Video recording may be useful adjunct to operative notes

Last Updated: 2019-01-29

By Marilynn Larkin

NEW YORK (Reuters Health) - Adding systematic video recording to the narrative operative report may increase the availability of important intraoperative information, according to researchers who studied its use in laparoscopic colorectal cancer surgery.

"This study is practice-changing as until now utilization of video in surgery and other invasive disciplines has been far from routine," Dr. Floyd van de Graaf of Erasmus MC-University Medical Center in the Netherlands told Reuters Health. "Through this study, healthcare providers in the field of surgery should now be able to recognize the added value of intraoperative video."

Dr. van de Graaf and colleagues studied 113 patients who underwent elective laparoscopic surgery for colorectal cancer and whose surgeons were videoed during the procedure. These patients were matched and compared with controls - i.e., cases from a historical cohort with only narrative operative reports.

The average case recording was 31 minutes long.

Ideally, the researchers say, for these cases, operative notes should detail six steps: introduction of trocars under vision, exploration, vascular control, mobilization and resection, creation of anastomosis, and closure.

In the control group, on average, these steps were adequately described in 52.5% of the narrative reports, according to the study, online January 23 in JAMA Surgery.

By contrast, the key moments were considered adequately reported in 78.5% of cases with a video record and in 85.1% of cases with a combination of the video and the narrative report.

However, the only significant difference in outcomes was a shorter mean postoperative stay in favor of the videoed group: 8 days versus 8.6 days.

"We envision a system in which recorded video is seamlessly incorporated in the patient record and the workflow of the surgeon," Dr. van de Graaf said. "Ease of use is therefore of major importance. One should be able to easily record, access and utilize these recordings. For this, implementation studies are important to determine the best format."

"As is the case in almost every innovation in medicine, some reservation (on the part of surgeons) is to be expected," he added. "Formalization of guidelines and a chain-of-command for eligibility to access these recordings, similar to the 'black box' in aviation, might be the solution."

Dr. Jeffery Nelson, Surgical Director at the Center for Inflammatory Bowel and Colorectal Diseases at Mercy Medical Center in Baltimore, told Reuters Health that while the study is well done, "it doesn't establish how videotaping procedures could actually be implemented. Videos of a procedure alone (aren't) sufficient to grade the quality of it, because it's information in a vacuum, just like the operative report alone is not sufficient."

"They found no difference in surgical outcomes, except for a slightly shorter hospital stay," he said by email. "So, you could argue that this study is really useful in demonstrating the information that should be consistently recorded. (However), I think many surgeons would object to having their procedures videotaped for just this reason. If it doesn't affect patient outcomes, then why do it?"

Also, he noted, "A video can be taken out of context and used as a weapon. As the authors point out, the entire unedited video of a procedure would be ideal in order to avoid this pitfall. But it would be pretty onerous to sift through hours of video trying to judge quality."

"The next step would be to define the rules of engagement for using video recordings for quality purposes," Dr. Nelson said. "What are the ethical and legal considerations? Would they be discoverable? Who would have access to them?"

Dr. Rahul Narang, a colorectal surgeon at Montefiore Health System in New York City, said by email that videorecording "is a valuable teaching tool for review and identifying ways to improve surgical technique."

That said, he added, "There is concern that procedure recording may enhance or suppress potential litigation. It may also bring an uncomfortable sense for the surgeon in the operating room if they know they are being recorded, especially during difficult portions of the surgery where there may be significant bleeding or other difficulty in the case."

Further studies are needed, he added, to see whether video recording improves outcomes or is "primarily being used for potential litigation and misinterpretation of surgical maneuvers performed during difficult or key (steps) in the surgery."

SOURCE: http://bit.ly/2RV1oHT and http://bit.ly/2CRr3qI

JAMA Surg 2019.