Use of low-cost video recording device in reflective practice in cataract surgery

Evaluation of Two-Dimensional (2D) versus Three-Dimensional (3D) Video Tutorials in Cataract Surgery for New Trainees

Purpose  Microscopic ophthalmic surgery requires an understanding of three-dimensional (3D) spaces within the eye. Recently, there has been an increase in 3D video training tools in health care. Studies have evaluated the efficacy of 3D tutorials in general surgery, but little has been published within ophthalmology. We present a randomized study evaluating differences in surgically naïve trainees after watching either a 2D or 3D phacoemulsification tutorial. Design  This was a double-blind, randomized study. A group of third and fourth year medical students at our institution were randomized with stratified randomization based on prior surgical courses to control for differences in baseline surgical skill. The two study arms were watching 2D or 3D instructional videos on phacoemulsification (Richard Mackool). Methods  Participants received a preliminary survey and participated in an hour-long microscopic surgery session. During the session, participants performed tasks evaluating baseline microscopic spatial awareness and surgical skill. The students were then instructed to watch either a 2D or 3D video on phacoemulsification based on their randomized study arm. During the postintervention session, participants performed the biplanar incision and capsulorhexis steps of cataract surgery discussed in the video on model eyes. Students were evaluated on speed and overall capsulorhexis quality. Results  Thirty-one students qualified for the study and completed the microscopic surgery session. Students in both groups had similar baseline speed and quality of preintervention microscopic tasks ( p  > 0.05 for all tasks). Postintervention, students randomized to the 3D video performed significantly faster than the 2D group for biplanar incision (11.1 ± 5.5 s vs. 20.7 ± 10.5 s, p  = 0.001). There were no statistically significant differences found between the groups in capsulorhexis timing ( p  = 0.12) or quality score ( p  = 0.60). Conclusions  3D video surgical training tutorials may improve speed of certain steps of cataract surgery for surgically naïve ophthalmology trainees. Given the limited sample size of this study, further investigation of their effectiveness is warranted.

Comparison of video-based observation and direct observation for assessing the operative performance of residents undergoing phacoemulsification training

Purpose:

To compare the video observation of procedural skills (VOPS) method with the direct observation of procedural skills (DOPS) method in the assessment of senior residents' performance utilizing the International Council of Ophthalmology's Ophthalmology Surgical Competency Assessment Rubric for phacoemulsification (ICO-OSCAR; phaco).

Methods:

This is a prospective comparative study conducted at a university-affiliated hospital. Six ophthalmology residents of postgraduate year 4 participated. Their performance in phacoemulsification was rated via DOPS and later in a masked manner through VOPS by a single faculty assessor.

Results:

Seventy-one surgeries were evaluated. There were no statistically significant differences between the scores of VOPS and DOPS regarding all ICO-OSCAR indices except “instrument insertion into the eye” in which DOPS had higher scores (P = 0.035). A significant correlation was observed in total scores of “task-specific” (r = 0.64, P < 0.001) and “global” (r = 0.38, P = 0.003) indices between VOPS and DOPS while some subscales did not show a correlation between the two methods of assessment. The Bland-Altman analysis demonstrated that nearly all data points of total “task-specific” and “global” scores fell within the 95% limits of agreement ([-5.84, 6.87] and [-4.78, 4.86], respectively).

Conclusion:

This study demonstrated that VOPS holds promise for a general rating of residents' performance.

Video recording in ophthalmic surgery

Video recording in ophthalmic surgery has immense potential to drive quality improvement in patient care, ophthalmology training, and research. Not only do surgical videos permit introspective and critical analyses of surgical technique, they also allow for objective assessment, allow for more informative audits, and are an invaluable medium for surgical education. Unfortunately, medical-grade video recording equipment is often costly. Various novel methods of video recording that utilize commercially available products offer adequate alternatives. Certain ethical and legal issues also need to be considered before the commencement of video recording in the operating room to protect both the patient and surgeon. We review the current applications and methods of video recording in ophthalmic surgery described in the literature, as well as the potential ethical and legal issues surrounding video recording.

