The Scalpel Report
Sharing the Latest in Surgical Education and Innovation

Scalp Reconstruction with a Free Anterolateral Thigh Flap

Surgical steps involved in complex scalp defect repair using a free anterolateral thigh (ALT) flap, with emphasis on microvascular anastomosis to the superficial temporal artery and vein. The video outlines critical stages including vessel identification, dissection, and

Endoscopic Transcanal Transpromontorial Removal of an Intracochlear Schwannoma and Cochlear Implantation

A rare and intricate endoscopic approach to removing an intracochlear schwannoma via the transcanal transpromontorial route, followed by 612 cochlear implant placement. The procedure features detailed steps such as tympanomeatal flap elevation,

Lower Lid Internal Blepharoplasty

Minimally invasive lower eyelid fat removal through a transconjunctival blepharoplasty technique that avoids external incisions. Ideal for patients without lid laxity, the procedure enhances lid-cheek contour through conjunctival access, clamp-cut-cauterize excision of fat pads, and bipolar cautery for hemostasis.

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MONTHLY DIGEST

Surgeons Reach Remote African Patients Through New 3D Telemedicine Technology

A pioneering 3D telemedicine project in Ghana is helping bridge the surgical care gap for patients in some of Africa’s most underserved regions. In late February, patients like Charles Owusu Aseku and George Opoku took part in the initiative’s first trial, which allowed them to undergo remote consultations with specialists from around the world—without leaving their communities. The portable system, developed by Microsoft Research in collaboration with local doctors, uses high-resolution cameras and lighting to capture 3D patient models from inside a mobile van.

Why It Matters

The technology enables doctors to conduct pre- and post-surgical consultations remotely, an essential breakthrough in a continent where access to specialists remains extremely limited. In Aseku’s case, the system brought together doctors from Brazil, Rwanda, and Scotland to review his keloid condition—offering multiple expert opinions in one session. For Opoku, a cancer patient, the system replaced a 100-kilometer journey with a consultation in a van parked near his home. Experts say this kind of innovation is vital in Africa, which has one of the lowest doctor-to-patient ratios globally.

What’s Next

The successful trial at Koforidua Regional Hospital is now serving as a model for potential expansion across Ghana and other African countries. While internet connectivity remains a challenge in some regions, project leaders are hopeful that the portable system’s design and real-world impact will attract support for broader implementation. Future phases may include use in plastic surgery, burns, and other specialties, offering a scalable solution for surgical access in the most remote parts of the world.

Perioperative Nurses Take Center Stage in Robotic Surgery Programs

As robotic-assisted surgery becomes the norm in operating rooms across the country, perioperative nurses are emerging as key players in driving its success. At institutions like Cleveland Clinic, where over 2,300 robotic procedures were performed in 2024, nurses are deeply involved in everything from preparing complex robotic systems to assisting in highly specialized operations like single-port kidney transplants and prostatectomies.

Why It Matters

The role of perioperative nurses in robotic programs goes far beyond traditional bedside care. These professionals undergo intensive training to manage robotic equipment, maintain sterile environments, assist surgeons, and troubleshoot real-time challenges in the OR. Nurses such as Alex Vasilevskiy and Carol Lung-Paskoff contribute to better patient outcomes by supporting nerve-sparing techniques and minimally invasive procedures that reduce blood loss and allow same-day discharges. Training is hands-on and methodical, progressing from basic tasks to high-stakes cases like pancreas and kidney transplants.

What’s Next

Their involvement is critical to the success of robotic programs, especially as technology continues to evolve. Improved visualization and instrumentation have elevated surgical precision, and nurses are essential in ensuring these tools are used effectively and safely. With new procedures and systems constantly emerging, Cleveland Clinic’s Robotics Steering Committee—where nurses play an active role—meets quarterly to align on trends, best practices, and ongoing education. As robotic surgery expands into more specialties, the demand for skilled perioperative nurses will only grow.

NHS Surgical Training Still Struggling to Recover Five Years After COVID, Experts Warn

Five years after the onset of the COVID-19 pandemic, the Royal College of Surgeons of England (RCS England) and the Association of Surgeons in Training (ASiT) are raising alarms over the continued disruption to surgical training within the NHS. Despite the return to normal operations across much of the healthcare system, surgical trainees continue to face limited access to operating theatres, reduced hands-on experience, and constrained training time—conditions that threaten to create long-term gaps in the surgical workforce.

Why It Matters

Since March 2020, more than three million surgical training cases have been lost, according to RCS England. Trainees report that service delivery demands often take priority over education, further limiting opportunities to build critical skills. The medical bodies are advocating for urgent action, including better integration of training within service delivery, development of surgical hubs that serve both patients and trainees, and greater involvement from the private sector to support training pathways.

What’s Next

This ongoing training gap poses a serious risk to future surgical care capacity. Without decisive steps, the NHS may face a shortfall of fully trained surgeons just as demand for elective procedures continues to rise. As platforms like CSurgeries expand access to high-quality, peer-reviewed surgical videos and education resources globally, they play a vital role in bridging these gaps—offering trainees supplementary tools to maintain skill development and stay connected to surgical best practices.

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