A free online webinar titled - Future of Surgical 3D - led by renowned healthcare futurists and practicing surgeons, is scheduled for Monday, July 29, at 7 PM BST.

This event promises to delve into the latest advancements in 3D technology in the surgical field and its transformative impact on medical procedures and patient outcomes.

Hosted by a panel of world-leading surgeons and industry stalwarts, the webinar is set to offer invaluable insights into the innovative applications of 3D printing in surgery. Attendees will have the opportunity to engage with experts, explore pioneering technologies, and gain a comprehensive understanding of the future trajectory of surgical innovations.

Esteemed Speakers:

Prof. Shafi Ahmed, commenting on the importance of the event, stated, “This webinar is an unparalleled opportunity to explore the advancements in 3D technology that are revolutionising the surgical field. We are excited to share our insights and discuss the future of surgical innovation with a global audience.”

The "Future of Surgical 3D" webinar aims to be the premier platform for exploring the rapidly evolving world of surgery. Organised by Surgery International – a free global news hub that seeks to build a global community by uniting surgeons, anesthetists, and the entire perioperative team to share unique insights, perspectives, and updates.

Surgery International has been created for surgeons by surgeons to provide the most up-to-date, cutting-edge, impartial, and independent news on surgery, curated daily by an expert team. It strives to develop a stronger voice for surgical professionals and their multidisciplinary teams in perioperative care.

Interested participants can register for free at Eventbrite.

A teenager who is the world’s first patient to take part in a clinical trial to use deep brain stimulation (DBS) to treat epilepsy has seen his daytime seizures reduce by 80%.

Oran, who had been having severe epileptic seizures for eight years and often needed resuscitation, was the first child in the UK to have this device implanted at Great Ormond Street Hospital in October 2023, aged 12.

Eight months on, his seizures have dramatically reduced in frequency and severity thanks to the device.

The rechargeable device is mounted onto the skull and is attached to electrodes deep in the brain to reduce seizure activity.

This is the first UK clinical trial measuring this type of treatment for children with epilepsy. The CADET pilot (Children’s Adaptive Deep brain stimulation for Epilepsy Trial) will now recruit three additional patients with Lennox-Gastaut syndrome, which is funded by the Royal Academy of Engineering before 22 patients take part in the trial, which is being supported by GOSH Charity and LifeArc.

The study is sponsored by UCL.

Martin Tisdall, Honorary Associate Professor at UCL and Consultant Paediatric Neurosurgeon at GOSH, said: ‘Every single day we see the life-threatening and life-limiting impacts of uncontrollable epilepsy. It can make school, hobbies, or even watching a favourite TV show utterly impossible. For Oran and his family, epilepsy completely changed their lives, and so to see him riding a horse and getting his independence back is astounding. We couldn’t be happier to be part of their journey.

‘Deep brain stimulation brings us closer than ever before to stopping epileptic seizures for patients who have very limited effective treatment options. We are excited to build the evidence base to demonstrate the ability of deep brain stimulation to treat paediatric epilepsy and hope in years to come it will be a standard treatment we can offer.’

Deep brain stimulation (DBS) is a treatment that involves surgery to insert a small device into the brain to stimulate specific parts.
Unlike other DBS devices, which are mounted on the chest with wires running up the neck to the brain, this device is mounted on the skull, meaning the leads are less likely to break or erode as the child grows.

The device is also rechargeable through wearable headphones, which can be used while watching a video or interacting with a tablet. Therefore, replacing it every three to five years does not require surgery.

Lead engineer, Professor Tim Denison (University of Oxford and Royal Academy of
Engineering Chair in Emerging Technologies), said: ‘Our mission is to design pioneering research systems for exploring the treatment of intractable health conditions such as paediatric epilepsy. Oran is the first child in the world to receive this device, and we are extremely pleased that it has had such a positive benefit for him and his family.’

The device targets the thalamus, a hub for electrical signals in the brain. Hopefully, the device will block electrical pathways and stop seizures from spreading.

