0:00:05 > 0:00:10Every year some three million major operations are carried out in the UK.
0:00:11 > 0:00:13The theatre doors are just here.
0:00:13 > 0:00:17But few of us will know what really happens once we're put to sleep.
0:00:17 > 0:00:20All right, all you've got to do now is think beautiful thoughts.
0:00:20 > 0:00:24I don't think that patient can even comprehend what you're doing in theatre to them.
0:00:24 > 0:00:28And that's what the plan is, that they don't know what they've been through.
0:00:28 > 0:00:33This series goes behind the theatre doors at the Queen Elizabeth Hospital in Birmingham...
0:00:33 > 0:00:36- Let's get cracking then. - Right, okey-dokes.
0:00:36 > 0:00:40..where for the first time, cameras have been allowed to join some of
0:00:40 > 0:00:44Britain's top surgeons during their most high-stakes operations.
0:00:44 > 0:00:46- Shall we go for it?- We'll go for it.
0:00:46 > 0:00:49Using new technology and pioneering skills,
0:00:49 > 0:00:52they are treating conditions that used to kill.
0:00:52 > 0:00:54We continue to push the boundaries,
0:00:54 > 0:00:57continue to take the inoperable and make it operable.
0:00:57 > 0:01:00This is surgery at its most experimental.
0:01:00 > 0:01:02This is where I've got to get it right.
0:01:02 > 0:01:04People didn't attempt this surgery a few years ago,
0:01:04 > 0:01:06because it was just perceived as being too big,
0:01:06 > 0:01:08too difficult and too scary.
0:01:08 > 0:01:12But pushing the human body to its limits comes with great risk...
0:01:12 > 0:01:14Keep it together, keep it together, keep it together.
0:01:14 > 0:01:17..for the patients and the surgeons.
0:01:17 > 0:01:22An operation will go wrong for a 30-second lapse of concentration.
0:01:22 > 0:01:24It needs to work, because if it doesn't I'm going to cry.
0:01:24 > 0:01:26Things worry you. You get very worried.
0:01:26 > 0:01:28This is going completely the wrong direction.
0:01:28 > 0:01:31The trick is to not appear to be worried.
0:01:31 > 0:01:34They need to be top of their game every time.
0:01:34 > 0:01:37People often characterise surgeons as bombastic and arrogant.
0:01:37 > 0:01:40Babcock, please, long one, to me. Slap it in, sweetheart.
0:01:40 > 0:01:43You've got to be dedicated to do it, you've got to love it.
0:01:43 > 0:01:46Oh, my God! Jesus Christ.
0:01:46 > 0:01:48You're only as good as your last result.
0:01:48 > 0:01:50BLEEPED EXPLETIVE
0:01:50 > 0:01:54This is what it takes to operate at the cutting-edge of medicine.
0:01:54 > 0:01:57You have to be jolly careful that you don't bugger it up.
0:01:57 > 0:01:59It's do or die, really.
0:02:08 > 0:02:11The Queen Elizabeth Hospital in Birmingham
0:02:11 > 0:02:14is one of the nation's largest surgical units.
0:02:16 > 0:02:21Today, there will be more than 120 operations in its 42 theatres.
0:02:21 > 0:02:25So, we are doing a left-hand nerve exploration,
0:02:25 > 0:02:27plus repair.
0:02:27 > 0:02:30Most are well-established procedures,
0:02:30 > 0:02:34but some are clinical trials in which surgeons will use cutting-edge
0:02:34 > 0:02:38techniques on humans for the very first time.
0:02:38 > 0:02:41If we go through the waiting list,
0:02:41 > 0:02:44at the moment we have got six active patients.
0:02:44 > 0:02:48Surgeon Richard Laing is working on a trial targeting
0:02:48 > 0:02:52one of the nation's biggest health crises - liver disease.
0:02:54 > 0:02:56Because of a Western diet,
0:02:56 > 0:02:59obesity is a huge problem, and is
0:02:59 > 0:03:01one of the biggest increasing causes of liver disease.
0:03:01 > 0:03:06Deaths from liver disease have soared by 40% in a decade.
0:03:06 > 0:03:10And more and more patients are waiting for life-saving liver transplants.
0:03:12 > 0:03:15- ON RADIO:- 'OK, you're on four blues, on your way, four blues it is.'
0:03:15 > 0:03:16OK. Thank you.
0:03:18 > 0:03:23Today a donor liver is being rushed from London to the team in Birmingham.
0:03:26 > 0:03:28This is where it will ask us to put in the data,
0:03:28 > 0:03:30so that takes about ten minutes.
0:03:30 > 0:03:34Surgeons will only use a liver that they believe is good enough quality
0:03:34 > 0:03:36to safely transplant,
0:03:36 > 0:03:39and so a number of livers every year are not used
0:03:39 > 0:03:41because they're considered too high risk.
0:03:41 > 0:03:46Each year, around 400 livers are judged unfit for use,
0:03:46 > 0:03:49leaving patients on the waiting list.
0:03:49 > 0:03:53Richard hopes to prove that many of the rejected livers are, in fact,
0:03:53 > 0:03:55viable for transplant.
0:03:55 > 0:03:58This trial has the potential to help so many patients on the list,
0:03:58 > 0:04:00but it's a high-risk trial.
0:04:00 > 0:04:04I mean, transplantation is risky as it is.
0:04:05 > 0:04:08But to take livers that have been rejected by everybody
0:04:08 > 0:04:11and to try and put them into patients,
0:04:11 > 0:04:14it is nerve-racking.
0:04:15 > 0:04:19The liver en route to Birmingham would normally be rejected,
0:04:19 > 0:04:22as it has come from a middle-aged donor who died of a heart attack
0:04:22 > 0:04:24away from hospital.
0:04:24 > 0:04:27And all the time that it's not connected to a live human
0:04:27 > 0:04:31body, the liver is deteriorating.
0:04:31 > 0:04:33The clock is ticking and time is absolutely critical.
0:04:36 > 0:04:38The liver is being starved of oxygen,
0:04:38 > 0:04:41and for every minute that passes,
0:04:41 > 0:04:43liver cells are dying, and the risks
0:04:43 > 0:04:46of that liver not working, following transplantation, increase.
0:04:48 > 0:04:50Arrow to arrow, it's colour-coded.
0:04:50 > 0:04:52Nice and simple for surgeons like myself.
0:04:52 > 0:04:56When it arrives, the donor liver will be connected to a machine at
0:04:56 > 0:04:58the heart of the trial.
0:04:58 > 0:05:00Through a process called perfusion,
0:05:00 > 0:05:04it will restore the liver to its best possible functioning state,
0:05:04 > 0:05:08giving the team a chance to assess whether it is healthy enough for a
0:05:08 > 0:05:10successful transplant.
0:05:10 > 0:05:14This machine tries to mimic the conditions that a liver would
0:05:14 > 0:05:16experience inside the human body.
0:05:16 > 0:05:19So, you give it blood, oxygen, nutrients,
0:05:19 > 0:05:22all at the body's normal temperature.
0:05:22 > 0:05:25When you give it those conditions, the liver starts to function.
0:05:25 > 0:05:27And not only does it function, but there is also a degree of
0:05:27 > 0:05:30reconditioning and the liver gets the opportunity
0:05:30 > 0:05:32to start to repair itself.
0:05:32 > 0:05:35And what this machine allows us to do is to take a liver that's deemed
0:05:35 > 0:05:38unsuitable, and prove in fact that it will function
0:05:38 > 0:05:40after it's transplanted.
0:05:42 > 0:05:47If all goes well, the donor liver will be transplanted to Connie O'Driscoll.
0:05:47 > 0:05:50Connie's lived in the UK for more than 30 years,
0:05:50 > 0:05:54almost as long as she's been suffering from a rare liver condition.
0:05:54 > 0:05:58This is like round three for me at the Queen Elizabeth.
0:05:58 > 0:06:04First was a bleed-out that brought me here for emergency rescue surgery.
0:06:04 > 0:06:08When that was finished they found I had liver cancer
0:06:08 > 0:06:10and they saved me again.
0:06:10 > 0:06:14Now it's time for a new liver, because the old one has
0:06:14 > 0:06:17pretty much taken a beating.
0:06:17 > 0:06:23The last two years there has been nothing but medical, medical, medical, medical.
0:06:23 > 0:06:25It has just absolutely consumed my life.
0:06:28 > 0:06:32For Connie, the chance to get a transplant quickly is outweighing
0:06:32 > 0:06:35any nerves about receiving experimental treatment.
0:06:37 > 0:06:43We are recruiting 6,500 plus new patients into trials per year.
