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Khashab MA, Muthusamy VR, Akshintala VS, Kothari S, Sethi A, Rastogi A, Palmisano DJ, Zhang LY, Hess MRR, Rashba K, Gupta N, Wani S, Komanduri S. Best live endoscopy practices: an ASGE white paper. Gastrointest Endosc 2023; 97:383-393.e3. [PMID: 36639318 DOI: 10.1016/j.gie.2022.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 09/27/2022] [Indexed: 01/15/2023]
Affiliation(s)
- Mouen A Khashab
- Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland.
| | - V Raman Muthusamy
- Division of Digestive Diseases, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Venkata S Akshintala
- Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Shivangi Kothari
- Division of Gastroenterology/Hepatology, University of Rochester Medical Center & Strong Memorial Hospital, Rochester, New York
| | - Amrita Sethi
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, New York
| | - Amit Rastogi
- Department of Gastroenterology, University of Kansas Medical Center, Kansas City VA, Kansas City, Kansas
| | | | - Linda Yun Zhang
- Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Mary-Rose R Hess
- Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Kira Rashba
- Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Neil Gupta
- Department of Gastroenterology, Loyola Medicine, Maywood, Illinois
| | - Sachin Wani
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Srinadh Komanduri
- Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Awad M, Chowdhary M, Hermena S, Falaha SE, Slim N, Francis NK. Safety and effectiveness of live broadcast of surgical procedures: systematic review. Surg Endosc 2022; 36:5571-5594. [PMID: 35604484 PMCID: PMC9125972 DOI: 10.1007/s00464-022-09072-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 01/20/2022] [Indexed: 11/16/2022]
Abstract
Introduction Live Broadcast of Surgical Procedures (LBSP) has gained popularity in conferences and educational meetings in the past few decades. This is due to rapid advancement in both Minimally Invasive Surgery (MIS) that enable transmission of the entire operative field and transmission ease and technology to help broadcast the operation to a live audience. The aim of this study was to update the evidence with specific emphasis on the patient safety issues related to LBSP in MIS. Methods A systematic review of the literature was performed using Medline, Embase and Pubmed using defined search terms related to LBSP in educational events across all surgical specialities, in accordance with the PRISMA guidelines. We also consolidated the prior guidelines and position statements on this topic. Outcomes included reports on the educational value of LBSP as well as patient safety outcomes and ethical issues that were captured by clinical outcomes. Results A total 1230 abstracts were identified with 27 papers meeting the inclusion criteria (13 original articles and 14 position statements/guidelines). All studies highlighted the educational benefits of LBSP but without clear measure of these benefits. Clinical outcomes were not compromised in 9 studies but were inferior in the remaining 4, including lower completion rate of endoscopic surgery and higher rate of re-operation. Only nine studies complied with dedicated consent forms for LBSP with no consistent approach of reporting on maintaining patient confidentiality during LBSP. There was a lack of recommendation on standardised approach of reporting on LBSP including the outcomes across the 14 published guidelines and positions statements. Conclusions Live Broadcast of Surgical Procedures can be of educational value but patient safety may be compromised. A standardised framework of reporting on LBSP and its outcomes is required from an ethical and patient safety perspective. PROSPERO registration CRD42021256901. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-022-09072-6.
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Affiliation(s)
- Mina Awad
- Department of General Surgery, Yeovil District Hospital, Higher Kingston, Yeovil, BA21 4AT, UK
| | - Manish Chowdhary
- Department of General Surgery, Yeovil District Hospital, Higher Kingston, Yeovil, BA21 4AT, UK
| | - Shady Hermena
- Department of Trauma and Orthopaedic Surgery, Yeovil District Hospital, Higher Kingston, Yeovil, BA21 4AT, UK
| | - Sara El Falaha
- Department of General Surgery, Yeovil District Hospital, Higher Kingston, Yeovil, BA21 4AT, UK
| | - Naim Slim
- Department of General Surgery, Yeovil District Hospital, Higher Kingston, Yeovil, BA21 4AT, UK
| | - Nader K Francis
- Department of General Surgery, Yeovil District Hospital, Higher Kingston, Yeovil, BA21 4AT, UK. .,Division of Surgery and Interventional Science, University College London, Gower St, London, WC1E 6DH, UK. .,Directorate of Training, Northwick Park Institute of Medical Research, Northwick Park Hospital, Harrow, HA1 3UJ, UK.
