Tag Archives: Surgery

Matt Durran – The Artist Pioneering Nose Reconstruction Surgery

Matt is an artist working with glass, who had never planned to work in the medical world. But when an opportunity came up that involved growing human noses within glass moulds, he jumped at the chance.

Just under the railway bridge at the end of a row of shops, there is a red door with frosted glass. The only suggestion of an artist’s residence is the pressed ceramic house number screwed to the wall. We ring the bell tentatively half expecting it to be the wrong address, but with a clunk of keys and a swing of the door Matt Durran, an artist working in glass, welcomes us in.

We first heard about Matt’s work through the Craft Council. He didn’t seem an obvious choice for a healthcare publication like this one, but after a bit of research around his work, we were fascinated and got in contact. Matt prides himself on his variety of work. Over the years his explorations have taken him from ancient lava-formed obsidian to stockpiled waste glass and the frontiers of new technologies. He has created unique pieces of installation art, up cycled waste glass as well as solved specific problems for the medical industry. One of Matt’s early jobs was carving ice for an events company back in the 1990s. He said, “It seemed a bit crazy, you’d do all that work for it just to melt away so I wanted to do something more permanent and was really intrigued by glass.” He started on lots of different projects using glass but quickly realised that he needed to understand the material technology side. When he got the opportunity to study in Sunderland and Copenhagen he jumped at it. He was fascinated with the technical and cultural differences in approach between the two countries. This led to a re-evaluation of his practice.

Matt’s insight into the material possibilities of glass, alongside his artistic ability to make creative leaps made him the obvious choice for the team at the Royal Free Hospital. They needed bespoke, highly accurate products but hadn’t managed to find a medical glass maker who could produce exactly what they were looking for, which was to create a non-reactive, detailed mould for tissue-engineered cartilage specifically to create a nose. Matt knew it could be done. He said, “Glass is the perfect material to use for this, it’s been used in the medical industry for 250 years, it can be sterilised easily, it’s inert and you can see cells growing through the material. It can also be manipulated to exact requirements.”

His creative approach allowed him to experiment with a number of different moulds until he happened upon one that would work perfectly. He began with a plaster cast of his own nose and then used a technique called slumping – laying warm glass over a mould with painstaking care – to make several glass moulds of his own nose. The moulds were then filled with a synthetic material, which contained the patients cells to create the scaffolding of the nose. It was then grown in a bioreactor. Once the basic structure of the nose was created it was attached to the inside of the patients forearm. This bio-integration allows blood vessels to populate it and skin to fix to it, a process that can take months. Then after successful bio-integration the nose is surgically removed from the forearm and carefully attached to the face. Matt said, “Although my part’s a small one, it’s an important part.’’ Getting the nose accurate for people is very important so the detail of the mould had to be just right. A lot of the patients lose their nose through cancer and other illnesses.

Losing something so central to the face can bring a loss of identity and self esteem, so this process allows patients to get back the important body part as well as their confidence. Since that first nose Matt has gone on to make a lot of different moulds for noses, ears and even voice boxes. He said, “Each nose job was completely different. I remember one particular nose I needed to re-create had a real bend in it and I suggested straightening it out to which I was met with ‘no thanks, that’s what makes my nose unique’.”

The research around this type of surgery is still on going and Matt’s skills are still requested from time to time, but his next project is away from the medical field in macro glass sculpture. He added, “My father said to me… the best job in the world is the one that’s different every day. If that’s true, then I guess I have the best job in the world.” Matt’s creative input opened doors for researchers that were previously closed. He researched, experimented and created moulds that were simple in production but detailed in execution giving patients the confidence to once again be comfortable in their own skin. An artist working in glass may be the last person you would associate with the medical industry but researchers may now increasingly look to local craftsmen to play a vital part in the process, acknowledging that problems sometimes need that external creative input to reach the desired outcome.

www.mattdurran.com

Learn more about the #HealthcareHeroes at: www.healthcare-heroes.com

Prof. Paulo Edwardo Stanga – The man behind the world’s first bionic eye transplant

In July 2015, Professor Paulo Stanga conducted the world’s first implant of a bionic eye. The pioneering technology means that patients who are completely blind are able to see for the first time, using technology which sends wireless signals between the brain and an implant in the retina.

Professor Paulo Stanga conducted the world’s first bionic eye transplant in July 2015, marking the beginning of a new era for patients with sight loss.