0:06:43 > 0:06:48Some of those are ground-breaking trials, and will potentially change
0:06:48 > 0:06:49the way in which care is delivered.
0:06:50 > 0:06:55Hilary Fanning is in charge of all clinical trial activity within the trust.
0:06:55 > 0:07:00Trials are about bringing the possibility of better treatment
0:07:00 > 0:07:05and, in some cases, hope to patients who may not otherwise
0:07:05 > 0:07:08have hope, because of their particular condition.
0:07:09 > 0:07:13Today's research is tomorrow's standard of care,
0:07:13 > 0:07:17so undertaking clinical trials is a fundamental part
0:07:17 > 0:07:22of the delivery of a high-quality clinical service in the NHS.
0:07:22 > 0:07:25SIRENS
0:07:27 > 0:07:29- ON RADIO:- 'Hello, it's Claire.' - Hello, Claire.
0:07:29 > 0:07:32- 'Just to let you know, your ten-minute warning has gone in.' - OK, thank you.
0:07:32 > 0:07:35The donor liver will soon arrive for the first stage of the trial.
0:07:35 > 0:07:37So, we'll go and set up the medications.
0:07:39 > 0:07:41There is an air of anticipation -
0:07:41 > 0:07:43"Is it going to work, is it not going to work?"
0:07:43 > 0:07:46"I think this one'll work." "This one's never going to work."
0:07:49 > 0:07:51Then the liver arrives.
0:07:57 > 0:08:00And we get the first sight. And it might look really good,
0:08:00 > 0:08:02it might look really awful.
0:08:02 > 0:08:05You know, there are some livers which we'll put on the machine that
0:08:05 > 0:08:06just don't function.
0:08:07 > 0:08:10So, is a bit fattier than we thought, isn't it?
0:08:12 > 0:08:15It's not the best-looking liver.
0:08:15 > 0:08:19There are features that would mean that you wouldn't necessarily want
0:08:19 > 0:08:21to transplant this liver straightaway.
0:08:21 > 0:08:22But this is what the trial is for.
0:08:24 > 0:08:26We've just been putting all the cannulas in so we can connect it to
0:08:26 > 0:08:30the device, and then over the course of the perfusion we'll start to see
0:08:30 > 0:08:33various readouts that will indicate whether or not the
0:08:33 > 0:08:34liver's functioning.
0:08:34 > 0:08:40Richard needs to run a series of tests to find out if it's healthy enough to transplant.
0:08:40 > 0:08:44The liver has four hours to prove itself.
0:08:44 > 0:08:46The liver might not function at all.
0:08:46 > 0:08:47Only time will tell.
0:08:52 > 0:08:56As well as being risky, clinical trials are expensive.
0:08:56 > 0:08:59Along with the funding comes intense scrutiny.
0:09:00 > 0:09:05In terms of income associated with awarded grants,
0:09:05 > 0:09:07can you remember where we are with that?
0:09:07 > 0:09:1025 million across Birmingham Health Partnership.
0:09:10 > 0:09:11Was that last financial year?
0:09:12 > 0:09:18I think it does take a particular type of person
0:09:18 > 0:09:22to undertake clinical trials.
0:09:23 > 0:09:28They have to be really sure that what it is that they're trying to
0:09:28 > 0:09:31achieve is the right thing, and they have to maintain their belief in
0:09:31 > 0:09:34themselves and their ability to deliver that.
0:09:36 > 0:09:38There is a huge amount
0:09:38 > 0:09:42of professional satisfaction in being a pioneer.
0:09:42 > 0:09:48That in itself pushes you to the point of accepting a degree of risk
0:09:48 > 0:09:50associated with clinical trials.
0:09:51 > 0:09:55As a surgeon you are really sticking your head above the parapet.
0:09:56 > 0:09:59If you're involved in trials like this, most people know you're doing it.
0:09:59 > 0:10:01It's hard to keep these things quiet.
0:10:01 > 0:10:04And if it doesn't work, you're still going to have to face them.
0:10:06 > 0:10:08But you take that chance.
0:10:08 > 0:10:11Consultant surgeon Richard Irving
0:10:11 > 0:10:12and Professor Philip Begg
0:10:12 > 0:10:15have received over £1 million to fund their trial.
0:10:15 > 0:10:19They hope it could one day help to transform the lives of thousands of
0:10:19 > 0:10:24people in the UK who have profound hearing loss.
0:10:24 > 0:10:27So, in relation to the access to Paul's middle ear,
0:10:27 > 0:10:31the pinna will be rotated out of the way and that's all going to be out
0:10:31 > 0:10:33of the operative field.
0:10:33 > 0:10:36The team are trailing a world first.
0:10:36 > 0:10:40They're going to surgically implant this tiny hearing aid microphone
0:10:40 > 0:10:41inside the patient's skull.
0:10:42 > 0:10:47Their goal is for it to be more discreet than today's external hearing aids
0:10:47 > 0:10:50and, perhaps, improve on their sound quality.
0:10:50 > 0:10:52The impetus behind this really comes from patients.
0:10:52 > 0:10:55They get a huge amount of benefit from an external hearing aid,
0:10:55 > 0:11:00but still there are some lifestyle restrictions that they have.
0:11:01 > 0:11:05And they're wearing something on their ear and on the outside of
0:11:05 > 0:11:07their head, so it's visible.
0:11:07 > 0:11:10For many patients that is a big downside.
0:11:10 > 0:11:13People don't like looking different.
0:11:13 > 0:11:16At night typically, patients, they take their device off
0:11:16 > 0:11:19and they go back into a world of silence.
0:11:19 > 0:11:24They can't hear, for example, a smoke alarm, a baby crying,
0:11:24 > 0:11:26and they would feel really cut off.
0:11:28 > 0:11:3363-year-old caretaker Paul Heaney started to lose his hearing more
0:11:33 > 0:11:36than 20 years ago. He currently wears a cochlear implant
0:11:36 > 0:11:41with an external sound processor microphone behind his ear.
0:11:41 > 0:11:45He will be one of the first six people to trial the new internal microphone.
0:11:45 > 0:11:50When your hearing goes, you feel a bit isolated in society.
0:11:50 > 0:11:53People sort of tend to avoid you in certain situations rather than
0:11:53 > 0:11:55having to repeat themselves.
0:11:55 > 0:11:57You feel a little bit left out.
0:11:59 > 0:12:03Paul is almost totally deaf, because of deterioration in his inner ear.
0:12:05 > 0:12:09Although the trial is focused on testing whether the new microphone
0:12:09 > 0:12:13is safe, he hopes it will lead on to the invention of completely internal
0:12:13 > 0:12:15hearing aids.
0:12:15 > 0:12:17Eventually when it's finished,
0:12:17 > 0:12:22we'll get rid of all the outside paraphernalia and just be straight
0:12:22 > 0:12:24through the ear.
0:12:24 > 0:12:27It's a little bit of a step in the dark for me at the moment,
0:12:27 > 0:12:29but from what I've read up about it
0:12:29 > 0:12:32it would definitely be an improvement to the current status.
0:12:35 > 0:12:39With Paul, that's an incredible thing to ask someone,
0:12:39 > 0:12:40a huge thing to ask someone,
0:12:40 > 0:12:43to agree to undergo an operation that they don't have to have.
0:12:45 > 0:12:48He has a genuine desire to help other people.
0:12:48 > 0:12:54If this is successful, then he will be down as one of the patients
0:12:54 > 0:12:56who helped with this revolution.
0:12:59 > 0:13:02Paul's procedure will take place in Theatre 15.
0:13:03 > 0:13:07Richard will perform the pioneering surgery while Philip and an audio
0:13:07 > 0:13:10research team will test the new implant.
0:13:13 > 0:13:17- OK.- What are we doing for Mr Heaney?
0:13:17 > 0:13:19Working on his left ear,
0:13:19 > 0:13:23placing a middle ear microphone and a pedestal through the skin.
0:13:23 > 0:13:26- OK, blood lost?- Minimal.
0:13:26 > 0:13:29- Duration of surgery? - Three-and-a-half.
0:13:29 > 0:13:32Yeah, any specific equipment you need?
0:13:32 > 0:13:34- Lots and it's all here.- OK.
0:13:34 > 0:13:36- Happy? - OK, microscope on, thanks.
0:13:36 > 0:13:38I'll just give this a clean.
0:13:39 > 0:13:43Richard will have to insert a hearing aid microphone smaller than
0:13:43 > 0:13:47a matchstick right inside Paul's head.
0:13:47 > 0:13:50And then connect it to the tiny bones in his middle ear.