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Puzo P, D'Oria F, Imburgia A, Incandela C, Sborgia A, Marchegiani EB, Rania L, Mularoni A, Alessio G. Live surgery outcomes in cataract surgery. Eur J Ophthalmol 2022; 32:3444-3450. [PMID: 35322704 DOI: 10.1177/11206721221089172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate and compare the outcomes of live surgery (LS) and no-live surgery (NLS) on cataract surgery with implantation of different types of intraocular lenses (IOLs). METHODS Retrospective, contralateral eye, case series of patients that underwent cataract surgery in live or non-live view during two consecutive editions of national meetings. Both eyes of the same patients were implanted with the same IOL, one in LS and the other in NLS. RESULTS 108 eyes of 54 patients, aged between 50 and 82 (72 ± 8.2) and implanted with different types of IOLs, were reviewed. Both eyes in each patient were well matched at baseline in terms of intraocular biometric characteristics, corneal curvature and endothelial cell density (ECD) (p > 0.05). There are no statistically significant differences between the biometric and topographic parameters, aberrometric data and the loss of ECD in the post-operative outcomes (p > 0.05). However, comparing the different types of IOLs, there is a significant loss of ECD in eyes implanted with a toric IOL during LS (p = 0.0014 and p = 0.04, in 2017 and 2018 edition respectively). CONCLUSIONS In this series of live cataract surgery, eyes operated in LS or NLS have comparable outcomes, underlying the importance and the benefits of live view in terms of medical education and the low-risk of complications. Nevertheless, we have found a significant increase in ECD loss in patients implanted with toric IOLs during LS.
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Affiliation(s)
- Pasquale Puzo
- Section of Ophthalmology, Department of Basic Medical Science, Neuroscience and Sense Organs, 9295University of Bari, Bari, Italy
| | - Francesco D'Oria
- Section of Ophthalmology, Department of Basic Medical Science, Neuroscience and Sense Organs, 9295University of Bari, Bari, Italy
| | - Aurelio Imburgia
- Department of Ophthalmology, Istituto per la Sicurezza Sociale, 387261San Marino State Hospital, Cailungo, Republic of San Marino
| | - Cosimo Incandela
- Section of Ophthalmology, Department of Basic Medical Science, Neuroscience and Sense Organs, 9295University of Bari, Bari, Italy
| | - Alessandra Sborgia
- Section of Ophthalmology, Department of Basic Medical Science, Neuroscience and Sense Organs, 9295University of Bari, Bari, Italy
| | - Eleonora B Marchegiani
- Department of Ophthalmology, Istituto per la Sicurezza Sociale, 387261San Marino State Hospital, Cailungo, Republic of San Marino
| | - Laura Rania
- Department of Ophthalmology, Istituto per la Sicurezza Sociale, 387261San Marino State Hospital, Cailungo, Republic of San Marino
| | - Alessandro Mularoni
- Department of Ophthalmology, Istituto per la Sicurezza Sociale, 387261San Marino State Hospital, Cailungo, Republic of San Marino
| | - Giovanni Alessio
- Section of Ophthalmology, Department of Basic Medical Science, Neuroscience and Sense Organs, 9295University of Bari, Bari, Italy
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Roman H, Prosszer M, Marabha J, Merlot B, Forestier D, Noailles M, Marpeau L, Tuech JJ. Live surgery of colorectal endometriosis broadcasted from a surgeon's routine operating theater is not associated with higher complications rate. Acta Obstet Gynecol Scand 2021; 100:2176-2185. [PMID: 34546562 DOI: 10.1111/aogs.14264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 08/02/2021] [Accepted: 08/30/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Although live surgeries are routinely included in surgical congress programs, they are the subject of an ongoing debate in terms of patient safety and teaching value. The goal of our study was to assess the risk of postoperative complications related to live surgery broadcast from the surgeon's routine theater, in patients managed for deep endometriosis infiltrating the digestive tract. MATERIAL AND METHODS We report a retrospective comparative study, enrolling women