She was Chief Medical Information Officer for the Dutch Ministry of Health, Welfare and Sports and was recently appointed a board member on ZonMw, the Dutch national organisation for health research and healthcare innovation.

When Amsterdam UMC announced her latest appointment to ZonMw, it said she fulfilled “the profile of a leading clinical scientific researcher who is active in a broader field than her own and a figurehead with insight into knowledge and research agendas in the broad field of healthcare”. This assessment is unsurprising when you consider her academic background spans medicine and design.

During a brief gap between back-to-back meetings, the highly sought after Professor explained: “I’m a hybrid surgeon. When I finished high school, I went to the Design Academy in Eindhoven for a year. Although I did well, I wasn’t the most brilliant kid there so I decided to make a change and went on to take degrees in Health Science and Medicine. They may seem different but really all my studies centred on solving problems in society.

“My background means I look at new technologies coming out of telecommunications companies and the gaming industry in a different way to most other surgeons. When I see a brilliant new technology, I immediately question if we can use it in healthcare.”

As the lead on E-health at her hospital, Marlies’ expertise was in huge demand when Covid-19 hit and Amsterdam UMC’s 10,000-plus employees had to transition to carrying out consultations with patients via video in just two weeks.

“We had to think about how to achieve that. Challenges like this are where technology, design and healthcare meet and because I’m able to think across boundaries it helps me to identify how hospitals can successfully use new technologies,” Marlies said.

Increasingly, over the past 10 years Marlies has found more and more of her colleagues have become enthusiastic about embracing the opportunities that new technologies are offering surgeons and medical students.

She said: “The old adage used to be big surgeon, big cut. Now if you’re a proficient abdominal surgeon you use little cuts. You use laparoscopy or robotic technology.

“A lot of technology has entered the operating room – indeed there’s so much technology in the OR that it can be hard for a surgeon to master it all. However, technology presents us with so many opportunities inside and outside the operating room.

“For example, when it comes to training, we have limited access to operating rooms and a shortage of people because of post-pandemic issues but also increased demands related to patient safety. We cannot train our residents to the standards we need to in the actual workplace so it makes sense to use simulation or serious gaming to address that problem.”

Currently, Marlies is working on another exciting research project to discover if technology can be used to help patients manage pain. The Digital Pain project was launched to help hospital patients who need wounds dressing as the painful process often makes patients fearful of their wound care, which increases their pain further. To tackle the problem, Marlies and her colleagues are studying whether virtual reality environments can be used to help patients while their wounds are dressed, and how to do that best.
She said: “We’ve started immersing patients in virtual reality environments so they’re distracted and the time it takes to take care of their wounds becomes shorter in their memory. As a result, they may need less pain medication.
“We’re studying which virtual reality situations relax patients the most because we want to discover whether it’s better for us or the patients to select which virtual reality situation is used. For example, I like pop music much more than classical music but my brain becomes more tranquil when I listen to Bach than when I listen to Madonna. It doesn’t necessarily follow that someone’s preference provides the best solution so research in this area is really exciting.”

Marlies says one of the biggest challenges with introducing new technologies to hospitals and operating rooms are the questions that arise in relation to privacy, ethics and logistics.

Marlies says one of the biggest challenges with introducing new technologies to hospitals and operating rooms are the questions that arise in relation to privacy, ethics and logistics.

Proponents of new technologies need to ensure they are CE marked, may be properly sanitised and are robust enough for nurses and doctors to use regularly. They also need to address who will be held responsible if a piece of expensive technology is damaged or stolen and if a piece of technology might breach patient privacy.

“We now use ‘Black Boxes’ in operating rooms to generate comprehensive output files of surgical procedures, so we can do a team de-brief but that raises questions about privacy,” said Marlies. “We scramble faces and alter voices, but we have to consider whether we need patient consent or just an opt-out option for them, when the objective is to improve processes in the OR instead of direct patient care.

“Another huge area for hospitals at the moment is how we use technology to provide care at a distance through teleconsultations and remote monitoring. We need to consider whether patients are using monitoring technology correctly at home, how we get that information into patient health records and how it is used. Realistically, it is too costly and most likely, also non-informative, to add all outpatient data recorded at home into hospital files, so you need to start looking at subsets and how the information that is entered into patient files is used."

“For instance, if a patient is having their health monitored remotely and they have a stroke at night that information will go into their files if there is a patent coupling of data. But data landing in an electronic health record is not automatically going to set off an alarm in the hospital. We need to think about these scenarios because as far as the patient is concerned, they’re being monitored and they feel protected.”

Marlies also feels it is time that we have a societal debate about the use of technology in hospital and patients’ rights to privacy to give the public a better understanding of the difficulties that hospitals face when it comes to implementing new technologies.

She said: “In terms of technology lots of things are possible. The question is how do we fit technology into the existing infrastructure of our hospitals?"

“People think about all the things they can do online in their daily lives and they don’t understand why hospitals can’t do the same thing. They’re not wrong in their wish but it can be difficult for us to explain that we are bound by old rules and regulations about privacy and safety."

“People are willing to sacrifice a lot of privacy when it comes to signing up to loyalty cards at the mall because it leads to them receiving special offers but in healthcare it doesn’t work that way.”

“People may want to sacrifice their privacy also to make processes run smoother in the hospital. But we are governing that by default, their privacy concerning health data is protected. That is in essence a good thing of course, but why do we not inform the public in more detail about the possible risks, so they can make a calculated decision themselves about what personal health data they want to share, and for what purpose? And, between health care providers and institutions, should we not enable a default ‘share all’ behind a good security layer if the patient wants this?"

