During a live surgery at the All India Institute of Medical Sciences, a 62-year-old patient suffering from liver cirrhosis died following excessive bleeding.
AIIMS said all measures had been taken to make the surgery a success. "The mortality rate of this procedure in patients with cirrhosis in most centers of the world is in the range of 5-10%," said the statement.
At the 23rd annual conference of the Indian National Association for Study of the Liver, hosted jointly by AIIMS and the Army Research & Referral Hospital, patient Shobha Ram was operated as part of a demonstration. He died soon after the surgery.
On July 31st Ram was operated by Dr Goro Honda from Japan's Tokyo Metropolitan Cancer and Infectious Diseases Center. The doctor performed a laparoscopic liver resection (removal of a portion of the organ through a small surgical puncture). He was assisted by a team of Indian doctors led by Dr Sujoy Pal, an associate professor in the gastrointestinal surgery department at AIIMS. The surgery was shown live in a hall of 100 surgeons gathered at the workshop.
"The doctors had taken our permission. They had warned us about the slim chances of survival. We do not want to take any action against the hospital," a relative of the patient said.
After reports were raised on the ethics and safety of live surgeries AIIMS issued a statement which said that "The patient had cirrhosis of the liver due to hepatitis B virus infection and a liver cancer. The patient had a detailed preoperative assessment for feasibility of removing the tumor surgically. He was planned for a laparoscopic surgical resection by a very renowned and experienced GI surgeon."
Former general secretary of the Indian Medical Association and former president of the Delhi Medical Association said he had organized several such live surgery workshops. He said these workshops were crucial to the process of learning. "Blaming the death of a patient at the hands of doctors as negligence will harm the medical association in that no doctor will then take risks. And medical science is all about taking risks, life is a risk," he said.
Live surgeries at workshops are performed by experts who would never want to make a blunder with so many colleagues watching, he added. "We can talk about a surgery retrospectively. But the situation is very different when the surgery is under way. There is always a debate among doctors and a continuous collective decision taken as per the condition of the patient... One can't call this negligence. It is an opinion which differs from doctor to doctor."
"Firstly, those who must have suggested a switch to open surgery were those who were learning from the experts conducting the operation. So they could not have known better. Secondly, the doctors conducting the surgery might have consciously chosen against open surgery because that would have taken additional time and might have led to more bleeding due to the delay. Moreover, liver surgeries involve profuse bleeding and the chances of the success of controlling the bleeding is equally negative as it is positive," said another member of the Delhi Medical Council.