Systematic review of live surgical demonstrations and their effectiveness on training

Challacombe, Benjamin; Abboudi, Hamid; Khan, Mohammad Shamim; Ahmed, Kamran

doi:10.1002/bjs.9635

Cited by 33 publications

(21 citation statements)

References 38 publications

(73 reference statements)

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“…Overall, data comparing the outcomes of live case presentations with cases undertaken in normal settings are scarce, and no pediatric report is available as of today. Brunckhorst et al [10] reviewed the literature from 1980 until 2014 on live surgery outcomes, identifying eight studies in differ- Table 2. Recommendations to ensure patient safety during live surgery events…”

Section: Discussionmentioning

confidence: 99%

Live-case demonstrations in pediatric urology: Ethics, patient safety, and clinical outcomes from an 8-year institutional experience

Andolfi

Gundeti

2020

Investig Clin Urol

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Purpose: Live case demonstrations have become a common occurrence at surgical meetings around the world. These demonstrations are meant to serve as an educational medium for teaching techniques, promote discussion, improve interventions and outcomes. Despite the valuable educational benefits, many authors still question the ethics of this approach. We present our 8-year experience in live surgery, discuss the ethical issues, and provide recommendations. Materials and Methods: We reviewed records of patients who underwent live robotic surgery during broadcasting events. Procedures performed were robot-assisted laparoscopic pyeloplasty (RAL-P), ureteral reimplantation (RALUR), and hemi-nephrectomy (RAL-HN). Peri-and post-operative outcomes were compared to our previously published case series. Results: From October 2011 to May 2019, the senior author (MSG) performed all live surgery demonstrations on 22 patients: 9 RAL-P, 9 RALUR, and 4 RAL-HN. Live RAL-Ps had a 100% success rate and lower 30-day Clavien-Dindo grade (CDG) III complications when compared to our previous case series (11.1% vs. 21.2%). RALURs performed during live demonstrations had a higher success rate than our previously published cohort (100% vs. 82%). RAL-HN operative time and length of stay were comparable to our nonlive control group. Conclusions: Live surgery is a valuable didactic tool, but even experienced surgeons may be adversely affected by inappropriate case selection, technical difficulty, and anxiety associated with particular settings, such as operating at different institutions or working with unfamiliar surgical teams. We suggest consultation of an ethics review board and formulation of standard guidelines for patient selection, surgical equipment, and operative team.

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Section: Discussionmentioning

confidence: 99%

Live-case demonstrations in pediatric urology: Ethics, patient safety, and clinical outcomes from an 8-year institutional experience

Andolfi

Gundeti

2020

Investig Clin Urol

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“…The attendance of live surgery events is an established means of learning anatomy as well as novel surgical techniques in nearly all surgical disciplines [20]. However, the demonstration of surgical procedures in real patients at live surgery events is subject to critical discussion from an ethical point of view [21,33]. Several studies have shown a potentially negative impact on the outcome of patients who have undergone live surgery, which is opposed to the no-harm principle of medicine [24][25][26]34].…”

Section: Discussionmentioning

confidence: 99%

“…Typically, the attendees are able to communicate with the surgeons during video transmission [18]. A large number of surgeons are introduced to new surgical techniques and the relevant clinical anatomy is demonstrated on a single patient [19,21]. Furthermore, live surgery events offer the opportunity to learn from experts as a role model in real life, as well as handle surgical complications and manage difficult cases appropriately [22,23].…”

Section: Introductionmentioning

confidence: 99%

Didactic Benefits of Surgery on Body Donors during Live Surgery Events in Minimally Invasive Surgery

