Video recordings in the operating room resulted in a significant improvement in the number of key operative steps captured during colorectal cancer surgery compared with a traditional narrative operative report (NR), a prospective, observational cohort study from the Netherlands found.
Combination use of an NR and systematic video recording (SVR) during laparoscopic surgery for colorectal cancer captured 85.1% of the predefined key steps of the operation compared with 52.5% of the steps in a control group where surgeons used NRs alone (P<0.001), which can be both inadequate and subjective, according to Floyd W. van de Graaf, MD, of Erasmus MC-University Medical Center Rotterdam, and colleagues.
Compared with NR alone, the capture of key steps was also significantly better with SVR alone (78.5%, P<0.001), they wrote in JAMA Surgery.
Upon review, the recorded moments captured were considered adequate in more than three-quarters of the cases compared with only about half with NR in both the historical control (52.5%, P<0.001) and study groups (58.3%, P<0.001).
“Systematic video recording in laparoscopic colorectal cancer surgery might add to the overall availability of important intraoperative information and improve quality control and objectivity,” van de Graaf’s group wrote.
Despite this difference in documentation, no significant differences for postoperative or pathologic outcomes occurred between patients with surgeries documented with NR compared with SVR. However, patients with operations documented with SVR did have a shorter hospital stay (8.0 vs 8.6 days, P=0.03).
In an editorial published with the study, Justin B. Dimick, MD, MPH, of the University of Michigan in Ann Arbor, and John W. Scott, MD, MPH, of the University of Washington in Seattle, wrote that these results add to a growing body of research demonstrating that video is an important source of data for quality improvement. However, they pointed out that improved operative documentation still lacks important information on the quality of the surgical procedure.
“Developing a scientific understanding of the quality of an operation from video will open new frontiers in surgical quality improvement,” Dimick and Scott wrote. “What is certain is that we owe it to our patients to push this frontier forward and develop the capability to continuously improve the quality of our craft.”
The Imaging for Quality Control Trial included 113 patients who underwent laparoscopic surgery for colorectal cancer from January 2016 to October 2017 at three centers in the Netherlands. The mean age of included patients was 66.
Details of the NRs showed that the steps most adequately described included vascular control (67.3%) and exploration (62.9%), whereas mobilization and resection were only adequately reported in about one-third of cases. Among cases documented with SVR, the most adequately described steps were introduction of trocars under vision (84.5%) and exploration (88.5%). Even the least adequately described steps in SVR cases were still recorded in more than three-quarters of cases: vascular control (79.4%) and creation of the anastomosis (76.1%).
“We foresee video documentation of surgical procedures becoming an essential part of surgery in the near future,” the study authors wrote. “Use of SVR is, however, intended as an extension to the written operative report — not a substitute.”
Van de Graaf and colleagues reported no conflicts of interest.
Dimick has received personal fees from and is an equity owner of ArborMetrix. Scott reported no conflicts of interest