SUSC 2017 Conference Booklet

9th Scalpel Undergraduate Surgical Conference 4th November 2017

Contents Welcome

Day Plan

Keynote Speakers

Tutors, Workshops, Sponsors Oral Presentations

6 7

Welcome It

is my pleasure to welcome you all to Scalpel’s 9 th Undergraduate Surgical Conference. The committee this year have been working diligently behind the scenes to bring a diverse range of events throughout the year. Our conference director Judith has worked tirelessly to build on last year’s fantastic conference and deliver an even better event this year. Using feedback from previous year, we have created a range of practical skills workshops with the new addition of our colorectal resection and anastomosis workshop.

We have incorporated a business and innovation theme into our conference this year, and have brought to you keynote speakers with impressive experiences behind them. Mr Manoj Ramachandran has founded his own company in digital health and medical technology, building into his role as director of informatics in Barts Health NHS Trust. Dr Elliot Street is a Manchester Medical School graduate who became involved with medical innovation right from his fourth-year student bedroom! More detailed descriptions of Mr Ramachandran and Dr Street can be found later in this booklet. Our society aims to inspire students and all attendees of our events. By listening to our keynote speakers as well as partaking in the wide range of practical and academic workshops, we hope that you will be able to meet and interact with surgeons at many different stages of their career. Some of the connections that you make today may last well into your future careers, whether students, trainees or consultants! In order to continue building on our events, please fill out the feedback as fully as you can. A massive thank you to all of the committee members and all the faculty who have made today possible. I hope you enjoy the day’s activities.

Rachel Khaw Scalpel President 2017

Day Plan Time

Event

0800 - 0900

Registration

0900 - 0915

Welcome Address by Scalpel President

0915 - 1000

‘The 200% Enterpreneur’ Mr Manoj Ramachandran

1000 - 1115

Practical Workshop Group A

1115 - 1130 1130 - 1245

1245 - 1330

1330 - 1445

Academic Workshop Group B Break

Presentations Group A

Practical Workshop Group B

Lunch and Poster Presentation Academic Workshop Group A

Practical Workshop Group B

1445 - 1500

Break

1500 - 1545

‘Medical student to CEO, how to build a medical device company from your bedroom’ Dr Elliot Street

1545 - 1700

1700 - 1730

Practical Workshop Group A

Presentation Group B

Prize Giving and Close

Keynote Speakers Mr

Manoj Ramachandran BSc(Hons) MBBS(Hons) MRCS(Eng) FRCS(Tr&Orth) Manoj Ramachandran is Consultant Paediatric and Young Adult Orthopaedic and Trauma Surgeon at the Royal London and Barts & The London Children's Hospitals, London, and Honorary Reader and Director of Clinical Strategy in the Institute of Bioengineering, Queen Mary University, University of London, England. He undertook

clinical and research fellowships in Sydney, Los Angeles and London and his main research interests are in paediatric and young adult bone and joint disease and trauma, cartilage and innovative and translational clinical trials. His other passions are entrepreneurship, digital health, medical technology and devices, and medical education. His most recent start-up is in artificial intelligence and medical imaging - Viz.ai. Website: manoj.strikingly.com

Dr Elliot Street BSc. (Hons), MBChB Dr Elliot Street is the co-founder and Managing Director of Inovus Medical, a leading designer and manufacturer of medical and surgical simulators and medical devices. Elliot started Inovus from his student bedroom during his final year at Manchester Medical School. Following graduation he completed his foundation training in the Oxford deanery where he worked at the prestigious John Radcliffe Hospital. After his foundation training Dr Street moved to a full time role with Inovus; a move

6 Linkdin: (Elliot Street) https://gb.linkedin.com/in/elliot-street-77900771 Website: www.inovus.org

that has seen the company enjoy significant growth in revenue and global reach. Inovus’ products are now in over 50% of NHS Trusts and over 35 countries worldwide; industry customers include some of the largest medical device companies in the world including Olympus, Medtronic, Bard and Cook Medical. Recent highlights for Dr Street and Inovus include the move to new headquarters in St Helens and his shortlisting for the ACW entrepreneur of the year award.