Ackermann

Wedel

Holthaus

et al. 2020

JCM

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Background: Live surgery events serve as a valuable tool for surgical education, but also raise ethical concerns about patient safety and professional performance. In the present study, we evaluate the technical feasibility and didactic benefits of live surgery on body donors compared to real patients. Methods: A live surgery session performed on a body donor’s cadaver embalmed in ethanol–glycerol–lysoformin was integrated into the live surgery program presented at a major gynecological convention of minimally invasive surgery. Surgical procedures carried out in real patients were paralleled in the body donor, including the dissection and illustration of surgically relevant anatomical landmarks. A standardized questionnaire was filled by the participants (n = 208) to evaluate the appropriateness, effectiveness, and benefits of this novel concept. Results: The live surgery event was appreciated as a useful educational tool. With regard to the use of body donors, authenticity was rated high (85.5%), and the overall value of body donors for surgical education and training was rated very high (95.0%). The didactic benefit of simultaneous operations performed on body donors and real patients was considered particularly useful (95.5%), whereas complete replacement of real patients by body donors was not favored (14.5%). Conclusions: The study demonstrated both the technical feasibility and didactic benefits of performing minimally invasive surgery in body donors as part of live surgery events. This novel concept has the potential to enhance anatomical knowledge, providing insights into complex surgical procedures, and may serve to overcome yet unresolved ethical concerns related to live surgery events.

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“…On the other hand, observational studies, comparing the outcomes of LSD with routine practice, give less cause for concern [ 6 , 13 , 14 ]. Brunckhorst et al reviewed the literature from 1980 until 2014 on LSD outcomes, identifying eight studies in different medical fields.…”

Section: Discussionmentioning

confidence: 99%

“…Brunckhorst et al reviewed the literature from 1980 until 2014 on LSD outcomes, identifying eight studies in different medical fields. In three of these studies, the success rates of LSD were lower than of routine practice, yet there were no statistically significant differences in complication rates [ 13 ]. More recently, three studies evaluated the outcomes of live endourological procedures and live robot-assisted radical prostatectomies.…”

Section: Discussionmentioning

confidence: 99%

Surgical teaching in urology: patient safety and educational value of ‘LIVE’ and ‘SEMI-LIVE’ surgical demonstrations

et al. 2018

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PurposeTo evaluate the opinion of urologists and their audience regarding patient safety and educational value of live surgical demonstrations (LSD) and semi-live surgical demonstrations (semi-LSD).MethodsFollowing the ‘2017 Challenges in Endourology’ meeting, a survey addressing patient safety and the educational value of LSD and semi-LSD was disseminated online to all participants. Survey outcomes of LSD and semi-LSD were compared. ResultsAll 279 respondents attended both LSD and semi-LSD. Overall, 53% of said respondents stated that patient safety was always the highest priority for LSD, while 74% noted the same for semi-LSD. The complication risk in LSD was perceived equal by 57% of the respondents when compared to cases of similar difficulty in routine practice, while 38% perceived it as a greater risk. For semi-LSD, the complication risk was perceived equal by 84%, while 5% perceived it to be a greater risk in comparison to general practice. On a scale from 0 (no value) to 10 (highly valuable), the average educational value of LSD and semi-LSD was rated 8.4 and 8.3, respectively. A substantial percentage of the surgeons who perform LSD express concerns that live surgery is not the optimal setting to ensure patient safety.ConclusionsLSD remains a popular tool for surgical education among urologists and their audience. However, patient safety remains a concern and is perceived less of a concern for semi-LSD. The educational value of LSD and semi-LSD was scored equally high. Therefore, we should consider to advocate the use of semi-LSD more often.Electronic supplementary materialThe online version of this article (10.1007/s00345-018-2291-x) contains supplementary material, which is available to authorized users.

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Systematic review of live surgical demonstrations and their effectiveness on training

Cited by 33 publications

References 38 publications

Live-case demonstrations in pediatric urology: Ethics, patient safety, and clinical outcomes from an 8-year institutional experience

Live-case demonstrations in pediatric urology: Ethics, patient safety, and clinical outcomes from an 8-year institutional experience

Didactic Benefits of Surgery on Body Donors during Live Surgery Events in Minimally Invasive Surgery

Surgical teaching in urology: patient safety and educational value of ‘LIVE’ and ‘SEMI-LIVE’ surgical demonstrations

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