“Personally, I don’t really care if someone knows what my blood type is any more than if they know that I like a particular type of granola – it doesn’t represent a threat to me. However, it can be a tricky balance because the moment you want to buy a house and an insurance company discovers you’re on a list of 10 medications you can’t get your mortgage cheap because of your risk factor."

“This type of information can be misused if purpose-binding of sharing and with whom it is shared is not clear; whereas the type of granola you eat, to my latest knowledge, can’t be used against you.”

Having worked as a journalist for more than 20 years I’ve come across my fair share of impressive figures – including several heads of government – but no one quite measures up to Scott Parazynski. The renowned American physician is a former NASA astronaut and a veteran of five Space Shuttle flights and seven spacewalks. He is also the only man to have ever flown into space and climbed to the summit of Mount Everest.

I’ll admit to having approached the prospect of interviewing this goliath of a man with some trepidation, but within seconds of our online meeting starting, Scott had dispelled my fears. Even though – for Scott at least – our interview began at around 6am due to his busy schedule, he greeted me from his office in Houston, USA, with a warm and easy smile.

We began by talking about his childhood. He explained to me how it was his love of reading about explorers such as Captain Meriwether Lewis, Second Lieutenant William Clark and Jacques Cousteau that had sparked his lifelong love of adventure. As the son of an engineer working on the Apollo programme, Scott also witnessed major historical events at a young age, including some of the programme’s early missions including the launch of Apollo 9 from the beach in Florida which he says had a lasting impact on him and strengthened his love of space.

"From a young age, I knew that it would be a meaningful life to live in service of other"

I wondered whether this fascination with exploration and innovation had also triggered his interest in medicine but it turns out the inspiration for his surgical career is even more heart-warming.

“My mother’s father died before my parents met but he had been a surgeon and his wife, my grandmother, was a nurse so I grew up listening to stories about healthcare and helping people in their times of greatest needs,” explained Scott.

“From a young age I knew that it would be a meaningful life to live in service of others and be a healer, so I always had that in the back of my head.

“When I went to college that was one of my primary ambitions along with flying in space and lo and behold I found a way to do both.”

Scott took his first steps to achieving his dreams when he went to Stanford Medical School in the Bay Area of California. Only 20 minutes down the road was NASA’s Ames Research Center which has been conducting world-class research and development in aeronautics, exploration technology and science since 1939.

Whilst attending medical school, Scott secured an opportunity to undertake space physiology research at the centre and worked on long duration exercise devices for astronauts who were preparing to board the International Space Station.

Working at the centre presented Scott with the perfect opportunity to marry his two greatest interests and gave him strong credentials when he went on to successfully apply to join NASA’s Astronaut Corps in 1992.
Highlights during his time in space included leading the first joint US-Russian spacewalk while docked to the Russian space station Mir, serving as Senator John Glenn’s crewmate and ‘personal physician’ and the assembly of the Canadian-built space station robotic arm.

Scott, who has been inducted into the US Astronaut Hall of Fame, also led the spacewalking team on STS-120 in 2007 during which he performed four extravehicular activity (EVA).

The final EVA of the mission is regarded by many people as one of the most challenging and dangerous ever performed. The coordinated effort in orbit and on the ground by Mission Control has been compared to the Space Shuttle and Space Station era’s ‘Apollo 13 moment’.

Scott’s love of space continues to grow to this day and he’s clearly thrilled by the amazing images currently coming from the James Webb Space Telescope which he is confident will ‘rewrite the textbooks of astronomy forever’.

His excitement about space not only stems from his passion for exploration but because it has led to huge steps forward in medicine and surgery.

When he speaks of how early forays into space exploration led to significant developments in intensive care medicine and cardiovascular medicine it is clear he is enthralled by the subject.

“The miniaturisation of sensors that are now at the tips of scopes and catheters, the algorithms that are used to detect rhythm abnormalities, all these different capabilities actually have their pedigree in the space programme.”

“In the early days they wanted to make sure the astronaut was still alive so essentially they invented the Holter monitor,” Scott explained.

“It was the very beginning of tele-physiological monitoring and at the time it was driven by the need to address that ‘cutting edge’ challenge. Now, we see the Holter monitor as just a fundamental part of medicine.

“When humans take on enormous challenges and lofty goals like going into space, and they spend lots of money to figure out how to do that safely, inevitably wonderful technologies find their way into our everyday lives and in particular into medicine.

“The miniaturisation of sensors that are now at the tips of scopes and catheters, the algorithms that are used to detect rhythm abnormalities, all these different capabilities actually have their pedigree in the space programme.”

Scott is not content to simply make use of such technologies – he is leading the way in creating innovative products with his new organisation Fluidity Technologies and is involved in a UK company called 3D LifePrints. The latter is a digital planning platform which aims to personalise and individualise surgical interventions. It relies on incredibly detailed anatomical imaging which can be used to develop and plan complex operations to optimise patient outcomes.

Scott said: “It’s an extraordinary capability where we’re actually leveraging a patient’s own anatomy to help perform the very best surgery possible.

“We’re using 3D imaging and 3D printing technologies to visualise it and do pre-operative planning and even to create specialised tools for that surgery. We’ve really got pretty cool stuff happening right now.”