Tutors and Workshops Practical Workshops Knot Tying

Basic Suturing

Dr Sinthuja Naguleswaran, Dr Djamila Rojoa, Dr Yousef Al Ebrahim and Dr Oluwatomisin Ashiru

Dr Omar Abbassi, Dr Martin Sharrock and Dr Danny Lanrezy

Laparoscopy

Local Skin Flaps

Mr Ian Farrell and Dr Alice Dempsey

Mr Hugh Wright and Dr Jordan Oldbury Advanced Suturing

Bowel Resection and Anastomosis

Mr Ralph Murphy, Mr Simon Barr, Mr Ibrahim Ibrahim and Mr Chris Rusius

Mr Richard McBride

Academic Workshop CV Clinic

Publish or Perish

Mr Manoj Ramachandran

Dr Joanne Taylor

Academic Foundation Programme

Dr Dele Sasegbon

Dr Aseem Mishra

Sponsors

Gold Sponsor

Oral Presentations Hemamali Nanayakkara - Audit Surgical Management of high grade gliomas in the elderly population"

Background As the population ages, the number of individuals diagnosed with gliomas are predicted to increase. Surgical resection of gliomas followed by adjuvant therapy based on evidence available could contribute to increase overall survival in the elderly population. Aim A retrospective study to assess the survival rates in elderly patients with high-grade gliomas against the survival and complication rates found in literature. The secondary objective is to identify whether a significant difference in survival exists between the <75 and â&#x2030;Ľ75 age groups. Method Patients surgically treated for histologically proven gliomas at the neurosurgical unit at Salford Royal Foundation Trust from 1st June 2011-3rd March 2016 were included into this study and data was obtained from the Neurooncology database and Electronic Patient Records. Results A total of 124 patients older than 65 years with 131 admissions were included. There were 46 males and 78 females. Gross total resection was performed in 25 patients (19%); subtotal resection in 69 patients (53%); partial resection in 12 patients (9%); and biopsy in 25 patients (19%). At last follow up, 7 patients were alive with a median overall survival of 6.4 months. In log-rank analysis, the median survival for <75 was 6.9 months and â&#x2030;Ľ75 was 5.2 months, with no statistically significant difference between the two groups. Complication rates amongst subgroups were not different. Conclusion In selected patients, surgery can be considered as a safe option. If surgery is accurately selected, patients above the age of 75 can benefit from surgical intervention with acceptable morbidity.

Mikolaj Kowal - Audit Introduction Inguinal lymph node dissection is utilised in the management of various malignancies. Surgical drains are inserted routinely to collect lymphatic fluid post-operatively. However, their dwell time fluctuates. Currently, the process for managing dwell time in such patients is variable. Aim To assess the drain dwell time and the processes utilised to manage them. Methods 10 patients were selected using operative diaries at the Trust. The Clinical Web Portal (CWP; Electronic Patient Record) was used for patient followup. 7 main criteria were employed to assess surgical drain care: Post-operative drain instructions; total, inpatient and outpatient drain dwell time; record of contact; contact as outpatient and who removed the drain. The data was anonymised and input into a spreadsheet to undergo descriptive statistics.

Results 2 patients had no information on drain dwell time in the CWP. The average drain dwell time was 10.4 (5-20 days). The average inpatient and outpatient drain dwell times were 4.6 (2-7 days) and 5.8 (0-15 days) respectively. A large degree of variation was observed in post-operative instructions regarding drain care. The average number of outpatient contacts was 3.8 (2-8 occasions). Drain removal was carried out by 4 different health practitioners. Conclusions Drain dwell time and care standards were variable in this small cohort. This study highlights the need for a more robust and standardised trust instruction to be followed for inguinal drains. This should include frequency of contact with patients, appropriate recording and further training on drain removal in the community.

