Surgery

Interventions to Reduce Surgical Site Infection in Transmetatarsal Forefoot Amputations: A Feasibility Survey (2026)

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Type of publication:

Journal article

Author(s):

*Alawattegama, Lakna Harindi; Al-Saadi, Nina; Bosanquet, David; Chetter, Ian; Fabre, Ismay; Garnham, Andrew; Gwilym, Brenig; Hitchman, Louise; Long, Judith; Magill, Laura; Worrallo, Katie; Pinkney, Thomas; Popplewell, Matthew; Wall, Michael.

Citation:

International Wound Journal. 23(4):e70846, 2026 Apr.

Abstract:

Surgical site infection (SSI) following transmetatarsal amputation (TMA) is common and associated with significant morbidity. However, there is limited evidence to guide perioperative strategies for SSI prevention in this population. A prospective, cross-sectional survey was conducted among vascular specialists. The questionnaire assessed current practice in SSI prevention for TMA, perceptions of evidence gaps, and willingness to participate in future research. Responses were analysed descriptively. Eighty-four valid responses were analysed, with 64.3% from consultant vascular surgeons and 84.5% from UK centres. Most respondents (84.5%) considered SSI after TMA to be a significant issue. The majority preferred primary closure in clean wounds (78.6%) and commonly used short-course antibiotics and interrupted sutures. Over 70% agreed no clear best practice exists, and 65.5% felt high-quality randomised trials are needed. Ninety-three percent expressed willingness to engage in future studies. Equipoise existed regarding interventions including antibiotic duration, wound adjuncts, and closure techniques. Opinion varied regarding whether TMA and major lower limb amputation should be pooled when undertaking research into SSI prevention. Current practice in SSI prevention for TMA is highly variable. This survey demonstrates broad support for rigorous trials to establish effective strategies and highlights the feasibility of future research in this area.

DOI: 10.1111/iwj.70846

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Breast Screening in Newport (2026)

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Type of publication:

Service improvement case study

Author(s):

*Breast Imaging Department

Citation:

SaTH Improvement Hub, March 2026

SMART Aim:

To maintain uninterrupted access to breast screening for residents in Newport between November 2025-March 2026 as evidenced by productivity figures to support early detection of breast cancer.

Link to PDF poster

Elective Hub High Flow Theatre List: Combined Robotic & Non-Robotic Double HIT List (2026)

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Type of publication:

Service improvement case study

Author(s):

*Saurav Chakravartty, *Adam Farquharson, *Rebekah Tudor

Citation:

SaTH Improvement Hub, June 2026

SMART Aim:

To improve elective performance by increasing cases per list and achieving >85% theatre utilisation on 23 June 2026.

Link to PDF poster

Variation, temporal trends and factors associated with ileostomy reversal after anterior resection surgery for rectal cancer in England: An observational study using administrative data (2026)

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Type of publication:

Journal article

Author(s):

*Olagunju N; *Cheetham M; Savage K; Briggs TWR; Gray WK

Citation:

Colorectal Disease. 28(3):e70427, 2026 Mar.

Abstract:

AIMS: The presence of a temporary ileostomy following anterior resection for rectal cancer substantially impacts the quality of life of patients and long-term functional outcomes. Timely reversal of the ileostomy can help to minimise negative impacts. Using an administrative dataset for England, this study aimed to explore temporal trends in ileostomy reversal rates, variation in reversal rates across trusts and factors associated with delayed reversal.

METHODS: This was an exploratory retrospective analysis of observational data from the Hospital Episode Statistics (HES) dataset for England. All patients aged >=17 years undergoing a planned anterior resection for rectal cancer with ileostomy creation between April 1, 2016, and March 31, 2023, were identified. The primary outcome of interest was ileostomy reversal within 18 months.

RESULTS: Data were available for 5,275 ileostomy creations during the study period. Ileostomy was reversed within 18 months in 3,338 (63.5%) patients. Frailty, socio-economic deprivation, open surgery and anastomotic leak were associated with failure to reverse ileostomy within 18 months. There was a steady decrease in rates of ileostomy reversal within 18 months over the course of the study period.

