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Tomita H, Ienaga N, Kajita H, Hayashida T, Sugimoto M. An analysis on the effect of body tissues and surgical tools on workflow recognition in first person surgical videos. Int J Comput Assist Radiol Surg 2024:10.1007/s11548-024-03074-6. [PMID: 38411780 DOI: 10.1007/s11548-024-03074-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 02/09/2024] [Indexed: 02/28/2024]
Abstract
PURPOSE Analysis of operative fields is expected to aid in estimating procedural workflow and evaluating surgeons' procedural skills by considering the temporal transitions during the progression of the surgery. This study aims to propose an automatic recognition system for the procedural workflow by employing machine learning techniques to identify and distinguish elements in the operative field, including body tissues such as fat, muscle, and dermis, along with surgical tools. METHODS We conducted annotations on approximately 908 first-person-view images of breast surgery to facilitate segmentation. The annotated images were used to train a pixel-level classifier based on Mask R-CNN. To assess the impact on procedural workflow recognition, we annotated an additional 43,007 images. The network, structured on the Transformer architecture, was then trained with surgical images incorporating masks for body tissues and surgical tools. RESULTS The instance segmentation of each body tissue in the segmentation phase provided insights into the trend of area transitions for each tissue. Simultaneously, the spatial features of the surgical tools were effectively captured. In regard to the accuracy of procedural workflow recognition, accounting for body tissues led to an average improvement of 3 % over the baseline. Furthermore, the inclusion of surgical tools yielded an additional increase in accuracy by 4 % compared to the baseline. CONCLUSION In this study, we revealed the contribution of the temporal transition of the body tissues and surgical tools spatial features to recognize procedural workflow in first-person-view surgical videos. Body tissues, especially in open surgery, can be a crucial element. This study suggests that further improvements can be achieved by accurately identifying surgical tools specific to each procedural workflow step.
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Affiliation(s)
- Hisako Tomita
- Graduate School of Science and Technology, Keio University, Yokohama, 2238522, Japan.
| | - Naoto Ienaga
- Institute of Systems and Information Engineering, University of Tsukuba, Tsukuba, 3058573, Japan
| | - Hiroki Kajita
- Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, Tokyo, 1608582, Japan
| | - Tetsu Hayashida
- Department of Surgery, Keio University School of Medicine, Tokyo, 1608582, Japan
| | - Maki Sugimoto
- Graduate School of Science and Technology, Keio University, Yokohama, 2238522, Japan
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2
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Goldenberg MG. Surgical Artificial Intelligence in Urology: Educational Applications. Urol Clin North Am 2024; 51:105-115. [PMID: 37945096 DOI: 10.1016/j.ucl.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Surgical education has seen immense change recently. Increased demand for iterative evaluation of trainees from medical school to independent practice has led to the generation of an overwhelming amount of data related to an individual's competency. Artificial intelligence has been proposed as a solution to automate and standardize the ability of stakeholders to assess the technical and nontechnical abilities of a surgical trainee. In both the simulation and clinical environments, evidence supports the use of machine learning algorithms to both evaluate trainee skill and provide real-time and automated feedback, enabling a shortened learning curve for many key procedural skills and ensuring patient safety.
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Affiliation(s)
- Mitchell G Goldenberg
- Catherine & Joseph Aresty Department of Urology, USC Institute of Urology, University of Southern California, 1441 Eastlake Avenue, Suite 7416, Los Angeles, CA 90033, USA.
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3
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Ali JT, Yang G, Green CA, Reed BL, Madani A, Ponsky TA, Hazey J, Rothenberg SS, Schlachta CM, Oleynikov D, Szoka N. Defining digital surgery: a SAGES white paper. Surg Endosc 2024; 38:475-487. [PMID: 38180541 DOI: 10.1007/s00464-023-10551-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 10/17/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Digital surgery is a new paradigm within the surgical innovation space that is rapidly advancing and encompasses multiple areas. METHODS This white paper from the SAGES Digital Surgery Working Group outlines the scope of digital surgery, defines key terms, and analyzes the challenges and opportunities surrounding this disruptive technology. RESULTS In its simplest form, digital surgery inserts a computer interface between surgeon and patient. We divide the digital surgery space into the following elements: advanced visualization, enhanced instrumentation, data capture, data analytics with artificial intelligence/machine learning, connectivity via telepresence, and robotic surgical platforms. We will define each area, describe specific terminology, review current advances as well as discuss limitations and opportunities for future growth. CONCLUSION Digital Surgery will continue to evolve and has great potential to bring value to all levels of the healthcare system. The surgical community has an essential role in understanding, developing, and guiding this emerging field.
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Affiliation(s)
- Jawad T Ali
- University of Texas at Austin, Austin, TX, USA
| | - Gene Yang
- University at Buffalo, Buffalo, NY, USA
| | | | | | - Amin Madani
- University of Toronto, Toronto, ON, Canada
- Surgical Artificial Intelligence Research Academy, University Health Network, Toronto, ON, Canada
| | - Todd A Ponsky
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | | | | | - Dmitry Oleynikov
- Monmouth Medical Center, Robert Wood Johnson Barnabas Health, Rutgers School of Medicine, Long Branch, NJ, USA
| | - Nova Szoka
- Department of Surgery, West Virginia University, Suite 7500 HSS, PO Box 9238, Morgantown, WV, 26506-9238, USA.
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Regazzoni P, Jupiter JB, Liu WC, Fernández dell’Oca AA. Evidence-Based Surgery: What Can Intra-Operative Images Contribute? J Clin Med 2023; 12:6809. [PMID: 37959274 PMCID: PMC10649165 DOI: 10.3390/jcm12216809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/25/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
Evidence-based medicine integrates results from randomized controlled trials (RCTs) and meta-analyses, combining the best external evidence with individual clinical expertise and patients' preferences. However, RCTs of surgery differ from those of medicine in that surgical performance is often assumed to be consistent. Yet, evaluating whether each surgery is performed to the same standard is quite challenging. As a primary issue, the novelty of this review is to emphasize-with a focus on orthopedic trauma-the advantage of having complete intra-operative image documentation, allowing the direct evaluation of the quality of the intra-operative technical performance. The absence of complete intra-operative image documentation leads to the inhomogeneity of case series, yielding inconsistent results due to the impossibility of a secondary analysis. Thus, comparisons and the reproduction of studies are difficult. Access to complete intra-operative image data in surgical RCTs allows not only secondary analysis but also comparisons with similar cases. Such complete data can be included in electronic papers. Offering these data to peers-in an accessible link-when presenting papers facilitates the selection process and improves publications for readers. Additionally, having access to the full set of image data for all presented cases serves as a rich resource for learning. It enables the reader to sift through the information and pinpoint the details that are most relevant to their individual needs, allowing them to potentially incorporate this knowledge into daily practice. A broad use of the concept of complete intra-operative image documentation is pivotal for bridging the gap between clinical research findings and real-world applications. Enhancing the quality of surgical RCTs would facilitate the equalization of evidence acquisition in both internal medicine and surgery. Joint effort by surgeons, scientific societies, publishers, and healthcare authorities is needed to support the ideas, implement economic requirements, and overcome the mental obstacles to its realization.
