Views & Reviews Review of the Week

Performing surgery

BMJ 2009; 338 doi: (Published 03 June 2009) Cite this as: BMJ 2009;338:b2257
  1. Roger Kneebone, reader in surgical education,
  2. Rajesh Aggarwal, clinical lecturer in surgery
  1. 1Department of Biosurgery and Surgical Technology, Imperial College London, London
  1. Correspondence to: R Kneebone r.kneebone{at}

    Public education or thrill seeking voyeurism? Roger Kneebone and Rajesh Aggarwal find last week’s televised surgery a little bit of both

    In Surgery Live last week, four operations were televised on Channel 4. On consecutive nights expert teams carried out major procedures, which were relayed in real time. The four were highly complex—mitral valve repair, resection of a brain tumour, laparoscopic fundoplication, and removal of a pituitary tumour.

    This was breathtaking theatre, in every sense. The operations themselves displayed stunning skill and technical mastery. And the sense of presence, of being in the same space as the surgeon, gave an immediacy that we have never seen on television before.

    But if these programmes were about enlightening the public, an important concern surfaces at once. Seeing these procedures is one thing but understanding them quite another. Even for us as surgeons, watching operations from an unfamiliar specialty can be deceptive. The transnasal removal of a pituitary tumour through an endoscope, for example, was performed so expertly that the dangers of drilling between the carotid arteries and under the optic nerve were almost invisible.

    The programme approached this in two ways. Firstly, by having two way contact between the operating team and the programme’s presenter in the studio, Krishnan Guru-Murthy. Taking the part of a lay viewer, Guru-Murthy asked what was happening at every stage, relaying this to the studio audience at London’s Wellcome Collection. Cleverly, there was another consultant surgeon in the studio each night who explained the operation as it unfolded and commented on events. This kept a sense of continuity even at tricky moments, when the operating surgeon had to focus entirely on what he was doing.

    But this television was never intended to be a one way process where viewers just watch. The programme was billed as an opportunity for the public to get involved. Questions flooded in through Twitter and were fed to the team while the surgery was taking place.

    So what did this programme achieve? In one sense, watching surgery live is nothing new. Early operating theatres provided just that—a theatre where students watched while surgeons taught. Today, surgeons routinely watch one another operate during conferences, and patients can see a wide range of procedures on YouTube. But this is the first time that these operations have been aimed at a more general public.

    As theatre, the programme was successful, providing fascinating insights into a world of which most people are completely unaware. But live transmission of complex surgery on mainstream television raises some challenging questions. Where is the line between entertainment and public engagement? And what about the conflicting agendas of television and surgery?

    The programmes emphasised that the patients were the most important people in the events. Yet we didn’t hear how the patients felt about being broadcast live on air. Especially interesting might have been a discussion with the patient who had brain surgery while awake. How did he feel about being in front of an audience during such a serious life event?

    And did these programmes need to be broadcast live? Like watching the Cup Final as it happens, this certainly heightens tension. At one point in the cardiac operation, for example, the surgeon asked that he be taken off the air, causing a palpable frisson in the audience. Had something gone dreadfully wrong? Was the patient in danger? It turned out that the surgeon had simply needed space to think, and the team was soon back on screen. But where is the line between voyeuristic thrill seeking and gaining a genuine understanding of the pressures of surgery?

    Another tension is between the need for surgery to inform and for television to entertain. Simply watching an operation is not enough: the viewer needs to be involved, and this in turn must affect the surgery. Commercial television added an additional dimension. At intervals during the operations, the presenter would explain that a commercial break was needed, often asking the surgeon to slow down so that the audience would not miss a key step. It is an illusion that television simply opens a window onto a hidden world without affecting it. Any act of observation alters what is being observed. Like it or not, it is a two way street.

    Was Surgery Live successful? As theatre, as education, and as entertainment it was. The programmes were handled with sensitivity and professionalism, showing skill, humanity, and restraint. But it remains to be seen whether these values will remain central if surgery were to become a television reality show. We started by thinking that this programme would bring the operating theatre to the public. We ended by realising that it also brought the public into the operating theatre. And that’s a challenging thought.


    Cite this as: BMJ 2009;338:b2257


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