Pediatric Urology, Section of Urology, Department of Surgery, Comer Children's Hospital, The University of Chicago Medicine, Chicago, IL, USA.
Investig Clin Urol. 2020 Feb;61(Suppl 1):S51-S56. doi: 10.4111/icu.2020.61.S1.S51. Epub 2020 Jan 31.
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.
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.
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.
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.
现场手术演示已成为世界各地外科会议的常见活动。这些演示旨在作为一种教学手段，教授技术、促进讨论、改进干预措施和结果。尽管具有宝贵的教育意义，但许多作者仍对这种方法的伦理提出质疑。我们介绍了我们在现场手术方面的 8 年经验，讨论了伦理问题，并提出了建议。
我们回顾了在广播活动中接受机器人辅助腹腔镜肾盂成形术（RAL-P）、输尿管再植术（RALUR）和半肾切除术（RAL-HN）的患者记录。比较了围手术期和术后结果与我们之前发表的病例系列。
从 2011 年 10 月至 2019 年 5 月，资深作者（MSG）对 22 名患者进行了所有现场手术演示：9 例 RAL-P、9 例 RALUR 和 4 例 RAL-HN。与我们之前的病例系列相比，现场 RAL-P 的成功率为 100%，30 天 Clavien-Dindo 分级（CDG）III 并发症较低（11.1% vs. 21.2%）。在现场演示中进行的 RALUR 成功率高于我们之前发表的队列（100% vs. 82%）。RAL-HN 手术时间和住院时间与我们的非现场对照组相当。
现场手术是一种有价值的教学工具，但即使是经验丰富的外科医生也可能会受到不合适的病例选择、技术难度以及与特定环境相关的焦虑等因素的不利影响，例如在不同机构进行手术或与不熟悉的手术团队合作。我们建议咨询伦理审查委员会，并制定有关患者选择、手术设备和手术团队的标准指南。