Potential Utility of a 4K Consumer Camera for Surgical Education in Ophthalmology

Purpose. We evaluated the potential utility of a cost-effective 4K consumer video system for surgical education in ophthalmology. Setting. Tokai University Hachioji Hospital, Tokyo, Japan. Design. Experimental study. Methods. The eyes that underwent cataract surgery, glaucoma surgery, vitreoretinal surgery, or oculoplastic surgery between February 2016 and April 2016 were recorded with 17.2 million pixels using a high-definition digital video camera (LUMIX DMC-GH4, Panasonic, Japan) and with 0.41 million pixels using a conventional analog video camera (MKC-501, Ikegami, Japan). Motion pictures of two cases for each surgery type were evaluated and classified as having poor, normal, or excellent visibility. Results. The 4K video system was easily installed by reading the instructions without technical expertise. The details of the surgical picture in the 4K system were highly improved over those of the conventional pictures, and the visual effects for surgical education were significantly improved. Motion pictures were stored for approximately 11 h with 512 GB SD memory. The total price of this system was USD 8000, which is a very low price compared with a commercial system. Conclusion. This 4K consumer camera was able to record and play back with high-definition surgical field visibility on the 4K monitor and is a low-cost, high-performing alternative for surgical facilities.

The Surgeon's View: Comparison of Two Digital Video Recording Systems in Veterinary Surgery

Video recording and photography during surgical procedures are useful in veterinary medicine for several reasons, including legal, educational, and archival purposes. Many systems are available, such as hand cameras, light-mounted cameras, and head cameras. We chose a reasonably priced head camera that is among the smallest video cameras available. To best describe its possible uses and advantages, we recorded video and images of eight different surgical cases and procedures, both in hospital and field settings. All procedures were recorded both with a head-mounted camera and a commercial hand-held photo camera. Then sixteen volunteers (eight senior clinicians and eight final-year students) completed an evaluation questionnaire. Both cameras produced high-quality photographs and videos, but observers rated the head camera significantly better regarding point of view and their understanding of the surgical operation. The head camera was considered significantly more useful in teaching surgical procedures. Interestingly, senior clinicians tended to assign generally lower scores compared to students. The head camera we tested is an effective, easy-to-use tool for recording surgeries and various veterinary procedures in all situations, with no need for assistance from a dedicated operator. It can be a valuable aid for veterinarians working in all fields of the profession and a useful tool for veterinary surgical education.

Identification of surgeon-individual treatment profiles to support the provision of an optimum treatment service for cataract patients

One objective of ophthalmological departments is the optimization of patient treatment services. A strategy for optimization is the identification of individual potential for advanced training of surgeons based on their daily working results. The objective of this feasibility study was the presentation and evaluation of a strategy for the computation of surgeon-individual treatment profiles (SiTPs). We observed experienced surgeons during their standard daily performance of cataract procedures in the Ophthalmological Department of the University Medical Center Leipzig, Germany. One hundred five cases of cataract procedures were measured as Surgical Process Models (SPMs) with a detailed-to-the-second resolution. The procedures were performed by three different surgeons during their daily work. Subsequently, SiTPs were computed and analyzed from the SPMs as statistical 'mean' treatment strategies for each of the surgeons. The feasibility study demonstrated that it is possible to identify differences in surgeon-individual treatment profiles beyond the resolution of cut-suture times. Surgeon-individual workflows, activity frequencies and average performance durations of surgical activities during cataract procedures were analyzed. Highly significant (p < 0.001) workflow differences were found between the treatment profiles of the three surgeons. Conclusively, the generation of SiTPs is a convenient strategy to identify surgeon-individual training potentials in cataract surgery. Concrete recommendations for further education can be derived from the profiles.