A new study sheds light on the persistent lack of diversity across gender and race in the surgical workforce.

Research from Yale University has prompted concerns about career paths for medical students from marginalised groups – and the potential impact of this on patient care.

The authors say their findings emphasise the need for increased efforts to address bias and promote inclusivity within surgical departments.

The study, published in the Annals of Surgery, examined the career paths of 22,660 medical students who enrolled in US schools between 2014 and 2015.

It highlighted two distinct paths – a sustained route where students entered medical school with a surgical interest and pursued a surgical residency upon graduation and a cultivated option where students initially lacked surgical interest but were placed in surgical residencies upon graduation.

Mytien Nguyen, the study’s lead author and an MD-PhD student at Yale School of Medicine, emphasised the importance of diversity in the surgical workforce.

She said: ‘A diverse workforce that reflects the population is important to patient care because patients tend to trust physicians with whom they identify. Prior studies have shown that racial concordance between patient and physician leads to better patient outcomes.’

The study revealed that female students and those identifying with Asian, Hispanic, or low-income backgrounds were less likely to enter surgical residencies compared to their male and non-marginalised counterparts.

Additionally, a disparity was observed among students with marginalised identities, such as female, ethnoracial groups underrepresented in medicine, and low-income backgrounds, who were least likely to pursue surgical paths.

Past research has highlighted the challenges medical students and surgical residents face from diverse backgrounds, including feelings of not belonging, mistreatment, financial barriers and a lack of role models.

The Yale researchers proposed several recommendations to counter these issues and foster diversity in surgical specialties.

They urged medical schools to initiate outreach programmes targeting high school students and undergraduates to spark an early interest in surgery.

Furthermore, the establishment of surgical mentorship initiatives and efforts to address bias and mistreatment were suggested to ensure equitable career progression.
Dr Paris Butler, associate professor and vice chair of diversity, equity and inclusion in the Department of Surgery at Yale School of Medicine and co-senior author of the study, stressed the importance of creating a welcoming environment for students from marginalised backgrounds.

‘Fostering belonging among students from marginalised backgrounds will be key to boosting diversity in surgery departments. Transforming the surgical learning environment and the culture of the surgical field is essential for building a diverse workforce and ensuring the best experiences and outcomes for our patients.’

The study’s conclusions underscore the urgent need to address the substantial disparities in sustained and cultivated paths in surgery during undergraduate medical education.

The researchers call for innovative measures to promote surgical identity development and inclusivity, particularly for female students, those underrepresented in medicine and those from low-income groups.

Recent data from the Association of American Medical Colleges (AAMC) further highlights the discrepancy between physician demographics and the US population.

While Black or African American individuals account for around 12% of the US population, only 5.7% of physicians identify as such. Similarly, gender disparities persist in physician specialties, with women remaining concentrated in specific fields.

As the conversation around diversity and equity in the medical field gains momentum, researchers and medical institutions continue to work toward a more inclusive future, emphasising the need to reshape surgical departments to reflect their diverse populations.

Photo caption - Image created with generative AI (Michael S. Helfenbein)

A spine robot has expanded the capabilities of surgeons at the University of Alabama at Birmingham’s hospital.

UAB Medicine, a pioneer in minimally invasive robotic surgeries, achieved a significant milestone by surpassing 20,000 robotic surgical procedures in early 2023.

Now, it is incorporating a cutting-edge spine robot, demonstrating a commitment to precision and innovation.

Precision is paramount in spinal surgery, where targets often measure a mere half centimetre, leaving no room for error.

Dr Jake Godzik, a skilled neurosurgeon and assistant professor in the UAB Department of Neurosurgery, emphasised that while robotic techniques do not revolutionise the field, they empower adept surgical teams to achieve heightened precision, consistency and proficiency – even in the realm of intricate surgeries.

The latest addition – the ExcelsiusGPS spine robot – was developed by Globus Medical, and the Department of Neurosurgery utilises its minimally invasive techniques for precise instrument placement and the treatment of degenerative spinal conditions.