0:13:51 > 0:13:55To implant the device he'll need to drill out a minute channel
0:13:55 > 0:13:58through solid bone,
0:13:58 > 0:14:01navigating between two important nerves.
0:14:01 > 0:14:03One that controls facial movement,
0:14:03 > 0:14:06and another connected to the sense of taste.
0:14:10 > 0:14:14It is a surgical challenge to work in that area of the body.
0:14:14 > 0:14:18So, you have to be incredibly careful.
0:14:18 > 0:14:20OK, if you've got the razor...
0:14:23 > 0:14:27I need to take this to the table, Richard, at some point.
0:14:27 > 0:14:30Yeah, let me just clean out his ear and then I'll put the probe in.
0:14:32 > 0:14:37Richard is one of the most talented surgeons I've ever met.
0:14:37 > 0:14:39Suction can be on, please.
0:14:39 > 0:14:42We've got a very unique relationship.
0:14:42 > 0:14:45We are two people who you might expect to have quite big egos.
0:14:45 > 0:14:47We kind of leave our egos at the door.
0:14:47 > 0:14:51And we work really, really well together.
0:14:51 > 0:14:54It is a relationship that's based on respect.
0:14:54 > 0:14:57- Ready?- It is ready to go in, yeah.
0:14:57 > 0:14:59So, this probe goes in the external ear.
0:15:01 > 0:15:05Before Richard begins, he tapes a small speaker inside Paul's ear.
0:15:06 > 0:15:10This will play test sounds, so the microphone can be checked by sound
0:15:10 > 0:15:14engineer Rob Morse once it's implanted.
0:15:14 > 0:15:19So, we are putting a sound into the ear to make sure that's our levels right.
0:15:19 > 0:15:21- Happy? Let's start, yeah.- Right.
0:15:21 > 0:15:24Just going to start the incision
0:15:24 > 0:15:26working my way through the
0:15:26 > 0:15:29scalp and the soft tissues.
0:15:29 > 0:15:32I'll just get enough exposure and then I'll start.
0:15:32 > 0:15:34Make my access route through the skull.
0:15:36 > 0:15:38OK, right, great, let's have the drill, thanks.
0:15:41 > 0:15:46So, I now make a passageway through the bone, working
0:15:46 > 0:15:51in an area behind the ear canal.
0:15:52 > 0:15:55First Richard has to drill a channel into Paul's skull,
0:15:55 > 0:15:59less than a centimetre from the membrane that protects his brain.
0:15:59 > 0:16:02When you first do this, you're incredibly nervous.
0:16:02 > 0:16:04You're incredibly slow.
0:16:04 > 0:16:08There is a risk that the membranes could be breached,
0:16:08 > 0:16:12and of infection that could spread inside the skull.
0:16:12 > 0:16:15These are incredibly rare, but they're things
0:16:15 > 0:16:17that go through your mind.
0:16:17 > 0:16:21Can I have the microscope, as well? Thanks.
0:16:21 > 0:16:25I often compare it to how NASA prepares astronauts,
0:16:25 > 0:16:29where they'll spend maybe 20 years preparing for a flight
0:16:29 > 0:16:32that takes ten, 20, 30 days.
0:16:32 > 0:16:35And it's the same with this, with the surgery.
0:16:35 > 0:16:40We spent a year planning for every possible disaster that could happen.
0:16:40 > 0:16:41Have you got a one cutter, thanks?
0:16:41 > 0:16:43- One cutter.- And a smaller sucker.
0:16:44 > 0:16:46As you become more and more comfortable,
0:16:46 > 0:16:52somehow you're able to switch off in this surreal world.
0:16:52 > 0:16:56I am conductor of that orchestra while I'm operating,
0:16:56 > 0:16:59and I determine what is happening in that environment.
0:16:59 > 0:17:04I have now got a much smaller tip and I'm making a small passageway
0:17:04 > 0:17:06into the back of the middle ear,
0:17:06 > 0:17:09running between the facial nerve,
0:17:09 > 0:17:12that's the nerve that moves the face
0:17:12 > 0:17:15and the nerve that supplies taste.
0:17:15 > 0:17:18Two structures that I would very much like to avoid.
0:17:19 > 0:17:24We are doing a surgical procedure on what is arguably one of the most
0:17:24 > 0:17:26delicate parts of the human body
0:17:26 > 0:17:28in the skull.
0:17:30 > 0:17:34So, within a tiny area, a couple of centimetres across,
0:17:34 > 0:17:38I have all of those anatomical structures to deal with,
0:17:38 > 0:17:40and what I am doing is taking a high-speed drill
0:17:40 > 0:17:43and making my way through.
0:17:44 > 0:17:47Clearly if things do not go to plan,
0:17:47 > 0:17:50that could have a huge impact on that patient's quality of life.
0:17:56 > 0:18:00In Theatre 5, Richard Laing has been monitoring a donor liver
0:18:00 > 0:18:04he wants to use in the transplant trial for the last two hours.
0:18:07 > 0:18:11The organ's being kept alive by the perfusion machine,
0:18:11 > 0:18:15supplying it with blood, nutrients and oxygen.
0:18:15 > 0:18:18I'm going to take a biopsy in here.
0:18:18 > 0:18:22Only specific tests will determine if the liver is now good enough for
0:18:22 > 0:18:24transplant.
0:18:24 > 0:18:27We'll look for various readouts that will indicate whether or not the liver is functioning.
0:18:27 > 0:18:30It shouldn't be too much longer before we can make a decision on
0:18:30 > 0:18:32whether or not it's transplantable.
0:18:33 > 0:18:37One of the liver's main jobs is to turn lactate,
0:18:37 > 0:18:41an acid produced by muscular activity, into glucose.
0:18:42 > 0:18:44A lactate reading of 2.5 or lower
0:18:44 > 0:18:48indicates the liver is functioning well enough for transplant.
0:18:50 > 0:18:53- It's 2.6.- Oh, fantastic. - Nearly there.
0:18:53 > 0:18:55Nearly there.
0:18:55 > 0:18:59The liver is very close to coming into criteria.
0:18:59 > 0:19:01We're just waiting on this last result.
0:19:05 > 0:19:07Before the lactate was 2.6.
0:19:07 > 0:19:08It's now down to 2.1.
0:19:08 > 0:19:10Textbook liver function.
0:19:10 > 0:19:14The liver's met the criteria, which is fantastic,
0:19:14 > 0:19:16but this is just the start.
0:19:16 > 0:19:19The question now is will that liver continue to function
0:19:19 > 0:19:21after it's transplanted?
0:19:28 > 0:19:31Hello, Mrs O'Driscoll, how are you?
0:19:31 > 0:19:34Nice to see you. Lovely to see you again.
0:19:34 > 0:19:36I didn't think we'd be seeing each other so soon.
0:19:36 > 0:19:38I know, it has been soon, hasn't it?
0:19:38 > 0:19:39Good thing I had my suitcase packed.
0:19:39 > 0:19:41HE CHUCKLES
0:19:41 > 0:19:43This liver was offered to us yesterday.
0:19:43 > 0:19:45We were able to put it on the machine.
0:19:45 > 0:19:48- And it performed very well. - Excellent.
0:19:48 > 0:19:51Mr Perera doesn't see any reason why we shouldn't use the
0:19:51 > 0:19:53liver. He will be making his way...
0:19:53 > 0:19:55- Is he the surgeon?- He's the surgeon who will be doing the operation.
0:19:55 > 0:19:57Very, very experienced.
0:19:57 > 0:19:59- Oh, good.- You're in safe hands.
0:19:59 > 0:20:00I feel in safe hands.
0:20:00 > 0:20:04- OK, well, it's good to see you again, OK?- Thank you. - And we'll see you soon.
0:20:04 > 0:20:05- All right?- Bye.
0:20:05 > 0:20:08By signing up for the trial,
0:20:08 > 0:20:11Connie will get the transplant she needs fast.
0:20:12 > 0:20:15But everyone is conscious of the price she could pay.
0:20:16 > 0:20:18With any clinical trial, there is a degree of risk.
0:20:18 > 0:20:21But the stakes are huge with this trial.
0:20:21 > 0:20:23If we can't do what we're setting out to do,
0:20:23 > 0:20:26which is show whether or not a liver's going to function after it's
0:20:26 > 0:20:29transplanted, for us as clinicians it's really disappointing.
0:20:29 > 0:20:33But for the patients, that could be devastating.
0:20:33 > 0:20:35Worst case scenario, they can die.
0:20:40 > 0:20:43In theatre, Connie's life will be in the hands of transplant surgeon
0:20:43 > 0:20:45Thamara Perera.
0:20:46 > 0:20:50In the last seven years he's performed hundreds of transplants.
