The X-Factor, Reality TV, and Live Surgery Demonstration

My first suggestion to my wife was that I enter Pop Idol with my modified, radiation-bashing rendition of American Pie (chorus “bye bye brachytherapy seeds“). She quickly retorted “DIVORCE! YOU CANT SING!” I begrudgingly agreed. Then Britain’s Got Talent came along and I saw an overweight Greek father and son duo, Stavros Flatley, prance around the stage bare-chested, dancing to some traditional Greek music and I thought “YES! There is hope!” I put on Riverdance, grabbed my then three-year-old son and started teaching him the basics of an Irish jig. I pleaded with my wife to allow us enter the X Factor (or whatever reality TV show was auditioning at that time), but she again screamed “DIVORCE!”. It appeared my hopes of finding fame on reality TV were dashed forever (although I expect Masterchef might be interested in my prowess on the BBQ – Murphy’s Marvellous Marinade on a whole eye fillet deserves a wider audience).

At about that time, the vogue of having live surgery demonstrations featuring at clinical meetings was really gaining momentum. The World Robotic Symposium, European Robotic Urology Symposium, European Society for Urological Technology section meeting at the EAU, Challenges in Laparoscopy & Robotics and others, were all featuring live surgery demonstrations as a prominent part of their scientific program. These sessions feature enormous high-definition screens, 3D broadcast in some circumstances, parallel operating rooms, and live interaction with the surgical team, and have proved enormously popular with audiences and sponsors alike. In fact, without live surgery, some of these meetings would be quite dull –there is certainly a commercial value in featuring live surgery as part of the program as is demonstrated by the huge numbers attending these sessions. Whether it is the lure of seeing world-famous surgeons perform robotic prostatectomy, partial nephrectomy or various types of salvage surgery, or the ever-present possibility of seeing a complication and its management, there is a blood-lust which surgical audiences have for this type of entertainment, sorry – education, and which is being met by the organisers of urology conferences. A merry band of surgeon-entertainers roam the world turning up at these conferences with their entourage of assistants and scrub nurses, and turning on the charm for the huge audiences which the big names now attract.

However, some controversy surrounds the ethics and conduct of live surgery. We wrote in the BJUI previously about some concerns we had and questioning the absolute educational value of these demonstrations. Well known leaders such as Dr Arthur Smith have also voiced concerns about live surgery and in some specialties and some countries, live surgery demonstrations are banned. In response, it has been encouraging to see the European Robotic Urology Society (now an official Section of the EAU), whose annual meeting is a live surgery spectacular, work with others to generate guidelines and ethical standards for the conduct of live surgery at scientific meetings. These will be published in the coming months.

So when it dawned on me that the personal price to pay for fame on reality TV was too high, I resigned myself to a life away from the glamour and fame of reality TV. However, I was very interested when Alex Mottrie and Ben Challacombe invited me to do a live robotic radical prostatectomy for the European Robotic Urology Symposium in London a few months ago. I had only ever done live surgery demonstrations for quite small audiences previously (I had done my karaoke version of American Pie to bigger audiences), and I was somewhat daunted and excited by the prospect of doing live surgery for a big audience, especially one full of the “Gods of Robotic Surgery”. The reality TV star inside me was saying ‘YES! I AM GOING TO BE A STAR!!” So I said yes. And the nerves started soon after. By the time it got to the opening morning of ERUS (in stunning post-Olympics London), I was pretty anxious. The case was straight-forward and I had done hundreds already, so why was I nervous? Well the audience was big (>800), and they looked blood-thirsty – I could feel them licking their lips at the prospect of something going badly wrong. I knew that a few of the “good luck mate” wishes that I had received that morning could be interpreted as “I hope you don’t hurt your head when you fall off your pedestal”. And the big guys were all over the place. The live surgery roll included Vip Patel, Richard Gaston, Alex Mottrie, Prokar Dasgupta, James Porter, Ronney Abaza, Mike Stiefleman, Ashok Hemal and Peter Wiklund. Francesco Montorsi was in the operating room next door and we would be operating in parallel. It was somewhat daunting. Even the stars looked nervous before going live with their surgery, some were even quite temperamental as the stress builds, but when they go live to the convention centre, they put on their “TV-face” and the show begins – all sweetness and charm. Quite a show.

In the “Green Room” before live surgery at Guy’s Hospital in London for ERUS 2012: Ken Palmer, Geoff Coughlin, Jim Porter, Vip Patel, Declan Murphy, Francesco Montorsi and Declan Cahill

For me, I figured out that the reason I was nervous was that I did not want to make a mess of it in front of a big audience. Human nature has a vain streak to it, and much as I am embarrassed to admit it, I realised that some of my anxiety was just that – I wanted to look and sound good on the big screens. There – I’ve said it! Something certainly added a different stress to the normal pressure of wanting to do an excellent job for your patient, and I expect that even the highly experienced live surgery stars who feature at these meetings do feel this extra pressure. Especially when things get a little sticky or you cause some bleeding and someone at the other end is asking “why did you do that?” Thankfully my case went nicely and my patient has done very well – details to be presented at next year’s ERUS as part of their new guidelines which will see feedback from all cases from the previous Symposium – an excellent initiative.

Doing robotic radical prostatectomy at ERUS 2012

So for now, the reality TV star in me has been sated and life goes on. Although I did hear there may be a new reality TV series in Australia for amateurs who fancy themselves as crocodile hunters. I wonder would she let me do that….

Declan Murphy
@declangmurphy

Declan Murphy is Honorary Clinical Associate Professor at the Department of Surgery, University of Melbourne, St Vincent’s Hospital and Director of Robotic Surgery at the Peter MacCallum Cancer Centre. He had previously been consultant urological surgeon at Guys & St Thomas’ NHS Foundation Trust in London.

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