Investig Clin Urol.  2020 Feb;61(Suppl 1):S51-S56. 10.4111/icu.2020.61.S1.S51.

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

• Andolfi C
• Gundeti MS

• KMID: 2469126
• DOI: http://doi.org/10.4111/icu.2020.61.S1.S51

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.

Keyword

Ethics, clinical; Minimally invasive surgical procedures; Robotic surgical procedures; Teaching; Urology

MeSH Terms

Anxiety
Cohort Studies
Ethics*
Ethics, Clinical
Humans
Length of Stay
Minimally Invasive Surgical Procedures
Operative Time
Patient Safety*
Patient Selection
Replantation
Robotic Surgical Procedures
Surgeons
Surgical Equipment
Ureter
Urology*

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