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Affiliation(s)
- Pietro Regazzoni
- Department of Trauma Surgery, University Hospital Basel, 4031 Basel, Switzerland
| | - Jesse B. Jupiter
- Hand and Arm Center, Department of Orthopedics, Massachusetts General Hospital, Boston, MA 02114, USA;
| | - Wen-Chih Liu
- Hand and Arm Center, Department of Orthopedics, Massachusetts General Hospital, Boston, MA 02114, USA;
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
| | - Alberto A. Fernández dell’Oca
- Department of Traumatology, Hospital Britanico, Montevideo 11600, Uruguay;
- Residency Program in Traumatology and Orthopedics, University of Montevideo, Montevideo 11600, Uruguay
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van Kesteren J, van Goudoever LAE, Conteh A, van Acker GJD, Bonjer HJ, Bolkan HA. Technical Perspective for Video Based Assessment of Surgeries in Low-Resource Settings. JOURNAL OF SURGICAL EDUCATION 2023; 80:495-498. [PMID: 36775728 DOI: 10.1016/j.jsurg.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 01/05/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE Scalable digital learning environments are essential to sustain surgical training programs worldwide. Detailed images of surgeries enriched with educational annotations are vital to train the eyes of the learners. Here, we report a low-cost method, deployed in a low-resource setting in West Africa, which may contribute to the growth of use in open-sourced digital surgical resources world-wide. DESIGN This paper is based on the authors participatory and observational experiences creating surgical video content by way of recording surgical procedures and reflecting on field notes and video content. All surgeries were recorded between January and December 2018. SETTING Masanga Hospital, a rural district hospital in Sierra Leone, West Africa. PARTICIPANTS Thirty-five patients undergoing inguinal hernia repair, elective caesarian section, salpingectomy, bowel resection, hydrocele repair, or below-knee amputation consented for recording their surgical procedure and using the anonymized material for educational purposes. RESULTS This manual for non-professional cinematographers provides chronological steps for shooting a surgical procedure in a low-resource setting. Recording a surgical procedure to explain surgical techniques, and perform quality assessment through error analysis and coaching requires more than just point-and-shoot. While taking into account local customs and possibilities, practical tips were provided to prepare for the set-up, and recording of a surgical procedure in a low-resourced setting. CONCLUSION Commercially available digital video technology allows for filming high-quality surgical procedures for educational purposes at rural district hospitals in a low-resource setting.
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Affiliation(s)
- Jurre van Kesteren
- Department of Surgery, Amsterdam University Medical Centers, location Vrije Universiteit, Amsterdam, The Netherlands; Global Surgery Amsterdam, Amsterdam, The Netherlands.
| | - Leandra A E van Goudoever
- Global Surgery Amsterdam, Amsterdam, The Netherlands; Faculty of Medicine, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Amara Conteh
- Masanga Hospital, Tonkolili district, Sierra Leone
| | | | - H Jaap Bonjer
- Department of Surgery, Amsterdam University Medical Centers, location Vrije Universiteit, Amsterdam, The Netherlands; Global Surgery Amsterdam, Amsterdam, The Netherlands
| | - Håkon A Bolkan
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Clinic of Surgery, St. Olavs Hospital HF, Trondheim University Hospital, Trondheim, Norway; CapaCare, Norway
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Butson R, Barnes T, Wright D. Fostering Authenticity in Surgical Education: Creating a Safe Space for Medical Students to Practice as Doctors. JOURNAL OF SURGICAL EDUCATION 2023; 80:159-165. [PMID: 36117087 PMCID: PMC9475379 DOI: 10.1016/j.jsurg.2022.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 06/19/2022] [Accepted: 08/15/2022] [Indexed: 06/15/2023]
Abstract
Over the past 10 years we have witnessed major changes to the medical education landscape in response to advances in digital technologies. Couple this with the disruptions imposed by the COVID-19 pandemic and we have what could be described as a 'perfect storm.' Rather than hunker down and wait for it to pass, we took it as an opportunity to re-evaluate how we practice surgical education in the fourth year of our 6 year medical programme. In this article, we describe the formation of 6 core principles that function as pivot points in developing a new perspective centered on the importance of engaging and empowering our students as emerging clinicians. From these 6 principles, we designed and developed 3 interventions. Each intervention is discussed in regard to its purpose, operation and overall integration into the program.
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Affiliation(s)
- Russell Butson
- Higher Education Development Centre, University of Otago, Dunedin, Otago, New Zealand.
| | - Tracey Barnes
- Department of Surgical Sciences, University of Otago, Dunedin, Otago, New Zealand
| | - Deborah Wright
- Department of Surgical Sciences, University of Otago, Dunedin, Otago, New Zealand
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7
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Intraoperative video recording in otolaryngology for surgical education: evolution and considerations. J Otolaryngol Head Neck Surg 2023; 52:2. [PMID: 36658628 PMCID: PMC9851573 DOI: 10.1186/s40463-023-00620-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 01/02/2023] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Otolaryngology is a surgical speciality well suited for the application of intraoperative video recording as an educational tool considering the number procedures within the speciality that utilize digital technology. Intraoperative recording has been utilized in endoscopic surgeries and in evaluating technique in mastoidectomy, myringotomy and grommet insertion. The impact of intra-operative video recording in otolaryngology education is vast in creating access to surgical videos for preparation outside the operating room to individualized coaching and assessment. The purpose of this project is to highlight the role of intraoperative video recording in otolaryngology training and elucidate the challenges and considerations associated with implementation. METHODS Related publications between 1999 to 2022 were reviewed from PubMed and Embase databases utilizing search terms "intraoperative videography," "video recording surgery," "otolaryngology," and "surgical education." 109 articles were screened independently by HB and SK, by title and abstract then full text review. 28 articles from the original search and 6 from the secondary reference review were included. RESULTS The application of intraoperative video recording is evident in otolaryngology surgeries including endoscopic sinus surgery, laryngeal surgery, and other endoscopic procedures. There have been significant advancements in recording tools, including devices that can capture the surgeon's perspective. The considerations and challenges identified with utilizing this educational tool were categorized into different themes including ethics/consent, regulation, liability, data, technology, and human resources. CONCLUSION Intra-operative video recording has been demonstrated to have significant impact within otolaryngology education. It is critical to elucidate the challenges and considerations involved to utilize this educational tool effectively. Future directives will see video-based performance analytics providing comparative metrics to encourage precise coaching of surgical residents.
