London’s Royal Free Hospital was shortlisted for AIMed Best COVID-19 AI solution for its use of technology to facilitate communication in the operating theatre while wearing PPE. Here’s the inside story


Surgery is stressful at the best of times. But going about your work in the middle of a pandemic in front of TV cameras is almost off the scale!

“I didn’t even know when I turned up at the hospital that day that I would be on television,” recalls Professor Martin Birchall, ENT Surgeon at the University College London Hospitals NHS Foundation Trust, and Director of the NIHR RCSE Advanced Surgical Technology Incubator. Professor Birchall appeared in series 6 of Hospital, a BBC TV documentary which was filmed when the UK underwent its first lockdown in March 2020.

Professor Birchall was about to carry out an emergency procedure on Nancy, a community nurse who has worked for the public health service, NHS, since 1970. Nancy was diagnosed with COVID-19. While on the ventilator, the breathing tube was stuck in Nancy’s larynx and an operation was needed to remove it. “I’d never done this before,” said Professor Birchall. “It was the first COVID-19-positive operation I’d done and the first COVID-19-positive patient to have any sort of surgery at the Royal Free. We didn’t know at that stage what the risks were and it was frightening.”

During the operation, ulcers were discovered around Nancy’s larynx. Professor Birchall and the surgical team had to free up the constricted airway and insert a smaller breathing tube. It transipred that Nancy was one of the first patients to suffer from COVID-related laryngitis in Britain. To safeguard its care team, Royal Free Hospital required fit and leak testing to be performed on members with an FFP3 mask, to ensure protection was not compromised due to an inadequate seal.

“This is very important to give you confidence that your mask is doing what it’s meant to do,” Professor Birchall added. “It was very reassuring that they’d thought about it and gave me the best possible protection”. However, communication became challenging when the whole surgical team was in full PPE and began working in an isolated operating theatre. The FFP3 mask, coupled with a full face shield and visor were hindering team members from speaking and listening out for others.

This was shown in the documentary when the medical staff outside the operating theatre were seen holding onto a plastic-wrapped walkie-talkie and unable to make sense of what the surgical team was asking for. Fortunately, Royal Free Hospital had already foresaw the possibility of restrictive communications early on in the pandemic and knew it might pose a risk to any environment where teamwork is crucial.

As such, the hospital had been piloting products from tech giants like Apple and MRTC, a global motorsport and event communication company, which offered customized radio and intercom communications used by Formula One racing teams. According to Professor Birchall, MRTC supplied sets of voice-activated systems that enable anyone who is speaking, to talk to the whole surgical team.

In addition, Apple provided its Powerbeats earpieces for staff to wear throughout surgery without interfering with their PPE. The surgical team would set up FaceTime audio during surgery to speak with different members or other medical staff. Royal Free Hospital also planned to run a similar project by James Kinross, a surgeon at Imperial College Healthcare NHS Trust who used Microsoft virtual reality headset HoloLens to do ward rounds so that only one medical staff is required to be physically present at any one point in time in the COVID-19 positive wards.

While all these technologies have shown clear benefits, Professor Birchall noted there currently still isn’t a perfect unified solution to operating and working in full PPE. “There is a clear need for someone to develop a bespoke set of equipment for operating theatres,” he added.

Despite that, Professor Birchall stressed the importance of wearing PPR at appropriate levels despite the discomfort and difficulties; “It doesn’t’ just protect us but also increases the confidence of patients. They need to know that if they come to us for surgery or outpatient treatment, they will be protected as much as possible.”

Since the first patient with coronavirus was admitted to the Royal Free Hospital on 9th February 2020, the medical facility has treated nearly 2000 COVID-19 positive patients and been forced to double the size of its intensive care unit.

The battle continues.