Friends of Guy's Millennium Project

4-D Skull Base Microsurgery at Guy's

  Shortly before Christmas last year the ENT theatres at Guy's took delivery of a much-needed new operating microscope - a millennium gift from the friends of Guy's Hospital, costing £64,000. The old microscope had done much valiant service over the last 15 years but technology had moved on. After an estimated 25,000 operations the precision joints that moved and focused its lenses were no longer precise. Stiff and unstable, suitable only for short and simple operations, it lacked the optics and staying power necessary for 21st century in microsurgery. Drifting out of focus at critical stages during long operations, it made microsurgery more difficult than it needed to be and any further deterioration was likely to have a negative impact on patient outcomes. The capital expenditure required to purchase a much-needed replacement was far beyond the scope of the Trust's funds. To own and use the latest Leica microscope was beyond the wildest dreams of the ear nose and throat surgeons at Guy's or, indeed any in the capital. The Friends of Guy's Hospital and the goodwill of Leica made a wish a reality. 

The new microscope is far from a replacement. Not just the top of the range from Leica, the new microscope is the ultimate surgical and teaching tool, simply the best. Equipped with a specially developed zoom lens, its range of operational effectiveness allows a seamless transition for all objects in the ears, nose and throat. When previously three different focal length lenses were required now there is just one. No Intra-operative changes are necessary and this in itself decreases the risk of accidental contamination and subsequent wound infection - an important issue when operating near the brain at the base of the skull. Zoom and focus are achieved by fine micro motors and the optical parameters for each surgeon are stored in memory and instantly adjusted by touching a menu screen. Is this just a gimmick? Not at all. For surgery that can take up to 12 hours, it means that surgeons can collaborate more easily, help each other and their patient more effectively, and feel instantly at home with the microscope the moment they take over responsibility for the case. 

If that were all it would be wonderful but of course it is not. Today's surgeons have a responsibility to train the next generation and to make sure that they fully appreciate the intricate anatomical relationships of the structures that enter and exit the skull, not to mention the special senses of hearing and balance that are housed in the temporal bone. Much has been achieved by side arms for observers and small television cameras attached to operating microscopes. Both have their shortcomings. They only see the view from one side or the other and lack depth perception - an important issue when trying to learn how deep you drill before a major artery or nerve is encountered! Our new microscope has 3-D vision for everyone. A tiny camera extracts image data from both eyepieces and transmits it to a special television screen. By wearing polarised glasses, the surgical trainees or medical student sees the operative field as if the surgeon, in 3-D and, over the time course of the procedure, can truly say that they have witnessed microsurgery in 4-D 

Few centres in the world have such a facility and certainly no other ENT clinic in the United Kingdom has to date. In August 1999, centres of excellence in Skull Base Surgery were selected and invited to participate in a 3-D training scheme for aspiring skull base surgeons from all over the world. Just nine departments were chosen, three from Europe, five from the Americas and one from Australia. Guy’s was one of these departments and now, adequately equipped, can continue to play its part in the development of surgical expertise - a tradition that those connected with the Hospital have for so long come to expect. 

Professor M.J. Gleeson M.D., F.R.C.S

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Report for Friends of Guy's from the Renal Unit.  

Thanks to the generosity of the Friends, I am pleased to report that the refurbishment of 10 haemodialysis chairs has now been successfully completed to the great benefit of our patients who attend for treatment three times weekly for dialysis. 

The chairs, which were all in excess of 7 years old, have been refurbished to the current specification with superior padding and upholstery, new patient handsets and replacement motors. Hy‑med Healthcare were extremely accommodating and loaned us between 2‑4 hire chairs at a time, free of charge, so that the existing chairs could be removed from the unit and upgraded on a rolling programme with minimal disruption to the patients.

We are extremely grateful for the support of everyone who has made this possible and I wish to take this opportunity to extend a special vote of thanks to the Friends on behalf of the patients and staff in the haemodialysis units. 

Lisa Burnapp

Senior Nurse, Renal Directorate.

    Photo from the Renal Unit - as can be seen, for the purposes of hygiene the chairs have to be covered

From the ENT Department  

The ENT department which has always been well supported by the Friends of Guy's Hospital, received the sum of £18,000.00 last summer (2000) for the purchase of a new rhinomanometer for use in the rhinology clinic. This piece of apparatus is designed primarily to measure airway resistance and is a substitute for an outdated machine which is so cumbersome as to be of little use. The assessment of airway resistance and flow provides a useful measure as to the patency of the nasal airway, thereby allowing clinicians to decide to what extent a patient would need an operation, or not. It is also useful in the assessment of the results of surgery, by comparing values after operation with those before surgery.  