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Fu D, Li W, Li W, Han Y. Improved skill for tracheal intubation using optical stylets through remote training model: a before and after interventional study. BMC MEDICAL EDUCATION 2022; 22:668. [PMID: 36085051 PMCID: PMC9462891 DOI: 10.1186/s12909-022-03715-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 08/22/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Conducting on-site, hands-on training during the Coronavirus disease 2019 (COVID-19) pandemic has been challenging. We conducted a before and after interventional study to estimate the efficacy of a new remote hands-on training model for improving the trainees' tracheal intubation competency using optical stylets. METHODS Residents or physicians in anesthesiology apartment who have not received the nominated training in tracheal intubation using optical stylets were enrolled. The 4-week training course contains theoretical knowledge along with preclinical and clinical training of optical stylets techniques. Competency of intubation using optical stylets on patients with normal airways was evaluated according to an assessment tool with a maximum score of 29 points based on video recording pre-post training performance. Pre-post questionnaires measured theoretical knowledge and self-efficacy. RESULTS Twenty-two participants were included (8 females, 14 men, mean age of 33.5 years). The total score of intubation competency was significantly improved after training from 14.6±3.7 to 25.3±2.6 (P < 0.0001). The scores of three subitems (anatomical identification, hand-eye coordination, and optimized intubation condition) were all significantly increased after training (P < 0.0001). The total percentage of correct answers in the multiple-choice questionnaire increased from 58.2%±8.2% before training to 85.2%±7.2% shortly after training (P < 0.0001). In addition, the self-efficacy score was significantly increased from 2.5±1.2 to 4.4±0.6 (P < 0.0001). CONCLUSIONS The new remote and progressively advanced hands-on training model improved the competency of intubation using optical stylets under the COVID-19 pandemic.
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Affiliation(s)
- Danyun Fu
- Department of Anesthesiology, Eye & ENT Hospital of Fudan University, No.83 Fenyang Road, Xuhui District, Shanghai, 200031 China
| | - Weixing Li
- Department of Anesthesiology, Eye & ENT Hospital of Fudan University, No.83 Fenyang Road, Xuhui District, Shanghai, 200031 China
| | - Wenxian Li
- Department of Anesthesiology, Eye & ENT Hospital of Fudan University, No.83 Fenyang Road, Xuhui District, Shanghai, 200031 China
| | - Yuan Han
- Department of Anesthesiology, Eye & ENT Hospital of Fudan University, No.83 Fenyang Road, Xuhui District, Shanghai, 200031 China
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Leitenberger JJ, Juhasz M, Hutchison DM, Shive M. Video Recording of Surgical Techniques and Considerations for Educational Content. Dermatol Surg 2022; 48:789-792. [PMID: 35560116 DOI: 10.1097/dss.0000000000003474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Margit Juhasz
- Department of Dermatology, University of California, Irvine, Irvine, California
| | - Dana M Hutchison
- School of Medicine, Irvine, University of California, Irvine, California
| | - Melissa Shive
- Department of Dermatology, University of California, Irvine, Irvine, California
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10
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Esposito AC, Yoo PS, Lipman JM. Video Coaching: A National Survey of Surgical Residency Program Directors. JOURNAL OF SURGICAL EDUCATION 2022; 79:708-716. [PMID: 34952818 DOI: 10.1016/j.jsurg.2021.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 11/16/2021] [Accepted: 11/27/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Video coaching has been demonstrated to improve resident and attending skills and is overwhelmingly well received by the participants. However, misperceptions about its utility among those who do not use video coaching may be a barrier to widespread implementation. DESIGN Cross-sectional web-based survey SETTING: National survey PARTICIPANTS: Surgical program director members of the Association of Program Directors of Surgery STUDY DESIGN: The survey was developed via a deductive approach after a literature review and was piloted with surgical attendings and residents. All Likert scale were averaged and comparisons between groups was performed via independent t-tests. RESULTS There were 52 responses from PDs. 27/52(51.9%) PDs reported their program supported video coaching of residents. PDs from residences with video coaching programs were more likely to believe that video coaching was useful in identifying their own strengths and weakness (p = 0.005), was a useful adjunct for resident feedback (p = 0.024), and a personal library of video recordings would be helpful (p = 0.015) when compared to PDs from residencies without video coaching. Programs without video coaching were more likely to believe barriers to implementation included it being ineffective (p = 0.024) and that the technology was unavailable (p = 0.006). Over 50% of respondents from both groups believed expense, difficulty with set up, time required, and patient privacy were "Very" or "Extremely" likely to be barriers to implementation. CONCLUSIONS This is the first national survey of PDs regarding the use of video coaching. Residency programs without video coaching may underestimate the utility of video coaching in training surgical residents.
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Affiliation(s)
- Andrew C Esposito
- Yale School of Medicine, Department of Surgery, New Haven, Connecticut.
| | - Peter S Yoo
- Yale School of Medicine, Department of Surgery, Division of Transplant Surgery, New Haven, Connecticut
| | - Jeremy M Lipman
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Department of Colorectal Surgery, Cleveland Clinic, Cleveland, Ohio
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Esposito AC, Coppersmith NA, White EM, Yoo PS. Video Coaching in Surgical Education: Utility, Opportunities, and Barriers to Implementation. JOURNAL OF SURGICAL EDUCATION 2022; 79:717-724. [PMID: 34972670 DOI: 10.1016/j.jsurg.2021.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/30/2021] [Accepted: 12/04/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE This review discusses the literature on Video-Based Coaching (VBC) and explores the barriers to widespread implementation. DESIGN A search was performed on Scopus and PubMed for the terms "operation," "operating room," "surgery," "resident," "house staff," "graduate medical education," "teaching," "coaching," "assessment," "reflection," "camera," and "video" on July 27, 2021, in English. This yielded 828 results. A single author reviewed the titles and abstracts and eliminated any results that did not pertain to operative VBC or assessment. All bibliographies were reviewed, and appropriate manuscripts were included in this study. This resulted in a total of 52 manuscripts included in this review. SETTING/PARTICIPANTS Original, peer-reviewed studies focused on VBC or assessment. RESULTS VBC has been both subjectively and objectively found to be a valuable educational tool. Nearly every study of video recording in the operating room found that subjects, including surgical residents and seasoned surgeons alike, overwhelmingly considered it a useful, non-redundant adjunct to their training. Most studies that evaluated skill acquisition via standardized assessment tools found that surgical residents who underwent a VBC program had significant improvements compared to their counterparts who did not undergo video review. Despite this evidence of effectiveness, fewer than 5% of residency programs employ video recording in the operating room. Barriers to implementation include significant time commitments for proposed coaching curricula and difficulty with integration of video cameras into the operating room. CONCLUSIONS VBC has significant educational benefits, but a scalable curriculum has not been developed. An optimal solution would ensure technical ease and expediency, simple, high-quality cameras, immediate review, and overcoming entrenched surgical norms and culture.
