Surgical news
Exploring topics relevant to both surgeons and people without medical training, Surgical news is accessible to everyone.
Many patients seek reliable information on the best treatments for surgical diseases, whilst others have a general interest in reading quality articles about surgeons and surgical practice.
All roads lead to outsourcing
Dr Paul McCoubrie
Welcome back to Dr Paul McCoubrie’s a 'view from the dark side' — a series looking at the world of surgery through the lens of a radiologist.
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The UK National Health Service (NHS) in common with many other health systems internationally is a sorry state. Specialities are stretched, most beyond the point of elasticity. Many have snapped and are broken. It is not just left-wing rabble rousing or doctors having a good old whinge. NHS and healthcare understaffing is completely genuine. Workload has grown as the populace lives longer, gets frailer and as healthcare grows in complexity. Funding has been either cut in real terms or never reaches the front line. Productivity has dropped as the NHS becomes more difficult to work in.
Are we risk aware or risk averse?
Dr Helgi Johannsson
Last year, I anaesthetised a woman for a diagnostic procedure. This is hardly a groundbreaking way to start an article about risk, but she had been highlighted to me because of her multiple co-morbidities. She had a surgical condition – an intra-abdominal cyst – that caused her constant pain every day, affecting her ability to walk, to eat and to perform even her basic activities, making her entirely reliant on her daughter. She had been turned down for surgery due to her other risk factors by the anaesthetic pre-assessment clinic and the multi-disciplinary team (MDT) looking after her, yet she continued to live with constant pain and distress. After a short discussion with her and her daughter, it became obvious that she did not want to spend the rest of her life in agony and would be very happy to take the additional risk of surgery for the benefit of not being in constant pain.
Every day, every hour we work in medicine we are assessing risk. Every decision to go ahead with surgery is a risk assessment and discussion with our patient. Usually the decision is straightforward, the patient has a surgical condition, an operation will relieve it and the risk of complications from the operation or the anaesthetic is low.
Low incidence problems
Dr Paul McCoubrie
Welcome back to Dr Paul McCoubrie’s a 'view from the dark side' — a series looking at the world of surgery through the lens of a radiologist.
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Every few years a campaign is launched to improve the diagnosis of a particular disease. There is often a catchphrase such as, “Think x” or “Could it be y?”, with social media-ready hashtags and bright logos. Campaigns that spring to mind include aortic dissection, sepsis and, oddly, porphyria.
Beyond repair, beyond Kegels: a pelvic physiotherapist’s reflection on working with surgeons
Amadea Kezar
As a pelvic health physiotherapist, I’ve spent my career standing at the intersection of two worlds—where conservative rehabilitation meets surgical expertise. Working alongside surgeons has taught me not only about anatomy and surgical outcomes, but about perspective: how each of us sees only part of the patient’s journey until we start talking to one another.
In pelvic health, the human story is rarely linear. Patients may arrive years after a traumatic delivery, a hysterectomy, an endometriosis excision, or a prostate surgery—often having navigated layers of medical interventions before anyone asked, “How do you feel in your body” and “Can you use it how you’d like to?”
While a surgeon’s focus is often the success of a procedure—optimal resection, reduced pain, restored structure—mine is on function, integration, and lived experience. Where the surgeon works with a scalpels, cautery and sutures, I work with breath, skilled touch, and purposeful movement—restoring awareness, slowly unwinding guarded tissue and fear. Our work is complementary.
BJS Bookshelf: Presidents Under the Knife by Per-Olof Hasselgren
Thomas E Cataldo, MD FACS FASCRS
Assistant Prof of Surgery Harvard Medical School; Program Director in Colon and Rectal Surgery; Beth Israel Deaconess Medical Center, Boston MA
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The case for more surgical x-ray meetings
Dr Paul McCoubrie
Welcome back to Dr Paul McCoubrie’s a 'view from the dark side' — a series looking at the world of surgery through the lens of a radiologist.
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This summer has been difficult for me. A very good friend died in June. My pal, Barry Kelly, was a Belfast-based radiologist who originally trained as a surgeon in Glasgow. Kind and supportive, he was a brilliant wit and raconteur; everyone’s favourite colleague. He was also a polymath who seamlessly wove together literature, philosophy, history and science: very much the Stephen Fry of radiology.
Who said nil-by-mouth?