0:20:51 > 0:20:54Transplant surgery, it's not a very popular field,
0:20:54 > 0:20:58because it has quite a lot of hard work that you need to put in,
0:20:58 > 0:20:59but someone has to do it.
0:21:00 > 0:21:02There are so many patients out there
0:21:02 > 0:21:06waiting on the transplant waiting list, so you don't want to stop.
0:21:06 > 0:21:08You just need to keep going.
0:21:08 > 0:21:11I can see the transformation, which I like, you know?
0:21:11 > 0:21:16You really feel that you have done something to the patient and the
0:21:16 > 0:21:17patient has got a new life.
0:21:18 > 0:21:21That is what makes this job worthwhile.
0:21:29 > 0:21:32There comes a point where you've done every bit of planning,
0:21:32 > 0:21:34every bit of preparation...
0:21:36 > 0:21:39You've just got to take that leap of faith and go to the next stage,
0:21:39 > 0:21:40and just hope that it works.
0:21:40 > 0:21:43Patient's name and procedure.
0:21:43 > 0:21:46We've got Connie O'Driscoll on the table for liver transplant.
0:21:46 > 0:21:48OK, expected blood loss.
0:21:48 > 0:21:51Unpredictable, could be loads depending on the situation.
0:21:52 > 0:21:55Thamara is a machine.
0:21:55 > 0:21:58He is so dedicated to becoming the best in the world,
0:21:58 > 0:22:01I've no doubt about it. He's so driven.
0:22:01 > 0:22:05He fights for every single patient, to get them a transplant.
0:22:05 > 0:22:09If I needed a liver transplant, Thamara would be definitely at that table.
0:22:09 > 0:22:12Can I get the temperature down on theatres, please?
0:22:14 > 0:22:18The main surgical challenge is to connect Connie's new liver
0:22:18 > 0:22:20as quickly as possible.
0:22:22 > 0:22:26First, Thamara must carefully divide and detach the major arteries and
0:22:26 > 0:22:30veins connected to Connie's diseased liver.
0:22:31 > 0:22:34These need to be securely clamped so Connie doesn't bleed out.
0:22:36 > 0:22:40He'll then have to work fast to put the donor liver in position and
0:22:40 > 0:22:43connect it to Connie's blood vessels and bile duct.
0:22:45 > 0:22:47The time is critical,
0:22:47 > 0:22:51because each and every second where the liver is out of the machine,
0:22:51 > 0:22:54it undergoes a degree of damage,
0:22:54 > 0:22:58which could lead to failure and emergency re-transplant.
0:23:05 > 0:23:08In Theatre 15, Richard Irving and Philip Begg
0:23:08 > 0:23:12are two-and-a-half hours into surgery to plant a new
0:23:12 > 0:23:15kind of hearing aid microphone inside their patient's skull.
0:23:17 > 0:23:22So far Richard has managed to work around Paul's delicate facial nerves
0:23:22 > 0:23:25as he drills towards the middle ear.
0:23:25 > 0:23:30Now he needs to drill even deeper to reach the tiniest bones in the body,
0:23:30 > 0:23:33which transmit sound to the inner ear.
0:23:34 > 0:23:37Slower, more careful progress in this area.
0:23:37 > 0:23:41Exposing the bits of the middle ear that I want to get access to.
0:23:45 > 0:23:47The ambition is for this new technology
0:23:47 > 0:23:50to improve on the broad range of sound
0:23:50 > 0:23:53that gets picked up by external microphones.
0:23:53 > 0:23:55Instead, it is designed to produce
0:23:55 > 0:23:58much more directional sound, by
0:23:58 > 0:24:02picking up the vibrations from the tiny incus bone in the middle ear.
0:24:02 > 0:24:04OK.
0:24:04 > 0:24:07So, straight ahead of me is the incus bone,
0:24:07 > 0:24:10and this is where we are going to attach our microphone.
0:24:12 > 0:24:13Drill, thanks.
0:24:14 > 0:24:18Next Richard has to drill a hole into the fragile incus
0:24:18 > 0:24:20which is scarcely three millimetres wide.
0:24:24 > 0:24:26There is not a large number of us that do this,
0:24:26 > 0:24:30and it does require fine dexterity
0:24:30 > 0:24:33and a lot of confidence in what you're doing.
0:24:33 > 0:24:35It takes time, it takes expertise,
0:24:35 > 0:24:39so the skill that Richard demonstrates in bucketfuls
0:24:39 > 0:24:43gives us a safe place to implant.
0:24:46 > 0:24:48OK, that looks a nice depth.
0:24:48 > 0:24:52Thanks. So there is the little hole on the incus bone.
0:24:54 > 0:24:57OK, have you just got the fixation piece there for me?
0:24:57 > 0:24:58Fixation device.
0:25:06 > 0:25:08Needle to me, please.
0:25:11 > 0:25:14What I want is that hole in my incus
0:25:14 > 0:25:16to be pretty much in the centre of that disc.
0:25:18 > 0:25:19Which is there.
0:25:19 > 0:25:23Which it is. That looks pretty good, doesn't it, yeah.
0:25:23 > 0:25:25So I can fixate here, yes?
0:25:25 > 0:25:28- Yes.- Right. - Shall we get the implant?
0:25:31 > 0:25:34Richard now has to insert the tip of the microphone
0:25:34 > 0:25:37into the tiny hole he's drilled in the incus.
0:25:41 > 0:25:46It has to be implanted with just the right amount of pressure.
0:25:46 > 0:25:50Too much, or too little, and the microphone won't work.
0:25:50 > 0:25:53The recess is 0.6 of a millimetre across
0:25:53 > 0:25:55and about a millimetre deep.
0:25:55 > 0:25:58Come on.
0:25:58 > 0:26:00That is the key challenge as to whether this thing works -
0:26:00 > 0:26:04can you get this coupled precisely to the bones of hearing?
0:26:06 > 0:26:10- I'll straighten this. - Yes, it can be straight.
0:26:12 > 0:26:17I have to try and gauge really, just using the senses in my hand the
0:26:17 > 0:26:20tension between that bone and the microphone.
0:26:24 > 0:26:27We really do not want anything to go wrong.
0:26:30 > 0:26:31Yeah. Good job.
0:26:34 > 0:26:35Green screen over, thanks.
0:26:38 > 0:26:40OK. Shall we connect up, yeah?
0:26:42 > 0:26:44The implant is in place.
0:26:45 > 0:26:48Now Phil and the audio team need to play sounds through the speaker in
0:26:48 > 0:26:51Paul's ear, to check the microphone picks them up.
0:26:53 > 0:26:54You should start hearing it now.
0:26:59 > 0:27:01- There's nothing.- Nothing.
0:27:04 > 0:27:06Just trying advancing it slightly.
0:27:08 > 0:27:10See if that's any better.
0:27:10 > 0:27:11No, it's still low.
0:27:13 > 0:27:15You're not picking up any sound in theatre either.
0:27:17 > 0:27:19Yeah, it's too quiet.
0:27:19 > 0:27:23Unless they can get the implanted microphone working,
0:27:23 > 0:27:26the operation won't have any benefit for Paul.
0:27:27 > 0:27:30This has developed over a number of years.
0:27:30 > 0:27:33The responsibility for it does sit on my shoulders as the chief
0:27:33 > 0:27:37investigator. That's something I have to manage and is something
0:27:37 > 0:27:39that I am accountable for.
0:27:48 > 0:27:52Clinical trials wouldn't be possible if there weren't the patients who
0:27:52 > 0:27:54were brave enough to take part,
0:27:54 > 0:27:57and put their own health on the line in a lot of cases,
0:27:57 > 0:28:00and their lives on the line.
0:28:00 > 0:28:04We have a duty to really look after these patients as much as possible,
0:28:04 > 0:28:07and make it as safe as possible and really try and get them through it.
0:28:09 > 0:28:12In the transplant trial in Theatre 3,
0:28:12 > 0:28:17Thamara Perera is about to remove Connie's diseased liver, and replace
0:28:17 > 0:28:21it with a donor organ that's been revived and rehabilitated.
0:28:21 > 0:28:24We'll have to start, thank you.
0:28:24 > 0:28:26Just starting.
0:28:27 > 0:28:31The surgery itself is extremely complicated,
0:28:31 > 0:28:34and you have an organ that is diseased,
0:28:34 > 0:28:37but also is receiving two litres of blood a minute,
0:28:37 > 0:28:40and you have to be able to get that liver out quickly,
0:28:40 > 0:28:42and you have to be able to put the new one in.
0:28:42 > 0:28:44Argon, please.