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Affiliation(s)
- Andrew C Esposito
- Yale School of Medicine, Department of Surgery, New Haven, Connecticut
| | | | - Erin M White
- Yale School of Medicine, Department of Surgery, New Haven, Connecticut
| | - Peter S Yoo
- Yale School of Medicine, Department of Surgery, New Haven, Connecticut.
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Video-based fully automatic assessment of open surgery suturing skills. Int J Comput Assist Radiol Surg 2022; 17:437-448. [PMID: 35103921 PMCID: PMC8805431 DOI: 10.1007/s11548-022-02559-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 01/03/2022] [Indexed: 01/09/2023]
Abstract
Purpose The goal of this study was to develop a new reliable open surgery suturing simulation system for training medical students in situations where resources are limited or in the domestic setup. Namely, we developed an algorithm for tools and hands localization as well as identifying the interactions between them based on simple webcam video data, calculating motion metrics for assessment of surgical skill. Methods Twenty-five participants performed multiple suturing tasks using our simulator. The YOLO network was modified to a multi-task network for the purpose of tool localization and tool–hand interaction detection. This was accomplished by splitting the YOLO detection heads so that they supported both tasks with minimal addition to computer run-time. Furthermore, based on the outcome of the system, motion metrics were calculated. These metrics included traditional metrics such as time and path length as well as new metrics assessing the technique participants use for holding the tools. Results The dual-task network performance was similar to that of two networks, while computational load was only slightly bigger than one network. In addition, the motion metrics showed significant differences between experts and novices. Conclusion While video capture is an essential part of minimal invasive surgery, it is not an integral component of open surgery. Thus, new algorithms, focusing on the unique challenges open surgery videos present, are required. In this study, a dual-task network was developed to solve both a localization task and a hand–tool interaction task. The dual network may be easily expanded to a multi-task network, which may be useful for images with multiple layers and for evaluating the interaction between these different layers. Supplementary Information The online version contains supplementary material available at 10.1007/s11548-022-02559-6.
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Kim MB, Lee JH. Resident Education on the Surgical Treatment of Distal Radius Fractures Using a Point-of-View Camera. Clin Orthop Surg 2022. [DOI: 10.4055/cios22172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Min Bom Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Jeong Hyun Lee
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
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14
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Schuster-Bruce J, Spiteri M, Mistry R, Ofo E. A high-definition, low cost endoscope to video record head and neck surgery- our experience. J Vis Commun Med 2021; 45:2-5. [PMID: 34889162 DOI: 10.1080/17453054.2021.2008231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Head and neck surgery is a challenging speciality to video-record due to its open, small and sometimes deep operative field. Consequently current commercial technologies yield a high financial cost. This study explores how a low-cost, commercially available endoscope, called a borescope, may be used to overcome these challenges. It was hypothesised that due to its size, versatility and low-cost, it may be an accessible tool to circumnavigate the pitfalls of previously trialled recording devices. We report two cases in which a borescope was used intra-operatively. We found that the borescope can capture images suitable for teaching and training purposes but not when mounted as a headcam. As such the borescope is unable to provide a surgeons point of view.
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Affiliation(s)
- James Schuster-Bruce
- Department of ENT, Head and Neck Surgery, St George's University Hospitals NHS Trust, London, UK
| | - Marija Spiteri
- Department of ENT, Head and Neck Surgery, St George's University Hospitals NHS Trust, London, UK
| | - Rakesh Mistry
- Department of ENT, Head and Neck Surgery, St George's University Hospitals NHS Trust, London, UK
| | - Enyi Ofo
- Department of ENT, Head and Neck Surgery, St George's University Hospitals NHS Trust, London, UK
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Deng T, Gulati S, Rodriguez W, Dawant BM, Langerman A. Automated detection of electrocautery instrument in videos of open neck procedures using YOLOv3 . ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:2071-2074. [PMID: 34891696 DOI: 10.1109/embc46164.2021.9630961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
With the rapid development of deep learning approaches, tremendous progress has been made in computer- assisted analysis of minimally-invasive, videoscopic surgery. However, surgery through open incisions ("open surgery"), which constitutes a much larger portion of surgical procedures performed, is rarely investigated because of the difficulty in obtaining high-quality open surgical video footage. Automated detection of surgical instruments shows promise for evaluating surgical activities, and provides a foundation for quality/safety review, education, and identification of surgical performance. In this paper, we present results using YOLOv3 to successfully identify an electrocautery surgical instrument in a library of images derived from 22 open neck procedures (an 887-image training/validation set, and a 1149-image testing set) captured using a wearable surgical camera. We show that our method effectively detects the spatial bounds of the electrocautery pencil in still images and we further demonstrate the ability of our method to detect the location of this instrument in video footage. Our work serves as the first demonstration of open surgical instrument detection using first-person video footage from a wearable camera and sets the stage for further work in this field.Clinical Relevance- Detection of instrumentation in surgical video is the necessary first step towards automating surgical task identification and skills assessment, which will be useful for surgical quality improvement and training.
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Jopling JK, Visser BC. Mastering the thousand tiny details: Routine use of video to optimize performance in sport and in surgery. ANZ J Surg 2021; 91:1981-1986. [PMID: 34309995 DOI: 10.1111/ans.17076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/20/2021] [Accepted: 07/06/2021] [Indexed: 12/31/2022]
Affiliation(s)
- Jeffrey K Jopling
- Department of Surgery, Stanford University, Stanford, California, USA
| | - Brendan C Visser
- Department of Surgery, Stanford University, Stanford, California, USA
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Manfuso A, Pansini A, Cassano L, Pederneschi N, Tewfik K, Califano L, Copelli C. Osmo Pocket© vs VITOM®: comparison of surgical educational video recording means in head and neck reconstructive surgery. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 123:209-214. [PMID: 34273574 DOI: 10.1016/j.jormas.2021.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 06/01/2021] [Accepted: 06/21/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE To highlight the needs for better intraoperative educational video recording in head and neck reconstructive surgery and to provide some information to standardize camera positioning in operative room. METHODS The Authors compared the Osmo Pocket© and the VITOM® 0° Telescope, evaluating the faculty and trainees point of view through specific questionnaires. The study was performed during two Masterclasses on Head and Neck Reconstructive Surgery that took place in the Hospital Casa Sollievo della Sofferenza in 2018 e 2019. Camera positioning in the Operative Room was also assessed. RESULTS In the faculty group, Osmo Pocket© was reported as frequently interfering with surgical intervention; the need for repositioning was reported more frequently in recording with VITOM®, that was evaluated as better in keeping a good "recording flow". In trainees' group, the perceived image quality with VITOM® was more appreciated, while Osmo Pocket© was considered superior in surgical field vision. Regarding the systems' positioning in the OR, in all the surgical procedures it was observed the need for the first operator and the trainees to have the HD monitor placed in front of them. Only during forearm flap harvesting the HD monitor was placed laterally to the first operator and the trainees. CONCLUSIONS The Osmo Pocket© is a cheap solution and allows a stable and continuous vision of the operative field, without the needing for stop and repositioning. The Vitom®, despite its major costs and the needing for periodic repositioning, allows a better view of anatomical details with less discomfort for the surgeon. Moreover it's important a standardization of the video means positioning in the operative room to reduce the pre-operative times and to aid in the choice of the most useful method for educational video recording.