managed for colorectal endometriosis by a gynecologic surgeon, from September 2013 to March 2020 in two referral centers. We compared the rate of postoperative bowel fistula in women managed during live surgery in the routine operating theater, with that observed in women for whom surgery was not broadcast. RESULTS Among 813 women, 33 (4.1% of cases) underwent surgical procedures transmitted live to various conference rooms located outside the hospital and were compared with 780 patients who underwent non-broadcast surgery. Women's age, body mass index, past surgical and obstetrical history, and major preoperative complaints were comparable. Cases presented with impaired constipation score, more frequent sciatic pain, and infiltration of the vagina, whereas overall revised American Fertility Society classification scores were more severe in controls. The rate of rectal nodules over 3 cm in size was comparable between the two groups (72.7% in cases vs. 72.1% in controls). Operative time was also comparable (153 ± 52 minutes vs. 148 ± 79 minutes). Cases were more frequently managed by disk excision of rectal nodules (63.7% vs. 30.3%), and more frequently involved the sacral plexus (18.2% vs. 7.3%). Postoperative complications were comparable between the two groups, in terms of bowel fistula (3% in the live surgery group vs. 4.1% in controls), pelvic abscess requiring secondary laparoscopy (3% vs. 4.9%), or bladder dysfunction requiring self-catheterization after discharge (6.1% vs. 5.3%). CONCLUSIONS Performing laparoscopic management of colorectal endometriosis with live transmission of surgery from a surgeon's routine operating theater, is not related to a higher risk of major postoperative complications.
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Affiliation(s)
- Horace Roman
- IFEMEndo, Endometriosis Center, Clinique Tivoli-Ducos, Bordeaux, France.,Department of Gynecology and Obstetrics, University Hospital Aarhus, Aarhus, Denmark
| | - Maria Prosszer
- IFEMEndo, Endometriosis Center, Clinique Tivoli-Ducos, Bordeaux, France
| | - Jamil Marabha
- IFEMEndo, Endometriosis Center, Clinique Tivoli-Ducos, Bordeaux, France
| | - Benjamin Merlot
- IFEMEndo, Endometriosis Center, Clinique Tivoli-Ducos, Bordeaux, France
| | - Damien Forestier
- IFEMEndo, Endometriosis Center, Clinique Tivoli-Ducos, Bordeaux, France
| | - Myriam Noailles
- IFEMEndo, Endometriosis Center, Clinique Tivoli-Ducos, Bordeaux, France
| | - Loïc Marpeau
- Expert Center in the Diagnosis and Multidisciplinary Management of Endometriosis, Rouen University Hospital, Rouen, France
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Risks and Benefits of Live Surgical Broadcast: A Systematic Review. Eur Urol Focus 2021; 8:870-881. [PMID: 34148861 DOI: 10.1016/j.euf.2021.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/04/2021] [Accepted: 06/08/2021] [Indexed: 11/24/2022]
Abstract
CONTEXT Live surgical broadcast (LSB), also known as live surgery, has become a popular format for many types of surgical education meetings. However, concerns have been raised in relation to patient safety, ethical issues, and the actual educational value of LSB. OBJECTIVE To summarize current evidence on LSB with a focus on the risks of complications and the educational impact. EVIDENCE ACQUISITION We performed a systematic review of the literature according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify studies up to December 2020. We identified original articles reporting on patient outcomes, educational value, current use, and development of LSB. We also interrogated surgical society guidelines for position statements on LSB. EVIDENCE SYNTHESIS Our literature search identified 46 studies spanning six surgical specialties, with urology being the most frequent. Approximately half of the studies reported on outcomes of surgical procedures during LSB. In urology, the few comparative studies available did not suggest higher complication rates in LSB, whereas data for other surgical fields highlighted evidence of worse outcomes. Four studies assessed the educational value of LSB via survey administration, for which the evidence is limited and of low quality. Thirteen guidelines and