Over its 200-year history, Manchester Royal Eye Hospital has been home to a wealth of pioneering individuals who’ve pushed the boundaries in eye care. One such individual is Professor Paulo Stanga, who carried out the world’s first implant of an artificial retina, popularly known as a ‘bionic eye’, in patients with Age-Related Macular Degeneration (AMD).

Professor Stanga is a Consultant Ophthalmologist and Vitreoretinal Surgeon at Manchester Royal Eye Hospital. He has travelled the world and held jobs in some of the busiest cities, from Buenos Aires, to New York, London, Liverpool and now Manchester. We meet him at a room in the NIHR/Wellcome Trust Manchester Clinical Research Facility surrounded by a number of specialist retinal imaging devices and looked on by a number of printed eyes displayed on posters attached to the walls. Professor Stanga became interested in pioneering research early in his career, saying that he wanted, “To challenge established concepts and develop new ways of treating patients.” Those early days were busy and demanding. He spent the early ’90s in New York working for Professor Harvey Lincoff who was one of the most famous retinal surgeons of his time. Paulo was working long hours in the week and also at weekends. He smiled as he said, “I even had to bring my wedding forward and delay my honeymoon in order to hit a deadline two days after I was married. My wife still reminds me now that we haven’t had a honeymoon.”

After New York, Paulo worked in London and Liverpool before settling in Manchester in 2003. “The opportunity was brilliant, the role gave me a chance to set up a team around my research and push on with pioneering trials.” After introducing, amongst others, new imaging and retinal laser technologies as well as treatment techniques into clinical care, in 2008 Paulo started setting up trials with the bionic eye. He worked closely with a US company called Second Sight who produce the Argus II Retinal Prosthesis System also known as the bionic eye. The initial trial focused on the implantation of the bionic eye for complete blindness in Retinitis Pigmentosa. He subsequently set up a pilot study of the bionic eye system in Dry AMD, one of the most common forms of severe loss of central vision, which affects 20-25 million people worldwide and 44,000 more people per year in the UK. The condition causes an impairment of the central vision resulting in people being unable to discriminate faces, read or drive. The world’s first surgery on a patient with this condition was completed by Paulo in 2015 on 80-year-old Mr Flynn, whose central vision had completely disappeared. The procedure involved attaching the implant within one of Mr Flynn’s eyes. This implant receives its visual information from a miniature camera mounted on glasses worn by the patient. The information is then transmitted wirelessly to a receiver that sits on the wall of the eye and from which the information is transferred to an array of electrodes that sits on the surface of the macula where they stimulate the remaining cells and replicate the patterns of light and darkness for the brain. The surgery was a huge success and less than two weeks later Mr Flynn was able to detect patterns of horizontal, vertical and diagonal lines on a computer screen using the newly acquired central vision provided by the implant. Paulo said, “Over time Mr Flynn is learning to interpret these patterns of light and darkness and regain some central visual function.” The implant itself cannot provide any detailed vision but it can help patients to detect distinct patterns such as door frames and shapes without having to rely solely on their peripheral vision. Paulo praised all patients who are taking part in the trial.

“We are learning because of the courage and generosity of the patients taking part in this trial. At the moment there are only five patients in this trial but their involvement now means that in time we will be able to enrol others and this way help a lot more people. We are very excited and feel very positive about this trial. Our patients are the first ever human beings to experience the combination of their natural and residual with artificial vision. This successful integration of these two types of vision will hopefully pave the way for the treatment of many other causes of blindness”. Paulo told us that he still vividly remembers when one of the first patients with Retinitis Pigmentosa to be implanted in 2009 told him that, “Over Christmas he had seen fireworks for the first time in 30 years and also the glow of the Christmas lights, he could even make out his grandkids running towards him. These are the stories that drive us.”

These unique trials are only taking place through the Manchester Vision Regeneration (MVR) Lab at the Manchester Royal Eye Hospital and NIHR/Wellcome Trust Manchester Clinical Research Facility, as well as an independent Retinal Clinical-Research Fellowship Programme which Prof. Stanga set up in 2010 to contribute to this and other research. He said, “I couldn’t do any of this without the support of my team and the understanding of my family.” His fascination with the eye and his continued interest in how high end technology can help the medical industry allows Prof. Paulo Stanga to seek out solutions that haven’t been trialed or even thought of. He’s building a strong team and continues to treat patients with career defining surgery, improving the vision of many and in some cases restoring some visual function and helping patients to live more independently.

www.cmft.nhs.uk/royal-eye

Learn more about the #HealthcareHeroes at: www.healthcare-heroes.com

Tal Golesworthy – The boiler engineer that repaired his own heart

This week’s inspirational Healthcare Hero is Tal Golesworthy, a former boiler engineer — he knows piping and plumbing. When he needed surgery to repair a life-threatening problem with his aorta, he mixed his engineering skills with his doctors’ medical knowledge to design a better repair job.

