The Theatre of Surgery: The Ethical and Legal Implications of Live Surgeries.

Surgical training has long emphasized learning through direct observation, allowing young surgeons to gain practical insights from experienced surgeons. The advent of live surgical demonstrations has extended this learning method, providing real-time broadcasts of surgeries to wider audiences. Live surgery is a surgery that is broadcasted in real time to an audience. While live surgeries offer substantial educational benefits, enabling the rapid dissemination of advanced surgical techniques and reducing the learning curve for surgeons, they also raise critical ethical and legal questions. Concerns include potential compromises in surgical outcomes due to increased pressure on surgeons, the ethical implications of patient consent, privacy issues, and the ambiguity of accountability when complications arise. In India, these concerns have intensified following a patient's death during a live surgery, prompting legal scrutiny and a Supreme Court petition seeking to regulate the practice. This article delves into the multifaceted debate surrounding live surgeries, examining both their educational value and the ethical, legal, and practical challenges they pose. We aim to provide a comprehensive overview that will inform readers about the complexities of live surgeries, spread awareness, and stimulate further discussions on this evolving practice.

Safety and Efficacy of Live Retrograde Intrarenal Surgery in Patients with Kindey Stone: Outcomes from a Boutique Course Series Which Complies with the Live Surgery Event Policies.

BACKGROUND: Live surgery events (LSEs) are frequently organized for sharing the surgical experiences with surgeons at the beginning of their learning curves. The aim of this study was to investigate whether the outcomes and complication rates of patients underwent retrograde intrarenal surgery (RIRS) at LSEs are comparable with regular cases. METHODS: Ten courses were organized during 2017-2022. Data of 32 patients who operated in the LSEs were 1:3 matched (for stone burden and surgeon) with the data of patients who underwent regular RIRS within the course periods at the same centers (n = 96). All courses took place in concordance with the latest LSE policies. The primary outcomes were stone-free and complication rates. Fluoroscopy and operation times were the secondary outcomes. RESULTS: Stone-free rates of the groups were similar (84% in LSE and 79% in control group; p = 0.520). Similarly, there were no differences in complication rates (p = 0.428) and fluoroscopy time (p = 0.477). Duration of the LSE cases (82.24 ± 31.12 min) was slightly but insignificantly longer than regular cases (73.77 ± 20.89 min, p = 0.092). Moreover, guest surgeons tend to have longer operation time with statistically insignificant prolongation (74.92 ± 30.43 min for host, 89.52 ± 28.34 min for guest surgeons, p = 0.064). CONCLUSIONS: RIRS can be performed without jeopardizing operation efficiency and patient safety in LSEs. If surgeon is not familiar with operating room set-up or staff, live surgery must be performed by host surgeon to avoid extended operating time.

The characteristics of Laennec's capsule around the hepatic veins: A histological study based on 71 liver surgical specimens.

Background: Laennec's capsule is a fibrous membrane attached to the surface of the liver, which is independent of the hepatic veins. However, the presence of Laennec's capsule surrounding the peripheral hepatic veins is controversial. This study aims to describe the characteristic of Laennec's capsule around the hepatic veins at all levels. Methods: Seventy-one hepatic surgical specimens were collected along the cross and longitudinal sections of the hepatic vein. Tissue sections of 3-4 mm were cut and stained with hematoxylin and eosin (H&E), resorcinol-fuchsin (R&F), and Victoria blue (V&B). Elastic fibers were observed around the hepatic veins. They were measured using K-Viewer software. Results: Morphologically, we observed a thin, dense fibrous layer (so-called Laennec's capsule) around the hepatic veins at all levels, which was different from the thick elastic fibers of the hepatic vein wall. Therefore, there was a potential gap between Laennec's capsule and the hepatic veins. Laennec's capsule was visualized significantly better with R&F and V&B staining compared to H&E staining. The thickness of Laennec's capsule around the main, first, and secondary branches of the hepatic vein were 79.86 ± 24.20 µm, 48.41 ± 18.25 µm, and 23.56 ± 10.03 µm in the R&F staining, and 80.15 ± 21.85 µm, 49.46 ± 17.52 µm, and 25.05 ± 11.03 µm in the V&B staining, respectively. They were significantly different from each other (P < .001). Conclusion: The hepatic veins were surrounded by Laennec's capsule at all levels, including the peripheral hepatic veins. However, it is thinner along the vein branches. The gap between the Laennec's capsule and hepatic veins shows potential supplemental value for liver surgery.