Beyond elevating surgical precision, the robot boasts minimal invasiveness, contributing to swifter patient recovery times.

Dr Godzik also emphasised the robot’s utility in trauma scenarios, where patients might not be sufficiently stable for extensive procedures but necessitate surgical intervention.

Although robotic surgical procedures have been established for some time, their integration into neurosurgery is recent.

Speaking in a recent podcast, Dr Godzik said: ‘Using robotic techniques doesn't revolutionise what we do, but what it allows us to do, especially an experienced surgeon or experienced team, is make surgery just much more consistent. It can help do more complex surgeries with minor potential errors or complications. So, it's a powerful tool in practice, whether in a community hospital or an academic teaching institution.

‘It's beneficial for patients a bit more heavyset because it allows us to be accurate and make smaller incisions, decreasing the infection rate. But it's useful for all spine pathologies, which is great for degenerative conditions.’

He added: ‘Of course, surgeon skill and experience are very important. This doesn't eliminate that or doesn't eliminate the need for quality decision-making and good judgement. Still, I think it takes us and elevates us to another level of performance, and that's something that’s here to stay. Robotics will only get more powerful as we move forward.’

Dr Godzik anticipates a future where this technology is incorporated into various specialities and procedures across UAB, fostering the continual enhancement of patient care.

Photo caption - Neurosurgeon Jake Godzik trains on the ExcelsiusGPS spine robot by Globus Medical. Photography: Lexi Coo

Clinicians in the UK have successfully conducted robotic-assisted lung biopsies for the first time.

A significant step forward in medical innovation, it could prove ‘transformative’ for cancer patients.

A robot that can reach suspect lung tumours could diagnose cancer much earlier, reducing patient anxiety and speeding up treatment.

The pioneering procedure utilised the Ion Endoluminal System (Ion), a cutting-edge robotic-assisted bronchoscopy system developed by technology company Intuitive.

The technology was used for the first time in the UK at St Bartholomew’s and Royal Brompton hospitals.

Clinicians insert a thin and highly manoeuvrable catheter with a camera on the end into the lungs via the mouth to navigate to a potentially cancerous growth or lung nodule.

The Ion creates a 3D roadmap of the lungs, directing surgeons to hard-to-reach areas more precisely than ever.

This approach, which requires no incision, is less risky than other biopsy techniques that can potentially hit blood vessels and puncture the lung.

Clinicians can take a small tissue sample, with the results usually available within five days.

This recent breakthrough is part of an ongoing clinical study at the Royal Brompton Hospital and St Bartholomew's Hospital in London designed to explore the potential benefits of this novel approach.

Teams from both London hospitals are participating in the clinical study looking at the impact of this technology on early diagnosis.

Each hospital will recruit around 50 patients with suspicious nodules detected on computerised tomography (CT) scans.

St Bartholomew’s consultant Kelvin Lau said: ‘The UK is leading the way in lung cancer screening. However, only some lung nodules identified are cancerous and need treatment. Current biopsy techniques carry risks and are not always accurate, and many patients wait for a repeat scan. The uncertainty of the wait causes anxiety and could allow cancer to grow and spread.

‘With this shape-sensing robotic technology, I have the precision and stability to lock onto a very small lung nodule and obtain an accurate biopsy quickly and safely. This could transform early diagnosis and treatment, reduce the need for repeat scans and treat lung cancer earlier.’

Professor Pallav Shah, consultant respiratory physician at Royal Brompton Hospital, said:
‘When we see patients with cancerous lung nodules of more than 30mm, their five-year survival rate is around 68%, but if we can detect these nodules at a smaller size when they are less than 10mm in size, we are looking at a 92% survival rate.’

The UK is gearing up to introduce a nationwide lung cancer screening program, emphasising improving the early detection of cancers.

Earlier this year, the LIBRA study, led by The Royal Marsden NHS Foundation Trust, highlighted the potential of artificial intelligence (AI) in enhancing early lung cancer diagnosis. Intuitive has already placed over 400 Ion systems throughout the United States and aims to expand its presence in the UK and Europe.

