In hospital Webcasts, only the surgeons get closer

It wasn't easy for Victor Ganderson, 61, to agree to GERD surgery in June. For four years he had stalled, researching treatment options and talking to his doctors. But it wasn't until the Columbia, Md., man watched - live, via his home computer - the operation being performed that he decided to go ahead.

Ganderson learned about the "Webcast" through his job as a database manager at the University of Maryland Medical Center (UMMC). The surgery was broadcast live on the Internet, from what was billed as the Baltimore hospital's "Operating Room of the Future."

Ganderson said he wasn't squeamish about watching surgeon Adrian Park point out a region of pulsating pink tissue inside the patient's stomach.

"This thing that's beating right here is - we're just under the diaphragm, underneath of the patient's heart," says Park, head of general surgery at UMMC, in a video of the procedure. Despite the sometimes-graphic scenes, Ganderson called his doctor afterward and was referred to Park for surgery to correct his GERD, or gastroesophageal reflux disease, a condition in which the stomach contents leak back, sometimes painfully, into the esophagus.

"After watching it and seeing how benign the minimally invasive surgery was, I was convinced to go ahead and have it done," said Ganderson. Four years earlier, he had decided against traditional GERD surgery because the procedure was more complex and recovery time was longer (a month, compared with about half that time for the less-invasive version).

UMMC is among the hospitals nationwide now recording surgical procedures for broadcast on the Web for patients, physicians and the just plain curious. The operations are either broadcast live or aired later.

UMMC's broadcasts began soon after the June 2003 opening of the hospital's new operating facilities, which include state-of-the-art equipment such as touch-screen monitors that hang from the ceiling on movable booms, permitting doctors to view patients' lab results and diagnostic films during surgery. Four rooms have "telemedicine capability" - live audio and video feeds - and two permit voice-activated adjustments to patient beds, lights, monitors and camera views, individually programmed for each surgeon.

So far, UMMC has aired two surgeries - the GERD procedure and a minimally invasive repair of a mitral valve, a tissue flap that regulates blood flow through the heart. (The GERD procedure is accessible at www.or-live.com/umm/1202/, the mitral valve surgery at www.or-live.com/umm/1151/.) The hospital plans two more webcasts in the early fall: one of an orthopedic spinal surgery and another of a sympathectomy, in which a surgeon destroys or removes part of a nerve that causes excessive sweating in the arm.

Live broadcasts allow viewers not only to watch but to e-mail in questions, some of which are answered by an operating room narrator while surgery continues.

James Gammie, a cardiac surgeon at UMMC, said one patient traveled from Florida for mitral valve repair surgery after her husband found UMMC's Web page describing its minimally invasive surgical technique.

"Many (patients) have said they watched the Webcast," Gammie said in a telephone interview. "So I find that probably 50 to 60 percent of people who come to us now ... are much more prepared." Gammie provided commentary during the mitral valve operation while another doctor performed the surgery.

Some consumer health advocates question the Webcasts' value to consumers. Arthur Levin, director of the nonprofit Center for Medical Consumers in New York, said he thinks a surgical Webcast serves more as a public relations tool for hospitals than as education for consumers.

"The important things that patients need to know about surgery are: What are the risks? What are the alternatives? That's the kind of information people need. They don't need to see someone else's stomach open," Levin said.

Hospitals see the matter differently.

A surgical Webcast "allows us to demonstrate our expertise, both the physician expertise as well as the expertise of our facility," said Dave Brond, UMMC's vice president of marketing and planning. "It also wasn't a traditionally used part of our marketing toolbox. ... This is a way of funneling more people into our Web site who are searching for health-care information online."

The Webcasts cost about $35,000 each, according to Dan Aitchison, regional sales director for slp3D Inc., the Connecticut-based video production company that contracts with UMMC. Aitchison said his company has about 50 clients, including Georgetown University Hospital. All told, the company estimates it will air 100 surgeries by year's end; some of them can be accessed at www.or-live.com

Even within the medical community, there are some qualms about Webcasts.

The Society of Thoracic Surgeons issued guidelines in 1998 advising against live broadcasts of thoracic surgical procedures to the general public.

"The society believes a possibility exists wherein participating surgeons might fail to follow proper medical procedures or might be distracted because of the media and, thereby, deprive the patient of the highest quality care," the guidelines say.

Sensitive to such concerns, surgeons at UMMC recorded the mitral valve surgery - rather than showing it live - and aired it later that day. They plan to do the same with the sympathectomy surgery.

Hospitals often choose to broadcast minimally invasive procedures, Aitchison said, because these transmissions show off new technology while featuring procedures that reduce patient discomfort and recovery time. But not all surgical Webcasts fit this format. One of UMMC's upcoming broadcasts, the spinal procedure, will be a traditional "open" surgery - but one that is not available at many hospitals, Brond said.

Manufacturers of surgical equipment have also gotten into the act, covering or contributing to broadcast costs.

"If we are contacted by a hospital that will be conducting one of these online programs, we are always excited to participate," e-mailed Sara Shelton Brock, a technical writer at Medtronic Sofamor Danek, which manufacturers spinal products. "Surgical Webcasts give us the opportunity to share information about our extensive range of spinal systems with surgeons and patients."

UMMC paid for its Webcasts on its own, Brond said.

Aware that some viewers might find the surgical close-ups overly strong stuff, UMMC officials said last week they planned to post a disclaimer on the Web page that links to the mitral valve procedure Webcast, warning viewers of its graphic content.

Brond said officials feel this is sufficient warning. "People have to select to see this. ... (They) have to go to the Web site (and) see the disclaimer," Brond said. "They make an active choice to see it. ... We don't market it to the general public."