0:28:44 > 0:28:48Using an electrosurgical pencil, Thamara needs to carefully separate
0:28:48 > 0:28:52Connie's liver from the surrounding tissue in her abdomen.
0:28:52 > 0:28:57As surgical lead, he must stay aware of everything that happens in theatre.
0:28:58 > 0:29:01There are three zones in a surgeon's focus.
0:29:01 > 0:29:03The immediate focus is there,
0:29:03 > 0:29:05the structures, what I'm going to do.
0:29:07 > 0:29:09At the same time I have a peripheral focus,
0:29:09 > 0:29:12the team are on me, what are they doing?
0:29:12 > 0:29:16Is the scrub nurse ready with the next instrument?
0:29:21 > 0:29:23The third zone, it's the environment,
0:29:23 > 0:29:25the theatre environment.
0:29:25 > 0:29:27Are you OK?
0:29:27 > 0:29:32Without the three zones, you cannot perform a good operation.
0:29:35 > 0:29:37Left hepatic artery is going.
0:29:37 > 0:29:40The liver is attached to major blood vessels,
0:29:40 > 0:29:44including the arteries supplying blood from the heart and the portal
0:29:44 > 0:29:48vein which carries blood to the liver from the stomach and intestines.
0:29:50 > 0:29:53These all need to be disconnected with immense care.
0:29:53 > 0:29:57They will need to be used again, when attaching the donor liver.
0:29:57 > 0:30:00There are two sources of blood supply into the liver,
0:30:00 > 0:30:03these are the portal vein and the hepatic artery.
0:30:07 > 0:30:09But this is not for people who are chicken-hearted.
0:30:11 > 0:30:14This lay is a bit...awkward, isn't it?
0:30:15 > 0:30:19Until Connie's vessels get joined up to the new liver,
0:30:19 > 0:30:22they need to be clamped to prevent dangerous blood loss.
0:30:22 > 0:30:26If you don't get it right, the bad outcomes happen
0:30:26 > 0:30:27in front of your eyes.
0:30:29 > 0:30:3015 minutes.
0:30:30 > 0:30:32Yeah, fine, I'll be ready.
0:30:35 > 0:30:38Thamara is close to removing Connie's liver,
0:30:38 > 0:30:41so it's time to get the donor organ ready.
0:30:41 > 0:30:43John, are you OK for me to take the portal vein?
0:30:43 > 0:30:45- Yes.- Thank you.
0:30:45 > 0:30:47Portal vein is clamped.
0:30:55 > 0:30:57It's going to be flushed in a second.
0:30:57 > 0:30:59Disconnect the liver, we are ready.
0:31:01 > 0:31:04Disconnect the liver, right, OK.
0:31:04 > 0:31:06We'll work our way through taking it off now.
0:31:08 > 0:31:10Connie's liver has been removed.
0:31:13 > 0:31:16And with the donor organ coming off the machine's
0:31:16 > 0:31:20oxygen and blood supply, the team must move fast.
0:31:20 > 0:31:21The timing is important,
0:31:21 > 0:31:25because I do not want too much time spent
0:31:25 > 0:31:29between it coming out the machine and reconnection of blood supply.
0:31:29 > 0:31:31It has to be 20 minutes.
0:31:31 > 0:31:34- And then it is connected. - It will be two minutes, OK?
0:31:35 > 0:31:39Once that liver is removed from the machine, the clock is ticking.
0:31:41 > 0:31:43It is deteriorating, the cells are dying.
0:31:43 > 0:31:45I'm coming.
0:31:47 > 0:31:50Now the donor liver is in Theatre 3,
0:31:50 > 0:31:54Thamara has just 13 minutes to connect it to Connie's blood vessels.
0:31:56 > 0:31:58He will start with the large portal vein,
0:31:58 > 0:32:01which delivers 75% of the liver's blood supply.
0:32:03 > 0:32:04Clamp on the cable, please.
0:32:12 > 0:32:15It is one of the most complex operations.
0:32:15 > 0:32:18There has to be a mental design in your head.
0:32:18 > 0:32:22How am I going to put these two structures together?
0:32:22 > 0:32:23Scissors, please.
0:32:24 > 0:32:26You need to know what I am going to do now,
0:32:26 > 0:32:29my next suture is going to be there.
0:32:29 > 0:32:31Add the following suture is going to be there.
0:32:31 > 0:32:33Hold this, please. With my hand, please.
0:32:33 > 0:32:34OK, that's finished.
0:32:34 > 0:32:37Cut the bottom two needles, please.
0:32:37 > 0:32:40Big spoon clamp, please. Pick-ups to me.
0:32:40 > 0:32:41Starting the portal vein.
0:32:42 > 0:32:45The portal vein is a thin, fine structure,
0:32:45 > 0:32:49susceptible to tear during the operation.
0:32:51 > 0:32:55The integrity of these vessels are important for the survival
0:32:55 > 0:32:57of the liver.
0:32:57 > 0:33:00You cannot take hours and hours doing these two joints.
0:33:03 > 0:33:05Do you see what I am doing?
0:33:05 > 0:33:07Holding the cut edge and stretching it.
0:33:07 > 0:33:11Imagine a line parallel to that edge.
0:33:14 > 0:33:16Five minutes.
0:33:24 > 0:33:26Four o'clock.
0:33:28 > 0:33:30Eight o'clock.
0:33:33 > 0:33:35Scissors ready, please.
0:33:35 > 0:33:36Turn one minute.
0:33:36 > 0:33:40It is an enormous responsibility to operate on a patient,
0:33:40 > 0:33:44so you need to have courage and you need to have expertise.
0:33:44 > 0:33:46Portal vein is finished. Hold this, please.
0:33:49 > 0:33:51You need to take the clamps off,
0:33:51 > 0:33:55let the blood flow through the liver into the patient.
0:33:55 > 0:33:58With blood now flowing through the donor organ,
0:33:58 > 0:34:02Connie's body could have an adverse reaction to such a major procedure.
0:34:02 > 0:34:06This is the period the patient can become really unstable.
0:34:07 > 0:34:12Sometimes the changes are powerful enough to stop the heart.
0:34:15 > 0:34:17OK, that clamp's off.
0:34:29 > 0:34:31In Theatre 15,
0:34:31 > 0:34:34the hearing aid trial team have been working for five hours.
0:34:36 > 0:34:40But the operation has been at a standstill for the last 45 minutes.
0:34:44 > 0:34:46Are we getting something?
0:34:46 > 0:34:49It is not good, though.
0:34:49 > 0:34:53The miniature microphone implanted in Paul's middle ear still isn't
0:34:53 > 0:34:55picking up any sound.
0:34:55 > 0:34:57We can't really proceed with that.
0:34:58 > 0:35:04It is one of those episodes in your surgical career
0:35:04 > 0:35:08where you emotionally go from somewhere up here
0:35:08 > 0:35:12to the bottom, and instantly you think,
0:35:12 > 0:35:15"I've done something wrong. What have I done?"
0:35:18 > 0:35:20OK, well, we will have a look at that and see.
0:35:21 > 0:35:23- Did it?- I think so.
0:35:23 > 0:35:25I think you're right.
0:35:25 > 0:35:27I think it's the mic.
0:35:29 > 0:35:31If the microphone HAS been damaged,
0:35:31 > 0:35:35they will need to extract it and repeat the operation with a new one.
0:35:35 > 0:35:37No real change. I have done all of the surgical sounds
0:35:37 > 0:35:40- and your voice and all of that. - There was nothing?
0:35:40 > 0:35:41There was nothing. No.
0:35:41 > 0:35:44We are checking the channels as well, just in case.
0:35:46 > 0:35:49Doing a surgical procedure that has never been done before,
0:35:49 > 0:35:51it doesn't always go to plan.
0:35:51 > 0:35:56And sometimes you can't explain why it doesn't go to plan.
0:35:56 > 0:35:59That is part of the life as a surgeon.
0:35:59 > 0:36:00But you take that risk.
0:36:00 > 0:36:03Before unscrewing, can we just check that probe first?
0:36:03 > 0:36:05Yeah.
0:36:05 > 0:36:08Next they decide to check if there is any fault with the speaker they
0:36:08 > 0:36:10are using for the test.
0:36:10 > 0:36:12It is taped inside Paul's ear.
0:36:12 > 0:36:14Is that better now?
0:36:14 > 0:36:15Oh, my God!
0:36:15 > 0:36:17What? Good.
0:36:17 > 0:36:18I can hear everyone.
0:36:19 > 0:36:21- The probe slipped off.- Ah.
0:36:21 > 0:36:23That is... I can hear myself...
0:36:23 > 0:36:25That is perfect.