Dr Oliver Wagner, Vice President and Medical Officer of Endoluminal at Intuitive, expressed his commitment to improving lung cancer outcomes, praising the UK's role in spearheading advancements in this critical field of medicine.

The aspiration is to create a positive shift in lung cancer care, ultimately improving patient prognosis and wellbeing.

Photo caption - St Bartholomew’s consultant Kelvin Lau (pictured) said: ‘The UK is leading the way in lung cancer screening.'

A recent investigation has sparked fresh concerns about the lasting impact of bariatric operations, particularly those involving gastric bypass surgery.

The findings from Lund University in Sweden suggest that the significant metabolic changes triggered by gastric bypass procedures occur predominantly in the immediate aftermath of the operation. Many of these metabolic indicators revert to their pre-surgery levels within a year.

While patients often initially experience positive outcomes such as weight loss and diabetes remission, the study’s results cast doubt on the sustained durability of these benefits, which were previously assumed to be more enduring.

The research focused on the metabolic effects of gastric bypass surgery. Researchers examined a cohort of overweight individuals, both with and without type 2 diabetes, who had undergone gastric bypass operations in Sweden.

Lead author of the study, Peter Spégel, an associate professor of molecular metabolism at Lund University, emphasised the importance of moving beyond simple weight tracking: ‘Just following up on people’s weight can be a blunt instrument for studying the effects of the procedure. Our study provides a greater understanding of what happens to the metabolism in connection with a gastric bypass operation.’

The investigation underscored that the most substantial metabolic transformations occur immediately post-operation. Still, within a year, a significant portion of participants exhibited metabolite and fat levels nearing those recorded before surgery.

This revelation challenges earlier studies that suggested enduring and profound metabolic improvements.

Nils Wierup, a professor of neuroendocrine cell biology at Lund University and one of the study’s principal authors, noted: ‘We could see the changes while the participants still had a low BMI after the operation. By studying metabolism, we can obtain a clear indication that unhealthy changes are on the way. We hope the knowledge can be used in follow-up to implement preventive measures.’

One notable discovery from the study was the reduction and subsequent elevation in the concentration of a specific type of amino acids following the procedure. These amino acids are typically elevated in individuals with insulin resistance and are associated with an increased risk of developing type 2 diabetes.

Peter Spégel said: ‘One conclusion we draw is that the risk of developing type 2 diabetes is considerably reduced after the operation among individuals who do not have the disease, but one year later, we see an increased risk again. Among individuals who already had type 2 diabetes at the time of the surgery, we see a remission of the disease. Still, the risk of the disease returning then increases over time.’

Despite shedding light on potential setbacks, Nils Wierup remains cautiously optimistic about the benefits of bariatric operations, particularly their impact on diabetes remission:
‘One advantage of bariatric operations is that most people with type 2 diabetes see a remission of their disease afterwards. And even though a large percentage of individuals who undergo this procedure gain weight afterwards, it’s usually not a return to the same weight as before.’

While further research is needed to draw definitive conclusions, the findings prompt a re-evaluation of the understanding of the enduring effects of bariatric procedures.

The study appears in the journal Obesity.

A prototype technology designed to reduce the risks of spinal fusion surgery could be commercially available as early as next year.

The cutting-edge prototype device and software also offer remote postoperative monitoring, raising the bar for patient care.

Associate Professor Debbie Munro of the University of Canterbury in Christchurch, New Zealand, unveiled her solution to the inherent challenges of the procedure earlier this month.

A high failure rate often plagues spinal fusion surgery and can occur within five years.

Associate Professor Munro has been on a relentless quest to enhance the outcome of spinal fusion surgery for two decades.

Her prototype device attaches to the rod inserted during the operation, similar to a strain gauge.

To complement this hardware, she has also invented a wireless sensor and sophisticated software to interpret the gauge's outputs, thereby determining the success of the fusion.

The current challenge surgeons face in spinal fusion surgery lies in the uncertainty of its success until months after the operation, typically around the four-month mark when it becomes visible on an X-ray.

