What do you think about live surgery demonstrations? Do you enjoy watching them? Do you think they are important? Would you feel confident as a surgeon in performing live surgery? Would you also participate as a patient? There are several things you should know before answering.
Some years ago, the American College of Surgeons banned live surgery demonstrations following the death of a patient during an aortic aneurism live repair in 2006. There are several surveys about live surgery demonstrations and conclusions are interesting and important. The quality of the operation was slightly worst for 19,4% of surgeons, and for 2,2% it was significantly worst. When performing away live surgery these numbers increased to 23,9% and 3,3% respectively. In fact, performing away live surgery was reported to create anxiety to the acting surgeon in 19,4% of cases, contrasting to 6,5% of cases in home live surgery. Important to retain is that a significant number of surgeons agree that live surgery increases stress, can be harmful to the patients, and that they would not let their children be the patient of a live surgery demonstration. As someone said: do not do to others what you would not like to be done to you.
In complex operations, the patient may be in higher risk.
These ideas were explored by Dr Vinay Kumaran from India, in his publication entitled “The ethics of live demonstrations of surgery” available since 2015. According to these authors there seems to be no difference in complications in simple operations, however this is not the same in complex procedures. In complex operations, the patient may be in higher risk during a live demonstration than in a routine procedure. For that, they point out several reasons against live surgery demonstrations:
Surgeon must ensure the camera shows the entire operation, sometimes operating in the wrong side of patient.
Surgeon can get distracted because he must answer questions while operating.
Surgeon sometimes operates in an unfamiliar operation room, with different instruments, working with unfamiliar anesthesiologist and remaining staff.
Surgeon can feel the pressure to perform the whole operation.
The audience will want to see an intraoperative complication to see how an expert deals with a difficult situation; this will make it a better “spectacle”.
Sometimes organizers may force the indication to have a patient available, or delay treatment till the live demonstration date.
Host institution may not be prepared to deal with post-operative care of that particular operation.
In case of complications the host institution will be responsible, but there will always be the idea – “This operation was not performed by me.”
Dr Vinay et al analyzed several articles and found other interesting and most of all unbelievable ideas, I think. First, although both performing surgeon and audience admit that live surgery puts the patient in higher risk, they believe the learning justifies that same risk. This is easy to say when is not our live that is at risk. For me this is nonsense and goes against the “do not do unnecessary harm to your patient” idea, which all doctors must follow. Secondly, one author said live surgery it is what gives the audience adrenaline to keep focus, and performing live surgery is like playing a match on live tv. Other compared live surgery to a reality TV show. (Minutes of silence) I have no words. We are talking about patients who are seeking a correct treatment, offered in the best conditions to promote the best outcome possible, in an environment developed to decrease the possibility of mistakes. I as a patient would like to be operated with the lowest risk possible. My life is not a “reality show”. I am not a test subject. Third, one author arguing against video presentations, said watching a video is like watching a recorded football match. It gives no adrenaline. Absurd. Is the audience going for the learning or for the adrenaline and fun? Surgery is not a sport! Surgery is about healing and saving lives. Surgery is no game at all.
Learning from video is equal and with less risk for the patients.
So, nowadays there is the possibility of video demonstrations, which should replace completely the live surgery demonstrations. According to Dr Vinay, learning from video is equal and with less risk for the patients. Authors who are against video demonstrations justify saying an edited video masquerades the difficulties felt by the surgeon during the procedure. Well, this is easy to overwhelm by showing an unedited video. By doing this, the surgeon can comment the entire operation in a more relaxed environment, is free to answer questions, and the final outcome can be discussed with the audience. This last point is a great advantage of video demonstrations. In live demonstrations the audience do not have the feedback of the post-operative period nor the final outcome. A well-performed operation can have catastrophic complications. There are reports of live surgeries going fine but hours later the patient was being operated due to complications, sometimes by another surgical team (resident one) because the “star surgeon” was already gone. Live surgery demonstrations fail to have an outcome discussion, while video presentations allow for this important discussion giving the possibility to point out maneuvers that could have been performed in a different way.
Surgery is about healing and saving lives. Surgery is no game at all.
In my opinion, live surgery demonstrations should not be part of our learning instruments. In the minimal invasive surgery era, which allows for video recordings of great quality, there is no justification to submit a debilitated patient to unnecessary risk, not putting additional pressure on the performing surgeon.
You as a doctor must remember one day you will be a patient…
Link to article:
Dr. Carlos Eduardo Costa Almeida
General Surgeon
Comments