Mr Tom Routledge

Conditions
  • Comprehensive, compassionate expertise
  • Fast, accurate diagnosis
  • Clear guidance at every step
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Appointments

020 3457 6259

020 3457 6259

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Expert insight, guidance and reassurance

Thoracic conditions can be complex and worrying, but with the right expertise, many can be managed or treated effectively. A leading consultant thoracic surgeon with years of experience, Mr Routledge’s unique expertise and depth of experience means you’re in safe hands – from first investigations to advanced, minimally invasive surgery for cancer or other diseases.

You can find information on the conditions Mr Routledge treats below. If you can’t find what you’re looking for, don’t worry, you can get in touch and a member of the team will be happy to help. 

Lung cancer: primary and secondary (metastatic)

Lung cancer develops when abnormal cells in the lung begin to grow uncontrollably, forming a tumour that can affect breathing and sometimes spread to other parts of the body. “Primary” lung cancer starts in the lung itself, while “secondary” (or metastatic) cancer has spread from elsewhere.

Smoking is the main cause, but not all cases are linked to it. Other risk factors include: 

  • Long-term exposure to second-hand smoke
  • Air pollution
  • Asbestos

Some people, however, can develop lung cancer without any known cause.

Common symptoms include: 

  • Persistent cough
  • Breathlessness
  • Chest pain
  • Coughing up blood
  • Unexplained weight loss
  • Unexplained tiredness 

Occasionally, a patient will have no symptoms, and the cancer is discovered incidentally on a scan for another issue.

Diagnosis usually begins with a chest X-ray or CT scan, followed by further imaging and a biopsy. Advanced techniques such as robotic navigational bronchoscopy (Ion™ system), used by Mr Routledge, can reach small or deep lung nodules safely, providing accurate diagnosis with minimal discomfort to the patient.

Treatment depends on the type and stage of the cancer. The options include:

  • Surgery
  • Chemotherapy
  • Radiotherapy
  • Targeted drugs
  • Immunotherapy

When surgery is appropriate, Mr Routledge uses robotic and minimally invasive approaches to achieve precise tumour removal, smaller scars and a faster recovery from surgery.

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Benign and malignant chest tumours (including thymoma)

A chest tumour is an abnormal growth within the chest. It may be benign (non-cancerous) or malignant (cancerous). Malignant tumours can spread to nearby parts of the body, while benign tumours usually remain localised. Thymomas are tumours of the thymus gland in the upper chest.
Causes vary depending on the type of tumour. Malignant tumours can develop due to genetic changes, previous exposure to radiation, or underlying lung conditions. Benign tumours, meanwhile, can occur spontaneously. Thymomas can be linked with autoimmune diseases such as myasthenia gravis.
Symptoms depend on the tumour’s size and position. Some cause chest pain, coughing, breathlessness, or excessive fatigue. Thymomas can present with muscle weakness or autoimmune symptoms. Many people with benign tumours won’t be aware of any early symptoms.
Diagnosis usually involves CT or MRI scans and tissue sampling from a biopsy procedure. Minimally invasive or robotically assisted techniques allow for an accurate and safe diagnosis. Blood tests and specialist assessments are often used to guide treatment, particularly for thymomas.

Treatment depends on the type and behaviour of the tumour. If your tumour is benign, then monitoring it may be the best course of action. 

Malignant tumours will often require surgery and, for some patients, a course of chemotherapy or radiotherapy. Mr Routledge uses robotic and minimally invasive surgical procedures whenever possible to reduce pain, shorten your hospital stay and promote a smooth recovery. 

 
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Undiagnosed or incidental lung nodules

A lung nodule is a small, round area seen on a lung scan. “Incidental” nodules are those found unexpectedly, often during imaging for another reason. It’s important to remember that most are harmless, however a small number can indicate early-stage cancer.
Lung nodules can result from old infections, inflammation, scar tissue, or, in rare cases, cancer. Smoking, previous lung infections or chronic lung conditions can increase the likelihood of developing nodules.
Most nodules cause no symptoms at all. Larger nodules may occasionally lead to a mild cough, shortness of breath or some discomfort in the chest.
Assessment typically starts with a CT scan. Ion™ robotic navigational bronchoscopy, as used by Mr Routledge, allows for a precise and minimally invasive biopsy of very small nodules, giving rapid and reliable results while minimising risk.
Benign nodules are usually monitored with the patient coming back for regular scans. If we do detect cancer, then we’ll recommend surgery to remove them. Mr Routledge performs these procedures using robotic and minimally invasive techniques, enabling safe, precise treatment and a quicker recovery than with traditional techniques.
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Pleural effusions (fluid around the lung)

Pleural effusion is a build-up of fluid in the area between the lung and chest wall, known as the pleural space. This can restrict breathing and may signal an underlying issue such as infection, heart failure or cancer.