It also has settings for optimising seizure patterns that, although not utilised in this trial, could be used in the future for patients with LGS.

The CADET Pilot is a collaboration between UCL, GOSH, King’s College London, the University of Oxford, and Amber Therapeutics, a UK-based company.

The second phase of the trial will be jointly funded through GOSH Charity and LifeArc’s Translational Research Accelerator Grants.

A nine-year-old boy with a rare genetic condition has become the youngest in the UK to undergo an operation to remove his pancreas and transplant his insulin-producing cells at the same time.

Archie Routledge, from Workington, Cumbria, carries a rare genetic mutation which causes hereditary pancreatitis, causing significant abdominal pain and a significantly increased risk of pancreatic cancer later in life.

The boy spent five months in the Great North Children’s Hospital with pancreatitis, unable to eat whilst receiving nutrition via a drip.

Surgeons seized the opportunity to carry out the life-saving operation whilst the pancreas had slightly recovered.

During the total pancreatectomy and autologous islet cell transplant, the specialist team removed the pancreas, harvested the insulin-secreting islet cells from the pancreas, and then reinfused the cells back into the liver to find a home and help manage blood sugar by producing insulin.

Professor Steve White, consultant in hepato-pancreato-biliary and transplant surgeon at Newcastle Hospitals, was involved in the first operation of this kind when he was training in Leicester. He has since carried out this complicated procedure mainly for adults in the northeast.

He said: ‘Archie has a rare mutation which caused him to have repeated inflammation of the pancreas and had been in hospital for over five months, which was a real strain for his whole family who live in Cumbria.

‘We had a window of opportunity when his pancreas settled down to operate and perform the transplant. Taking out someone’s pancreas makes the individual diabetic, so they must then take insulin to prevent them from having complications such as blindness and kidney failure.

‘To help reduce the risk of diabetes, during the operation, once we had removed the pancreas, we isolated the islet cells at the Centre for Life. The islets, which produce insulin, were then returned whilst the operation was still underway and injected into the liver so Archie could produce some of his own insulin. They will survive many years and help control Archie’s blood sugar levels. We are unique in Newcastle as we have the skills to do many complex transplant operations.’

The 15-hour surgery saw Professor White lead a team involving paediatric surgeon Liz O’Connor, who performed Archie’s previous surgery, another surgeon, Professor Sanjay Pandanaboyana, anaesthetists, pain specialists, psychologists, diabetes specialists, gastroenterologists and scientists.

Archie is now recovering at home and is making good progress.

Pancreatic cancer patients who received chemotherapy before and after surgery had longer survival rates compared to those who had surgery followed by chemotherapy.

That is according to new research published in JAMA Oncology and by Yale Cancer Centre and Yale School of Medicine.

The study included patients with pancreatic ductal adenocarcinoma (PDAC), which accounts for 90% of pancreatic cancers.

An aggressive cancer with a high mortality rate, PDAC is predicted to become the second leading cause of cancer-related deaths in the US by 2030.

Results are encouraging for the 15 to 20% of pancreatic cancer patients whose tumours are operable.

The single-arm (only one treatment type or regimen) Phase II trial evaluated a modified form of the chemotherapy treatment FOLFIRINOX (a combination treatment consisting of leucovorin calcium, fluorouracil, irinotecan hydrochloride, and oxaliplatin approved in 2011 as a first-line treatment for patients with metastatic pancreatic cancer).

Patients in the trial received six cycles of the modified FOLFIRINOX before surgery, followed by an additional six cycles of chemotherapy treatment after surgery.

The modified regimen consisted of slightly lower doses of FOLFIRINOX to improve tolerability, which was previously shown in a 2016 publication not to impact outcomes negatively.

