Educational technology: revolutionizing surgical education

The age of surgical operative video big data - My bicycle or our park?

BACKGROUND

Surgery is a major component of health-care provision. Operative intervention often employs minimally invasive approaches incorporating digital cameras creating a 'digital twin' of both intracorporeal appearances and operative performance. Video recordings provide richer detail than the traditional operative note and can couple with advanced computer technology to unlock new analytic capabilities capable of driving surgical advancement via quality improvement initiatives and new technology design. Surgical video is however an under-utilized technology resource, in part, because ownership along with broader issues including purpose, privacy, confidentiality, copyright and inclusion in outputs have been poorly considered using outdated categorisation.

METHOD

A first principles perspective on operative video classification as a useful public interest resource enshrining fundamental stakeholder (patients, physicians, institutions, industry and society) rights, roles and responsibilities.

RESULT

A facility of noble purpose, understandable to all, for fair, accountable, safe and transparent access to large volumes of anonymised surgical videos of intracorporeal operations that enables advances through cross-disciplinary research is proposed. Technology can be exploited to protect all relevant parties respecting both citizen data-rights and the special status doctor-patient relationship. Through general consensus, the capability can be understood, established and iterated to perfection.

CONCLUSION

Overall we argue that new and specific classification of surgical video enables responsible curation and serves the public good better than the current model. Rather than being thought of as a bicycle where discrete ownership is ascribed, such data are better viewed as being more like a park, a regulated amenity we should preserve for better human life.

Future Directions

Transanal total mesorectal excision (taTME) is a novel technique that has evolved over the years to address the challenges of low rectal cancer surgery by applying the principles and benefits of laparoscopic surgery to more historic transanal techniques. It has been popularized through its use in rectal cancer, but the transanal approach is slowly being expanded to tackle different clinical scenarios including benign conditions such as inflammatory bowel disease and endometriosis. For all of these new indications, it is the desire to access and begin the dissection in native tissue beyond the pathology which makes this approach applicable to other diseases where anatomy can be challenging. Training pathways to safely introduce taTME in a standardized manner are being developed and implemented in a bid to ensure adequate training to all the surgeons using this technique and thus minimize complications and patient morbidity. The future directions of this promising technique include the use of image and optical technological enhancement to aid navigation, the use of pneumorectum stabilization, and perhaps the use of fluorescence as a safety improvement. Developments have come also from the field of robotics. After a demonstration of feasibility in cadaver models, a growing experience has been gathered in the robotic approach to taTME, covered in the last part of this chapter.