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Live surgery: highly educational or harmful?

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Abstract

Purpose

Live surgery (LS) is considered a useful teaching opportunity. The benefits must be balanced with patient safety concerns. To evaluate the rate of complications of a series of urologic LS performed by experts during the Congress Challenge in Laparoscopy and Robotics (CILR).

Methods

We present a large, multi-institution, multi-surgeon database that derives from 12 CILR events, from 2004 to 2015 with a total of 224 cases. Radical prostatectomy (RP) was the most common procedure and a selection of complex cases was noted. The primary measure was postoperative complications and use of a Postoperative Morbidity Index (PMI) to allow quantitative weighing of postoperative complications.

Results

From 12 events, the number of cases increased from 11 in 2004 to 27 in 2015 and a total of 27 surgeons. Of 224 cases (164 laparoscopic and 60 robotic), there were 26 (11.6%) complications: 5 grade I, 5 grade II, 3 grade IIIa, 12 grade IIIb and 1 grade V, the latter from laparoscopic cystectomy. Analysis of PMI was 23 times higher from cystectomy compared to RP.

Conclusions

In the setting of live surgery, the overall rate of complications is low considering the complexity of surgeries. The PMI is not higher in more complex procedures, whereas RP seems very safe.

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Author information

Authors and Affiliations

  1. Department of Urology, Nuovo Ospedale Civile Sant’ Agostino Estense (N.O.C.S.A.E.) di Baggiovara, University of Modena and Reggio Emilia, Modena, Italy

    B. Rocco

  2. Department of Urology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy

    A. A. C. Grasso, E. De Lorenzis & G. Albo

  3. Department of Urology, Anderson Cancer Center, University of Texas, Houston, TX, USA

    J. W. Davis

  4. Department of Urology, Henri Mondor Hospital, Créteil, France

    C. Abbou

  5. Urology Department, Fundacio Puigvert, Cartagena, Barcelona, Spain

    A. Breda, J. Palou & H. Villavicencio

  6. Departments of Urology and Minimally Invasive and Robotic Surgery, Memorial Atasehir Hospital, Istanbul, Turkey

    T. Erdogru

  7. Department of Urology, Clinique Saint Augustin, Bordeaux, France

    R. Gaston & T. Piéchaud

  8. Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California Institute of Urology, Los Angeles, CA, USA

    I. S. Gill

  9. Department of Urology, University of Patras, Patras, Greece

    E. Liatsikos

  10. Medical Faculty, Department of Urology, Uludag University, Gorukle, Bursa, Turkey

    B. Oktay

  11. Department of Urology, University of Leipzig, Leipzig, Germany

    J. U. Stolzenburg

  12. Department of Urology, Changhai Hospital, Second Military University, Shanghai, China

    Y. Sun

  13. Department of Urology, Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing, People’s Republic of China

    X. Zhang

  14. Department of Urology, Pansadoro Foundation, Rome, Italy

    V. Disanto, P. Emiliozzi & V. Pansadoro

Authors
  1. B. Rocco
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  2. A. A. C. Grasso
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  3. E. De Lorenzis
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  4. J. W. Davis
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  5. C. Abbou
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  6. A. Breda
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  7. T. Erdogru
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  8. R. Gaston
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  9. I. S. Gill
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  10. E. Liatsikos
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  11. B. Oktay
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  12. J. Palou
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  13. T. Piéchaud
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  14. J. U. Stolzenburg
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  15. Y. Sun
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  16. G. Albo
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  17. H. Villavicencio
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  18. X. Zhang
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  19. V. Disanto
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  20. P. Emiliozzi
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  21. V. Pansadoro
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Contributions

BR was involved in project development and edited the manuscript. AACG wrote the manuscript and was involved in data collection and analysis. EDL collected the data, wrote the manuscript and was involved in analysis. JWD edited the manuscript and was involved in supervision. CA organized the event and collected the data. AB collected the data and was involved in project development. TE organized the event and collected the data. RG organized the event and collected the data. ISG organized the event and collected the data. EL organized the event and collected the data. BO organized the event and collected the data. JP organized the event and collected the data. TP organized the event and collected the data. JUS organized the event and collected the data. YS organized the event and collected the data. GA analyzed the data and edited the manuscript. HV organized the event and collected the data. XZ organized the event and collected the data. VD created the event. PE organized the event and collected the data. VP created the event, edited the manuscript and was involved in supervision.

Corresponding author

Correspondence to B. Rocco.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study, formal consent is not required.

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Cite this article

Rocco, B., Grasso, A.A.C., De Lorenzis, E. et al. Live surgery: highly educational or harmful?. World J Urol 36, 171–175 (2018). https://doi.org/10.1007/s00345-017-2118-1

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  • DOI: https://doi.org/10.1007/s00345-017-2118-1

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