Our EPSRC CDT in Advanced Engineering for Personalised Surgery & Intervention will train a new generation of researchers for diverse engineering careers that deliver patient and economic impact through innovation in surgery & intervention. We will achieve this through cohort training that implements the strategy of the EPSRC by working across sectors (academia, industry, and NHS) to stimulate innovations by generating and exchanging knowledge. Surgery is recognised as an "indivisible, indispensable part of health care" but the NHS struggles to meet its rising demand. More than 10m UK patients underwent a surgical procedure in 2021, with a further 5m patients still requiring treatment due to the COVID-19 backlog. This level of activity, encompassing procedures such as tumour resection, reconstructive surgery, orthopaedics, assisted fertilisation, thrombectomy, and cardiovascular interventions, accounts for a staggering 10% of the healthcare budget, yet it is not always curative. Unfortunately, one third of all country-wide deaths occur within 90 days of surgery. The Department of Health and Social Care urges for "innovation and new technology", echoing the NHS Long Term Plan on digital transformation and personalised care. Our proposed CDT will contribute to this mission and deliver mission-inspired training in the EPSRC's Research Priority "Transforming Health and Healthcare". In addition to patient impact, engineering innovation in surgery and intervention has substantial economic potential. The UK is a leader in the development of such technology and the 3rd biggest contributor to Europe's c.150bn euros MedTech market (2021). The market's growth rate is substantial, e.g., an 11.4% (2021 - 2026) compound annual growth rate is predicted just for the submarket of interventional robotics. The engineering scientists required to enhance the UK's societal, scientific, and economic capacity must be expert researchers with the skills to create innovative solutions to surgical challenges, by carrying out research, for example, on micro-surgical robots for tumour resection, AI-assisted surgical training, novel materials and theranostic agents for "surgery without the knife", and predictive computational models to develop patient-specific surgical procedures. Crucially, they should be comfortable and effective in crossing disciplines while being deeply engaged with surgical teams to co-create technology solutions. They should understand the pathway from bench-to-bedside and possess an entrepreneurial mindset to bring their innovations to the market. Such researchers are currently scarce, making their training a key contributor to the success of the UK Government's "Build Back Better - our plan for growth" and UKRI's "five-year strategy". The cross-discipline collaboration of King's School of Biomedical Engineering & Imaging Sciences (BMEIS, host), Department of Engineering, and King's Health Partners (KHP), our Academic Health Science Centre, will create an engineering focused CDT that embeds students within three acute NHS Trusts. Our CDT brings together 50+ world-class supervisors whose grant portfolio (c.£150m) underpins the full spectrum of the CDT's activity, i.e., Smart Instruments & Active Implants, Surgical Data Science, and Patient-specific Modelling & Simulation. We will offer MRes/PhD training pathway (1+3), and direct PhD training pathway (0+4). All students, regardless of pathway, will benefit from continuous education modules which cover aspects of clinical translation and entrepreneurship (with King's Entrepreneurship Institute), as well as core value modules to foster a positive research culture. Our graduates will acquire an entrepreneurial mindset with skills in data science, fundamental AI, computational modelling, and surgical instrumentation and implants. Career paths will range from creating next generation medical innovators within academia and/or industry to MedTech start-up entrepreneurs.

Every year chronic diseases, including neurodegenerative and cardiac diseases, cause 40 million deaths worldwide. This toll is predicted to double in the next twenty years, based on an ageing population, population growth and unhealthy lifestyles. In the UK, chronic conditions are the leading cause of deaths and disability, affecting approximately one in three of adults. GLUTRONICS seeks to enhance the quality of life of the millions worldwide affected by chronic conditions, and reduce the incidence of the associated premature deaths, by advancing the progress on implantable bioelectronics for personalised therapy though long-lasting, lightweight and miniature implantable power sources. The use of bioelectronics in healthcare is fast-growing; the UK government has recognised as critical the development of innovative technologies, such as neuromodulators and electroceuticals, that can support preventative, personalised and digitalised care by enabling real-time monitoring, informing on disease progression, and providing tailored intervention. Nonetheless, current implantable medical devices are invasive, primarily due to the need for a power source, typically lithium-ion batteries, which can represent over 80% of the total volume and weight of a device. Lithium batteries hinder long-term use and comfortable deployment of medical devices because are difficult to miniaturise and require high-risk routine surgeries for replacement. As an example, the neurostimulation of the cervical vagus nerve for the treatment of patients affected by epilepsy, requires the implantation of the bulky pacemaker battery in the chest (approximately the size of a tea bag of 20-50 gr), which is connected to electrodes located in the neck via extension wires. In the UK, there are approximately 60,000 children who suffer from epilepsy and may need to have such an invasive device implanted in their body. Moreover, although the neuromodulation of the vagus nerve has shown potential therapeutic benefits for several conditions, including depression, attention disorder and Parkinson's, the invasiveness of current bioelectronic devices, and the consequent major intervention their installation would require, makes their use for these conditions unpractical. GLUTRONICS will lead to a new generation of bioelectronics that are powered by the sugars naturally present in physiological fluids with cutting-edge glucose fuel cells. With a team's experience spanning research on fundamental science (electrocatalysis, glucose fuel cells, mathematical modelling), proof-of-concept trials in animals, in-human studies, regulatory approvals, and commercial translation, and with a cohort of industrial collaborators, GLUTRONICS will globally lead innovation on implantable glucose fuel cells. This success will be possible by: i) generating stable and biocompatible, fully-integrated abiotic glucose fuel cell designs, optimised for maximum power extraction; ii) creating a safe implantation design and an artificial subcutaneous pocket that enables long-term operations thanks to a continuous replenishment of glucose and minimum biofouling risks; iii) creating an implantable monitoring system to measure daily rhythms for tailored in vivo energy management. Load cell tests, both in vitro and in vivo, will simulate the powering of a neuromodulator (power demand >1µW). Chronic tests in large animal models (i.e., pigs), in surgical sites that align with potential areas of application, will demonstrate the clinical potential of the proposed technology. Technical, legal and ethical challenges in the research will be considered via dedicated co-creation activities and several other engagement initiatives, which will provide inputs from a diverse range of stakeholders (patients, carers, clinicians, Med Tech experts, health economists, policymakers) and enable responsible innovation.