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Surgeons: At the Edge of Life: Episode 5 (S4EP5 BBC Two Thurs 9 Dec 2021)

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Addenbrooke’s Hospital in Cambridge is an internationally renowned university teaching hospital and a centre of excellence for a number of specialities. The surgeons here take on complex cases from across the UK where a successful operation can save and transform the patient’s quality of life.

Ekpemi Irune is one of the hospital’s leading head and neck surgeons, and treats over 500 patients each year. Today her patient is a woman who has been successfully treated for cancer, but it has left her unable to swallow or speak.

Seventy-five-year-old Nancie is a farmer’s wife who was diagnosed with laryngeal cancer two years ago and received radiotherapy which cured her. But the radiotherapy left her larynx damaged and severely narrowed her oesophagus, so she is unable to swallow or speak properly. This has been life-changing for Nancie, a lover of food and especially puddings, who now can’t join her husband for meals and must connect herself to a feeding pump each night to get the nutrition she needs.

To enable Nancie to eat and speak normally again, Ekpemi must perform a complex operation to remove her larynx and rebuild her oesophagus. She will need to carefully navigate around important blood vessels and nerves in Nancie’s neck to remove the larynx, which will leave a hole in her oesophagus. To repair the hole and to widen Nancie’s narrowed swallowing tube, plastics consultant Nic Segaren must take a flap of skin and tissue from Nancie’s arm, with a vein and artery attached, to use to reconstruct the oesophagus. This flap will be connected to vessels in Nancie’s neck for it to have a blood supply and keep it alive.

The challenge for Nic is making that connection between the vessels, especially when he discovers the main vein for the flap is not working. Instead, he must use much smaller vessels to make the connection. But if these vessels are not big enough to keep the blood flowing out of the flap, the reconstruction could be at risk.

Addenbrooke’s is also a centre for complex neurosurgery, and today consultant Tom Santarius has a challenging case where a young mother has a tumour growing between her brain and eye socket that needs to be removed, as it is threatening her sight.

Thirty-six-year-old mother of three, Gemma, has always had headaches, but earlier this year they became worse. Eventually an MRI scan revealed she had a meningioma, a type of tumour that grows from the membrane around the brain. In her case, it was growing towards the eye socket, infecting bone and causing swelling behind her right eye. If left untreated, it would eventually threaten her sight, and even her life.

The operation to remove the tumour and infected bone is a demanding and long procedure, as Tom must operate in a very small space in the skull, using drills to remove the tumour and bone while avoiding important nerves and blood vessels behind the eye. Here, the margins for error are miniscule; a tiny slip could cause blindness or a torrential bleed if the carotid artery is damaged.

To make the operation even more difficult, the tumour needs to be carefully taken off the membrane around the eye socket and the dura, the membrane around the brain. As a substantial amount of the dura has to be cut out, Tom will need to carefully repair this with a patch of manufactured collagen so that the brain is protected. And the repairs don’t stop there. Because a substantial amount of bone is removed, Tom must use titanium mesh to support the eye socket, so that Gemma’s eye sits well within her skull.

Airdate: Thurs 9 Dec 2021 at 21:00 on BBC Two

Season 4 Episode 5

Documentary series going beyond the theatre doors of Queen Elizabeth Hospital Birmingham, where surgeons push medical boundaries to the limits.