Episode list

Neurosurgeons perform brain surgery on 20-year-old trainee army medic Cameron to remove a brain tumour. Cardiac surgeon Jorge Mascaro performs a huge operation on a 71-year-old woman.

Tim Martin operates on a woman with a disease so rare, he is thought to be the first in the UK to attempt the procedure. Neurosurgeon Alex Paluzzi is taking on one of the toughest cases of his career too.

This edition explores how surgeons within the NHS endeavour to meet the needs of patients who require surgery to improve their very poor quality of life.

In recent years, huge advances have been made in the surgical treatment of serious conditions that have developed in the womb. These groundbreaking interventions - often carried out in the first few years of life - have the power to dramatically increase life expectancy. But the risks are often high, and the surgeons who specialise in these procedures need to cope with the added pressure of wanting to get the best possible results for their patients' desperately anxious parents. Birmingham Children's Hospital has a reputation as a world-leading centre for complex paediatric procedures. Consultant paediatric cardiac surgeon David Barron is a specialist in heart conditions that are diagnosed before birth, and his patient, three-year-old Madison, has a rare condition which prevents blood from reaching her lungs - giving her low blood-oxygen levels, and impeding her growth and the development of her organs. To correct Madison's unusual anatomy, David must carry out an intricate 12-hour operation to reconstruct the blood supply between her heart and lungs. This is a rarely performed, multi-stage procedure that requires extraordinary stamina and skill on the part of the surgical team, and during which Madison's heart will be stopped altogether. Madison's body has compensated for being born without a proper arterial connection carrying blood from her heart to her lungs by relying on a network of tiny vessels called MAPCAs. We all have these vessels to allow for circulation while we are in the womb, but normally they become redundant after birth. In the operation, David will have to locate the minute MAPCAs in Madison's chest and combine them with her malformed artery, in order to build a new connection between her heart and lungs. A second surgical team is led by consultant paediatric urology and transplant surgeon Liam McCarthy - a specialist in conditions affecting the kidneys and bladder. Two-year-old Isaac's kidneys were damaged in the womb, and to avoid long-term dialysis, he needs a transplant. His father Lee is a match - so he will donate one of his healthy kidneys. He has never had doubts about that decision - after all, as he says, Isaac is "half of me", and this is a chance to make a drastic difference to the quality and length of his son's life. They both undergo surgery on the same day. Lee's kidney is removed at the Queen Elizabeth Hospital Birmingham and rushed across the city to theatre at Birmingham Children's Hospital, ready for the transplant. Isaac's damaged kidneys will not be removed - instead, the donor kidney will be connected in an entirely new position, lower down in the abdomen. The challenge for Liam and consultant hepatobiliary and transplant surgeon Khalid Sharif is to fit this adult kidney safely into the body of a two-year-old, and to make the connections quickly, before the donor organ begins to degrade. If they succeed, they will dramatically improve the quality of Isaac's life and extend his life expectancy by many decades. Birmingham Children's Hospital is part of Birmingham Women's and Children's NHS Foundation Trust.

At the Queen Elizabeth Hospital Birmingham, surgeons with highly specialised skills perform intricate operations that promise to be life-enhancing for their patients. When 44-year-old AnnMarie was just a toddler, she accidentally drank bleach, which caused severe damage. She has been struggling to cope with her badly scarred oesophagus ever since. AnnMarie has trouble swallowing and visits hospital several times a year to have her oesophagus stretched. It is a highly uncomfortable procedure in which a balloon is inserted into the oesophagus and inflated. Now AnnMarie has opted to have an oesophagectomy, even though the procedure is high risk and over 30 per cent of patients have serious post-operative complications. Her surgeon is Ewen Griffiths, one of the Queen Elizabeth's leading consultant upper gastro-intestinal surgeons, who has spent years mastering one of the most complex and risky operations in his field: an oesophagectomy. In this three-stage procedure, the patient's oesophagus - the 25-centimetre feeding tube, which joins the throat to the stomach - is removed and their own stomach is used to replace it. The procedure can last up to eight hours and involves three different operating sites in the neck, chest and abdomen. Consultant colorectal surgeon Simon Radley also performs highly specialised operations in his field: complex colorectal cancer. His patient is 64-year-old retired grandmother Hazel, who has a colon tumour that has spread into her liver and abdominal wall. Without the operation Hazel will have only a few months to live, but there is an outside chance that surgery could remove the cancer entirely and cure Hazel of her disease. It is not yet clear if the cancer has advanced into other internal organs and Simon will only find out once he operates. If it has spread further, then Simon knows he will not be able to remove it entirely. But if it is confined to the bowel, liver and abdominal wall Simon believes he might just get the result Hazel and her husband Alan are pinning their hopes on. The surgical teams need all their skill and years of experience to get the best possible results. As consultant upper GI surgeon John Whiting says, in demanding cases like these, "good enough actually isn't good enough".

The second season of the groundbreaking show concludes with an episode focused on the work of surgeons in the fast-paced field of trauma surgery. With access to the emergency department and trauma theatres of the Queen Elizabeth Hospital Birmingham, the episode features some of the UK's top surgeons battling to make the difference between life and death for critically injured patients who arrive at the QE by land and air. The Queen Elizabeth receives 9,000 patients to its emergency department each month. Many of the most seriously injured can only be saved by urgent surgical intervention. To cope with these trauma cases, the QE has 140 consultant surgeons regularly on call, night and day. With no time to plan and often little or nothing known about a patient's medical history, surgeons must make life-critical, split-second decisions, while racing to perform operations that are no less demanding than their day-to-day elective cases. Consultant neurosurgeon Ismail Ughratdar has just minutes to operate to save the life of a 64-year-old woman who has a bleed on the brain after falling in the street. Blood is accumulating and putting pressure on her brain that is very likely to lead to permanent disability or death unless Ismail can perform a craniotomy to alleviate the pressure in time. As the QE is also the base for receiving all military casualties from overseas, surgeons, doctors, nurses and anaesthetists from the armed forces work alongside NHS staff in the hospital's unique major trauma service. Lessons drawn from the battlefield are especially useful when dealing with polytrauma patients - those brought in with multiple serious injuries. One of the leading consultant general surgeons at the QE, Catherine Powell, is also a commander in the Royal Navy. When a motorcyclist is rushed in by helicopter, she must decide whether to operate on his internal bleeding, or whether the badly dislocated shoulder that could cost him an arm is the most urgent priority.