Cutting edge blog
This section is designed to add value to the articles published in BJS and BJS Open.
If you wish to send a written (or even recorded) comment on one of the published articles, please send it to katie@bjsacademy.com.
If you wish to respond more immediately, please use social media directly by tagging @BJSurgery, @BjsOpen or @BJSAcademy
Cutting edge blog sample document
Bengi Balci, Cihangir Akyol, Correspondence to: Bengi Balci (email: bengibalci@gmail.com)
This article will have this DOI
To the Editor
We read the article by van Oostendorp on Ligation of intersphincteric fistula tract (LIFT).1 The study was interesting but concerning, given the low fistula healing rate (28%) and surprisingly high incontinence rates after LIFT.
Cutting edge blog sample document - Rvt testing
Bengi Balci1, Cihangir Akyol2
Correspondence to: Bengi Balci (email: bengibalci@gmail.com)
This article will have this DOI
To the Editor
Science in a flash: pain, anxiety, stress and sleep disturbances among surgical patients
Jetske Marije Stoop, Markus Klimek, MD, PhD, DEAA, EDIC, FESAIC
How often do surgical patients experience pain, anxiety, stress, and sleep disturbance during their hospital stay? And how severe are these symptoms? In collaboration with numerous Dutch hospitals, we set out to answer these questions, using an uncommon and innovative, but for our goals perfectly fitting method: a flash mob study.
A flash mob study is a novel research design in which data is collected on a single day, simultaneously in multiple centres. It’s an efficient way to address clinically relevant questions on a large scale – in our case the point prevalence of surgical patient pain, anxiety, stress, and sleep disturbance. But this approach also requires meticulous planning: there’s only one shot to get it right.
The preparation for the project took a year. We started by developing the methodology and drafting the study protocol, followed by compiling all necessary documents for submission to the Medical Ethics Review Committee (MERC). While awaiting approval, we reached out to all hospitals across the Netherlands. Through secretaries and outpatient clinics, we found surgeons and residents in 29 Dutch hospitals who were eager to participate and helped forming a local research team and arranging institutional approval from the hospital board.
Author response: Assessment of nodal staging and risk factors for nodal involvement in gallbladder cancer
Anita Balakrishnan, Petros Barmpounakis, Nikolaos Demiris, Bodil Andersson, Alejandro Brañes, Xavier de Aretxabala, Malin Sternby Eilard, Paul Gibbs, Simon J F Harper, Emmanuel L Huguet, Asif Jah, Vasilis Kosmoliaptsis, Javier Lendoire, Siong S Liau, Shishir Maithel, Jack L Martin, Colin Noel, Raaj K Praseedom, Alejandro Serrablo, Volkan Adsay, the OMEGA Study Investigators
Correspondence to: Anita Balakrishnan (email: ab2031@cam.ac.uk)
Department of Hepatopancreatobiliary Surgery
Cambridge University Hospitals NHS Foundation Trust
The BJS Instrumentalist Collection in association with the Hunterian Museum
Alice Watkinson-Deane
At the heart of the Royal College of Surgeons of England lies the Hunterian Museum, a space dedicated to the history of surgery from ancient times to the present day. Many visitors are drawn to the specimens on display - over 2,000 preparations of human and animal tissue collected by John Hunter in the 1700s. However, the story of surgery is equally told through the wealth of surgical instruments in the collection, from the simplest probes to the latest minimally invasive technologies.
Mick Crumplin, a retired surgeon and Honorary Curator of Instruments at the Royal College of Surgeons of England, delves into this fascinating history in his series of 20 articles for ‘The Instrumentalist’ in the BJS. This brilliant resource reviews the origin of a wide range of instruments, some of which will be very familiar to today’s surgeons, while others are less well-known.
Liston pattern bone-cutting forceps. © 2014 All rights reserved. Courtesy of Surtex Instruments Ltd.
Author response: Tumour deposit count is an independent prognostic factor in colorectal cancer—a population-based cohort study
Simon Lundström, Erik Agger, Marie-Louise Lydrup, Fredrik Jörgren, Pamela Buchwald
Correspondence to: Simon Lundström (e-mail: Simon.Lundstrom@med.lu.se)
Department of Surgery
Skåne University Hospital
Comment on: Tumour deposit count is an independent prognostic factor in colorectal cancer—a population-based cohort study
Ranjith Kumaran Ramu, Aryan Dwivedi, Faraz Ahmad, Kushagra Gaurav Bhatnagar, Akshay Anand, Nizamuddin Ansari, Abhinav Arun Sonkar
Correspondence to: Ranjith Kumaran Ramu (e-mail: ranjithkumaran2009@gmail.com)
Senior Resident
Department of General Surgery
Non-technical error leading to patient mortality in the Australian surgical population
Jesse D Ey, Victoria Kollias, Octavia Lee, Kelly Hou, Matheesha B Herath, John B North, Ellie C Treloar, Martin H Bruening, Adam J Wells, Guy J Maddern
Despite an increasing emphasis on patient safety, modern surgical practice is still plagued by the occurrence of serious Adverse Events (AEs). A large proportion of these AEs are caused not by technical errors, but short comings in non-technical skills (NTS) or non-technical errors.1 NTS are the cognitive and interpersonal components of surgical professionalism including communication, decision-making, situational awareness and leadership.2 Few studies have attempted to quantify the significance of non-technical errors leading to patient harm. Those that have, only include small, non-representative cohorts, or have assessed for NTS shortcomings using heterogeneous, non-standardised, and non-comprehensive assessment methods.3-6 As a result, the true impact of non-technical errors, and information about how, when, and why these errors occur are poorly understood. Evidence to guide NTS improvement is lacking.