Of the 46 patients who started the modified treatment, 37 completed all six cycles of chemotherapy before surgery, and 27 had successful tumour removal operations. For all enrolled patients, the 12-month progression-free survival rate — meaning the disease did not worsen – was 67%, indicating significant progress in controlling the disease. Furthermore, 59% of all patients lived at least two years after completing the chemotherapy treatment plan and surgery.

When senior author and YCC member Dr Jill Lacy started the study in 2014, it was the first of its kind for patients with PDAC. The study goal was a 12-month progression-free survival rate of at least 50% of patients.
Dr Michael Cecchini, the first author of the study and the co-director of the colorectal program at the Center for Gastrointestinal Cancers at Smilow Cancer Hospital and YCC, said: ‘When the study launched, even with operable pancreatic cancers, 90% of patients were still relapsing and dying from their cancer eventually. We sought to move chemotherapy up in their treatment regimen and give it before surgery to see if we could improve the outcome for our patients.’

The study used advanced techniques to monitor treatment progress, including analysing circulating tumour DNA (ctDNA) and using the cancer biomarker keratin 17 to help predict outcomes.

For example, patients with detectable ctDNA four weeks post-surgery had significantly worse progression-free survival than those without detectable ctDNA.

Cecchini said more extensive randomised clinical trials are needed to continue investigating the role of FOLFIRINOX before surgery for patients with operable PDAC.

‘Even though there have been changes in the standard of care for patients with this aggressive pancreatic cancer type, we have very promising data to justify a larger study.’

The FDA in the US has signed off on human tests for a new brain-mapping device designed to make surgery safer for patients with a brain tumour or severe epilepsy.

Dr Ahmed Raslan is a neurosurgeon at Oregon Health & Science University who helped develop the flexible film.

It has tiny sensors that rest on the brain’s surface and detect the electrical activity of nerve cells below.

Designed to help surgeons remove diseased tissue while preserving essential functions like language and memory, the technology is similar in concept to sensor grids already used in brain surgery, but the resolution is 100 times higher.

In addition to aiding surgery, the film should offer researchers a much clearer view of the neural activity responsible for functions such as movement, speech, sensation, and even thought.

Engineer Shadi Dayeh from the University of California, San Diego, is developing the innovation. He said: ‘Imagine that you’re looking at the moon on a clear night, then imagine [looking through] a telescope.’

John Ngai directs the BRAIN Initiative at the National Institutes of Health, which has funded much of the project’s development. He said: ‘We have these complex circuits in our brains. This will give us a better understanding of how they work.’

The film is intended to improve functional brain mapping, often used when a person needs surgery to remove a brain tumour or tissue causing severe epileptic seizures.

During an operation, surgeons place a grid of sensors on the surface of an awake patient’s brain, taking care not to tear the delicate film. Then, they ask the patient to do tasks, like counting or moving a finger.

The accuracy of a brain map depends on the number of sensors used.

Dr Raslan explained: ‘The clinical grid we use now uses one point of recording every one centimetre. The new grid uses at least 100 points.’

Each sensor on the new grid is a fraction of the diameter of human hair, and the grid is bonded to a plastic film so thin and flexible that it can conform to every contour of the brain’s surface.

Dayeh and Raslan say the team is already working on a wireless version that could be implanted for up to 30 days. That would allow people with severe epilepsy to be monitored for seizures at home instead of in the hospital.

Ultimately, the researchers hope to use this diagnostic tool as a brain-computer interface for people unable to communicate or move.

Scientists have already created this brain-computer interface using sensors implanted deep in the brain. However, a grid on the brain’s surface would be safer and could potentially detect the activity of many more neurons.

Dayeh’s research is part of the federal BRAIN Initiative, launched 10 years ago.

Ngai says the new grid promises to improve care for people with brain disorders.

‘Ultimately, the goal was to develop better ways of treating human beings, and I think this gives us a pretty big stride toward that goal.’

Credit: Fritz Liedtke/Oregon Health & Science University]

A new study suggests that robotic liver surgery can be a safe outpatient procedure.

