Nausea and vomiting are common after surgery, but wearing noise-cancelling headphones during the procedure helps prevent these unpleasant side effects. This simple intervention also supports the idea that our brain processes sounds even when we鈥檙e not consciously aware of our surroundings.

鈥淭hat data is really encouraging and is actually in line with decades of research showing that anaesthesia is not simply an off switch,鈥� says at the Baylor College of Medicine in Houston.

Nausea and vomiting are common side effects of anaesthetics. Patients are routinely given drugs to prevent them, but at the First Affiliated Hospital of Soochow University in Suzhou, China, and his colleagues wanted to investigate a non-pharmacological approach and presented their results at the Anesthesiology conference in San Diego.

The team recruited 192 patients who had keyhole gynaecological surgery under general anaesthesic. Half were randomly assigned noise-blocking ear defenders, which they wore from the start of anaesthesia until the end of surgery. All the patients received standard anaesthesia and anti-nausea medication.

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Within 48 hours of the surgery, 35 per cent of those wearing ear defenders experienced nausea or vomiting, compared with 52 per cent of those without them. The researchers also found that symptoms were less severe among those whose hearing had been protected, defined as the patients vomiting less and it having less of an impact on their daily life.

Operating theatres aren鈥檛 generally quiet places, with Liu recording average noise levels of 66 decibels 鈥� around the level of a normal conversation 鈥� during the study.

The relationship between sound, nausea and vomiting, and anaesthesia is unclear. However, the latter affects the nervous system, and noise is thought to trigger a stress response that activates the autonomic nervous system. This helps regulate involuntary bodily functions, such as heart rate, and interacts with the brainstem pathways involved in nausea and vomiting.

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However, Liu stresses that the researchers didn鈥檛 look into the mechanism behind how ear defenders prevent nausea and vomiting, so the idea of them dampening this response 鈥渞emains a hypothesis鈥�.

Nevertheless, the results tell us more about brain activity under anaesthesia. 鈥淭he biological plausibility is that general anaesthesia produces unconsciousness without necessarily eliminating all neural processing of sound,鈥� says Liu.

Liu hopes to one day conduct a larger trial at multiple locations that measures noise exposure relative to nervous system activity among patients under general anaesthetic.

A patch made of stem cells from donor placentas has been used to treat fetuses in the womb with a severe form of spina bifida as part of a world-first trial. The novel approach seems to have reversed a brain complication associated with the congenital condition at least as effectively as the go-to treatment, but is expected to enable more children to walk over the long term.

The mother of one of the babies, who is now 4 years old, says she expected that her son Toby would require a wheelchair when he was diagnosed with the condition in the womb. 鈥淏ut Toby is healthy [and] has hit all of his milestones 鈥� he鈥檚 walking, running and jumping 鈥� and has no problems with bladder control, which is rare for people with the condition,鈥� she says.

Spina bifida 鈥� which affects about 鈥� occurs when a baby鈥檚 spine and spinal cord do not fully develop in the womb. In the most severe form of the condition, called myelomeningocele, the spinal cord and its surrounding tissue protrude out of a gap in the vertebrae, which often impairs mobility and bowel and bladder control. The cause of spina bifida is unknown, but folic acid deficiency during pregnancy raises the risk.

One of the standard treatments involves surgery in the womb that tucks the spinal cord and the surrounding tissue back into the vertebrae, before sewing up the skin to form a tight seal. 鈥淏ut many children still end up unable to walk and there鈥檚 [usually] no improvement in bowel or bladder control,鈥� says at the University of California, Davis.

This led Farmer and her colleagues to wonder if the addition of stem cells could help by promoting the growth and repair of spinal tissue. To find out, they recruited six pregnant women carrying fetuses with myelomeningocele.

By about 24 weeks鈥� gestation, all the fetuses had developed a common complication called hindbrain herniation, where too much fluid builds up in the skull, pushing the bottom of the brain, the cerebellum, through a hole at the skull鈥檚 base. The standard surgery often helps to reverse hindbrain herniation, but many children still have complications.

