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Counterpoint: The important educational value of live surgical broadcasts
  1. Demetrius Klee Lopes1,
  2. Ricardo A Hanel2,
  3. Elad I Levy3,4,
  4. H Saruhan Cekirge5,6,
  5. Pedro Lylyk7,
  6. Isil Saatci8,
  7. Jianmin Liu9,
  8. Naci Kocer10,
  9. Charbel Mounayer11,
  10. Osman Kizilkilic12,
  11. Jacques Moret13,14,
  12. Laurent Spelle13,14,
  13. René Chapot15,
  14. Civan Islak10,
  15. Gaurav Goel16,
  16. Pengfei Yang17,
  17. Mynzhylky Berdikhojayev18,
  18. Kirill Orlov19,
  19. Adnan H Siddiqui3,4
  1. 1 Brain and Spine Institute, Advocate Aurora Health, Park Ridge, Illinois, USA
  2. 2 Department of Neurosurgery, Lyerly Neurosurgery, Jacksonville, Florida, USA
  3. 3 Departments of Neurosurgery and Radiology and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
  4. 4 Department of Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
  5. 5 Department of Radiology, Koru Health Group, Ankara, Turkey
  6. 6 Private Office, Saruhan Cekirge, Ankara, Turkey
  7. 7 Department of Interventional Neuroradiology, ENERI-Clínica Sagrada Familia, CABA, Argentina
  8. 8 Koru Health Group, Ankara, Turkey
  9. 9 Second Mil Med University, Shanghai, Shanghai, China
  10. 10 Department of Radiology, Cerrahpasa Medical School, Istanbul, Turkey
  11. 11 Department of Interventional Neuroadiology, Dupuytren Hospital, Limoges, France
  12. 12 Istanbul University, Istanbul, Turkey
  13. 13 NEURI the Brain Vascular Center, Bicetre Hospital Interventional Neuroradiology, Le Kremlin-Bicetre, France
  14. 14 Paris-Saclay University Faculty of Medicine, Le Kremlin-Bicetre, France
  15. 15 Department of Interventional Neuroradiology, Alfried Krupp Hospital Ruttenscheid, Essen, Germany
  16. 16 Department of Neurointervention, Medanta The Medicity Medanta Institute of Neurosciences, Gurugram, Haryana, India
  17. 17 Department of Neurosurgery, Naval Medical University Changhai Hospital, Shanghai, Shanghai, China
  18. 18 Department of Neurosurgery, JSC Central Hospital, Almaty, Kazakhstan
  19. 19 Endovascular Neurosurgery Research Center, Federal Center of Brain Research and Neurotechnologies of the Federal Medical Biological Agency of Russia, Moscow, Russia
  1. Correspondence to Dr Adnan H Siddiqui, Departments of Neurosurgery and Radiology and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York 14203, USA; asiddiqui{at}

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"Live cases are to recorded cases what theater is to cinema: two complementary forms of expression”

Neurointerventional training and education, like most surgical and interventional disciplines in their original and most effective forms, is an apprenticeship for an extended period. The requisites vary by geography; but in essence, committed physicians enter a period of ‘fellowship’ during which they observe, participate, and perform actual procedures alongside experienced mentors as they conduct their business of providing clinical care to patients. Essentially, they learn through ‘live cases’ where they are standing next to experienced physicians through thick and thin, experiencing the invigoration of success and torment of failure. This is true for all fellowships and is the standard mechanism for generating proficiency in trainees.

At most major academic centers, the stress of performing a procedure under scrutiny from faculty, mentees, and other observers is the norm, rather than the exception. There is no perceived additional stress to those who do this day in and day out with observers. Similarly, at most major centers with multiple neurointerventionalists, it is routine for their partners to join in cases, be consulted during a case, or offer opinions during a complex case or complication management, with or without solicitation. Their opinions are usually valued and entertained and at other times ignored as the primary physician manages the case as deemed necessary. This is all routine, commonplace, and a daily occurrence.