Dr Helgi Johannsson
“Is the patient nil-by-mouth”?
A few months ago, I anaesthetised a patient for a routine operation. He was nervous, as many of them are, and had made the decision to forego his evening meal the night before surgery, and drink nothing after 6pm the previous day in order to be “extra safe” for his anaesthetic. When he told me, I responded with an outward smile and an inward eye-roll, popped out and came back with a glass of apple juice for him to drink, and a gentle explanation of how prolonged fasting is actually bad for his recovery.
Aspiration under anaesthesia is extremely rare in Europe, but it’s difficult to get accurate figures. Incidence for elective cases is around 1:5000 to 1:10,000. According to a UK Royal College of Anaesthetists audit, obstetrics is even lower with only 12 cases between 2013-2016, equating to around 5 cases per million pregnancies.
BJS Bookshelf: Atomic Habits by James Clear
Dr Wissam Benhami
Forget “New year, new me.” Atomic Habits by James Clear isn’t about wishful resolutions or grand transformations. It’s about the quiet power of small actions that compound into radical change. The central thesis?
“You don’t rise to the level of your goals. You fall to the level of your systems.”
BJS Bookshelf: Your Heart, My Hands by Atul K. Singh, MD
Saarim Bari
This book traces the extraordinary life of Dr. Arun Singh, whose journey begins at grassroots level in a modest household, in a socioeconomically disadvantaged area in India, and leads to his becoming one of the most prolific Cardiothoracic Surgeons in the United States. Born with dyslexia and suffering physical injuries, Singh dropped out of school and was educated at home by his mother. During medical school, thanks to relentless pursuit and grit, Singh emerged as a bright student who defied enormous odds through ingenuity, discipline, and unwavering encouragement from his mother amid every challenge. Leaving behind a life marked by crippling setbacks and embracing his father’s distrust in his potential, Singh arrived in Massachusetts in 1967 with meagre financial means, steadfast in his claim to the American dream, embarking on an unimaginably arduous yet beautiful journey he once could only imagine. Through gripping accounts of failure, triumph, and the emotional burdens of his life, he would perform over 15,000 open-heart surgeries, lead pioneering residency programs in cardiac surgery, and mentor the next generation of surgeons. This book is more than a medical memoir; it is an immigrant’s saga of grace, grit, passion, and a burning pursuit of excellence, defying all odds.
Aspiring surgeons and professionals alike should read this not only for inspiration but for much-needed professional reflection. Singh’s journey offers invaluable takeaways in endurance, humility, and ethical surgical practice. His story resonates with any surgeon, at any stage, who wrestles with feelings of being an imposter, outwardly or inwardly. Born with a disability and burdened by physical injuries, he had every reason to give up. Yet he forged his path to master complex cardiac procedures, his resilience embodying the determination all surgeons should nurture. Despite his prolific career, Singh spoke candidly about the emotional toll of losing patients and the sense of responsibility that never fades, regardless of experience. He confronted systemic barriers and navigated cultural challenges with grace, blending seamlessly into a new world while underscoring the value of resilience and cultural humility in building trust and achieving peak outcomes. Above all, this book captures a surgeon’s devotion to patients, to the craft, and the lifelong pursuit of continued growth. It serves as both an emotional and technical guide for medical students and surgeons seeking meaning beyond the scalpel, and as a tribute to the hands that heal hearts and the hearts that sustain them.
Decision paralysis
Dr Paul McCoubrie
Welcome back to Dr Paul McCoubrie’s a 'view from the dark side' — a series looking at the world of surgery through the lens of a radiologist.
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Several years ago, a corridor conversation changed the way I thought about surgery and surgeons. Talking with a surgical colleague, the chat ended on the topic of physical dexterity and procedural competence. I explained that my physical ineptitude drove me away from interventional radiology. It is also why I don’t do DIY. Whether I’m trying to cannulate a femoral artery or screw something to a wall, I’m hopeless. I’ve got hands like cow’s udders.
I’m exhausted
Dr Paul McCoubrie
Welcome back to Dr Paul McCoubrie’s a 'view from the dark side' — a series looking at the world of surgery through the lens of a radiologist.
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“I’m absolutely bloody exhausted”
The other side of the barrier
Dr Helgi Johannsson
What’s wrong?
Do you want me to deflate the pneumoperitoneum?
