“Defibrillation, defibrillation, where is the defibrillator? We made 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.
Published reports of mishaps are few and far between. A patient who underwent live video surgery in Japan died 2 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.
A few months ago, all upper GI cancer operations were suspended at a UK hospital due to excess mortality. One case, which resulted in a malpractice suit, involved a patient who 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.
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 to undergo live demonstration surgery, but only 44% said they would undergo such a procedure themselves.
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. If most surgeons would not allow live broadcast surgery on themselves or family, 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.
Although some papers [here and here] have reported success rates of televised operations were comparable to those of standard procedures, patients whose surgery was televised were obviously highly selected.
I wouldn’t want my surgery televised in real time. Would you?
Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and critical care and has re-certified in both several times. He blogs at SkepticalScalpel.blogspot.com and tweets as @SkepticScalpel. His blog averages over 1400 page views per day, and he has over 9900 followers on Twitter.