Get hospital drama live from the theatre

'ER' not realistic enough? Then watch the ultimate hospital drama - real-life surgery beamed to your laptop
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Indy Lifestyle Online

Connoisseurs of TV medical soaps have always had access to the operating theatre - but in a version where the flash of a mascaraed eye matters more than the wielding of a scalpel.

George Clooney and his ilk may pump a chest, shock a heart or insert a fluid line, but the drama lies in the relationship between the players, not in what is taking place on the operating table.

Now, anyone can get a grandstand seat at the operation itself. Like armchair travel, armchair surgery is a reality. Thanks to modern technology and the internet, it is possible to see for the first time how surgeons insert a knife into a patient's chest and stitch new blood vessels on to their failing hearts.

Surgeons perform 3 million operations a year in Britain and most people about to go under the knife never question the competence of the person holding it. The website OR-live.com offers video footage and live broadcasts of operations as they should happen, but without the swooning relatives, bitching interns and conscience-stricken surgeons trying to do what's right for their patients.

Major surgery has always been mystifying as well as frightening. A life hangs in the balance while the surgeon deploys his or her skills - but always in secret, behind closed doors. The rigorous demands of infection control see to that.

OR-live.com reveals, undramatised, what goes on in the operating theatre. This is good news for the patients whose only concern is that the surgeon has a steady hand, long experience and the confidence to cut and stitch successfully, not which profile they should present to the camera. But unfortunately it is short on entertainment.

The best thing about the webcasts is their immediacy. You can log on at any time of the day, and if you are squeamish you can watch at your own pace. In fact, modern surgery is relatively bloodless, compared with the gory scenes from TV dramas.

For patients about to have surgery, or considering it, the website offers a way of finding out what they are letting themselves in for. Operations carried out in some of the world's top hospitals can be selected from the archive and viewed on demand. Hip replacements, coronary bypasses - you can take your pick.

Live performances are also held. Anyone who logged on to the site at 5pm on 1 November could have witnessed an innovative in-vitro fertilisation technique carried out by surgeons from the Centre for Reproductive Medicine at Wake Forest University Baptist Medical Centre in Winston-Salem, North Carolina, one of the leading infertility treatment units in the US. A week earlier, specialists from the Brigham and Women's Hospital in Boston demonstrated a new approach to breast cancer surgery and also hosted a live online question-and-answer session.

But do not be misled. These shows are not going to be packing them in on a Friday night. This is strictly educational. Most of the action occurs in an area no more than a foot square around the incision.

We see little of the major players, the surgeons, and nothing of the patient. What we do see is a disembodied opening on to glistening surfaces and pulsing vessels being manipulated by long-handled instruments that look as though they may once have belonged to the Spanish Inquisition.

One virtue of the deadpan, as-it-happens presentation is that it helps to demystify the human body and the medical profession. A heart specialist, Mehmet Oz, who has viewed the site, wrote: "Lay people tend to think that surgery is always a very precise process. That may be true when it comes to removing a brain aneurysm, but just wait until you see footage of an arthroscopic knee operation. Basically [surgeons] just go in there with a blender and blend up the meniscus."

The website is intended chiefly for doctors in training who want to hone their knowledge to impress their consultant the next day. It also speeds communication of new procedures and techniques, helping to transmit expertise from one medical centre to the next.

But will it help an anxious patient - or add to their anxiety? I chose to watch an osteotomy, an operation on the hip in which the femur (thigh bone) is broken and re-set in order to fit its head more firmly and deeply into the socket.

It is an operation that was carried out on my then four-year-old son many years ago. He had a condition called Perthe's disease, which can cause deformation of the hip - and the surgery was paritcularly successful.

I say this because 10 years later he was crowned fastest boy in his school after winning the 100 metres, a remarkable achievement (or so I thought) for a lad with a gammy hip. But another surgeon who inspected his hip for a routine check up told me he might have done just as well without the operation. That's the problem with medicine - once you submit to treatment you never know if you would have got better without it.

Having viewed the osteotomy, I am thankful this website was not available when my son was going into hospital. Even within the restricted view of the camera, the operation looked more like carpentry than surgery. All surgery on the hip involves sawing and banging - which is why orthopaedic surgeons have arms like tree trunks and hands the size of dinner plates. When the surgeons in the footage started hacking away with the chisel I logged off.

A decade ago a video of this kind was at the centre of a political and legal row. Called Everyday Operations, it featured excerpts from 20 surgical procedures that had been selected for maximum shock effect.

The 53-minute film was aimed at ghoulish voyeurs who enjoyed traffic accidents and other disasters and provoked outrage among MPs and guardians of the nation's morals, who demanded it be banned.

Its content was not dramatically different from what is now available at OR-live.com. It showed a skull being sawn open in a brain operation and an eye being sliced with a scalpel in cataract surgery.

But it was the sound effects that betrayed its true purpose. The cultured voice of the commentator was almost drowned by the crack of hammers, the rasp of saws and the whine of drills. There was a surfeit of blood, pulsing vessels and livid tissue. Surgery is a highly skilled but often crude business and the film dwelt on all its roughest edges.

Now, 10 years on, although the material presented on OR-live. com is similar, the context is very different. Operations are shown in full, not edited to focus on the gory bits. Only those with a serious interest are likely to stay the course.

There are also disadvantages. The operations shown are best-case scenarios, performed by doctors at the top of their form. That standard of treatment may not be available in every district hospital.

On the other hand, as Mehmet Oz observes, you get a better idea of what an operation is really like when it is not meticulously choreographed for TV.

"Surgery is controlled chaos," he wrote. "But when it's done well, it's worth watching as an art form in its own right."

Top of the ops...

* Hysterectomy: view a minimally invasive technique that makes a usually big op into a small one. Live from Florence, North Carolina, at 10pm GMT on 29 November

* Heart disease: to treat a patient with arrythmia, electrophysiologists at Morristown Memorial Hospital, New Jersey, will surgically implant an automated cardio defibrillator. The device delivers a life-saving shock if the heart goes into atrial fibrillation. At 7pm on 2 December

* Anal fistulas: watch a revolutionary technique to treat tears in the wall of the anus with a simple plug. "An innovative treatment for a notoriously difficult condition." At 9.30pm on 30 November

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