The problems with broadcasting surgeries as they happen.

Every eye in the Las Vegas hotel conference room was fixed on the screen, watching the action broadcast by satellite live from three time zones away. There were no wasted moves, no evidence of indecision. Then there was blood, like a geyser filling the screen. The audience gasped collectively.

In a minute, the bloodshed was over. Dr. Ted Lee  used forceps to grasp the offending artery, magnified enormously by the video camera that guided his surgery and broadcast in real time to hundreds of surgeons watching at the American Association of Gynecologic Laparoscopists annual meeting. Lee applied a current, and the artery was sealed.

The audience audibly relaxed.

Combining education with entertainment and patient care with promotion, live telesurgery is a fixture at surgical conferences and marketing campaigns by hospitals and medical device manufacturers. It's natural that conference attendees want to see the best surgeons performing the most advanced procedures with the newest equipment. There's no inherent reason why they need to watch it happen live—a narrated DVD would provide the same or better educational experience, with mundane sections eliminated and critical points in the surgery highlighted. But try telling that to conference organizers who know that live telesurgery is, rationally or not, a high point of many conferences.

In the beginning, surgery was a spectator sport. Nineteenth-century paintings show surgeons operating on patients with an auditorium of doctors looking on. Fortunately for the patient, antisepsis changed that practice. But the audience never left the operating room. Surgery continues to be taught to medical students, residents, and visiting surgeons who watch from glassed-off galleries or at the surgeon's elbow, scrubbed into the operating room. (Remember the scenes in Grey's Anatomy in which Meredith and O'Malley snack and chat in the room overlooking the O.R.? These rooms are increasingly rare because of concerns about confidentiality, but they can still be found in some hospitals.)

Traditional surgery, performed through an open incision, is difficult to televise because of poor visibility. Surgeons make the smallest incisions possible, and their work space is obscured by hands and instruments. Even a camera mounted on the bright lights illuminating the surgical field gets only an intermittent view of the organ being repaired.

With the advent of laparoscopy—surgery conducted using small instruments on narrow steel sticks placed through 1-centimeter incisions in the patient's abdomen—the video image from an instrument-tipped camera that guides the surgery could be displayed in the next room or the next continent. Laparoscopic surgery allows for superior visualization of anatomic structures. Stick a microphone on the surgeon's scrub shirt and park a satellite truck in the ambulance bay, and the operating room becomes a production studio.

Lee's laparoscopic hysterectomy was typical: a challenging operation by a surgeon recognized for his expertise. Another surgeon serves as moderator, pointing out technical details of educational significance, asking the surgeon to explain tactical decisions and relaying questions from the audience for the surgeon to answer. All patients who participate in live telesurgery agree in writing prior to the operation and aren't compensated. Surgeons typically receive no additional payment to televise their surgery, although they occasionally collect an honorarium from the conference. The invitation to operate live is a considerable honor, and the stakes are high. "If you screw it up," notes Lee, "you will never be invited back."