With an astronaut’s perspective on intuitive motion through space, Fluidity Technologies has patented an intuitive drone controller anyone can use called the FT Aviator. It could play a role in the tele-delivery of healthcare in the future and other technologies being developed by the company are of interest to surgeons.

“I’m really excited about minimally invasive surgery, natural orifice surgery and anything that we can do that reduces the toll of surgery on recovery and discomfort and so on,” said Scott.

“At Fluidity Technologies we’ve developed things to be able to precisely target the tip of a surgical instrument. Whether it’s an articulating scope of some sort that you’re navigating through the belly or the GI tract or through the lung to be able to get to your target, effect a repair and then come out the way you entered – that’s going to be really game changing in many different applications.

“We’re also in simulation mode right now on a project where our goal is to have a flying vehicle that is very efficient and very easy to fly but also very safe, within two years.

“We’re trying to create a two-person aircraft to begin with – something that you would feel comfortable sending your kids to school in alone.

“We’re also having serious conversations with several surgical robotics companies about our unique capabilities.

“Looking ahead I’m sure there will also be other things that will start to happen in and around the space programme as we begin to think about moving from near earth to actually living on Mars.

“It could take 21 minutes for a transmission to get from Earth to Mars and then another 21 minutes to get back, so you won’t be able to rely upon Mission Control, or even a robotic surgeon.

“We’re going to have to train robotic assets with machine learning and deep learning to virtually operate scripts and perhaps have a trained observer so that if something isn’t looking right they can stop the procedure and ask questions. It’s going to press the boundaries of automation in surgery.”

Scott’s talk of pushing boundaries in surgery made me question whether the 61-year-old has any personal challenges he still wants to conquer.

As well as being a highly respected surgeon, astronaut, company founder and accomplished mountaineer, Scott is also a prolific inventor, diver, serves on the boards of several companies and is a commercial, instrument, multiengine and seaplane-rated pilot.

Recently, he and a colleague became the first people to set bootprints next to the world’s youngest lava lake inside the crater of Massaya Volcano in Nicaragua.

Scott pauses to ponder my question about personal challenges for a second before addressing some of the toughest feats he has already conquered. Unsurprisingly, it’s a list unlike anyone else’s featuring his ‘really wild space walk’ to repair a solar ray and climbing Mount Everest but he says his toughest challenge is what he’s doing right now – building and growing a tech start-up.

The Mariana Trench ‘that’s the one big adventure I’ve got left’

Laughing, he said: “I always simplistically thought all you need to do is have a really great idea and all this other stuff will magically happen. The easy part is coming up with the cool idea; the execution is very difficult.

“It’s not just having a good idea and building a team around you to do it; it’s the fundraising, the manufacturing, the regulatory, the marketing – there’s so many different parts in and around doing that.”

Almost as an afterthought he adds that he has also always wanted to go to Challenger Deep – the deepest known part of the earth’s seabed – located in the Mariana Trench.

“I have a number of friends who’ve recently done that. There’s a submersible that goes to the full ocean depth – in fact the crew is out there right now doing multiple dives so I’m very jealous of that,” Scott said.

“That’s one part of our planet that I would love to see with my own eyes. I’ve done some deep dives down to the Titanic but never to those depths. That’s the one big adventure that I’ve got left.”

It’s a challenge that would be well out of the reach of most people but with Scott’s track record, it can surely only be a matter of time before he achieves that dream too.

With the possible exception of Schrodinger’s cat, there can be few who have yet to be touched by her social media presence where she is nothing less than a force of nature.

For over a decade, Rhea has driven the agenda for change by promoting equity and diversity issues in Surgery. The results have impacted not only on women in Surgery but also on those from minority ethnic backgrounds. Despite all this she is without doubt a very reluctant interviewee. Even now she is still not convinced that her story is one the wider international surgical community is eager to hear. But we have agreed to differ on this point.

I start our meeting with a confession. I admit to having been a little duplicitous by engaging a mutual friend to gently cajole her into agreeing to this interview. In reality, I think she has already rumbled me but has the good grace not to say so. In fact, she’s only just in time for our scheduled meet – having spent the three previous hours in theatre with an emergency laparotomy and from which she is still ‘buzzing’. After 15 years as a Consultant surgeon she still finds the experience both exhilarating and professionally satisfying. It is a reminder that despite the heavy social media presence Rhea is still very much a ‘jobbing’ surgeon with a busy ‘day job’ and a 1:6 emergency on-call rota to contend with.

Despite the nick-name ‘Scrubby’ at Medical School Rhea had never intended to become a surgeon.

As it transpires the label refers not to a predilection for wearing ‘scrubs’ but an unflattering reference (she thinks) to her short stature or alternatively the answer to a cryptic crossword clue she and friends once struggled with on the back row of a lecture theatre whilst studying Medicine in Auckland! Rhea had very much planned a career as a General Practitioner (Family Medicine) feeling it played to her communication strengths - a skill that has certainly not been wasted or gone unnoticed in the surgical arena.

Much of Rhea’s achievements in the field of equality and diversity promotion have come through her involvement with the Royal Australasian College of Surgeon’s (RACS) Operating with Respect Education Committee (and of which she is the immediate past Chair). Her interests in the field however predates her committee membership by some years. Rhea established an interest in Medical and Surgical Education – perhaps stimulated by the perceived ‘cognitive dissonance’ in surgical teaching methodology – which spurred her on to post-graduate qualifications in the field. She became an instructor and then Director of the CCrISP course (Care of the Critically Ill Surgical Patient) as well as becoming responsible for the delivery of the surgical curriculum at the newly established Bond Medical School.

