Televised live surgery: Would you want to be the patient?

"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."

Over 270 vascular surgeons replied to a survey about live case demonstrations, and one-third of them felt that patients were exposed to more risk in this setting. More than 70% said they would support the decision of a relative or friend who undergo live demonstration surgery, but only 44% said they would undergo such a procedure themselves.

Another survey included 253 urologists who felt that live case demonstrations were more beneficial than edited videos mostly because of the opportunity to ask questions and to see the entire case. However, only 58% would agree to having a family member or themselves be the subject of a live broadcast procedure.

Survey responses were received from 63% of 856 ophthalmology consultants in the UK. More than two-thirds felt that live broadcast surgery offered no educational advantage over edited videos, 92% said that the surgeon was placed under greater stress, and 83% felt that such surgery was not in the best interest of the patient.

Here's what I think.

If most surgeons would not allow live broadcast surgery on themselves, then why should any patient be subjected to it?

A major complication will inevitably occur during a live broadcast. No matter the reason, it will be blamed on the live video surgery.

Still not convinced? Then take a look at this emphatic opinion piece by Dr. Duke E. Cameron, chief of cardiac surgery at Johns Hopkins.

If a surgeon feels it must be done, then follow the example of Dr. Andrew Wright, a surgeon at the University of Washington. When he does a live demonstration, he focuses on the patient, and one of his partners talks to the audience and answers questions.

ADDENDUM 3/7/14: Five minutes after I posted this, @MarkCheetham tweeted that all upper GI cancer operations have been suspended at a UK hospital due to excess mortality. One case has resulted in a malpractice suit. A patient died of hemorrhage 5 days after discharge. She had undergone a minimally invasive esophageal resection which had been broadcast live to a conference of consultants and trainees. Link here.