CONCLUSIONS: This study highlights a need to review current ileostomy closure pathways across England, provide equitable access to timely reversal and improve the shared decision-making process between clinicians and patients undergoing surgery for rectal cancer.

DOI: 10.1111/codi.70427

National multi-specialty robotic surgery training curriculum and implementation for UK surgical residents: a delphi consensus (2026)

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Type of publication:

Journal article

Author(s):

Francis N; Shakir T; McLarty E; Haddad F; *Farquharson A; Garnham A; Siddiq S; Bannon A; Collins J; Yassin N

Citation:

Journal of Robotic Surgery. 20(1), 2026 Aug 29.

Abstract:

Robotic-assisted surgery is now established across multiple surgical specialties in the United Kingdom, yet training for surgical residents remains variable, resource-dependent, and insufficiently standardised at national level. This study sought multispecialty expert consensus on the essential components of a national robotic surgery training curriculum for UK surgical residents. A four-round modified Delphi study was conducted between September and December 2025 under the RaDaR network of the Royal College of Surgeons of England. Round 1 used open-ended questionnaires with independent dual-coder thematic analysis; Round 2 was a hybrid face-to-face and online meeting with live anonymous electronic voting; Rounds 3 and 4 were online questionnaires addressing statements not yet reaching the pre-defined consensus threshold of 70% agreement or greater. The panel comprised consultant surgeons, surgical trainees, curriculum and training authorities, and industry representatives with deliberately bounded, non-clinical input. 25 participants completed the final round. Of 26 statements, 22 (84%) reached consensus. A three-tier framework of device, basic skills, and procedural training was endorsed, with device training introduced during Phase 1 (76%) and basic skills and procedural training introduced after Phase 1 (96% and 88% respectively). Competency assessment integrated within the Annual Review of Competence Progression was supported (84%), alongside multi-source funding; trainee self-funding was not endorsed. This consensus offers a pragmatic foundation for standardising robotic surgery training for UK residents, contingent on coordinated investment in platform access, simulation infrastructure, and faculty development.

DOI: 10.1007/s11701-026-03864-x

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The volume-outcome relationship for incisional hernia repair: analysis of an administrative dataset for England (2026)

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Type of publication:

Journal article

Author(s):

Monaghan M.; *Cheetham M.; Thomas R.; Parker S.; Briggs T.W.R.; Gray W.K.

Citation:

Hernia. 30(1) (no pagination), 2026. Article Number: 322. Date of Publication: 01 Dec 2026 [epub ahead of print]

Abstract:

Purpose: Incisional hernia is a common complication following abdominal surgery and repair can be complex. We aimed to use an administrative dataset for England to investigate the relationship between surgeon and provider volumes and outcomes. Method(s): We used data from the Hospital Episodes Statistics database for adult incisional hernia repair conducted in England from 1st April 2013 to 31st March 2025. The exposure variables were annual surgeon and provider volume defined as the number of procedures conducted in the 12 months prior to the index procedure. The primary outcome was reintervention surgery within two-years. Secondary outcomes were reintervention surgery at one and five years, length of stay greater than the median, 30-day all-cause emergency readmission and post-surgery complications. The relationship was modelled using multilevel, multivariable logistic regression with adjustment for prespecified covariates. Result(s): Data were available for 75,664 incisional hernia repairs conducted by 4355 surgeons within 165 providers. There was a significant relationship between greater surgeon annual volume and lower rates of reintervention surgery at two years (OR 0.995 (95% CI 0.992 to 0.998), p = 0.002) and five years (OR 0.994 (95% CI 0.991 to 0.997), p < 0.001) and between greater hospital provider volume and stay greater than the median (OR 1.001 (95% CI 1.000 to 1.002), p = 0.004). There was no relationship between volume and other short-term surgical outcomes. Conclusion(s): A relationship exists between lower surgeon volume and higher rates of reintervention surgery for incisional hernia repair. There was no relationship between lower surgeon or provider volume and poorer peri-surgical complications. Setting minimum surgeon annual volume thresholds may help to improve repair rates.

