- Email: [email protected]
Ethics of live surgery demonstration
current medicine research and practice 5 (2015) 159–160
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.elsevier.com/locate/cmrp
Editorial
Ethics of live surgery demonstration Keywords: Ethics Live surgery Demonstration
Live surgical demonstrations have become one of the key highlights of most national and international conferences, where an expert surgeon demonstrates his surgical technique LIVE to an audience via a video link. The organizers advance their conferences by promoting these live surgery workshops as lead events of the conference, where world renowned surgeons operate live and interact with the audience in real time. The advancements made in audiovisual technologies and telecommunications have been phenomenal, which have also worked in their favor. The current scenario shows no signs of abating with these workshops becoming increasingly popular and one of the most effective learning opportunities for the budding surgeons. The advantages of conducting these live workshops are numerous. Live demonstration of a complex operation can benefit the audience with learning the technique from the experts for managing the complications and replicating the same in their practice. Those among the audience who are already using the technique demonstrated, may do so better after watching an expert perform the same. The patients may derive benefit from being operated by an expert at a place that is remote from the normal location of expert. Nonetheless, the concerns arising due to these live demonstrations cannot be ignored. There does exist potential of suboptimal outcomes and even complications in such a setting. Majority of these concerns arise due to the surgeon's unfamiliar environment, which include unfamiliar equipments and instruments and unfamiliar OT Staff (anesthetists, technicians). When the procedure is being done by a visiting expert/surgeon, the preoperative evaluation of the patient may be compromised and a lack of involvement in the
postoperative management cannot be disregarded. Jet lag and language barriers are also added reasons for discomfort for the surgeon. Having being involved in a number of these live surgery workshops nationally as well as internationally, my personal perspective states that the best outcomes are obtained when a surgeon performs in his own operation theater with familiar assistants, anesthetists, and staff and with familiar instruments and equipments. There is no doubt that there is an element of stress involved to demonstrate the technique in front of a live audience. Distractions are numerous, particularly from the dialog between the audience and the surgeon. Task of performing live becomes even more difficult when the environs are unfamiliar to the surgeon. There are occasions when one suddenly finds that an important instrument/ equipment may not be available. Moreover, proper assistance during the surgery is vital to the surgical outcomes and this maybe suboptimal in an alien setting. The shortcomings and disadvantages may get magnified if this involves complicated as opposed to simple surgery. We are fortunate that with the recent advancements in technology, there exists an option of the surgeon operating live in his own operation theater with his own team and familiar instruments and equipments, and transmitting the surgery live to the location of the audience with a two-way communication made possible between the audience and the surgeon. Such a setting increases the level of comfort for the surgeon manifold and the pitfalls are sorted to a great extent. Furthermore, there need to be established guidelines for the conduct of such live surgery demonstrations. Registration of the operating surgeon with the local Medical council should be mandatory. The line of interaction between the surgeon and the audience should be limited to the technique with the remaining cross-questioning restricted to after the end of the procedure. Patient's consent must be sought with complete transparency. Establishment of such guidelines would prove to be a win-win situation for both the surgeons and the patients, where the surgeon will have the comfort of operating
160
current medicine research and practice 5 (2015) 159–160
in familiar environs without stress and the patients would be able to derive the benefits of being operated by the 'expert'.
*Tel.: +91 9999668200/700; fax: +91 11 66115585 E-mail address: [email protected] (P. Chowbey)
Pradeep Chowbey* Max Super Speciality Hospital, 2 Press Enclave Road, Saket, New Delhi 110017, India
http://dx.doi.org/10.1016/j.cmrp.2015.07.006 2352-0817/ # 2015 Published by Elsevier B.V. on behalf of Sir Ganga Ram Hospital.
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.elsevier.com/locate/cmrp
Editorial
Ethics of live surgery demonstration Keywords: Ethics Live surgery Demonstration
Live surgical demonstrations have become one of the key highlights of most national and international conferences, where an expert surgeon demonstrates his surgical technique LIVE to an audience via a video link. The organizers advance their conferences by promoting these live surgery workshops as lead events of the conference, where world renowned surgeons operate live and interact with the audience in real time. The advancements made in audiovisual technologies and telecommunications have been phenomenal, which have also worked in their favor. The current scenario shows no signs of abating with these workshops becoming increasingly popular and one of the most effective learning opportunities for the budding surgeons. The advantages of conducting these live workshops are numerous. Live demonstration of a complex operation can benefit the audience with learning the technique from the experts for managing the complications and replicating the same in their practice. Those among the audience who are already using the technique demonstrated, may do so better after watching an expert perform the same. The patients may derive benefit from being operated by an expert at a place that is remote from the normal location of expert. Nonetheless, the concerns arising due to these live demonstrations cannot be ignored. There does exist potential of suboptimal outcomes and even complications in such a setting. Majority of these concerns arise due to the surgeon's unfamiliar environment, which include unfamiliar equipments and instruments and unfamiliar OT Staff (anesthetists, technicians). When the procedure is being done by a visiting expert/surgeon, the preoperative evaluation of the patient may be compromised and a lack of involvement in the
postoperative management cannot be disregarded. Jet lag and language barriers are also added reasons for discomfort for the surgeon. Having being involved in a number of these live surgery workshops nationally as well as internationally, my personal perspective states that the best outcomes are obtained when a surgeon performs in his own operation theater with familiar assistants, anesthetists, and staff and with familiar instruments and equipments. There is no doubt that there is an element of stress involved to demonstrate the technique in front of a live audience. Distractions are numerous, particularly from the dialog between the audience and the surgeon. Task of performing live becomes even more difficult when the environs are unfamiliar to the surgeon. There are occasions when one suddenly finds that an important instrument/ equipment may not be available. Moreover, proper assistance during the surgery is vital to the surgical outcomes and this maybe suboptimal in an alien setting. The shortcomings and disadvantages may get magnified if this involves complicated as opposed to simple surgery. We are fortunate that with the recent advancements in technology, there exists an option of the surgeon operating live in his own operation theater with his own team and familiar instruments and equipments, and transmitting the surgery live to the location of the audience with a two-way communication made possible between the audience and the surgeon. Such a setting increases the level of comfort for the surgeon manifold and the pitfalls are sorted to a great extent. Furthermore, there need to be established guidelines for the conduct of such live surgery demonstrations. Registration of the operating surgeon with the local Medical council should be mandatory. The line of interaction between the surgeon and the audience should be limited to the technique with the remaining cross-questioning restricted to after the end of the procedure. Patient's consent must be sought with complete transparency. Establishment of such guidelines would prove to be a win-win situation for both the surgeons and the patients, where the surgeon will have the comfort of operating
160
current medicine research and practice 5 (2015) 159–160
in familiar environs without stress and the patients would be able to derive the benefits of being operated by the 'expert'.
*Tel.: +91 9999668200/700; fax: +91 11 66115585 E-mail address: [email protected] (P. Chowbey)
Pradeep Chowbey* Max Super Speciality Hospital, 2 Press Enclave Road, Saket, New Delhi 110017, India
http://dx.doi.org/10.1016/j.cmrp.2015.07.006 2352-0817/ # 2015 Published by Elsevier B.V. on behalf of Sir Ganga Ram Hospital.