It is however her landmark Lancet paper in 2019 that remains to this day a wake-up call to the profession.

Based on her thesis it candidly examined the reasons why women left surgical training – and at an alarmingly higher rate than their male counterparts.

Did she ever contemplate leaving surgical training? At least twice. The first was after the birth of her son in an early part of her surgical training. At a time when flexible training had yet to emerge even as a concept and working hours remained medieval, there was the inevitable guilt that comes with the “balance of being full time surgeon and full-time Mother”. Rhea admits that things are a little easier now for her – not least because said baby is now at University! The second time was as she approached the end of training and approaching the Australian equivalent of the surgical ‘exit’ exam. She was undermined, belittled, disparaged and derided by a senior Consultant entrusted with her training. Although she doesn’t use the word ‘bullied’ there can be little doubt that the actions amounted to this. Her chances of successfully achieving the necessary academic goal was openly mocked. Rhea is (by her own admission) nothing if not ‘stubborn’ and true to form hurdled this final academic milestone with ease. She has no interest in naming names but her story will be a depressingly familiar one to many. It represents the vestigial and shameful remnants of a damaged training scheme where individuals in authority held draconian sway over individual careers and against which there was no right of appeal. Although training environs have clearly improved Rhea argues there are still the day to day micro-aggressions which women and those from ethnic minority backgrounds contend with on-a-daily basis.

Has this left a simmering discontentment at these past injustices? Surprisingly no – just a desire to make a difference for the next generation of trainees. Has it changed her? No – at least not outwardly. She has the same interests in baking (we have a shared passion for egg tarts) the sharing of recipes and crochet, that she ever did. In fact (and for some years prior to her Twitter account reaching over 15,000 followers) trainees in difficulty were often advised to look out for the ‘crochet lady’ at surgical meetings. Having identified her, there came the casual introduction followed by the inevitable heart to heart about training related problems.

What are her greatest professional achievements to date? These are much easier to extoll. All surgeons now undergo on-line training in issues relating to equality and diversity and this fundamental learning exists today only because of the unrelenting drive of the Operating with Respect Committee at the RACS. There are more in-depth and nuanced face-face training for all those more senior surgeons involved with training roles. The ‘RACS Speak Up’ App (available in both Android and iOS) is freely available to download and whilst it was originally intended to complement formal training it remains a valuable stand-alone resource for those who find themselves in the position of having to have ‘difficult’ conversations. Rhea herself has contributed to a wide variety of other social media sites on the theme of equality and diversity and this includes the famed ‘The Theatre’ podcast which was run by the Royal College of Surgeons of England. More recently she has contributed to the Diversity review at the RCS England which was Chaired by Baroness Kennedy.

What does the future hold for Rhea? She is unlikely ever to be able to divest herself of her pre-eminent role in improving equity in surgical training (nor would she want to) but I suspect there is a deep-seated hope that one day (but probably not very soon) that it will not be necessary and she will be able, at last, to return to using her Twitter account just to share recipes again! In the meantime, her newly appointed role as Sub-Dean for Medicine at Bond Medical School is likely to keep her busy inspiring a new generation of clinicians whilst secretly perfecting the recipe for egg tarts.

Interview by Tim Lane

Nobel laureate Marie Curie once said: “be less curious about people and more curious about ideas”. It’s a philosophy surgeon Professor Dhananjaya Sharma has very much taken to heart.

He took time out from the Center for Global Surgical Innovations and Low-Cost Solutions in Jabalpur, India, to talk to SURGERY about his work: from what drives him to ‘modify, simplify and apply’, to his thoughts on retiring in less than two year’s time.

Dhananjaya takes inspiration from Occam’s Razor, the hypothesis that if there are multiple explanations for any phenomena, the simplest is likely to be the correct one. “Similarly there are many ways of doing things in surgery, I want to find the simplest and the most economical way. It’s a good intellectual exercise,” he said.

Both his grandfather and father were physicians, and “from day one” Dhananjaya knew he would follow them into healthcare, choosing to become a surgeon because he wanted greater involvement with his patients.

He explained: “40 years ago, if you had a heart attack, you took out an ECG, prescribed aspirin and sent people home. There were no interventions. Now, physicians are doing so many therapeutic interventions, including endoscopies and heart catheterisation and stenting.”

Two decades ago, Dhananjaya started Central India’s first gastrointestinal surgery unit. Over the years, he gradually took a back seat. “I started thinking ‘what more can I offer?’ as I started approaching the evening of my career, before I hung up my gloves, so to speak.”

A passion and addiction.

He describes the “revelation” that he could find local solutions for patient’s requirements. “It became a passion, I became addicted to it. It’s all I think about now: how I can simplify a procedure, how I can make it more economical.”

Oddly, not everyone was enthusiastic about Dhananjaya’s efforts. “I used to call them low-cost or cheap innovations, but I realised these words are counter-productive,” he said. “Everyone has social aspirations, they don’t like the sound of the words ‘cheap’ or ‘low cost’ so I now call them affordable or cost-effective solutions.”

One of the best examples of the eye-opening work carried out at the Center is with patients who have stomas following abdominal surgery. “There is excoriation of skin around the stoma, so we apply medication to protect it,” he explained.

“Commercially available treatments are quite expensive, so we use linseed oil. It’s available in rural areas and even an uneducated patient knows about its medicinal qualities.

