Ann Thorac Surg 2006;81:408-409
© 2006 The Society of Thoracic Surgeons
Correspondence
Digital Recording of Operations
Faisal H. Cheema, MD,
David L. Colman, BA,
Timothy P. Martens, MD,
Veli K. Topkara, MD
Department of Surgery, Division of Cardiothoracic Surgery, College of Physicians & Surgeons of Columbia University—New York Presbyterian Hospital, Milstein Hospital Building, 7 Garden North Room 435, 177 Fort Washington Ave, New York, NY 10032-3784
(Email: fc2020{at}columbia.edu).
To the Editor:
The technical aspects of the digital recording of operations were quite elegantly described by Kanani and colleagues [1] and its significance was described by Gold [2]. However, the practical aspects remain unclear, and they will have to be addressed before this modality is used on a routine basis.
We will be interested in the authors' comments regarding the following concerns: (a) Consent — in this study, a few families declined to consent for video capturing. Will there be a need for such consent in the future, considering this modality is being proposed as an essential component of electronic patient record (EPR)? (b) Learning curve — because it will be an important factor for any new surgeon or resident, we are curious to know how long it took for the only surgeon in the study [1] to become comfortable with his head camera in order to minimize unnecessary movement. (c) Size — the authors [1] describe the difficulty in applying their methods to larger children. We wonder if there is a role for this modality in adult patients, and if so, what are the differences in recording such videos? (d) Cost — what were the initial costs of the recording equipment and the cost per tape, including the labor costs of editing? and (e) Integration — what role, if any, do the authors see for their recording system described as part of a larger multi-track recording system, as with the Remote Analysis of Team Environments (RATE) system described by Guerlain and colleagues [3]? What issues do the authors envision in the event that the digital records were to increase in complexity to include multiple camera angles, audio tracks, and sensor inputs?
In addition to these specific questions, there are a number of issues that will need to be discussed and resolved before this system is to become a part of common surgical practice. Will there be any need for institutional review board approval if such video records were to be made part of the EPR? What will be the guidelines for sharing these videos? Should patients and their families be given access to these surgical videos, which may potentially lead to unnecessary law suits? If these tapes could be utilized to settle future legal issues, then who should edit them (ie, a surgeon, physician, medical assistant, or audiovisual technician) or should they remain unedited? How long should these digital tapes be archived? Should cases without any complications or academic significance, or both, be deleted on a regular basis? We believe that it is important to introduce some of these questions now in anticipation of the debate that will surely follow.
Undoubtedly, this subtle modality will be a cornerstone of the EPR in the future. Besides playing an important role in the teaching and training of younger surgeons, it would definitely add to the already available evaluation tools for assessing their surgical skill. The question is not whether these videos are the future, but who is going to set the guidelines to make sure this process is regulated based on solid principles so that classified and sensitive information remains protected while all concerned parties may benefit.
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References
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- Kanani M, Kocyildirim E, Cohen G, Bentham K, Elliott MJ. Method and value of digital recording of operations for congenital heart disease Ann Thorac Surg 2004(78):2146-2149.
- Gold JP. Invited commentary Ann Thorac Surg 2004;78:2149.[Free Full Text]
- Guerlain S, Adams RB, Turrentine FB, et al. Assessing team performance in the operating roomdevelopment and use of a "black-box" recorder and other tools for the intraoperative environment. J Am Coll Surg 2005;200:29-37.[Medline]
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