Using Surgical Video to Improve Technique and Skill.
Using Surgical Video to Improve Technique and Skill.
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DOI：
10.1097/sla.0000000000001592
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发表时间：
2016-07
影响因子：
9
通讯作者：
Dimick JB
中科院分区：
文献类型：
--
作者：
Grenda TR;Pradarelli JC;Dimick JB
尽管最近的质量改进工作在改善围手术期护理方面取得了相当大的进展，但这些方法在很大程度上忽略了手术本身发生的细节。人们普遍认为，在手术过程中外科医生手中发生的事情对患者的结局有重大影响。然而，客观地评估外科医生在手术室中的表现一直是困难的。因此，替代措施，如程序量，已作为代理的操作熟练度。1最近，人们越来越热衷于解决使用术中视频直接评估和提高外科医生表现的挑战。这项工作与执业外科医生建立在以前的经验，使用视频来评估住院医生的腹腔镜技能。2，3为说明这一策略，最近一项关于减肥手术的备受瞩目的研究表明，通过对腹腔镜胃旁路手术期间的表现进行视频分析评估，手术技能的同行评分较高，与术后不良事件的发生率较低相关。[4]虽然更高的技能与更好的结果相关似乎是显而易见的，但这是第一项证明技术技能的差异可以通过执业外科医生的同行评价可靠地测量的研究。也许最重要的是，这项研究是第一个明确地将同行对技能的评价与患者的结果直接联系起来的研究。这项研究仅仅触及了使用视频分析来提高术中性能的表面。视频分析提供了研究手术技术（即，如何进行手术的细节）和手术技能（即，外科医生如何执行手术）的机会。该策略可能特别适用于已经具有捕获视频能力的技术复杂的手术（例如，高级腹腔镜手术、机器人手术、视频辅助胸腔镜手术）。此外，这项工作还可以扩大到使用其他录像方式的公开程序。
Although the recent quality improvement efforts have made considerable gains in improving perioperative care, these approaches largely ignore the details of what occurs during the operation itself. It is generally accepted that what occurs at the hands of the surgeon during a procedure has significant influence on patient outcomes. However, objectively assessing surgeon performance in the operating room has been difficult. As a result, surrogate measures, such as procedural volume, have served as proxies for operative proficiency. 1 Recently, enthusiasm has been growing to tackle the challenges of directly evaluating and improving surgeon performance using intraoperative video. This work with practicing surgeons builds on the previous experience of using video to assess laparoscopic skills among residents. 2, 3 Illustrating this strategy, a recent high-profile study in bariatric surgery demonstrated that higher peer ratings of surgical skill—assessed by video analysis of performance during laparoscopic gastric bypass—were associated with lower rates of postoperative adverse events. 4 Although it may seem obvious that greater skill would be associated with improved outcomes, this was the first study to demonstrate that variations in technical skill could be reliably measured by peer evaluation of practicing surgeons. Perhaps most importantly, this study was the first to definitively link peer ratings of skill directly with patient outcomes. This study has only scratched the surface of using video analysis to improve intraoperative performance. Video analysis affords the opportunity to study both surgical technique (ie, the details of how an operation is conducted) and surgical skill (ie, how well a surgeon performs a procedure). This strategy may be particularly applicable for technically complex procedures that already have the capability to capture video (eg, advanced laparoscopy, robotic surgery, video-assisted thoracoscopic surgery). Furthermore, this work could also be extended to open procedures using other video-recording modalities.