This study7 aimed to investigate the incidence of non-technical errors linked to patient death in a large representative Australian cohort, investigate factors associated with fatal non-technical errors, and whether the incidence of non-technical errors had changed over time. To achieve this, an 8-year retrospective audit using surgical mortality cases was conducted. Data were derived from the Australian and New Zealand Audit of Surgical Mortality (ANZASM) a mandatory, national surgical mortality audit overseen by the Royal Australasian College of Surgeons. In Australia, every surgical death is reported to ANZASM for external peer review for the purpose of identifying clinical management issues (CMI’s) that could be improved in future. CMI’s are rated on a three-tiered system with ‘area of concern’ or ‘Adverse Event’ representing the two most serious. All surgical deaths between 2012-2019 (excluding New South Wales), flagged with an area of concern or AE were included with no further exclusions. Each case was assessed using the System for Identification and Categorization of Non-technical Errors in Surgical Settings (SICNESS), a validated tool, developed by the study authors.8 The SICNESS enabled assessors to identify if a non-technical error linked to patient death had occurred, and if so, to which NTS domain it belonged.
There were 30,971 surgical deaths reported to ANZASM during the study. Of these, 3829 were flagged with an AE or Area of concern. Some 134 had insufficient information for assessment, leaving 3695 cases for review. A non-technical error linked to patient death was identified in 2354 cases (63.7%). Of the cases with non-technical errors, 1375 (58.4%) had decision making errors, 1328 (56.4%) had situational awareness errors, 357 (15.2%) had communication/teamwork errors, and 128 (5.44%) had leadership errors.
Author response: Impact of postoperative complications on clinical outcomes after gastrectomy for cancer: multicentre study
Sander J. M. van Hootegem, Bas P. L. Wijnhoven
Correspondence to: Sander J. M. van Hootegem (e-mail: s.vanhootegem@erasmusmc.nl)
Department of Surgery
Erasmus Medical Centre
Comment on: Impact of postoperative complications on clinical outcomes after gastrectomy for cancer: multicentre study
Anyin Wang, Tingting Fu, Xigui Tian
Correspondence to: Anyin Wang (email: Hospitalpwkedu@163.com)
Department of Gastrointestinal/Hernia Surgery
The People's Hospital of Liangping District
Aortic aneurysm screening: a personal history
Jonothan Earnshaw
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My first significant contact with abdominal aortic aneurysm (AAA) screening was when I was appointed as a consultant surgeon in Gloucestershire in 1991. My consultant colleague, Brian Heather, had already started an AAA screening programme for 65-year-old men in Gloucestershire. The burden of managing vascular disease single-handed for a population of 350,000 was significant for him; in addition, patients with ruptured AAA were major consumers of critical care services in Gloucestershire at the time. Brian contacted all the GP surgeries in Gloucestershire asking whether (i) they were prepared to identify the 65-year-old men in their practice each year, and then (ii) to receive a visit once a year for them to be scanned. He secured the services of a research nurse, Elaine Shaw, who took a portable ultrasound scanner to the GP surgeries to do the scans. The screening programme in Gloucestershire was born in 1988 and has run ever since1.
Volatile versus intravenous anaesthesia for oesophagectomy: addressing confounding factors and temporal trends in clinical practice
Shuting Yin
Correspondence to: Shuting Yin (e-mail: yin13938214200@163.com)
Department of Education and Sports
Zhengdong New District
Comment on: Parathyroid vascular anatomy using intraoperative mapping angiography: the PARATLAS study
Rajni K Sah, Sabaretnam Mayilvaganan
Correspondence to: Sabaretnam Mayilvaganan (drretnam@gmail.com)
Additional Professor
Department of Endocrine Surgery
Comment on: Endoscopic appendix opening sphincter incision to remove faecolith
Chahrazed Dous
Correspondence to: Chahrazed Dous
(email: douschahrazed@yahoo.com)
Tazoult City
Author response: Endoscopic appendix opening sphincter incision to remove faecolith
Gang Bian
Correspondence to: Gang Bian (e-mail: bianganglingling@163.com)
Department of Gastroenterology
Qingdao Third People's Hospital Affiliated to Qingdao University
Introducing ‘Surgeons unscrubbed’
Dominic Slade and Prita Daliya bring you the opening teaser for their upcoming podcast: Surgeons unscrubbed! A collaboration between the British Hernia Society (BHS) and BJS Academy.
