Ann Thorac Surg 2009;87:940-941. doi:10.1016/j.athoracsur.2008.07.111
© 2009 The Society of Thoracic Surgeons
Case Reports
Saved By the Video: Added Value of Recording Surgical Procedures on Video
Johann Andreas Hoschtitzky, MSc, FRCSEd-CTh*,
Dipesh B. Trivedi, MCh,
Martin J. Elliott, FRCS
Cardiothoracic Unit, Great Ormond Street Hospital for Children, London, United Kingdom
Accepted for publication July 11, 2008.
* Address correspondence to Dr Hoschtitzky, Cardiothoracic Unit, Great Ormond Street Hospital for Children, Great Ormond St, London, WC1N 3JH, United Kingdom (Email: ahoschtitzky{at}yahoo.com).
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Abstract
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Intraoperative imaging has immense value for teaching and training surgeons by providing part of a future digital medical record of the patient and supportive evidence of good practice and an open attitude to patient safety. We report a case in which intraoperative video recording of an operation allowed us, after an incorrect count, to confidently assert that there was no equipment left behind in the patient.
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Introduction
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Missing equipment and incorrect counts during and after the end of a surgical procedure can cause significant problems. The smaller the piece of equipment, the more difficult the search. The morbidity of the procedure, up to and including reopening a wound, may be increased by delay. Lost equipment may lead to claims of medical negligence and substantial financial settlements. We report a case in which intraoperative video recording of an operation allowed us, after an incorrect count, to confidently assert that no equipment was left behind in the patient.
A 29-month-old girl was referred for surgical closure of an atrial septal defect considered too large for device placement. The operation was digitally video-recorded with a head camera worn by the operating surgeon as is routine in our institution [1]. The patient underwent a median sternotomy and was placed on cardiopulmonary bypass by cannulating the ascending aorta, inferior vena cava, and superior vena cava. Cardioplegia was given to arrest the heart as usual, and the right atrium was opened. Stay sutures were placed inside the right atrial appendage to help exposure of the atrial septal defect. These sutures were clipped with silastic shod hemostats.
The operation proceeded uneventfully, and we were ready to wean the child from cardiopulmonary bypass and commence modified ultrafiltration (MUF) when the scrub nurse informed us that one of the silastic shod hemostats was missing a transparent sleeve. After a very thorough search in the operative field, on the operating table and on the floor, we elected to wean the patient off cardiopulmonary bypass and perform modified ultrafiltration.
Further elaborate searching took place for the next 30 minutes on the operating table, around the bypass equipment, over the entire operating room floor, and again inside the pericardial well. An epicardial echocardiogram was performed confirming no residual atrial septal defect, and it revealed no evidence of a retained piece of plastic, although we were unsure whether or not it would have been visible.
After a total of 90 minutes of searching we still had not found the silastic tip. We proceeded to finish the operation uneventfully, after which the surgeon left the operating table to talk to the parents of the patient to inform them of what had happened. Before doing so, he reviewed the recorded videotape of the procedure. This revealed that at the beginning of the operation, when the silastic shod hemostat was first placed in the surgical field, the shod in question had only one rather than two plastic sleeves (Fig 1). The sleeve was missing, but not lost! We were able to tell the parents with confidence that nothing had in fact been lost. The patient did well and went home in good health after 3 days in the hospital.
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Fig 1. Illustration of the silastic shod hemostat when it was first placed in the surgical field, clearly demonstrating that the shod in question only had one (*) rather than two plastic sleeves.
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Comment
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Recording surgical procedures is of immense value for teaching and training surgeons [1, 2]. It generates live recordings of procedures in the setting of ever decreasing opportunities and time for training [3]. It also provides part of a future digital medical record of the patient. This case demonstrates a previously unidentified benefit. By accurately documenting the steps taken during the operation, digital video recording allowed us confidently to state that no missing equipment was inadvertently left behind inside the patient. We have received many verbal criticisms that video recording of surgical procedures puts the surgeon at risk in medical negligence litigation. We take the opposite view, and believe that recording the operation on tape provides supportive evidence of good practice and an open attitude to patient safety [2]. This case has very clearly demonstrated this assertion. By video recording the operation, we avoided the potential to have to re-explore the patient in search of the missing equipment and avoided a potential claim of medical negligence.
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References
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- Kocyildirim E, Franck LS, Elliott MJ. Intra-operative imaging in paediatric cardiac surgery: the reactions of parents who requested and watched a video of the surgery performed on their child Cardiol Young 2007;17:407-413.[Medline]
- 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.[Abstract/Free Full Text]
- Mestres CA, Revuelta JM, Yankah AC. The European working time directive: quo vadis?. A well-planned and organized assassination of surgery. Eur J Cardiothorac Surg 2006;30:571-573.[Free Full Text]
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Abstract
Introduction