0:36:25 > 0:36:29The speaker had come loose, so no sound was reaching the microphone.
0:36:29 > 0:36:32There is always a solution.
0:36:32 > 0:36:35It is about working the problem,
0:36:35 > 0:36:38using the Apollo 13 mission statement,
0:36:38 > 0:36:39"Failure is not an option."
0:36:41 > 0:36:43It is just, you know, your seven o'clock beer becomes a nine
0:36:43 > 0:36:46o'clock beer. That's the only difference in life.
0:36:48 > 0:36:50OK, anything else we need to do, or can I close up?
0:36:50 > 0:36:51- OK.- Yeah.
0:36:51 > 0:36:53- Time to close, yeah?- OK.
0:36:53 > 0:36:55Table up in the air a little bit, please.
0:36:57 > 0:37:00- VOICEOVER:- If this is successful, it will be hugely satisfying.
0:37:00 > 0:37:06To think that a significant advance in science has been attributed to
0:37:06 > 0:37:09something that you have actually done, and that is huge.
0:37:09 > 0:37:12OK. Everything is nearly finished.
0:37:12 > 0:37:15Just putting a dressing on your head.
0:37:15 > 0:37:18- Should be good, shouldn't it, really, with those results?- Yeah.
0:37:18 > 0:37:20Although the microphone is functioning,
0:37:20 > 0:37:24the team will not know whether it is helping Paul until he has recovered
0:37:24 > 0:37:27from surgery, and it gets switched on for testing.
0:37:27 > 0:37:31If we are successful, it is a game changer,
0:37:31 > 0:37:35and potentially will be life-changing for tens of thousands
0:37:35 > 0:37:38of people across the globe.
0:37:58 > 0:37:59Throughout the hospital,
0:37:59 > 0:38:03tools and treatments that have emerged from clinical trials are
0:38:03 > 0:38:05revolutionising everyday health care.
0:38:05 > 0:38:07Now, then, how is your elbow?
0:38:07 > 0:38:09I think it looks good.
0:38:09 > 0:38:14Lieutenant Colonel Professor Steven Jeffery is a consultant plastic
0:38:14 > 0:38:16surgeon who specialises in treating burns.
0:38:17 > 0:38:21Many burns patients like David Walsh struggle with recurring wound
0:38:21 > 0:38:24- infections.- The flap's fine.
0:38:24 > 0:38:27Yeah, that looks very good, but...
0:38:27 > 0:38:29Having a large number of bacteria present in your wound
0:38:29 > 0:38:31is not good for your wound,
0:38:31 > 0:38:34so that tells you you have got to do something about it.
0:38:34 > 0:38:39Steven is using a new device that has recently been through successful
0:38:39 > 0:38:40clinical trials.
0:38:40 > 0:38:44It detects bacteria much faster than traditional methods.
0:38:45 > 0:38:50Previously, if you suspected a lot of bacteria to be present and maybe
0:38:50 > 0:38:53infection, you would take a swab, microbiology swab,
0:38:53 > 0:38:56and you'd send that off to the lab and you'd wait three or four days
0:38:56 > 0:38:58and you'd get the result back.
0:38:58 > 0:39:02We will take a look using this camera, the MolecuLight camera.
0:39:02 > 0:39:06- Yeah.- What it does is, it shows you bacteria.
0:39:06 > 0:39:08OK, so we are going to have to darken in the room
0:39:08 > 0:39:10for this to work.
0:39:10 > 0:39:14Illuminating the skin with a specific wavelength of light
0:39:14 > 0:39:18makes bacteria fluoresce under the MolecuLight screen.
0:39:18 > 0:39:20Most bacteria will shine red.
0:39:20 > 0:39:23There's another type of molecule which will fluoresce
0:39:23 > 0:39:27a kind of greeny blue, and that's found in pseudomonas,
0:39:27 > 0:39:31which is something that is particularly troubling to us in the
0:39:31 > 0:39:32burns world.
0:39:32 > 0:39:35You see that there, the lightened bits? Are they the infected bits?
0:39:35 > 0:39:39- Yeah, they are.- I knew it, I bloody knew it.- Yeah.
0:39:39 > 0:39:43With faster, more accurate diagnosis, treatment can be more effective.
0:39:43 > 0:39:46You have got pseudomonas in that...
0:39:46 > 0:39:47- Definitely?- Yeah.
0:39:47 > 0:39:49But it is OK, now we know what it is, we can treat it.
0:39:51 > 0:39:55I don't think the inventor had fully appreciated how big this was
0:39:55 > 0:40:00going to be, and how important it is to see bacteria in real time.
0:40:00 > 0:40:02That has never been possible before.
0:40:09 > 0:40:13Trials targeting Britain's most widespread and deadly health problems have
0:40:13 > 0:40:16the potential to save thousands of lives.
0:40:17 > 0:40:22Urology surgeon Prashant Patel is looking for new ways of tackling a
0:40:22 > 0:40:26disease that will strike one in eight men in their lifetime -
0:40:26 > 0:40:28prostate cancer.
0:40:28 > 0:40:32Cancer in the UK at the moment is an epidemic.
0:40:32 > 0:40:36Prostate cancer is now the most leading cause of cancer diagnosis
0:40:36 > 0:40:37in UK men.
0:40:37 > 0:40:4110,000 patients are also dying from prostate cancer every year.
0:40:41 > 0:40:45Prashant's team are working with the University of Birmingham to trial an
0:40:45 > 0:40:50ambitious technique that could supersede today's treatment options.
0:40:50 > 0:40:53Chemotherapy and radiotherapy, whilst effective,
0:40:53 > 0:40:56it causes a significant amount of collateral damage.
0:40:56 > 0:41:01The idea of doing the trial is to go for the punching -
0:41:01 > 0:41:04see whether we can cure and control the cancer,
0:41:04 > 0:41:06but at the same time minimise the side-effects.
0:41:08 > 0:41:12The trial will involve injecting a patient with a genetically modified
0:41:12 > 0:41:17virus, triggering a process which should attack and destroy the cancer
0:41:17 > 0:41:22cells. Only 11 patients have signed up to try it out so far.
0:41:28 > 0:41:3379-year-old William Yates is a grandfather of five.
0:41:33 > 0:41:34He will be Prashant's 12th subject.
0:41:36 > 0:41:40- Good morning, Mr Yates.- Good morning.- Morning.- Good morning.
0:41:40 > 0:41:43- How are you?- I am very good.- Good.
0:41:43 > 0:41:45- All set?- Yes, thank you.- Excellent.
0:41:45 > 0:41:46You have met Sian and Fiona already.
0:41:46 > 0:41:49- Yes. I have met the Angels. - Excellent. So you know what is happening today?
0:41:49 > 0:41:53- Yes.- So we are going ahead with the prostate cancer gene therapy trial.
0:41:53 > 0:41:55Yes.
0:41:55 > 0:41:58The stakes for conducting any particular clinical trial
0:41:58 > 0:41:59are extremely high.
0:41:59 > 0:42:03All things we do in medicine is associated with risks.
0:42:03 > 0:42:07And there are known risks and there are the unknowns.
0:42:07 > 0:42:09When it comes to clinical trials,
0:42:09 > 0:42:12it is the unknowns which we are trying to explore.
0:42:12 > 0:42:15But that is the way medicine evolves.
0:42:15 > 0:42:18And just to recap, we are doing this
0:42:18 > 0:42:21because you have had prostate cancer diagnosis,
0:42:21 > 0:42:23a few years ago you had radiotherapy
0:42:23 > 0:42:27- and now there is some biochemical failure.- Yes, yes.
0:42:27 > 0:42:31William is taking part in this trial as his prostate cancer has returned
0:42:31 > 0:42:34after eight years in remission.
0:42:34 > 0:42:37He is keen to get involved with testing the innovative treatment,
0:42:37 > 0:42:40despite its lack of a proven track record.
0:42:40 > 0:42:44- So we have got this opportunity to treat you with gene therapy.- Yeah.
0:42:46 > 0:42:49I was quite proud to be a guinea pig, to be quite honest.
0:42:49 > 0:42:52And if that can wipe it out in years to come, I think
0:42:52 > 0:42:56I have done my little bit, so I am quite happy about that.
0:42:56 > 0:42:59- Are we ready to rock and roll? - Yes.- OK, great.
0:42:59 > 0:43:03Right, we will get you changed and I will be seeing you in theatre in a
0:43:03 > 0:43:07- few minutes.- OK.- OK? Right. We shall see you in a bit.
0:43:14 > 0:43:18OK, good morning, all. William Yates, gene therapy trial.
0:43:18 > 0:43:20Intraprostatic injection.
