Surgery as Performance: What I’ve Learned from Performing Live Surgeries in Front of an Audience

Live surgery events can be an enriching, exhilarating, and educational experience. In this article, I’ll share how I’ve made a success of live surgeries in the past—and the advice I give to any surgeons wanting to participate.

Over the past 20 years, I’ve been lucky to attend and perform at many events abroad. They are often an international phenomenon, bringing together delegates from all over the world to observe and participate in an immersive and interactive learning experience.

At a typical event, surgeons are given access to an operating room and surgical team with the entire surgery broadcast live into a nearby auditorium filled with several hundred observers. As the surgery progresses, moderators ask questions about the case, with surgeons responding in real-time as they perform the intricate steps of the assigned procedure. Here’s a roundup of advice based on my participation in many live surgery events.

Bring your nerves of steel.

The live surgery experience is an exhibition of your surgical and clinical skills. Not only are you working with an unfamiliar team and possibly equipment, communication may also be challenged at international events by language barriers amongst team members about terminology related to the equipment or surgical steps. These challenges are only compounded by the live audience comprising surgeons who scrutinize each other’s work, animatedly voicing their approval or concerns. To withstand these pressures, surgeons must have a high level of experience and confidence.

Teach as you work.

A critical component of performing live surgery is being able to provide a broader context to your procedure by providing the fundamental principles of the patient’s underlying condition and answering questions from the moderator or audience while your hands are busy carrying out the actual surgery. A few years ago, I had a particular challenge in this regard. The surgeon before me ran quite late, so my time to prepare was reduced and the video feed was slightly re-arranged. The change in schedule meant that I had to lecture on the case during surgery—but on a different step than I was actually doing. My hands were doing one step while I was actually explaining another step. Fortunately, my preparations prior to the event saw me through the challenge.

When it’s your turn to perform, it’s important to embrace the experience, tune out the pressure, and fully focus on the tasks at hand.

Practice your speaking skills.

Practice makes perfect, so it’s critical to practice lecturing while you operate. I’ve seen experienced surgeons melt under the pressure of teaching and answering audience questions while operating. Another common misstep is if a surgeon stops operating to effectively answer a question, which can substantially disrupt the pace of the procedure.  From my perspective, it’s not enough to simply go to a cadaver lab and practice surgical technique—you need to rehearse how to keep talking throughout the entire surgery. Then, once you get to the event, it will be natural to seamlessly teach while you operate—even when you come up against unforeseen complexities in a case.

Find your flow.

High-level athletes describe moments of laser-like focus that happen during high-stake games. They often describe the world fading away and time slowing down. The same is true for me during live surgery events. When it’s your turn to perform, it’s important to embrace the experience, tune out the pressure, and fully focus on the tasks at hand. During each live surgery, there is a moment for me where everything non-essential fades into the background and suddenly I’m in a state of flow. Interestingly, this mindset can help generate new discoveries and fresh perspectives for my work, leading to innovations that can be developed for future cases.

Prepare with the team.

As part of the preparation before the surgery, I recommend meeting with your surgical team to walk through the steps of the procedure. As part of this conversation, I emphasize the importance of listening to my presentation to the audience for strong clues about the next instrument, implant, or step in the procedure. This allows the surgical team to anticipate and stay one step ahead, providing a more seamless and professional appearing demonstration. Also, this preparation helps to remove common distractions during the operation that can disrupt the focus and flow of all members of the team, including the surgeon. 

If you would like to participate in a live surgery event, make an honest self-assessment of your strengths and weaknesses as a surgeon.

Know your strengths and weaknesses.

There is a certain amount of talent that needs to be present in order to participate in a live event. Some surgeons are more gifted technically while others are brilliant teachers. If you would like to participate in a live surgery event, make an honest self-assessment of your strengths and weaknesses as a surgeon. Identify possible workarounds to address whatever is holding you back. For example, you may be allowed to bring in a second person who can either do portions of the speaking or surgery to lighten the cognitive load. Bringing your own surgical technician to prepare and scrub in for the case can truly elevate the quality of your demonstration.

Although there have been some criticisms of live surgery events, I do think that the pros outweigh the cons. These events serve an important educational role to physicians. They expose participants to cutting-edge techniques from elsewhere in the world, expand surgeon perspectives, and can even push surgeons to greater efficiencies.

I’m grateful for the opportunities I’ve had to participate in live surgery events. The competitive spirit, passionate audience, and surgical challenges have bolstered my skills and confidence as a surgeon. If you are ever presented with an opportunity to attend, I highly recommend you grab it.

This article was first published on Linkedin. Find it here.

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