Outcome from 5-year live surgical demonstrations in urinary stone treatment: are outcomes compromised?

Abstract

PurposeTo compare intra- and post-operative outcomes of endourological live surgical demonstrations (LSDs) and routine surgical practice (RSP) for urinary stones.MethodsConsecutive ureterorenoscopic (URS) and percutaneous (PNL) urinary stone procedures over a 5-year period were reviewed. Procedures were divided into LSDs and RSP. Differences between the groups were separately analysed for URS and PNL. Primary outcomes included intra- and post-operative complication rates and grades. Secondary outcomes were operation time, length of hospital stay, stone-free rate, and retreatment rate. Pearson’s Chi-square analysis, Mann–Whitney U test, and logistic and linear regression were used to compare outcomes between LSDs and RSP.ResultsDuring the study period, we performed 666 URSs and 182 PNLs, and 151 of these procedures were LSDs. Among URSs, the overall intra-operative complication rate was 3.2% for LSDs and 2.5% for RSP (p = 0.72) and the overall post-operative complication rate was 13.7% for LSDs and 8.8% for RSP (p = 0.13). Among PNLs, the overall intra-operative complication rate was 8.9% for LSDs and 5.6% for RSP (p = 0.52) and the overall post-operative complication rate was 28.6% for LSDs and 34.9% for RSP (p = 0.40). For both URSs and PNLs, no statistically significant differences in complication grade scores were observed between LSDs and RSP. Operation time was significantly longer for LSD-URS group, but there was no difference between the PNL groups. There were no significant differences in length of hospital stay and stone-free rate. The retreatment rate was higher in the LSD-URS group compared with RSP-URS group but similar between the PNL groups. Multiple logistic regression analyses, adjusting for confounders, revealed no association between LSD and more or less favourable outcomes as compared to RSP.ConclusionLive surgical demonstrations do not seem to compromise patients’ safety and outcomes when performed by specialised endourologists.Electronic supplementary materialThe online version of this article (doi:10.1007/s00345-017-2050-4) contains supplementary material, which is available to authorized users.

Evaluation of Live Surgery Meetings: Our Experience with the “Live Makeover Aesthetic Surgery Symposium”

“…Safety and ethical issues of live surgery have also been debated. Some articles are in favor of live surgery 4 , 6 , 7 , 12 – 14 reporting surgical outcomes similar to routine cases. Other articles, however, express concerns about the possible distraction of the surgeon due to the stressful nature of live broadcast and potential increase in patients’ risk.…”

Surgical teaching in urology: patient safety and educational value of ‘LIVE’ and ‘SEMI-LIVE’ surgical demonstrations

“…On the other hand, observational studies, comparing the outcomes of LSD with routine practice, give less cause for concern [ 6 , 13 , 14 ]. Brunckhorst et al reviewed the literature from 1980 until 2014 on LSD outcomes, identifying eight studies in different medical fields.…”

“…More recently, three studies evaluated the outcomes of live endourological procedures and live robot-assisted radical prostatectomies. These studies did not report statistically significant differences in outcomes in comparison to routine cases [ 6 , 14 , 15 ].…”

“…Technical innovations facilitate high-quality broadcasts for large audiences. The increase of LSD and their popularity fuelled the debate on patient safety and their educational value [ 1 – 6 ].…”

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

“…More recently, three studies evaluated the outcomes of live endourological procedures and robot-assisted prostatectomies. These studies did not report statistically significant differences in surgical outcomes as compared to routine cases [11][12][13].…”