position statements on live surgery were identified among major surgical societies, including the European Association of Urology (EAU). Some surgical societies have expressly prohibited the use of LSB at their major meetings. The perspective of surgeons performing and/or attending live surgical sessions was evaluated in six studies, and four studies looked at urologists' perception of LSB compared to semi-LSB. Limitations of this systematic review include the limited number of studies available, the low quality of the evidence, and data heterogeneity. CONCLUSIONS Evidence regarding outcomes of LSB is limited. Almost all the studies do not show a higher risk of complications or worse outcomes for patients undergoing a procedure during LSB. Only one study on gastrointestinal surgery reported that LSB outcomes were worse. Ongoing concerns have led to specific guidelines by several scientific societies, including the EAU, with the ultimate aim of minimizing surgical risks and maximizing patient safety. PATIENT SUMMARY Live surgery events are often part of surgical conferences. Data in the literature show mixed outcomes for operations performed during live surgery events, but with no increase in complication rates. Safety and ethical concerns remain. Other educational tools, such as prerecorded videos and live surgery transmission from the home institution of the operating surgeon might become preferred options in the future. This review was prospectively registered on the PROSPERO website (www.crd.york.ac.uk/PROSPERO, registration number CRD42020194023).
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Rosado-Urteaga M, Prera Á, Muñoz J, Domínguez A, Ferran A, González J, García D, Prats J. Live surgery: Safety study after 17 editions of retroperitoneoscopic surgery. Actas Urol Esp 2021; 45:281-288. [PMID: 33602592 DOI: 10.1016/j.acuro.2020.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/27/2020] [Accepted: 10/26/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Live surgery has become an excellent tool for medical training. Despite this, there is controversy about the safety of the patients involved. OBJECTIVE To analyze the results of live surgeries performed in 17 consecutive retroperitoneoscopy courses organized in our center. Procedures performed were partial nephrectomy (PN), radical nephrectomy (RN) and nephroureterectomy (NU). MATERIAL AND METHODS Review from January 2010 to October 2017 of all live surgeries carried out by an expert surgical team in the retroperitoneoscopy courses, compared with a control group of surgeries performed in standard conditions. A matching (1:1 for each RN and 1:2 for each PN and NU) according to age, body mass index and comorbidities was performed. RESULTS Twenty-one live surgeries were analyzed (eight PN, seven RN and six NU) with a global median follow-up of 38 months. No significant differences were observed between both groups in terms of perioperative variables (operative time, operative bleeding and intraoperative complications) or of postoperative complications and length of hospital stay. Likewise, there were no differences between recurrence rates (PN: 0% vs. 6.3%, p = 0.47, NU: 33.3% vs. 66.7%, p = 0.180, RN: 0% vs. 28.6%, p = 0,127). CONCLUSIONS Live surgery in the hands of expert surgeons in a suitable environment and with well-selected patients does not increase the risk of complications and allows maintaining the same oncological outcomes.
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Evaluation of Live Surgery Meetings: Our Experience with the "Live Makeover Aesthetic Surgery Symposium". PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3350. [PMID: 33564581 PMCID: PMC7859118 DOI: 10.1097/gox.0000000000003350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 11/04/2020] [Indexed: 11/25/2022]
Abstract
Live Surgery Meetings have been established as a vey effective means to demonstrate certain surgical techniques and intraoperative decision-making. However, many authors still question the ethics of this approach. We present our experience as organizers of the Live Makeover Aesthetic Surgery Symposium, an annual international live surgery meeting taking place in Athens, Greece.