In this series, Dominic and Prita will be interviewing prominent surgeons around the world and asking them questions submitted by you!
Enhancing methodological rigor in prepectoral breast reconstruction studies
Janhavi Venkataraman, Kefah Mokbel
Correspondence to: Janhavi Venkataraman (email: Janhavi.Venkakataraman@hcahealthcare.co.uk; janhavivraman@gmail.com)
The London Breast Institute
Princess Grace Hospital
Author response: Enhancing methodological rigour in prepectoral breast reconstruction studies
Shelley Potter, Kate L Harvey, Paul White
Correspondence to: Shelley Potter (email: Shelley.potter@bristol.ac.uk)
Translational Health Sciences
Bristol Medical School
Colorectal Cancer Awareness Month 2025
In recognition, we present seven of the most important colorectal cancer studies published in BJS and BJS Open over the past year. These articles highlight significant advancements in the understanding and management of colorectal cancer, covering topics such as surgical innovations, oncological outcomes, and prognostic markers. This collection showcases the latest research aimed at improving patient care and survival.
Explore these key contributions to the field and join us in raising awareness of colorectal cancer this March.
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Comment on: Effect of peritoneal and wound lavage with super-oxidized solution on surgical-site infection after open appendicectomy in perforated appendicitis (PLaSSo): randomized clinical trial
Saburi Oyewale
Correspondence to: Dr Saburi Oyewale (email: saburioyewale@yahoo.com)
Division of General Surgery
Department of Surgery
Author response: Effect of peritoneal and wound lavage with super-oxidized solution on surgical-site infection after open appendicectomy in perforated appendicitis (PLaSSo): randomized clinical trial
Harivinthan Sellappan
Correspondence to: Harivinthan Sellappan (e-mail: hari.vs@gmail.com)
Department of Surgery
Queen Elizabeth Hospital
Re-evaluating enoxaparin for thromboprophylaxis in liver transplantation: a closer look
Dipesh Kumar Yadav, MD, PhD, Yiren Hu, MD, PhD
*Corresponding author: Yiren Hu (email: yirenhu@hotmail.com)
Department of General Surgery
The Third Clinical Institute Affiliated to Wenzhou Medical University
Insights into tumour deposit pathology
Antonio Manenti, Stefania Carmaschi, Luca Reggiani Bonetti, Gianrocco Manco
Correspondence to: Antonio Manenti (e-mail: antonio.manenti_2024@libero.it)
Department of Surgery
Polyclynic Hospital
On the importance of idle curiosity in research
John C Alverdy MD FACS FSIS
In the book “The Idea Factory,” the CEO of the then monopolized telephone services American Telephone and Telegraph Company (AT&T)) in the US (circa 1880-1930) decided that although the business was highly profitable as a result of the massive laying down of cable across the world, hiring someone who could advance an understanding of how the telephone actually worked was needed. He decided that a more fundamental understanding of electricity and sound would improve the business model and overall telephone services. He hired a physicist from the University of Chicago who was offered a salary of $25,000/year to head up the project. This person was thrilled to just be able to obtain employment, given that a PhD in those days was no guarantee of employment, even when graduating from an elite university.
When the newly appointed physicist asked the CEO “what is my job?” he responded — you are to spend your time in “idle curiosity” so you can think and perform experiments. So began the independently funded and famous Bell laboratories, designed so that its faculty could walk its outdoor paths, think great thoughts and perform solution-agnostic experiments. More Nobel Prizes were won by the faculty at that institution than all other private free-standing research facilities in the US. Imagine what it felt like to be hired by a powerful CEO of a company and being told spend all your time in idle curiosity. Yet without that level of trust in the very process of science itself, the development of radio astronomy, the transistor, the laser, the photovoltaic cell, the charge-coupled device, information theory, the Unix operating system, and several programming languages would not have occurred. This approach led to eleven Nobel Prizes and five Turing Awards.
This story illustrates that a key element of success in research is the recognition of the value that idle curiosity brings to a scientific project. It is inefficient and costs money, time and resources. Yet without it, the foundational knowledge needed to drive innovation cannot emerge. The CEO of AT&T’s idea to let “scientific inquiry run its natural course” was not only visionary but demonstrated his trust in scientists and the process of science itself. And remember science is a process, not a result and is “true whether you believe it or not”, to quote Neil deGrasse Tyson.