Radiofrequency ablation versus liver resection and liver transplantation for small combined hepatocellular-cholangiocarcinoma stratified by tumor size.

PURPOSE: Although radiofrequency ablation (RFA) has been proven to provide a good survival benefit for small hepatocellular carcinoma (HCC), there is limited information about RFA for combined hepatocellular-cholangiocarcinoma (cHCC-CC). The purpose of this study was to explore the clinicopathological features of cHCC-CC and the curative effect of RFA in small cHCC-CC without distant metastases compared with liver resection (LR) and liver transplantation (LT). METHODS: Patients with cHCC-CC, intrahepatic cholangiocarcinoma, or HCC were identified in the Surveillance, Epidemiology, and End Results database. RESULTS: cHCC-CC had the highest rate of poor pathological grade and the lowest rate of bone metastases compared with intrahepatic cholangiocarcinoma and HCC (all P < 0.05). In patients with cHCC-CC after surgery, multivariate analysis showed that compared with RFA, LR and LT were independent protective factors for survival (all P < 0.05). But in cHCC-CC stratified by tumor size, for tumor size ≤ 3.0 cm, there was no significant difference among RFA, LR, and LT in univariate survival analysis (P = 0.285). For tumor size 3.0-5.0 cm, multivariate analysis showed that RFA for cHCC-CC yielded worse survival outcomes in comparison with that of LR (hazard ratio [HR]: 7.51, 95% confidence interval [CI]: 2.09-26.94, P = 0.002) and LT (HR: 4.48, 95% CI: 1.20-16.64, P = 0.025). CONCLUSIONS: In patients with cHCC-CC without distant metastases, for tumor size ≤ 3.0 cm, there was no significant survival difference among RFA, LR, and LT. However, for tumor size 3.0-5.0 cm, RFA may provide a worse survival benefit than LT and LR.

[Interactive intraoperative annotation of surgical landmarks in student education to support learning efficiency and motivation]. / Interaktive intraoperative Annotation chirurgischer Anatomie in der studentischen Ausbildung zur Unterstützung der Lerneffizienz und -motivation.

BACKGROUND: The development of technological innovations has not only changed social life and the healthcare system, but also affects medical education. The aim of this pilot study was to evaluate whether students, when observing a microsurgical procedure of the temporal bone, gain an additional understanding of the anatomical structures and surgical site when visualization is used that provides identical views for the surgeon and viewer in 3D. MATERIALS AND METHODS: During regular attendance tutorials, students were randomly assigned to three different groups: control group, 2D group, or 3D group. Evaluation questionnaires and intraoperative student annotation of the surgical view were used to assess the subjective didactic value of different visualization formats and resultant learning experiences for the students. RESULTS: A total of 47 students were included in the investigations during conventional attendance tutorials. The majority indicated a high added value of the 3D visualization in terms of method (70%) and vividness (80%) compared to the 2D group and self-study; 69% of the students fully agreed with the statement that 2D and 3D visualization increases learning motivation and is a very good way to improve recognition of anatomical topography and structures. CONCLUSION: New interactive visualization options in teaching promote learning efficiency and motivation among students. Especially 3D visualization and intraoperative annotation of the surgical view by the student is a useful didactic tool and increases the quality of clinical teaching. It supports the perception of anatomical topography and enables more focused surgical training.

Live surgery outcomes in cataract surgery.