“If you keep your mind open, the ideas are raining down all the time. It is we who have closed our minds - you can learn from everyone”

“When I really looked into it, I found it had been used by every civilisation in history. I didn’t know, I was taught about it by a patient. It is 10% of the cost and patients are happy: they know from their grandmothers that linseed oil has medicinal properties.”

He admitted that if resources and wealth were more evenly distributed, he probably wouldn’t have to apply the Center’s ‘modify, simplify and apply’ maxim.

“My Western counterparts don’t have to think or worry about it. Everything is laid out in front of them and they can pick and choose. I have to modify so I can make that surgery more affordable for my patients.”

He went on: “disparities are everywhere, not only in the field of medicine. The bottom line is: medicine is a social science. Patients are affected by the lack of money and support. When they go back nobody’s at home to look after them, and when they lose their jobs and salary, who’s going to compensate them? What we’re doing is social work.”

Inspiration in unusual places.

Dhanajaya and his team also devised an abdominal closure technique after reading about another Nobel laureate, French surgeon Alexis Carrel. He was awarded the prize for developing a suturing method based on his mother’s lace making and tatting (a technique for handcrafting durable lace) skills.

“When I found out about this, my mind immediately went to: ‘what more can we learn from this?’” Dhananjaya said. “If you keep your mind open, the ideas are raining down all the time. It is we who have closed our minds - you can learn from everyone. I learned how to give an intravenous drip from nursing staff, they taught me how to draw a blood sample.”

The exchange of knowledge is a fundamental part of how the Center operates. “Usually our ideas are the result of interactions among our consultants,” he explained. “We all sit together in between cases and talk about surgery and ideas.

“In my department, one of the things that is banned is ‘no cribbing’. Don’t cry on my shoulder, don’t come to me with a problem, I tell them to try to find a solution. Don’t tell me ‘I don’t have this, I can’t perform this operation’. I always tell them that we are all intellectuals and we need to find the solution to our patient’s needs.”

He went on: “If you portray yourself as an intellectual, you must do intellectual things. We try to find solutions. People come to us when they come across a new idea, they bounce it across us.

I’m always happy to assist my younger colleagues. I have so many students spread across the world, with visiting professorships in 29 countries. Now with videoconferencing, things have become so easy: I can demonstrate an operative technique or show my slides.

Dhananjaya revealed how, despite the complex relationships between India and Pakistan and Afghanistan, video conferencing technology has enabled him to teach there for the past several years. “They ask if I’m available and I say ‘why not?’. My time is running out, I have to share my ideas and philosophy.”

“I’m not a surgeon for the elite, I’m a surgeon for the common man.”

As eager as he is to share the wisdom he’s accrued during his career, Dhananjaya aims to provide a holistic learning environment. “There should be no pressure,” he said. “Education means I’m just creating an atmosphere for my students to learn. If they vibe with me, good, if they don’t vibe with me, I still have to teach them during those three years they spend in my department. I have to show them that this is how things are done, this is how you go along.”

He continued: “In a teaching hospital, everything is clear. The college part is for students, the hospital part is for patients. I’m nowhere - I have to leave my ego out.”

When asked if all surgeons have an ego, Dhananjaya laughed. “Come on! Surgeons are driven by ego! They used to have God syndrome, but they grew up and realised it’s not them doing things, there is a higher power.

“It’s only when my patients do well that I get credit, or when my students do well as a teacher I get credit. I’m the last one to get credit, so where is my ego? I have to focus on my patients and my students. That should be the philosophy.”

Although he admitted he is an agnostic - preferring to “worship at the altar of education” rather than a temple, mosque or church - he insists there is a place where faith and medicine meet. “Every thinking surgeon has to believe in God, because we’ve all seen so many miracles.

“People who we thought won’t survive do so against all odds, and sometimes patients who are not supposed to have any complications, we lose them. There are many things we can’t define.”

A ‘glocal’ way of working.

Things are a lot clearer-cut when it comes to innovation, and why Dhananjaya champions what he dubs a ‘glocal’ way of working, based on a combination of “wisdom from everyone and local technology”.

He explained: “I want to use technology that is locally available. I’m involved in its co-creation so I can maintain it and if some part is not available, I don’t have to wait for it to arrive from overseas after three months.”

That staunch independence means he isn’t beholden to technology companies who would force him to buy models by making previous versions obsolete. “Companies splurge on their advertising, they sponsor doctors and even their thinking: people become their mouthpieces.

“When a new technology comes in, it’s being driven by the commercial interest of the company. I could never be sponsored like that. My sponsor is right here in between my two ears, that is all.”

His team’s work has resulted in several affordable surgical solutions such as simplifying prognostic scores and simplifying various surgical procedures so they can be used even in small hospitals. A simple elegant example is restoring sensation in the feet of patients with leprosy and diabetes by a simple nerve transfer.

Not that he is opposed to technology. “It’s made everything safe for all of us,” Dhananjaya said. “I just want to add a word in front of technology and that is ‘affordable’. I don’t want to invent an operation that costs $1 million to perform.

“I’m not a surgeon for the elite, I’m a surgeon for the common man.”

And so he innovates, not only to help his patients, but also in a bid to reclaim the word from linguists who he said have “hijacked” it and “defined it in such a way that only very high tech innovation will be termed as such”.

“I innovate because my patients can’t afford it. They innovate because they have to justify buying that multi-billion dollar machine. We’re both doing the same thing but they are doing it more expensively, that is all.”

