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"The exponential development of technology and its smart use, will profoundly, positively impact the healthcare system in ways that are difficult to even imagine." Rafael J. Grossmann Zamora, MD, FACS

A free online webinar led by healthcare futurists and full-time surgeons takes place this coming Monday 29th April 7pm (BST).

The event - Digitizing The Operating Room - is led by world leading surgeons including Rafael J. Grossmann, Marlies Schriven, Stefano Bini, Shafi Ahmed & Tim Lane.

Focusing on Digital Surgery the event covers the use of technology for the enhancement of surgical planning, surgical performance and training employing technological solutions, such as telemedicine, artificial intelligence, machine learning and big data analysis.

Prof Shafi Ahmed, Medical Director of Surgery International stated: “I’m delighted to host such an esteemed panel of surgeon futurists. The adoption of Digital Surgery is the future of our profession and this event offers an excellent opportunity for every clinician to fast track your knowledge on this important subject”

Free online registration here

The surgical community is embarking on a new frontier in robotic surgery. With increasing pressure on hospitals, new innovations coming to the market and surgical robotics here to stay, the 'Global Robotic Surgery Summit: Robotic Surgery, then, now and beyond' is a first-of-its-kind Summit that will explore topics including the great debate; robotics vs manual laparoscopic surgery

Presented by CMR Surgical attendees will have the opportunity to have their say on the future of training, the importance of safety in medical devices and how technology can build a more equal surgical workforce.

In addition to specialty specific workshops across thoracic surgery, colorectal surgery, gynaecology and urology; interactive panel discussions and talks hosted by leading voices in surgery will explore a range of questions from across the robotic surgery landscape, including:


• Are there advantages to surgical robotics?
• Ergonomics with surgical robotics – are we creating a more equal surgical workforce?
• Where should training in surgical robotics be going?
• What is the role of data in surgical robotics? And how can we open up opportunities for the future?
• Why has surgical robotics not become common place in health systems?
• How can inequality in care be addressed with robotic surgery?
• Patient safety vs profit, where do we sit today on this debate and is there a trade off?

This free to attend virtual summit is aimed at surgeons and surgical teams, surgical trainees and hospital C-Suite and will be hosted virtually on 6-7 July 2024. Find out more by registering your interest here:

The event is been run In partnership with Surgery International. This meeting has been funded by CMR Surgical.

Surgeons are well-placed to be advocates for change in driving sustainable practices forward within the healthcare sector. However, patient safety remains paramount in any move towards achieving net zero.

These were the takeaway messages from a webinar on ‘Sustainability in Surgery’.

The event, hosted by Surgery International in collaboration with The Royal College of Surgeons of Edinburgh, JAV Medical and Orascoptic, was the latest in the Talk Surgery series of webinars. It covered many vital points that underscored the urgency of integrating sustainability into surgical practices.

The session was Chaired by Tim Lane, Consultant Urologist and Robotic surgeon at Lister Hospital, Stevenage, UK and Surgery International Editor-in-Chief.

The panel of experts assembled for the webinar included:

Together, they delved into the role sustainable practices play in shaping the trajectory of surgery and healthcare, considering the planet's pivotal point and the need to place patient safety at the heart of any progress.

With figures showing that up to 70% of the total hospital waste is from surgical operating rooms, Professor Shafi Ahmed warned: ‘By 2040, if the temperature continues to rise, as of the moment, there’s evidence from WHO, there will be 125 million more people with health issues due to dehydration, heat stroke and cardiovascular disease. Also, of course, an increase in pollution leads to an increase in respiratory disease. And with that, there will be more natural disasters, so there will be more trauma for us to deal with as surgeons. The impact will be overwhelming if we don’t adjust and manage this rise in global temperature and think about climate change and sustainability. Also, it is predicted there will be a 53.7% increase in mortality just due to heat by 2040 in over 65-year-olds. So, that will be a huge burden of problems for the healthcare systems to adjust to. That’s why it’s important we do our bit.’

Calling for ‘bold measures’, Aneel Bhangu urged the global surgical community to effect change within their own environments.

‘As a network of surgeons, we have a unique opportunity because we are in virtually every major hospital. Surgeons tend to be relatively permanent fixtures in hospitals, and in low-middle income countries, for example, they can easily reach the management. So, there are agents for changes. One of our missions is to see the surgeons in these hospitals lead the mission to install clean and reliable energy because you can’t operate without energy. We can be agents for change and push the agenda for solar installation.’

Speaking about her role as a sustainability champion with the Royal College of Surgeons of England, Lucinda Cruddas echoed the sentiment for collaboration, whilst noting the importance of solid leadership.

‘Leadership is one of the most important factors going forward. And that can be top-down or bottom-up. One of the significant things you come up against as a sustainability champion is a lot of resistance to making change. You can create presentations in your department and your hospital, and it’s tough sometimes to translate that into a change in behaviours. The idea of the champions is to share ideas and experiences so that you can take those back to your hospital and try to progress toward those changes. Then, it creates a network. It adds some unity to the sustainability fight, which sometimes feels fragmented.’

Addie Macgregor led the audience through the UK’s NHS net zero supplier roadmap, explaining that companies must deliver on sustainable promises. Adherence to a specific roadmap is imperative if you're a supplier to the NHS.

She said: ‘If you're now supplying to the NHS supply chain, about 60% of all things procured for the NHS in England go through this. You must also complete the Evergreen assessment, an extensive tool that asks organisations what they do beyond the mandatory ask. It’s more than collecting information about what organisations are doing; it is also about how they can work collaboratively to move forward. So, all organisations should measure their carbon emissions in-house and commit to what they will do over the next few years to change and reduce it.’

Touching upon the need to protect patient interests, Dr Ingo Aicher added: ‘There’s a lot involved in supply chain optimisation and things that you can do, but it varies in terms of the products you produce. If you’re directly involved in surgery and use inpatient or indirect contact products in open surgery with the patient, compromising there is different because patient safety is the primary driver here.’

The event attracted a diverse audience eager to explore the multifaceted realms of sustainability within the field of surgery.

Along with a strong emphasis on collaboration, innovation and regulatory compliance were also considered essential components in achieving meaningful progress.

Speakers discussed the various challenges the health tech industry faces, including limited resources. Suggestions were made for immediate actions, such as optimising supply chains and challenging major industry players to invest in sustainable solutions.

Other key points discussed included:

Whilst it was acknowledged that meeting sustainability regulations requires a steep learning curve and multiple challenges, there is a growing commitment to sustainability goals globally.

Watch again here

To book for the next in the series of Talk Surgery webinars, Digitizing The Operating Room, taking place on 18 April, click here.

Surgical International, the leading global hub for surgical news, presented its second ground-breaking webinar – Sustainability in Surgery – in collaboration with The Royal College of Surgeons of EdinburghJAV Medical, and Orascoptic.

Continuing Surgery International’s commitment to exploring the multifaceted realms of surgery, this event shinned a spotlight on the pivotal role sustainable practices play in shaping the field’s trajectory.

Part of the Talk Surgery series of webinars

A ground-breaking webinar that unveiled The Future of Surgical Robotics attracted surgeons from across the globe to the first in a series of educational experiences.

Surgical International, the leading source for surgical news, in collaboration with Orascoptic and The Royal College of Surgeons of Edinburgh, hosted its inaugural surgical webinar last week (Thursday, 15 February).

The event kicked off an exciting Talk Surgery educational series, attracting registration from 1200 delegates from all specialties and across 82 countries.

The webinar served as a platform for experts to discuss the latest advancements in surgical robotics.

Professor Shafi Ahmed, also known as the world’s most-watched surgeon, hosted the event.

The panel - composed of leading robotic surgeons and industry experts from around the globe - delved into various aspects of robotic surgery which ranged from technological advancements to its integration into healthcare institutions around the world.