In New Zealand, the situation is even more precarious, as patients are not routinely subjected to postoperative X-rays unless they experience severe pain after 12 weeks.

Associate Professor Munro’s device aims to turn the tables on this dilemma.

She explained: ‘When the sensor is first implanted, it should display the maximum strain. If my software shows no strain, the surgeon knows it hasn't worked and can address the issue before closing up the patient.’

This early detection could prevent a second, highly invasive surgery, sparing patients the ordeal of bone grafts and further complications.

Additionally, once deemed successful, the device will continue to play a pivotal role in the patient's recovery journey, offering a tangible way for them to track their progress.

This is particularly crucial, as spinal fusion surgery necessitates weeks of bedrest – a challenging regimen for many patients, especially those in physically demanding jobs.

What makes this technology even more promising is its potential for remote monitoring. Associate Professor Munro envisions a future where patients can scan the surgical site themselves, with the data transmitted directly to the surgeon.

Face-to-face appointments would only be necessary in the event of an issue, making healthcare more accessible and convenient.

The device and its accompanying software boast long-term advantages, as they require no batteries, eliminating the risk of leakage.

Furthermore, in case of accidents, individuals with the implant can quickly assess whether the fusion has been impacted, offering a sense of security and peace of mind.

Associate Professor Munro also believes this technology could find applications beyond spinal fusion, potentially extending to monitoring hip and knee replacements for signs of degradation.

Further testing is planned, with the device possibly ready for commercial interest as early as 2024.

Spine surgery fusion rates continue to increase worldwide due to new developments in spine fusion procedures and surgical techniques, improved implants and interbody devices, and advancements in complication prevention strategies. Lumbar degenerative disc disease is the most common diagnosis for spine fusion surgery.

According to a literature review in 2020, how this increasing upward trend will affect healthcare systems worldwide is ‘one of the important future questions’.

Photo caption - UC lecturer and researcher Associate Professor Debbie Munro has developed a prototype device and software to reduce the risk in spinal fusion surgery.

Scientists have shared promising findings from a phase I clinical trial centred on an advanced stem cell therapy for repairing cornea damage.

The innovative therapy, known as cultivated autologous limbal epithelial cell transplantation (CALEC), demonstrates both safety and short-term efficacy in patients suffering from severe cornea damage caused by chemical burns.

Published in the journal Science Advances, the team’s study showcases the potential of CALEC in transforming the lives of patients previously deemed untreatable due to their extensive cornea injuries.

The trial tracked four patients over 12 months and revealed remarkable outcomes.

Two individuals could undergo successful corneal transplants, while the remaining two reported significant enhancements in vision without requiring supplementary interventions.

Though the primary aim of the phase I trial was to assess the therapy's initial safety and feasibility, the researchers are optimistic about its implications.

Principal investigator Dr Ula Jurkunas, who is also the associate director of the Cornea Service at Mass Eye and Ear and an associate professor of ophthalmology at Harvard Medical School, emphasised the potential of CALEC to address the critical treatment gap for patients enduring vision loss and pain due to major cornea injuries.

The CALEC procedure involves harvesting stem cells from a patient’s healthy eye through a minimally invasive biopsy.

These cells are then expanded and cultured on a graft using an innovative manufacturing process at the Connell and O’Reilly Families Cell Manipulation Core Facility at Dana-Farber Cancer Institute.

After two to three weeks, the cultivated graft is transplanted back into the damaged eye at Mass Eye and Ear.

This ground-breaking collaboration is the brainchild of Dr Jurkunas and her peers at the Cornea Service at Mass Eye and Ear, alongside researchers from Dana-Farber Cancer Institute, Boston Children’s Hospital, and the JAEB Centre for Health Research.

The clinical trial, noteworthy for being the first human study of a stem cell therapy funded by the National Eye Institute (NEI), signifies a pivotal step in advancing treatment options for patients suffering from chemical burns and related eye injuries.