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Schuettfort VM, Ludwig TA, Marks P, Vetterlein MW, Maurer V, Fuehner C, Janisch F, Soave A, Rink M, Riechardt S, Engel O, Fisch M, Dahlem R, Meyer CP. Learning benefits of live surgery and semi-live surgery in urology-informing the debate with results from the International Meeting of Reconstructive Urology (IMORU) VIII. World J Urol 2020; 39:2801-2807. [PMID: 33140166 PMCID: PMC8332562 DOI: 10.1007/s00345-020-03506-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 10/15/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To analyze the perceived learning opportunities of participants of the International Meeting on Reconstructive Urology (IMORU) VIII for both live surgery demonstrations (LSD) and semi-live surgery demonstrations (SLSD). Safety and educational efficacy of LSD and SLSD at live surgery events (LSE) have been debated extensively, however, objective data comparing learning benefits are missing. Methods We conducted a detailed survey, which employed the Kirkpatrick model, a well-established assessment method of training models, to investigate participants preferences as well as the learning benefit of LSE. Furthermore, we employed an audience response system and the Objective Structured Assessment of Technical Skills (OSATS), a well-established assessment method of surgery skills, to let our participants rate the perceived learning opportunity of LSD and SLSD. Results Of 229 participants at the IMORU VIII, 39.7% returned our questionnaires. 90% stated that they prefer LSD. On all levels of Kirkpatrick’s training evaluation model, the IMORU received high ratings, suggesting a high learning benefit. For the assessment of OSATS, a total of 23 surgical cases were evaluable. For all six utilized items, LSD scored significantly better ratings than SLSD. Conclusion Our study suggests that there is still a rationale for LSD, as participants attributed a statistically significant higher learning benefit to LSD over SLDS. Evaluation of the survey showed that for LSE such as the IMORU VIII, a high learning benefit can be expected. Considering that most of our participants are active surgeons with high caseloads, their opinion on the educational value of LSE is of high relevance.
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Affiliation(s)
- Victor M Schuettfort
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Tim A Ludwig
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Phillip Marks
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Malte W Vetterlein
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Valentin Maurer
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Constantin Fuehner
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Florian Janisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Armin Soave
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Silke Riechardt
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Oliver Engel
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Margit Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Roland Dahlem
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian P Meyer
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Ackermann J, Wedel T, Holthaus B, Bojahr B, Hackethal A, Brucker S, Biebl M, Westermann M, Günther V, Krüger M, Maass N, Mettler L, Peters G, Alkatout I. Didactic Benefits of Surgery on Body Donors during Live Surgery Events in Minimally Invasive Surgery. J Clin Med 2020; 9:jcm9092912. [PMID: 32917056 PMCID: PMC7563950 DOI: 10.3390/jcm9092912] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 09/04/2020] [Accepted: 09/07/2020] [Indexed: 12/11/2022] Open
Abstract
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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Affiliation(s)
- Johannes Ackermann
- Department of Obstetrics and Gynecology, Kiel School of Gynaecological Endoscopy, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller Str. 3, House C, 24105 Kiel, Germany; (J.A.); (M.W.); (V.G.); (M.K.); (N.M.); (L.M.); (G.P.)
| | - Thilo Wedel
- Institute of Anatomy, Christian-Albrechts University Kiel, Otto-Hahn-Platz 8, 24118 Kiel, Germany;
| | - Bernd Holthaus
- Clinic of Obstetrics and Gynecology, St. Elisabeth Hospital, 49401 Damme, Germany;
| | - Bernd Bojahr
- Clinic of Minimally Invasive Surgery, Kurstraße 11, 14129 Berlin-Zehlendorf, Germany;
| | | | - Sara Brucker
- Department für Frauengesundheit, University Hospital Tübingen, Calwer Straße 7, 72076 Tübingen, Germany;
| | - Matthias Biebl
- Department of Surgery, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany;
| | - Martina Westermann
- Department of Obstetrics and Gynecology, Kiel School of Gynaecological Endoscopy, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller Str. 3, House C, 24105 Kiel, Germany; (J.A.); (M.W.); (V.G.); (M.K.); (N.M.); (L.M.); (G.P.)
| | - Veronika Günther
- Department of Obstetrics and Gynecology, Kiel School of Gynaecological Endoscopy, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller Str. 3, House C, 24105 Kiel, Germany; (J.A.); (M.W.); (V.G.); (M.K.); (N.M.); (L.M.); (G.P.)
