Re: Walter Artibani, Vincenzo Ficarra, Ben J. Challacombe, et al. EAU Policy on Live Surgery Events. Eur Urol 2014;66:87–97

Abstract

We read with interest the excellent paper, ‘‘EAU Policy on Live Surgery Events,’’ for meetings [1]. We wholeheartedly agree with the committee that the purpose of live surgical events (LSEs) is education, not entertainment, and that patient safety is the priority, requiring a structured, regulated approach that minimises patient exposure to risks [1]. However, we feel that the discussion, which currently focuses on LSEs at meetings from hosting hospitals and home institutions [2], should include LSEs outside of meetings, such as routine surgery transmitted over the Internet, and should consider the broadcasting approaches currently available. If dissemination of surgical expertise is the justification for live surgery, then we need to review the ways in which this educational content can be shared. How much more potent could this valuable teaching resource be if disseminated more widely and accessible to registered and regulated viewers on the Internet? This is a modern and ethical approach with the potential to reach far wider audiences of surgical trainees. When considering this wider audience, it is important to adjust the balance of content among complex or infrequently performed surgeries, novel techniques, and repetition of standardised routine surgery. The panel reached >80% consensus on the view that performing at a home institution may be safer. Surely, the natural evolution of all LSEs is that a greater proportion are broadcast from home institutions [2]. The committee correctly identifies the issues with a ‘‘travelling surgeon’’ performing complex surgery in an unfamiliar environment with a surgical team that is not experienced with the intricacies of the surgeon’s technique. In addition, there is the potential for a jet-lagged surgeon performing suboptimally due to the combination of fatigue and increased stressors. LSEs from a home institution remove these negative aspects [2]; however, there are other important reasons why LSEs are enhanced when performed at a highvolume home institution. The potential to optimise surgical