It considered the challenges and prospects of robotics in surgery, providing insights into the current landscape, emphasising collaboration, affordability, technological advancements, AI integration and sustainable practices within surgery.

Tim Lane, Consultant Urologist and robotic surgeon at Lister Hospital, Hertfordshire, UK; Bhavan Rai, Consultant Urological surgeon at Freeman Hospital, Newcastle, UK; and Peter Vaughan-Shaw, Consultant Colorectal surgeon at the Edinburgh Colorectal Unit in Scotland, shared their thoughts on the latest developments in robotic surgery.

Industry leaders Paul Gibbons, managing director UK of Corin Group, and Tom Shrader, founder and president of R2 Surgical, provided valuable perspectives on the future direction of robotic surgery and its impact on healthcare delivery.

Key topics included preserving traditional surgical skills alongside technological advancements, challenges in medical product development, collaboration for data analysis and technology, and making robotic surgery more affordable and accessible.

Participants explored the potential of artificial intelligence (AI) in surgical techniques, its applications in cancer prediction and surgical training and its role in enhancing surgical precision and outcomes.

The discussion also touched upon the advancements in neurosurgical cranial robotic surgery and the hybrid model for medical training.

Key takeaways

The webinar concluded with a call for promoting robotics in colleges and associations.

The Future of Surgical Robotics webinar provided a comprehensive overview of the current landscape and prospects of robotic surgery, setting the stage for further exploration in subsequent sessions of the Talk Surgery series.

Click here to watch The Future of Surgical Robotics webinar  

Next month’s webinar focuses on sustainability and practices that could help surgeons and their teams achieve net zero. Book your place here.

Connecting surgeons across the world to improve outcomes and inspire the next generation of surgeons. Surgery International attracts subscribers from 138 countries.

Dr Karan Rangarajan (MBBS 2014) – better known as Dr Karan Rajan – is an NHS surgeon, a lecturer at Sunderland University, an educator and a storyteller. He is undoubtedly TikTok’s favourite general surgeon and he has more than eight million followers online to prove it. His latest venture is as the author of a book This Book May Save Your Life: Everyday Health Hacks to Worry Less and Live Better, which is due to be published in January. It’s a hilarious, myth-busting survival guide that aims to demystify the human body and offers health hacks to help readers ‘worry less and live better’.

‘He is undoubtedly TikTok’s favourite general surgeon’

Karan qualified from Imperial College London in 2014 but has made his name as a social media sensation. His following rocketed during the COVID-19 lockdown, but his online activity began a lot earlier when he launched a YouTube channel as a medical student in 2012, guiding fellow students through practical exams.

Now, he posts hugely engaging videos about health, science and medicine on various platforms that, although comedic, come with a serious message. His watchword for his audience is always to consume with ‘caution’. Much of his social media work debunks the swathe of health tips and medical myths posted by pseudo-experts that litter the internet. Still, he also tells his thousands of followers, ‘Don’t believe everything you see or hear online and always do your own research – and I urge the same after watching my videos.’

He is wise to caveat his work with this advice. His irreverent approach to patient communication doesn’t always sit well with colleagues, and he has encountered a little criticism, often from within the medical profession itself. For some colleagues, social media is not a space for surgeons. Although he would argue that health-related content should only be created by those within the profession. And, rather than offer comprehensive explanations, his videos are merely intended as a touchpoint – an invitation for followers to explore topics he discusses and into which they can later investigate further. After all, nobody can impart years of medical science in 60 seconds of in-your-face video content.

‘Critical thinking is what he encourages from his audience’

Surgery International catches up with Karan as he zips between the OR, his university lectures and editing videos that slay those ‘pseudoscience social media posts that go viral far more quickly than factual, scientific information’. If they feed into that human desire for shortcuts and quick fixes, then so will he.

A couple of days prior to our conversation, Karan is featured in a reel on Prime Minister Rishi Sunak’s Instagram, engaging in a discussion about the UK government’s initiative to establish a ‘smoke-free generation’. Endorsements, it seems, come from on high.

With headline-grabbing social media posts such as, ‘You started life as an asshole’ and ‘Have you ever seen your doctor Googling?’ among other nuggets of instantly shareable content, UK general surgeon Dr Karan Rajan is trailblazing digital engagement with patients.

‘He is one of the world’s leading health and science content creators’

His first foray into video-making began over a decade ago as a medical student in 2012. Inspired by excelling in science at school and hearing about his Mum’s experiences as a haematologist, the two sparked his interest in Medicine. His adeptness at practical, hands-on work led him to create educational YouTube videos during medical school, focusing on simulated procedures. There was a dearth of high-quality training material available back then and he plugged the gap.

Now, with a different audience, it is something he continues to do. Since 2020, he has been educating the masses with his irreverent, down-to-earth take on health. As a result, Karan has amassed an army of followers on the mainstream social media platforms, with TikTok delivering his greatest fanbase. In doing so he confronts those pseudo-scientific influencers who believe (for example) that sunning one’s perineum boosts energy levels.

‘‘
‘His TikTok reel pleading with viewers not to ‘harvest solar energy with your b*tthole’ is worth searching for’
‘‘

His quest? To make sound medical knowledge more accessible.

His podcast, which launched in May, continues this theme and The Referral… with Dr Karan is a ‘one-stop-shop demystifying the world of medicine and health’.

To date, he has clocked up 2.02 million subscribers on YouTube, 4,059 X/Twitter followers
and 956K on Instagram. On TikTok, his account dr.karanr has amassed 5.2 million followers – and the numbers continue to grow.

It’s a canny move. He can grab the attention of a much younger audience (for now, at least) and hit them early with his perfectly pitched delivery of evidence-based facts wrapped up in viral videos which contain profanity and profound truths in equal measure. Here, he counters the lies and, quite frankly, bizarre and sometimes dangerous health tips that litter the internet.

‘Far easier to contradict these inaccuracies with humour on a platform where they’re posted than in a dusty social media space where nobody under the age of 30 has ever existed’

‘‘
‘Far easier to contradict these inaccuracies with humour on a platform where they’re posted than in a dusty social media space where nobody under the age of 30 has ever existed’
‘‘

Debunking the many myths surrounding health, science and medicine, his delivery is fast and furious – and the snippets of information he offers involve genuine laugh-out-loud moments.

He edits 95% of the content he creates himself – ‘for the longer videos, I get someone external’. He is self-taught but has developed his skills over time. The rise of mobile editing apps has further extended his repertoire.

He uses earthy (some might suggest vulgar) language which (let’s face it) is basically very funny. The principles of healthcare are beautifully entwined with a large helping of dark humour to elicit attention. Karan provides patients with a more relatable and human connection, breaking down the barriers of medical jargon and fostering a sense of trust. His approach demystifies complex medical concepts to allow patients to better understand and engage with their own healthcare. This then promotes a more open and informed doctor-patient relationship.

His quickfire delivery appeals to a ‘scrolling’ and ‘swiping’ society, many of whom have too little time to digest vast chunks of detail. So, it is ideally suited for those sitting on the train during their daily commute, waiting in a GP waiting room or at home pondering complex health issues.

TikTok’s global reach also allows him to connect beyond his patient list. Its algorithm cleverly analyses user preferences and behaviour patterns to curate a personalised ‘For You’ feed, streamlining the process of engaging with patients. In today's fast-paced digital culture, where attention spans are short, Karan’s bite-sized content fits well.

But while his army of followers might appreciate his simplified takes on controversies and poorly considered tips, a handful of his professional colleagues are less comfortable with how Karan disseminates medical information.

‘As my career has developed and I have moved into positions of authority and responsibility, I have received some unwanted attention,’ he admits. ‘But the numbers are low.’

