The US National Aeronautics and Space Administration (NASA) will be familiar to most across the world. Leading highly dangerous and innovative space travel, NASA has gone from a blame culture in the 1960s to an environment that keeps safety at the forefront and a top priority. NASA culture aims to ensure that staff work safely through balancing challenges and risks, feel comfortable communicating safety issues and learn from both successes and error. Surgery, and healthcare in general, still has a long way to go to embed a safety culture that values staff and looks at why incidents and errors have happened, and what can be learnt from them, instead of who was to blame. NASA's safety journey is a powerful study in learning from failure, evolving culture and leading with humility. From the Apollo 1, Challenger and Columbia disasters, NASA built a more transparent, accountable and resilient safety system and one that continues to evolve with the frontiers of space exploration. In many ways, surgeons can learn a lot from NASA to improve both patient safety and culture.

Four-dimensional computed tomography (4DCT) has emerged as an effective imaging modality to aid parathyroid localisation before surgery. Following a service change in 2018, we evaluated the accuracy of 4DCT to lateralise culprit parathyroid glands causing primary hyperparathyroidism (PHPT) in patients undergoing parathyroid surgery in our centre.

Right hemicolectomy has evolved from open to minimally invasive approaches. Laparoscopic right hemicolectomy (LRH) is widely adopted, yet challenges persist, particularly in complex dissections. Robotic right hemicolectomy (RRH) offers enhanced precision and ergonomics but remains under scrutiny for its comparative advantages. This study critically evaluates the perioperative outcomes of LRH vs RRH within a single-centre framework.

Variation of the main branches of the abdominal aorta is not uncommon and its spectrum is broad. However, here we present the supradiaphragmatic origin of the coeliac artery, superior mesenteric artery, and bilateral renal arteries - a variation that has not been reported previously in the literature.

Bone conduction hearing implants (BCHIs) are a valuable alternative option for patients with hearing loss when conventional hearing aids are not effective or a viable option. In the UK, specialist sites offer BCHI services. We aimed to understand whether patients face geographical barriers to accessing this healthcare service.

Nasal obstruction secondary to septal deformity is a common problem, for which surgery is the gold-standard treatment. Long waiting times for surgery, however, leave patients in need of effective, patient-led strategies in the interim. Many wearable nasal devices are commercially available for patients to help relieve nasal obstruction while waiting for surgery; however, the literature around their efficacy is limited.

There is an almost universal perception that following the COVID-19 disruption laparoscopic cholecystectomies (LCs) have become more technically demanding, resulting in poorer outcomes. This study quantifies the differences in outcomes before and after the pandemic.

Oncotype-DX testing has reduced adjuvant chemotherapy use in breast cancer but there is limited evidence on patients with sentinel lymph node micrometastasis (SLNmi). This study aimed to evaluate the real-world use of Oncotype-DX testing on adjuvant chemotherapy decision-making in patients with SLNmi.

During consent, surgeons discuss surgical and anaesthetic risks with patients. We investigated whether patients also wish to be informed about hospital organisational risks.

Oral and maxillofacial surgery (OMFS) is a surgical specialty dealing with a broad spectrum of pathology affecting the head and neck. Despite a rising burden of head and neck conditions, exposure to OMFS in the undergraduate medical curriculum remains limited. This has consequences for medical undergraduates' competence and confidence in managing related conditions and their recruitment into this specialty.

Musculoskeletal (MSK) conditions affect over 20 million people in the UK. Follow-up appointments account for nearly two-thirds of all outpatient activity. Patient-initiated follow-up (PIFU) allows patients to request follow-up appointments based on clinical need, aiming to reduce unnecessary reviews and optimise service use. This study evaluated the impact and utilisation of PIFU in a secondary care Elective Upper Limb (Shoulder and Elbow) Clinic, focusing on patient engagement, re-presentation rates, and suitability across common upper limb conditions.

Balloon sinuplasty is an established technique for treating chronic rhinosinusitis and its role in managing complicated acute rhinosinusitis (ARS) is emerging. Complicated ARS is a potentially life-threatening condition and balloon sinuplasty is not currently a competency required by UK otolaryngology trainees. To our knowledge, we are the first to investigate whether a balloon sinuplasty model simulator was able to improve trainee self-perceived competence.

We aimed to investigate the effect of unplanned conversion to open surgery during laparoscopic pancreaticoduodenectomy on resection margins and complications.

Partial nephrectomy for small renal masses is well established as the preferred means of surgical treatment for kidney cancer, to preserve renal function. Although minimally invasive techniques are now standard in many countries, open surgery remains an important technique for difficult cases. Partial nephrectomy in patients with autosomal dominant polycystic kidney disease (ADPKD) is challenging and not widely reported. We describe the open surgical technique for partial nephrectomy in patients with multicystic kidneys who are not on renal replacement therapy (RRT). We illustrate the technique using three cases of patients with multicystic kidneys and solid renal masses. All had early chronic kidney disease, making partial nephrectomy for suspected kidney cancer the preferred strategy. The patients had stable creatinine and were recurrence-free at last follow-up. Open partial nephrectomy remains an important surgical technique for resection of challenging kidney tumours, such as those in multicystic kidneys. Patients with ADPKD and solid renal masses who are not on RRT should be managed in the same manner as the background population, with nephron-sparing surgery wherever possible.

Self-inflicted harm is a complex behavioural phenomenon and a manifestation of a variety of underlying factors. Penetrating trauma is increasingly common, with rising knife crimes, gun violence and terrorism-related ballistics in the civilian arena. The study aims to review the changing patterns of penetrating neck injury (PNI) over a period of six years in our major trauma service (MTS).