Chemical burns and similar ocular traumas can result in limbal stem cell deficiency, a condition marked by the irreversible loss of cells around the cornea.

This often leads to chronic vision impairment, pain, and discomfort in the affected eye. The CALEC procedure looks to revolutionise treatment by utilising a patient's stem cells, which are then cultured and expanded to create a cell sheet that facilitates tissue growth.

Dr Jerome Ritz, executive director of the Connell and O'Reilly Families Cell Manipulation Core Facility at Dana-Farber and professor of medicine at Harvard Medical School, highlighted the challenges in creating a manufacturing process that meets stringent FDA regulations for tissue engineering.

The successful implementation of this process and the promising clinical outcomes witnessed in the trial’s initial cohort of patients mark a significant achievement.

As studies like these continue to underscore the potential of cell therapies in tackling previously incurable conditions, the Gene and Cell Therapy Institute at Mass General Brigham plays a pivotal role in translating scientific breakthroughs into tangible clinical trials.

This multidisciplinary approach positions the institute at the forefront of pioneering treatments, pushing the boundaries of technology and clinical application.

The phase I trial enrolled five patients with chemical burns to one eye, with four receiving the CALEC treatment. Detailed quality control assessments determined that the fifth patient's cells were unsuitable for expansion.

Over a 12-month follow-up period, the CALEC recipients demonstrated remarkable progress. One patient regained vision sufficiently for an artificial cornea transplant, while another experienced a substantial improvement from 20/40 to 20/30 vision.

The team is preparing for the next phase of clinical trials involving 15 CALEC patients, with an 18-month observation period to evaluate the therapy's overall efficacy.

There are high hopes that CALEC could eventually fill a crucial void in eye injury treatments, offering a lifeline to patients who have endured long-term deficits due to the lack of viable options.

Picture caption - Ula Jurkunas (left) at a monitor with researchers in her laboratory

New research suggests patients achieve improved results when treated by female surgeons.

In a cohort study of one million patients, those treated by a female surgeon were less likely to experience death, hospital readmission or significant medical complications at 90 days or one year after surgery.

This association was seen across nearly all subgroups defined by patient, procedure, surgeon, anaesthesiologist and hospital characteristics.

The research aimed to determine if a link exists between the gender of a surgeon and the long-term outcomes after surgery.

It also found that techniques, speed and levels of risk adversity seemingly shaped outcomes.

In the past, studies have indicated that female surgeons tend to achieve more favourable patient outcomes compared to their male counterparts in the short term.

This phenomenon can be attributed to various factors, such as variations in communication patterns, approaches to medical practice and the dynamics of the physician-patient relationship.

Additionally, their medical practices could have distinct qualitative aspects, extending to how they choose and interact with their patients.

With this new study, researchers felt it was essential to understand whether observations regarding the association between surgeon sex and surgical outcomes persist over a longer term – a critical step in evaluating the broader implications of diversifying surgical practice in health care delivery.

It suggests female surgeons tend to operate more slowly and may achieve better results by taking their time in the operating theatre.

These findings further support differences in patient outcomes based on physician sex that warrant deeper study regarding underlying causes and potential solutions, the authors say.

In another study conducted in Sweden, researchers examined the post-surgery outcomes of patients who underwent gallbladder removal procedures.

Their findings revealed that patients who were attended to by female surgeons experienced fewer complications and enjoyed shorter hospital stays compared to those treated by their male counterparts.

In the review of 150,000 patients, the female surgeons operated more slowly than male colleagues and were less likely to switch from keyhole to open surgery during an operation.

Dr My Blohm and colleagues at the Karolinska Institute in Stockholm, concluded their findings might contribute to an increased understanding of gender differences within this surgical specialty.

In an accompanying commentary, Sweden’s Skane University Hospital surgeon Martin Almquist noted that evidence has suggested that female surgeons are more likely to use patient-centred decision-making, more willing to collaborate, and more carefully select patients for surgery.

He argues that these differences might translate into different outcomes for female and male surgeons and that studying such differences can give important insights into how to avoid adverse outcomes.