0:43:20 > 0:43:22So everyone's eyes should be covered.
0:43:24 > 0:43:27This is a risky trial, because it is the first time
0:43:27 > 0:43:32this kind of genetically modified virus has been used on humans.
0:43:32 > 0:43:37All experimental treatments must be proven safe before they can progress
0:43:37 > 0:43:38to wider trials.
0:43:38 > 0:43:42We are the only people who are conducting these trials.
0:43:42 > 0:43:45We are dealing with biologically modified viruses.
0:43:45 > 0:43:47They do not normally exist.
0:43:47 > 0:43:49Here is our gene therapy pharmacist.
0:43:49 > 0:43:52We have got all six syringes ready.
0:43:52 > 0:43:55We hope that when this virus enters into the body, it will attack
0:43:55 > 0:43:57the cancer cells,
0:43:57 > 0:44:04and in addition will also provoke the immunity of the patient to fight
0:44:04 > 0:44:07against the cancer without causing significant side-effects.
0:44:08 > 0:44:11The treatment has two stages.
0:44:11 > 0:44:14First, the genetically modified sample of the common cold virus will
0:44:14 > 0:44:17be injected directly into the prostate.
0:44:19 > 0:44:21The virus is altered so it won't spread,
0:44:21 > 0:44:26and so it changes the biochemistry of the cancer cells.
0:44:26 > 0:44:31Next, after 48 hours, a drug is given to the patient.
0:44:31 > 0:44:34When this drug comes into contact with the cancer cells affected by
0:44:34 > 0:44:37the virus, it will start to kill them off.
0:44:38 > 0:44:41We have got the ultrasound scan set up of the prostate,
0:44:41 > 0:44:44and the grid is on there, as you can see.
0:44:44 > 0:44:48Prash needs to inject the live virus with great precision
0:44:48 > 0:44:51into the six cancer sites in William's prostate,
0:44:51 > 0:44:54showing up as the darker areas on the ultrasound.
0:44:56 > 0:44:59To keep William comfortable and completely still,
0:44:59 > 0:45:00he is under general anaesthetic.
0:45:01 > 0:45:05There are risks associated with these kind of trials.
0:45:05 > 0:45:07With live biological agents like viruses,
0:45:07 > 0:45:11we keep a very close eye on the patient's side-effects.
0:45:13 > 0:45:14Ready when you are.
0:45:14 > 0:45:20The worst-case scenario is virus related inflammatory reaction.
0:45:20 > 0:45:24It just doesn't give you a flu-like illness but a very severe
0:45:24 > 0:45:27inflammatory illness. In that case we are in problem.
0:45:28 > 0:45:32But as with all trials like this, they won't know how William's body
0:45:32 > 0:45:35will react until he has received the virus injections.
0:45:37 > 0:45:38Right, OK, we are ready to start.
0:45:39 > 0:45:41- Final needles.- Final needle.
0:45:48 > 0:45:52In Theatre 3, the transplant trial team have rushed to get Connie's
0:45:52 > 0:45:56new liver into position, and started connecting it to her blood supply.
0:45:58 > 0:45:59- Happy?- Yeah.
0:45:59 > 0:46:04Now surgeon Thamara Perera is moving on to the most delicate stage -
0:46:04 > 0:46:08plumbing in the network of hepatic arteries which help to supply the
0:46:08 > 0:46:10liver with oxygenated blood.
0:46:10 > 0:46:14In those very fine sutures, you need to slow down, focus.
0:46:14 > 0:46:20You need to make it the best possible way so that it will not
0:46:20 > 0:46:23make any clots or damage into the blood vessel.
0:46:23 > 0:46:28If a clot develops in the hepatic artery, that is going to
0:46:28 > 0:46:30damage the liver.
0:46:30 > 0:46:32Can I get this artery...
0:46:33 > 0:46:35If you rupture a blood vessel,
0:46:35 > 0:46:40the amount of bleeding is enough to kill a patient within 30 seconds.
0:46:44 > 0:46:47One of the arteries is proving difficult.
0:47:07 > 0:47:11One of my teachers told me, when I first became a surgeon,
0:47:11 > 0:47:16he said, "God has given you power. It is a privilege.
0:47:16 > 0:47:19"Please make sure every patient goes home safe."
0:47:21 > 0:47:26With all the blood vessels attached, Thamara has got one last task -
0:47:26 > 0:47:30reconnecting the bile duct which supplies the digestive system with
0:47:30 > 0:47:32the fluid we need to digest fats.
0:47:35 > 0:47:37That looks all right.
0:47:40 > 0:47:42- We are happy to close, then?- Yeah.
0:47:42 > 0:47:45- Looking very great.- Good.
0:47:45 > 0:47:50Once you know everything has gone OK, it is a big relief,
0:47:50 > 0:47:54so that is probably the time to take a proper deep breath.
0:47:54 > 0:47:56OK. Thank you. Thank you, everybody. Thank you. Thank you.
0:47:58 > 0:48:01Could we have staples, please?
0:48:01 > 0:48:03Calmly and nicely.
0:48:03 > 0:48:06The operation is complete in time.
0:48:06 > 0:48:09Lactate on the machine was 1.2, glucose was...
0:48:09 > 0:48:14Now they must wait to see if Connie's new liver continues to perform.
0:48:15 > 0:48:17The liver's functioned as we would have hoped.
0:48:18 > 0:48:20But, you know, this is a trial.
0:48:22 > 0:48:24Connie has got a long road ahead of her.
0:48:24 > 0:48:25And there are no certainties.
0:48:26 > 0:48:29We will just keep our fingers crossed that she does well.
0:48:43 > 0:48:46In Theatre 28, prostate cancer patient William Yates
0:48:46 > 0:48:51is about to be injected with a genetically modified virus.
0:48:51 > 0:48:55As you can see, whilst I am moving the needle, it is in that area.
0:48:55 > 0:48:56OK.
0:48:57 > 0:49:02For neurologist Prash to test his new gene therapy technique,
0:49:02 > 0:49:04he needs to deliver it to the site of the cancer
0:49:04 > 0:49:06with pinpoint accuracy.
0:49:06 > 0:49:08Prior to the procedure,
0:49:08 > 0:49:10we would have done all our prior mapping of the prostate,
0:49:10 > 0:49:12as to where the cancer is.
0:49:14 > 0:49:18But we use the grid to accurately place the virus within the cancer.
0:49:18 > 0:49:22OK, now, as soon as the virus goes in,
0:49:22 > 0:49:24you can see there, you see?
0:49:24 > 0:49:26You've got a very nice distribution.
0:49:30 > 0:49:31Second injection going in.
0:49:31 > 0:49:33And the co-ordinate for this is...
0:49:33 > 0:49:36..b2.5.
0:49:36 > 0:49:39- That will be going at the same depth?- Same depth, five.
0:49:42 > 0:49:44Yeah, that is perfect placement there.
0:49:44 > 0:49:46So it is e3, please.
0:49:48 > 0:49:50OK, I am happy with that.
0:49:50 > 0:49:54As soon as the virus goes in, I have got a very good coverage.
0:49:54 > 0:49:57How is he behaving on the top end?
0:49:57 > 0:49:59No problems?
0:49:59 > 0:50:01OK. The right side is all done.
0:50:01 > 0:50:04As you can see, it is all blanched out white.
0:50:05 > 0:50:07OK. Injections are done.
0:50:07 > 0:50:10Everything gone on schedule, which is good.
0:50:10 > 0:50:12Exactly as planned.
0:50:12 > 0:50:14OK. Over and out.
0:50:14 > 0:50:16- Thank you.- Thank you.
0:50:16 > 0:50:20During the next few hours, the virus should start to trigger
0:50:20 > 0:50:23changes in the cancer cells in William's prostate.
0:50:30 > 0:50:32So this is your infusion.
0:50:32 > 0:50:34This will work with the treatment that you had.
0:50:36 > 0:50:38- Is that the killer?- Yeah, this one...- This is the...
0:50:38 > 0:50:40It is? Oh, good.
0:50:41 > 0:50:45The drug William is getting will only become a tumour killer when it
0:50:45 > 0:50:48reaches any cancer cells affected by the virus.
0:50:48 > 0:50:53Unlike chemotherapy, it won't damage the healthy cells in his body.
0:50:53 > 0:50:56- And how long does this one take? - Five minutes.- Five minutes.
0:50:56 > 0:50:58- Five minutes? Is that all? - Yeah.
0:50:59 > 0:51:01All done.
0:51:02 > 0:51:05So it is a battlefield inside my body now, then?
0:51:05 > 0:51:07- Yeah.- Good.
0:51:09 > 0:51:11If this works, I shall feel marvellous.