Dhananjaya is set to retire in 17 months, but admitted the notion fills him with a “mixed bag of emotions”. He wants to continue teaching and already has offers of work in Thailand, Bangladesh and even in Antigua. Primarily, his focus is on giving students the confidence to find their own solutions to situations.

From arrogance to pride.

Talking about the potential end of his career prompts Dhananjaya to recount a story from his early years which offers a profound insight into the man he is today.

“When I was a final-year student, one of the consultants in paediatrics offered to analyse my handwriting,” he recalled. “So I wrote something, and she said ‘you are very ambitious and you are very arrogant’. I said ‘what is wrong with being ambitious?’ She said ‘that is your arrogance’.

“I found out there is a very fine line between arrogance and confidence, and also between arrogance and pride. If I think I’m the only one doing a good job, that is arrogance. But if I think many people are doing their work and I’m doing my work to the best of my ability, I can say this with pride. So over time, I’ve changed from an arrogant young surgeon to a man who has pride in his work and the students who are doing well that I’ve assisted.”

He smiled and added: I have close to 100 of my students who have become professors in so many places. Now they want me to teach the same values to their kids! I say they’re not working under me, I can’t teach your children.

“But most of them are in touch with me and when I travel they all come to meet me, so maybe I’ll do something with the next generation as well.”

He added: “I don’t want to use the word mentoring, which is often used in the Western world. Being a mentor is an honour that has to be bestowed by the student. It’s only when they pass out and they say ‘Professor Sharma is our teacher and I like him, he mentored me and showed me the way,’ that I’m ready to accept that compliment.”

It will be very much deserved.

It was the four crushed metatarsals in his left foot that first made Andrew Dold consider a career in Orthopaedics. And the dislocation of his right shoulder - twice - and a broken hand and jaw that made him begin “thinking to myself that it would be a rewarding profession to be in, to help young athletes like myself at the time, get back to the things that they love to do.” Dold, a keen rugby and ice hockey player in his teens, found himself struck by the skill of the physicians who returned him to the sports pitches in his native Ontario, Canada (one of whom he kept in touch with after being discharged). Throughout the most severe of his scrapes, “to this day [I] remember the interaction I had with the orthopaedic surgeon” - a relationship he too hopes to imprint on his patients.

Four crushed metatarsals in his left foot made Andrew Dold consider a career in Orthopaedics.

Since his teenage sporting days, “my training has taken me to different places” - from an undergraduate biology degree at the University of Western Ontario to medical school at Trinity College, Dublin, a Fellowship at New York University, a surgical leadership diploma at Harvard Medical School and his current role as director of sports medicine and arthroscopy at Star Orthopedics and Sports Medicine in Frisco,Texas. Along the way he has racked up a series of accolades, including a Top Doctor Award from the International Association of Orthopaedic Surgeons in 2018, being named among the Top 40 Under 40 by USA Top 100 Magazine in 2018, and D-Magazine Best Doctor Award for the past five years.

Whilst at NYU Dold, now 40, “became more aware and familiar with excess inventory” - the reams of medical stock that is bought in bulk and shunted to the back of hospital store-rooms, often expiring without ever being used. It became apparent “that this was a big, big problem,” Dold recalls - one that currently costs some $800bn each year. Never was that brought into focus more sharply than when he asked for some suture anchors to practice with - and was handed “about 10 boxes of the supplies that I was after," worth around $1,000 a pop. “I sort of looked at them, and said, aren't these needed here?” Far from it; they were a small part of the mountain of overstock clogging up cupboard space that staff were only too keen to offload.

Finding himself confronted with the same issue in the posts that followed, it became clear that “there's not really a great solution to this problem… [so] it seemed like it would be a good opportunity to come up with some sort of an alternative idea for wasted inventory.” The end result is RevMed - a service he describes as “a niche eBay for hospitals and ambulatory surgery centres to interact.” Medical outfits can list stock that is sure to go unused on the platform, with others who are in need able to purchase it (and in far smaller numbers than the bulk often required to get reasonable prices) without contributing to the mass overbuying that’s creating a needless stock mountain in the first place. “It creates more of a niche, boutique option for the buyer,” Dold says - adding that, while “we’re a work in progress,” the ultimate ambition is to “hopefully reach every hospital in the United States, and then eventually the rest of the world.” It’s a considerable task. But Dold is spurred on by the desire to boost sustainability in healthcare (the environmental toll “appears to me to be a significant one”), prevent waste, and lower the cost of supplies for both the providers and, ultimately, the patients.

Dold is spurred on by the desire to boost sustainability in healthcare.

The name RevMed was inspired by the revision procedure used to correct orthopaedic surgeries; Dold realising that here was a problem in need of revising, too. The venture taps into both his medical experience, and his business interests: “I recognise this is a big problem and a big opportunity at the same time," he explains. "I feel like I'm an entrepreneur, and I'm always looking for things that can be done better. And this was certainly a glaring opportunity in the healthcare world.”
His public platform will no doubt help spread RevMed’s reach; Dold has a YouTube channel and podcast detailing his work, along with 50,000 followers on Instagram, where his feed is a mix of x-rays, theatre shots and smiling portraits with national sports stars he’s worked on, from American footballers with the Dallas Cowboys, Tennessee Titans and Minnesota Vikings to basketball players from the Utah Jazz and Philadelphia 76ers. He has been a physician and consultant for the men’s and women’s Canadian rugby teams, the Mississauga Steelheads of the Ontario Hockey League, and the NFL Scouting Combine in Indianapolis; the hallway of his Texas surgery is lined with signed sports jerseys, tributes scrawled in black Sharpie to ‘the best in the biz.’

