[Guidelines on live demonstrations of thoracic and cardiovascular surgery: pros and cons]

Guidelines on live demonstrations of cardiothoracic surgery were established in Japan following a single incident of an inappropriately performed live demonstration of an open repair of a thoracic aneurysm. Although the guidelines have contributed to ensuring patient safety and privacy, live demonstrations of surgical procedures in Japan have nearly been eliminated due to their strict regulations. However, since the guidelines only apply to surgeons who belong to surgical societies, live demonstrations performed by interventionalists are still performed without following the guidelines. Furthermore, the guidelines regulate both open repair as well as interventional procedures. Some procedures, such as stent graft and laparoscopic procedures, are suited for live demonstrations and some are not, and the guidelines should be tailored to each procedure. At Jikei University, we have held seven live demonstration symposiums with 5,700 participants, of whom 90% provided positive feedback on the value of the live demonstrations. In addition, a survey showed that the morbidity and mortality rates of the 122 live demonstrations performed during this period did not differ from those of similar procedures performed conventionally at our institution, indicating that live demonstration surgery can be performed without compromising safety. If performed by experienced surgeons obeying the guideline, live demonstration surgery is an effective, safe educational tool.