When an operating theatre becomes a lab

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Image caption Surgical research 'key' to NHS

Scientific research takes place in a lab, doesn't it? Well, not when the developments are in surgery. Then it takes place in the clinics, wards and even the operating theatre.

In this week's Scrubbing Up, Prof Dion Morton, director of research at the Royal College of Surgeons, says it is crucial that patients understand how important the work is - and that they take part.

When people think about clinical trials their first thought might be of laboratories where pharmaceutical companies test the safety and effectiveness of drugs and vaccines.

But in surgery too, clinical trials are a vitally important way of assessing the benefits new treatments bring to patients.

Research and clinical trials are a daily part of the NHS, with many studies carried out by doctors and healthcare professionals who treat patients on a daily basis.

Although 98% of people in the UK will need surgery at some point in their lives, less than 5% of government funding for medical research goes on improving surgery and developing new techniques.

Surgery has been referred to as the 'Cinderella' of medical research, although funding has been slowly improving in recent years.

From treating acute trauma to replacing joints after chronic disease, surgery has a broad impact and still cures more cancers than any other form of treatment.

It is a vital part of the health service and investment in research is crucial if we are to be at the forefront of improving patient care.

Tackling cancers

This is why new surgical clinical trial centres have been set up across the country. Surgeons are currently recruiting patients to assess new surgical techniques and determine which procedures give patients the best chance of making a full recovery.

Each centre will focus on many different types of surgery including transplantation, heart and orthopaedic.

Trials are challenging to design and it can be difficult to recruit patients, but with careful planning and good communication they are made possible.

I am working on an international study which aims to find out at what point patients with late stage bowel cancer should be given chemotherapy.

Bowel cancer is the fourth most common cancer in the UK and patients currently have to have surgery first to remove the cancer and then have chemotherapy.

However, when the disease is advanced, all too often the cancer returns in the months or years that follow.

This trial will look at whether patients who are given some chemotherapy prior to surgery are less likely to see their cancer return in the two years after treatment.

In Bristol, colleagues are running a trial to compare the effectiveness of two common operations to treat severe obesity - gastric band and gastric bypass.

During the course of the trial doctors will study over 700 patients, of which half will have been fitted with a gastric band and half will have had a bypass.

Over three years they will compare how much weight patients' lose, whether they experience any complications following surgery and to what extent their quality of life improves following the operation.

'Hand in hand'

Obesity is a rapidly increasing global health problem which costs the NHS billions of pounds.

Surgery is both a clinically-effective and cost-effective way of treating this disease and so the results of this trial will help the NHS decide which of these two treatments they should offer to patients.

Surgical research has the potential to make real improvements in the way we care and treat patients.

Patient safety and innovation go hand in hand as it is the evidence gained from these trials that will ultimately lead to reduced patient mortality and sickness.

Despite limited investment, surgeons are striving to develop the evidence for new techniques and procedures that can change the face of hospital care.

Raising standards, delivering new surgical treatments to patients and delivering them safely nationwide is central to a high quality health service.

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