Retaining a tight lens on one area naturally means you become more familiar with the individual operations.

Will he ultimately switch to working on RevMed fulltime? “I can't, to be honest, imagine doing anything else as a profession; I really, really love what I do. So I'm certainly not going to abandon my orthopaedic and sports medicine career. That's something that I would always like to keep going.” As well as driving his career for two decades, it provides the kind of stability that enables plenty of  time with his wife and sons, four-year-old Jack, Sam, two, and newborn Rowan. "My top priority is my family and my children and being as involved with their lives as I possibly can be,” he says. Outside of family and clinical practice, he is a keen golfer (Dold played on the university team at Trinity), and reviews courses across the US for Golf Digest magazine to rank the “aesthetics and upkeep” of various clubs (Cypress Point in California remains a favourite). He also plays in amateur events at home in Texas, as part of the US Golf Association. The state has now been his home for seven years and, after a peripatetic few decades, he is content to stay in one place, and focus on one clinical area, using his research into stem cell and platelet-rich therapies for management of injured joints along with the numerous reconstructions he carries out each year. Retaining a tight lens on one area naturally means “you become more familiar with the individual operations that you can focus on and they become more and more comfortable for you as you advance.” But complicated reconstructions - no matter how many have come before - still “keep you on your toes,” Dold says. With two careers, three kids and a sideline in golf analysis, no doubt that’s how he likes it.

Interview by Charlotte Lytton.

Northumbria Healthcare NHS Foundation Trust has launched a new digital pre-operative assessment (POA) pathway to improve operating theatre utilisation by filling last-minute surgery slots and reducing the number of face-to-face appointments the department processes.

The project is part of the trust’s drive to create a more efficient theatre booking pathway by creating a pool of ‘pre-op ready’ patients that consultants can use to create theatre lists and fill last-minute surgery slots

Digitising the pre-operative assessment process will also allow consultants and anaesthetists to access full patient notes from any of the trust’s four main hospital sites.

The project has been rolled out across North Tyneside General Hospital, Northumbria Specialist Emergency Care Hospital, Hexham General Hospital and Wansbeck General Hospital, giving staff across all four hospitals secure access to patient records and a real-time view of each patient’s status through the pre-operative pathway.

Idris Wilson, operational services manager, emergency surgery & elective care at Northumbria Healthcare NHS Foundation Trust, said: “The pre-op assessment department faces high volumes of last-minute requests for patient appointments. Any delays in the pathway, including last-minute transportation of notes, can often result in delays in theatre starting.

In addition, if something is flagged at the pre-op stage which could prevent a patient proceeding to surgery, consultants need to be able to access a digital pool of pre-op ready patients to fill any spaces in theatre lists.

As part of the project, patients waiting for surgery will also be able to complete their POA health questionnaire at home via a secure link on the trust’s website.

Results are then sent to the trust’s pre-operative assessment department where staff can triage and swim-lane patients into the correct fitness and readiness categories.

Rambam Health Care Campus is the first Israeli hospital to introduce the method, called anterior-to-psoas which is less invasive than the traditional version of the operation which involves opening up the back.

The innovative procedure has also been used in the US, Australia and some other countries, but only in a small number of institutions.

Doctors take advantage of the anatomical corridor running from the waist to the back by inserting a tube into the waist, through which they can operate.

They then perform the spinal fusion which connects two or more vertebrae in the spine to reduce pain, correct a deformity or improve stability.

Dr Shai Menachem performed the operation on an 80-year-old woman with degenerative scoliosis at the Rambam Health Care Campus in Haifa, Israel, with his colleague Dr Ory Keynan.

Dr Menachem was performing the operation for the first time in Israel, but he had carried it out multiple times in Sydney, Australia, where he recently spent a stint working and mastering the technique.

In an interview with The Times of Israel, he said: “It allows us to perform spinal fusions through a small incision in the waist, and as a result achieve faster and easier recovery from the surgery compared to the common technique.

Normally you would open up the back and disconnect the muscles from the spine, but using this method we don’t. The way we’re going in, we disrupt less tissue, and there is less bleeding and less post-operative pain.

“The surgery was performed by making a small side-front incision in the abdominal wall. With the help of medical equipment designated for this surgical approach, specially imported from Australia, the patient’s degenerative scoliosis — curvature of the spine — was repaired, and the stressed nerves that caused pain along the leg were released.”

Dr Menachem added he expects to start using the procedure widely.

Hundreds of residents in neurological surgery across the United States have trained on a first-of-its-kind simulator intended to mimic true-to-life catastrophes which they might potentially face in operating rooms.

The nationwide study involved a total of 526 residents who trained on the simulator model while their heart rate was measured.

Originally developed at Oregon Health & Science University (OHSU), the simulator model appeared to be a feasible and cost-effective approach worthy of incorporating as part of standard training for neurosurgeons nationwide, according to a study published this month in the journal Operative Neurosurgery.

The model represents the first successful launch of a complex, multi-modal simulator on a specialty-wide, national scale.

The positive results were similar to that previously demonstrated in a pilot study by OHSU researchers

“This study shows that simulation of real, complex situations in the neurosurgical operating room is feasible and economical across an entire specialty,” said senior author Nathan Selden, M.D., Ph.D., Chair of Neurological Surgery in the OHSU School of Medicine.

