Surgical checklist to improve the safety of operations
The NIHR Imperial Patient Safety Translational Research Centre investigated factors relating to human behaviour, team skills, and the surgical environment in the operating theatre, to determine their contribution to errors in surgery. Their findings fed into the World Health Organisation’s (WHO) Surgical Safety Checklist.
The international pilot evaluation of the WHO Checklist, which was carried out across eight countries, demonstrated significant improvements in patient outcomes following Checklist implementation worldwide — including reduction in patient mortality following major operations from 1.5% to 0.8% and reduction of inpatient complications from 11% to 7%. In 2009, use of the checklist was mandated throughout the NHS, and now more than 1,700 healthcare organisations worldwide are use this checklist.
An intelligent knife for surgical removal of tumours
When a surgeon removes a tumour, it’s not always possible to tell by sight which areas of tissue are cancerous and which are healthy. As a consequence excess tissue is sometimes removed, or some of the tumour gets left behind. In these cases it can mean the patient faces going back under the knife; particularly when part of the cancer remains, which can lead to tumour re-growth.
Researchers at the NIHR Imperial Biomedical Research Centre are developing a solution to this problem in the form of an intelligent knife - the ‘iKnife’. The iKnife provides instant feedback to surgeons about the tissue they are cutting into, enabling a more accurate approach to tumour removal.
The iKnife to produces heat as it cuts and causes smoke generation, which is sucked into a mass spectrometer hooked up to the device. The mass spectrometer is then able to provide information about the composition of the tissue being targeted for removal, enabling accurate real-time differentiation between normal and cancerous tissue.
Testing two approaches to fix a broken tibia
Fractures of the tibia near the ankle can be difficult to treat because the bone lies so close to the skin. Surgery aims to realign the ends of the broken bone and then to hold them securely in place while they heal. There is uncertainty whether fixing a rod inside the bone using nails is better or worse than a locking plate screwed onto the surface of the bone.
The FixDT trial was funded by the NIHR Health Technology Assessment (HTA) Programme and supported by the NIHR Oxford Biomedical Research Centre and the NIHR Collaboration for Leadership in Applied Health Research and Care Oxford.
The study assessed fixation using a metal rod nailed to the inside of the bone was compared with a locking plate screwed onto the surface of the bone In people who had broken the lower part of their tibia. The researchers found that was no difference in the quality of life, disability or pain at 12 months for people who had fractures of the lower tibia fixed using either technique.
Find a surgery study in your area
You can find out more about surgery studies in your area through the Be Part of Research website.
The NIHR provides researchers with the practical support they need to make clinical studies happen in the NHS and social care. This support covers every stage of research, from set up to delivery.
We provide world-class health service infrastructure - research support staff such as clinical research nurses, and research support services such as pharmacy, pathology and radiology - to support organisations seeking to conduct clinical research in the NHS in England. Some of this research is funded by the NIHR, but most of it is funded by NHS non-commercial partners and industry.
We support the set up and delivery of clinical research in the NHS through our Study Support Service and our Research Design Service helps researchers develop proposals to secure funding from our research programmes.
We oversee research that involves surgical procedures or “operations”. This area of research spans all healthcare and is therefore split into many surgical sub-specialties which focus on different areas or aspects of the human body such as the heart, brain, bones, veins. Surgery is also often defined by the type of surgical procedure involved. We support all types of surgical research. Examples include open surgery, keyhole surgery, laparoscopic surgery and microsurgery.
We work closely with a number of other specialties, the main one being Cancer but also Cardiovascular Disease, Musculoskeletal Disorders and Injuries and Emergencies, to ensure a seamless approach to the set-up and delivery of research studies across all the surgical specialties. We have a vast portfolio of over 400 studies which are broken down into a number of sub-specialty areas detailed below and Surgical Subspecialty Champions have been appointed for each of these subspecialty areas within each of the Local Clinical Research Networks to foster engagement amongst their respective surgical communities and provide detailed local knowledge.
Surgery subspecialty areas:
- head and neck
- plastics and hand
- upper gastrointestinal
The NIHR works with key stakeholders to promote the successful delivery of research studies in the NHS and to help plan new studies that will address patient needs.
Royal College of Surgeons (RCS)
We have a strong relationship with the RCS which includes both the Surgery and Cancer specialties.
A Surgery Research Steering Committee was established to bring together the RCS, the NIHR and the National Cancer Research Institute (NCRI) to coordinate joint initiatives. This includes:
- A programme of national meetings to bring together the RCS’s national subspecialty leads with the NIHR Surgery Subspecialty Leads which have been appointed in the Local Clinical Research Networks.
- Promoting interactions between the RCS’s 7 Surgical Trials Centres and the Local Clinical Research Networks (including adjoining ones) in which they are based in order to develop communities and the local infrastructure to improve patient access to high quality surgical research studies.
- A series of workshops (including 'Tomorrow’s Leaders') which raise awareness of research and provide training and expert knowledge to grow and develop the surgical research community.
Royal College of Physicians (RCP)
Since its inception in 2006, the NIHR has significantly increased the scale of clinical research in the NHS, particularly through the NIHR Clinical Research Network. The enthusiastic engagement of NHS physicians and trainees is essential for sustaining and building on this success, particularly given the many competing demands on clinician time and resources.
The NIHR in partnership with RCP run a joint awards programme. The awards recognise outstanding contributions of NHS consultants and trainees who are active in research. For further information visit the awards webpage.
The NIHR provides the support and facilities the NHS needs for first-class research by funding a range of infrastructure.
NIHR Biomedical Research Centres
NIHR Biomedical Research Centres (BRCs), partnerships between England’s leading NHS organisations and universities, conduct translational research to transform scientific breakthroughs into life-saving treatments. The following BRCs undertake research in surgery:
NIHR Medtech and In vitro diagnostics Co-operatives
NIHR Medtech and In vitro diagnostics Co-operatives (MICs) build expertise and capacity in the NHS to develop new medical technologies and provide evidence on commercially-supplied in vitro diagnostic tests. The following MICs undertake research in surgery:
NIHR Surgical Reconstruction and Microbiology Research Centre
The NIHR Surgical Reconstruction and Microbiology Research Centre (SRMRC) is a national centre for trauma, surgery and infection research, taking discoveries from the military frontline to improve outcomes for all patients.
Work with our infrastructure
All of the NIHR facilities and centres are opening to working with the public, charities, industry and other partners. If you are interested in collaborating with the NIHR please contact the NIHR Office for Clinical Research infrastructure: firstname.lastname@example.org
Our experts in the NIHR Clinical Research Network (National Specialty Leads) can advise on delivering your surgery study in the NHS.
Professor Thomas Pinkney
Professor Thomas Pinkney is the NIHR Clinical Research Network National Specialty Lead for Surgery.
Tom is the George Drexler Foundation and Royal College of Surgeons Chair of Surgical Trials at the University of Birmingham and an Honorary Consultant General and Colorectal Surgeon at University Hospitals Birmingham NHS Foundation Trust. He is also Co-Clinical Research Lead for Division 6 of the NIHR Clinical Research Network West Midlands.
He is Director of the Birmingham Surgical Trials Consortium and sits on the NIHR Health Technology Assessment Clinical Evaluation and Trials Board and the NIHR Research for Patient Benefit West Midlands Panel.
Research interests are predominantly in clinical and translational research in inflammatory bowel disease, anastomotic leak and surgical site infection. He leads a variety of national and international research groups, and is the Chief Investigator of five current NIHR portfolio trials and studies.