Does live surgery cause greater risk to the patient?
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It does and it should be discontinued
Live surgery causes greater risk to the patient, and as a consequence, the practice should be discontinued at meetings.
Surgeons undertaking live surgery will often be in an unfamiliar environment, in a theater they never have operated in before, using equipment they may not be used to, performing a procedure on a patient they may not have met. Inevitably, they will be under a lot of stress, with an earphone in their ear, multitasking and not able to fully concentrate on the operation. If complications happen — and we have seen them happen many times during live surgery meetings — surgeons may find it difficult to stay calm and manage the situation appropriately. In such circumstances, even the very best surgeon may not react in the way they would in a conventional surgical environment.
Several years ago, a questionnaire developed by an informal focus group and approved by the honorary secretary of the Royal College of Ophthalmologists was sent to 856 U.K. ophthalmology consultants to survey their opinions on live surgery. Nearly 70% of respondents believed that the complication rate was higher for live surgery. More than 80% thought that live surgery was not in the patient’s best interest. Close to two-thirds of consultants thought live surgery should not continue to be performed. Inadequate consent was another perceived disadvantage of live surgery, mentioned by around half of the respondents.
Furthermore, digital technology has moved on, and there is limited benefit in live surgery events compared with watching a video. At a meeting or conference, the surgeon can talk to the relevant video and take audience questions without any unnecessary stress or added risk to the patient. We all do video recordings of our surgical procedures, and they can be used for teaching much more safely. Having this excellent alternative, it is hard to understand what would justify the additional risk to patients in live surgery. Maybe decades ago, when we did not have these facilities, live surgery served a training purpose with the added risk justified. But the world has moved on. Indeed, in our questionnaire, when asked whether watching live surgery might teach more than a surgical video, only 26% of respondents agreed.
- Reference:
- Hollick EJ, et al. J Cataract Refract Surg. 2008;doi:10.1016/j.jcrs.2008.02.023.
- For more information:
- Emma Hollick, MD, FRCOphth, is with King’s College Hospital, London.
It does not if properly organized
Live surgery, in expert hands as it should always be, does not cause a greater risk for patients.
In 2022, we published the results of a contralateral eye study comparing the outcomes of live and routine cataract surgery interventions during two consecutive editions of the Italian Association of Cataract and Refractive Surgery annual meeting. A total of 108 eyes of 54 patients were included, operated in one eye during our live surgery sessions and in the other eye by a different surgeon as part of the routine surgery sessions in the same clinics that hosted the live broadcast. The surgeons who operated live had not seen the patient beforehand but had told us their preferences in terms of instruments, ophthalmic viscosurgical devices and settings. The other surgeons had operated as per the routine established by the hospital. No difference was found in terms of outcomes or complications.
Every day when I walk into the operating room, I find patients I have never seen, and due to my role of head of department, I get the most complicated cases and the most difficult, uncooperative patients. I cannot choose the patients I am going to operate on, and I am confronted with a wide variety of cases in terms of age, health status, condition, degree of severity, personality and expectations. Conversely, when I invite a surgeon to a congress to do live surgery, say cataract surgery with IOL implantation, I ask what kind of patients they want, with hard, soft or medium density cataract. I ask whether they prefer to operate on the left or right eye. I ask them a lot of questions to make sure they are provided with the best equipment, the kind of patient they feel comfortable with and the eye they expect. In addition, patients who are selected for live surgery are usually cooperative patients who feel comfortable being operated on by a surgeon they do not know in a busy setting. For all these reasons, I think that quite a few surgeons would agree that operating live was easier and smoother than many of their routine surgery sessions.
Of course, it is the responsibility of the scientific societies that organize these events to rely on only the most skilled and experienced surgeons and establish this as a clear priority with the companies when they propose physicians of their choice.
- Reference:
- Puzo P, et al. Eur J Ophthalmol. 2022;doi:10.1177/11206721221089172.
- For more information:
- Giovanni Alessio, MD, is with Bari University Hospital, Bari, Italy.
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