"These types of simulations for pilots have hugely reduced the rate of airline catastrophes in the past 50 years. We want to do the same for neurosurgical operations.”

“These types of simulations for pilots have hugely reduced the rate of airline catastrophes in the past 50 years. We want to do the same for neurosurgical operations.”

The OHSU-developed simulator was tested nationally under the auspices of the Society of Neurological Surgeons, representing residency program directors and department chairs at academic health centres around the country. Selden and dozens of other educators ran the simulations at multiple sites nationwide.

Simulation exercises use a 3D-printed model of a brain, skull and membrane — complete with mock blood and patient monitors.

The model was originally devised with Selden’s guidance by Dominic Siler, M.D., Ph.D., and Daniel Cleary, M.D., Ph.D., while they were students in the OHSU School of Medicine.
Siler is now a resident and Cleary a fellow in neurological surgery at OHSU, and both were co-authors on the new study.

In fact, Siler envisions the potential for expanding the simulator concept to help in training not just surgeons, but also anaesthesiologists and nurses working together in their respective jobs as a team in a high-stress scenario.

The study evaluated the feasibility of a simulator over current surgical training using cadavers.

“Cadavers will always be great for anatomy, but they don’t bleed and can’t die if you make mistakes, so no one is stressed out about that,” Siler said during a previous demonstration of the simulator in 2017.

The study was supported by the Society of Neurological Surgeons. Co-author H.E. Hinson, M.D., M.C.R., associate professor of neurology in the OHSU School of Medicine, reports funding from the National Institute of Neurological Disorders and Stroke of the National Institutes of Health, award 1K23NS110828.

The Vascular and interventional radiology department (VINRAD) of Ghent University Hospital in Belgium has become the first in Belgium, the Netherlands and Luxembourg, to use a robot for the treatment of cerebral aneurysms.

When treating an aneurysm in the cerebral artery, the clinician first inserts a flexible catheter into a blood vessel through the arm or groin. From there, they manoeuvre the catheter through the arterial system to the brain, assisted by X-rays and contrast medium to visualise the vessels and blood flow. The VINRAD service at the University of Ghent undertakes this procedure about 80 times a year.

Head of Department, Prof Dr Luc Defreyne said: “Thanks to this technology, we can work even more precisely and limit the radiation exposure to healthcare providers.”

The robot, a Siemens Corindus CorPath GRX, has been taking over the treatment for several months now.

Prof Defreyne explained: 'We control the robot via a panel of joysticks, from a cockpit that is shielded against radiation.

“The robot moves the catheter, metal wires or stents to the site of the aneurysm. In the meantime, we closely monitor the work through classical imaging.

“If the robot does get stuck, we can intervene immediately and take over the treatment manually.”

“If the robot does get stuck, we can intervene immediately and take over the treatment manually.”

Now the clinician is seated in a cockpit, he no longer has to stand in a lead apron in the harmful X-ray radiation around the patient, making the work safer and more comfortable.

The patient-side assistant (usually a specialist nurse) can also keep a greater distance from the radiation when the robot is at work.

Deputy head nurse Elise Devlieghere added: “The robot also generates efficiency gains.

“Nurses now play a greater role in the preparation and performance of the procedure and the interventional radiologists can focus on their core tasks.”

The Siemens robot is already being used in some Belgian hospitals for cardiological procedures. Now it has also been used for the first time to treat vascular diseases in the brain.

Prof Defreyne said: “In the long term, the robot could navigate itself with the help of microcameras or sensors, but that remains a distant future.”

A team of hospital staff in the UK has devised a scheme to make the experience of surgery less frightening for children and young people.

Surgical care practitioner Patricia Velazquez-Ruta and anaesthetist John Coombes at East Kent Hospitals came up with the idea of creating caps in special fabrics for children to wear during their operation.

Youngsters admitted to Padua Ward at the William Harvey Hospital for surgery can choose from a range of fabrics including unicorns, Marvel Heroes, Star Wars and Harry Potter - with their anaesthetist wearing a matching one.

Dover Mum Cassie Jenkins, whose six-year-old son Abel had his tonsils removed, said the project really helped him feel at ease.

She said: “He was really nervous beforehand but the staff were absolutely fantastic and being able to choose his own cap really helped.

“It meant he felt a bit more in control of the process and he was so proud to take his cap home and show his siblings.

“It made the experience a lot more fun and put him at ease, and Patricia was brilliant at explaining the project and chatting to him.

“We really felt cared for and I think it’s an amazing project.”

Patricia, who also runs a textile design company, said: “The idea is to make children and young people feel more empowered, and part of the team and the process, and to make their surgery feel less scary.

“Before the project, they would be the only person in theatre not wearing a cap, so giving them the option to choose one really helps them to bond with the team and makes it more fun.

“They will be able to keep the cap as a memento of their visit.”

The children’s surgical caps project is initially a pilot at the William Harvey Hospital and the team are collecting feedback and will write a research paper on its impact.

They hope to expand it to other hospitals within the Trust if it proves to help ease children’s nerves and improve their experiences.

The caps have been created by volunteers from the Ashford, Dover & Folkestone Scrubbers, the fabric is funded by the Friends of the William Harvey Hospital and Made in Ashford have also lent their support by providing meeting space for the group.

connecting surgeons. shaping the future
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