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Affiliation(s)
- A Manfuso
- Fondazione IRCCS Casa Sollievo della Sofferenza, Operative Unit of Maxillo-Facial Surgery, Otolaryngology and Dentistry, San Giovanni Rotondo (Fg), Italy
| | - A Pansini
- Maxillo-Facial Surgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences; Federico II University, Naples, Italy
| | - L Cassano
- Fondazione IRCCS Casa Sollievo della Sofferenza, Operative Unit of Maxillo-Facial Surgery, Otolaryngology and Dentistry, San Giovanni Rotondo (Fg), Italy
| | - N Pederneschi
- Fondazione IRCCS Casa Sollievo della Sofferenza, Operative Unit of Maxillo-Facial Surgery, Otolaryngology and Dentistry, San Giovanni Rotondo (Fg), Italy
| | - K Tewfik
- Fondazione IRCCS Casa Sollievo della Sofferenza, Operative Unit of Maxillo-Facial Surgery, Otolaryngology and Dentistry, San Giovanni Rotondo (Fg), Italy
| | - L Califano
- Maxillo-Facial Surgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences; Federico II University, Naples, Italy
| | - C Copelli
- Maxillo-Facial Surgery, Department of Surgical Sciences, University of Turin, Corso A.M Dogliotti 14, 10126 Turin, Italy.
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18
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Alexander A, Radke H. Reshaping surgical specialist training in small animal surgery during and after the COVID-19 pandemic. Vet Surg 2021; 50:924-932. [PMID: 34036591 PMCID: PMC8242755 DOI: 10.1111/vsu.13660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/05/2021] [Accepted: 05/08/2021] [Indexed: 01/28/2023]
Abstract
Objective To assess the perceived effects of the COVID‐19 pandemic on small animal surgical specialist training, among trainees and supervisors and to propose changes, based upon the results, that could be incorporated into training programs. Study Design Anonymous online questionnaire survey. Sample Population Eighty‐one eligible responses were collected in September 2020, including 52 European College of Veterinary Surgeons (ECVS) residents and 29 ECVS Diplomates acting as supervisors. Methods Descriptive statistics were used to analyze the data. Fisher's exact test was used to test for significance. Results A reduction in surgical case load was reported by 82% (n = 66/81) of respondents, with 82% (n = 54/66) of those believing that COVID‐19 had a mild‐to‐moderate impact on training. Compared to supervisors, residents were less likely to feel that appropriate guidance, a safe working environment, and measures to preserve training had been provided (p < .01). Only 45% (n = 22/49) of residents reported confidence with performing teleconsultations. Ninety percent (n = 73/81) of respondents considered online “case presentations” and “edited surgical video footage” as a positive ancillary tool. Conclusion COVID‐19 has resulted in a reduction in case load and training for the majority of residents. A discrepancy between the opinions of residents and supervisors was noted on various aspects of COVID‐19 related effects. Impact Open communication, as well as the use of additional training tools through digital platforms may help to preserve safe and effective training during times of decreased clinical activity. While this study has focused on surgical specialist training, the results could be applied to other disciplines.
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Affiliation(s)
- Akash Alexander
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - Heidi Radke
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
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19
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Hein J, Seibold M, Bogo F, Farshad M, Pollefeys M, Fürnstahl P, Navab N. Towards markerless surgical tool and hand pose estimation. Int J Comput Assist Radiol Surg 2021; 16:799-808. [PMID: 33881732 PMCID: PMC8134312 DOI: 10.1007/s11548-021-02369-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 04/06/2021] [Indexed: 01/16/2023]
Abstract
Purpose: Tracking of tools and surgical activity is becoming more and more important in the context of computer assisted surgery. In this work, we present a data generation framework, dataset and baseline methods to facilitate further research in the direction of markerless hand and instrument pose estimation in realistic surgical scenarios. Methods: We developed a rendering pipeline to create inexpensive and realistic synthetic data for model pretraining. Subsequently, we propose a pipeline to capture and label real data with hand and object pose ground truth in an experimental setup to gather high-quality real data. We furthermore present three state-of-the-art RGB-based pose estimation baselines. Results: We evaluate three baseline models on the proposed datasets. The best performing baseline achieves an average tool 3D vertex error of 16.7 mm on synthetic data as well as 13.8 mm on real data which is comparable to the state-of-the art in RGB-based hand/object pose estimation. Conclusion: To the best of our knowledge, we propose the first synthetic and real data generation pipelines to generate hand and object pose labels for open surgery. We present three baseline models for RGB based object and object/hand pose estimation based on RGB frames. Our realistic synthetic data generation pipeline may contribute to overcome the data bottleneck in the surgical domain and can easily be transferred to other medical applications. Supplementary Information The online version supplementary material available at 10.1007/s11548-021-02369-2.
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Affiliation(s)
- Jonas Hein
- Research in Orthopedic Computer Science, University Hospital Balgrist, University of Zurich, Balgrist CAMPUS, Zurich, Switzerland. .,Computer Vision and Geometry Group, ETH Zurich, Zurich, Switzerland.
| | - Matthias Seibold
- Research in Orthopedic Computer Science, University Hospital Balgrist, University of Zurich, Balgrist CAMPUS, Zurich, Switzerland. .,Computer Aided Medical Procedures, Technical University Munich, Garching, Germany.