He believes this is based on a combination of fear of the unknown and a generation gap, with criticism often coming from surgeons rarely exposed to social media.

‘I guess what I do disturbs the natural status quo, and the profession remains resistant to change. Medicine is archaic, and surgery even more so – racism, sexism, gender bias, assault and misogyny continue to exist,’ he says.

The suggestion that it impacts his work as an NHS surgeon is a bit of a straw man argument – ‘It doesn’t make sense to conflate the two – my time is clearly demarcated, and I put together my videos in my own time. I also suspect there is a little schadenfreude. Intrinsically, we rarely celebrate success.’

On LinkedIn’s professional and business-focused social media platform, his posts are a little more refined, and he seizes opportunities to speak frankly to colleagues with clarity and passion, addressing serious shared issues of physician burnout and concerns about his social media presence.

Karan recalls: ‘The worst thing about being a doctor on social media is the trolling from those within your field. In the last three years, I’ve worked with the NHS, WHO, UN, British Red Cross, No 10 Downing Street, Royal College of Surgeons, Royal Society of Medicine and many more established institutions – I see this as an acknowledgement of good work, credibility and authenticity. But the problem I face – and the problem that many doctors who have a presence on social media face – isn’t from anonymous trolls but from other doctors who aren’t on social media who refuse to accept that this is a viable form of education and public health-centred communication. These same doctors, with their fixed ideologies that social media is “for kids” and who don’t see that it is the future of digital health, are also sadly the ones who are in positions of power. I’ve had a senior doctor in a high-level position tell me: “As a surgeon, you shouldn’t be on social media.” That was in 2020. Good thing I didn’t listen!

‘This backward thinking plagues medicine. It holds back change and progress. Will some doctors use social media for nefarious purposes? Sure. But does it have the power to transform healthcare on an epidemiological level and act as an adjunct to public health services? F*ck yes.’

He refers to the ‘crisis in trust’ between clinician and patient: ‘Misinformation is sexier than sanity and science. Public trust in medicine continues to erode, thanks partly to low levels of average health literacy and the rise of pseudoscientific wellness influencers who promote far-fetched naturopathic remedies. A step towards building trust in the public is having more doctors talk about simple facts online. Don’t leave a power vacuum for rogue wellness podcasters and celebrities!’

Besides the profession’s historic resistance to change, Karan also believes there is a need for broader policy reforms to address the issues within the UK’s healthcare system that are often beyond frontline medical care.

‘The institutional challenges are changing slowly, but I think there are many negatives beyond the scope of what the average clinician can do about funding, waiting lists, etc. The NHS has its contractual issues, and the profession continues to haemorrhage staff to other industries, as well as abroad.’

He has ambitions to be part of the decision-making process – and hopes that one day a government health secretary might hail from within the medical profession – a frontline NHS surgeon perhaps? One suspects we still have a long way to go. Still, Karan is undoubtedly considered a bit of a mover and shaker by people in high office – his chat with Prime Minister Rishi Sunak, posted on the PM’s Instagram account, is a nod to Karan’s immense influence on a younger patient base.

The media recognise his appeal, too. He has been featured on BBC Morning Live, Good Morning Britain, BBC News, Sky News and national radio, with coverage in the Guardian, Independent, Washington Post, New York Post, Metro, Sun, LADBible and the Daily Mail, and several other international online news outlets. He was co-presenter on BBC Two’s six-part series Your Body Uncovered. Over the past few years, he has been a regular health promotion advocate on behalf of the NHS, working closely with the UN, the World Health Organisation and the British Red Cross in an ambassadorial capacity.

Those outlets that give him a platform evidently appreciate his refreshingly frank approach. Entertainment is a powerful vehicle for mass messaging.

Aside from all this social media activity, Karan is a senior clinical lecturer at the University of Sunderland Medical School and formerly at Imperial College London – presumably bringing the same passion for education, health and science to his lectures. He has delivered keynote speeches and talks at Oxford University, Imperial College London, Birmingham University, Uber, Peloton, TikTok and General Electric, to name but a few.

More recently, he has written a book. This Book May Save Your Life is due to be published just after Christmas (the Kindle edition is already available) and promises to build on those social media posts with a ‘rollicking journey through the intricacies of the human body’.

For Karan, it’s his ‘magnum opus’. He mentions that he is off to the printers to see the hardback version of the book roll off the presses, and his enthusiasm to see his creation come to life is clear.

‘The writing journey started two years ago with lots of weekends, my days off, post- and pre-night shift hours dedicated to writing and planning my book,’ he says. ‘It wasn’t even juggling work as a surgeon, taking care of the beast (my dog Shadow), making social media videos AND just the small matter of writing a book… this has been the biggest project I’ve ever undertaken. My magnum opus so far.’

The book’s PR best sums it up: ‘The hilarious, myth-busting survival guide to the human body from TikTok’s favourite general surgeon. Though the odds are stacked against us, the human body has an extraordinary tendency to survive. Here, Dr Karan Rajan explains the weird and wonderful bodily functions that keep us going and offers practical advice to help you thrive. Full of everyday health hacks to worry less and live better, This Book May Save Your Life will teach you: The dangers of plucking your nose hair, how embracing your inner dolphin can help manage stress, the simple mind tricks for dealing with pain and why you should never hold in a fart.’

As the popularity of medical content on social media continues to grow, content creators and viewers must exercise caution and seek reliable, comprehensive sources of medical information when making health-related decisions. Karan is making this possible.

‘Ridiculing so-called wellness experts who hail the holistic benefits of perineum sunning goes beyond an earthy butt joke’

Ultimately, the medical profession needs patients to be well-informed and have an evidence-based understanding of medicine to ensure the best possible patient outcomes.

‘My posts have reached many people who wouldn’t have otherwise read up on certain health news. Social media allows them to consume information accidentally. A follower messaged me recently to say that they had shown a neighbour my post about bowel cancer screening. This neighbour was afraid of healthcare practitioners, but after seeing my video, they went to their GP, who referred them to a specialist. The neighbour had a colonoscopy, and pre-cancerous growth was found, so social media can save lives.’

If people are more likely to engage with posts on TikTok than read a patient information leaflet, then Karan is more than happy to play the game.

‘Social media is part of most people’s “everyday” and has become the new Google, the new news source, the new place for information. It is how people communicate with friends, and it has integrated into ‘real’ life. There’s no escape; as a profession, we should embrace it and use it to educate. It is impossible to eliminate all misinformation from the internet – and if social media is to remain democratic, there should be minimal censorship. But by contradicting the poorly considered posts, platforms like TikTok can be policed by its users.’

Has he ever considered a social media detox? He’s unequivocal. He hugely enjoys the space, so no, but he does have a life outside the virtual world. He lives in the south of England with his dog, Shadow, a mastiff and finds solace in his companionship – and the gym (when he can get there) and good food.

In a world of high patient turnover, huge expectations, regulatory demands and physician burnout, surgeons rarely get opportunities to debunk myths or have face-offs with health-related conspiracy theorists. Karan is doing the whole profession a favour because as long as he is making it his business to wade through the murky, muddy information highway to offer clarity to misinformed patients, those who take a more perfunctory approach to social media activity simply don’t have to.

To order your copy of the book, click here

As a specialist wildlife veterinary surgeon, Dr Romain Pizzi has travelled the globe operating on almost every species you can think of - and some you won’t have heard of.

Romain’s species expertise ranges from tree snails to elephants. An international expert in wildlife surgery, he has carried out numerous world first wildlife operations in endangered wild animals, from the first laparoscopic procedure in wild orangutans, to the first neurosurgical intervention on a wild bear.

His long association with wildlife means his life is brim full of memorable moments, “but some of them are memorable for all the wrong reasons”, he says.

