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The RCSEd Vascutek Cardiothoracic Surgery Placements is supported by the Royal College of Surgeons of Edinburgh (RCSEd), and is offering senior medical students from the UK’s universities this exciting experience.

Denis Ajdarpasic, a medical student from the University of Nottingham, recently completed a two-week placement at Bristol Royal Infirmary and Bristol Royal Hospital for Children as part of the placement scheme.

His five-star feedback on the experience has been overwhelmingly positive, highlighting the immersive nature of the placement and the invaluable learning opportunities it provided.

Now it’s your chance!

Students have until 23:59 GMT on Friday 12 April 2024) to apply. Submissions must include a 500-word essay detailing aspirations to pursue cardiac or thoracic surgery.

The placements aim to provide students with hands-on experience in the operating room and exposure to the day-to-day activities of cardiothoracic surgery departments.

Cardiothoracic surgery is one of the more specialised fields in surgery and presents many diverse opportunities for medical practitioners.

Denis had the opportunity to experience this wide range of cardiothoracic surgeries, including adult cardiac, thoracic and congenital cardiac procedures. He welcomed the flexibility to explore different aspects of the specialty – from ward rounds to intensive care and from assisting in surgeries to shadowing anaesthetists and intensivists.

The placements provide a chance to work at esteemed institutions such as James Cook Hospital in Middlesborough, Royal Papworth Hospital in Cambridge, University Hospitals Bristol, and other centres across the UK.

The programme grants students supervised access to operating theatres and the chance to shadow the daily routines of trainees, consultants and allied healthcare professionals within the department.

The objectives include allowing students to shadow their assigned consultant and allied clinicians during patient clinics, ward rounds and surgical procedures.

An initial induction will familiarise students with the placement’s framework.

Students are expected to maintain a logbook record, utilising the Surgical eLogbook, and document their time spent in the operating theatre.

They will receive a certificate and a reference letter from their supervising consultant surgeon upon satisfactory completion.

These attachments are brief, typically spanning two weeks, but are designed to be immersive, offering students a first-hand glimpse into the workings of a modern cardiothoracic surgery team.

Participating hospitals provide exposure to a wide spectrum of cardiothoracic procedures, encompassing adult and congenital heart surgery, thoracic surgical oncology and heart or lung transplantation for cases of failure.

Applicants should be within two years of graduating from a UK medical school and demonstrate prior engagement in extracurricular activities related to cardiothoracic surgery, such as conference attendance, research involvement, or specialised reading.

Selected applicants will have the opportunity to choose their preferred hospital upon acceptance.

Successful candidates will receive support in the form of accommodation within hospital residences and a small grant covering accommodation expenses and one return journey, up to £300 per student.

Applications can be found and submitted here.

Any questions or queries can be directed to awards@rcsed.ac.uk

Surgical International, the global premier surgery news hub, is thrilled to announce its inaugural surgical webinar in partnership with Orascoptic and The Royal College of Surgeons of Edinburgh.

This free-to-attend expert panel webinar is the first in an exciting new Talk Surgery educational series and takes place at 7.00pm (GMT) on Thursday, 15 February.

The event marks the start of a the Talk Surgery series, an exploration into the diverse realms of surgery, encompassing robotics, artificial intelligence (AI) and the integration of sustainable practices within the field.

The webinar brings together leading robotic surgeons and surgical manufacturers worldwide to feature insights from some of the C-level executives and clinical leaders who are leading the way in transformative change.

Discover the latest advancements and innovations in this rapidly evolving field including Enhanced Robotics Platforms, Integration of Artificial Intelligence, Teleoperation and Telepresence, Haptic Feedback, Open Platform Solutions, Autonomous Surgical Robots, Augmented Reality (AR) and Virtual Reality (VR), Surgical Training and Simulation & increased accessibility.

This event is a must for anyone interested in the future of this fast moving sector.

Hosted by the world’s most-watched surgeon, Professor Shafi Ahmed, The Future of Surgical Robotics webinar is a must-attend.