He has now founded his own company that funds the research and development of devices that will help people with aortic dilation avoid major surgery and lifelong drug therapy.

“I’m being unwittingly emotionally blackmailed by the patients.” Tal bellowed with a wry smile on his face and a subtle shake of the head. “We’ve helped 78 people with the syndrome and have over 300 years of trouble free, post operative success, but still it’s like wading through thick mud trying to get the NHS to use the product.” But it’s these 78 success stories that keep pushing Tal every day, knowing the positive impact his invention can have.

Tal Golesworthy is in his 50s, he’s an ageing rocker, a former combustion research and development engineer who has found himself in the medical world innovating new products because of a syndrome he’s had from birth. Tal has Marfan syndrome, a genetic disorder that can cause problems with eyes, skeleton, and in Tal’s case, his heart, more specifically his aorta. As the heart pumps blood around the body, the aorta stretches to accommodate the blood flow. In most cases it relaxes back to normal size but in Tal’s case it doesn’t, gradually enlarging over time. He’d known about the syndrome from an early age but a genetic study in 1992, found his aortic root diameter was significantly above the norm. This started an annual review process and in 2000 he was told the time had come to consider pre-emptive surgery.

Tal scoured the net and sought advice from the best doctors and surgeons in the business. He wasn’t happy with any of the options available. “Traditional surgery dictated I have my chest cut open, a metal valve and prosthetic aorta inserted to replace my own aortic valve and aorta and then live on a blood thinning drug for the rest of my life. No thank you!” Tal’s research and development background meant he was well equipped to handle a medical project, so he set about researching everything there was to know about Marfan syndrome, the aortic valve and the complications of this medical procedure.

He approached the project from an unusual angle. He thought that if a hosepipe is bulging, then you simply get some insulation tape and wrap it round the outside of the hosepipe to stop it bulging. So rather than replacement, his idea was to protect the current aortic root by surrounding it with a medical grade mesh. What started out as a side project became his full-time job and he set up a small team which over four years developed the various stages of imaging, CAD modelling, manufacturing, cleaning and sterilising the implant until they were happy to proceed.

Part of that team was Prof. Tom Treasure, then at Guy’s Hospital London, and Prof. John Pepper, of the Royal Brompton Hospital, London. It was John who would be carrying out the first surgery on Tal. Tal said, “I had to trust this man with my life; I had total faith in John, I was completely happy with the implant, but that didn’t mean I wasn’t completely petrified.” The operation was a success, the implant fitted and there were no immediate complications. The breakthrough had happened, a procedure that took half the time of the current one, one which meant Tal wouldn’t be reliant on debilitating drugs and would allow him to go on and live a full life. He was ready to shout from the rooftops about this amazing new product that could save the NHS time and money and decided his time would now be better spent getting this product to market, allowing people to go on living life drug-free, through his company Exstent.

The operation has been completed 78 times since that day, the youngest patient being 11 years old, the oldest, 56. There are currently over 30 publications written about the procedure in major journals, Tal talks a lot at medical conferences and his TED talk has had over one million hits. However this surgery relies on GPs and cardiologists offering the implants. “For me it’s more than 12 years post op and we’ve only done 78 patients. It’s a joke.” When you consider that with this cardiac problem there are approximately 2,000 operations a year around Europe that could benefit from the implant, it is easy to see Tal’s frustration.

This frustration is shared by a lot of other inventors trying to break into a tough medical arena. He said, “All I set out to do was to fix myself. I didn’t set out to change the world, but I’ve found myself in a position where I’m trying to change a part of the world that is very resistant to change. If I had any sense I’d walk away, but it seems I don’t have any. I can’t abandon those patients who want to exercise their choice of treatment.” It’s easy to see the desire Tal has, the passion that bursts out of him when he talks and the fact that his job isn’t a job, it’s a mission to realise the potential of an implant that can make such a positive impact on people’s lives.

Watch Tal’s TED talk here.

Learn more about the #HealthcareHeroes at: www.healthcare-heroes.com