| | - Federica Bogo
- Mixed Reality & AI Zurich Lab, Microsoft, Zurich, Switzerland
| | - Mazda Farshad
- Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Marc Pollefeys
- Computer Vision and Geometry Group, ETH Zurich, Zurich, Switzerland.,Mixed Reality & AI Zurich Lab, Microsoft, Zurich, Switzerland
| | - Philipp Fürnstahl
- Research in Orthopedic Computer Science, University Hospital Balgrist, University of Zurich, Balgrist CAMPUS, Zurich, Switzerland
| | - Nassir Navab
- Computer Aided Medical Procedures, Technical University Munich, Garching, Germany
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20
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Saun TJ, Grantcharov TP. Design and validation of an inertial measurement unit (IMU)-based sensor for capturing camera movement in the operating room. HARDWAREX 2021; 9:e00179. [PMID: 35492042 PMCID: PMC9041183 DOI: 10.1016/j.ohx.2021.e00179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 12/21/2020] [Accepted: 02/09/2021] [Indexed: 06/14/2023]
Abstract
Intraoperative surgical video enables better surgical training, continued performance enhancement for surgeons and system-level quality improvement initiatives, however the capture of high-quality intraoperative video of open surgical procedures is difficult. Wearable cameras, typically in the form of a head-mounted action camera are frequently used for this purpose, although the video from these devices often contains significant motion artifact due to movement of the surgeon's head. When trying to compare the performance of various wearable cameras in the surgical setting, we could not find a motion sensor appropriate for this purpose. We therefore describe in this article the design, assembly and validation of a small sensor that can be attached to wearable cameras in the operating room to objectively quantify camera motion. The sensor incorporates an inertial measurement unit coupled to a microcontroller. Concurrent validity is established by comparing the positional sensing of the device to a geared tripod head that allows for fine, measured manipulations of the sensor in three orthogonal axes. The methodology of capturing, processing and reporting camera movement for a surgical procedure is also detailed.
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Affiliation(s)
- Tomas J. Saun
- International Centre for Surgical Safety, St. Michael’s Hospital - Li Ka Shing International Healthcare Education Centre, Canada
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, ON, Canada
| | - Teodor P. Grantcharov
- International Centre for Surgical Safety, St. Michael’s Hospital - Li Ka Shing International Healthcare Education Centre, Canada
- Division of General Surgery, Department of Surgery, St. Michael’s Hospital, Toronto, ON, Canada
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21
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Gupta R, Joshi M, Gupta L. An Integrated Guide for Designing Video Abstracts Using Freeware and Their Emerging Role in Academic Research Advancement. J Korean Med Sci 2021; 36:e66. [PMID: 33686811 PMCID: PMC7940117 DOI: 10.3346/jkms.2021.36.e66] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 02/15/2021] [Indexed: 12/23/2022] Open
Abstract
Video abstracts (VAs) are a motion picture equivalent of written abstracts. With greater use of social media platforms for post publication promotions of research articles, VAs have gained increasing popularity among researchers in recent years. Widespread lockdowns and social distancing protocols in the pandemic period furthered the use of VAs as a tool for efficient learning. Moreover, these may be the preferred medium for communicating certain types of information, such as diagnostic or therapeutic procedures, qualitative research, perspectives, and techniques. In this article, the authors discuss the role of VAs in the advancement of academic research, plausible designs, freeware for making videos, and specific considerations for crafting good VAs.
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Affiliation(s)
- Ria Gupta
- Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune, India
| | - Mrudula Joshi
- Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune, India
| | - Latika Gupta
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
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22
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Saun TJ, Grantcharov TP. Development of the User Experience (UX) and Video Quality Evaluation (VQE) Instruments for Assessment of Intraoperative Video Capture Technology. JOURNAL OF SURGICAL EDUCATION 2021; 78:201-206. [PMID: 32600890 DOI: 10.1016/j.jsurg.2020.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 05/09/2020] [Accepted: 06/14/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE There exists a lack of technology to reliably and routinely capture high-quality video of open surgical procedures. To critically evaluate and compare new and existing technology solutions, we must have widely accepted evaluation criteria for intraoperative camera devices. The objective, therefore, was to develop evaluation criteria for intraoperative camera devices, as well as the video product they produce. DESIGN A modified Delphi process that included 2 iterative surveys was used to build expert consensus and develop 2 evaluation instruments: one to evaluate the user experience (UX) of using an intraoperative camera device, and the second for video quality evaluation (VQE) of the video product. SETTING Global, through iterative online surveys. PARTICIPANTS Surgeons who perform open surgery and have experience with intraoperative video capture. RESULTS Eighty-six experts participated in the first iteration of the survey and 46 in the second. Ten factors met the a priori cutoff for >80% agreement for the UX survey: (1) ease of setup/integration with current practice, (2) comfort, (3) distracting during case, (4) overall satisfaction with wearing the device, (5) would you use this device again, (6) would you recommend this device to colleagues, (7) the weight of wearing the device, (8) sufficient battery life, (9) ability to control device while operating, and (10) degree to which the device interferes or is incompatible with other surgical accessories. Six factors met the cutoff for the VQE survey: (1) camera stability, (2) brightness/exposure, (3) resolution/sharpness, (4) unobstructed view of the surgical field, (5) appropriate field of view, and (6) overall satisfaction with video quality. CONCLUSIONS These instruments can be used to critically evaluate camera technologies for intraoperative video capture of open surgery.
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Affiliation(s)
- Tomas J Saun
- International Centre for Surgical Safety, St. Michael's Hospital - Li Ka Shing International Healthcare Education Centre, Toronto, Ontario, Canada; Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
| | - Teodor P Grantcharov
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of General Surgery, Department of Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
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23
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Yuen JC, Gonzalez SR, Osborn T, Abu-Rmaileh M. Untethered and HIPAA-compliant Interactive Livestreaming of Surgery to Residents and Medical Students. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3165. [PMID: 33173681 PMCID: PMC7647663 DOI: 10.1097/gox.0000000000003165] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 08/07/2020] [Indexed: 11/27/2022]
Abstract
Traditional livestreaming of surgery to an audience requires stationary video broadcasting infrastructure, with viewers congregating in front of a screen, while audiovisual technicians provide support in the background. In recent years, livestreaming technologies from cameras to teleconference platforms have advanced dramatically, even to allow for compliance with the Health Insurance Portability and Accountability Act of 1996 with web-based encryption. The objective of this article is to show that livestreaming surgery in medical education is possible using portable devices, with the resident and medical students as audience at home interacting on their computer or smart devices. The surgeon utilizes a head-mounted camera transmitting video feed using a wireless transmitter broadcasting to a laptop computer, which is hosting a Health Insurance Portability and Accountability Act-compliant version of Zoom. The entire setup is portable, and the surgeon is tethered neither to a cord nor to the institution's audiovisual enterprise. This prototype setup allows the surgeon to broadcast live surgery interactively at any time and from any operating room with remote medical students and surgical residents. We posit that our medical education industry would need to condense the devices into a turnkey livestreaming camera system with optimized frames per second reception.