The new Rhinomanometer is top of the range and incorporates three methods of assessing the nasal airway compared with the older instrument which had been in the department for years. It is presently being assessed in an out patient setting for the purpose of gaining clinical information, but has also been used as a research tool. The Ethics committee have granted their approval to carry out an assessment of the airways before and after surgery, a project which is being carried out in collaboration with the allergy department.  

The ENT department therefore thanks the Friends of Guy's Hospital once again for their strong support.  

ELFY B CHEVRETTON Ms FRCS

CONSULTANT OTOLARYNGOLOGIST

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From D M Calver for a Goldman Perimeter

I am writing to you to thank the Friends of Guy's for the Goldman Perimeter. This equipment is used regularly in the eye department to test the field vision of the patient, in particular those with glaucoma and benign intracranial hypertension.  

Thank you very much for donating this essential piece of equipment to our department.

D M CALVER FRCS FRCOphth

CONSULTANT PAEDIATRIC OPHTHALMOLOGIST

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Toys for the Nursery

I would like to thank the Friends of Guy’s Hospital for the fantastic donation of over £700 to help the nursery buy garden toys and equipment for the children.  

The delight on the children’s faces when the new bikes, scooters, trucks and toys arrived was a picture to see.  

They have enjoyed many hours of play and are taking good care of their new toys.  

The Nursery is solely funded by the Trust and there is only so much that we can buy with a small budget, so fundraising events and donations from people like yourselves give us the money we need to buy new equipment.  

Once again, a big thank you from all of the staff, parents and children of Guy’s Nursery  

Jennifer Gagg (née Etienne)

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From Denise Mabey  - Consultant Ophthalmic Surgeon

I would like to express my gratitude to the Friends for their great generosity in providing an autokeratorefractor for the eye department.

This expensive piece of equipment allows us to take a map of the front surface of the eye. From the map we can work out how strong an implant is needed in cataract surgery and where we should place our incisions. It is also of use in monitoring people with progressive conditions of the cornea, such as keratoconus.

The great benefit to our patients at Guys will be felt in the New Year. Thanks to the machine we will be able to give many of our patients a date for their cataract surgery at their first visit. Previously they have been sent to St Thomas' for measurements on an older and somewhat unreliable alternative, thus causing an extra hospital visit.

Again heartfelt thanks for helping us to streamline our cataract service to the many elderly recipients of sight-restoring surgery.

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From Professor Mark McGurk MD FRCS DLO FDS RCS. Department of Oral and Maxillofacial Surgery,

On behalf of our team I would like to thank Friends of Guy's for their kind award which has allowed us to purchase an endoscopy system for visualizing the internal environment of the salivary glands. The bulk of the equipment has been received. Our initial experience has been very positive; it is relatively easy to identify the salivary stones and break them with a laser beam aimed through the endoscope. 

The equipment has given Guy's the advantage of being the only hospital in the UK to treat salivary stones in this way. We recently presented our results at an international conference in Geneva and are one of the leading exponents of this technique in the world. Our data show that in the last four years we have seen 250 patients with salivary stones and removed only four submandibular glands. 

Minimally invasive techniques are a great advantage to the patient. We are grateful that the Friends of Guy's have helped us to head the way in developing this new field of clinical practice.

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From Angela Nicholl, Orthopaedic Theatres

I’m just writing to say a tremendous thank you for funding the purchase of the Abbot i-STAT which is a portable blood gas analyser for the major spinal correctional surgery here at Guy’s. 

This essential piece of equipment provides fast accurate blood gas and glucose results in theatre therefore allowing efficient treatment/medication to be given almost immediately. This has greatly assisted the anaesthetists and therefore increased the level of patient care. 

Before we had this piece of equipment delays were incurred with getting up to date blood results from haematology or anaesthetic staff going to Paediatric Russell Brock I.T.U. With fast moving major surgery a lot can happen in a short amount of time particularly with children and adolescents so there is even less room for flexibility. 

So once again, a huge thank you from the spinal anaesthetists, consultant surgeons and the theatre staff. 

Yours sincerely 

Angela J Nicoll

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