Top robotic surgeons and industry leaders will share ground-breaking insights and discuss the latest advancements in this rapidly evolving field.

Meet the stellar line-up of clinical speakers:

Industry experts joining the conversation are:

Professor Ahmed said: ‘The Future of Surgical Robotics webinar will discuss the latest advances in robotic surgery and offer a glimpse into the future. It will also discuss the global expansion and the advantages and barriers of incorporating robots into the wider surgical practice.’

Don't miss this unique opportunity to gain valuable insights into the forefront of surgical innovation.

Register here to secure your spot at this ground-breaking event and connect with like-minded individuals.

With thanks to our partners

Orascoptic is an innovator of surgical loupes and constantly pushes the limits to provide clinicians with the latest products that achieve superior visualisation through enhanced ergonomics, improved magnification, and illumination.

The Royal College of Surgeons of Edinburgh was founded in 1505 by Royal Charter granted by King James IV. From the discoveries of Simpson and Lister to modern-day pioneers of medicine and dentistry who are developing simulation, VR, and robotics, the College has been a seat of learning and advancement for over 515 years.

Surgery International is an innovative platform pioneering the future of surgical information. It is committed to unveiling the latest advancements in the field and providing up-to-date surgery news.

Around 2010, the concept of digital health was developed. Its definition is rather broad but can be thought of as: ‘Digital technologies using computing platforms, connectivity, software and sensors for health care. These technologies span a wide range of uses – from applications in general wellness to managing chronic disease or as applications as medical devices. They include technologies intended for use as a medical product, in a medical product, as companion diagnostics or as an adjunct to other medical products (devices, drugs, and biologics).’

Surgeons have taken a while to jump on this bandwagon to claim digital as their own.

The first surgical operation was carried out in Borneo around 31,000 years ago. It was an amputation involving the removal of the distal third of the left lower leg. The person survived the operation and lived for another six to nine years. For centuries, surgeons have practised analogue surgery. The term ‘digital surgery’ has recently become a concept and is increasingly accepted into the surgical fraternity. It has the real and exciting potential to revolutionise surgical practice.

My own definition, having been a recognised pioneer over the last decade in this field, is as follows: ‘Digital surgery are technologies that allow better visualisation and more precise surgery with real-time navigation and planning, use data to drive and improve surgical performance and patient outcomes and offer high fidelity simulation for training.’

CARED and connected

I consider digital surgery as essentially five pillars and remember these using the acronym CARED:

Connected surgery and remote collaboration.

Artificial intelligence and data analytics

Robotics

Extended Reality

3D printing.

We are now more connected than ever as a civilisation, with 95% of the world having at least a 3G connection. With the increasing availability of 5G and high-speed broadband, including Starlink, in many parts of the world, we are now hyperconnected.

Now, many platforms are available that allow surgeons to mentor from a distance using telemedicine.

As the global ambassador, I am pleased to share that Rods & Cones has connected 1,000-plus hospitals globally using their augmented reality smart glasses platform to allow remote training – a real milestone in mass adoption.

The mobile platform allows a surgeon to carry the set anywhere in a small case and set it up in a few minutes, truly helping to democratise surgical training.

I cannot believe that it has been nine years since I performed the world’s first Google Glass operation to a global audience and, in a small way, showcased what was possible. I think Google Glass was at least a decade ahead of its time, and it has been mooted that it is about to make a comeback of sorts.

With the introduction of robots and hyper-connectedness, remote robotic surgery is no longer the realm of science fiction. In 2000, Professor Jacques Marasceaux performed the first remote robotic transatlantic surgery, a laparoscopic cholecystectomy, with the patient in Strasbourg whilst, with his team, he operated from a robotic console in New York, some 4,000 miles away.

The operation was called the Lindberg Operation, named after Charles Lindbergh, who first flew across the Atlantic from Paris to New York. More recently, it was upgraded to version 5.0.

