Cutting, stitching, implanting and transplanting - medical science is consistently pushing the boundaries of surgery. There are some amazingly interesting ops out there.

Advances in computer imaging, fibre optic endoscopes, and the development of more and more advanced surgical tools, means that things are changing fast at the cutting edge of surgery. It's not all brand new either: we have been capable of extraordinary things for years.

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Angioplasty and stenting
Angioplasty is a procedure performed to open up blocked coronary arteries and is sometimes done as an alternative to coronary bypass surgery.

In this procedure a wire is inserted into the patient's body at the groin, hand or arm. This thin wire is threaded all the way to the aorta and up to the blocked coronary artery. A small amount of dye is released and tracked using x-rays.

The x-rays help pinpoint the exact position at which the blockage is situated. The blocked artery is then forced open by inflating a special kind of balloon. Once opened, it is kept open by a stent (a cylindrical wire mesh), allowing blood to once again flow freely.

Angioplasty made our list because of the simple physical principles that it is based on. A stent, for example, is basically a pipe, much like those that bring water to our houses.

Face transplantation
In 2005 French surgeons completed the world's first partial face transplant. In most skin transplant cases, the patient's own skin is used. In this case, however, skin from a brain-dead donor was used.

Tissue, muscles, arteries and veins from the donor were attached to the lower part of the recipient's face. A year later, the woman was reported to be doing extremely well. Facial senstivity and mobility had returned; and the patient was said to be able to smile, eat and drink with no trouble. With make-up scarring was barely visible.

At the time of the operation, the surgeons stressed that the new face would look like a hybrid of the donor and the recipient. Since then, however, the patient has declared that she in fact looks like herself - and that friends recognised her in the street.

Fetoscopic foetal surgery
Foetal surgery involves operating on the foetus before birth. It is done to correct, or limit the damage from congenital abnormalities that cannot be equally well treated after birth.

In fetoscopic surgery the foetus is operated on while still inside the womb. Fibre optic telescopes and specially designed instruments are inserted through a small incision in the uterus.

The tools used in such surgery are extremely small and highly specialised. In addition, fetoscopic surgery requires immense precision from the surgeon.

Fetoscopic surgery can be used to treat spina bifida, congenital diaphragmatic hernia, and twin-twin transfusion syndrome, among others.

Awake brain surgery
In awake brain mapping surgery the patient is awake during part of the brain surgery. This procedure is usually done to remove brain tumours.

The patient is anaesthetised and part of his scull is cut open, exposing the brain. MRI scans help the surgeons locate the exact location of the tumour.

During the surgery the patient is given a cocktail of drugs to wake him or her up. Once awake, the patient is asked to count, read, talk, or to identify a number of pictures. Pulses are also sent through certain brain regions and the patient is asked about sensations in different parts of the body.

The information gathered, combined with advanced computer modelling allows the brain to be very accurately mapped. As a result, surgeons can remove more of the tumour, and the risk of damage to areas of the brain related to motor and speech function is decreased.

Heart transplantation
First performed in 1967 by the South African heart surgeon Christiaan Barnard, heart transplantation remains one of man's most incredible achievements in the field of medical science.

A donor heart is taken from a brain-dead individual and placed in a special solution. The recipient's breastbone is cut open and before the heart is removed the patient is connected to a bypass machine that keeps the body going while there is no heart.

The new heart is inserted, stitched in place, the necessary connections made, and if all goes well, it will start beating. If it doesn't start beating by itself, an electric shock may be used to jolt it into action.

Thousands of heart transplants are carried out each year and survival after a transplant has been significantly improved by the use of anti-rejection drugs. (Marcus Low, Health24, updated April 2008)
 

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