Surgeons: At the Edge of Life - 6 ª Season

Surgeons at University Hospital Southampton take on high-risk surgery to remove life-threatening tumours. Consultant thoracic surgeon Alessandro Tamburrini will have to remove a section of rib to remove a tumour from a patient's lung.

At University Hospital Southampton, surgeons perform life-saving surgery. Maxillofacial consultant Sanjay Sharma and his colleague Madan 'Ethu' Ethunandan's next case is particularly challenging: removing a patient's eye to cut out cancer that is growing deep behind it and then reconstruct his face. It's a rare operation, with just ten carried out in the UK every year. Without the procedure, their patient, 76-year-old retired lorry driver Mick, would die. The hope is that the operation will leave Mick cancer-free. Meanwhile, urology consultant Vicky Dawson and her mentor Julian Smith have an elderly patient who urgently needs a life-saving operation. Eighty-three-year-old patient Norman has been successfully treated for prostate cancer but now has cancer in his bladder, so both his bladder and prostate need to be removed. But the entire operation is placed in jeopardy when Norman, who has a pre-existing heart issue, develops an irregular heart rhythm as he is being anaesthetised.

University Hospital Southampton provides care for close to three million people across the south of England every year, treating patients with the most complex surgical needs. Those with serious liver and pancreatic conditions are seen by consultants on the hepato-pancreato-biliary or HPB team. One of its leading consultants is Arjun Takhar. His patient is 55-year-old Lisa, who has an egg sized tumor in her pancreas which has spread causing multiple tumors in her liver. These are a rare type of neuroendocrine tumor, diagnosed in just 4000 people each year. If Arjun can't remove Lisa's tumors, they will continue to grow and will eventually kill her. To operate, Arjun is joined by fellow HPB consultant surgeon Tom Armstrong. Accessing and removing as many tumors as possible will be a challenge for the duo as the liver contains 13% of the body's blood supply and when they cut into it there's a high risk of bleeding. The anesthetist plans to mitigate this risk by keeping Lisa's hydration as low as possible, lowering her blood volume, so the veins in her liver are less likely to bleed. But, when the surgeons start removing the tumors there's more bleeding than they anticipated, and they need to come up with a new plan. This involves clamping off the blood supply to the liver at intervals, which is a challenge; if the organ is left for too long without blood it could be permanently damaged. To remove the cancer in Lisa's pancreas, they need to cut off the tumorous section, and they must also cut out the spleen as the cancer may have spread there. To do this they need to locate and tie off the splenic artery which supplies both organs with blood. But Lisa's anatomy means Arjun has difficulty locating the artery. If he can't find and isolate the vessel, the operation can't continue. Southampton also takes on rare and ground-breaking operations in its orthopedic department. Specialist knee consultant Amir Qureshi's patient is 42-year-old Bruno, who has bow legs that are now at such a severe angle he's in constant pain and has difficulty walking. The bones in Bruno's legs, which curve outwards at the knee, are in danger of breaking because of the stress. The procedure to correct them is so complex it's been two years in the planning. Amir will need to make four corrections to Bruno legs, above and below the knee on each leg. On Bruno's tibias, or shin bones, Amir will add a wedge of donor bone to each. While on the femurs, or thigh bones, he will remove a wedge of bone. Precision is key in the operation, so Amir has planned it with medical engineer Sam Grasso. Sam has produced 3D models of all the bones, and then created cutting guides that will sit on the bones, so Amir knows exactly where to cut. If any angle or measurement is out, then the correction will fail. There's also a risk that Bruno's bones could break all the way through. This would mean making another incision to fix the problem which would cause his body to have a huge inflammatory response, leading to congested lungs and potentially heart failure.

As one of the country's largest hospitals, surgeons at University Hospital Southampton carry out over 34,000 operations every year, many of which are the last hope for their patients. Maxillofacial consultant Sanjay Sharma takes on some of the most challenging cases involving the face, jaw and mouth. Sanjay originally operated on sixty-seven-year-old Sue three years ago to remove cancer and to reconstruct her jaw. However, subsequent radiotherapy caused her to develop a rare condition that damaged blood vessels and caused the bone in the reconstruction to die. Sue's jaw has started to crumble, resulting in infections and a loss of function, including difficulty eating and speaking. Sanjay now faces the challenging task of rebuilding Sue's jaw once again. The procedure is so extensive that Sanjay will be joined in theatre by three other surgeons. As Sanjay removes dead bone and tissue from the jaw, plastic surgeon Nigel Horlock will work on Sue's leg, cutting a skin flap and section of fibula bone to form the new facial reconstruction. Because the blood vessels in Sue's neck have been damaged, the surgeons also need to create a new blood supply to Sue's face by harvesting an alternative blood vessel. This will be connected to her mammary artery and then tunneled underneath the skin to reach the neck, where it will be connected to the flap's vein and artery. When problems develop with the blood flow, Sue's reconstruction hangs in the balance. Challenging operations at Southampton also include complex gastrointestinal surgery, and Professor Tim Underwood specializes in these procedures. His patient, 67-year-old Monique, requires an esophagectomy, as she has advanced cancer in her esophagus, or swallowing tube. To potentially cure Monique, Tim will need to remove the cancerous section of her esophagus and then repurpose her stomach to create a new swallowing tube. But taking out the esophagus is not straightforward; the section where the cancer sits is stuck to the aorta, the body's biggest blood vessel, and also the pericardium, the membrane surrounding the heart. Damaging either could have fatal consequences. Even if Tim manages to free and remove the cancerous section of oesophagus, he must still successfully shape the stomach into a new swallowing tube by stapling it, pulling it up into the chest and connecting it to the remaining top end of the oesophagus in Monique's neck.

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