Aisha Sooltangos - Audit Aim To investigate the efficacy of endoscopic submucosal dissection (ESD) at diagnosing and treating superficial neoplastic lesions of the stomach in a UK Caucasian population. Methods Data of patients treated with or considered for ESD at a tertiary referral centre in the UK were retrieved for a period of 3 years (May 2014 to June 2017) from the Electronic Patient Records. Primary outcomes were curative resection (CR) and was defined as resections with clear horizontal and vertical margins and an absence of lymphovascular invasion, poor differentiation and submucosal involvement on histology. Secondary end-points were reversal of dysplasia at 12 months endoscopic follow-up and/or at the latest follow-up. Change in histological grade pre and post ESD was also analysed. Results 24 patients were initially identified with intention to treat. 19 patients were eligible after mapping gastroscopy and ESD attempted on 25 lesions. 4 attempts were aborted due to adverse events. En-bloc resection was achieved in 71.4% of cases. Resection was complete on endoscopy in 90.5% of cases compared to 38.1% on histology. 6 resections were curative (28%), 5 noncurative (24%) and 10 indefinite (24%). The histological diagnosis changed in 66.6% of cases. Endoscopic follow-up in the Indefinite and CR group showed clearance of dysplasia in 50% and 80% of patients at the latest follow-up respectively; 2 cases of recurrence occurred in the Indefinite group. Conclusion This study provides early evidence in favour of the use of ESD in Caucasian populations in the UK.

Priya Dharshini Loganathan - Audit The aim of this audit is to compare the outcomes of the use of interbody cage versus no cage in patients undergoing lumbar spinal fusion surgery for spinal degenerative conditions. This audit is based on a retrospective analysis performed on 86 patients who underwent spinal fusion surgery for spinal degenerative diseases. These 86 patients who underwent single level lumbar spinal fusion surgery from January 2013-December 2015 were followed up at three months, six months, one year and where possible, two years. Patients were divided into those who had surgery with cage and those who had surgery without cage. Patients 65 years old and above and below 65 were also analysed separately. Pre and post-operative back pain and leg pain were assessed and compared using the visual analogue scale. Post-operative complications were also recorded. The results showed that after 1 year, back pain had improved in 83% of patients in with cage compared to 68% of patients without cage. Leg pain had improved in 79% of patients with cage compared to 66% of patients without cage. In patients under 65, there was a significant improvement in back pain in patients with cage (77%) compared to without cage (29%) [p=0.003]. There was also a significant improvement in leg pain in patients with cage (77%) compared to without cage (43%) [p=0.03]. In conclusion, the use of cage provides a better outcome for patients compared to non-cage, in improving back pain and leg pain, especially for patients below 65 years old.

Edward Hart - Audit Background Measuring outcomes is an important aspect of surgical care, and in the case of septorhinoplasty, this is best achieved through the use of validated patient-reported outcome measures (PROMs) which allow quantification of patient satisfaction. Aims The aim of this study was to retrospectively assess functional outcomes using the Nasal Obstruction Symptom Evaluation (NOSE) tool, and cosmetic outcomes using the Rhinoplasty Outcomes Evaluation (ROE) tool. Methods All patients in a 4-year period who had undergone septorhinoplasty by a single surgeon at Stepping Hill Hospital were identified and sent a copy of each questionnaire. A chart review was completed to attain revision rate and to allow comparison of subgroups based on gender, age, open or closed technique,

primary or revision surgery, trauma or non-trauma, and whether patients had comorbid allergic rhinitis. Results A total of 77 patients were invited to participate, of which 33 responded. The median NOSE score was 25%, and the median ROE score was 66.7%, both indicating positive results. No significant difference was reached when comparing any of the subgroups, although the average ROE score was 15% lower after revision operations in comparison with primary operations. The revision rate for the study was 8.62%. Conclusion An acceptable level of patient satisfaction was achieved, from both a functional and cosmetic perspective, adding to the body of literature in support of septorhinoplasty for the treatment of nasal obstruction and deformity. Further, revision procedures may be associated with worse patient- reported outcomes.