DOI: 10.1007/s10029-026-03827-z

Robotic hysterectomy: an umbrella review and regional access in the Midlands, UK - Is there inequity? (2026)

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Type of publication:

Journal article

Author(s):

Saoudi, Tareq Al; Kanani, Trisha; McGill, Shaun; Isherwood, John; Fan, Frankie; Brown, Luke; Williams, Philippa; Sahare, Pankhuri; Sisodia, Shilpa; McVicar, Kathryn; Lacey, Patricia; Elleray, Rebecca; *Cheetham, Mark; Habiba, Marwan; Orrock, Emma; Wilson, Robert; Dennison, Ashley.

Citation:

European Journal of Obstetrics, Gynecology, & Reproductive Biology. 321:115041, 2026 Feb 28.

Abstract:

STUDY OBJECTIVE: To review current evidence on robotic-assisted hysterectomy (RAH) and assess hysterectomy practices across the Midlands, UK, with a focus on the availability of robotic procedures, geographical variations in the incidence of uterine cancer, and service provision.

DESIGN: An umbrella review conducted in accordance with the PRISMA guidelines combined with a descriptive regional data analysis.

SETTING: Midlands, UK.

PATIENTS: Women undergoing hysterectomy for uterine cancer between 2019 and 2023, based on national and regional datasets.

INTERVENTION: Comparison of RAH with open and laparoscopic approaches, and assessment of access to robotic surgery across integrated care boards (ICBs) in the Midlands.

MEASUREMENTS AND MAIN RESULTS: The final analysis included 12 systematic reviews. Compared with open hysterectomy, RAH was associated with reduced blood loss, lower transfusion rate, shorter hospital stay, and lower complication rates, while benefits over laparoscopic hysterectomy were less consistent. Descriptive regional analysis demonstrated substantial variation in uterine cancer incidence and hysterectomy rates across ICBs in the Midlands. Visual comparison suggested that areas with a higher
incidence of uterine cancer did not align consistently with higher rates of RAH, and access to robotic surgery varied across the region, with some ICBs having no local provision.

CONCLUSION: The continued expansion of RAH in the UK highlights the need for coordinated governance and service planning. Observed regional variation supports the development of clear referral pathways, standardized patient selection criteria, and regional oversight to guide equitable and effective integration of robotic surgery, particularly in areas with limited local provision.

DOI: 10.1016/j.ejogrb.2026.115041

Day case and inpatient elective thyroid lobectomy across England: observational study of variation in practice and safety (2026)

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Type of publication:

Journal article

Author(s):

Monaghan, Michael; Gray, William K; *Cheetham, Mark; Dent, Paul; Briggs, Tim W R; Lansdown, Mark.

Citation:

British Journal of Surgery. 113(2), 2026 Feb 11.

Abstract:

BACKGROUND: Day case elective surgery is becoming increasingly common across a range of procedures. The aim of this study was to investigate the safety of day case thyroid lobectomy, a procedure with low uptake in the UK.

METHODS: This study analysed the Hospital Episode Statistics administrative data set for all first-time elective thyroid lobectomies performed on adults in England from 1 April 2017 to 31 March 2024. The primary outcome was 30-day emergency readmission and secondary outcomes were 30-day emergency readmission for complications and specifically for haemorrhage. The primary exposure variable was whether patients were day case patients or inpatients. Models were adjusted for the demographic and frailty characteristics of the patients.

RESULTS: Over the 7-year interval, 41 518 elective thyroid lobectomies were performed by 127 different hospital trusts. The day case rate was 9.9% (4125 patients) across all hospital trusts. Rates in the 118 hospital trusts conducting >20 procedures during the 7 years varied from 0% to 74.6%. Day case surgery was associated with a lower 30-day emergency readmission rate (OR 0.73 (95% c.i. 0.56 to 0.96); P < 0.021), with no evidence of association with poorer outcomes. There was no evidence that trusts with day case rates >30% had poorer outcomes than trusts with day case rates <1%.

CONCLUSION: In low-risk patients, day case thyroid lobectomy is safe.