Eight per cent of the patients sampled in the analysis were discharged to go home on the same day.

The research, published in the Journal of the American College of Surgeons, is guided by a surgeon at City of Hope, one of the US’s largest cancer research and treatment organisations.

Yuman Fong, senior author of the study, Sangiacomo Family Chair in Surgical Oncology at City of Hope and director of City of Hope’s Centre for Surgical Innovation said: ‘This study is proof that for the right patients and with the right tools – meaning robotic surgery – we can get people through a liver operation quicker and toward recovery and normal life faster.’

Researchers evaluated patient data (n=4,408) between 2013 and 2023 from three American cancer centres, including the City of Hope, and three Dutch centres. They identified 307 patients who had received robotic liver surgery as outpatients, which was defined as a procedure requiring less than two nights of hospital stay.

While some patients had liver or biliary cancer in a single organ, most patients (n=150) had colorectal cancer that had spread to the liver.

Other diagnoses included cancers of the neuroendocrine system, breast and lung that had spread to the liver.

The medical community has been debating whether liver surgery can and should be a robotic procedure because liver surgery is complex.

Bleeding or other surgical complications often arise, requiring admission into the intensive care unit.

Fong said: ‘Not long ago, liver resections were considered an open surgery procedure that requires a fairly big incision. Patients often need to stay in the hospital for five to 14 days, and they're usually admitted to intensive care units. Even after leaving the hospital, recovery from such surgeries will often take three to six weeks. In this study of robotic surgery, we found that by one week, many of these patients could take 5,000 to 6,000 steps.’

Fong added that the readmission rate of open liver surgery is 20-25% at most prominent cancer centres. Yet, in this retrospective analysis of data from six centres in two nations, the readmission rate for robotic hepatectomy was 1.6%.

Photo caption - Dr Yuman Fong. Credit: CITY OF HOPE

Mortality rates for emergency general surgery patients increase with longer wait times for surgery after hospital admission.

This is according to a study presented at the 2024 annual Eastern Association for the Surgery of Trauma meeting.

Lead author David Silver, a general surgery resident at UPMC in Pittsburgh, US,
and his colleagues sought to determine whether the time from first contact to operation start is associated with mortality among emergency general surgery (EGS) patients.

He noted: ‘Knowing the current challenges of limited resources and often multiple patients requiring emergent surgery, triaging patients can be challenging. There is literature regarding the timing of specific pathologies, but no overarching protocol or scheme is widely used for triage.’

They conducted a retrospective cohort study using an EGS registry at four hospitals.

It focused on adults who underwent operative intervention for a primary American Association for the Surgery of Trauma–defined EGS diagnosis between 2021 and 2023.

People who underwent surgery more than 72 hours after hospital admission were considered nonurgent and excluded. The exposure of interest was defined as the time from the first vital sign capture to the skin incision time stamp.

The median time to OR for the 1,199 patients was 490 minutes.

The relative likelihood of in-hospital mortality increased with prolonged time to OR, with the highest odds of mortality for those who had their operation between 400 and 641 minutes after their vitals were first recorded.

Dr Silver said: ‘The study’s key findings highlight the critical significance of timely intervention in emergency surgery cases. The research identifies specific patient groups, such as those with signs of end-organ damage, prolonged transport times and frailty, as particularly vulnerable to adverse outcomes with delayed surgical procedures.’

He added that ‘what is also novel is that this study uses a newly developed EGS registry from a large healthcare system for the new EGS verification programme, offering a system-level and granular patient perspective, and examines timing from patient’s initial contact with the healthcare system to the initiation of surgery.

This comprehensive approach provides valuable insights that can inform improved management strategies for EGS patients. It emphasises the importance of timely intervention and the influence of specific patient characteristics on outcomes.

Dr Silver also highlighted several future research areas:
• Identifying patient groups and diseases most affected by surgical delay
• Finding ways to improve intervention times
• Using the study results to enhance emergency triage protocols.

