Surgery in real time

Surgery in real time

Paper explores ethics of broadcasting surgery on live TV

By Michelle Koidin Jaffee
Justin Rossi, a UF M.D./Ph.D. candidate, explores ethical considerations of live broadcasts from the operating room when the patient undergoing surgery is awake.

Justin Rossi, a UF M.D./Ph.D. candidate, explores ethical considerations of live broadcasts from the operating room when the patient undergoing surgery is awake.

The first surgery to be streamed live in 360-degree video hit the internet from London in April. It came on the heels of another first — a live international broadcast of deep brain stimulation surgery on a patient who was awake, which is typical in that procedure.

Live broadcasting of surgeries is not new, but today’s ubiquity of social media and the increasing popularity of live streaming services for individual use such as Periscope and Meerkat present ever-expanding platforms for such events. In an article published recently in the journal Brain Stimulation, UF M.D./Ph.D. student Justin Rossi and colleagues explored ethical considerations of such broadcasts.

Rossi became interested in the issue when UF Health Shands Hospital hosted CNN’s Sanjay Gupta in 2014 for a series that took viewers inside the operating room during a deep brain stimulation surgery. That footage was recorded and then edited — not broadcast live — but Rossi was nonetheless impressed with how the UF surgery team worked with the film crew to define boundaries, plan for contingencies and rehearse in order to best capture the experience without compromising the patient’s safety.

“Since then, we’ve seen several high-profile instances of broadcast media and social media in the operating room. It’s a trend that’s increasing, but currently there’s very little in the way of guidelines,” said Rossi, a student working in the UF College of Medicine’s departments of neurology, neuroscience and health outcomes and policy. “Many patients view their deep brain stimulation surgery as a major life event. So it’s not surprising that they are willing or even wanting to bring others into the experience.

This is also a very effective way to educate other patients and the public and to increase awareness about diseases and treatments. But filming during surgery, especially live streaming, raises important questions about safety and risk versus reward that need to be explored.”

In his article, co-authored by Michael Okun, M.D., chair of UF’s department of neurology, and colleagues from Georgetown University Medical Center and University Hospitals Case Medical Center (where the October live broadcast took place), Rossi describes how the decision to broadcast the surgery live to the general public sparked considerable controversy.

“Questions were raised whether the filming exploited the vulnerability of the patient, violated the physician’s guiding principle of acting in the patient’s best interest, and imposed — if not intruded — upon the physician’s professional discretionary space,” they wrote. “These concerns echo those raised more than a decade ago as live broadcasting of surgery on television and at medical conferences gained popularity.”

Now, new technologies and procedures are prompting even more questions.

October’s broadcast featuring the case of retired Ohio electrician Greg Grindley had the novel element of a patient who was not put under anesthesia. Grindley underwent deep brain stimulation, or DBS, for the treatment of Parkinson’s disease; the procedure, which has become widespread in the last decade, is performed on patients who remain awake in order to provide essential responses to the physicians.

And in April, an operation on a British man with colon cancer made headlines for being streamed from Royal London Hospital to anyone watching on a virtual-reality headset such as Google Cardboard, or even any smartphone.

The changes call attention to the need to balance concerns over safety and privacy with the benefits of education and “patient-centeredness,” Rossi said.

He and his colleagues are calling on professional medical associations, hospitals and patient advocacy groups to create new, contemporary guidelines to respond to ever-evolving technologies and social-media platforms.

“Such guidelines should be based upon pragmatic recognition of current and anticipated trends in both broadcast media and social attitudes and values, and upon evaluation of how these trends influence the safe and ethically sound conduct of medical practice,” they wrote.