“Was the delay in deciding to open influenced by the presence of an audience of 100 surgeons expecting to see a laparoscopic liver resection?”

“In addition to his tumor, the patient had hepatitis and cirrhosis. Was he a good candidate? A major complication was inevitably to occur during a live broadcast.”

As I predicted last year, it had to happen sooner or later.

In that post, I wrote, “A major complication will inevitably occur during a live broadcast. No matter the reason, it will be blamed on the live video surgery.” Of the many stories in the Indian media about this tragic case, most brought up the debate about the ethics of showing surgery to an audience in real time.

One article featured the response of a senior physician at the All India Institute of Medical Sciences (AIIMS) in Delhi, where the tragic event took place, who said, “Live surgery has nothing to do with the death; the whole world is moving from open to laparoscopic procedure for its safety rate. He succumbed because of his disease, and there were several experts present who did whatever was possible to save his life.”

Right. I’m not so sure about that. Here’s what happened.

A 62-year-old man who was having a laparoscopic resection for a liver cancer began bleeding during the procedure, which was being televised live to surgeons at a seminar. A Japanese liver surgeon was performing the operation assisted by a surgeon from the AIIMS, India’s most prestigious medical school.

Reports say members of the audience encouraged the surgeons to switch to an open operation after bleeding could not be controlled laparoscopically, but the conversion did not occur until several hours had elapsed.

The patient died in an intensive care unit about 90 minutes after the procedure ended.

Many questions come to mind. In addition to his tumor, the patient had hepatitis and cirrhosis. Was he a good candidate for the minimally invasive surgery? Did he or his family know the procedure was going to be televised to a conference? Did they know a Japanese surgeon would be doing the operation? Was that surgeon properly credentialed to operate in India?

In response to this incident, the Maharashtra Medical Council in Mumbai has strengthened its rules regarding foreign doctors performing surgery. They must now temporarily register with the Medical Council of India or of the state in which they plan to operate by submitting pertinent documents for review.

The Times of India said that three major societies in the city of Hyderabad are either banning or looking at more stringent regulations for live surgery broadcasts.

The Times added some excellent points: “The perils of live workshops are too many, especially when a foreigner or an outsider performs before an audience as they might be prone to develop anxiety or stress due to several factors such as unfamiliar patients, using unfamiliar instruments, performing the surgery with unfamiliar team members or talking during the surgery.”

We do not know all the facts in this case, but if the reports are correct, the surgeons probably waited too long to abandon the laparoscopic procedure.

Was the delay in deciding to open influenced by the presence of an audience of 100 surgeons expecting to see a laparoscopic liver resection?

Should medical organizations in the U.S. reassess their policies on live broadcast surgery?

“Skeptical Scalpel” is a surgeon who blogs at his self-titled site, Skeptical Scalpel.  This article originally appears in Physician’s Weekly.

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