Cutting edge blog

At the heart of the Royal College of Surgeons of England lies the Hunterian Museum, a space dedicated to the history of surgery from ancient times to the present day. Many visitors are drawn to the specimens on display - over 2,000 preparations of human and animal tissue collected by John Hunter in the 1700s. However, the story of surgery is equally told through the wealth of surgical instruments in the collection, from the simplest probes to the latest minimally invasive technologies.

Mick Crumplin, a retired surgeon and Honorary Curator of Instruments at the Royal College of Surgeons of England, delves into this fascinating history in his series of 20 articles for ‘The Instrumentalist’ in the BJS. This brilliant resource reviews the origin of a wide range of instruments, some of which will be very familiar to today’s surgeons, while others are less well-known.

Liston pattern bone-cutting forceps. © 2014 All rights reserved. Courtesy of Surtex Instruments Ltd.

Correspondence to: Simon Lundström (e-mail: Simon.Lundstrom@med.lu.se)

Department of Surgery

Skåne University Hospital

Correspondence to: Ranjith Kumaran Ramu (e-mail: ranjithkumaran2009@gmail.com)

Senior Resident

Department of General Surgery

Correspondence to: Sander J. M. van Hootegem (e-mail: s.vanhootegem@erasmusmc.nl)

Department of Surgery

Erasmus Medical Centre

Correspondence to: Anyin Wang (email: Hospitalpwkedu@163.com)

Department of Gastrointestinal/Hernia Surgery

The People's Hospital of Liangping District

Despite an increasing emphasis on patient safety, modern surgical practice is still plagued by the occurrence of serious Adverse Events (AEs). A large proportion of these AEs are caused not by technical errors, but short comings in non-technical skills (NTS) or non-technical errors.1 NTS are the cognitive and interpersonal components of surgical professionalism including communication, decision-making, situational awareness and leadership.2 Few studies have attempted to quantify the significance of non-technical errors leading to patient harm. Those that have, only include small, non-representative cohorts, or have assessed for NTS shortcomings using heterogeneous, non-standardised, and non-comprehensive assessment methods.3-6 As a result, the true impact of non-technical errors, and information about how, when, and why these errors occur are poorly understood. Evidence to guide NTS improvement is lacking.

This study7 aimed to investigate the incidence of non-technical errors linked to patient death in a large representative Australian cohort, investigate factors associated with fatal non-technical errors, and whether the incidence of non-technical errors had changed over time. To achieve this, an 8-year retrospective audit using surgical mortality cases was conducted. Data were derived from the Australian and New Zealand Audit of Surgical Mortality (ANZASM) a mandatory, national surgical mortality audit overseen by the Royal Australasian College of Surgeons. In Australia, every surgical death is reported to ANZASM for external peer review for the purpose of identifying clinical management issues (CMI’s) that could be improved in future. CMI’s are rated on a three-tiered system with ‘area of concern’ or ‘Adverse Event’ representing the two most serious. All surgical deaths between 2012-2019 (excluding New South Wales), flagged with an area of concern or AE were included with no further exclusions. Each case was assessed using the System for Identification and Categorization of Non-technical Errors in Surgical Settings (SICNESS), a validated tool, developed by the study authors.8 The SICNESS enabled assessors to identify if a non-technical error linked to patient death had occurred, and if so, to which NTS domain it belonged.

There were 30,971 surgical deaths reported to ANZASM during the study. Of these, 3829 were flagged with an AE or Area of concern. Some 134 had insufficient information for assessment, leaving 3695 cases for review. A non-technical error linked to patient death was identified in 2354 cases (63.7%). Of the cases with non-technical errors, 1375 (58.4%) had decision making errors, 1328 (56.4%) had situational awareness errors, 357 (15.2%) had communication/teamwork errors, and 128 (5.44%) had leadership errors.

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My first significant contact with abdominal aortic aneurysm (AAA) screening was when I was appointed as a consultant surgeon in Gloucestershire in 1991. My consultant colleague, Brian Heather, had already started an AAA screening programme for 65-year-old men in Gloucestershire. The burden of managing vascular disease single-handed for a population of 350,000 was significant for him; in addition, patients with ruptured AAA were major consumers of critical care services in Gloucestershire at the time. Brian contacted all the GP surgeries in Gloucestershire asking whether (i) they were prepared to identify the 65-year-old men in their practice each year, and then (ii) to receive a visit once a year for them to be scanned. He secured the services of a research nurse, Elaine Shaw, who took a portable ultrasound scanner to the GP surgeries to do the scans. The screening programme in Gloucestershire was born in 1988 and has run ever since1.