PURPOSE: To evaluate and compare the outcomes of live surgery (LS) and no-live surgery (NLS) on cataract surgery with implantation of different types of intraocular lenses (IOLs). METHODS: Retrospective, contralateral eye, case series of patients that underwent cataract surgery in live or non-live view during two consecutive editions of national meetings. Both eyes of the same patients were implanted with the same IOL, one in LS and the other in NLS. RESULTS: 108 eyes of 54 patients, aged between 50 and 82 (72 ± 8.2) and implanted with different types of IOLs, were reviewed. Both eyes in each patient were well matched at baseline in terms of intraocular biometric characteristics, corneal curvature and endothelial cell density (ECD) (p > 0.05). There are no statistically significant differences between the biometric and topographic parameters, aberrometric data and the loss of ECD in the post-operative outcomes (p > 0.05). However, comparing the different types of IOLs, there is a significant loss of ECD in eyes implanted with a toric IOL during LS (p = 0.0014 and p = 0.04, in 2017 and 2018 edition respectively). CONCLUSIONS: In this series of live cataract surgery, eyes operated in LS or NLS have comparable outcomes, underlying the importance and the benefits of live view in terms of medical education and the low-risk of complications. Nevertheless, we have found a significant increase in ECD loss in patients implanted with toric IOLs during LS.

Surgeons and ethical challenges in operating room.

Ethics lie in the heart of professionalism. In surgery, it represents an essential element, with surgeons facing ethical challenges in their routine practice. The rapid expansion of surgical technology and innovation along with the use of resources and consideration of conflict of interest have brought up the need for the development of current surgical code of ethics. Operating room represents a stressful environment where patients' lives depend upon careful preparation, planning and execution. The progression of surgery within the operating room must be done in harmony and in line with the ethical principles of autonomy, beneficence, non-maleficence and justice. Discussion of ethical problems arising in the operating room is not a common subject in surgical literature. The current narrative review was planned to cover ethical concerns related to patients' safety and privacy in the operating room and some of the evolving topics, like ethics of overlapping surgery, live surgical broadcast and 'do not resuscitate' policy in the operating room.

Interactive live-stream surgery contributes to surgical education in the context of contact restrictions.

BACKGROUND: Attendance teaching is the predominant teaching method at universities but needs to be questioned in the context of digital transformation. This study establishes and evaluates a method to accomplish electronic learning to supplement traditional attendance courses. MATERIALS AND METHODS: Surgery was transmitted in real-time conditions via an online live stream from the surgical theater. Visualization was transferred from a fully digital surgical microscope, an endoscope or an environmental camera in high definition quality. Students were able to participate at home from their personal computer. After following the surgery, they participated in an online-evaluation. RESULTS: A total of 65 students participated in the live stream. The majority of students (61.54%) indicated a significant subjective increase in knowledge after participation. The majority of students (53.85%) indicated that live surgeries should be offered as a permanent component in addition to classroom teaching. Likewise, a broader offer was desired by many students (63.08%). CONCLUSIONS: Live streaming of surgery is a promising approach as an alternative or supplement to traditional attendance teaching. An expansion of digital teaching can be explicitly supported on the basis of this study.

Risks and Benefits of Live Surgical Broadcast: A Systematic Review.

