Surgeons: At the Edge of Life Season 2 Episodes

Episode 1

One False Move

59 mins

Most people will have an operation in their lifetime, but very few of us know what happens once we have been put to sleep. This groundbreaking series returns behind the closed doors of the operating theatres of the Queen Elizabeth Hospital in Birmingham to reveal what goes on during an extraordinary range of procedures that test the limits of what is scientifically possible. In this first episode, one of the QE's top consultant neurosurgeons, Ismail Ughratdar, performs brain surgery on 20-year-old Cameron. In order for Ismail to remove as much of Cameron's tumour as possible, during the procedure Cameron will have to be awake and talking. It is an operation where even the smallest mistake can mean the difference between success and catastrophic failure. Cameron had just finished training as an army medic when a tumour the size of a ping pong ball was discovered in his left frontal lobe. The technique for removing as much of the growth as possible without damaging Cameron's ability to speak is an awake craniotomy. Cameron will be put to sleep for the first part of the operation, while the team cut through his skull to access his brain, and then woken up by the anaesthetist so Ismail can tackle the tumour. A speech therapist has to work closely with the surgeon, prompting Cameron to talk and perform word tasks as Ismail probes his brain using electrical stimulation. Whenever Cameron's speech is affected, Ismail knows that he must avoid that area of tissue when removing the tumour. It is an emotional test for the patient and his parents - as well as for Ismail and speech and language therapist Becky Marr. Normally surgeons don't need to worry about their patients' feelings during an operation, but when Cameron becomes distressed during his awake craniotomy, Ismail needs to pause the procedure. Consultant cardiac surgeon Jorge Mascaro also takes on a complex operation where the slightest error can mean the difference between life and death. Jorge's patient is 71-year-old Maggie, whose aorta - the main artery that delivers blood to the body - is weak and in danger of rupturing at any moment. It is very likely that for Maggie this would be fatal. As Maggie's daughter says, it is like living with timebomb. Jorge needs to perform an operation called a thoracic-abdominal aortic aneurysm repair. This is considered one of the most extreme procedures that the human body can withstand, requiring the entire torso to be opened up along a huge incision, starting just under the armpit, cutting across the chest and down to the belly. It will involve removing most of Maggie's aorta and replacing it with a synthetic tube. And while the procedure can save Maggie's life, it also comes with significant risks that include paraplegia and stroke. The Queen Elizabeth Hospital Birmingham is part of the University Hospitals Birmingham NHS Foundation Trust, one of the largest teaching hospital trusts in England.

Episode 2

Pushing The Boundaries

59 mins

At the Queen Elizabeth Hospital Birmingham, around 700 operations are carried out every week, across 42 specialist theatres. Most patients have conditions that are familiar to experienced surgeons, but occasionally the teams must tackle much rarer and more challenging cases. Consultant maxillofacial surgeon Tim Martin and his operating partner Sat Parmar are planning a marathon operation on former police officer Loretta. As far as they can tell from medical records, they will be the first UK surgeons to operate on the strange disease Loretta is suffering from. Nine months earlier, Loretta appeared in Tim's clinic with a mysterious condition that was destroying the bones and muscles in one side of her face, causing her mouth to fuse shut. After much detective work, the team arrived at a diagnosis of tumefactive fibroinflammatory disease - a condition so rare, Tim could only dig up some 50 documented cases worldwide. As all non-surgical treatments, including chemotherapy, have failed to halt the damage being done by the disease, and Loretta is now at serious risk of a fatal stroke, Tim is left with only one option: major surgery to remove the diseased area, followed by complex facial reconstruction. But operating without established medical protocol, on diseased tissue with unknown characteristics, makes Tim very uncomfortable. The procedure involves radical surgery to the entire left-hand side of Loretta's face, and means she will lose a section of her upper jaw, as well as facial muscles that have tough and hardened. It is a daunting prospect for both patient and surgeon. Having come to consider Loretta a friend during the lengthy period planning the surgery, Tim feels even more pressure than usual to get a good result. Removing the diseased area will save Loretta's life, but the surgeons know it will be devastating for her if she is left badly disfigured. To give her best possible outcome, they intend to fill the cavity left in her face with a section of bone and muscle removed from her hip. They will draw on the Queen Elizabeth's on-site maxillofacial prosthetics laboratory. Here technicians have adapted the latest 3D design techniques to transform patient scans into bespoke 3D-printed cutting guides. In theatre, these enable the surgeons to cut out the correct amount of bone from the face, and also cut a graft from the hip bone that will then slot into the hole in the face with total precision. This absolute accuracy has transformed the success rates for surgery, and achieves better cosmetic results for patients. During the all-day procedure, it isn't long before the disease's unpredictable characteristics put the team under severe pressure. Tim must keep working methodically in spite of the stress he feels when a bleed from a ruptured blood vessel that would usually be simple to control becomes a major challenge, due to the effects of Loretta's unusual condition. The programme also features consultant neurosurgeon Alex Paluzzi, who is taking on one of the toughest cases of his career too. His patient, 64-year-old Norah, fractured her neck while on a fairground ride with her grandchildren. A scan revealed that she had a rare and aggressive tumour called a clival chordoma, which had not only weakened the bones of her neck, but also wrapped itself around her brainstem - putting her life in imminent danger. As it is located in the area where all the nerves of the body plug in to the brain, attempting to remove the tumour surgically is fraught with danger. The big question Alex faces is, will operating cause more harm than good? Hoping for the best, Norah gives the go ahead, so Alex attempts two approaches, tackling the tumour first from the front via the nose, then from the rear. In order to reach the 'enemy', Alex has to remove a 'window' of skull bone from behind Norah's ear and then navigate a series of vital nerves without damaging them - if he does Norah may lose her ability to speak or breathe. He describes it as being like 'operating through prison bars'. With exceptional access to surgeons, anaesthetists, theatre staff and their patients, and filmed with specialist fixed-rig cameras, head-cams and microscope feeds, Surgeons: At the Edge of Life offers a unique insight into the sort of person it takes to be a surgeon taking responsibility for the most demanding procedures possible.