Common causes include: 

  • Heart failure
  • Pneumonia
  • Pulmonary embolism
  • Cancers of the lung, breast or pleura

Sometimes fluid builds up after surgery or because of autoimmune disease.

Symptoms can include: 

  • Breathlessness
  • Chest discomfort
  • A dry cough
  • Difficulty lying flat

In the case of smaller effusions, patients may experience no symptoms and find out incidentally, following a scan for an unrelated issue.

Diagnosis involves chest imaging (X-ray or a CT scan), and sometimes a fluid sample taken with ultrasound guidance. The fluid is then taken off for expert analysis to check for infection, inflammation or cancer. 
Treatment depends on the cause and size of the effusion. Options include drainage through a needle or chest tube, medication to treat the underlying condition or surgery. Mr Routledge uses minimally invasive and robotic approaches for surgical drainage where appropriate, helping patients to achieve better outcomes and recover faster and more comfortably.
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Pneumothorax (collapsed lung)

A pneumothorax, more commonly known as a collapsed lung, occurs when air leaks into the space between the lung and chest wall, causing the lung to collapse partially or fully. It can lead to sudden breathlessness and chest pain and requires prompt assessment and treatment.
It may occur spontaneously, after trauma, or in people with underlying lung disease such as COPD. Occasionally, it happens after medical procedures involving the chest, such as needle biopsies.

Some common symptoms of pneumothorax include: 

  • A dry cough 
  • Breathlessness
  • Sudden chest pain
  • Rapid breathing

While severe symptoms include: 

  • Low oxygen levels
  • Dizziness 
Most commonly, a collapsed lung is diagnosed using a chest X-ray or CT scan. These will also help to determine the severity of the condition.
Some cases of pneumothorax may resolve on their own with monitoring and oxygen. Larger or recurrent cases often need drainage or surgery. Mr Routledge offers minimally invasive or robotically assisted surgery to repair the lung and prevent recurrence, ensuring his patients’ long-term safety and comfort.
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Chest wall and rib trauma or pain (with or without fracture)

Chest wall and rib trauma means an injury to the ribs, muscles or cartilage that support and protect the chest. With the right care most injuries heal well but, in some cases, surgery may be needed to stabilise the ribs and ease long-term pain.
Common causes include falls, sports injuries or road traffic collisions. Repetitive strain or scarring from earlier surgery can also contribute to tenderness, or persistent chest wall pain.

Typically, the symptoms can include: 

  • Pain
  • Tenderness
  • Bruising
  • Swelling
  • Difficulty breathing

In more severe cases, fractures may cause the chest to look uneven or move unusually when you breathe.

Diagnosis is usually by way of physical examination and imaging (X-ray, CT scan, or ultrasound) which helps to assess the extent of injury and check for complications, such as pneumothorax.

Most injuries are managed with pain control, rest and physiotherapy. Complex or multiple fractures may require surgical stabilisation, often performed using minimally invasive methods to speed recovery and reduce long-term discomfort.
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Diaphragmatic paralysis

Diaphragmatic paralysis happens when one or both sides of the diaphragm – the main muscle that helps you breathe – stop moving as they should. This can make it harder to take deep breaths and may reduce overall lung capacity.

It can have several causes, including: 

  • Nerve injury
  • Trauma
  • Infection
  • Previous surgery
  • Neurological conditions 

While these are all possible causes, some cases don’t have a clear cause.

Common symptoms can include: 

  • Breathlessness – especially when lying flat
  • Fatigue
  • Reduced exercise tolerance
  • Sleep disturbance 
  • Headaches
Imaging such as X-ray, fluoroscopy, or ultrasound, together with lung function tests, can help to assess diaphragm movement and strength.

Milder cases may simply be monitored. For more severe symptoms, Mr Routledge can perform robotically assisted diaphragmatic plication, a minimally invasive procedure that restores diaphragm shape and function, helping patients breathe more comfortably and regain quality of life.

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Hyperhidrosis (excessive sweating/facial blushing)

Hyperhidrosis (excessive sweating), often accompanied by facial blushing, occurs when the nerves controlling sweat glands or blood flow are overactive. Although not dangerous, it can greatly impact on someone’s confidence and overall quality of life.
While facial blushing can result from overactive sympathetic nerves, emotions or sudden temperature changes, primary hyperhidrosis often has no clear cause, though environment and emotional triggers can exacerbate the condition.
Excessive sweating in specific areas – such as the hands, feet, underarms, or face – and frequent facial redness (blushing). While not serious, these symptoms can interfere with work or social life and have a significant impact for patients.
Diagnosis is based on medical history, physical examination and sometimes specialised tests to accurately assess the affected areas.
Milder cases are managed with topical treatments, oral medications or Botox injections. If symptoms remain severe after all non-surgical options have been explored, Mr Routledge offers robotically assisted sympathectomy, a procedure that offers long-term relief by safely interrupting the overactive nerves responsible for the condition.
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