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In the latest trial, all the fetuses underwent the standard surgery but also received a patch, measuring a few centimetres long, that contained stem cells derived from donated placentas that were embedded in a matrix of sticky proteins. Surgeons placed this patch on the spine before the skin was sewn around it. 鈥淭he cells secrete their magic stem cell juice,鈥� says Farmer.

At birth, the surgery site had healed well in all of the babies, with no signs of abnormal cell growth. 鈥淎 key worry was that adding stem cells in a fetus would make the cells grow like crazy, but we didn鈥檛 see that,鈥� says Farmer. MRI scans of their brains also showed that the treatment completely reversed hindbrain herniation.

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鈥淢y personal opinion is that this will improve long-term outcomes compared to the standard approach [based on evidence from animal studies],鈥� says at King鈥檚 College London.

The researchers hope to assess this in a trial where 35 fetuses with myelomeningocele will receive the stem-cell patch, and their outcomes will be compared against a previous study that used the conventional surgery, says Farmer.

But Shangaris says that a better comparison, which is more likely to lead to the treatment being approved, would be to compare the two approaches in a head-to-head trial that assesses their safety and efficacy on fetuses who were randomly assigned to each intervention.

With slight modifications, hot glue guns commonly used in arts and crafts can repair damaged bones quickly and cheaply, researchers say.

Bones can repair themselves after small injuries, but if there is a void 鈥� because of serious trauma or tumour removal, for example 鈥� then that space needs to be filled with either a graft or an artificial plug made of a material that encourages bone cells to spread.

One solution is to use 3D printers to create perfectly-fitting scaffolds to fill such voids, but this requires scanning and remote fabrication 鈥� a process taking at least a week. That is fine for a pre-planned operation to fix a worn-out joint, for example, but not for emergency trauma surgery.

To solve this problem, at Sungkyunkwan University in South Korea and his colleagues have developed a system that can be applied instantly during a single surgery.

They modified a hot glue gun by reducing the temperature at which it operates from over 100掳C to around 60掳C. They also concocted a material that acts as a biological glue 鈥� a mixture of hydroxyapatite, which makes up 50 per cent of the volume of normal human bones, and a biodegradable thermoplastic called polycaprolactone.

Surgeons can use the hot glue gun to fill bone voids in a matter of minutes during surgery and bone cells are then able to span the gap and permanently repair the injury over time.

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鈥淚t is basically made of commercially available hot glue guns,鈥� says Lee. 鈥淲e can save time and cost.鈥�

Lee and his colleagues tested the glue gun by repairing centimetre-long gaps in rabbits鈥� femur bones. In samples taken after 12 weeks, there were no signs of medical problems or separation between the glue and the bone.聽 The bone volume was more than twice as high in the animals treated with the glue gun than in control animals where the repair was made with traditional bone cement.

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The researchers also found they could incorporate vancomycin and gentamicin, two antibacterial compounds, into the filament to reduce the potential for infection. The drugs are released slowly and diffuse directly onto the surgical site over several weeks.

at the University of Nottingham, UK, who is researching 3D-printed scaffolds for bone repair, is sceptical a hot glue gun will end up becoming a widely-used solution ahead of faster scanning and 3D-printing technology.

鈥淒o I think it鈥檚 an interesting concept? Yes. Could it feasibly work?鈥� Yes. Do I think it鈥檚 within the range of the plausible? 鈥℡es,鈥� he says. 鈥淏ut this might not be the thing.鈥�

Surgery is typically a last resort for people with a chronically blocked or runny nose. But in some cases, it may actually work better than the antibiotics that are routinely prescribed to treat the condition.

Chronic sinusitis affects about and occurs when the mucus-producing cavities 鈥� sinuses 鈥� around the nose become inflamed. Common symptoms include a blocked or runny nose, a reduced sense of smell and facial pain, with these persisting for more than 12 weeks. The cause of the condition is usually unclear but may involve viral infections or a change to the nose microbiome.