Episode 3

A Risk Worth Taking?

59 mins

As well as saving lives, surgeons have the power to transform them. This episode explores how surgeons within the NHS endeavour to meet the needs of patients who require surgery to improve their very poor quality of life. The challenge is balancing the risk posed by highly invasive procedures, against the potential long-term benefit of treating incapacitating conditions which have left their patients housebound and in need of care. Years of wear and tear have taken their toll on the spine of former butcher Chris, leaving him bent forwards and in constant pain. Chris can't walk more than a few steps and spends up to 15 hours a day in bed. After three previous surgeries failed to fix the problem, Chris gave up hope - until he met consultant neurosurgeon and spinal surgeon Navin Furtado of the Queen Elizabeth Hospital Birmingham, who offered him a lifeline. Navin will attempt radical corrective surgery that involves breaking Chris's spine to remove a wedge of bone from one of his vertebrae, and then realigning his back using an extensive array of metalwork. Operating within millimetres of Chris' spinal cord means there is a significant risk of damaging important nerves or even leaving him paralysed. But if all goes well, Chris may eventually be free of pain and able to walk again. Judy also lives a severely restricted life, due to a huge growth on her abdomen. This apron of excess tissue is thought to weigh around six stone and hangs down below her knees. It has made walking almost impossible for Judy and left her feeling "like an alien". Although Judy was previously denied surgical treatment because a procedure to reduce the growth was categorised as cosmetic, now consultant plastic and reconstructive surgeon Sunil Thomas has secured funding in order to take on the task of removing the huge apron of excess flesh and fluid, in a bid to give Judy back her life. But, as the largest tissue removal ever carried out at the QE, the operation brings with it unprecedented challenges for Sunil and the 15-strong surgical team.

Episode 4

A New Beginning?

In recent years, huge advances have been made in the surgical treatment of serious conditions that have developed in the womb. These groundbreaking interventions - often carried out in the first few years of life - have the power to dramatically increase life expectancy. But the risks are often high, and the surgeons who specialise in these procedures need to cope with the added pressure of wanting to get the best possible results for their patients' desperately anxious parents. Birmingham Children's Hospital has a reputation as a world-leading centre for complex paediatric procedures. Consultant paediatric cardiac surgeon David Barron is a specialist in heart conditions that are diagnosed before birth, and his patient, three-year-old Madison, has a rare condition which prevents blood from reaching her lungs - giving her low blood-oxygen levels, and impeding her growth and the development of her organs. To correct Madison's unusual anatomy, David must carry out an intricate 12-hour operation to reconstruct the blood supply between her heart and lungs. This is a rarely performed, multi-stage procedure that requires extraordinary stamina and skill on the part of the surgical team, and during which Madison's heart will be stopped altogether. Madison's body has compensated for being born without a proper arterial connection carrying blood from her heart to her lungs by relying on a network of tiny vessels called MAPCAs. We all have these vessels to allow for circulation while we are in the womb, but normally they become redundant after birth. In the operation, David will have to locate the minute MAPCAs in Madison's chest and combine them with her malformed artery, in order to build a new connection between her heart and lungs. A second surgical team is led by consultant paediatric urology and transplant surgeon Liam McCarthy - a specialist in conditions affecting the kidneys and bladder. Two-year-old Isaac's kidneys were damaged in the womb, and to avoid long-term dialysis, he needs a transplant. His father Lee is a match - so he will donate one of his healthy kidneys. He has never had doubts about that decision - after all, as he says, Isaac is "half of me", and this is a chance to make a drastic difference to the quality and length of his son's life. They both undergo surgery on the same day. Lee's kidney is removed at the Queen Elizabeth Hospital Birmingham and rushed across the city to theatre at Birmingham Children's Hospital, ready for the transplant. Isaac's damaged kidneys will not be removed - instead, the donor kidney will be connected in an entirely new position, lower down in the abdomen. The challenge for Liam and consultant hepatobiliary and transplant surgeon Khalid Sharif is to fit this adult kidney safely into the body of a two-year-old, and to make the connections quickly, before the donor organ begins to degrade. If they succeed, they will dramatically improve the quality of Isaac's life and extend his life expectancy by many decades. Birmingham Children's Hospital is part of Birmingham Women's and Children's NHS Foundation Trust.