The use of live cases for surgical education has been in place since the beginning of the field. Live case broadcast became a more commonplace event when in-person observerships declined during the recent coronavirus disease 2019 (COVID-19) pandemic. Multiple platforms allow for live case broadcasts, such as Tegus Med (Hamburg, Germany), Avail Medsystems (Santa Clara, California, USA), Proximie (London, UK), and SKILL Assist/Careprod Technologies (Fremont, California, USA), among a slew of others. During these broadcasts, either an experienced interventionalist is providing a live …

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  • Contributors Conception and design: All authors. Acquisition of the data: All authors. Analysis and interpretation of the data: All authors. Drafting the manuscript: DKL, AHS. Critically revising the manuscript: All authors. Reviewed submitted version of manuscript: All authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests MB reports no competing interests. HSC receives consulting fees from Medtronic and MicroVention and holds stock or stock options in Neuravention Inc., Vesalio Inc., Bend It Tech, Syncron, Prometheus Inc, Piraeus Inc., Sim&Cure, and Borvo Medical Inc. RC receives consulting fees from Asahi, payment or honoraria from Balt, MicroVention, Cerenovus, Medtronic; support for attending meetings and/or travel from Balt and Rapid Medical; has a leadership or fiduciary role in Siemens; and holds stock or stock options in Bendit. GG reports no competing interests. RAH is a consultant for Medtronic, Stryker, Cerenovous, Microvention, Balt, Phenox, Rapid Medical and Q'Apel. He is on the advisory board for MiVI, eLum, Three Rivers, Shape Medical, and Corindus. Unrestricted research grant from NIH, Interline Endowment, Microvention, Stryker, CNX, and Balt. Investor/stockholder for InNeuroCo, Cerebrotech, eLum, Endostream, Three Rivers Medical Inc, Scientia, RisT, BlinkTBI, and Corindus. Dr. OK receives honoraria for lectures from Acandis (paid to institution). CI has received a grant from MicroVention; consulting fees and honoraria from MicroVention; patents USPAT 10,335,156 B2 and USPAT 10,271,852 B2 planned, issued or pending; and holds stock or stock options in Neurovention INC and Bendit INC. NK receives honoraria from MicroVention and is the ESNR INR chair. EIL is a shareholder of NeXtGen Biologics, RAPID Medical, Claret Medical, Cognition Medical, Imperative Care, Rebound Therapeutics, StimMed, Three Rivers Medical; has the following patent: Bone Scalpel; receives honorarium for training and lectures from: Medtronic, Penumbra, MicroVention, Integra; is a consultant for: Clarion, GLG Consulting, Guidepoint Global, Imperative Care, Medtronic, StimMed, Misionix, Mosiac; is Chief Medical Officer for: Haniva Technology; is a National PI for Medtronic- Steering Committees for SWIFT Prime and SWIFT Direct Trials, and site PI Study for: MicroVention (CONFIDENCE Study) Medtronic (STRATIS Study-Sub 1); is on the advisory board for: Stryker (AIS Clinical Advisory Board), NeXtGen Biologics, MEDX, Cognition Medical; Endostream Medical, IRRAS AB. He also serves as consultant/advisory board, and medical legal review: render medical/legal opinions as an expert witness; leadership or fiduciary roles in other board society, committee or advocacy group, paid and unpaid: CNS, ABNS, UBNS. JL reports no competing interests. DKL has received an institutional grant from Mentice; receives consulting fees from Asahi, Stryker, Corindus, Siemens, and Medtronic and honoraria from Cerenovus, Medtronic, and Stryker; participates on the data safety monitoring board for INFINITY [trial]; has a leadership role in WLNC and Advocate Health; and holds stock