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Affiliation(s)
- James C. Yuen
- From the Division of Plastic Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Ark
| | - Santiago R. Gonzalez
- Division of Plastic and Reconstructive Surgery, University of California San Francisco, Calif
| | - Tamara Osborn
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Ark
| | - Muhammad Abu-Rmaileh
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Ark
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24
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Simon F, Peer S, Michel J, Bruce IA, Cherkes M, Denoyelle F, Fagan JJ, Harish M, Hong P, James A, Jia H, Krishnan PV, Maunsell R, Modi VK, Nguyen Y, Parikh SR, Patel N, Pullens B, Russo G, Rutter MJ, Sargi Z, Shaye D, Sowerby LJ, Yung M, Zdanski CJ, Teissier N, Fakhry N. IVORY Guidelines (Instructional Videos in Otorhinolaryngology by YO-IFOS): A Consensus on Surgical Videos in Ear, Nose, and Throat. Laryngoscope 2020; 131:E732-E737. [PMID: 33270236 PMCID: PMC7891442 DOI: 10.1002/lary.29020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/10/2020] [Accepted: 07/20/2020] [Indexed: 11/16/2022]
Abstract
Objectives/Hypothesis Otolaryngology instructional videos available online are often of poor quality. The objective of this article was to establish international consensus recommendations for the production of educational surgical videos in otolaryngology. Study Design DELPHI survey. Methods Twenty‐seven international respondents participated in this study from 12 countries. Consensus was reached after three rounds of questionnaires following the Delphi methodology. The proposals having reached the 80% agreement threshold in the third round were retained. Results The main recommendations are as follows: 1) Ethics: patients must be anonymized and unrecognizable (apart from plastic surgery if necessary). A signed authorization must be obtained if the person is recognizable. 2) Technical aspects: videos should be edited and in high‐definition (HD) quality if possible. Narration or subtitles and didactic illustrations are recommended. 3) Case presentation: name of pathology and procedure must be specified; the case should be presented with relevant workup. 4) Surgery: surgical procedures should be divided into several distinct stages and include tips and pitfalls. Pathology should be shown if relevant. Key points should be detailed at the end of the procedure. 5) Organ‐specific: type of approach and bilateral audiometry should be specified in otology. Coronal plane computed tomography scans should be shown in endonasal surgery. It is recommended to show pre‐ and postoperative videos in voice surgery and preoperative drawings and photos of scars in plastic surgery, as well as the ventilation method in airway surgery. Conclusions International recommendations have been determined to assist in the creation and standardization of educational surgical videos in otolaryngology and head and neck surgery. Level of Evidence 5 Laryngoscope, 131:E732–E737, 2021
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Affiliation(s)
- François Simon
- Department of Pediatric Otolaryngology, Necker-Sick Children's Hospital, AP-HP-University of Paris, Paris, France
| | - Shazia Peer
- Division of Otolaryngology, University of Cape Town and Red Cross Children's Hospital, Rondebosch, South Africa
| | - Justin Michel
- Department of Oto-Rhino-Laryngology-Head and Neck Surgery, Aix Marseille University, APHM, University Institute of Industrial Thermal Systems, La Conception University Hospital, Marseille, France
| | - Iain A Bruce
- Division of Infection, Immunity, and Respiratory Medicine, Royal Manchester Children's Hospital, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Maryana Cherkes
- Departement of Otolaryngology, Lviv City Children's Clinical Hospital, Lviv National Medical University, Lviv, Ukraine
| | - Françoise Denoyelle
- Department of Pediatric Otolaryngology, Necker-Sick Children's Hospital, AP-HP-University of Paris, Paris, France
| | - Johannes J Fagan
- Division of Otolaryngology, University of Cape Town and Red Cross Children's Hospital, Rondebosch, South Africa
| | | | - Paul Hong
- Department of Surgery, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Adrian James
- Department of Otolaryngology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Huan Jia
- Department of Otolaryngology-Head Neck Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - P Vijaya Krishnan
- Department of Otorhinolaryngology, Madras Ear Nose and Throat Research Foundation, Chennai, Tamil Nadu, India
| | - Rebecca Maunsell
- Department of Otorhinolaryngology, Faculty of Medical Sciences, State University of Campinas UNICAMP, Campinas, Brazil
| | - Vikash K Modi
- Pediatric Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College/New York-Presbyterian Hospital, New York, New York, U.S.A
| | - Yann Nguyen
- Department of Otorhinolaryngology, Pitié-Salpêtrière Hospital, Robotic and surgical innovation research group, Inserm, Pasteur, "Innovative Technologies and Translational Therapeutics for Deafness," Hearing Institute, Sorbonne University, AP-HP, Paris, France
| | - Sanjay R Parikh
- Seattle Children's Hospital, University of Washington, Seattle, Washington, U.S.A
| | - Nirmal Patel
- Department of Otolaryngology-Head and Neck Surgery, University of Sydney and Macquarie University, Sydney, New South Wales, Australia
| | - Bas Pullens
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Gennaro Russo
- Department of Otorhinolaryngology, Monaldi Hospital, Naples, Italy
| | - Michael J Rutter
- Division of Pediatric Otolaryngology, Aerodigestive and Esophageal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Zoukaa Sargi
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - David Shaye
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Leigh J Sowerby
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Matthew Yung
- Department of Otolaryngology, Ipswich Hospital, Colchester, United Kingdom
| | - Carlton J Zdanski
- Division of Pediatric Otolaryngology/Head and Neck Surgery, Department of Otolaryngology/Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, U.S.A
| | - Natacha Teissier
- Department of Pediatric Otolaryngology, Robert-Debré Hospital, AP-HP-University of Paris, Paris, France
| | - Nicolas Fakhry
- Department of Oto-Rhino-Laryngology-Head and Neck Surgery, Aix Marseille University, APHM, Language and Speech Laboratory, La Conception University Hospital, Marseille, France
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25
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Hakimi AA, Chen JJ, Wong BJF. Response to Çelikoyar re: "Video Standards for Rhinoplasty Education: A Review and Recommended Guidelines". Facial Plast Surg Aesthet Med 2020; 22:399-400. [PMID: 32749858 DOI: 10.1089/fpsam.2020.0360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Amir A Hakimi
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, Irvine, California, USA
| | - Jason J Chen
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, Irvine, California, USA
- Department of Biomedical Engineering, Samueli School of Engineering, University of California, Irvine, Irvine, California, USA
| | - Brian J F Wong
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, Irvine, California, USA
- Department of Biomedical Engineering, Samueli School of Engineering, University of California, Irvine, Irvine, California, USA
- Department of Otolaryngology, Head and Neck Surgery, University of California, Irvine, Orange, California, USA
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26
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Hakimi AA, Hong EM, Prasad KR, Standiford L, Chang E, Wong BJF. A Novel Inexpensive Design for High Definition Intraoperative Videography. Surg Innov 2020; 27:699-701. [DOI: 10.1177/1553350620946315] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Amir A. Hakimi
- Beckman Laser Institute and Medical Clinic, University of California Irvine, Irvine, CA, USA
| | - Ellen M. Hong
- Beckman Laser Institute and Medical Clinic, University of California Irvine, Irvine, CA, USA
| | - Karthik R. Prasad
- Beckman Laser Institute and Medical Clinic, University of California Irvine, Irvine, CA, USA
| | - Lauren Standiford
- Beckman Laser Institute and Medical Clinic, University of California Irvine, Irvine, CA, USA
| | - Edward Chang
- Beckman Laser Institute and Medical Clinic, University of California Irvine, Irvine, CA, USA
| | - Brian J. F. Wong
- Beckman Laser Institute and Medical Clinic, University of California Irvine, Irvine, CA, USA
- Department of Biomedical Engineering, Samueli School of Engineering, University of California Irvine, Irvine, CA, USA
- Department of Otolaryngology, Head and Neck Surgery, University of California Irvine, Orange, CA, USA
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27
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Overhead Multiview Camera System for Recording Open Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2765. [PMID: 32440432 PMCID: PMC7209883 DOI: 10.1097/gox.0000000000002765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 02/12/2020] [Indexed: 11/27/2022]
Abstract
Supplemental Digital Content is available in the text.