The proportion of female surgeons is increasing and more women than men are now entering medical school.

A disturbing new report reveals that female surgeons are being sexually harassed, assaulted and sometimes raped by colleagues in the UK.

This is according to a widescale analysis of National Health Service staff.

BBC News reported the findings exclusively this morning (12 September), sharing stories from women, including those who have faced sexual assault in the operating theatre during surgery.

The study shows a pattern of female trainees being abused by senior male surgeons and suggests that sexual misconduct in the past five years has been experienced widely, with women affected disproportionately.

According to the authors, little is being done to address such assaults, and they conclude that ‘accountable organisations are not regarded as dealing adequately with this issue’.

The analysis was jointly delivered by the University of Exeter, the University of Surrey and the Working Party on Sexual Misconduct in Surgery (WPSMS), an organisation founded in 2022 to shed light on vital data in order to create an environment of ‘sexual safety in the surgical environment’.

Some 1,704 individuals participated, with 1,434 (51.5% women) eligible for primary unweighted analyses. Weighted analyses, grounded in NHS England surgical workforce population data, used 756 NHS England participants. Weighted and unweighted analyses showed that, compared with men, women were significantly more likely to report witnessing – and be a target of – sexual misconduct.

Their analysis shows that:
• Among women, 63.3% reported being the target of sexual harassment versus 23.7% of men (89.5% witnessing versus 81.0% of men)
• Additionally, 29.9% of women had been sexually assaulted versus 6.9% of men (35.9% witnessing versus 17.1% of men)
• 10.9% of women experienced forced physical contact for career opportunities (a form of sexual assault) versus 0.7% of men
• Being raped by a colleague was reported by 0.8% of women versus 0.1% of men (1.9% witnessing versus 0.6% of men).

Evaluations of healthcare-related organisations’ adequacy in handling sexual misconduct were significantly lower among women than men, ranging from 15.1% for the General Medical Council (GMC) to 31.1% for the Royal Colleges (men’s evaluations: 48.6% and 60.2%, respectively).

The findings from Christopher T Begeny and colleagues illustrate that women and men in the surgical workforce are experiencing very different realities.
For women, being around colleagues more often means witnessing and being a target of sexual misconduct.

The full study results can be found here.

The BBC reports: ‘It is widely accepted there is a culture of silence around such behaviour. Surgical training relies on learning from senior colleagues in the operating theatre. Women have told us it is risky to speak out about those who have power and influence over their future careers. The report, published in the British Journal of Surgery, attempts to get a sense of the scale.’

Recommendations for change
The WPSMS is now making recommendations for change in its report, Breaking the Silence Addressing Sexual Misconduct in Healthcare.

It also shares insights into victims’ experiences, with one revealing: ‘I was told that my complaint was possibly the 4th or 5th about this consultant. I was told not to refer to it as sexual harassment as this could be defamation of the consultant, which could be used against me legally. Incidents were raised to both training programme directors, and I was told it was taken to the hospital clinical director. The consultant remains employed four years later.’

Another victim writes in an impact statement: ‘I was sexually assaulted by a trusted recent clinical supervisor one evening at a conference when I was a first-year registrar trainee. He was drunk, he touched my breasts and punched my arm when I tried to get away, bruising me. Sometime later, he started calling me and threatened my career if I spoke to anyone about the incident. A senior mentor I approached for advice informed me he was known for this behaviour. Why had no one warned me? I had trusted this man.

‘The deanery told me they did not want to hear the details or be involved. This was a police matter, not a training matter. The police were kind and spent time talking to me, but made it clear that I lacked evidence and that any action they could take would be limited.

I have had to live with this incident on many levels. I lost trust in someone I looked up to, and I lost faith in my ability to judge people and my relationships. As a woman, I feared repeat incidents in all areas of my life. As a trainee, I listened to sexual jokes from colleagues and feared they would attack me. I am still too scared to attend any work social event, and I still never allow myself to be in a closed room with a male colleague or patient.

