Royal College of Surgeons of England

Introduction: Ovarian cancer is a leading cause of gynaecological cancer mortality. Ca125, the most widely used serum biomarker, has limited sensitivity for early-stage and type I tumours, prompting evaluation of additional blood-based markers. This umbrella review assesses the diagnostic and prognostic performance of serum and blood biomarkers in ovarian cancer.

<h3>Background</h3> Chronic liver disease (CLD) carries major morbidity and mortality burdens in the UK, with CLD deaths increasing substantially in recent decades. Many individuals with CLD present for the first time in emergency medical settings with already advanced disease, and 25% die within the first 60 days following index first emergency admission (FEA). Liver transplant (LT) is the only intervention with survival benefit in advanced CLD, however utilisation rates are very low. This analysis aimed to report survival outcomes among individuals who did and did not receive LT following FEA for CLD in England, it did not aim to estimate the causal effect of LT in this cohort. <h3>Methods</h3> National administrative hospital data were analyzed to construct a cohort of all adult patients in England with an FEA for CLD between 1 April 2012 and 31 March 2019. LT was ascertained in both hospital data and via linkage to NHS Blood and Transplant registry. Linkage to ONS death registrations enabled identification of death within first year following EA. Cumulative incidence of death from any cause throughout study duration was calculated, stratified by LT status. <h3>Findings</h3> The cohort was comprised a total of 82,402 individuals of whom 52,504 (63.7%) died during the study period, with a median time to death of 2.7 years. Only 0.7% of individuals underwent LT (n = 572, 95% CI 0.6% to 0.7%) within the first year following FEA. Of these, a minority (14.4%, n = 76) died following transplant. In contrast, the majority of individuals who did not undergo LT died. The difference in cumulative deaths across individuals who did and did not undergo LT was significant (figure 1, p &lt; 0.0001). The 5-year survival in individuals not undergoing LT was 40.8% (95% CI 40.6% to 41.2%), and was 88.2% individuals receiving LT (95% CI 85.1%, 90.8%). Patients undergoing LT are a highly selected group and systematic differences in their clinical and demographic characteristics likely account for some of the observed survival difference compared to non-LT patients. <h3>Conclusions</h3> Survival is very poor among individuals with CLD presenting acutely for the first time in an emergency hospital setting. Although survival was markedly higher in those receiving LT, fewer than 1% of patients received transplantation.

Abstract Background Virtual reality (VR) allows interaction with an artificial environment and is used for surgical training. The goal is to create a fully immersive and life-like experience, yet the quality of different metrics that impact its realism are not assessed in literature. This scoping review aimed to determine the key metrics which impact realism in VR training for surgery. Methods OvidMEDLINE &amp; Embase databases were interrogated for articles published in English between 1950-2024. A systematic search strategy was conducted to identify all qualitative and quantitative studies evaluating the realism and immersion of VR/Augmented Reality/Mixed Reality in surgical education. Results were reported according to PRISMA Extension for Scoping Review(PRISMA-ScR) guidelines. Results The systematic search returned a total of 4156 studies [11-156], of which 11 were included. Two digital-based studies showed that their models increased realism, and five surgical intervention studies reported improved realism through interventions measured with haptics, visual, design, general realism and force feedback metrics. Three studies provided quantitative outcomes. There was no clear definition of either realism or immersion and construct validity was only discussed by one study. Haptics and tactile metrics were the most common measures of realism and immersion. Conclusion Improving sensory and haptics metrics, as well as the transferability of skills, improves the realism and immersion of a VR training model. Definitions for ‘realism’ and ‘immersion’ should be universally established. Future research should aim to produce quantitative data for assessment of realism using as a minimum the 5 metrics identified.