His expertise ranges from Tree snails to Elephants

He recalls the time he was conducting the world’s first robotic-assisted operation on a wild animal - a ‘rescue’ tiger, that had been badly treated and had been rehomed by a zoo. “Halfway through the operation the tiger lifted its head and had a look at me - thankfully we were able to get it back to sleep”.

And that’s not the first time this has happened. “I was doing surgery on a bear in Vietnam, had finished operating and was just suturing up, when it started to wake up on the table. So with the bear on a stretcher, we ran through the jungle to its enclosure at the rescue centre.”

There have been many other memorable cases over the years, including the first laparoscopic surgical removal of diseased gallbladders in moon bears rescued from illegal bile farms in Vietnam, the first key-hole surgery on a reindeer at Edinburgh Zoo, and the first locking plate femur fracture repair on an animal, which was conducted on an infant chimpanzee in Sierra Leone.

‘‘
Halfway through the operation the tiger lifted its head and had a look at me
‘‘

No one month is the same for Romain - he could be anaesthetising a fish, x-raying a frog, or performing an endoscopy on a shark. He travels extensively, working with conservation charities, wildlife rescue and rehabilitation centres and zoos across the world.
Romain’s patients may often be unusual and exotic, but that is not why he chose his specialty. “Like most surgeons, the most rewarding thing is to have a good outcome for the patients,” says Romain. “People imagine operating on an elephant, giant panda or tiger is very exciting, but that’s because they find the animal interesting. Just as for any ‘human’ surgeon, this work is fulfilling to me because it’s about making patients better - whether it’s a tiger or a small squirrel monkey.”

A life working with wild animals was not Romain’s first choice of career. As a small child, he was “quite sickly and I spent some time in hospital, so I wanted to become a paediatrician”.

Growing up in South Africa, he was “surrounded by really interesting animals” and in high school “I hand reared orphaned and injured birds at home”. “This was really satisfying, and I thought: ‘maybe I should be a vet’. He also wanted to work with endangered wild animals “where you can have a real impact in terms of anything you can do to improve their lives”.

Romain did his veterinary degree in South Africa. Since qualifying in 1999, he has taken a Masters in London, a PhD researching key hole surgery in Barcelona, and specialist exams through the Royal College of Veterinary Surgeons, where he has also received a fellowship.

He finds watching paediatric surgeons at work ‘very selfless - their patients can be challenging, so there are actually quite a lot of similarities between their work and mine’

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He finds watching paediatric surgeons at work ‘very selfless - their patients can be challenging, so there are actually quite a lot of similarities between their work and mine’
‘‘

After doing a variety of wildlife work in general veterinary practice, and working in India with endangered vultures, by 2005, Romain had become a specialist in wildlife medicine. He then started to approach surgeons to observe their work to inform his practice. “Human surgery is much more developed and specialised than veterinary surgery and often its techniques take time to trickle down to the veterinary community, so it made sense to learn them at source,” he says.

For a quarter of a century, Romain has been building his expertise, training with many surgeons, and learning in particular about laparoscopic surgery - he is an honorary life member of the Association of Laparoscopic Surgeons of Great Britain. Many surgeons have influenced his work, and he finds watching paediatric surgeons at work “very selfless - their patients can be challenging, so there are actually quite a lot of similarities between their work and mine”.

His many role models from the natural world include the English primatologist and anthropologist Dame Jane Goodall, “who has worked selflessly to educate people about the need for conservation”.

Unlike ‘human’ surgeons who typically specialise, his practice involves “doing a little bit of everything”. And his patients present very different challenges and considerations to those faced by surgeons working in human hospitals.

Bedrest post operation is not an option with animals, he says. “You can’t keep an animal in bed when you’ve removed their gallbladder. An orangutang with a broken arm is still going to want to hang on that arm all day. And some patients, like sea lions or beavers, need to go straight back in the water. So it can be taxing to make sure my patients don’t do themselves harm, and that they are able to heal.”
He is constantly looking at different ways to achieve this, adapting surgical techniques for his wildlife patients, conducting minimally invasive surgery performed through wounds as small as 3mm - the same size as a microchip needle - or choosing different implants or locking plates and screws.

Surgical instruments are expensive, and so over the years he has “begged, borrowed, and bought equipment second hand”. After carrying out several thousand keyhole operations on wild animals over the decades, “I now have quite a caseload”, he says.

He generally travels with a 20kg suitcase of equipment to perform procedures. “You have to think very carefully about every single instrument you take, to have everything you will possibly need,” he says.

Operating conditions are a far cry from human, or veterinary hospitals, he explains, and he can find himself working in a shed, tent, or barn, on an operating table made out of bags of straw. In some countries, where conditions are fraught, he has been forced to smuggle instruments hidden in rice bags across borders, dodged secret police, and even been shot at.

Some of the animals he treats are critically endangered, like the hairy nosed otter at a rescue centre in Cambodia, the Socorro dove in Mexico, or the Polynesian snails that are now completely extinct in the wild. “When you treat these animals you know you’re making a difference not just to them, but also to the survival of an entire species,” he says. “Sometimes there’s a lot of pressure - you’re learning things for the first time and figuring out what will and won’t work, but overall it’s rewarding.”

He recalls just a few of the many rewarding moments he has experienced during the course of his career. Travelling to a sanctuary in northern Laos to perform the world’s first neurosurgical intervention on a Champa, an Asiatic black bear with hydrocephalus. Performing keyhole surgery one Christmas on ‘Eskimo’, a reindeer at Edinburgh Zoo to remove an undescended testis. And removing a metal nail lodged in the appendix of a wild Bornean orangutang using laparoscopic surgery, who after many months of recovery was then released back into the wild.

“The orangutang went on to foster a baby, and five years on they’re both doing great. Its deeply satisfying knowing that the orangutang who almost died is now happy and healthy with a baby of her own - it makes everything worthwhile,’ says Romain.
Of course, not all these stories have a happy ending. “There’s always those patients where you think about whether you could have made different decisions, or tried an operation slightly differently. But you try and learn from these experiences - sometimes there’s only so much you can do,” he says.

Sharing with others the benefit of his experiences, Romain trains wildlife veterinarians working in more than 30 countries, with everything from bears to orangutans, building local capacity and expertise to best treat confiscated wildlife as fast as possible.

When not traveling the globe, home is Roslin, a small village outside Edinburgh, where he lives with his specialist vet cardiologist wife and two children. He doesn’t have any pets - “when you’re travelling a lot with work I don’t think it’s fair on the animal, but maybe I’ll have a pet when I’m older”, he says.

He plays the cello - Bach Cello Suites - “to destress”, as well as a variety of other instruments, including jazz harmonica - “it fits easily in my luggage” - double bass, and the trumpet, which he taught himself to play during the pandemic. He likes to do wood engraving and wood prints, carving bits of wood - sometimes from the places he has travelled - with old surgical scalpels. He reads widely and has written a book - Exotic Vetting: What Treating Wild Animals Teaches You About Their Lives - about different aspects of wildlife work, and will hopefully finish another in the next two years.

‘‘
To his occasionally frustrated surgical colleagues he says: ‘Maybe take some comfort that your patient isn’t …. trying to eat you’
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There are still “things I would like to solve”, in particular keyhole surgery in dolphins, he says. “They are very challenging patients who are difficult to anaesthetise, their wounds tend to break open, and they can die quite quickly. I would really like to develop techniques that give them better treatment,” he says.

To surgeons dealing with challenges at work, who are “feeling frustrated because they want the newest piece of equipment or because the anaesthesia was a bit slow on the day”, things could be more difficult, he suggests. “Maybe take some comfort that your patient isn’t being very uncooperative and trying to eat you.”

