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From the President's Desk

01 April 2025

From the President’s Desk:
By the President of the Society for Cardiothoracic Surgery in Great Britain & Ireland (SCTS)

A theme for me this week has been robotics and other innovations shaping the future as cardiothoracic surgery continues to modernise.

I was particularly struck by the recently published Robotic Beating, Heart LIMA to LAD TECAB on CTSNet. The technical and clinical success was matched by small incisions, no thoracotomy or sternotomy, and rapid recovery. If we are to embrace such technology, it must come with measurably better outcomes for the patient and remain within the cost envelope. That comes through shorter stay and a faster return to normal life, as this case demonstrates.

We also had the very good news that the Belfast team has started robotic thoracic surgery. This whole team effort represents a major success for the unit and means that patients in both Northern Ireland and the Republic of Ireland now have access to robotics. Congratulations to the team for overcoming the hurdles and organising the system to deliver this.

At our 2025 SCTS Annual Conference in Edinburgh, we also received historic news: robotic thoracic surgery has now surpassed open thoracic surgery by volume, with VATS still maintaining a significant lead. After a slow start, and thanks to forward-thinking surgeons and systems, we may now be witnessing an ascent of robotic surgery in cardiothoracics.

At SCTS, we have contributed to multi-stakeholder reviews on Robotic Assisted Surgery (RAS).
My view is that robust RAS training must be included in cardiothoracic training. This must be delivered in a quality, and outcome assessed manner. Crucially, it must include the wider operating room team. This investment should be seen as part of the broader shift towards very short-stay cardiothoracic surgery.

We must also address the needs of consultants already in practice. I believe it is the responsibility of the primary employer, in Great Britain the NHS, and in Ireland the HSE, to ensure this. At the very least, it must be fully funded and include a significant period of immersive training, with backfill to maintain ongoing clinical services. This may even require paid sabbaticals for structured upskilling.

Some may be concerned that we lack the resources to deliver this. I contend that we do have the resources, but they are simply being spent elsewhere on less effective matters. Abolishing NHSE and merging its duties into the DHSC would release substantial funding and reduce red tape. I call for that benefit to be passed directly to patients through technology, clinical innovation, and system reform.

Which brings me to another point: the logistical challenges in our complex healthcare system. My own robotic list was thwarted when the team realised that, on the day, we did not have all the required sterile components. Fortunately, I was able to revert to VATS. But it made the point clearly: as we’ve also seen in cardiac surgery and elsewhere, our supply chains and inventory systems are sometimes fragile, and sensitive to disruption. Time for more in-built national resilience?

This fed into a broader reflection on our work in SCTS. Recent discussions have highlighted the financial constraints facing our charity, industry partners, and the wider economy. While fiscal prudence is essential, strategic investment, particularly in modernisation and leadership development remains vital. Without funding for dedicated personnel to manage SCTS and deliver our courses, grants, and other initiatives, even the best-designed programmes cannot achieve their full potential.

At SCTS, we are actively exploring novel fundraising sources, so we can provide greater value to our members, while avoiding fee increases and even considering how we might reduce costs. This will be a key focus at the upcoming SCTS Trustees’ meeting, where we will further develop our vision for the Society’s modernisation programme.

I hope you are enjoying the longer days and the blossoms of spring. This week, I’ve been invigorated by a moving Candlelight concert which I highly recommend, supporting my youngest son’s football match as designated team MVP (also known as ‘most valuable parent’) driver, and attending the first exhibition of a chemist-turned-ceramicist, a reminder that innovation, in all its forms, continues to surprise and inspire.

Warm regards,

Aman S Coonar
President, Society for Cardiothoracic Surgery in Great Britain & Ireland

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