title: Live robotic surgery: are outcomes compromised?
abstract: OBJECTIVE
  To determine the outcomes of patients undergoing robotic partial nephrectomy as a live broadcast surgery compared to a cohort treated without observers.
  
  
  METHODS
  From 2007 to 2011, 39 robotic partial nephrectomies were performed as live broadcast surgery by 1 of 5 high volume surgeons. Live broadcast cases were defined as surgeries viewed by multiple visiting physicians via live teleconference in which the visitors were able to interact with the operating surgeon. Live cases were compared with 847 cases performed under standard operating procedure during the same period. Cases performed under standard operating procedure were not broadcasted. Demographic, clinicopathologic, and perioperative outcomes were compared between groups. Logistic regression analysis was performed to the test the association between live broadcast surgery and adverse perioperative outcomes.
  
  
  RESULTS
  Demographic and clinicopathologic data were similar between both groups. The live broadcast surgery group experienced equivalent operative times (196.3 vs 183.8 minutes; P = .22), estimated blood loss (EBL; 187.8 vs 190.7; P = .93), warm ischemia time (WIT; 20.8 vs 18.8; P = .17), hospital length of stay (LOS; 2.8 vs 2.8 days; P = .99), positive surgical margin rate (2.6% vs 2.3%; P = .83), and rates of postoperative complications (5.1% vs 12.8%; P = .16). There were no Clavien III to V complications in the live broadcast group. Logistic regression analyses demonstrated that live broadcast surgery was not associated with any unfavorable perioperative parameter.
  
  
  CONCLUSIONS
  Live robotic surgery is associated with excellent patient outcomes which compare favorably to cases done under normal operating procedures. Live robotic surgery represents a powerful educational tool which may be used without increasing patient morbidity.
authors: Department of Urology, New York University, Langone Medical Center, New York, NY, USA. jmulli12@Jhmi.edu
authors: Jeffrey K
authors: JK
authors: Mullins
authors: Michael S
authors: MS
authors: Borofsky
authors: Mohamad E
authors: ME
authors: Allaf
authors: Sam
authors: S
authors: Bhayani
authors: Jihad H
authors: JH
authors: Kaouk
authors: Craig G
authors: CG
authors: Rogers
authors: Shahab P
authors: SP
authors: Hillyer
authors: Bartosz F
authors: BF
authors: Kaczmarek
authors: Youssef S
authors: YS
authors: Tanagho
authors: Michael D
authors: MD
authors: Stifelman
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D011446:Prospective Studies; D012371:Robotics; D013685:Telecommunications; D016896:Treatment Outcome