Most surgeons he has worked with are “very supportive and fascinated with what I do, and it does give them pause for thought”, he says. “They’ll ask things like: ‘How do you do an endoscopy on a tiny bird that weights 50g?”, or “Can you put a bandage on a tiger?’ - the answer is generally, ‘no you can’t’.” Romain says his work also “makes them appreciate the good and the bad bits of their jobs”.

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“Most surgeons are very supportive. I’m very fortunate.”
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Fiona Myint is Professor of Surgery at University College London (UCL) and a Consultant Vascular Surgeon at the Royal Free Hospital. In 2017 she established the Surgical Leadership Program with colleagues from Harvard with the specific aim of preparing Consultant Surgeons for leadership roles across the world. Having spent a life-time focusing on surgical training Surgery International met up with her in London to discuss surgery, leadership and life beyond Medicine.

Our appointment has been booked three weeks in advance. In the intervening weeks she has travelled to the West Indies as part of the ACCM to accredit Medical Schools before returning to a busy emergency Vascular on-call week which has seen her return home in the small hours of the morning on three consecutive nights out of seven. At the end of her emergency surgery week she Chairs a number of meetings at the Royal College of Surgeons in England where she is senior Vice-President before rounding up a 15 day period of exams at the Royal College of Surgeons of England as supervising examiner and which has seen over 600 trainee surgeons sit the MRCS examination. We have about an hour before she travels to Manchester to sit as part of a team on a GMC appeals panel. There is a lot to get through so we get started.

Fiona Myint trained at Guy’s Hospital Medical School in London before basic surgical training at St. Bartholomew’s Hospital. Most of her higher surgical training centred around London which has been home for as long as she can remember. During her training she spent some time in research working in the laboratory of Nobel Laureate Professor Sir John Vane. Her field of study (the mechanisms of ischaemia-reperfusion injury) appears to have cemented her aim to pursue vascular surgery as a career.

Was she particularly driven? She thinks not but was very much aware that she had opportunities that were denied her parents (both international medical graduates) and so was keen to avail herself of all those opportunities still denied to many who find themselves working in the UK having qualified abroad. That said it is noteworthy that both of her siblings hold the title Professor and have Chairs in their respective academic fields. If nothing else there appears to be an undeniable familial work ethic.

Was there anyone who stands out as being particularly influential in her training? There were many but the conversation returns to Professor John Wyllie on more than one occasion.

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‘He was good clinician who was devoted to the patients under his care and devoted to ensuring that the next generation of surgeons are adequately trained to serve their patients. I learned more from him than just surgical technique. I learned about being a surgeon in its entirety. He sadly passed away just recently but has left a generation of surgeons doing their very best to live up to the very highest of standards that he set’.
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Did she have any particular problems during her training because she was female in a substantially male dominated field? Surprisingly not. But she is quick to acknowledge that she was in many ways an exception to the rule.

‘I was lucky enough to train during a time where team structures were still the norm and I had supportive bosses. We all signed up to an unwritten agreement. You worked hard. You looked after the patients on your ‘firm’ and in return you were trained’. Does she regret the restriction in working hours that resulted in the demise of these traditional structures?

‘Not really. They had to change. Training has had to move away from a process of osmosis which happened over long weekends on-call to a more structured process. The casualty of that change however was in some cases removing that very immediate link between trainer and trainee which was always so important. Responsibility for training became a collective responsibility and as a consequence, diluted’

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‘When I was appointed only 6% of consultant surgeons were female and you could almost count the number of female Vascular Consultants on one hand. I’m pleased to say the picture is improving, but still has a way to go’
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What does she think of the recent revelations about female surgeons, sexual assaults in the work place and their under-representation in senior management roles? She gives me a slightly withering look.

‘Well they come as no surprise to any female surgeon … ever. The culture has to change’. There is a tacit acknowledgement here that whilst the current challenges facing female surgeons are trending on a variety of social media platforms the reality is that it has been this way for decades and no doubt responsible for many leaving the profession.

‘Women make up more than half the medical school intake yet few are encouraged into surgery. We need to change this at an early stage’. As Patron of the UCL Student Surgical Society she has done her best to engage all medical students at the earliest stages of their careers.

‘There is evidence that female surgeons have better surgical outcomes than their male counterparts. Rather than focusing on, and learning from, those aspects of surgical technique or practice which might benefit all surgeons in training the emphasis has always been to undermine such publications with the usual list of possible confounding variables’.

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‘Making surgery a positive choice for female graduates involves making some fundamental changes in the profession’.
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She talks encouragingly of her work as Chair of the ‘Parents in Surgery’ project at the Royal College of Surgeons of England (RCSEng). The ‘Parents in Surgery’ project was the flagship activity that emanated from Baroness Kennedy’s report on Equality Diversity and Inclusion commissioned by the RCSEng following widespread accusations of sexism and racism in surgery. During the course of writing her report it was noted that surgeons in particular have issues with parenthood.

‘Female surgeons have a higher incidence of fertility issues. Because of the nature of their training path they tend to start families late and commonly feel disadvantaged on the career ladder as they raise their families. Surgeons who are parents of any gender also find it difficult to balance childcare with the long inflexible hours of a surgeon’s working life’.

The ‘Parents in Surgery’ project first set out to establish what the problems were and in doing so also commissioned the Nuffield Trust to undertake some further survey work. There are issues with timetabling, rotations, childcare, finding time and support for fertility issues and a culture of regarding parenthood issues as not compatible with being a successful surgeon.

‘Having established the facts we are now working with stakeholders to effect changes that better support parenthood and a career in surgery’.

Professor Myint has held many key roles throughout her career, many of them traditionally held by her male counterparts. We talk about glass-ceilings and the lack of female surgeons in key leadership roles.

‘We have an increasingly diverse surgical workforce. Despite this the same traditional demographic appears to be returned to high office time and time again’.

It is noteworthy that in the 150 years that the Royal College of Surgeons has existed (and where she is currently senior Vice-President) it’s ruling Council has only ever elected one female surgeon as President and has never elected a person of colour.

What does she think of this?

‘It is disappointing considering the demographic of the surgical workforce. However, it takes time for change to happen. The constitution of Council is evolving and this will give us a more diverse pool from which the leadership can be elected. We have to stop thinking ‘what does the person in that role traditionally look like’ and start thinking ‘does this person have the potential to fulfil the role well’.

We talk about the Harvard Surgical Leadership Program (SLP) which she developed with Harvard. Where did the idea come from?

‘My involvement was seeded by an idea from one of my trainees. We developed the concept further because there were no courses available for more senior surgeons which dealt with Leadership issues’.

‘There were very many courses aimed at residents, or short term courses teaching specific components of leadership but what was needed was something more comprehensive and which linked a number of essential components’.

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‘Above all, it addresses those soft skills that nobody teaches you in medical school and that many of us only learn over a couple of decades in clinical practice’.
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The course is very much international attracting participants from every continent. There are three workshops each lasting four days and which are held either in Boston or London. There is a continuous on-line lecture course, webinars, group course work and an individual capstone (a business plan related to their practice). Harvard SLP benefits from access to faculty from Harvard Medical School, Harvard Business School as well as other Harvard schools.

‘Many of the speakers cover important aspects of team leadership, emotional intelligence, negotiation, understanding finances, human factors and team dynamics in the way that only Harvard faculty can.’

‘The capstone is the final achievement for the participants because they work on this with a named member of faculty and so many of these exciting entrepreneurial, quality improvement or educational projects have come to real life fruition, some on regional, national or international scales. This can only be good for surgical services to our patients worldwide’.

The Harvard Surgical Leadership Program (SLP) has been running since 2018 and Professor Myint continues to co-direct the program with Program Director Sayed Malek, the Clinical Director for Transplant Surgery at the Brigham and Women’s Hospital in Boston.

