Imperial College London

Mr Daniel Richard Leff

Faculty of MedicineDepartment of Surgery & Cancer

Reader in Breast Surgery



+44 (0)20 3312 1947d.leff




Queen Elizabeth the Queen Mother Wing (QEQM)St Mary's Campus





Daniel is currently a Reader in Breast Surgery working in the Departments of BioSurgery and Surgical Technology and Hamlyn Centre for Robotic Surgery at Imperial College London. He is an Honorary Consultant in Oncoplastic Breast Surgery working within the Breast Unit at Imperial College Healthcare NHS Trust. 

Daniel has undergone advanced Oncoplastic training having been competitively selected for a Training Interface Group (TIG) National Oncoplastic Fellowship, one of only nine such training posts in the United Kingdom. He trained at several centres of excellence in breast cancer and reconstructive breast surgery including the Imperial Breast Unit, the Royal Marsden NHS Foundation Trust and the St Andrews Centre for Plastic Surgery in Chelmsford. Daniel has a Master of Surgery degree in Oncoplastic Breast Surgery, he graduated with a first class distinction and attained the highest aggregate score of his peer group. In 2016, he won the "Issac Gukas Medal" for achievement in breast surgery. 

Daniel received his PhD in Surgery from Imperial College London in 2009, working under the supervision of Professor Lord Ara Darzi and Professor Guang-Zhong Yang. Daniel's primary research interest is in the field of "surgical neuroergonomics" - optimising clinical performance through investigations of brain function in surgeons.  He also pursues robotics, imaging and biosensing technology research geared to improving outcomes following breast conserving surgery and reconstructive breast surgery. 


Selected Publications

Journal Articles

Leff DR, Patani N, Finn M, et al., 2018, A ‘best practice’ care pathway improves management of mastitis and breast abscess, British Journal of Surgery, Vol:105, ISSN:1365-2168, Pages:1615-1622

Modi H, Singh H, Yang G, et al., 2018, Neural correlates of stress resilience in the operating room, Journal of the American College of Surgeons, Vol:227, ISSN:1072-7515, Pages:e208-e208

Singh H, Modi HN, Ranjan S, et al., 2018, Robotic surgery improves technical performance and enhances prefrontal activation during high temporal demand, Annals of Biomedical Engineering, Vol:46, ISSN:0090-6964, Pages:1621-1636

Leff DR, de Silva T, Henry F, et al., 2018, Streamlining decision making in contralateral risk-reducing mastectomy: impact of PREDICT and BOADICEA computations, Annals of Surgical Oncology, Vol:25, ISSN:1068-9265, Pages:3057-3063

Thiruchelvam P, Fisher C, Leff DR, et al., 2018, Pervasive genetic testing, The Lancet, Vol:391, ISSN:0140-6736, Pages:2089-2091

Modi HN, Singh H, Yang G, et al., 2017, A decade of imaging surgeons' brain function (Part II): a systematic review of applications for technical and non-technical skills assessment, Surgery, Vol:162, ISSN:1532-7361, Pages:1130-1139

Orihuela-Espina F, Leff DR, James DRC, et al., 2017, Imperial College near infrared spectroscopy neuroimaging analysis framework., Neurophotonics, Vol:5, ISSN:2329-4248

Modi HN, Singh H, Yang G, et al., 2017, A decade of imaging surgeons' brain function (Part I): terminology, techniques and clinical translation, Surgery, Vol:162, ISSN:1532-7361, Pages:1121-1130

St John ERC, Leff D, takats Z, et al., 2017, Rapid Evaporative Ionisation Mass Spectrometry of Electrosurgical Vapours for the Identification of Breast Pathology: Towards an Intelligent Knife for Breast Cancer Surgery, Breast Cancer Research, Vol:19, ISSN:1465-542X

Modi HN, SIngh H, Orihuela-Espina F, et al., 2017, Temporal stress in the operating room: brain engagement promotes "coping" and disengagement prompts "choking", Annals of Surgery, Vol:267, ISSN:1528-1140, Pages:683-691

Leff DR, Yongue G, Vlaev I, et al., 2017, "Contemplating the next maneuver": functional neuroimaging reveals intraoperative decision-making strategies, Annals of Surgery, Vol:265, ISSN:1528-1140, Pages:320-330

St John ER, Al-Khudairi R, Ashrafian H, et al., 2016, Diagnostic accuracy of intraoperative techniques for margin assessment in breast cancer surgery: a meta-analysis, Annals of Surgery, Vol:265, ISSN:1528-1140, Pages:300-310

Andreu-Perez J, Leff DR, Shetty K, et al., 2016, Disparity in frontal lobe connectivity on a complex bimanual motor task aids in classification of operator skill level., Brain Connectivity, Vol:6, ISSN:2158-0022, Pages:375-388

Shetty K, Leff DR, Orihuela-Espina F, et al., 2016, Persistent Prefrontal Engagement Despite Improvements in Laparoscopic Technical Skill, Jama Surgery, Vol:151, ISSN:2168-6262, Pages:682-684

Leff DR, Shetty K, Yang GZ, et al., Persistent Attentional Demands Despite Laparoscopic Skills Acquisition, Jama Surgery, ISSN:2168-6262

Leff DR, Petrou G, Mavroveli S, et al., 2015, Validation of an oncoplastic breast simulator for assessment of technical skills in wide local excision., British Journal of Surgery, Vol:103, ISSN:1365-2168, Pages:207-217

Leff DR, James D, Orihuela-Espina F, et al., 2015, The impact of expert visual guidance on trainee visual search strategy, visual attention and motor skills, Frontiers in Human Neuroscience, Vol:9, ISSN:1662-5161