Abstract Aim To create awareness among the surgeons to take into account the frailty score of the patients to assess the real risk for emergency laparotomy. NELA risk score does not take frailty into account while assessing the risk. According to the NELA findings, frailty doubles the risk of mortality amongst the patients aged 65 and above from 6% to 13% (doubles). NELA also recommends geriatric team to review all the elderly, frail and vulnerable patients postoperatively as that have shown better outcomes postoperatively in national audits. Method There were a total of 40 patients who fit the criteria of inclusion which was emergency laparotomy above the age of 65 which we collected from the NELA website performed by our department. We also looked into consultation, admission, progress and operative notes for more information. Results In the first cycle the total number of patients whose frailty scores were calculated was 53.8% with surgical team documenting none while other specialities like ICU, A&amp;E and anaesthesia doctors documenting it usually. 7.7% of the patients were referred to elderly care postoperatively. In the 2nd cycle, the outcomes were better with 85% of the patients calculated for frailty scores, total operated 40 patients. Out of the 85%, only 5% documentation were by the surgeons and rest by the other specialities. Geriatric referral did not show great improvement with only 10% of referrals postoperatively. Conclusion There were some improvements in all the three areas Requires regular discussion and awareness Think CFS whenever you calculate NELA

The uptake of robotic-assisted colorectal surgery (RACS) across the UK and Ireland has increased exponentially over the last 5 years. It is anticipated that most 'conventional' laparoscopic procedures will eventually move to a robotic approach within a National Health Service that is committed to embracing robotic-assisted surgery. Working in collaboration with the surgical Royal Colleges, a more structured framework is necessary for robotic training. Inequality in robotic access and the impact that RACS is having on current colorectal surgical trainees need to be addressed, The Association of Coloproctology of Great Britain and Ireland (ACPGBI) has set out a framework to help support training in RACS at basic, advanced and trainer levels. Safer, better-trained robotic surgeons will ensure improved patient outcomes, which is the overriding goal of the ACPGBI.

Abstract Aim To identify barriers perceived by medical students in entering cardiothoracic surgery (CTS) and propose interventions that combat identified barriers and equalise opportunities for medical students within CTS. Method An Equality, Diversity, and Inclusion (EDI)-focused survey was distributed to medical students across the UK and Ireland. The survey collected data on demographics, career ambitions, experiences in surgical fields, and specific perceptions of CTS. Quantitative and qualitative data were analysed. Chi-squared tests assessed associations between demographic factors and perceived barriers, with an alpha level of 0.05. Results Eighty-one responses identified three main barriers: financial constraints (37.8%), negative theatre experiences (37.8%), and perceived gender-based obstacles (56.1%). Financial challenges were associated with travel and portfolio-building, with a further association between self-funding students and perceived barriers (p=0.03). Negative theatre experiences included hostility, being ignored, and a lack of orientation to theatre and procedure. Gender-related barriers were reported by 56.1%, 91% of which were female. Additionally, first-generation medical students showed a significant correlation with perceived barriers in CTS (p=0.05). Conclusions Findings reveal perceived barriers to accessing opportunities in CTS. The data rejects the null hypothesis, though limitations in sample size suggest a potential type-II error. To optimise the future of CTS, we need to maximise student-engagement now. Implementation of financial initiatives and distribution of orientation material are required. With female cardiothoracic surgeons constituting less than 10% of our workforce, measures to enhance the representation of women in CTS are essential. Ongoing collaboration between EDI and CTS committees is crucial to overcome these barriers and equalise opportunities in CTS.

Objective: Recently, there has been increased competition for specialist urological training at National Selection. This paper aims to investigate potential factors that may contribute to individuals deciding to pursue a urological career. Materials and methods: Core trainee numbers and National Selection competition ratios for core training, general surgery, trauma and orthopedics, and urology were obtained from NHS England between 2016 and 2023. Trainees’ views about stress, burnout, teamworking, the training environment, and global satisfaction with training were extracted from General Medical Council survey data 2019–2024. NHSE data obtained 2010–2023 were analysed to assess urological consultant numbers and their work intensity. Results: Exposure to urology during core training increased by 165% between 2010 and 2023, accompanied by a 60% rise in applications for specialist training. Urology consistently demonstrated higher trainee satisfaction rates compared against general surgery and trauma and orthopedics. In addition, the evolution of consultant practice, a shift towards more outpatient-based activity, may further contribute to the specialty’s growing appeal to an increasingly female workforce. Conclusion: Multiple factors may contribute to the rising competition ratios observed in urological training. These include increased exposure to urology during core training, high levels of trainee satisfaction and the transition towards lower-intensity consultant practice. Level of evidence: Not applicable