I ask her about work-life balance (although she prefers to call it work-home balance given that she sees medicine and surgery as very much part of her life). How has she managed to balance professional and personal responsibilities?

‘It’s not been easy! Balancing the two has been a challenge. But I’m certainly not alone in having to juggle responsibilities. And it’s not just an issue for mothers either, its anyone with caring responsibilities and almost everyone who has a family to consider. One learns to plate spin’.

She acknowledges that having a husband (also a surgeon) who was adept at nappy changes and prepared to share child-care responsibilities was key to a success in balancing professional and family life.

‘We have spent nearly 18 years meticulously matching on-call schedules to avoid clashes and ensuring that at least one of us was available for school parents evening, summer holidays and the inevitable school Christmas performance!’ That said there have been more Christmases that she would care to remember where one or other of them was not at home for Christmas dinner because they were in the OR delivering emergency care.

Occasionally work and home responsibilities have merged. Rather than keep them strictly segregated she has been happy to allow a little blurring of the lines. During school holidays, rather than miss a teaching session to undergraduate medical students she has, on occasion, taken her daughter along to the sessions.

‘She was always royally spoilt there! After having been to a few she began to remember the key learning points of the teaching sessions to the extent that she insisted on taking part in the end of session quiz. She scored pretty well! I’m pretty sure some of the medical students realised this and I suspect there was a minor degree of collusion as a result! One year at an undergraduate surgical conference a medical student taught her how to hand tie surgical knots on the back row of the lecture theatre with a pair of shoelaces. She still ties knots that way to this day!’

Has her daughter followed her into Medicine? There comes a decisive ‘No!’ Having adjusted to parents who disappeared in the middle of the weekend only to return in the early hours of the morning following an emergency call it is perhaps no surprise then that she is currently studying Philosophy at University!

Does she have any free time? Perhaps a little more than before now her daughter is at University. How does she spend the time? When not at work she can be found on the North Norfolk coast bird watching or on occasion at a F1 Grand Prix venue at a variety of locations around the world. She has had some success in the field of wildlife photography and is a long-term supporter of the RSPB and the Zoological Society of London (ZSL). She is a long-term supporter of the NSPCC and has run up the stair cases of London sky-scrapers to raise money for the charity.

‘Time away from work is inevitably family time. Bird watching in and around the north Norfolk coast is a huge contrast to a busy on-call’.

There is also virtually no phone reception on the coast there which provides another undeniable advantage.

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‘Sometimes it is good just to be away and off the grid!’
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More information on Harvard’s Surgical Leadership Programme here

It is an insight into the character of a man who, when asked to reflect on a defining moment in an illustrious career, pays tribute to the patient whose life he saved rather than bask in his own extraordinary achievements. And if this feature were no longer than the first paragraph, it would be enough to convey the nature of Sir Terence English.

I have more than a passing interest in his distinguished career. My own father suffered from heart disease in his forties and had a life chequered with cardiac surgery. Kicking off with coronary artery bypass surgery in 1981, he wore his chest scar with pride. His ‘zipper’ was, he believed, testimony to ‘that wonderful British institution that is the National Health Service’. So, with this in mind, I take great pleasure in speaking with Sir Terence at his home one warm September morning.

Sir Terence English is a retired cardiac surgeon who now lives in Oxfordshire but spent his professional life in Cambridge, where he was a Consultant Cardiothoracic surgeon at Papworth and Addenbrooke’s Hospitals from 1972 to 1995. For many, his name is synonymous with an era of ground-breaking heart surgery. However, his entry into the field of Medicine was far from inevitable. In fact, Sir Terence’s background is as eclectic as his family descent – a mixture of Scottish, Irish and Afrikaans – all mixed with an essential Yorkshire goodness. Born in South Africa in 1932, he was schooled in Natal before a career in Mining Engineering in Johannesburg beckoned. After leaving school he spent a year as a diamond driller in Rhodesia (now Zimbabwe), something which ultimately provided timely opportunities for summer jobs whilst completing his degree at Witwatersrand University.

He is a mixture of Scottish, Irish and Afrikaans all mixed with an essential Yorkshire goodness

‘I had an extraordinary time as a diamond driller in Rhodesia as it was then. It was a small team and very tough. I learned quite a lot about life and teamwork and working under pressure. This inevitably has an impact on your outlook, too, particularly with regards to people and how they help you.’ It is a theme that Sir Terence will return to time and time again in his surgical career – namely, the importance of ‘teams’ in the delivery of care.

Following the unexpected inheritance of a small bequest from a family trust, Sir Terence decided to use this as an opportunity to refocus his efforts on a career in Medicine – in part inspired by a maternal uncle and surgeon. He used the money to travel to England where he studied Medicine at Guy’s Medical School. Whatever academic success Sir Terence had there was inevitably (and to this day) overshadowed by his captaincy of the Guy’s Hospital First XV Rugby Team in 1961, when he led the team that won the Rugby Inter-Hospital Cup. His establishment as a living legend (at Guy’s Hospital, at least) seems to have been assured from that moment on.

He qualified from London University in 1962 and began training – at first in general surgery and subsequently in cardiothoracic surgery. Surgical rotations brought him into contact with notable luminaries of the era, which included Donald Ross and Sir Russell Brock. After Fellowship exams, he completed cardiothoracic training at the Royal Brompton but took the opportunity to visit Christiaan Barnard in South Africa and spend a year with John Kirklin in Alabama. After he was ultimately appointed to Papworth and Addenbrooke’s hospitals, his main surgical interest became heart transplantation.

As a heart transplant pioneer, he overcame many challenges – public funding, public and professional fear and an ensuing press frenzy among them – to become the much-celebrated and renowned cardiac surgeon who, in 1979, performed the UK’s first transplant with long-term success.

But, instead of seizing the opportunity to fanfare his part in this incredible milestone, he warmly reflects on former patients, dedicated teams, his mother, four children and the invaluable support he received from all quarters to put others at the forefront of our conversation.

In the pantheon of medical pioneers, he is an unassuming interviewee. According to Sir Terence, the charismatic 52-year-old London builder Keith Castle, who enjoyed five-plus more years of life thanks to his life-saving transplant, was the PR powerhouse who piqued the public consciousness during the epoch of early human-to-human heart transplant surgery.

Sir Terence turns 91 this month (October 2023). Although sometimes hazy on specific dates (and rightly so, there have been so many of relevance), he is as passionate about heart transplantation as ever and cheerfully admits that as an early adopter and pioneer, the rules were there to be broken. With a moratorium imposed on the procedure in the UK at the time, Sir Terence ignored this national ban to perform his world-leading heart transplant operation on Castle at his base in Papworth Hospital. So inspired was he by the heart transplant programme at Stanford University in California, where excellent results were being achieved, he felt there was a great need to match it in the UK.

Sir Terence ignored a national ban to perform his world-leading heart transplant

Back then, the procedure seemed unsavoury for many – some medical colleagues included – and it is a wonder that heart transplants developed as they did. A Wellcome witness seminar that reflected on early transplant surgery in the UK and took place at Queen Mary University of London in 1997, almost 20 years later, summed up the mood perfectly: ‘The first human heart transplant challenged human concepts of individuality and the place of mankind in the same way as did the first pictures of Earth as seen from outer space – powerful, laudable, technical achievements that strangely disturbed, distorted and disrupted the sense of self.’

But bringing this vision to fruition was never a ‘one-man band’. Sir Terence is keen to name those who went before him, including Christiaan Barnard, a fellow South African who performed the world’s first human-to-human heart transplant operation, and Donald Ross, another South African-born British thoracic surgeon who led the team that carried out the first heart transplantation in the UK in 1968.