Geraint Morris - Research Hindfoot Nailing for Limb Salvage in Patients with Co-morbidities Ankle fractures prevalence in the elderly is increasing, leading to high morbidity. The most effective treatment remains controversial. Conventional treatments are associated with high complication rates, including problems with union. The tibiotalocalcaneal nail has been described as novel treatment of these unstable fractures reducing both operative time and hospital stay. This study describes 18 patients treated using tibiotalocalcaneal nails for unstable ankle fractures over a 4-year period and evaluates post-operative status. The demographic data, functionality and radiological outcomes were analysed using patient notes, image databases and patient telephone follow-up. 15 patients received this intervention (mean age 73 years, mean ASA 3). 89% of the unstable fractures were from low energy injuries. 67% of patients regained their pre-operative functionality, the mean Olerud and Molander score at follow up was 29. The Manchester-Oxford Foot Questionnaire gave a score of 48.2 for walking and standing, 35.8 for pain and 43.8 for social interaction. 1 superficial infection was reported (6%) with no deep infections seen. 1 patient suffered non-union (6%) that required prosthesis removal, with no cases of mal-union seen. Six-month mortality post-operatively was 6%. A lower complication rate was seen in hindfoot nailing compared to that of previous reports for open reduction and internal fixation. However, functional questionnaire scores were lower than previously reported, possibly due to limitations in study design. The use of the tibiotalcalcaneal nail in this group is

associated with few complications and maybe appropriate in patients with low functional demand.

Dilraj Bhullar - Audit The optimal type of flap cover for managing open lower limb fractures is an area of debate. Most studies have reported on surgical outcome but the impact on clinical outcome is largely unknown. The aim of this review was to determine whether there are differences in patient reported quality of life outcome between local flap versus free flap. All patients admitted with lower limb open fractures were retrospectively reviewed. Patient notes were assessed for time to fracture union, wound healing and patient reported quality of life with ED-5Q and ED-VAS. A total of 32 flaps were used 20 local flap (Group A) and 12 free flap (Group B). Overall average follow-up 9.4 months (range 8 to 12months). Group A â&#x20AC;&#x201C; 9 revision of flaps (45%) and 13 with surgical complications (65%). Fracture union - 156days and wound healing 118days. Quality of life EQ-5D scores 0.534 and EQ-VAS scores 70.2 respectively. Group B â&#x20AC;&#x201C; 8 revision of flaps (66.7%) and 10 with surgical complications (83.3%). Fracture union - 186days and wound healing 158days. Quality of life EQ-5D scores 0.311 and EQ-VAS scores 39.8 respectively. Aesthetic appeal - 50% Group A vs. 47% Group B. There was no statistical significant difference between the two groups, however, congestion was more common in free flaps (p=0.049). Individual rates of infection, haematoma formation, wound dehiscence and necrosis were similar with only minor differences between the flap groups (p>0.05). Whilst there are certain advantages of free flap, local flaps have better surgical outcome and patient-reported quality of life.

Organising Committee Conference Director – Judith Osuji President – Rachel Khaw Vice President – Bradley Storey Treasurer – Moradeke Orekoya Secretary – Thomas Turner Communications and Publicity – Yanish Poolovadoo Workshop Lead – Kiran Nadeem

Lectures Lead – Samuel Wade Membership and IT – Jenny Quang Salford Representative – Angus Hotchkies MRI Representative – Yasmin Harris UHSM Representative – Sasha Vucicevic Phase 1 Representative – Sarah Michael Phase 1 Representative – Jenny Hobbiss

Notes

Booklet Designed by Judith Osuji