CaRi-heart technology
Revolutionary new technology to assess the risk of a serious heart condition or heart attack – many years before anything happens.
The consultant bringing together dual expertise in heart and lung surgery
Cardiothoracic surgeon Mr David Lawrence initially applied to study engineering at university. His love of finding solutions to practical problems - his family know him to be a keen DIY enthusiast - led to his choice. But then he changed his mind. He wondered, could he mend humans instead?
“I decided I’d rather repair people,” he smiles. And four years into his medical studies, he decided operating on the heart and lungs seemed the most transformative repair of all. “You can make a patient’s life so much better,” he explains.
Twenty years after he became a consultant, it is the people he mends, his patients, who remain his motivation. “I’ve never seen what I do as work,” he explains. “I get to know these patients and their families, and many keep in touch.”
The Kings College London-trained surgeon, who has contributed to some 100 medical publications, and whose pioneering research has helped to determine guidelines for national lung cancer screening and the overall treatment of the disease, operates at The Harley Street Clinic, part of HCA Healthcare UK.
His combined expertise in the fields of both heart (cardiac) and lung (thoracic) surgery brings a unique quality to the excellence of care the hospital can provide. The majority of surgeons only perform within one discipline.
"There are vanishingly few private hospitals that offer a surgeon who can do both. But disease does not recognise the boundary between the heart and lungs. They are intricately related and to be able to do both is a very useful skill."
He explains: “I’ve been asked to assist thoracic surgeons in cases where tumours have crossed the boundary into cardiac territory, and where there was a bleed towards the heart after a lung operation. There are a good number of cases where lung tumours invade the area of the heart. I am comfortable operating on the two areas in one sitting.”
What allows Mr Lawrence to maintain both disciplines is the sheer volume of his work. He is one of the most prolific thoracic surgeons in the country, performing around 400 lung procedures a year, and simultaneously works relentlessly in the cardiac field, performing over 150 operations annually. Across his two-decade career he estimates performing 5,000 cardiac operations and “several thousand” lung operations. Hundreds of each have been performed at The Harley Street Clinic.
Within cardiac surgery Mr Lawrence works across all areas, including bypass and valvular surgery, with a special interest in mitral valve repair surgery, in which the valve between the left heart chambers is made to fully close again or stop leaking. He often uses a standard incision method, although can also perform minimally invasive surgery through a smaller incision when it is better suited to the patient, using an endoscope, a flexible tube containing a small camera, to guide him.
He says one key benefit of the hospital is how its specialist, focused teams work so closely.
"Because we have a small team to communicate with, and we’re very familiar with each other’s work, we can get things right quickly or review things at speed. We can operate very swiftly, sometimes within 24 hours if necessary."
This stands for his thoracic work, too. Within this field he regularly works with cancer patients, removing tumours. “Lung cancer is one of the most common cancers in the UK and, left untreated, has one of the highest mortality rates. Surgery offers the best outcome,” he explains.
Advances within oncology mean tumours which have spread outside the chest cavity are generally now removed. Previously, they tended not to be because there was no means to treat the escaped cancer cells. Today, chemotherapy, immunotherapy, which uses the patient’s own immune system to target cancer cells, and radiotherapy, can be used, which means he can perform more complex operations on more complex tumours.
He regularly implements minimally invasive surgery. “A telescope is used for vision, alongside tools which may go through an incision of four or five millimetres,” he explains. “The length of a patient’s stay after the operation is shorter, and their recovery quicker. They usually stay three to four days and need simple painkillers for two to three weeks.”
At The Wellington Hospital, also part of HCA Healthcare UK, Mr Lawrence can perform this surgery using the da Vinci robot, a flexible system which accesses the chest with nimble tools. The surgeon controls the machine away from the patient while viewing the procedure on a screen.
Although an operation using the robot may take longer - usually up to 90 minutes compared to manual, minimally invasive procedures often taking under an hour - it can benefit patients with complex cases. “The robot is particularly good for tumours that are very deep within the chest and in difficult to access places,” he says. “Then robotic surgery has an advantage because of the dexterity of its instruments. Within HCA UK we can tailor the approach we take.”
What is vital to providing excellent care is how he and the oncology team work closely to target a patient plan. Numerous treatment methods will be discussed for both before and after surgery.
"Preoperative chemotherapy and immunotherapy are proving in some patients to provide a 75% increase in survival. The combined approach has a massive impact. Our multidisciplinary team, including surgeons, oncologists, anaesthetists and so on, has weekly meetings. We are not each treating our bit, but treating the patient as a whole."
Mr Lawrence, an honorary associate clinical professor at University College London (UCL), is also involved in cutting edge trials at The Harley Street Clinic, in association with the world-leading Sarah Cannon Research Institute (SCRI), part of the research arm of HCA UK’s global cancer institute, a dedicated clinical trials centre.
This has included harvesting cancer cells from patient tumours aimed at developing cellular-based patient immunity treatments. Also, the testing of tumours to pinpoint and understand their individual sensitivity to different types of chemotherapy. This has been used on some patients, although is not yet regularly implemented. “It has meant patients have not been given drugs that aren’t going to work,” explains Mr Lawrence.
Mr Lawrence believes the personalisation of patient care is key to The Harley Street Clinic’s excellent results.
"We carry out very well thought out, planned procedures, at the absolute cutting edge of current strategies, to give the patient the best outcome."
It is the patient who remains his motivation, and he would never want to offer them anything less.
The Harley Street Clinic, part of HCA Healthcare UK, is a hospital in central London offering a wide range of cutting-edge treatments and services in buildings steeped in history. We are recognised as a cardiac centre of excellence and offer access to a range of specialist centres.
Mr David Lawrence is a Consultant Cardiothoracic Surgeon with nearly two decades of experience in the treatment and diagnosis of cardiothoracic conditions including lung cancer and mitral valve issues. He sees private patients at The Harley Street Clinic.