0:51:13 > 0:51:17And if it helps to help other people,
0:51:17 > 0:51:20then at least I have done something useful in my life.
0:51:20 > 0:51:23OK, that one is all done.
0:51:25 > 0:51:29It is often the case with medical trials we have to wait and watch,
0:51:29 > 0:51:32and in William's case that will be very much applicable.
0:51:33 > 0:51:36We just keep our fingers crossed, hold the nerve,
0:51:36 > 0:51:40and see whether he has withstood treatment without any significant
0:51:40 > 0:51:42side-effects.
0:51:42 > 0:51:44And from William's perspective,
0:51:44 > 0:51:46whether the treatment has had any effect on his cancer.
0:51:54 > 0:51:57For every successful clinical trial,
0:51:57 > 0:52:01there are countless others that end in failure, or doubt.
0:52:01 > 0:52:05And with a failed trial, it is not just the clinicians who are affected.
0:52:05 > 0:52:07It just might not work,
0:52:07 > 0:52:10and we would all be very disappointed after all this effort.
0:52:10 > 0:52:11Particularly the patient.
0:52:11 > 0:52:15They would be hugely disappointed if they have gone through this
0:52:15 > 0:52:16and it doesn't work.
0:52:18 > 0:52:22Paul is about to find out if the implanted microphone has helped his hearing.
0:52:22 > 0:52:25Having recovered from the operation,
0:52:25 > 0:52:29today he is having it switched on for the first time.
0:52:29 > 0:52:34OK, so I just need to make a few changes on your existing processor.
0:52:34 > 0:52:38He is still wearing his old external microphone.
0:52:38 > 0:52:42But now they are going to switch that off and turn on the new implanted microphone instead.
0:52:44 > 0:52:46- I will start speaking to you, Paul...- Right.
0:52:46 > 0:52:49You are listening to me now through the middle ear microphone.
0:52:49 > 0:52:53- Right.- So how does my voice sound compared to your normal microphone?
0:52:53 > 0:52:55- More clarity.- More clarity?
0:52:55 > 0:52:58- Yeah.- Excellent. That's great.
0:52:58 > 0:53:02I haven't heard with this much clarity for the last 20 years.
0:53:02 > 0:53:05The general background noise is completely gone.
0:53:05 > 0:53:08Much more volume and more clarity.
0:53:08 > 0:53:09You're all set.
0:53:09 > 0:53:11It definitely gives me a lot of hope to be a bit more social.
0:53:11 > 0:53:13It is a fantastic device.
0:53:13 > 0:53:17- Good luck with it, Paul. - Yes, it has been quite an adventure.
0:53:18 > 0:53:24If this really works, and the early evidence is very encouraging,
0:53:24 > 0:53:28then in years to come, there could be surgeons all around the world
0:53:28 > 0:53:32putting this technology and benefiting tens of thousands of patients.
0:53:33 > 0:53:37And that's really the buzz of a project like this.
0:53:37 > 0:53:40That, to me, is probably about the most exciting thing you can do
0:53:40 > 0:53:41as a surgeon.
0:53:44 > 0:53:46- Morning, William.- Good morning.
0:53:46 > 0:53:49- How are you?- I'm fine, thanks. - Good, good.
0:53:49 > 0:53:52It has been two weeks since William received experimental gene
0:53:52 > 0:53:56therapy, in the hope it will stop the spread of his prostate cancer.
0:53:56 > 0:53:58Right, so have a seat.
0:53:58 > 0:54:01He has had no bad reaction to the live virus -
0:54:01 > 0:54:04a crucial factor in this initial trial.
0:54:05 > 0:54:07Your blood results are available,
0:54:07 > 0:54:09so let's have a look at them and see how you are.
0:54:09 > 0:54:12Something which you will be very keen to know is the PSA.
0:54:14 > 0:54:16PSA is a protein produced by the prostate,
0:54:16 > 0:54:19and is used as an indicator
0:54:19 > 0:54:23for cancer. A reduction would mean William's treatment is working.
0:54:23 > 0:54:26Recently your PSA was on a sharp rise.
0:54:26 > 0:54:28- A very steep rise.- Yeah.
0:54:28 > 0:54:31And when we did the injection, your PSA has dropped down...
0:54:31 > 0:54:35- Oh, good.- Your results so far have been quite reassuring.
0:54:35 > 0:54:39- Yeah.- I don't think you should open a bottle of champagne as yet.
0:54:39 > 0:54:42The most important thing is what the trends are and how it is
0:54:42 > 0:54:44- over a course of time.- Yeah, yeah.
0:54:44 > 0:54:50William will need to return for regular PSA testing over the months ahead.
0:54:50 > 0:54:52- Oh, that's lovely to hear, anyway, yeah.- OK?- Yeah.- That's great.
0:54:52 > 0:54:55- I will see you in a week's time. - Thank you.- Any problems give us a bell.- OK.
0:54:55 > 0:54:57- Take care.- Thank you.- Bye-bye.
0:54:59 > 0:55:03Although William's results are promising, this is just the start.
0:55:03 > 0:55:08The current trial is aimed at proving the treatment is safe from dangerous side-effects.
0:55:08 > 0:55:12Next, the team will need to run a phase two trial to assess
0:55:12 > 0:55:15just how effective it is against the cancer.
0:55:16 > 0:55:20It is an extremely long process for something that starts off
0:55:20 > 0:55:23from a bench side to enter into clinical practice.
0:55:23 > 0:55:28You may not even find that light at the end of the tunnel,
0:55:28 > 0:55:31but that doesn't stop me from exploring.
0:55:34 > 0:55:38The ultimate goal for Thamara Perera, is to increase the number
0:55:38 > 0:55:42of donor livers available for patients who will die without them.
0:55:42 > 0:55:45Today he is checking up on Connie after her transplant.
0:55:45 > 0:55:47- Good morning. - Good morning, Connie. How are you?
0:55:47 > 0:55:50Just what I like to see, those smiley faces.
0:55:50 > 0:55:52- How are you feeling? - I am feeling wonderful,
0:55:52 > 0:55:55and excited and ready to go home.
0:55:55 > 0:55:57- That is good.- I couldn't be more happy.
0:55:57 > 0:56:01Without that machine, I would not have received this liver.
0:56:01 > 0:56:03I'm looking forward to a future.
0:56:03 > 0:56:08I think those two words right there, "a future," says it all.
0:56:08 > 0:56:11Good. We will see you in the clinic next Monday, then.
0:56:11 > 0:56:12Thank you. Thank you, thank you.
0:56:12 > 0:56:14Good, you're welcome. See you Monday.
0:56:16 > 0:56:18Well, she has done remarkably well, actually.
0:56:18 > 0:56:20Perfectly normal liver functions.
0:56:20 > 0:56:22She is up and about.
0:56:22 > 0:56:23And she is a happy woman today.
0:56:23 > 0:56:26OK. Right...
0:56:26 > 0:56:30It is a privilege to be in this era.
0:56:30 > 0:56:34People are excited, transplantation practice is changing.
0:56:34 > 0:56:36- Is this my chariot?- Yes.
0:56:36 > 0:56:40Come ten years, transplantation of organs on machines
0:56:40 > 0:56:43is probably going to be the gold standard.
0:56:44 > 0:56:46Bye, and take care.
0:56:46 > 0:56:48I think when you start out doing research,
0:56:48 > 0:56:51you can only really hope to be part of something like this.
0:56:51 > 0:56:55To see someone who enrols in the trial and receives one of these livers,
0:56:55 > 0:56:58and then you see them in the follow-up clinic a month later,
0:56:58 > 0:57:00they've changed dramatically.
0:57:00 > 0:57:03Feels great to be minutes away from fresh air.
0:57:03 > 0:57:05Oh, I'm just, I'm just...
0:57:06 > 0:57:10To make a difference to people, it is absolutely a fantastic feeling.
0:57:10 > 0:57:12Oh, God...
0:57:15 > 0:57:17You can't really ask much more than that.
0:57:19 > 0:57:24There are now more patients involved in clinical trials in the NHS than
0:57:24 > 0:57:28ever before. And like the medical pioneers who came before them,
0:57:28 > 0:57:31the surgeons at the Queen Elizabeth will keep daring to attempt
0:57:31 > 0:57:35tomorrow's procedures in their theatres today.
0:57:35 > 0:57:39Wherever you have expertise, and whatever area you're working in,
0:57:39 > 0:57:42you look at what you've got and you think, can we make it any better?
0:57:44 > 0:57:49Whether or not it does actually push the envelope, time will tell, but
0:57:49 > 0:57:51we're determined and we'll keep pushing it.