People have defended the perpetrator, blamed me, not believed me or have normalised the incident. I am aware of others who have been sexually harassed by him both before and after myself. I feel powerless to protect those who are yet to be subject to his behaviour. He remains in post.’

The authors of the WPSMS report, Professor Carrie Newlands, Consultant Oral and Maxillofacial Surgeon and Co-Lead WPSMS; Philippa Jackson, Consultant Plastic Surgeon and WPSMS member; and Tamzin Cuming, Consultant Colorectal Surgeon, Chair of Women in Surgery at RCS England and Co-Lead WPSMS, are now for a swathe of changes to be made by those who have the power to do so.

They note: ‘Those who have been impacted by sexual misconduct rarely report it for multiple reasons, based around fear and lack of faith in those currently tasked with investigating reports. There is insufficient expertise and a lack of organisational memory around this complex matter within individual healthcare organisations. Moreover, perpetrators are often powerful individuals, and there is a culture of complicity.’

Among their requests, they are asking the Department of Health and Social Care (DHSC) and accountable organisations to support:
• A National Implementation Panel to oversee progress by organisations on the recommendations in this report
• Reform of reporting and investigation processes of sexual misconduct in healthcare to improve safety and confidence in raising concerns and to ensure investigations are external, independent and fit for purpose.

Additionally, they are calling for every NHS Trust and healthcare provider to have an appropriate, specific and clear Sexual Violence/Sexual Safety Policy in place with all healthcare educational bodies and professional associations to have an appropriate, specific and clear Code of Conduct, which includes sexual behaviour.

‘These codes should be signed up to by those employed by, study at, and belong to these entities, and should apply both within the workplace and at work-related events such as conferences,’ they urge.

They conclude: ‘There needs to be a safe reporting system where victims can speak up without fear, which encourages confidence in reporting and results in a just outcome. Healthcare needs to be a safe and welcoming environment in which to work. We do not want colleagues leaving a career because they were sexually assaulted. We want robust mechanisms put in place to ensure that perpetrators’ behaviours are addressed and that justice prevails for those who have been silenced and damaged.’

There is also a list of agencies set up to offer support. These can be found on pages 29-30 of the report.

A hospital in Nigeria has successfully performed the country's first minimally invasive cardiac procedure.

The landmark achievement marks the country's inaugural foray into minimally invasive cardiac surgery.

Based in Lekki, Tristate Hospital recently performed the first coronary artery bypass grafting, or off-pump CABG, surgery in Nigeria.

The hospital’s surgical team also accomplished another milestone by conducting the nation's initial mitral valve replacement. .

Tristate Healthcare Systems is at the forefront of this development, trailblazing the realm of minimally invasive coronary artery bypass and mitral valve repair within Nigeria.

The successful outcomes of these operations have positioned the West African nation among the select few in the developing world equipped with the capability to undertake intricate surgical interventions of this nature.

The procedures were performed on four patients. One of the patients was an 81-year-old woman who needed a valve replacement.

Cardiologist and Professor of Medicine Kamar Adeleke led the cardiology team and announced the feat at a press conference, outlining how they have conducted more than 120 regular open-heart procedures nationwide.

Previously, Nigerians had to travel to the West, India or South Africa for life-saving, minimally invasive heart operations.

Professor Adeleke said: ‘Now, we’re using techniques that have never been done in Nigeria. Apart from the fact that it is minimally invasive, we also did not stop the heart. The heart was beating while the blood vessels were bypassed.’

He explained that, unlike the traditional on-pump CABG method of bypass surgery, the off-pump CABG is a relatively new procedure that does not require a lung and heart (cardiopulmonary bypass) machine.

‘Historically, the way you carry out heart surgery is to open up the chest, then put the patient on a respirator, sedate the patient, and then make an incision to expose the heart. Depending on what you are doing, for instance, if you are doing the valves inside the heart, you have to open up the heart itself. You must stop the heart completely and connect it to the heart-lung machine to do that.’
Professor Adeleke explained to the press that the delivery of innovative cardiovascular surgical procedures reduces the duration of operations, minimises risk, shortens hospital stays and is more financially viable.
‘As a Nigerian that loves Nigeria, you can’t be happier that Nigeria can do this; Nigeria can come out of a mess. When Nigeria puts its mind to something, it becomes doable.’