CONTEXT: Live surgical broadcast (LSB), also known as live surgery, has become a popular format for many types of surgical education meetings. However, concerns have been raised in relation to patient safety, ethical issues, and the actual educational value of LSB. OBJECTIVE: To summarize current evidence on LSB with a focus on the risks of complications and the educational impact. EVIDENCE ACQUISITION: We performed a systematic review of the literature according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify studies up to December 2020. We identified original articles reporting on patient outcomes, educational value, current use, and development of LSB. We also interrogated surgical society guidelines for position statements on LSB. EVIDENCE SYNTHESIS: Our literature search identified 46 studies spanning six surgical specialties, with urology being the most frequent. Approximately half of the studies reported on outcomes of surgical procedures during LSB. In urology, the few comparative studies available did not suggest higher complication rates in LSB, whereas data for other surgical fields highlighted evidence of worse outcomes. Four studies assessed the educational value of LSB via survey administration, for which the evidence is limited and of low quality. Thirteen guidelines and position statements on live surgery were identified among major surgical societies, including the European Association of Urology (EAU). Some surgical societies have expressly prohibited the use of LSB at their major meetings. The perspective of surgeons performing and/or attending live surgical sessions was evaluated in six studies, and four studies looked at urologists' perception of LSB compared to semi-LSB. Limitations of this systematic review include the limited number of studies available, the low quality of the evidence, and data heterogeneity. CONCLUSIONS: Evidence regarding outcomes of LSB is limited. Almost all the studies do not show a higher risk of complications or worse outcomes for patients undergoing a procedure during LSB. Only one study on gastrointestinal surgery reported that LSB outcomes were worse. Ongoing concerns have led to specific guidelines by several scientific societies, including the EAU, with the ultimate aim of minimizing surgical risks and maximizing patient safety. PATIENT SUMMARY: Live surgery events are often part of surgical conferences. Data in the literature show mixed outcomes for operations performed during live surgery events, but with no increase in complication rates. Safety and ethical concerns remain. Other educational tools, such as prerecorded videos and live surgery transmission from the home institution of the operating surgeon might become preferred options in the future. This review was prospectively registered on the PROSPERO website (www.crd.york.ac.uk/PROSPERO, registration number CRD42020194023).

Outcomes of EAU-endorsed Live Surgical Events over a 5-year Period (2015-2020) and Updated Guidelines from the EAU Live Surgery Committee.

CONTEXT: Live surgery events (LSEs) have been used in all surgical fields for education and training and to demonstrate new techniques. The European Association of Urology (EAU) live surgery guidelines were established in 2014. OBJECTIVE: To review the compliance of outcomes for procedures performed at EAU-affiliated LSEs with the 2014 guidelines and to establish updated guidelines for LSEs and semi-LSEs. EVIDENCE ACQUISITION: Patients from EAU-affiliated LSEs were included for all surgical procedures carried out between January 2015 and January 2020. All these events were pre-evaluated by the EAU Live Surgery Committee and met the criteria for an EAU LSE, with outcomes recorded and submitted to the registry. Data were collected for the type of procedure and for intraoperative and short- and long-term complications. EVIDENCE SYNTHESIS: A total of 246 procedures were performed across 18 LSEs, with an annual volume ranging from 19 to 74 procedures. These included 109 (44.3%) robot-assisted procedures, 21 (8.5%) laparoscopic procedures, 10 (4%) transurethral bladder procedures, 11 (4.4%) prostate enucleation procedures, 72 (29.2%) endourological procedures, and 23 (9.3%) andrology or reconstruction procedures. A total of 77 different surgical techniques and variations for 55 different types of surgery were performed as LSEs over the past 5 yr. There were 44 (17.8%) short-term complications and 11.3% (nine/79) long-term complications observed, with Clavien grade III/IV complications seen in 5.2% and 7.5% of cases over short- and long-term follow-up, respectively. CONCLUSIONS: The 5-yr outcomes for EAU LSEs show that they are safe and follow previous guidelines set by the panel. It seems likely that the fine balance between patient safety and educational value might be best achieved if LSEs are performed by local surgeons in their parent hospital with patients and staff they know, and that technological advances will make live streaming a seamless process. The current EAU Live Surgery Committee has updated the guidelines on LSEs and provided new guidelines for semi-live events. PATIENT SUMMARY: We reviewed 5-year outcomes for live surgery events endorsed by the European Association of Urology. We found that the operations carried out at these events were safe and followed the guidelines previously set. We have updated the guidelines and provided new guidelines for semi-live events.

Live surgery: Safety study after 17 editions of retroperitoneoscopic surgery. / Cirugía en directo: estudio de seguridad tras 17 ediciones de cirugía retroperitoneoscópica.