DOI: 10.1093/bjs/znaf299

intra-Peritoneal Gallstone Leading to Chronic Sinus Formation Following Laparoscopic Cholecystectomy and Common Bile Duct Exploration - Rare Case Report (2025)

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Type of publication:

Conference abstract

Author(s):

*Lakshmipathy G.; *Parampalli U.; *Pattar J.;

Citation:

British Journal of Surgery. Conference: AUGIS Annual Scientific Meeting. Glasgow United Kingdom. 112(Supplement17) (pp xvii23-xvii24), 2025. Date of Publication: 01 Dec 2025.

Abstract:

Background: Dropped gallstones can be a common occurrence during laparoscopic cholecystectomy. However, only 3% patients develop abscess secondary to intra-peritoneal spilled gallstone. We report the case of a 41-year-old woman who suffered with persistent intra-abdominal collections and sinus tract discharge following laparoscopic cholecystectomy. Case Presentation: Our patient originally underwent elective laparoscopic cholecystectomy and common bile duct (CBD) exploration for CBD stones. Two weeks later, she underwent incision and drainage procedure for port site abscess. Three years later, she re-presents with right upper quadrant pain, discharge through the umbilical wound and raised inflammatory markers. Computed Tomography (CT) scan revealed a collection postero-lateral to the right lobe of the liver, which was then drained through interventional radiology. Despite drainage, patient re-attends with recurrence of pain, a repeat CT scan confirmed a persistent peri-hepatic collection likely secondary to retained intra-peritoneal gallstone. Patient underwent diagnostic laparoscopy, in which, the collection was tracked by flushing radiological drain and then the stone was retrieved. Patient recovered well. Discussion(s): Diagnosis of an intra-peritoneal gallstone following cholecystectomy and CBD exploration can be hampered by unusual clinical presentations, radiologically occult nature of stones and the vast area they can settle into. Whilst rare, retained intra-peritoneal gallstones have the potential to cause economic burden to the health service, in addition to, the physical and psychological impact on the patient. Our case demonstrates that it is imperative to be meticulous in clearance of bile and stone spillage all cases of cholecystectomy with CBD exploration.

DOI: 10.1093/bjs/znaf270.088

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Audit of Laparoscopic Cholecystectomy Operative Notes in a DGH (2025)

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Type of publication:

Conference abstract

Author(s):

*Ramesh S.; *Magalong J.A.; *Parampalli U.

Citation:

British Journal of Surgery. Conference: AUGIS Annual Scientific Meeting. Glasgow United Kingdom. 112(Supplement17) (pp xvii60), 2025. Date of Publication: 01 Dec 2025.

Abstract:

Introduction: Operation notes are essential documents in patient care. The use of standardized guidelines, such as those endorsed by recognized organizations, is crucial to ensure consistent and detailed record-keeping. Documenting parameters specific to laparoscopic cholecystectomy provides valuable information for management in the event of complications and it also provides direction for follow-up care. Aim(s): This audit aims to assess the quality of laparoscopic cholecystectomy operative notes in our trust by comparing them against NHS England's GIRFT (Getting It Right Rirst-Time) recommendations. It also aims to Identify areas for improvement and implement targeted interventions. Method(s): A retrospective audit of 78 laparoscopic cholecystectomy operative notes conducted in 2024 were selected by systematic random sampling. Data were compared against GIRFT recommendations. After intervention, a re-audit of 78 laparoscopic cholecystectomy operative notes from 2025 was done using the same methodology and compared against initial audit. Result(s): Significant improvement was observed in the re-audit compared to the initial audit, after intervention in the form of surgeon education and use of modified operation note proforma specific to laparoscopic cholecystectomy was implemented. Documenting significant steps involved in Laparoscopic cholecystectomy for example, details of calot's triangle dissection, details of bile/gallstone spill and its management and mention of port used to extract gallbladder increased by 13%, 42%, and 48%, respectively. Conclusion(s): This audit demonstrates a significant improvement in operative note quality by implementing interventions from an initial audit, emphasising the importance of use of recommendations issued by GIRFT. Audits should be conducted at regular intervals to sustain improvements.

DOI: 10.1093/bjs/znaf270.230

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