The American College of Surgeons recently shared its 2024 OR playlist to mark World Music Day last month.

Announcing it on X, they posted: ‘We're back at it with an O.R. playlist made up of real favourites from our surgeons – from classical music to modern pop to some from @drmlb’s (Mary Le Brant Emeritus Professor of Surgery, Paediatrics, and Medical Ethics) very own OR mix!’

Offering 100 songs and seven and a half hours of music, the introduction on Spotify reads: ‘Our 2024 #WorldMusicDay OR playlist infuses your suggestions of classical music and modern pop with a sprinkle of hits from the newly released Apple Music 100 Best Albums list. It’s an eclectic mix of tunes.’

The songs include two of this year’s Glastonbury headliners SZA and Dua Lipa, and woman of the moment Taylor Swift.

And there are some old-school favourites, too, with Aretha Franklin, Elton John and Kiki Dee (Don’t go breaking my heart one for the cardiac team perhaps) and inevitably, The Beatles with Let It Be (or not if you’re halfway through a procedure) making the cut.

Inevitably, among the list were the classics – including Tchaikovsky, Holst, Beethoven and Mozart.

You can download the playlist, In the O.R. (2024), here.

But what is the history of music in the OR?

Dr Terhi Korkiakangas was part of a team of researchers who, taking into account both the benefits and the risks, advocated for the whole OR team to make the decision to play music during an operation.

In an observational project on teamwork in the operating rooms of a London teaching hospital, music was often played through mobile phones and iPods, with modern theatre suites equipped with docking stations and speakers.

She said: ‘Music has a long history in the world of surgery. Dating back to 1914, music was played through a gramophone to relax surgical patients. Rules were in place for not playing jazz or sentimental tunes; instead, soft smoothing music was deemed acceptable. A body of work suggests that surgeons perform better when music is playing: it can help concentration and make surgeons operate faster. Some surgeons tell us how music masks white noise and other distracting talk in the theatre.’

Another study used AC/DC and The Beatles to ascertain the effect of different music genres and amplitudes on laparoscopic performance.

The authors concluded, ‘A generally well-accepted music genre in the right volume could improve the performance of novice surgeons during laparoscopic surgeries.’

However, trainee surgeon and musician Anantha Narayanan, who investigated the potential of music in the operating room, suggests that while playing some top tunes may or may not be beneficial, musical taste will always remain up for discussion.

‘Many questions remain about the relationship between music and surgery. Does the type of music matter? Why isn’t jazz played more often? Who chooses the music? If there’s a disagreement, how should consensus be reached?’

Musical tastes vary widely among individuals – and that includes teams in the OR. What serves as a vital and inspiring playlist for one person might be irritating or distracting to someone else.

The big question is whether it is possible to nail a playlist that delivers the perfect musical backdrop for the whole operating room team.

UK research has found that weight-bearing following ankle fracture surgery may be more beneficial than previously thought.

The Queen Mary University of London reports that a Bone and Joint Health research group study proposes a potential shift in advice on more effective post-surgical care.

It moves away from previous considerations about weight-bearing after treatment for ankle fractures, potentially leading to improved outcomes.

The comprehensive paper by Christopher Bretherton from the Bone and Joint Health research group in the Blizard Institute, published in The Lancet, presents compelling evidence that weight-bearing after ankle fracture surgery may not lead to worse patient outcomes – and could potentially expedite the return to normal activities.

While further research may be needed to examine the risks of returning to weight-bearing, the study suggests that putting weight on the ankle as it heals may also help reduce the stiffness and muscle atrophy often seen after surgical interventions for a fracture.

This marks a change to the standard treatment protocols, which recommend that patient keep their weight off the affected foot until healing is complete.

The authors concluded that the trial finds that an early weight-bearing strategy is non-inferior to delayed weight-bearing after ankle fracture surgery and is highly likely cost-effective.

‘This should provide clinicians around the world the confidence to recommend early weight-bearing to their patients after ankle fracture surgery.’