Tristate is equipped to conduct two to three of the procedures daily. Professor Adeleke explained that a session takes an average of three hours to complete, compared to the traditional open-heart surgery, which could take up to 15 hours or more.

Professor Adeleke is a US-trained medical practitioner with over 34 years of experience as a consultant physician and interventional cardiologist.

He has extensive healthcare leadership experience in the USA and Africa, leading many successful and highly impacting medical missions in Africa, South America and the Caribbean.

Ukrainian medical professionals have received training in reconstructive surgery by partnering with military medical specialists from the UK.

Trauma surgeons from the Defence Medical Services and the Royal Centre for Defence Medicine (RCDM) have been sharing their expertise with medical personnel from the war-torn country.

Lieutenant Colonel James Baden, an expert in reconstructive surgery for combat-related injuries, guided the initiative to lead the UK delegation in training six Ukrainian medical professionals.

The Ukrainian cohort, comprising military and civilian members, received comprehensive training in various reconstructive surgery methodologies.

The training occurred at the Freeman Hospital and Royal Victoria Infirmary in Newcastle, where participants could observe surgical procedures within an NHS theatre setting.

Subsequent sessions are scheduled at the Royal Centre for Defence Medicine (RCDM) at the Queen Elizabeth Hospital in Birmingham. This centre specialises in treating military personnel who have sustained injuries and are repatriated from overseas operations.

Major General Tim Hodgetts CB CBE, UK Surgeon General and Chair of the Committee of Surgeon Generals in NATO, said: ‘Sharing medical skills and expertise amongst allies is the right thing to do. Both military and civilians injured in Ukraine have similar injury patterns, so sharing the expertise to enhance all patient outcomes equally is also right in this circumstance. Military and civil collaboration is at the heart of NATO’s new Medical Support Capstone Concept.

‘I am hugely impressed by the actions of the Ukrainian Armed Forces Medical Services, their valour, and their dedication to saving lives in the most challenging circumstances.
In an increasingly abstract world dominated by digital and technology innovation, we still need surgeons with exquisite practical skills to treat the complex and disfiguring wounds of physical combat.’

Earlier this year, Ukrainian surgeons visited St Mary’s Hospital in London to observe life- and limb-saving trauma surgery techniques and learn complex surgery techniques to save victims of the war.

The visit was arranged by Shehan Hettiaratchy, the major trauma director and consultant plastic and reconstructive surgeon at the Imperial College Healthcare NHS Trust, as part of his work with frontline medical aid charity UK-Med.

More recently, several cohorts of Ukrainian surgeons have travelled to OU Health University of Oklahoma Medical Centre, US, to train with an interdisciplinary group of experts to help them better treat patients with severe war-related facial injuries.

Collaborating alongside the American Academy of Facial Plastic and Reconstructive Surgery, Dr Mark Mims, an expert facial plastic and reconstructive surgeon affiliated with OU Health, spearheaded the effort to host Ukrainian surgeons in Oklahoma.

Dr Mims specialises in surgical and non-surgical cosmetic and reconstructive procedures for the face, head and neck. The visiting Ukraine surgeons were educated in plastic, oral and maxillofacial surgery, ENT services and ophthalmology.

After refining their surgical proficiencies, they returned to Ukraine, accompanied by peers from different parts of the US who will continue to collaborate with them for a brief duration.

According to statistics from the UN, there have been 26,015 civilian casualties recorded in the country in total, with 9,369 killed and 16,646 injured. However, the Office of the UN High Commissioner for Human Rights (OHCHR) believes the figures are considerably higher.

Russian air strikes, missile strikes, and artillery shelling have targeted densely populated urban centres, apartment buildings, schools, hospitals, military bases and vital infrastructure nationwide.

connecting surgeons. shaping the future
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