ST. PETERSBURG — Dr. Ernest Rehnke — gloved, gowned and masked just like those prime-time TV surgeons — leaned over his anesthetized patient, her 360-pound body obscured by blue surgical drapes except for her abdomen.
"A little poke," he said, making an incision to insert a tiny device she hopes will help her lose a lot of weight.
"A little?" squeaked somebody watching the proceedings on a large projector screen 15 miles away from the Palms of Pasadena Hospital operating room.
Another of Rehnke's incisions drew "oohs" from the remote audience, packed into a St. Petersburg Marriott conference room. Some people held on to their partners tightly as Rehnke retracted his patient's liver for a better view of her stomach, layered with glistening yellow fat. Organ revealed, he fastened a little white gadget, the Lap-Band.
"It makes me wheezy," said a nervous-looking Connie Laster. The Ruskin woman, like the rest of the audience, was drawn to the free event by an ad offering a firsthand look at the Lap-Band procedure, which reduces the size of the stomach pouch so you're satisfied with less food. She got up and walked to the back of the room, but continued to gaze at the satellite feed.
"Watching that makes me not want to eat for two days."
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Welcome to health care marketing and education for the reality TV/YouTube world, where you don't have to venture far to watch a patient going under the knife. A YouTube search of the word "surgery" generates nearly 70,000 videos, including facelifts, knee replacements and even open-heart procedures.
But while online video hosting sites and TV shows on networks like the Discovery Channel may cater to the merely curious, Rehnke, 56, is among a growing number of health care practitioners who see live surgery broadcasts as a way to reach prospective patients as no pamphlet or conversation can.
"Most things that are done in (operating rooms) are kind of behind closed doors for most people," Rehnke said. "The idea here was to further educate them."
Watching a Lap-Band procedure, he said, can help patients see that it is safer, quicker and has an easier recovery than a gastric bypass, a procedure that permanently reduces the stomach pouch.
Along with the education came a hefty shot of marketing, too. A PowerPoint slide proclaimed "The weight is over." A video featured Rehnke and patients who have lost more than 100 pounds. Will insurance cover the surgery? A number of companies will, participants are told, but some require you go to a bariatric "Center of Excellence."
And Palms is one such place.
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Though the live surgery was a first for Rehnke, Palms and Tampa Digital Studios, the crew hired to broadcast it, the idea is gaining traction nationally.
MedlinePlus, created by the National Library of Medicine, provides links to hundreds of prerecorded Web casts of surgical procedures, available to anyone with an Internet connection. Last week, a surgical team at Henry Ford Hospital in Detroit used the Twitter micro-blogging site to provide real-time updates on a kidney cancer surgery.
Tampa General Hospital has done live Internet broadcasts of surgeries since 2005, and archives them for future Web viewing.
The broadcasts showcase the hospital to physicians and consumers. They fit with TGH's being a teaching hospital, said Jean Mayer, senior vice president of strategic services.
"They've been very successful," she said, adding that the hospital tracks its Web traffic.
Hospital guidelines insist that the patient remain anonymous. There are two surgeons in the operating room. If something goes "not according to plan," the camera crew would be signaled to pull away.
"That's never happened," she said.
Rehnke expects Palms of Pasadena will do more live Lap-Band broadcasts, judging by response to the Marriott event on Tuesday, followed by another beamed to a Tampa hotel on Wednesday. Demand for gastric bands is high, and Rehnke says he performed 357 last year, up 10 percent from the year before.
That's almost one per day.
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With lights dimmed in the Marriott conference room, the audience watched the action captured by three robotic cameras, plus a feed from the medical camera inside the patient. Rehnke identified her only as a woman with a body mass index of 58. Forty and over is considered morbidly obese, the category of people whose weight puts them at greatest risk for serious health problems and even death. In exchange for her participation, the patient got a discount on the procedure, which normally costs $15,800.
The audience was invited to submit questions on index cards during the seminar. Rehnke, working with a team that included another surgeon, answered them — before, during and after surgery.
"How do you choose which size band to use?"
"Is there constant diarrhea after surgery?"
"Does the liver bleed?"
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Nina Gonet and her son Ben came down from New Port Richey after seeing a newspaper ad for the live broadcast.
"I thought it was cool," said Ben, 22, who stands 6 feet 3 and weighs 360 pounds. "Though it was not what I expected — the way they were pushing."
Nina, 51, who says she has lost and gained 100 pounds a few times, came away with more questions. She wonders about the risk of infection, and how her diet would change after surgery.
The two agreed, however, that watching the surgery gave them more confidence in it, and they thought it a better option than continuing as they are.
"I've been skinny, and I've been fat," Nina said. "It's not a fat person's world."
Richard Martin can be reached at firstname.lastname@example.org or (727) 893-8330. For the latest in health news, visit tampabay.com/health.