Abstract
Background
Videos are used by surgeons when learning new techniques; however, online videos are often not vetted. Our aim is to review online videos of laparoscopic inguinal hernia repairs based on a benchmark for critical view of the myopectineal orifice (MPO) and safe inguinal hernia repair as defined by Daes and Felix and commonly referred to as “the 9 Commandments.”
Methods and materials
YouTubeⓇ was queried for “laparoscopic inguinal hernia repair.” The top 50 videos were ranked based on number of views. Those endorsed and/or vetted by surgical societies were excluded (n = 4). Three expert hernia surgeons scored the videos based on adherence to the 9 Commandments.
Results
The 50 videos originated from 11 countries. They had 72,825 mean views and a mean runtime of 14 min. Videos obeyed a median of 77.8% of commandments shown. Eight videos (16%) obeyed all 9 (100%) commandments. Three videos (6%) failed to obey any commandments. Operations employed TEP (18, 36%), TAPP (28, 56%), and rTAPP (4, 8%) approach. Stratification by approach showed significant variance in commandments obeyed (Kurskal–Wallis, p = 0.016) with significant difference between TEP and rTAPP scores (p = 0.008) and no significant difference between TEP and TAPP or rTAPP and TAPP scores.
Twenty-three videos (46%) displayed unsafe techniques including: threatened critical structures (16, 32%), rough tissue handling (15, 30%), and dangerous placement of fixation (9, 18%).
Conclusion
Online surgical videos on YouTube are not reliable in demonstrating best practices for minimally invasive inguinal hernia repairs. In our study, only 16% of the most viewed videos followed all 9 Commandments for critical view of the MPO. Many showed suboptimal repairs with significant safety concerns. While a significant number of online videos are a free and readily available resource for surgeons around the world, we recommend caution in relying on non-vetted videos as a form of surgical education.
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Desmond Huynh, Negin Fadaee, Hakan Gök, Andrew Wright, Shirin Towfigh have no conflicts of interest or financial ties to disclose.
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Huynh, D., Fadaee, N., Gök, H. et al. Thou shalt not trust online videos for inguinal hernia repair techniques. Surg Endosc 35, 5724–5728 (2021). https://doi.org/10.1007/s00464-020-08035-z
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DOI: https://doi.org/10.1007/s00464-020-08035-z