Live Surgery for Laparoscopic Radical Prostatectomy—Does it Worsen the Outcomes? A Single-center Experience

Published:October 08, 2018DOI:



      To compare outcomes of laparoscopic radical prostatectomy (LRP) performed in live surgery versus daily routine LRP.


      From January 2014 to June 2017, data from LRP performed at our Institution in live broadcasting by 3 experienced laparoscopic surgeons during educational events were collected. A 1:2 matching (according to BMI, comorbidities, NCCN risk groups, and operating surgeon) was performed with the routine LRP patients collected in our prospectively-maintained database. Chosen procedures were performed within the same time span by the same surgeons. Data of interest were compared.


      Twenty-three live surgery LRPs were analyzed (Group A). Forty-six matched patients were the controls (Group B). Groups were comparable at baseline. No differences were found in perioperative data (operative time, blood loss, and intraoperative complications, 4.3% in both Groups) and postoperative complications. Particularly, 10 (43.5%) and 22 patients (47.8%) did not report complications (Group A vs B, respectively, P = .54). The majority of complications were Clavien 1-2, with 2 patients per Group requiring blood transfusion. Overall positive surgical margins rate was 26.1%. It was significantly higher in Group A (43.5% vs 17.4%; P = .02), but no differences were found in the number of patients who relapsed, who needed radiotherapy or androgen deprivation therapy within a median follow-up of 25 months in both Groups. No differences were found regarding functional data. Limitations include a low sample size and limited follow-up.


      LRP has similar perioperative outcomes when performed in either live surgery or daily routine setting. We underline the higher positive surgical margins rate after live surgeries that should increase the awareness before embarking on it.
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        • Rao A.R.
        • Karim O.
        A benedictory ode to urological live surgery.
        BJU Int. 2013; 112 (PubMed PMID: 23351124): 11-12
        • Roser F.
        • Pfister G.
        • Tatagiba M.
        • Ebner F.H.
        Live surgery in neurosurgical training courses: essential infrastructure and technical set-up.
        Acta Neurochir. 2013; 155 (PubMed PMID: 23242711): 541-545
        • Challacombe B.
        • Weston R.
        • Coughlin G.
        • Murphy D.
        • Dasgupta P.
        Live surgical demonstrations in urology: valuable educational tool or putting patients at risk?.
        BJU Int. 2010; 106 (PubMed PMID: 21125714): 1571-1574
        • Duty B.
        • Okhunov Z.
        • Friedlander J.
        • Okeke Z.
        • Smith A.
        Live surgical demonstrations: an old, but increasingly controversial practice.
        Urology. 2012; 79 (1185 e7-e11. PubMed PMID: 22365455)
      1. Misaki T, Takamoto S, Matsuda H, et al. Guidelines to live presentations of thoracic and cardiovascular surgery. 2007.

        • Sade R.M.
        • American Association for Thoracic Surgery Ethics C, Society of Thoracic Surgeons S, Ethics C
        Broadcast of surgical procedures as a teaching instrument in cardiothoracic surgery.
        J Thorac Cardiovasc Surg. 2008; 136 (PubMed PMID: 18692626): 273-277
        • Artibani W.
        • Ficarra V.
        • Challacombe B.J.
        • et al.
        EAU policy on live surgery events.
        Eur Urol. 2014; 66 (PubMed PMID: 24560818): 87-97
        • Mullins J.K.
        • Borofsky M.S.
        • Allaf M.E.
        • et al.
        Live robotic surgery: are outcomes compromised?.
        Urology. 2012; 80 (PubMed PMID: 22818566): 602-607
        • Ogaya-Pinies G.
        • Abdul-Muhsin H.
        • Palayapalayam-Ganapathi H.
        • et al.
        Safety of live robotic surgery: results from a single institution.
        Eur Urol Focus. 2017; (Aug 28. pii: S2405-4569(17)30196-7. doi: 10.1016/j.euf.2017.08.004. [Epub ahead of print])
        • Rocco B.
        • Grasso A.A.C
        • De Lorenzis E.
        • et al.
        Live surgery: highly educational or harmful?.
        World J Urol. 2018; 36 (PubMed PMID: 29124346): 171-175
        • Stolzenburg J.U.
        • Truss M.C.
        • Rabenalt R.
        • et al.
        Endoscopic extraperitoneal radical prostatectomy. Results after 300 procedures.
        Urologe A. 2004; 43 (PubMed PMID: 15067408. Die endoskopische extraperitoneale radikale Prostatektomie (EERPE). Ergebnisse nach 300 Eingriffen): 698-707
        • Ramirez-Backhaus M.
        • Mira Moreno A.
        • Gomez Ferrer A.
        • et al.
        Indocyanine green guided pelvic lymph node dissection: an efficient technique to classify the lymph node status of patients with prostate cancer who underwent radical prostatectomy.
        J Urol. 2016; 196 (PubMed PMID: 27235788): 1429-1435
        • Park A.
        • Schwartz R.W.
        • Witzke D.B.
        • et al.
        A pilot study of new approaches to teaching anatomy and pathology.
        Surg Endosc. 2001; 15 (PubMed PMID: 11344423): 245-250
        • Legemate J.D.
        • Zanetti S.P.
        • Freund J.E.
        • Baard J.
        • de la Rosette J.
        Surgical teaching in urology: patient safety and educational value of 'LIVE' and 'SEMI-LIVE' surgical demonstrations.
        World J Urol. 2018; (Oct;36(10):1673-1679. doi:10.1007/s00345-018-2291-x. Epub 2018 Apr 21)
        • Phan Y.C.
        • Segaran S.
        • Wiseman O.
        • et al.
        Which is better? “Live” surgical broadcasts vs “As-Live” surgical broadcasts.
        J Endourol. 2016; 30 (PubMed PMID: 27268127): 1022-1028
        • Misrai V.
        • Guillot-Tantay C.
        • Pasquie M.
        • et al.
        Comparison of outcomes obtained after regular surgery versus live operative surgical cases: single-centre experience with green laser enucleation of the prostate.
        Eur Urol Focus. 2018; (Jan 17. pii: S2405-4569(18)30001-4. doi: 10.1016/j.euf.2018.01.001. [Epub ahead of print])
        • Yossepowitch O.
        • Briganti A.
        • Eastham J.A.
        • et al.
        Positive surgical margins after radical prostatectomy: a systematic review and contemporary update.
        Eur Urol. 2014; 65 (Epub 2013 Aug 3): 303-313
        • Cadeddu J.A.
        Re: live robotic surgery: are outcomes compromised?.
        J Urol. 2013; 189: 1286-1287