In 2017, at the Fujian Medical University Mengchao Hepatobiliary Hospital, 5G was used to perform a robotic operation on an animal that was devoid of its liver in China. This demonstrated the latency and fast speed to operate in real-time. The first cholecystectomy was carried out on a 30-year-old woman in Xinjiang, China, in only 30 minutes through remote surgery, in an operation orchestrated from more than 4,500km (2,800 miles) away.

The operation is part of broader national plans to advance 5G-based robotics in medical care as part of the country’s five-year plan. There are now reports of robotic hysterectomies being routinely performed remotely on patients in China.

There has been a welcome proliferation of surgical robots over the last few years, offering choice and healthy competition to the consumer. Still, Intuitive’s instantly recognisable Da Vinci robot completed much of the early groundwork and adoption into the surgical community.

Smaller and sleeker

As robots become smaller, sleeker, modular with open consoles, and increasingly more affordable, there should be rapid global adoption into emerging markets. The West has already reached its tipping point in adoption and will rapidly reach market saturation. For many countries, however, the robot remains an aspiration.

Undoubtedly, many surgeons will eye up the opportunity to be the first in their country to use the robot and count the column inches in the national press and media.

Virtual reality has finally found its place in surgery. We are seeing increasingly suitable content for surgical training, particularly in orthopaedic surgery, using computer-generated images built on platforms like Unity or Unreal Engine. Repetitive and systematic training improves surgical performance and helps surgeons understand the 3D perception and environment early in their careers.

Surgery is also now being augmented using smart glasses or mixed-reality headsets. The incredible ability to overlay DICOM images from an MRI or CT with 3D visualisations allows surgeons to plan surgery or, indeed, be guided during a surgical operation.

The analogue surgeon is rapidly replacing the Swann & Morton scalpel with a digital one. There has also been a digital to analogue transformation of surgical implants and prostheses created by the mesmerising technology of 3D printing – although the uptake and reimbursement models have been challenging.

Surgeons have always relied on two innate skills, accumulated over time, to improve their surgical and diagnostic prowess. One could argue that intuition and judgment are more important than surgical skills in the OR. Could AI replace a surgeon? Well, the answer, of course, is no, but certainly, a surgeon's practice could be augmented.

AI will become valuable to a surgeon, allowing more precision, and the data collected will undoubtedly improve surgical outcomes.

If we look at the automotive industry, with the introduction of smart cars that aim to be autonomous (although no car has officially reached level 5 of true autonomy yet), we get a sense of what may be possible in surgery.

Companies are using computer vision to train AI algorithms on thousands of surgical operations to allow real-time surgical navigation, which would be highly useful in video-assisted surgery like laparoscopy. Aiding a surgeon through a complex operation, perhaps to avoid important structures or indeed help define the margins of a cancer, will support precision surgery.

In 2017, we saw the world’s first ‘autonomous surgeon’, a rather grainy video of a robot performing a surgical anastomosis apparently as well as a trained surgeon. Interestingly, this has not been repeated or indeed reported widely, which obviously casts doubt as to the claimed outcome.

Surgery is often compared with aviation regarding ensuring safety with the introduction of checklists, but now we have a new analogy. We now have the ability to collect all of the data from the OR, including the laparoscopic video feed, patient biometrics from the intensive monitoring of the anaesthetised patient, and a bird’ s-eye view via cameras of the entire surgical team in action.

The data is collected in the so-called surgical black box, comparable to an aeroplane flight recorder. This data could be used to examine individual and team performance and provide documentation of a procedure allowing risk analysis when things do not go as planned.

The Silver Scalpel accolade is awarded yearly to the best national surgical trainer in the UK. I was most fortunate to be awarded this in 2016. I wonder what the best digital surgeon will be awarded in the future. Answers on a postcard.

Next-generation sutures are being developed to close wounds, detect inflammation, and deliver therapeutic drugs, further raising the bar in surgical recovery. 