Chris Bretherton, NIHR Academic Clinical Lecturer in the Bone and Joint Health Group, Centre for Neuroscience, Surgery and Trauma, said: ‘It’s fantastic how the National Institute for Health and Care Research has facilitated collaboration among clinical teams across the UK to challenge the long-standing practice of delayed weight-bearing after surgery. This research will empower surgeons to promote early weight-bearing, significantly aiding patients during the most critical phases of their recovery from ankle fractures.’

The Bone and Joint Health research group aims to transform research, education and care for people with bone and joint disorders.

The group brings together all aspects of orthopaedics and works across two world-renowned UK institutions – Barts Health NHS Trust and Queen Mary University of London.

Ankle fracture has a high incidence – it is one of the most common injuries treated by orthopaedic surgeons worldwide – and complication rate with residual pain affects more than one-third of all patients.

According to a paper in 2022, ‘ankle fracture presents a significant societal impact in terms of patient outcomes and payer burden’.

A UK study has found that a glowing dye that clings to prostate cancer cells could help surgeons remove them in real time.

The dye, initially developed for prostate cancer but potentially adaptable to other cancer types, highlights cancerous tissues that are not visible to the naked eye during surgery.

This enables surgeons to remove more cancer, significantly reducing the likelihood of recurrence.

Cancer Research UK, which funded the research, stated that full clinical trials are underway to determine if surgery using the marker dye removes more prostate cancer and preserves more healthy tissue than current surgical methods.

In an initial study, 23 men with prostate cancer were injected with the marker dye before their prostate removal surgeries.

The fluorescent dye illuminated the cancer cells and showed their spread into other tissues, such as the pelvis and lymph nodes.

A specialised imaging system illuminated the prostate and surrounding areas, making the cancer cells glow.

This level of detail allowed surgeons to excise the cancerous tissue while sparing healthy tissue.

Professor Freddie Hamdy from the University of Oxford and lead author of the study, explained, ‘We are providing the surgeon with an extra set of eyes to locate the cancer cells and track their spread. This is the first time we've been able to see such fine details of prostate cancer in real time during surgery.

‘With this technique, we can remove all the cancerous cells, including those that have spread from the tumour, which could otherwise lead to recurrence. It also helps us preserve as much healthy tissue as possible, minimising life-changing side effects like incontinence and erectile dysfunction. Prostate surgery is transformative, and we want patients to feel confident we’ve done everything possible to eradicate their cancer and improve their quality of life afterwards. I believe this technique makes that goal attainable.’

The new method combines the dye with a targeting molecule known as IR800-IAB2M.

Together, they bind to a protein called prostate-specific membrane antigen (PSMA), commonly found on prostate cancer cells. This approach was developed by Oxford scientists in collaboration with ImaginAb Inc., a company based in Inglewood, California.

Experts hope that in the future, the marker dye can be used for other cancers by adjusting the protein it binds to. The imaging system that detects the glowing cancer cells could also be incorporated into the robotic tools used for prostate surgery.

Dr Iain Foulkes, executive director of research and innovation at Cancer Research UK, noted: ‘Surgery can effectively cure cancers when removed early. However, at these early stages, it’s nearly impossible to distinguish which cancers have locally spread and which have not. We need better tools to detect cancers that have started to spread. The combined marker dye and imaging system developed by this research could revolutionise prostate cancer treatment. The technology could be applied to other cancers by attaching it to antibodies binding to proteins found in other cancer types.

‘We hope this new technique continues to show promise in future trials. It is exciting that we might soon have surgical tools that can reliably eradicate prostate and other cancers, giving people longer, healthier lives free from the disease.’

The research was funded by Cancer Research UK and supported by Oxford’s Nuffield Department of Surgical Sciences, Department of Oncology, and the National Institute for Health and Care Research biomedical research centre.

The findings were published in the European Journal of Nuclear Medicine and Molecular Imaging.

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