With the increased use of laparoscopic, endoscopic, arthroscopic and thoroscopic surgery, it was just a matter of time before the use of a video monitor would be introduced into all surgical suites. Prior to this time, the eye piece of the lens was literally held up to the surgeons eye. Not only did this promote unsterile conditions, it made it impossible for the assistants around the table to anticipate the needs of the surgeon or to see what was going on. The surgeon used one hand to hold the scope and the other to hold instruments or perform procedures.
Video recording technologies offer a powerful way to document what happens in clinical areas. Cameras, and to a lesser extent, microphones, can be found in a growing number of modern operating rooms in the USA, UK and other parts of the world. While they could be used to create a detailed record of what happens in and around the operating table, this is still rarely being done; the vast majority of operations are still only documented in written operation notes.
When operations are being recorded, it is primarily for educational purposes: for instance,
- to broadcast a live feed of a surgical demonstration to a remote audience;
- to provide an ‘adjunct’ to live observation;
- to collect authentic footage for edited, instructional videos on a surgical technique or procedure;
- to facilitate video enhanced debriefing and coaching;
- to formally assess surgical skills.
Endoscopic surgery is a general term describing a form of minimally invasive surgery in which access to a body cavity is achieved through several small percutaneous incisions. The surgery is performed using specialized instrumentation inserted through the incisions (i.e., trocar sites) and guided by the use of a fiberoptic endoscope that provides visualization of the body cavity on a video screen.
In endoscopic surgery, the surgeon does not have direct visualization of the surgical field, and thus endoscopic techniques require specialized skills compared to the corresponding open surgical techniques. Endoscopic surgery may also refer to the use of a fiberoptic endoscope inserted through a body orifice into a body cavity such as the gastrointestinal tract, bronchi, uterus, or bladder.
While endoscopic surgery is a general term, laparoscopic, thoracoscopic, and arthroscopic surgery describe endoscopic surgery within the abdomen, thoracic cavity, and joint spaces, respectively. Endoscopic, arthroscopic, laparoscopic and thorascopic procedures may be considered medically necessary as an alternative to the corresponding open surgical procedures when they duplicate the same surgical techniques and principles of the corresponding open technique with the only difference being the surgical access.
Some surgeries can combine an open approach with the endoscopic approach, such as a laparoscopic assisted vaginal hysterectomy.
The introduction of video monitors not only increased the efficiency of the surgeon by making both hands available for surgery and giving the scope with a camera attached to it to an assistant to hold, it made it possible for the assistants to help grasp tissue with special laparoscopic instruments because they could now see the surgical field.
Use of video monitors made it possible for a large audience of students to learn specific maneuvers without being scrubbed at the field. A record of the entire surgery was available if the recording device was utilized. If networking is employed, several monitors are connected and placed strategically around the operating room, giving a birds eye view to the entire OR staff.
State of the art video equipment now includes computer operated robotic arms employed to hold the scope with the camera attached. The arm is attached to the operating table and draped with a sterile drape. Voice activated, the arm moves up and down telescoping in and out, and side to side by obeying the commands of the surgeons voice which is programmed into the computer prior to the surgery. Making use of robotic arms to hold the scope insures consistent motion in a dynamic situation.
An effective way to curb medical malpractice?
Preventable medical errors are absolutely rampant in this country, and what goes on in operating rooms is not always carefully documented. A study conducted by Patient Safety America estimates that more than 400,000 people die each year of preventable medical errors in hospitals and other medical settings. There are several cases of preventable medical errors that caused the death or permanent injury to a patient and their loved ones were left unable to pursue medical malpractice actions because there was no documentation of the surgery.
There is a growing group of Americans who are pushing for laws that would require hospital operating rooms to have video and audio recording capabilities. Had there been cameras in the operating rooms, the families who lost loved ones would be able to know exactly what went on and who was responsible for their loved one’s injuries or death. Toronto surgeon Teodor P. Grantcharov has designed a “black box” that synchronizes a patient’s data with the video and audio recordings in the operating room in the same way athletes and airline pilots review video of their performances.