Aspects of video documentation in pediatric endoscopic surgery
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Contemporary endoscopic surgery offers the possibility of documentation in the form of videos. There are multiple aspects to endoscopic surgical video recordings as their utility is not only limited to documentation. Important aspects with regards to video documentation in endoscopic surgery include the ability to replay videos for assessing individual steps of the procedure, self-reflection to improve technique, medico-legal reasons, setting of quality standards, training in endoscopic surgery courses, dissemination of information through presentations or social media and secure video data storage. The aspects of its application in pediatric endoscopic surgery that has never been reported to date, which includes technical variations aspects in patients that are operated, as they present with wide range in ages and body sizes (newborns to adolescents) in this age group and also the limitations in instrument options to perform similar procedures done in adolescents to be replicated in the neonatal age group.
KeywordsNewborns Adolescents Children Pediatrics Video documentation Training Medico-legal Quality Standards
Harold Hopkins glass rod lens system invention in the 1950s was extremely effective as it gave images 80 times better than traditional Galilean optics and set the pace for the exponential growth in endoscopic surgery . In the same decade, evolving fiber optic technology contributed to the development of flexible endoscopy and the transfer of light from a high voltage source into the body to illuminate internal organs . Solid-state camera technology, developed in the late 1970s and 1980s, gave images of exceptional detail from a camera chip at the eyepiece of an endoscope. In 1987, Phillipe Mouret from Lyon used an electronic scope on a woman suffering from both a gynecological disorder and gallstones . He never published this experience as he did not see any chance for publishing in a surgical journal and opted to present “only” a video-tape with laparoscopic cholecystectomy at a gynecological meeting in Paris . This presentation led to the exponential growth of video endoscopic surgery and documentation of procedures.
Since then, technology has advanced across electronic and computer formats to document videos and enable cross-platform transfer of information. Developments on the electronic front from the video home system (VHS) and digital video disc (DVD) recorders to the contemporary high-definition data recorders on computer hard drives have enabled not only high-definition (HD) quality video acquisition and storage, but also the possibility to transfer data from these systems to home personal computers (PCs). Rapid progress in computer technologies has offered an array of software options to edit videos, review operations and enable their presentation at meetings and conferences as well as facilitate their publication on websites and peer-reviewed video endoscopic journals.
Although HD-quality images can be readily captured during endoscopic surgery, there are no guidelines for documentation of data from these videos or how to best measure surgical quality from an operative video. O’Mahoney et al. evaluated the feasibility and compliance in documenting ‘key surgical steps’ using edited videos of laparoscopic right hemicolectomy and sigmoid colectomy in adults and reported a compliance of 43–100% and 78–100%, respectively . The edited videos had a median duration of 3 min 47 s (range 1 min 44 s–5 min 38 s) with a production time of nearly 1 h and a resolution of 1440 × 1080 pixels. They concluded that ‘key surgical steps’ during laparoscopic right hemicolectomy and sigmoid colectomy can be documented and edited into a short representative video and that standardization of this process should allow video documentation to improve quality in laparoscopic colon surgery. It is, however, important to point out here that short representative video may represent the ‘key surgical steps’ but authors of such videos should also mention the total duration of the unedited videos to enable a clearer picture for the audience to grasp the complexity of the entire procedure in relation to the edited version. Technical difficulties should be part of such videos and should not be omitted in the editing to enable projection of the actual level of difficulty.
Documentation of the attainment of endoscopic surgical skills is required during and after completion of procedures and these could be tasks that could be performed in controlled setting. Assessment-driven feedback interspersed during fundamentals of laparoscopic surgery (FLS) training is expected to improve the quality of practice and increase skill acquisition . But the direct observation of FLS task performance by experts required to reflect on this feedback is not always feasible. Video recordings can reproduce a display of FLS task performance identical to the original camera view and can provide the critical observations needed for FLS assessment with advantages that include permanent documentation of performance, quality-controlled assessment, accurate quantification, and emergence of new observations on patterns of intermediate skill development.
Although videos have a major role in reviewing techniques, Tullavardhana et al. highlighted the role of information associated with videos in a study on laparoscopic cholecystectomy . Since laparoscopic cholecystectomy has an incidence of bile duct injury up to 0.20–3.40%, the critical view of safety (CVS) technique has been developed in an attempt to prevent complications . Video records have shown to provide superior quality to prove the CVS than photo prints; however, a combination of documenting modalities that include operative notes, videos and photo prints proved that a conclusive CVS establishment could be achieved in all cases [6, 8]. Mandatory use of imaging documentation methods for assessment of adequate CVS has shown to facilitate good quality control in surgical practice. Video-assisted retrospective ‘failure analysis’ has also been found to be an effective method to optimize the results in minimal invasive hernia repair .
Concerns with malpractice in pediatric endoscopic surgery have recently been reported . The role of video documentation has not been discussed in this report in details; however, in endoscopic surgeries, these documentations could prove to be useful in confirming the facts during the procedure.
Step-by-step instructions for trainees along with operating note details.
Instilling a habit of video documentation of all procedures irrespective of frequency.
Documentation for medico-legal reasons.
Observation of steps in advanced endoscopic procedures.
Reflection on advanced procedures to improve surgical skills.
Presenting complete operating time in edited videos.
Translation of techniques safely from pediatric to neonatal procedures.
High-definition (HD) quality video selection for presentations.
Video documentation has also been found to be of advantage during pediatric endoscopic surgery training courses where instructors can expose novice trainees to procedure scenarios so as to not only obtain a better understanding on the concepts, but also make them appreciate the levels of skills they will need to develop to achieve the same levels of fluency. Video documentation in advanced pediatric procedures that need to be translated for neonates will require multiple video views and better understanding of the working space especially when alternatives are to be employed due to the unavailability of small size instruments for neonatal age group.
An important aspect in video documentation that needs to be addressed is the storage of videos. Patient information should not be compromised when these videos are shared on social media as well as presentations. Storage of videos just on the hard drives at the hospital should be assessed with regards to the storage capacity and the duration that these videos will be stored, as these systems may reset with the loss of data. It is advisable to keep 1–2 backup copies of these video data securely to avoid any loss of important video data that may be incurred due to malfunctioning of these storage systems.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.