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Send to a FriendIn July 2005, in the "In My Opinion" column on the CTSnet homepage, Professor Duke Cameron published an article titled "Surgery as Spectacle," expressing his concern about the attitudes engendered by the recent prevalence of live surgery. The problems arising from live surgery had been a subject of discussion among surgeons in Japan also, but had not reached the scale of drawing major attention in academic society meetings. In a live surgery session that was conducted by a surgical society in September 2006, during an operation to repair a thoracoabdominal aortic aneurysm, retrograde dissection took place from the clamp on the aortic arch to the root of the aorta, and, although replacement of the root of the aortic arch and a coronary artery bypass were performed, the patient died 2 days after surgery.
On request from the organizers, the Japanese Society for Cardiovascular Surgery set up an investigation team that produced a report in February 2007 outlining the various problems associated with live surgery. The report strongly criticized the casual attitude toward patient safety that had been engendered by the largely unmonitored environment in which live surgeries had been taking place. This resulted in the decision to create guidelines for live surgery by the Executive Board, and a Live Surgery Guidelines Committee was formed. This was expanded to include several members of the Japanese Society for Cardiovascular Surgery, the Japanese Association for Thoracic Surgery and the Japanese Society for Vascular Surgery, as well as three members from outside the medical field, namely, one patient representative, a lawyer, and a journalist.
The main discussion revolved around the issue of live surgery straying from its original educational purposes and becoming a platform for surgical performance, advertisement for surgical equipment, and other forms of neglect of patient interest such as excessive conversation between the surgeon and moderator. The dangers of suboptimal surgical performance due to high stress levels and nervousness were also discussed. In addition, it was pointed out that the relevant academic society must carry out follow-up post-operative investigations and assessments on patients who have undergone live surgery.
During the Committee meeting, when the lawyer member asked the Committee as a whole, "Would you all be willing to be the patient in a live surgery session?", all members representing the Societies replied in the negative. At this, the patient representative asked, "In that case, shouldn't live surgery be prohibited?" The prohibition of live surgery was considered, but some agreement was reached on the point that to entirely ignore the educational benefits of live surgery was also surely not to contribute to the future progress of medicine.
However, in order to carry out live surgery, guidelines were drawn up on August 10, 2007, with the aims of preserving the maximum degree of safety for each patient; of obtaining fully informed consent after the dangers inherent in live surgery have been clearly explained; of keeping strict observance of the prepared guidelines; and, if an authentic video record is to be used as an educational alternative for live surgery, of making as much use as possible of video. The Guidelines were officially released in the name of three Societies. In addition, in Japan, cardiology, endoscopic surgery, and other specialties are each in the process of producing Guidelines for Live Procedures along the same lines as those drawn up for Live Surgery.
These Guidelines have been translated into English, and were enthusiastically discussed at the Leadership Meeting of STS/AATS/EACTS/ESTS/ASCVTS held in Geneva on 15 September 2007. A broad agreement was reached, and it was decided that the guidelines would be taken back to the boards of directors of the respective Societies for consideration of endorsement, where they would be used as a tentative proposal and basis for discussion, that might lead to the creation of International Guidelines for Live Surgery.
As these Guidelines make their way around the world, it is my earnest hope that, not only in our specialties of cardiovascular surgery and thoracic surgery, but also in other surgical specialties and specialties such as cardiology, visual education giving the highest priority to patient safety will be carried out with dedication and sincerity.
I would like to express my gratitude for Professor Duke Cameron's initial courageous proposal.