INTRODUCTION: Live surgery has become an excellent tool for medical training. Despite this, there is controversy about the safety of the patients involved. OBJECTIVE: To analyze the results of live surgeries performed in 17 consecutive retroperitoneoscopy courses organized in our center. Procedures performed were partial nephrectomy (PN), radical nephrectomy (RN) and nephroureterectomy (NU). MATERIAL AND METHODS: Review from January 2010 to October 2017 of all live surgeries carried out by an expert surgical team in the retroperitoneoscopy courses, compared with a control group of surgeries performed in standard conditions. A matching (1:1 for each RN and 1:2 for each PN and NU) according to age, body mass index and comorbidities was performed. RESULTS: Twenty-one live surgeries were analyzed (eight PN, seven RN and six NU) with a global median follow-up of 38 months. No significant differences were observed between both groups in terms of perioperative variables (operative time, operative bleeding and intraoperative complications) or of postoperative complications and length of hospital stay. Likewise, there were no differences between recurrence rates (PN: 0% vs. 6.3%, p = 0.47, NU: 33.3% vs. 66.7%, p = 0.180, RN: 0% vs. 28.6%, p = 0,127). CONCLUSIONS: Live surgery in the hands of expert surgeons in a suitable environment and with well-selected patients does not increase the risk of complications and allows maintaining the same oncological outcomes.

Non-technical skills in robotic surgery and impact on near-miss events: a multi-center study.

BACKGROUND: Robotic surgery requires a set of non-technical skills (NTS), because of the complex environment. We aim to study relationship between NTS and near-miss events in robotic surgery. METHODS: This is an observational study in five French centers. Three robotic procedures were observed and filmed by one of expert trainers in NTS. They established and scored a non-technical skills in robotic surgery (NTSRS) score, that included eight items, each scored from 1 to 5, to assess the whole surgical teams. The surgical teams also self-assessed their work. The number of near-miss events was recorded and classified as minor, or major but no harm incidents, independently by two surgeons. Correlations were Spearman coefficients. RESULTS: Of the 26 procedures included, 15 were prostatectomy (58%), 9 nephrectomy (35%), and 2 pyeloplasty (7.7%). Half of procedures (n = 13) were performed by surgeons with extensive RS experience (more than 150 procedures). Per procedure, there was a median (quartiles) of 9 (7; 11) near-miss events. There was 1 (0; 2) major near-miss events, with no harm. The median NTSRS score was 18 (14; 21), out of 40. The number of near-miss events was strongly correlated with the NTSRS score (r = - 0.92, p < 0.001) but was not correlated with the surgeon's experience. The surgeons for fifteen (58%) procedures, and the bed-side surgeons for 11 (42%) procedures, felt that there was no need for an improvement in the quality of their NTS. None of the surgeons gave a negative self-evaluation for any procedure; in three procedures (12%), the bed-side surgeons self-assessed negatively, on ergonomics. CONCLUSION: Occurrence of near-miss events was reduced in teams managing NTS. Specific NTS surgical team training is essential for robotic surgery as it may have a significant impact on risk management.

["Halle surgery week": how a teaching format awakens medical students' interest in surgery]. / "Hallesche OP-Wochen": Wie ein Lehrformat das Interesse von Medizinstudierenden an der Chirurgie weckt.

BACKGROUND: A practical education in surgery is difficult to conduct in a student-centered manner and is thus often inadequate. New teaching concepts are required to provide students with insights into surgery and make the field more appealing. METHODS: As part of a two-week facultative event, medical students followed eight live surgical procedures from different disciplines from an auditorium. In the auditorium, the procedures were simultaneously moderated by an experienced surgeon. Before and after every procedure, questionnaires were used to analyze whether the teaching event was suited to improve an understanding and interest for the field of surgery. RESULTS: A total of 709 completed questionnaires (pre and post) from 381 students were collected. The self-reported learning effect was evaluated as good or very good by students. In many of the presented disciplines, experiencing a live surgical procedure was associated with significant positive changes in attitude regarding each discipline in general, a potential clinical traineeship in the discipline and choosing the discipline as a later specialization. CONCLUSION: The high attendance as well as the evaluation results suggest a high acceptance for the teaching event. The teaching format is suited to improve the understanding of surgical procedures and had a positive effect on medical students' attitude towards surgical disciplines.