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28
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Hakimi AA, Prasad KR, Hong EM, Standiford L, Chang E, Cobo R, Jang YJ, Wong BJF. Video Standards for Rhinoplasty Education: A Review and Recommended Guidelines. Facial Plast Surg Aesthet Med 2020; 22:219-224. [PMID: 32101478 DOI: 10.1089/fpsam.2020.0006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Importance: Intraoperative videography is widely used to record rhinoplasty procedures, yet little is known about the optimal surgical vantage points at critical procedural steps. Objective: To assess commonly used camera angles in public and proprietary intraoperative rhinoplasty videos and discuss approaches to obtaining these viewing angles. Design: Public and propriety rhinoplasty videos were reviewed and categorized based on procedure type, specific area(s) of focus, and camera angles utilized at a series of critical operative steps. The most commonly used camera angles were recorded and assessed based on surgical field visualization and the authors' personal recording experiences. Results: Of the 114 videos that met inclusion criteria, 49 were full-length open rhinoplasty procedures, 20 full-length endonasal rhinoplasty procedures, 17 tip techniques, 8 opening techniques, 7 fashioning grafts, 7 osteotomies, and 6 cartilage harvests. With respective to footage acquisition, the upward camera angle was most frequently used for recording, and endoscopic view was least frequently used. Conclusions and Relevance: These findings demonstrate that there is extensive variability in camera angles between surgical films. Moreover, many of these camera angles are insufficient due to obstruction by surgical staff, inability to visualize deep structures, and difficulty capturing the three-dimensional nasal framework. A guide indicating the best viewing angles for different aspects of the procedure would be useful to optimize educational videos.
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Affiliation(s)
- Amir A Hakimi
- Department of Otolaryngology, Beckman Laser Institute and Medical Clinic, University of California Irvine, Irvine, California, USA
| | - Karthik R Prasad
- Department of Otolaryngology, Beckman Laser Institute and Medical Clinic, University of California Irvine, Irvine, California, USA
| | - Ellen M Hong
- Department of Otolaryngology, Beckman Laser Institute and Medical Clinic, University of California Irvine, Irvine, California, USA
| | - Lauren Standiford
- Department of Otolaryngology, Beckman Laser Institute and Medical Clinic, University of California Irvine, Irvine, California, USA
| | - Edward Chang
- Department of Otolaryngology, Beckman Laser Institute and Medical Clinic, University of California Irvine, Irvine, California, USA
| | - Roxana Cobo
- Department of Otolaryngology, Centro Médico Imbanaco, Cali, Colombia
| | - Yong J Jang
- Department of Otolaryngology, Asan Medical Center, Seoul, Republic of Korea
| | - Brian J F Wong
- Department of Otolaryngology, Beckman Laser Institute and Medical Clinic, University of California Irvine, Irvine, California, USA.,Department of Biomedical Engineering, Samueli School of Engineering, University of California Irvine, Irvine, California, USA.,Department of Otolaryngology, Head and Neck Surgery, University of California Irvine, Orange, California, USA
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Cambron JC, Wyatt KD, Lohse CM, Underwood PY, Hellmich TR. Medical Videography Using a Mobile App: Retrospective Analysis. JMIR Mhealth Uhealth 2019; 7:e14919. [PMID: 31793894 PMCID: PMC6918202 DOI: 10.2196/14919] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/06/2019] [Accepted: 09/24/2019] [Indexed: 12/04/2022] Open
Abstract
Background As mobile devices and apps grow in popularity, they are increasingly being used by health care providers to aid clinical care. At our institution, we developed and implemented a point-of-care clinical photography app that also permitted the capture of video recordings; however, the clinical findings it was used to capture and the outcomes that resulted following video recording were unclear. Objective The study aimed to assess the use of a mobile clinical video recording app at our institution and its impact on clinical care. Methods A single reviewer retrospectively reviewed video recordings captured between April 2016 and July 2017, associated metadata, and patient records. Results We identified 362 video recordings that were eligible for inclusion. Most video recordings (54.1%; 190/351) were captured by attending physicians. Specialties recording a high number of video recordings included orthopedic surgery (33.7%; 122/362), neurology (21.3%; 77/362), and ophthalmology (15.2%; 55/362). Consent was clearly documented in the medical record in less than one-third (31.8%; 115/362) of the records. People other than the patient were incidentally captured in 29.6% (107/362) of video recordings. Although video recordings were infrequently referenced in notes corresponding to the clinical encounter (12.2%; 44/362), 7.7% (22/286) of patients were video recorded in subsequent clinical encounters, with 82% (18/22) of these corresponding to the same finding seen in the index video. Store-and-forward telemedicine was documented in clinical notes in only 2 cases (0.5%; 2/362). Videos appeared to be of acceptable quality for clinical purposes. Conclusions Video recordings were captured in a variety of clinical settings. Documentation of consent was inconsistent, and other individuals were incidentally included in videos. Although clinical impact was not always clearly evident through retrospective review because of limited documentation, potential uses include documentation for future reference and store-and-forward telemedicine. Repeat video recordings of the same finding provide evidence of use to track the findings over time. Clinical video recordings have the potential to support clinical care; however, documentation of consent requires standardization.
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Affiliation(s)
- Julia C Cambron
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Kirk D Wyatt
- Division of Pediatric Hematology/Oncology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, United States
| | - Christine M Lohse
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States
| | | | - Thomas R Hellmich
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN, United States
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