Surgery

Today, more than one in three of the patients that visit GOSH undergo a surgical procedure so it should come as no surprise that our surgical research is just as progressive as elsewhere in the hospital.

Multiple teams can be involved in a patient’s journey to surgery and our use of research and innovation means many disciplines can be brought together by using state–of–the– art imaging such as MRI and computerized tomography (CT) scans, virtual reality and complex 3D–modelling, so the surgical teams are better equipped than ever before.

Nowhere is the need for close collaboration felt as keenly as when our teams take on one of medicine’s most challenging situations – separating conjoined twins. We are internationally renowned for being one of only a few hospitals in the world to have the infrastructure, facilities and team of experts to meet this challenge and give these twins the best chance of survival. Interdisciplinary teams including general surgeons, neurosurgical, urological, orthopaedic surgeons and anaesthesiologists, have successfully treated more conjoined twins at GOSH than any other hospital in the world.

Among the most complex separations, craniophagus twins are fused at the cranium (the part of the skull that holds the brain) and their division is led by a large team involving radiologists and engineers who, under the leadership of Neurosurgeon Professor Owase Jeelani, have designed innovative imaging and 3D–printing to guide the difficult and challenging surgery.

In the earliest surgical intervention, one of GOSH’s most complex pieces of research carries out life–changing surgery on babies that are still in the womb.

Babies born with severe spina bifida have a gap in their spine. They are often unable to walk, control their bowel or bladder and need operations to drain fluid from their brain. Surgery to close the gap can be carried out soon after birth, but this has its limitations in what it can solve.

In 2018, the first UK prenatal surgeries for spina bifida were performed by a 30–strong team from UCL Hospital and GOSH. The operation involves opening the womb to expose the defect in the spine, repair it, then closing the womb, without delivering the baby. Previously, expecting mothers in the UK had to travel abroad for this surgery.

This innovative procedure has now been carried out in the NHS on more than 25 babies, with some already starting to see the incredible impact of this treatment.

Through a collaboration of NHS and international hospitals, charities and research institutions, we are now looking to develop fetoscopic surgery. These are operations carried out using tiny 3–4mm incisions that do not need to open the womb and so may reduce complications for mother and baby. The hospital has already successfully used this approach in a small number of patients.

Many surgical interventions, such as the one described above, are also exploring an area of research that sounds more like something from science fiction: regenerative medicine.

Right now, around 50 children are waiting for a heart transplant in the UK but hearts of the right size are especially hard to find for a child. The agonising wait to find out if a suitable heart is available for an urgent transplant is over twice as long for children and babies – an average wait of 88 days compared to 35 days for an adult, while children deemed ‘non–urgent’ will wait over a year, on average.

Our surgical teams are constantly researching new ways to increase the chances that a child could find a new heart and, in 2021, two such techniques made headlines. In the first, donated hearts were kept beating outside the body – in a collaboration between GOSH, Royal Papworth Hospital (RPH) in Cambridge and NHS Blood & Transplant – allowing more hearts to be donated and giving surgical teams time to assess and plan for this vital surgery.

In the second breakthrough, research led by Perfusionist (someone who carefully controls the machines that support patients during a heart and lung transplant), Dr Richard Issitt, has used a special ‘filter’ during heart transplants that allows children as old as eight to receive hearts that don’t match their blood type – a solution that was previously only available to very small children.