Correspondence to: Shuting Yin (e-mail: yin13938214200@163.com)

Department of Education and Sports

Zhengdong New District

Correspondence to: Sabaretnam Mayilvaganan (drretnam@gmail.com)

Additional Professor

Department of Endocrine Surgery

Correspondence to: Chahrazed Dous

(email: douschahrazed@yahoo.com)

Tazoult City

Correspondence to: Gang Bian (e-mail: bianganglingling@163.com)

Department of Gastroenterology

Qingdao Third People's Hospital Affiliated to Qingdao University

Dominic Slade and Prita Daliya bring you the opening teaser for their upcoming podcast: Surgeons unscrubbed! A collaboration between the British Hernia Society (BHS) and BJS Academy.

In this series, Dominic and Prita will be interviewing prominent surgeons around the world and asking them questions submitted by you!

Correspondence to: Shelley Potter (email: Shelley.potter@bristol.ac.uk)

Translational Health Sciences

Bristol Medical School

Correspondence to: Janhavi Venkataraman (email: Janhavi.Venkakataraman@hcahealthcare.co.uk; janhavivraman@gmail.com)

The London Breast Institute

Princess Grace Hospital

In recognition, we present seven of the most important colorectal cancer studies published in BJS and BJS Open over the past year. These articles highlight significant advancements in the understanding and management of colorectal cancer, covering topics such as surgical innovations, oncological outcomes, and prognostic markers. This collection showcases the latest research aimed at improving patient care and survival.

Explore these key contributions to the field and join us in raising awareness of colorectal cancer this March.

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Correspondence to: Dr Saburi Oyewale (email: saburioyewale@yahoo.com)

Division of General Surgery

Department of Surgery

Correspondence to: Harivinthan Sellappan (e-mail: hari.vs@gmail.com)

Department of Surgery

Queen Elizabeth Hospital

*Corresponding author: Yiren Hu (email: yirenhu@hotmail.com)

Department of General Surgery

The Third Clinical Institute Affiliated to Wenzhou Medical University

Correspondence to: Simon Lundström (e-mail: Simon.Lundstrom@med.lu.se)

Department of Surgery

Skåne University Hospital

Correspondence to: Antonio Manenti (e-mail: antonio.manenti_2024@libero.it)

Department of Surgery

Polyclynic Hospital

Correspondence to: Min Ni (email: 15278054120@163.com)

Department of Gastrointestinal Surgery

The Second Nanning People’s Hospital

In the book “The Idea Factory,” the CEO of the then monopolized telephone services American Telephone and Telegraph Company (AT&T)) in the US (circa 1880-1930) decided that although the business was highly profitable as a result of the massive laying down of cable across the world, hiring someone who could advance an understanding of how the telephone actually worked was needed. He decided that a more fundamental understanding of electricity and sound would improve the business model and overall telephone services. He hired a physicist from the University of Chicago who was offered a salary of $25,000/year to head up the project. This person was thrilled to just be able to obtain employment, given that a PhD in those days was no guarantee of employment, even when graduating from an elite university.

When the newly appointed physicist asked the CEO “what is my job?” he responded — you are to spend your time in “idle curiosity” so you can think and perform experiments. So began the independently funded and famous Bell laboratories, designed so that its faculty could walk its outdoor paths, think great thoughts and perform solution-agnostic experiments. More Nobel Prizes were won by the faculty at that institution than all other private free-standing research facilities in the US. Imagine what it felt like to be hired by a powerful CEO of a company and being told spend all your time in idle curiosity. Yet without that level of trust in the very process of science itself, the development of radio astronomy, the transistor, the laser, the photovoltaic cell, the charge-coupled device, information theory, the Unix operating system, and several programming languages would not have occurred. This approach led to eleven Nobel Prizes and five Turing Awards.

This story illustrates that a key element of success in research is the recognition of the value that idle curiosity brings to a scientific project. It is inefficient and costs money, time and resources. Yet without it, the foundational knowledge needed to drive innovation cannot emerge. The CEO of AT&T’s idea to let “scientific inquiry run its natural course” was not only visionary but demonstrated his trust in scientists and the process of science itself. And remember science is a process, not a result and is “true whether you believe it or not”, to quote Neil deGrasse Tyson.

Correspondence to: Raafat Gendy (email: raafat.gendy1@nhs.net)

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Correspondence to: Dr. Davide Serrano (email: davide.serrano@ieo.it)

Division of Cancer Prevention and Genetics

European Insitute of Oncology