Learning benefits of live surgery and semi-live surgery in urology-informing the debate with results from the International Meeting of Reconstructive Urology (IMORU) VIII.

PURPOSE: To analyze the perceived learning opportunities of participants of the International Meeting on Reconstructive Urology (IMORU) VIII for both live surgery demonstrations (LSD) and semi-live surgery demonstrations (SLSD). Safety and educational efficacy of LSD and SLSD at live surgery events (LSE) have been debated extensively, however, objective data comparing learning benefits are missing. METHODS: We conducted a detailed survey, which employed the Kirkpatrick model, a well-established assessment method of training models, to investigate participants preferences as well as the learning benefit of LSE. Furthermore, we employed an audience response system and the Objective Structured Assessment of Technical Skills (OSATS), a well-established assessment method of surgery skills, to let our participants rate the perceived learning opportunity of LSD and SLSD. RESULTS: Of 229 participants at the IMORU VIII, 39.7% returned our questionnaires. 90% stated that they prefer LSD. On all levels of Kirkpatrick's training evaluation model, the IMORU received high ratings, suggesting a high learning benefit. For the assessment of OSATS, a total of 23 surgical cases were evaluable. For all six utilized items, LSD scored significantly better ratings than SLSD. CONCLUSION: Our study suggests that there is still a rationale for LSD, as participants attributed a statistically significant higher learning benefit to LSD over SLDS. Evaluation of the survey showed that for LSE such as the IMORU VIII, a high learning benefit can be expected. Considering that most of our participants are active surgeons with high caseloads, their opinion on the educational value of LSE is of high relevance.

Didactic Benefits of Surgery on Body Donors during Live Surgery Events in Minimally Invasive Surgery.

BACKGROUND: Live surgery events serve as a valuable tool for surgical education, but also raise ethical concerns about patient safety and professional performance. In the present study, we evaluate the technical feasibility and didactic benefits of live surgery on body donors compared to real patients. METHODS: A live surgery session performed on a body donor's cadaver embalmed in ethanol-glycerol-lysoformin was integrated into the live surgery program presented at a major gynecological convention of minimally invasive surgery. Surgical procedures carried out in real patients were paralleled in the body donor, including the dissection and illustration of surgically relevant anatomical landmarks. A standardized questionnaire was filled by the participants (n = 208) to evaluate the appropriateness, effectiveness, and benefits of this novel concept. RESULTS: The live surgery event was appreciated as a useful educational tool. With regard to the use of body donors, authenticity was rated high (85.5%), and the overall value of body donors for surgical education and training was rated very high (95.0%). The didactic benefit of simultaneous operations performed on body donors and real patients was considered particularly useful (95.5%), whereas complete replacement of real patients by body donors was not favored (14.5%). CONCLUSIONS: The study demonstrated both the technical feasibility and didactic benefits of performing minimally invasive surgery in body donors as part of live surgery events. This novel concept has the potential to enhance anatomical knowledge, providing insights into complex surgical procedures, and may serve to overcome yet unresolved ethical concerns related to live surgery events.

Summary of hands-on supermicrosurgery course and live surgeries at 8th world symposium for lymphedema surgery.

The hands-on supermicrosurgery course provided participants a valuable learning experience of in-depth practices of supermicrosurgical skills with experts. Seven live surgeries were successfully demonstrated at 8th World Symposium for Lymphedema Surgery. Variable donor sites for vascularized lymph node transfer were the submental, supraclavicular, groin, and omental; while the recipient sites included the wrist and axilla in upper limb; and popliteal and groin in the lower limb. The therapeutic and preventive lymphovenous anastomosis was also satisfactorily performed.

