and experience of our individual surgeons can be found by clicking on their name in the left menu. |
| Quality of Care is Paramount |
| The Probus team are committed to providing a high quality of service in primary care. It is our firm belief that low-risk operations performed under local anaesthetic can be effectively carried out in primary care settings such as that provided at Probus (and in our satellite centre at Penzance). |
| That is why Probus has an established programme of patient satisfaction surveys and procedures in place to record and act upon any patient's care which results in some form of complication or infection. The following pages (under this section on the left hand menu) give more information on these areas but if you would like to feedback any comments you may have of your personal experience of Probus Surgical Centre we would be delighted to hear from you. |
| We are happy to receive referrals for any of the procedures listed here. In addition, please read the following referral guidelines:- |
| MRSA - Due to the limited number of theatres at Probus, we cannot accept patients who are known to carry MRSA. |
| Transport - As ALL of our surgery is performed as a day-case using local anaesthesia, it is essential that patients have transport to and from the surgical centre |
| Local Anaesthetic Suitability – patients need to be generally fit enough to undergo the proposed procedure under LA. |
| Chronic Illness - Most patients with chronic stable medical conditions will be acceptable. |
| Warfarin - Patients on warfarin are also accepted as long as there is no barrier to stopping their anticoagulation therapy for a few days pre-operatively. |
| Under 16s - We are unable to take referrals for children under 16 |
| Mental Health – We are unable to take referrals for patients with unstable psychiatric/anxiety states. |
| Allergies - Previous severe allergy to local anesthetic agents would also be a contra-indication. |
| Disabilities/Access - please include any special needs the patient may have in your referral letter so that we may make necessary preparation to meet their needs. Probus Surgical Centre and the satellite centre at Morrab Surgery Penzance are both wheelchair friendly. |
| Our contact details |
| Probus Surgical Centre |
| Tregony Road |
| Probus |
| Nr Truro TR2 4JZ |
| Tel: 01726 885104 |
| Fax: 01726 883945 |
| Email: pscenquiries@probus.cornwall.nhs.uk |