·	The main symptoms of bowel cancer are change in bowel habit, rectal bleeding, anaemia (loss of blood), and weight loss.  Rectal bleeding is the most common  symptom which people see their GP for, as it is a symptom of other conditions such as haemorrhoids and diverticular disease.

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Mr Ockrim has a preferred interest in laparoscopic (keyhole) surgery.  Yeovil District Hospital is the Laparoscopic Centre of Excellence and has developed the care pathway known as the Enhanced Recovery Programme.  Yeovil was the first centre in the UK to use this pathway, headed by Mr Robin Kennedy, who has now left Yeovil to work at a specialist centre in London.

·	A power point presentation was given, which showed pictures of the theatres at Yeovil Hospital, and the instruments, which are used during surgery

·	During laparoscopic surgery, ports are used to make holes in the patients’ abdomen.  The abdomen is then inflated with CO2 so that the procedure can be performed through the ports.

·	Mr Ockrim stated that patient safety is paramount during surgery and that patients are actually strapped down onto the theatre table using belts and side supports, so that the table can be tipped as necessary, ensuring gravity can be used effectively during surgery.

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The main principle of surgery is to remove the tumour, and also the blood supply to the tumour, as well as any lymph glands attached.  Lymph glands are used to return excess fluid in the body back to the heart and they also gate-keep infection.  They are removed as cancer could be spread through the lymph system to other parts of the body.

·	A film was shown of a laparoscopic procedure taking place.  Mr Ockrim talked through this film, and explained that if keyhole surgery was not appropriate, it could always be converted to open surgery.

·	The benefits of laparoscopic surgery are reduced blood loss during surgery, an excellent view of operation site, a faster post-operative recovery time (usually weeks rather than months), and less chance of complications such as incisional hernias etc.

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There has been resistance in the past from some people for using laparoscopic surgery.  This is because it usually takes a long time to train a surgeon, and laparoscopic surgery is a new technique which would mean surgeons having to retrain.  Only approximately 10% of surgery worldwide is performed laparoscopically.  Several trials have been performed internationally to check that it is a safe and applicable technique – one trial in the UK had twelve centres taking part, one of which was Yeovil Hospital, and was called the CLASSIC trial.  Alongside this, another trial was also carried out in America.  This was called the COLOR trial.  Both trials have shown laparoscopic surgery is safe, although there is no proof that it is a better technique or gives better results than open surgery.