Is remote live urologic surgery a reality? Evidences from a systematic review of the literature.

INTRODUCTION AND OBJECTIVES: The possibility of performing remote-surgery has been the goal to achieve, since the early development of the first surgical robotic platforms. This systematic review aims to analyse the state of the art in the field and to provide an overview of the possible growth of this technology. METHODS: All English language publications on Telementoring and Telesurgery for minimally invasive urologic procedures were evaluated. We followed the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) statement to evaluate PubMed®, Scopus®, and Web of Science™ databases (up to June 2019). RESULTS: Our electronic search identified a total of 124 papers in PubMed, Scopus, and Web of Science. Of these, 81 publications were identified for detailed review, which yielded 22 included in the present systematic review. Our results showed that remote surgery has been under-utilised until today, mostly due to the lack of appropriate telecommunication technologies. CONCLUSION: Remote live surgery is a growing technology that is catalyzing incremental interest. Despite not being yet reliable today on a regular basis in its most advanced applications, thanks to the advent of novel data-transmission technologies, telepresence might become a critical educational methodology, highly impacting the global healthcare system.

Live surgery in reconstructive urology: evaluation of the surgical outcome and educational benefit of the international meeting on reconstructive urology (IMORU).

PURPOSE: The international meeting on reconstructive Urology (IMORU) is a live surgery event (LSE) where expert surgeons perform various reconstructive surgeries. To evaluate patient safety, an extended follow-up of the complications of two subsequent IMORU meetings were gathered. Also, a detailed survey concerning the participant's assessment of the educational benefit was performed. METHODS: All patients that were operated during the IMORU V and VI were included. Primary endpoint was the analysis of complications. Outcome was reviewed 36 months postoperatively via telephone survey and clinical database assessment, registrating any complications. At IMORU VII all participants were able to participate in a survey using a standardized, not-validated questionnaire concerning the learning effect and the quality of the surgeries. RESULTS: 57 operations by 32 different surgeons were reviewed. The total number of any complications (peri- or postoperative) was n = 9 (15.8%) with three major complications. Four (7%) perioperative complications and five (8.8%) postoperative complications were noted. The Charlson score proved to be the only significant recorded predictor of the incidence of any complication (p = 0.019; univariate logistic regression analysis). Participant survey showed that the surgeons, surgical technique, and surgical presentation were perceived as excellent. Improvement of knowledge and of the surgical armamentarium both received positive ratings. CONCLUSIONS: This is to our knowledge the first follow-up of LSE in the field of reconstructive urology. Rate of complications in general was acceptable. The performed survey showed participants value the quality and the educational benefit. Further studies are needed to improve learning possibilities.

ELS live surgery: a developing story.

INTRODUCTION: Since 2015, the European Laryngological Society (ELS) has organized on a yearly basis the European Laryngological Live Surgery Broadcast. The goal of this paper is to demonstrate the increasing worldwide audience. MATERIAL AND METHODS: The number of individual computers logged in, number of estimated audience, and number of countries with an active audience were calculated and compared to the numbers in 2015. RESULTS: In 2018, 19 live interventions were performed in three parallel sessions. The surgeons worked in 10 departments in 8 different countries. The number of individual computers logged in increased from 1000 in 2015 to 16000 in 2018. The estimated audience increased from 3000 to 32000 visitors. The number of countries with an active audience increased from 52 to 91. DISCUSSION: The amount of computers logged in is increasing year by year. The audience was presenting despite inconvenient broadcasting times, highlighting the educational importance. The teaching aspect remains visible on videos of this year's and previous year's interventions. They can be seen on website http://els.livesurgery.net/home.php . The organization of the European Laryngological Live Surgery Broadcast concurs to the idea that live broadcast of laryngologic surgery is feasible and attractive. Therefore, the ELS is going to continue to organize additional European Laryngological Live Surgery Broadcasts in the future.