My surgeon stops what he’s doing and just looks at me expectantly. I hadn’t said anything to him, nor had I really clocked my own discomfort as something about my patient’s physiology didn’t quite fit with the usual Feng Sui pattern I was expecting.
A view from the coffee room...Academic craving for praise: vanity or simple human nature?
Dhananjaya Sharma, MBBS, MS, PhD, DSc, FRCS, FCLS (Hon), FRCST (Hon)
The pursuit of knowledge, often heralded as the noblest of human endeavours, occupies a paradoxical space in academia. On one hand, it is driven by curiosity, the desire to uncover truths about the world, and the betterment of society. On the other hand, it is inextricably tied to recognition - a longing for accolades, titles and applause. This craving for praise, manifesting through the relentless chase for honours and awards, raises a question: is it vanity or an intrinsic aspect of human nature?
Humans are fundamentally social beings and Psychologists have long established that recognition and validation play critical roles in shaping self-esteem and motivation. Abraham Maslow, in his hierarchy of needs, placed esteem, including respect and recognition, just below self-actualization1. Academics’ work often unfolds in the solitary realms of research and contemplation, such external validation provides a tangible acknowledgment of their contributions.
Clinical examination is dead
Dr Paul McCoubrie
In this new series, Dr Paul McCoubrie offers a 'view from the dark side' — looking at the world of surgery through the lens of a radiologist.
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I was at a national radiology conference four years ago when a consultant surgeon stood up and stated, “Clinical examination is dead”. There was a stunned silence for a few moments then hushed murmurs of discontent. She clearly believed it and stated it without embarrassment.
A surgical life by James Shapiro
A.M. James Shapiro, MD PhD
I completed Medical School at the University of Newcastle-on-Tyne. My first taste of research was in islet transplantation. I knew I wanted to be a surgeon but it was super-competitive at the time. I was convinced I was not smart enough to get in, so several people advised me to think about a year of research to help me stand out. I went to see a surgeon called John Farndon who was a Consultant Surgeon and Senior Lecturer at the time. He had a long list of typed out projects. One caught my eye – islet transplants in rats, and the use of cryopreservation to alter immunogenicity. I had never seen a rat before, knew nothing about diabetes or cryopreservation, but signed up for a year’s research (B.Med.Sci.) project. I asked John if this was a good topic to pick. He told me he wouldn’t sell me a lemon! It set me on my path forward to today. I completed the one-year research project with John Farndon and Tom Lennard – both of whom later became Professors and Heads of Department in Bristol and Newcastle respectively. My initial islet experiments were all failures despite my working day and night (including sleeping in the animal house to monitor 24-hour glucoses from the rat tails).
I completed House Jobs at the Royal Victoria Infirmary in Newcastle and in Cambridgeshire, and in moving I had a small upright piano for sale. One evening I got a phone message from John Farndon saying “No, I don’t want to buy a bloody piano, but if you want a job in Bristol call me back!” I was an Anatomy Demonstrator in Bristol for a year, then applied to the junior (Senior House Officer, SHO) rotation in General Surgery – but did not get in (perhaps because John couldn’t make it to the interview). I was lucky enough to spend six months as an SHO in Urology which was great fun and provided early solid training in major retroperitoneal surgery. Finally, I was appointed to the SHO rotation in Bristol in General Surgery and completed the two-year training and an additional six months as a Registrar. I had a career advice meeting with John at one point – he told me to go to Canada to train in liver transplant surgery, and that I shouldn’t come back (more than a subliminal message that it was time to get rid of me)! Professor Derek Alderson had direct contacts with the Professor Norman Kneteman in Edmonton, Canada and one phone call set me on my way to Fellowship. I completed a two-year fellowship in liver transplant surgery in Edmonton, completed a Ph.D. in experimental surgery with Norman in models of islet transplantation (this time the experiments worked). The paediatric liver transplant surgeon in Edmonton left unexpectedly and they begged me to stay – where I have remained ever since. I completed a further two years of Chief Residency in General Surgery, during which time I was able to complete three additional 6-month Fellowships – in hepatobiliary oncologic surgery in Vancouver with Buz Scudamore, whole pancreas transplant surgery with Stephen Bartlett at the University of Maryland, and in living donor liver transplant surgery with Professor Koichi Tanaka in Kyoto. I joined the Faculty at the University of Alberta in 1998 and moved through the ranks to Full Professor and Canada Research Chair. I am now the Director of the liver transplant program where we perform around 110 liver transplantations per year, the living donor liver transplant program, and the islet transplant program, as well as over 300 major hepatobiliary operations per year.