Chang TP, Leff DR, Shousha S, et al., 2015, Imaging breast cancer morphology using probe-based confocal laser endomicroscopy: towards a real-time intraoperative imaging tool for cavity scanning, Breast Cancer Research and Treatment, Vol:153, ISSN:1573-7217, Pages:299-310

Kulendran M, Leff DR, Kerr K, et al., 2013, Global cancer burden and sustainable health development, The Lancet, Vol:381, ISSN:0140-6736, Pages:427-429

James DR, Leff DR, Orihuela-Espina F, et al., 2012, Enhanced frontoparietal network architectures following "gaze-contingent" versus "free-hand" motor learning., Neuroimage

Mylonas GP, Kwok K-W, James DRC, et al., 2012, Gaze-Contingent Motor Channelling, haptic constraints and associated cognitive demand for robotic MIS, Medical Image Analysis, Vol:16, ISSN:1361-8415, Pages:612-631

Leff DR, Orihuela-Espina F, Elwell CE, et al., 2011, Assessment of the cerebral cortex during motor task behaviours in adults: A systematic review of functional near infrared spectroscopy (fNIRS) studies, Neuroimage, Vol:54, ISSN:1053-8119, Pages:2922-2936

Leff DR, Vashisht R, Yongue G, et al., 2011, Endoscopic breast surgery: where are we now and what might the future hold for video-assisted breast surgery?, Breast Cancer Research and Treatment, Vol:125, ISSN:0167-6806, Pages:607-625

Leff DR, Orihuela-Espina F, Athanasiou T, et al., 2010, "Circadian Cortical Compensation" A Longitudinal Study of Brain Function During Technical and Cognitive Skills in Acutely Sleep-Deprived Surgical Residents, Annals of Surgery, Vol:252, ISSN:0003-4932, Pages:1082-1090

Orihuela-Espina F, Leff DR, James DRC, et al., 2010, Quality control and assurance in functional near infrared spectroscopy (fNIRS) experimentation, Physics in Medicine and Biology, Vol:55, ISSN:1361-6560, Pages:3701-3724

Paggetti G, Menegaz G, Leff DR, et al., 2010, Exploring the link between depth perception, hand eye coordination and parietal lobe activation during robotic-assisted interventions, Perception, Vol:39, ISSN:0301-0066, Pages:162-163

Warren OJ, Leff DR, Athanasiou T, et al., 2009, The Neurocognitive Enhancement of Surgeons: An Ethical Perspective, Journal of Surgical Research, Vol:152, ISSN:0022-4804, Pages:167-172

Leff DR, Orihuela-Espina F, Atallah L, et al., 2008, Functional prefrontal reorganization accompanies learning-associated refinements in surgery: a manifold embedding approach., Comput Aided Surg, Vol:13, Pages:325-339

Leff DR, Leong JJH, Warren O, et al., 2008, Near-infrared spectroscopy: Potential clinical benefits in surgery, Journal of the American College of Surgeons, Vol:206, ISSN:1072-7515, Pages:761-762

Leff DR, Leong JJH, Aggarwal R, et al., 2008, Could variations-in technical skills acquisition in surgery be explained by differences in cortical plasticity?, Annals of Surgery, Vol:247, ISSN:0003-4932, Pages:540-543

Leff DR, Warren OJ, Enfield LC, et al., 2008, Diffuse optical imaging of the healthy and diseased breast: A systematic review, Breast Cancer Research and Treatment, Vol:108, ISSN:0167-6806, Pages:9-22

Leff DR, Aggarwal R, Rana M, et al., 2008, Laparoscopic skills suffer on the first shift of sequential night shifts: Program directors beware and residents prepare, Annals of Surgery, Vol:247, ISSN:0003-4932, Pages:530-539

Leff DR, Elwell CE, Orihuela-Espina F, et al., 2008, Changes in prefrontal cortical behaviour depend upon familiarity on a bimanual co-ordination task: An fNIRS study, Neuroimage, Vol:39, ISSN:1053-8119, Pages:805-813

Leff DR, Leong J, Yang G-Z, et al., 2008, Visuo-spatial ability and fMRI cortical activation insurgery residents, American Journal of Surgery, Vol:195, ISSN:0002-9610, Pages:138-138

Leff D, Aziz O, Darzi A, 2007, Trucks, planes, and scalpels - Is there an evidence-based approach to surgeons' working hours?, Archives of Surgery, Vol:142, ISSN:0004-0010, Pages:817-820

Leff DR, Orihuela-Espina F, Atallah L, et al., 2007, Functional near infrared spectroscopy in novice and expert surgeons - A manifold embedding approach, Lecture Notes in Bioinformatics, Vol:4792 LNCS, ISSN:0302-9743, Pages:270-277

Leff DR, Koh P, et al., 2006, Optical mapping of the left frontal cortex during a surgical knot tying task, a feasibility study., Lncs, Vol:4091, Pages:140-147


James DRC, Orihuela-Espina F, Leff DR, et al., 2010, Cognitive Burden Estimation for Visuomotor Learning with fNIRS, 13th International Conference on Medical Image Computing and Computer-Assisted Intervention (MICCAI), SPRINGER-VERLAG BERLIN, Pages:319-326, ISSN:0302-9743

Leong JJH, Atallah L, Mylonas GP, et al., 2008, Investigation of partial directed coherence for hand-eye coordination in laparoscopic training, 4th International Workshop on Medical Imaging and Augmented Reality, SPRINGER-VERLAG BERLIN, Pages:270-+, ISSN:0302-9743

Leff DR, Orihuela-Espina F, Darzi LAA, et al., 2007, Functional near infrared spectroscopy in novice and expert surgeons - A manifold embedding approach, 10th International Conference on Medical Image Computing and Computer-Assisted Intervention (MICCAI 2007), SPRINGER-VERLAG BERLIN, Pages:270-+, ISSN:0302-9743

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