Ultimately, the ‘team’ has always been the heartbeat of excellent clinical practice – something learned and remembered from diamond drilling on the African continent and beyond. Even the press officer at the time of Castle’s operation was instructed to talk about the ‘Papworth team’ rather than reference the surgeon himself – the legacy listed among his proudest achievements.

‘I realised very early on that this was not a one-man band as it had been with Chris Barnard in Cape Town and that I had to get people who were all involved and committed. I managed to build up a team at Papworth over about 18 months. They were top trainees who had seen what was happening and wanted to participate, so I could be very selective. I’d say: “Unless you are prepared to work as a team and not as an individual without reference to your immediate colleagues, we don’t want you.” This was a powerful message that resonated, and we became known as the Papworth team.’

Amid a scenario where there were few successful cases globally, and ethical concerns were rife within and outside the field, Sir Terence knew the consequences of not getting it right.
‘The chief medical officer put together the advisory panel, and they interviewed me to decide whether it was worth pursuing. I prepared very rigorously and was very surprised that things went so well. I left feeling that we’d taken a big leap forward. But then I got a letter from the chief medical officer saying, “Well done, English, you’ve done some good work but there is no money for a programme, and we don’t want to see any one-off transplants.” And that was that.’

Undaunted, Sir Terence decided to proceed with heart transplantation, beginning a challenging yet transformative period in his life.

‘People were very much against heart transplantation at the time, largely because Donald Ross, who I greatly admired, had done a transplant in London, which hadn't worked. And that was soon after Barnard’s first procedure. I only got on the scene five years later because it took me time to build up a proper team, which was vital. You've got to fill all the notches – great anaesthetists, immunology, histology and so on, and you have to project it to become acceptable.’

His first transplant operation, however, was a heart-wrenching setback, as the patient’s condition took a critical turn, while Sir Terence was removing the donor heart at a different hospital, forcing him to make a fateful decision. He proceeded with the transplant, but tragically, the recipient had suffered brain damage and never recovered consciousness.

‘The first one was a bloody disaster; it was so sad. My senior registrar, who was very good and had worked with me a lot, was with the patient at Papworth, and I was taking the heart out from the patient not very far away in East Anglia, and we communicated and so on. And then I got a phone call just as I took out the donor heart to say that our patient, Charles McHugh, arrested before they could even start anaesthetising him. They resuscitated him, but couldn’t determine whether he’d suffered brain damage. It was a tough decision but I knew this was his only chance. It was a difficult operation because he had high pulmonary vascular resistance, but it worked. The problem was he never woke up properly afterwards and we had to keep him on and off the ventilator. Inevitably, he got a lung infection and died after 12 days. And then the roof fell in.’

The demise of McHugh created a bit of a press circus, with criticism from all angles, including a particularly virulent column written by journalist Bernard Levin. Undeterred, Sir Terence carried on.

‘I went to see this wonderful woman in charge of medicine in the region around Addenbrooke’s, and I told her: “Listen, I want you to know. I will do two more transplants using my facilities at Papworth. If I can get funding after that, I will go on. If I can't get funding, I will stop”. And bless her, she supported us, thank goodness.’

But for Sir Terence, the second recipient was Keith Castle, who had a pivotal role in winning over sceptics. His resilience and personable character helped renew confidence in heart transplantation, while honed surgical skills did the rest. Castle became somewhat of a celebrity in the UK, and his willingness to raise the organ donation profile quickly captured the public imagination. All of which was hugely helpful to Sir Terence’s desire to push forward.

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‘Keith was a tremendous character and a wonderful man – a builder from Wandsworth, south London, he took it all in his stride. He lived for five and a half years after the transplant and, in that time, did more for transplantation than I ever did because I wanted to keep a low profile at that point.’.
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This propensity to champion others is a theme throughout our conversation and a laudable character trait. Paying tribute to those around him matters greatly, and one wonders if his early mining engineering experience shaped this attitude toward the ‘team’ concept.

That initial successful operation allowed him to grow Papworth into one of Europe’s leading heart and lung transplant programmes. It also paved the way for many subsequent accomplishments, including the first heart-lung-liver transplantation in the world in conjunction with Professor Roy Calne.
The path to establishing a successful heart transplantation programme could have been smoother. Sir Terence encountered resistance and competition. Nonetheless, he pushed forward with unrelenting determination, securing funding and support.

His autobiography, Follow Your Star: From Mining To Heart Transplants - A Surgeon’s Story, catalogues his unique career path and his recollections are littered with anecdotes about fellow surgeons, family life and his mother, whose influence was central to his developing a career in medicine.

A ‘remarkable woman’, he fondly recalls, she faced the challenge of raising two children under the age of four alone after her husband’s untimely death. Her unwavering support and belief in her son's pursuit of medicine left an indelible mark. Indeed, his mother seemingly predicted his path with extraordinary prescience shortly before his second MB exams in 1958 and just before she was killed in a car accident in South Africa.

In a letter published in his book, she writes: ‘But I – and everyone who loves you… will hold strongly to the conviction that you will not know failure, and that your lucky star will be shining strong and serene – even if it’s behind the fog and clouds of a London sky. Keep a clear head and a stout heart, and you will not fail.’

If he was to find a crumb of comfort in this tragedy, she did at least know that he was finally on his way to becoming a doctor.

Even now, Sir Terence is moved by the memory of her.
‘I'm so sad. She was young when she died. She never saw anything I achieved, but she knew I had gone back to study medicine and knew I would stick with it.’

A stand-out aspect of Sir Terence’s career is his commitment to educating and mentoring the next generation of surgeons. He takes great pride in the success of his trainees, who have all made significant contributions to the field of transplantation. For him, it is a source of immense satisfaction and fulfilment.

In his memoirs, he writes: ‘Certainly, I found the relationship between trainer and trainee to be one of the most rewarding aspects of my professional career, and it has been a great pleasure in retirement to see how many of our Papworth trainees subsequently achieve leadership positions within the speciality of cardiac surgery.’

Aware of the difficulties that many surgical trainees faced because of rapidly shortening surgical training programmes, Sir Terence intervened in the implementation of the 1991 New Deal for Junior Doctors in the UK to allow surgical trainees to work beyond the 72-hour limit (without compulsion or pay) to achieve the requisite surgical competencies. The exemption for surgical trainees from restricted training hours became widely known as the ‘English’ clause. Less than six years later (and despite widespread concerns within the profession), it was abolished by the Department of Health.

Sir Terence’s achievements extend beyond his surgical prowess. He has advocated for informed patient consent, ensuring that patients fully understand the complexities of heart transplantation before proceeding. He also highlights the critical role played by anaesthetists and the need to collaborate closely with them.

Sir Terence has held numerous roles throughout his career. These include Membership of the General Medical Council (1983-1989), President of the International Society for Heart Transplantation (1984-5) and President of the Royal College of Surgeons (1989-1992), President of the British Medical Association (1995-6) and latterly Master of St. Catherine’s College in Cambridge (1993-2000).

Despite these unrivalled personal awards and successes, he hopes his legacy will be that he has ‘projected the value and strength of teamwork as opposed to individual surgeons’.

And what of his professional heroes? There is no hesitation in his answer. ‘Dr John W Kirklin, one of my generation’s most influential cardiac surgeons, Sir Russell, later Lord Brock, who was a leading British chest and heart surgeon and one of the pioneers of modern open-heart surgery, and of course Donald Ross, who was a great guy,’ he adds.

As our conversation delves into the future of transplantation, Sir Terence acknowledges the ongoing research in xenotransplants and artificial hearts. He concedes that researchers worldwide are inching closer to solutions, although the artificial heart ‘remains a distant and difficult goal’.

