Page last updated at 23:06 GMT, Saturday, 28 June 2008 00:06 UK

A 60-year revolution in surgery

By Jane Elliott
Health reporter, BBC News

Sir John Charnley
Sir John Charnley created the hip replacement

In the six decades since the birth of the NHS, treatment has changed almost beyond recognition.

What was the stuff of fantasy in 1948, such as organ transplants, is now routine.

In 1948, a cataract operation meant a week without moving with the head which was supported by sandbags - now it is over within 20 minutes, and most patients have day surgery.

The first UK heart transplant patient in 1968 only survived 46 days - now 24 are carried out in the same period.

In 1958, hip replacements were so unusual that the surgeon who invented them, Sir John Charnley, asked patients to return them after death - now there are 1,000 every week.

From being an area where nothing was possible it has now become a discipline where nearly everything can be repaired and where the whole organ can be transplanted
Tom Treasure, former heart surgeon

To mark the 60th anniversary of the NHS, the Royal College of Surgeons asked members about which developments have made the biggest impact.

Heart surgery

In 1948 any sort of heart surgery was almost unheard of and surgeons could not work a stopped heart as there was no way to keep a patient alive for any length of time.

Former heart surgeon Tom Treasure said two developments in the 1940s and 50s made all this possible.

"From being an area where nothing was possible it has now become a discipline where nearly everything can be repaired and where the whole organ can be transplanted," he said.

"In 1948 around the birthday of the NHS three surgeons working independently operated successfully inside the beating heart to open up the narrowed heart valve and restore normal flow of blood.

Heart valve surgery. Photo credit: Michelle Del Guercio, Peter Arnold inc/SPL
Heart surgery was almost unheard of in 1948

"The second enabling step was the machinery to fully replace the function of the heart and lungs so that surgeons could repair the heart and then restore it to action.

"Ever more ingenious means were being devised to operate on the still beating and functioning heart.

"Total body cooling was used to allow the action of the heart to be paused so that the surgeon could hastily work inside it, and children were supported by blood flow from parents for long enough to allow a repair operation.

"And lastly - viewed perhaps by some as the least likely to succeed - was a contrivance of pumps and tubes to do the work of the heart and lungs.

"In 1953 this was achieved and in due course was refined to become usable as a routine."

Day surgery

As treatments developed patients needed to spend less time in hospital. Surgeons say this has not only benefited the patients but the NHS, enabling more operations and cutting hospital stay costs.

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In the 1980s only a few operations were done by day surgery - now 170 different procedures can be done this way.

Douglas McWhinnie, of the British Association of Day Surgery (BADS), said: "In 1948 a relatively simple operation like hernia repair would have meant an average hospital stay of two weeks."

Laparoscopic or keyhole surgery has had a similar effect, according to Professor Robin Kennedy, of the Association of Coloproctologists (colon and rectal specialists).

"With laparoscopic surgery you can recover better and faster, you shorten the stay and lessen the risk of a hospital acquired infection," he said.

Reconstructive surgery

Reconstructive surgery has also seen a number of big steps forward: from the first toe-to-thumb transplant at East Grinstead to whole sections of the body now.

Professor Simon Kay, vice-president of the British Association of Plastic and Reconstructive Surgeons, said microsurgery - the joining together very small arteries and veins to restore the vital blood supply to a piece of living tissue - helped to transform patients' lives.

"This technique has been the single biggest advance in plastic surgery in the last 60 years," he said, "because it allows a surgeon faced with a defect in the body to move tissue from another part of the same body and restore life to the transplanted tissue, so that healing begins immediately.

"An example might be seen after removal of a large cancer from the face, leaving a deep hole that a simple skin graft cannot fill, but which can be repaired by transplanting muscle and skin from the back.

"Microsurgery has moved on to apply this concept widely, so that whole bones may be transplanted to replace diseased structures such as the jaw bone."

Vascular surgery

Peter Taylor, a vascular surgeon at London Bridge Hospital, praised the development of keyhole surgery to treat some aortic aneurysms - a swollen blood vessel below the heart.

"They make it much safer for the patient and the mortality across the board has fallen by at least three percentage points," he said.

"It reduces the hospital stay so your patient is out in two days as opposed to 10, and they do not need to go to intensive care or high dependency."

Breast enhancement. Photo Credit: Dr P Marazzi/SPL
Silicone revolutionised cosmetic surgery

In 1948, the NHS had some support available for those with hearing problems such as special schools, sign language and even cumbersome hearing aids.

Over the past 20 years, however, an increasing number of patients have benefited from a surgical innovation.

"Cochlear implantation - surgically implanting a device to directly stimulate the inner ear - is the greatest ever advance in the treatment of profound deafness and has transformed the lives of thousands of adults and children worldwide," said Richard Ramsden, president of ENT UK.

Douglas McGeorge, president of the British Association of Aesthetic Surgeons, said the advent of new man made materials such as silicone for breast implants had enabled dramatic advances.

" It means that we can rejuvenate breasts we can give people who have been born with very little breast tissue normal breasts."

Bernard Ribeiro, president of Royal College of Surgeons, summed up the revolution that has taken place.

He said: "Over the last 60 years surgery has transformed almost out of all recognition.

"A patient in 1948 would have almost certainly been treated by a general surgeon covering a wide range of specialties in surgery and could expect a lengthy hospital stay.

"Today, advances have led to much greater degree of specialisation and, as shown by this snapshot of our members, led to sophisticated treatments for previously incurable conditions, better quality of life and shorter hospital stays."





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