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Televised Live Surgery: Would You Want To Be The Patient?

Tue, 03/11/2014 - 9:31am
Skeptical Scalpel

Defibrillation, defibrillation, where is the defibrillator? We did a mistake while talking," said a cardiologist when a patient went into ventricular fibrillation during a live broadcast of a percutaneous coronary intervention at a meeting in Europe last year.

Before it was recognized by the operators, the complication was identified by members of a panel and an audience who were watching the procedure remotely.

The Medscape article with a link to the video of the procedure is available here.

Live broadcasting of procedures—is it really educational; is it just self-promotion; is it marketing?

Several societies have published guidelines for live broadcasts of operations and procedures, and some papers have discussed the ethics of the practice. I won't get into those areas.

Here are some things to consider.

A few studies have reported that outcomes of live broadcast procedures are equivalent to those found in cases without observers. A paper on live transmitted carotid artery stenting showed that technical success was achieved in 185 (99.5%) of 186 cases with complication rates similar to those in the current literature.

Compared to 847 standard procedures, the outcomes of 39 live broadcast robotic partial nephrectomies were not significantly different. The paper concluded, "Live robotic surgery represents a powerful educational tool which may be used without increasing patient morbidity."

Is it really more powerful than an edited video? Why would that be so?

Reports of mishaps are few and far between. A patient who underwent live video surgery in Japan died two days postoperatively. Like the PCI case above, this came to light in a non-peer-reviewed publication. And as in the PCI, the surgeon was answering questions from the audience while doing the procedure.

Ninety members of the American Association of Genitourinary Surgeons responded to a survey. Most (93%) had performed live surgical broadcasts as visiting professors, and 73% of them rated their anxiety levels as either moderate, high, or very high when doing these procedures. Just over 40% said excessive conversation in the OR was a major distraction. But most telling was that "Only 28.2% of AAGUS members would let a visiting faculty member operate on them or a family member."

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