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Live case demonstrations: patient safety, ethics, consent, and conflicts

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.

To summarize current evidence on LSB with a focus on the risks of complications and the educational impact.

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.

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.

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.

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).

Since the global outbreak of coronavirus disease-2019 (COVID-19), plastic surgeons were forced to transition from traditional didactics to virtual lectures to practice “social distancing.” As this method of education continues to be widely used, understanding the current trend of its usage is critical. In this study, we performed a survey study of virtual lecture attendees and presenters to determine current usage and general consensus on virtual lectures in plastic surgery education.

An electronic survey was sent to attendees and presenters of virtual lectures using Google Forms. Demographic data, webinar usage patterns, and views on virtual lectures were collected.

A total of 417 surveys were received. Prior to the COVID-19 era, 39.1percent of attendees did not use virtual lectures and 45.6percent of presenters did not give webinars at all. Both groups reported that the lack of opportunities and need were the most common cause of no use of lectures or webinars. After the outbreak, 35.4percent of attendees now use virtual lectures daily and 51.4percent of presenters give lectures weekly. Over 90percent of the study population reported a positive experience with the virtual lectures due to increased interaction, convenience, outreach, and usability. Finally, over 75percent stated that virtual lectures might replace classroom lectures in the future.

Our study shows that a majority of plastic surgeons have begun to use and give virtual lectures daily after the COVID-19 outbreak. Virtual education is a powerful and versatile tool that has great potentials, and it may continue to serve as a part of surgical training in the future.

Live surgery is a topic of interest at every meeting or course in the field of surgery. The potential of laparoscopy for live broadcasting makes it an excellent tool in continuing medical education. Surgeons who participate in live surgeries are usually experienced, but several conditions may influence the results and safety of a procedure.

To analyze safety and outcomes in a series of patients who underwent surgery in the last 10 years in a live surgery course at our institution.

University public hospital in Spain.

Retrospective review of patients who underwent surgery during these courses from 2006 to 2016. Morbidity, mortality, and long-term results were analyzed.

Of 107 patients, 74 (68.5%) were women, and 38 (35.2%) had revision surgery. Five had surgery during previous editions. The most performed procedures were Roux-en-Y gastric bypass (38.9%), sleeve gastrectomy (16.7%), and duodenal switch (14%). Ten cases were endoscopic procedures. Morbidity was 13% (14 cases), and 6 required early postoperative revision (5.6%). Most of the complications were Clavien types III and I. Bleeding was the most common (72.4%). There was no anastomotic leak, but 1 duodenal stump leak occurred. During follow-up, 6 patients had a surgical complication and 5 required revision surgery. There was no mortality.

We found higher morbidity and reoperation rates. The conversion rate in long-term follow-up was higher. Despite the educational benefits, we should take into consideration the higher risk to our patients for future editions.

Live surgery is an important part of surgical education, with an increase in the number of live surgery events (LSEs) at meetings despite controversy about their real educational value, risks to patient safety, and conflicts of interest.

To provide a European Association of Urology (EAU) policy on LSEs to regulate their organisation during urologic meetings.

The project was carried out in phases: a systematic literature review generating key questions, surveys sent to Live Surgery Panel members, and Internet- and panel-based consensus finding using the Delphi process to agree on and formulate a policy.

The EAU will endorse LSEs, provided that the EAU Code of Conduct for live surgery and all organisational requirements are followed. Outcome data must be submitted to an EAU Web-based registry and complications reported using the revised Martin criteria. Regular audits will take place to evaluate compliance as well as the educational role of live surgery.

This policy represents the consensus view of an expert panel established to advise the EAU. The EAU recognises the educational role of live surgery and endorses live case demonstration at urologic meetings that are conducted within a clearly defined regulatory framework. The overriding principle is that patient safety must take priority over all other considerations in the conduct of live surgery.

Controversy exists regarding the true educational value of live surgical demonstrations on patients at surgical meetings. An EAU committee of experts developed a policy on how best to conduct live surgery at urologic meetings. The key principle is to ensure safety for every patient, including a code of conduct and checklist for live surgery, specific rules for how the surgery is organised and performed, and how each patient's results are reported to the EAU. For detailed information, please visit www.uroweb.org.