or stock options in Syncron, Three Rivers, Q’apel, VIZ.AI, Methinks, Vastrax, Borvo, BendIT, Collavidence, NDI, Prometheus, NextGen, Galaxy, Global Intervention, and Sim&Cure. PL receives consulting fees from Medtronic, Cerevasc, and Phenox GmbH (paid to his institution); honoraria from Medtronic (paid to him); and support for attending meetings and/or travel from Cerevasc, Medtronic, and Philips (paid to him); and participates on the Cerevasc data safe monitoring board. JM receives consulting fees from MicroVention and Balt and holds stock or stock options in Instent start-up. CM reports no competing interests. IS receives consulting fees from Medtronic and MicroVention, is a member of the ESNR Neurointervention Section subcommittee, and serves on the editorial boards of Neuroradiology and JNIS. KO is serving on the organizational committee of the 2023 ICENS (International Course on Endovascular Neurosurgery) with live transmissions.AHS is a consultant for Amnis Therapeutics, Apellis Pharmaceuticals, Inc., Boston Scientific, Canon Medical Systems USA, Inc., Cardinal Health 200, LLC, Cerebrotech Medical Systems, Inc., Cerenovus, Cerevatech Medical, Inc., Cordis, Corindus, Inc., Endostream Medical, Ltd, Imperative Care, InspireMD, Ltd., Integra, IRRAS AB, Medtronic, MicroVention, Minnetronix Neuro, Inc., Peijia Medical, Penumbra, Q’Apel Medical, Inc., Rapid Medical, Serenity Medical, Inc., Silk Road Medical, StimMed, LLC, Stryker Neurovascular, Three Rivers Medical, Inc., and VasSol,, Inc. He holds a leadership or fiduciary role in the following other board, society, committee or advocacy group: Secretary – Board of the Society of NeuroInterventional Surgery 2020-2021, Chair – Cerebrovascular Section of the AANS/CNS 2020-2021. He has stock or stock options in: Adona Medical, Inc., Amnis Therapeutics, Bend IT Technologies, Ltd., BlinkTBI, Inc, Borvo Medical, Inc., Bridgewater Ventures, LLC, Cerebrotech Medical Systems, Inc., Cerevatech Medical, Inc., Code Zero Medical, Inc., Cognition Medical, Collavidence, Inc., CVAID Ltd., E8, Inc., Endostream Medical, Ltd, Galaxy Therapeutics, Inc., Imperative Care, Inc., InspireMD, Ltd., Instylla, Inc., International Medical Distribution Partners, Launch NY, Inc., Neurolutions, Inc., NeuroRadial Technologies, Inc., NeuroTechnology Investors, Neurovascular Diagnostics, Inc., Peijia Medical, PerFlow Medical, Ltd., Piraeus Medical, Inc., Q’Apel Medical, Inc.,, Inc., Radical Catheter Technologies, Inc., Rebound Therapeutics Corp. (Purchased 2019 by Integra Lifesciences, Corp), Rist Neurovascular, Inc. (Purchased 2020 by Medtronic), Sense Diagnostics, Inc., Serenity Medical, Inc., Silk Road Medical, Sim & Cure, SongBird Therapy, Spinnaker Medical, Inc., StimMed, LLC, Synchron, Inc., Three Rivers Medical, Inc., Truvic Medical, Inc., Tulavi Therapeutics, Inc., Vastrax, LLC, VICIS, Inc., Viseon, Inc., Whisper Medical, Inc., Willow Medtech, Inc. Other financial or non-financial interests: National PI/Steering Committees: Cerenovus EXCELLENT and ARISE II Trial; Medtronic SWIFT PRIME, VANTAGE, EMBOLISE and SWIFT DIRECT Trials; MicroVention FRED Trial & CONFIDENCE Study; MUSC POSITIVE Trial; Penumbra 3D Separator Trial, COMPASS Trial, INVEST Trial, MIVI neuroscience EVAQ Trial; Rapid Medical SUCCESS Trial; InspireMD C-GUARDIANS IDE Pivotal Trial. LS is a consultant for Balt, Medtronic, Phenox, MicroVention, and Stryker and receives honoraria from Balt, Medtronic, MicroVention, and Stryker. He participates on a Data Safety Monitoring or Advisory Board for CHOICE Study, INSPIRE Study, CLEVER Study, and COATING Study. PY reports no competing interests.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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