Scalpel in the Sand Another 5 starred review

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The above book received another 5 starred review at and also at  17/04/2013.


Scalpel in the Sand

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Scalpel in the Sand.

EPUB and NOOK versions of Scalpel in the Sand

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Just to announce that the EPUB and NOOk ebook versions are availebale at

Barnes and Noble
View latest review at

Scalpel in the Sand – Memoirs of a surgeon in Saudi Arabia


I never thought that I would meet up with so many ex-colleagues from Saudi Arabia when I started on the book.  It has been a journey of introspection of a very significant period of my life – the 10 years from 1979 till 1989 in Saudi Arabia.  I went out initially for two years having not been able to make any headway in the NHS, but stayed for ten.  I accepted the many opportunities and challenges open to me, increasing my range of surgical skills in the process.  It was to be a very good training ground in preparation for my final position as the Founding Director of the brand new Transplant Centre at St George’s Hospital, London in November 1994.   The period 1994 till 2009 was not covered in the book.  The following is  a very brief thumbnail sketch.

The challenge of building a new transplant centre in the UK when almost all other centres have had histories of at least 25 years was immense.  I decided that to justify the new unit’s rather peculiar position, it had to deliver quality in patient and transplant outcomes and also be very innovative.

Thus, the unit pioneered the use of the third generation immuno-suppressive agent tacrolimus in combination with prednisolone as prophylaxis against acute rejection after kidney transplants.  It introduced the first Annual Public Audit of transplantation to which patients and management were invited initiating a new transparent approach to transplantation.  It started the first accredited surgical training programme in London, culminating in the provision of large animal experimentation in transplantation for surgical trainees.  The Annual Review and Christmas Quiz, free and open to all staff members as a gesture of thanks for their hard work during the year were very popular dates on the calendar.  For some ten years the Annual Review in which the Unit reviewed its work of the past year and sets targets for the following year was followed by a free dinner and dance for all staff at the Savoy Hotel in London.  Screening of patients prior to transplantation was a very important innovation which led to years of 100% patient and graft survivals after kidney transplant.  The latest development was hand assisted retroperitoneal laparoscopic living kidney donor nephrectomies.   This unique keyhole surgery technique, available in the UK only at St George’s Hospital reduced the length of stay of living donors to fewer than 72 hours post-operatively and the length of the procedure to an average of one hour thirty minutes.  St George’s was the only UK unit doing two living donor transplants in one day.  The length of stay after a kidney transplant was also reduced to 5 nights.  In 2010, the number of kidney transplants performed during the year exceeded 100.  The concept that transplant surgeons do NOT own the kidneys, but have CUSTODY of a national resource, an even more onerous task, was introduced to the department. There were two signal failures during my 15 years in post – the failure to add a new Renal Wing although detailed plans had even been drawn and financiers from Malaysia found; and the failure to have a transplant properly costed.  It is sad that even in 2009, the hospital was charging a paltry £5,000 for a transplant when a more realisic cost was in the region of £20,000.

The lessons learnt in Saudi Arabia were very important in the successful development of the brand new transplant centre at St George’s Hospital, Tooting, London.