Episode 5

Getting Better

At the Queen Elizabeth Hospital Birmingham, surgeons with highly specialised skills perform intricate operations that promise to be life-enhancing for their patients. When 44-year-old AnnMarie was just a toddler, she accidentally drank bleach, which caused severe damage. She has been struggling to cope with her badly scarred oesophagus ever since. AnnMarie has trouble swallowing and visits hospital several times a year to have her oesophagus stretched. It is a highly uncomfortable procedure in which a balloon is inserted into the oesophagus and inflated. Now AnnMarie has opted to have an oesophagectomy, even though the procedure is high risk and over 30 per cent of patients have serious post-operative complications. Her surgeon is Ewen Griffiths, one of the Queen Elizabeth's leading consultant upper gastro-intestinal surgeons, who has spent years mastering one of the most complex and risky operations in his field: an oesophagectomy. In this three-stage procedure, the patient's oesophagus - the 25-centimetre feeding tube, which joins the throat to the stomach - is removed and their own stomach is used to replace it. The procedure can last up to eight hours and involves three different operating sites in the neck, chest and abdomen. Consultant colorectal surgeon Simon Radley also performs highly specialised operations in his field: complex colorectal cancer. His patient is 64-year-old retired grandmother Hazel, who has a colon tumour that has spread into her liver and abdominal wall. Without the operation Hazel will have only a few months to live, but there is an outside chance that surgery could remove the cancer entirely and cure Hazel of her disease. It is not yet clear if the cancer has advanced into other internal organs and Simon will only find out once he operates. If it has spread further, then Simon knows he will not be able to remove it entirely. But if it is confined to the bowel, liver and abdominal wall Simon believes he might just get the result Hazel and her husband Alan are pinning their hopes on. The surgical teams need all their skill and years of experience to get the best possible results. As consultant upper GI surgeon John Whiting says, in demanding cases like these, "good enough actually isn't good enough".

Episode 6

Every Second Counts

The second season of the groundbreaking show concludes with an episode focused on the work of surgeons in the fast-paced field of trauma surgery. With access to the emergency department and trauma theatres of the Queen Elizabeth Hospital Birmingham, the episode features some of the UK's top surgeons battling to make the difference between life and death for critically injured patients who arrive at the QE by land and air. The Queen Elizabeth receives 9,000 patients to its emergency department each month. Many of the most seriously injured can only be saved by urgent surgical intervention. To cope with these trauma cases, the QE has 140 consultant surgeons regularly on call, night and day. With no time to plan and often little or nothing known about a patient's medical history, surgeons must make life-critical, split-second decisions, while racing to perform operations that are no less demanding than their day-to-day elective cases. Consultant neurosurgeon Ismail Ughratdar has just minutes to operate to save the life of a 64-year-old woman who has a bleed on the brain after falling in the street. Blood is accumulating and putting pressure on her brain that is very likely to lead to permanent disability or death unless Ismail can perform a craniotomy to alleviate the pressure in time. As the QE is also the base for receiving all military casualties from overseas, surgeons, doctors, nurses and anaesthetists from the armed forces work alongside NHS staff in the hospital's unique major trauma service. Lessons drawn from the battlefield are especially useful when dealing with polytrauma patients - those brought in with multiple serious injuries. One of the leading consultant general surgeons at the QE, Catherine Powell, is also a commander in the Royal Navy. When a motorcyclist is rushed in by helicopter, she must decide whether to operate on his internal bleeding, or whether the badly dislocated shoulder that could cost him an arm is the most urgent priority.