Sadly, Sir Terence suffers from faltering eyesight due to age-related macular degeneration, which is a constant source of frustration for him and dramatically impacts two of his favourite passions – driving and reading. With his vision impaired, he can no longer get behind the wheel, but his love for cars is well-documented in his book. ‘If my vision were still okay, I’d still be driving. What would I have? I’d have a nice old Land Cruiser, and then I’d have something a little modern, something smarter.’

Regarding his other much-loved hobby, he relies on Lady (Judith) English to read to him. Luckily, they agree on most genres, but should one lose interest in a chosen book, they will happily abandon it to start a new one.

Lady English is the former Principal of St Hilda’s College, Oxford and has also enjoyed an impressive career. Interestingly, she drew much press attention when, under her leadership the Governing Body of Oxford’s last remaining women-only college voted to admit men. Together, the couple seem a spirited and indomitable force.

As I leave their home in the pretty Oxfordshire village of Iffley, Lady English welcomes a gift of Sir Terence’s ‘favourite bread’ from their next-door neighbour, the American folk singer-songwriter Peggy Seeger. It is an apt and quintessentially English scene.

A BBC Radio 4 programme plays on my journey home, and there is a discussion on transhumanism, the yearning for immortality and how merging humans with artificial intelligence is pretty close. ‘Post-human’ apparently is on the horizon for us all. It seems a fitting footnote to the day, and one wonders what Sir Terence would have to say about this so-called next evolutionary step. One suspects there would most definitely be mention of the power of pioneering collaboration and teamwork.

Julie Bissett

Lebanon, September 1982. A young woman, with the fear of death and helplessness in her eyes and amongst the rubble and destruction all around her, approached Dr Ang Swee Chai, a volunteer orthopaedic surgeon from London. She was holding a small baby boy in her arms. She held the baby out towards Swee, begging her to take the boy to save its life from the soldiers and militia. Swee found out later that both mother and baby were killed. Sitting in my office, Swee looks up, her eyes filled with sadness and regret as she describes this heart-breaking encounter in her soft voice and in vivid detail. This experience and that of the Sabra Shatila massacre where hundreds of Palestinian refugees were killed that she witnessed have left an indelible mark on her life and given her purpose, passion and desire to help humanity. As a Christian she feels that this has been her calling.

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“If we are silent in the face of massacres we would not be fit to be doctors and scientists. We have to be witnesses.”
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Swee has spent her lifetime using her surgical skills as an orthopaedic surgeon and her commitment for humanity to work in conflict zones, having made visits to Lebanon dozens of times, to Gaza for 6 humanitarian missions, to the aftermath of the Pakistan earthquake, setting up an NGO and being a voice for peace. She went to Jerusalem as a witness to the Israeli Kahan Commission into the massacre of 1982 and gave evidence. During the enquiry she stated “If we are silent in the face of massacres we would not be fit to be doctors and scientists. We have to be witnesses.” Swee has been arrested, deported, marched at gunpoint and yet has always remained strong, calm, brave and defiant. As she approached her seventieth birthday, she was invited to be medic on board a converted Norwegian fishing boat, the Freedom Flotilla al-Awda, heading for blockaded Gaza with life-saving antibiotics and medical supplies. She accepted knowing that she was frail and elderly, prone to seasickness and unable to swim!

She has received countless international awards. In 2016 she was inducted into the Singapore National Women’s Hall of Fame and was also the recipient of the Star of Palestine award by President Arafat, the highest honour for service to the Palestinian people. She has given highly acclaimed TEDx talks and also appeared on HARDTalk on the BBC, a programme renowned for its hard-hitting in-depth interviews of sensitive topics with famous personalities. Following her missions to Lebanon and Gaza she set up the charity Medical Aid for Palestinians in 1984 and now serves as a patron.

Human rights and defending justice have been a common theme in Swee’s life which I am sure has made her the person that she is. Her parents actually met in a Japanese concentration camp as prisoners of war during the latter part of the second world war during the Japanese occupation of Singapore. Her mother was a female leader of the opposition to the occupation and her father a journalist who also opposed the brutal occupation. Her late husband Francis Khoo was a commercial lawyer and a staunch human rights activist wanted for imprisonment for his defence of those persecuted.

Swee was born in Penang, Malaysia, but raised in Singapore. Her grandfather, who, like most Asian men of that era, was traditional and refused to let her mother go to school because he believed educated girls made bad wives. But her mother was defiant then as her daughter Swee is now and went to the school and refused to leave until they admitted her. The eldest of four children, Swee Chai attended Kwong Avenue Primary School, Raffles Girl’s School and then the University of Singapore to study medicine. She was silver medallist for her undergraduate medical degree and gold medallist for her post-graduate degree in Occupational Medicine. It is no surprise that she holds education dear to her heart and is renowned throughout the UK for her exemplary teaching of orthopaedic surgery to her junior colleagues. She tells me why she chose medicine:

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“We had dedicated teachers who taught us to think for ourselves and be independent. I also learned that science, to be meaningful, must be channelled to alleviating suffering and poverty. So I chose to study medicine.”
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Swee worked in Singapore for a number of years building her career but her husband had to flee Singapore in 1977 because of a government crackdown. She was arrested a few weeks later under the Internal Security Act and subjected to solitary confinement and continuous interrogation concerning his whereabouts. Upon her release, they both found refuge in the UK.

It was rare for a woman to train as a surgeon and orthopaedic surgery was very much male dominated even more then than it is today. At 4ft 10” she defies all the physical characteristics associated with orthopaedic surgery. Swee has broken many barriers in surgery as an Asian woman and a refugee. She was the first female orthopaedic consultant surgeon appointed in Bishop Auckland University Hospital, near Newcastle-upon-Tyne, in 1992 and at that time, one of only 4 female consultant orthopaedic surgeons in the UK. She highlights her mentor Prof Jack Stevens who supported and defended her appointment. She was appointed as the first woman to the orthopaedic consultant staff at St Bartholomew’s Hospital and Royal London Hospital in 1996 where she continues to work. She has a specialist surgical interest in patients with rheumatoid arthritis who suffer with pain, deformity and reduced function of their hands due to this chronic condition.

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“We are not afraid.”
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Swee has published widely but will be remembered for two books. The first book War Surgery: Field Manual she co-authored with Hans Husum and Erik Fosse which is a comprehensive book for the management of trauma in war zones.

The second book From Beirut to Jerusalem describes her journey over the last 40 years. The book also contains many pictures. One of these is of 6 destitute children standing amongst the ruin and rubble. They survived the massacre but lost their parents and homes. They raised their hands and said to Swee “we are not afraid”. Swee returned to the camp many times but never found them again. She says that they live forever in her heart and whenever the situation in her own life becomes unbearable, she visits that picture for strength.

The last 18 months have been a difficult time for Swee as she was diagnosed with aggressive breast cancer and had to undergo surgery and chemotherapy which thankfully has been successful. She has returned to work a year ago at the age of 73. I hope that picture has given the strength that Swee has needed.

What of her legacy I ask her? As a true professional and compassionate surgeon, Swee cares first and foremost for her patients at the Royal London Hospital. As she approaches retirement, she wants to ensure that she passes her specialist skills of treating patients with complex rheumatoid arthritis to her proteges in order that these patients are not forgotten, and those skills are not lost. She wishes to leave a world full of hope and to hand over the baton of helping the sick, destitute, and vulnerable and the Palestinian struggle to the next generation. She is also worried about the wellbeing of her cats. She has 12 cats, of which 5 share her home throughout her cancer treatment.

Occasionally a surgeon simply transcends the profession and there can be no doubt as to the impact that Swee has had on the world, and we owe her our deepest gratitude. There will never be another like Swee who represents the very best of us. Dr Ang Swee Chai is without doubt the most inspirational person that I have ever met, and it was a real privilege and honour to be able to share her life story for Surgery.

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.

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“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.”
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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."

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“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.”
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“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.”

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