| | - Magret Krüger
- Department of Obstetrics and Gynecology, Kiel School of Gynaecological Endoscopy, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller Str. 3, House C, 24105 Kiel, Germany; (J.A.); (M.W.); (V.G.); (M.K.); (N.M.); (L.M.); (G.P.)
| | - Nicolai Maass
- Department of Obstetrics and Gynecology, Kiel School of Gynaecological Endoscopy, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller Str. 3, House C, 24105 Kiel, Germany; (J.A.); (M.W.); (V.G.); (M.K.); (N.M.); (L.M.); (G.P.)
| | - Liselotte Mettler
- Department of Obstetrics and Gynecology, Kiel School of Gynaecological Endoscopy, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller Str. 3, House C, 24105 Kiel, Germany; (J.A.); (M.W.); (V.G.); (M.K.); (N.M.); (L.M.); (G.P.)
| | - Göntje Peters
- Department of Obstetrics and Gynecology, Kiel School of Gynaecological Endoscopy, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller Str. 3, House C, 24105 Kiel, Germany; (J.A.); (M.W.); (V.G.); (M.K.); (N.M.); (L.M.); (G.P.)
| | - Ibrahim Alkatout
- Department of Obstetrics and Gynecology, Kiel School of Gynaecological Endoscopy, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller Str. 3, House C, 24105 Kiel, Germany; (J.A.); (M.W.); (V.G.); (M.K.); (N.M.); (L.M.); (G.P.)
- Correspondence: ; Tel.: +49-431-500-21450
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10
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Andolfi C, Gundeti MS. Live-case demonstrations in pediatric urology: Ethics, patient safety, and clinical outcomes from an 8-year institutional experience. Investig Clin Urol 2020; 61:S51-S56. [PMID: 32055754 PMCID: PMC7004838 DOI: 10.4111/icu.2020.61.s1.s51] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 01/12/2020] [Indexed: 12/13/2022] Open
Abstract
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 non-live 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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Affiliation(s)
- Ciro Andolfi
- Pediatric Urology, Section of Urology, Department of Surgery, Comer Children's Hospital, The University of Chicago Medicine, Chicago, IL, USA
| | - Mohan S Gundeti
- Pediatric Urology, Section of Urology, Department of Surgery, Comer Children's Hospital, The University of Chicago Medicine, Chicago, IL, USA
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Schuettfort VM, Schoof J, Rosenbaum CM, Ludwig TA, Vetterlein MW, Leyh-Bannurah SR, Maurer V, Meyer CP, Dahlem R, Fisch M, Reiss CP. Live surgery in reconstructive urology: evaluation of the surgical outcome and educational benefit of the international meeting on reconstructive urology (IMORU). World J Urol 2019; 37:2533-2539. [DOI: 10.1007/s00345-019-02666-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 01/31/2019] [Indexed: 01/12/2023] Open
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Surgical teaching in urology: patient safety and educational value of 'LIVE' and 'SEMI-LIVE' surgical demonstrations. World J Urol 2018; 36:1673-1679. [PMID: 29680950 PMCID: PMC6153636 DOI: 10.1007/s00345-018-2291-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 04/05/2018] [Indexed: 01/04/2023] Open
Abstract
Purpose To 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). Methods Following 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.
Results All 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. Conclusions LSD 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 material The online version of this article (10.1007/s00345-018-2291-x) contains supplementary material, which is available to authorized users.
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Rocco B, Grasso AAC, De Lorenzis E, Davis JW, Abbou C, Breda A, Erdogru T, Gaston R, Gill IS, Liatsikos E, Oktay B, Palou J, Piéchaud T, Stolzenburg JU, Sun Y, Albo G, Villavicencio H, Zhang X, Disanto V, Emiliozzi P, Pansadoro V. Live surgery: highly educational or harmful? World J Urol 2017; 36:171-175. [DOI: 10.1007/s00345-017-2118-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 10/30/2017] [Indexed: 12/17/2022] Open
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