Live surgery “at home” is as safe as non‐live surgery when performed by a surgeon who can do it safely under such conditions

Roman et al.1 demonstrated that live surgery for deep endometriosis infiltrating the digestive tract did not increase the risk of postoperative complications when broadcasted from a surgeon's routine operating theater. We believe that their context is not confined to this specific surgery but applies to other surgeries as well. Thus, it might be reasonable to state that live surgery performed at a surgeon’s routine operating theater (“at home”) is safe. However, we have a concern. They compared 33 live with 780 non-live surgeries: the former caused no higher incidence of surgery-associated complications than the latter. However, it is noteworthy that only one experienced operator performed all live surgeries, which may be insufficient to generalize their conclusion regarding the safety of live surgery. In addition, we have to consider the specific conditions of live surgery, including the construct of surgical and anesthetic teams. Live surgery, even when performed “at home” may alter surgeon’s mental status. The presence of an audience can be positive or negative. As such, doctors may have different personality types regarding their flexibility to handle changing conditions, when a live surgery is broadcasted. Sharing surgical experience is important, as the number of surgeries is limited.2, 3 Live surgery undoubtedly provides excellent educational opportunities for trainees. Thus, experts may be expected to perform live surgery. However, there are personality types even among expert surgeons, and not every expert enjoys performing live surgery. Here, we make two proposals. First, society should not force surgery-experts to do live surgery regardless of the situation (surgery at home or in a hospital near congress venue). Second, experts in live surgery should mentor and train their successors. Some researchers emphasize that live surgery should only be performed by surgeons with previous experience of live surgery.4 When choosing trainees, perhaps their personality types should also be taken into account. We agree with Roman et al.’s view that live surgery “at home” may be safer than that performed by visiting surgeons in a hospital near a congress venue. However, the present conclusion is based on the performance of a single operator. These data simply show that live surgery performed at a familiar environment is as safe as non-live surgery when performed by a surgeon who can do it safely under such conditions.