Engineers at the Massachusetts Institute of Technology (MIT) have created bioderived sutures to reduce patient discomfort and complications after surgery.

These smart sutures could help patients heal after bowel resection or other types of surgery.

The MIT researchers used pig tissue to create sutures that can carry sensors, drugs or cells and could also be adapted to heal wounds or surgical incisions elsewhere in the body.

Their work draws inspiration from catgut sutures that utilise collagen from cows, sheep and goats to form strong, naturally dissolving knots within around 90 days. 

Former MIT postdocs Jung Seung Lee and Hyunjoon Kim are the lead authors of the paper published in Matter.

Giovanni Traverso is an associate professor of mechanical engineering at MIT, a gastroenterologist at Brigham and Women’s Hospital and the study's senior author.

Building on the concept of catgut, Traverso and his collaborators aimed to develop a tissue-derived suture material with enhanced properties such as toughness, absorbability and the advanced functionalities of sensing and drug delivery. 

Such sutures could prove especially valuable for patients with Crohn’s disease, necessitating intestinal section removal due to scarring or inflammation-induced blockages. 

The resealing of the remaining intestine ends following a procedure like this demands a secure seal to prevent hazardous leaks.

To mitigate this risk, the MIT team conceived the suture design that anchors the tissue and detects inflammation – a critical sign that the healed intestines are not recovering as expected. 

The researchers crafted their innovative sutures from pig tissue, employing a ‘decellularisation’ process involving detergents to reduce the likelihood of triggering inflammation in the host tissue. 

This process leaves a cell-free material called De-gut, encompassing structural proteins such as collagen and other biomolecules in the extracellular matrix around cells.

The team assessed its tensile strength after dehydrating and twisting the tissue into strands. 

The results indicated comparable strength to commercially available catgut sutures, with the benefit of inducing significantly lower immune responses in surrounding tissue than traditional catgut.

Lee said: ‘Decellularised tissues have found extensive use in regenerative medicine due to their remarkable biofunctionality. We now propose an innovative platform for sensing and delivery using decellularised tissue that will unlock new applications for tissue-derived materials.’

The researchers progressed to enhance the suture material further by coating it with a hydrogel layer. Various cargo types could be embedded within this hydrogel, including microscopic particles capable of sensing inflammation, diverse drug compounds and even living cells.

The team designed microparticles coated with peptides released by inflammation-associated enzymes called MMPs for sensing. 

These peptides can be detected through a simple urine test. Additionally, the researchers demonstrated the potential to carry drugs like dexamethasone and adalimumab—used for treating inflammatory bowel disease – via microparticles crafted from FDA-approved polymers like PLGA and PLA. 

This method controls the drug release rate and can be adapted for other drug types like antibiotics or chemotherapy.

The versatility of these intelligent sutures extends to delivering therapeutic cells such as stem cells. 

In exploring this application, the researchers incorporated stem cells engineered to express a fluorescent marker into the sutures, observing their viability for at least seven days after implantation in mice. 

These cells could also produce vascular endothelial growth factor (VEGF), stimulating blood cell growth.

The team is now focused on comprehensively testing each potential application and scaling up suture manufacturing. They are also eager to investigate the feasibility of utilising these sutures in body regions beyond the gastrointestinal tract.

MIT engineers have designed tissue-derived smart sutures, pictured here, that can not only hold the tissue in place but also detect inflammation and release drugs. The sutures are coated with hydrogels that can be embedded with sensors, drugs, or cells that release therapeutic molecules. Image courtesy of the researchers

A new tool is changing how surgeons assess risks for adult heart surgery. 

The Society of Thoracic Surgeons (STS) has harnessed advanced technology to help them better understand the risks involved in surgery.

The Operative Risk Calculator is a pioneering tool that draws on the extensive STS Adult Cardiac Surgery Database. It encompasses 97% of cardiac operations – or the treatment experiences of more than eight million patients across the States.

