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University Hospital Southampton provides care for close to three million people across the south of England every year, treating patients with the most complex surgical needs.

Those with serious liver and pancreatic conditions are seen by consultants on the hepato-pancreato-biliary or HPB team. One of its leading consultants is Arjun Takhar. His patient is 55-year-old Lisa, who has an egg sized tumour in her pancreas which has spread causing multiple tumours in her liver. These are a rare type of neuroendocrine tumour, diagnosed in just 4000 people each year. If Arjun can鈥檛 remove Lisa鈥檚 tumours, they will continue to grow and will eventually kill her.

To operate, Arjun is joined by fellow HPB consultant surgeon Tom Armstrong. Accessing and removing as many tumours as possible will be a challenge for the duo as the liver contains 13% of the body鈥檚 blood supply and when they cut into it there鈥檚 a high risk of bleeding. The anaesthetist plans to mitigate this risk by keeping Lisa鈥檚 hydration as low as possible, lowering her blood volume, so the veins in her liver are less likely to bleed. But, when the surgeons start removing the tumours there鈥檚 more bleeding than they anticipated, and they need to come up with a new plan. This involves clamping off the blood supply to the liver at intervals, which is a challenge; if the organ is left for too long without blood it could be permanently damaged.

To remove the cancer in Lisa鈥檚 pancreas, they need to cut off the tumorous section, and they must also cut out the spleen as the cancer may have spread there. To do this they need to locate and tie off the splenic artery which supplies both organs with blood. But Lisa鈥檚 anatomy means Arjun has difficulty locating the artery. If he can鈥檛 find and isolate the vessel, the operation can鈥檛 continue.

Southampton also takes on rare and ground-breaking operations in its orthopaedic department. Specialist knee consultant Amir Qureshi鈥檚 patient is 42-year-old Bruno, who has bow legs that are now at such a severe angle he鈥檚 in constant pain and has difficulty walking. The bones in Bruno鈥檚 legs, which curve outwards at the knee, are in danger of breaking because of the stress. The procedure to correct them is so complex it鈥檚 been two years in the planning.

Amir will need to make four corrections to Bruno legs, above and below the knee on each leg. On Bruno鈥檚 tibias, or shin bones, Amir will add a wedge of donor bone to each. While on the femurs, or thigh bones, he will remove a wedge of bone. Precision is key in the operation, so Amir has planned it with medical engineer Sam Grasso. Sam has produced 3D models of all the bones, and then created cutting guides that will sit on the bones, so Amir knows exactly where to cut.

If any angle or measurement is out, then the correction will fail. There鈥檚 also a risk that Bruno鈥檚 bones could break all the way through. This would mean making another incision to fix the problem which would cause his body to have a huge inflammatory response, leading to congested lungs and potentially heart failure.