• Mr Guri Sandhu

Health

Q&A: Mr Guri Sandhu

The pioneering ENT surgeon at The London Clinic in Marylebone, on the magic of the larynx and his discovery of a new condition

Interview: Viel Richardson
Images: Joseph Fox

Have you always wanted to be a surgeon?
I have always been good with my hands. As a child I would make models, build home electronics kits—I loved creating intricate things. So when I realised I wanted a career in medicine, I knew that I wanted to be a surgeon.

What attracted you to the field of ear, nose and throat (ENT)?
I think one of the biggest drivers behind the decision to pursue a particular specialism is the people you find inspiring. When I encountered ENT as a junior doctor it blew me away. Firstly, everyone was so nice, and the surgeon was a complete gentleman. Then I watched my first operation on the middle ear. I had never seen what was underneath the eardrum before. It is so delicate, and under the microscope it is beautiful. I watched a senior colleague take out one of the bones and replace it. The slightest mistake and the patient could end up with deafness or hearing loss, so the skills involved in operating successfully were immense. That challenge appealed to me.

What do you specialise in?
I specialise in treating problems with the larynx (voice box) which includes voice, swallowing and breathing disorders. In many aspects of our work we are world leaders.

What is the larynx for?
The main role of the larynx is to protect your airway. The food you eat, what you drink and the air you breathe initially share a common pathway through the neck called the pharynx. But then the air has to go one way, into your lungs, and the food and drink to your stomach. The larynx is the gateway which controls the process. It is normally open, allowing air to pass into the lungs when you are breathing, but when you swallow, it closes and in combination with the tongue, food is swept into the oesophagus and down to the stomach. The larynx then reverts to the breathing position. So it is quite a complex mechanism and it all happens in a fraction of a second. If it doesn’t work and food gets into the lungs it can cause some very serious—sometimes fatal—chest infections, so the larynx is extremely important.

Is it important for speech?
Absolutely. It is what allows us to generate the range of sounds necessary for true language. Humans can talk because the larynx sits lower down in the neck than in any other mammals and it is this that allows the level of sound modulation necessary for speech. In humans, the fine and intricate movements in the larynx, throat and mouth are what give us the ability to create musical magic.

So what was the pathway into laryngology?
There wasn’t one. When I started my training you could get excellent training on the ear, the nose and cancer in the head and neck, but in the UK training in relation to the larynx was very limited. There were no key people that you could go to and say, “I want you to train me”. Laryngology, as we call it, had not established itself firmly as a sub-specialty.

Mr Guri Sandhu

So how did you proceed?
Towards the end of surgical training in the UK I went to the USA for a short while and attended courses, went to conferences, read research papers, talked to people. But a lot of it was self-taught. I’ve studied new technologies and different techniques to see if they could apply to laryngology. After that it comes down to experience.

It was clearly a very good decision. Haven’t you identified a new condition?
We have, it is a condition called exercise induced laryngeal obstruction. Many young people and athletes who struggle to breathe after exercise are often diagnosed with exercise induced asthma. We have discovered that in many of these cases, the person actually has a collapsing larynx. The exercise makes them breathe heavily which increases the airflow. This increases the negative pressure in the upper airway, causing the larynx to partially collapse inwards, restricting the amount of air that flows to the lungs.

It now means some people who had been forced to stop exercising can start exercising again and live a healthier lifestyle—all through a 10 to 15 minute procedure. Now exercise induced laryngeal obstruction is a condition that we are starting to recognise, diagnose and treat.

How else has the field moved forward?
A lot of the progress stems from improvement in technology—particularly all the minimally invasive techniques we now have available to us. It has allowed us to see and do things that were impossible before. For example, when I started, if a patient had a damaged windpipe or larynx, the surgeon would go in via an incision in the neck, remove the damaged tissue and connect the rest back together. It was quite major surgery. Sometimes the patient was a bit better, other times they were no better at all. In some instances, the patient would end up with a permanent tracheotomy, which is a tube inserted in the neck, to help them breathe because the larynx had ceased to function. I thought there had to be a better way, so decided to approach the whole process using as minimally invasive technology as possible. Today I operated on two patients with compromised airways, and they will be going home this evening breathing better.

Can you talk about some of the technology that you are now using?
When I do an operation—apart from when I have to open the neck, which is very traditional surgery—one of the instruments we use is called a laryngoscope, which goes in through the mouth and down to the larynx. At the top of the laryngoscopes we have a microscope and camera and can pass micro instruments such as lasers and specialised cutting tools through it. We can also use it to administer drugs.

What do you like most about your job?
It’s a bit corny, but I like to make a difference to people’s lives; make them feel better and healthier. I remember a patient I operated on a few years ago. I had repaired her damaged larynx and was able to remove a tracheotomy that she’d had in for years. When I did my post-operative ward round she was actually jumping up and down on the bed out of pure joy because she could see how much it was going to transform her life. I can see her face to this day. It is difficult to get that kind of gratification anywhere else.

The other thing that drives me is being able to move my little area of medicine forward. When I have retired, it will be satisfying to feel that I have made a bit of a difference: I have put a few bricks in the wall of building this particular field. I think my biggest contribution has been allowing patients to have airway surgery in a much less invasive way. Thousands of people can now have treatment which has less side effects, a quicker recovery time and less exposure to the risks that larger procedures can entail.