Professor James Shapiro and his wife, Vanessa.
A view from the coffee room...How to retire gracefully: 10 commandments for surgeons
Dhananjaya Sharma, MBBS, MS, PhD, DSc, FRCS, FCLS (Hon), FRCST (Hon)
Retirement is a major transition for any professional, but for surgeons, it is particularly complex. The identity, purpose and intense commitment associated with surgical practice make stepping away from the operating room both a psychological and logistical challenge. To ensure a smooth transition, surgeons must plan their exit strategy. Here are 10 commandments for retiring gracefully from surgical practice:
The key to a seamless retirement is early and thoughtful planning. Ideally, this process should begin 5–10 years before retirement. This period allows time for assessment of financial security, professional succession planning, and gradual disengagement from clinical duties. Developing a timeline ensures that retirement is a proactive decision rather than a reactive necessity due to declining health or external pressures. Such planning is the key to a graceful landing in the post-retirement life.
Financial security is crucial to a stress-free retirement. Surgeons should work with financial planners to evaluate their savings, investments and retirement benefits. Diversifying income sources—such as pensions, savings, and passive investments—ensures stability.1It is also wise to consider medical insurance coverage post-retirement, and planning to safeguard wealth for future generations.
A view from the coffee room…on the friendship between residents
Virve Koljonen MD, PhD
Residency, and especially surgical residency is hard1. Burnout, depression, harassment, emotional exhaustion, and stress are way too familiar with current surgery residents2-7. Unfortunately, the situation has not changed much since I was resident8, 9. But what has changed is that we acknowledge this now. I have to say though, it is good that I did not read these articles before I started my surgical career about 27 years ago.
Surgery residency and residency in general changes previous personal relationships and this is tied to evolving professional identity10. Strange working hours, and patient-doctor relationship confidentiality may lead to fewer talking points with non-medical friends and family11. Further, these relationships with non-medical friends and family may not thus provide the support they used to,11, 12 especially when dealing with work-life and residency.
A view from the coffee room…When you are feeling down and you are an introvert, and someone asks you for your mini autobiography (and other benefits)
Virve Koljonen MD, PhD
Now really personal stuff: I am very reluctant to talk about me. I am more into talking about factual professional stuff. Nonetheless I was asked by BJS Academy to write about my path from there to here. How to solve this problem? I solved this by making a very boring bullet point list of turning points in my life. Then I entered this list into the AI podcast generator.
Hear, Hear, a lot of wows, ooohhs, love its and I like that’s, with an American accent. Not exactly what we call European mentality and certainly not Scandinavian or Finnish. Listening to this was balancing between embarrassment and proud - in the beginning. The further the podcast got, the better I felt. Actually, it is quite good to hear voices talk about you enthusiastically.
View from the coffee room…LARPing ChatGPT
Virve Koljonen MD, PhD
LARP, live action role play, is immersive role-playing where participants physically and mentally/emotionally portray their characters, interact in real-world settings, and shape the story through improvisation. There are not many chances for surgeons to LARP during professional hours. Well, other than occasionally LARP internist, when someone asks about medicines.
Medical research and writing have changed after introduction to LLMs, large language models, such as ChatGPT (OpenAI, San Francisco, CA, USA) launched Nov 30, 2022. LLMs employ neural network and have been trained to understand and generate human language and produce human-like responses1.
A view from the coffee room… on communication in the OR
Virve Koljonen MD, PhD
I maintain a shortlist of stupid or dare I say idiotic statements given by hospitals top administration to the newspapers. A decade ago, we were in a similar situation as today: a lack of nurses. The solution to this shortage was to bring in nurses from other countries. So far this sounds great, but there is more to this. In the newspapers I learned that the nurses were to be placed in the OR. Again fine, we need to do operations and operate more. The next sentence blew my mind: these nurses were placed in the OR since they did not have to learn Finnish, because no one talks in the OR.