The first line of treatment involves anti-inflammatory nasal sprays and flushing saline solution through the nose daily. But if symptoms persist, doctors often prescribe a three-month course of the antibiotic clarithromycin. This is used for its anti-inflammatory properties rather than its bacteria-killing properties, says at the University of East Anglia in the UK.

As a last resort, people can undergo surgery to widen the sinuses and remove any benign nasal growths, or polyps, which form and worsen symptoms in of cases. Yet no prior study has directly compared surgery with antibiotics.

To fill this gap, Philpott and his colleagues recruited more than 500 adults with chronic rhinosinusitis. In surveys, the participants rated the severity of 22 symptoms, such as facial pain and how runny their nose was, with an average score of 55 out of 110.

The team then randomly assigned the participants to take either a three-month course of clarithromycin, placebo pills or undergo nasal surgery. All the participants also used nasal sprays and rinsed their noses with saline.

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Six months later, those who took either clarithromycin or placebo pills reported a roughly 10-point reduction in the severity of their symptoms compared with before the treatment, a level that would noticeably improve their quality of life, says team member at King鈥檚 College London. But since the effect was seen in both the antibiotic and placebo groups, it was probably due to the nasal sprays and rinsing, she says.

Those in the surgery group saw a roughly 30-point improvement in their symptoms compared with before surgery, suggesting doctors should offer this instead of antibiotics, says Hopkins.

There is an important caveat, however. About 80 per cent of the participants had nasal polyps, possibly because the study took place during the covid-19 pandemic, and catching the coronavirus may trigger the , says Hopkins. Further studies are needed to check whether the results apply to those without polyps, who we know harbour different types of inflammation, she says.

An AI-powered robot was able to separate the gall bladder from the liver of a dead pig in what researchers claim is the first realistic surgery by a machine with almost no human intervention.

The robot is powered by a two-tier AI system trained on 17 hours of video encompassing 16,000 motions made in operations by human surgeons. When put to work, the first layer of the AI system watches video from an endoscope monitoring the surgery and issues plain-language instructions, such as 鈥渃lip the second duct鈥�, while the second AI layer turns each instruction into three-dimensional tool motions.

In all, the gall bladder surgery required 17 separate tasks. The robotic system performed the operation eight times, achieving 100 per cent success in all of the tasks.

鈥淐urrent surgical robotic technology has made some procedures less invasive, but complication rates haven鈥檛 really dropped from previous laparoscopic [keyhole] surgeries [by human surgeons],鈥� says team member at Johns Hopkins University in Maryland. 鈥淭his made us look into what is the next generation of robotic systems that can help patients and surgeons.鈥�

鈥淭he study really highlights the art of the possible with AI and surgical robotics,鈥� says at University College London. 鈥淚ncredible advances in computer vision for surgical video with the availability of open robotic platforms for research make it possible to demonstrate surgical automation.鈥�

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But many challenges remain to make the system practical in clinical use, points out Stoyanov.

For one thing, while the robot completed the task with 100 per cent success, it had to self-correct six times per case. For example, this could mean a gripper designed to grasp an artery missed its hold on the first try.

鈥淭here were a lot of instances where it had to self-correct, but this was all fully autonomous,鈥� says Krieger. 鈥淚t would correctly identify the initial mistake and then fix itself.鈥� The robot also had to ask a human to change one of its surgical instruments for another, meaning some level of human intervention was required.

at Imperial College London is enthused about the growing potential of robotic surgery. 鈥淭he future is bright 鈥� and tantalisingly close,鈥� he says. 鈥淭hough to realise this safely in humans, regulation will need to follow suit, which remains a significant open challenge in our sector.鈥�

The next step, says Krieger, is to let a robot operate autonomously on a live animal, where breathing and bleeding could complicate things.