20 YEARS OF CS J


are often standing room only, which tells me that there is a hunger and openness to learn from patients’/families’ experiences, to make care safer, and to improve. When attending presentations, like Clare Bowen’s, I have been impressed by the response of delegates – they show a great deal of self- reflection and humility in learning from these difficult to hear accounts. They demonstrate compassion and gratitude for the speaker in sharing their experience, and an eagerness to take key messages back to their teams to enact change. I often wonder about the conversations that follow.


This is one of the reasons that face-to- face healthcare conferences are still such an important part of the learning experience. Over the years, CSJ has reported on many events – organised by the Institute of Decontamination Sciences, the Central Sterilising Club, the Infection Prevention Society, Knowlex, the British Society of Gastroenterology, Quality Improvement in Surgical Teams, MEDICA and many more. One of the many highlights of the calendar year was the annual conference and exhibition for perioperative practitioners – held in Harrogate. This was hosted by the National Association of Theatre Nurses (NATN), which went on to become the Association for Perioperative Practice (AfPP) in 2005 – reflecting the significant changes that were happening in the healthcare sector and the wider perioperative environment. The name change to ‘Association for Perioperative Practice’ was chosen to accommodate the growing numbers of operating department practitioners and healthcare support workers, and the event evolved into ‘AfPP Residential’, held at the University of York. It has continued to be a sell-out event. The EBME Expo has also gone from


strength-to-strength, and this year saw the largest event in its history – the show recently expanded into a much larger venue at the Coventry Building Society Arena, in order to accommodate over 4,500+ attendees and 220+ exhibitors. It is no longer just focused on biomedical engineering and has added an educational programme on operating theatres. We have also seen new entrants – such


as Future Surgery, which have taken the healthcare sector by storm, by taking advantage of exciting tele-mentoring technologies to beam live surgical procedures to an eager audience of 3,500 surgeons, anaesthetists and perioperative practitioners – in addition to providing an educational programme on hot topics such as robotic technologies and innovation in surgery. A new experience for me was donning a virtual reality headset, walking into a virtual theatre, seeing a consultant surgeon ‘virtually scrub in’, talking me


through a simulated laparoscopic technique, and feeling the sensation of haptic feedback from the instrumentation. COVID-19 halted face-to-face events for a time, and there was a move to webinars, for a while, but as restrictions eased, it is has become clear that healthcare professionals still want to network, to receive educational opportunities face-to-face, and to touch and see healthcare innovations in person.


OR technology


The operating theatre environment has advanced significantly, over the past 20 years, as my experience at Future Surgery demonstrates. We are seeing the increasing role of digital technologies, smart controls, robots, artificial intelligence, virtual reality, tele-mentoring platforms, 3D printing, holographic glasses, haptic sensing, high quality imaging and much more. The first edition of CSJ reported on a


state-of-the-art ‘operating theatre of the future’ installed at Leeds Nuffield Hospital – featuring Stryker’s Endosuite. A key feature highlighted in the article was the voice-activated control centre that allowed surgeons “direct and seamless control of critical surgical equipment”. While this generated much excitement at the time, fast- forward two decades and operating theatres are becoming even smarter. However, among the most exciting technology developments I have witnessed, during my time as editor, has been the increasing adoption of robotics. When CSJ first launched in 2002, Intuitive’s da Vinci surgical system had been available for just a few years and the discussion was mostly around how robotic-assisted surgery was ‘pioneering but unaffordable’. In 2007, when I first joined as editor, this was still the dominant view. Professor Sir Ara


18 l WWW.CLINICALSERVICESJOURNAL.COM


Darzi, wrote in Saws and Scalpels to Lasers and Robots – Advances in Surgery,15


that


prostate cancer is “increasingly being treated laparoscopically and one new technique for doing this is a robotic prostatectomy.” He added that the equipment is “very expensive and much specialist training is required to use it. It clearly would not make sense for every hospital to offer such treatment.” 15 Today, robotic-assisted surgery is used for over 90% of radical prostatectomies in the UK.16


Over 10 million procedures have been


performed worldwide using the Da Vinci system and the technology is now used by surgeons in 67 countries around the world. UK Trusts have adopted robotic-assisted technologies across a variety of specialties, while increasing competition in the market from other robot manufacturers is helping to drive down the cost of the technology. Recently, Trusts have been focusing on


the opportunity to clear surgical backlogs by expanding access to robotic-assisted surgery. With a 60% reduction in patients’ length of stay, a new da Vinci X surgical system has been a key component in seeing the University Hospitals Coventry and Warwickshire NHS Trust become the first teaching Trust in the country to eliminate the number of patients waiting more than 104 weeks for elective surgery since the start of the COVID-19 pandemic.17


Nevertheless,


issues remain around training. In 2020, the Association of Surgeons in Training (ASIT) surveyed members and found that >70% had received no access to any form of robotic- assisted surgery exposure during their surgical training.


Digitisation of healthcare Some technology transformations have taken much longer. The paperless NHS was supposed to happen in 2018. Today, the


NOVEMBER 2022


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