This upgraded calculator is primed to empower medical practitioners and usher in a new era of enhanced patient care by harnessing big data.

Mobile-friendly, it features a simplified, intuitive user design to improve physician-patient decision-making. 

The heart of its innovation lies in its real-time risk estimation, facilitating timely and informed decisions for surgeons and multidisciplinary medical teams. 

Powered by the latest nationwide data from the 2023 STS Adult Cardiac Surgery Database, the risk assessments are underpinned by resilient models that receive quarterly updates.

STS President, Dr Thomas MacGillivray, said: ‘This next-generation Operative Risk Calculator is a powerful, user-friendly tool that makes it easier for cardiothoracic surgical teams to assess risk and predict outcomes in real time for the vast majority of adult cardiac surgery procedures.’

The unveiling serves as a precursor to a series of upcoming enhancements to the STS National Database. 

The expansion takes place in the coming months and is tailored to meet the day-to-day needs of surgeons, data managers and cardiothoracic care units. 

User feedback informed the design of the new Risk Calculator and is also driving the development of other innovations to fully leverage the nearly 10 million cardiothoracic surgery procedures in the database.

By early 2024, its coverage looks to encompass more than 90% of all adult heart interventions, as it incorporates risk models for less frequently undertaken procedures.

Noteworthy features of this pioneering tool include:

The calculator generates real-time clinical summaries of simulated patients, complete with corresponding risk evaluations, streamlining integration with electronic health records.

The STS National Database incorporates data from around the US and spans 11 countries and is considered the benchmark for clinical registries chronicling patient outcomes in cardiothoracic surgery.

It unites data-driven precision with medical acumen to shape a future marked by improved patient outcomes and more informed medical decision-making.

The Adult Cardiac Surgery Operative Risk Calculator can be found here.

A research team has been recognised for developing histotripsy – a cutting-edge treatment that uses focused sound waves to disintegrate diseased tissue.

The pioneering technology employs precision-focused ultrasound waves to disrupt targeted tissue without resorting to thermal ablation techniques.

And as histotripsy emerges as a viable non-invasive alternative to conventional surgical interventions, the researchers’ work has been rewarded as they scooped this year’s prestigious Distinguished University Innovator Award. 

The award recognises the outstanding contributions of University of Michigan faculty members who have nurtured transformative concepts, processes, or technologies and guided their journey to the broader market for societal benefit.

The innovative team from the University of Michigan’s College of Engineering and Medical School includes:

Mary-Ann Mycek, interim chair and professor of biomedical engineering, commended the collaborative team’s remarkable achievements and highlighted how their contribution has taken the innovation towards clinical translation and commercialisation.

A start-up enterprise called HistoSonics was established in 2010 and dedicated to steering research commercialisation initiatives.

While minimally invasive and non-invasive techniques have become standard practice in clinical settings, they have limitations. 

HistoSonics has accomplished the seemingly unattainable feat of using sound wave energy to obliterate diseased tissue.

Zhen Xu expressed gratitude for the support from the University of Michigan during the journey of inventing and developing histotripsy. 

She said: ‘Science’s most thrilling aspect lies in converting the impossible into reality. Our team’s achievement of providing a painless, non-toxic method to obliterate diseased tissue through sound wave energy is truly remarkable.’

She sees further applications for histotripsy across many medical domains, including stroke, neurological diseases, cardiovascular disorders and skin ailments.

Earlier this year, a ground-breaking milestone was achieved as 73-year-old Anthony Harris became the world's first cancer patient to undergo kidney tumour ‘removal’ using histotripsy. 

Leeds Teaching Hospitals NHS Trust and HistoSonics jointly announced the momentous achievement that marked the inaugural treatment in the CAIN Trial, a Phase I prospective, multi-centre study designed to evaluate the safety and technical success of the histotripsy system in targeting and obliterating primary solid renal tumours in a completely non-invasive manner.

Example of HistoSonics technology targeting kidney tissue to be destroyed in a non-invasive histotripsy procedure.

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