So, basically everyone in the OR, surgeons, anesthetists, nurses and orderlies, work in total silence; maybe listen to radio, but no talking. We don't say a word. Maybe we communicate with hand gestures or perform pantomime. To me, this shows that the hospital administration does not understand what kind of work is done in the OR and especially how the work is actually done. Communication is of the utmost importance in the OR. One of the first things I learned in OR about communication, was that anyone can and should speak out if they notice shortcomings in sterility. This is really, really important.
BJS Bookshelf: Why We Sleep by Matthew Walker
Begum Pekbay
Why do we need seven to eight hours of sleep? What is a good power nap? How do we maintain adequate sleep hygiene?
In ‘Why We Sleep’ by neuroscientist Matthew Walker, these questions are answered based on extensive research. Sleep is a necessity for our brain to enhance a wide variety of functions such as memory consolidation, emotional regulation, and even physical recovery. Our REM sleep is like overnight therapy and fuels creativity. Perhaps the reason why sleep is often easily neglected, contrary to diet and exercise, is because sleep enhances our health in ways we usually cannot easily see or grasp. As such, sleep deprivation can subtly lead to a range of health issues including cognitive decline, chronic diseases, and shortened lifespan. Chronic insomnia not only affects us individually; societal consequences are also mentioned by the author.
A view from the coffee room…What every surgeon should know about spontaneous interjection exclamations
Virve Koljonen, MD, PhD
Every surgeon should know about spontaneous interjection exclamations, at least the following:
1. avoid them in certain situations
2. observe them in your patients.
A view from the coffee room… Pokémon vs. Predator
Virve Koljonen, MD, PhD
Department of plastic surgery
Helsinki University and Helsinki University Hospital
Helsinki, Finland
@plastiikkaope
I am a big fan of Pokémon Go. I play it regularly and by that, I mean, every day. The inventiveness of the appearance of Pokémon characters and their witty back stories appeal to me. It is nice to look at a new character and try to find out its real-world counterpart. Further, the structure of the game is to collect as many as possible Pokémon or walking a certain amount of kilometers doing projects within the specified time, perfectly aligning with my competitive personality. Some time ago I was browsing through the medical literature. I am always trying to keep up with new literature, although nowadays it is very difficult. It has been estimated that medical knowledge doubles in just 73 days 1. I do really miss those golden old days when you just did a brisk walk to the library to find what you were looking for. I cannot overestimate my joy when I found out that my favorite leisure time hobby, Pokémon go was employed to expose predator publishers2! Pokémons have helped to reveal that predatory publications have no peer review, nor editing, and what is most choking, not even a reality check2. I am not going the reference these publications, since I feel that the journal gets undeserved glory for including them in the reference list. However, I will walk you through some of these genius publications. For the purposes of this article, I also made AI images in the Pokémon go -style.
A view from the coffee room… congress abstracts – good science or bad science?
Virve Koljonen, MD, PhD
Department of plastic surgery
Helsinki University and Helsinki University Hospital
Helsinki, Finland
@plastiikkaope
I vividly remember when attending congresses was in real life only. Today that seems like another reality. I do remember the awkward moments, when I had like one microsecond to decide how to greet my congress acquaintances. Should I greet them with familiarity, or formally, or just casually wave my hand when walking by. As a person coming from a northern country, apart from choosing the right way to greet acquaintances, another custom of the continental Europe is causing me quite a lot of anxiety: air kisses. Which cheek comes first and how many are appropriate, because I don’t want to seem like a stalker, and what if I accidentally belch simultaneously. So many things to consider and be afraid of. Traditionally the success of congresses have been measured by the number of participants and by the number of abstracts 1. This obviously translates to money made by the organizing entity. Before the advent of internet, medical congresses were truly occasions where top scientific innovations were presented, new techniques were introduced, and with a chance to learn from experts 2. Nowadays knowledge is available for anyone at anytime and anywhere. Of course, I will not dismiss the value of face-to-face interactions, that has led to great innovations and is personally meaningful to those participating in such actions. What about the keynote speakers – superstars of their specialty. The more famous the keynote speaker, the more attractive congress is likely to be. In social media, there are events that are called meet-and-greet events. By definition, these events are arranged so that a famous person i.e. influencer can meet and talk to the people. Or is it vice versa actually. Meet-and-greet events are not quite the normal fan event, but almost. Well, to me it sounds a lot like inviting keynote speakers.
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