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The growth of surgical video: new ways to collaborate

Video has become a familiar and pervasive technology in operating rooms (ORs) around the world. It plays a critical role in laparoscopy and other minimally invasive surgery (MIS) techniques, providing the visual direction practitioners need inside a patient’s body without resorting to incisions.

In integrated and hybrid ORs, video forms part of an extensive toolkit of modern digital visualisation technologies. Within the OR itself, video platforms stream visual feeds, CAT scans, X-rays and more to screens around the theatre to keep everyone in the surgical team fully up to date with progress.

As screen and camera definitions evolve through HD towards 4K and, in the future, 8K, on-screen resolution and clarity is improving, allowing surgeons to zoom in on very precise anatomical details difficult to pick up with the naked eye. Video is therefore helping surgery to become more precise and more efficient, with better patient outcomes.

Video recordings are increasingly being used alongside audio and other digital data to review surgical performance and allow practitioners to analyse their own practice as well as that of their peers. This has opened the door to the evolving field of surgical telementoring, where video resources, either recorded or streamed live, are used to help coach and train students and qualified surgeons alike. The great benefit of video telementoring is the way that it breaks down geographic and logistical barriers to expertise, allowing young practitioners to observe procedures wherever they take place in the world, or receive coaching from the world’s most eminent specialists.

Finally, video has also opened the door to the emerging field of remote telesurgery. As with telementoring, telesurgery uses video and the long-distance communication qualities of the internet to remove physical obstacles to accessing surgical expertise. Via a live video feed, specialists can supervise and guide procedures from afar. The better video technology gets, the faster streaming becomes, the more control remote experts can exert coaching and instructing without physically being in the theatre. This is what the Proximie platform does, adding an Augmented Reality (AR) overlay to a video feed which allows the digital image to be manipulated and extra content added, taking remote instruction to a deeper, more immersive and more intuitive level.

Recorded hip arthroscopy cases

Photo: A hip arthroscopy case recorded live on the Proximie platform, enabling surgeons to review at a later date and invite their colleagues to participate in a live discussion.

From remote surgery to live educational webcasts, from MIS imaging to peer coaching, one concept sums up the role all forms of surgical video are playing in the OR and beyond – collaboration. Video technology is opening up new avenues for practitioners to work together, share expertise and learn, which has the potential to significantly reshape the provision of surgical services.

So just how quickly is the use of surgical video growing, and what kind of impact is it having?

A rapidly growing market

Because of the wide variety of uses video is put to in surgery these days, it is difficult to pin down an exact figure for just how fast its adoption is accelerating. But one thing seems certain – use of video in some capacity is now commonplace in the overwhelming majority of surgical settings. According to one study, 98.6% of practitioners say they have used video to prepare for surgery.

Further indications of growth in the use of video technology in surgery can be gleaned from medical equipment market reports, whether those that focus directly on video and camera-related technologies or on areas where video plays an integral role, such as MIS devices.

So, for example, depending on which reports you read, the OR visualisation systems market, which includes video cameras, streaming platforms, screens and so on, is forecast to grow at a CAGR (compound annual growth rate) of 6.5% to 2025 or 4.3% to 2026, by which time it will be worth $1.5bn worldwide. The hybrid OR equipment market is predicted to grow at 12.5% CAGR to 2023, while the gigantic MIS market, which of course includes surgical camera systems, is expected to continue increasing by 7.2% CAGR to 2024, reaching an enormous $42.6bn in value.

Focusing in on video equipment markets in particular, we can get a snapshot of the scale of global demand from the fact that analysts iData Research put the value of OR video solutions in the US alone at $2.3bn in 2017. The firm anticipates strong growth in markets including the US, China and Japan going forward as demand for 4K platforms increases in integrated and hybrid OR environments to help boost visualisation and data accuracy.

Surgical video and cultural change

In the example of laparoscopy and other MIS approaches, video has helped to change the culture of surgical provision in a very obvious way, effectively allowing surgery to be carried out without open incisions for the first time in history. But this is far from the sum of the cultural changes that video is driving in surgical practice, or that it is likely to be responsible for in the future.

Collaboration and access to information are central to these changes. It has become commonplace for video recordings of procedures and techniques to be showcased at conferences and to form a central part of lectures and lessons in teaching hospitals. Video thus forms a rich resource for training and development which is transforming how expertise and knowledge is shared, and opening the door to more surgeons developing better skills across a wider range of disciplines.

Nadine Hachach Haram Ted Talk

Photo: Proximie CEO Nadine Hachach-Haram using video content of a live recorded surgery at her TEDWomen talk. Photo: Stacie McChesney / TED

According to this systematic review of existing literature on the role of video in surgical training, its use is associated with improved resident knowledge and greater participant satisfaction in all papers reviewed, and with improved operative performance in most of them. Recorded video used preoperatively or postoperatively is still more common than livestream coaching or collaboration, although the eventual upgrade to ‘true 4K’ systems, with much sharper and more detailed visualisation and faster streaming, may lead to this evening up.

The use of video places new demands on practitioners in the OR. It introduces new practical and technical considerations, such as remembering to check the battery life on cameras, making sure internet connections for streaming and file upload are working, managing storage and playback systems. Data protection and privacy are important compliance considerations here, especially in the age of GDPR.

In situations where collaborative procedures are carried out via video link, there is some concern that video adds to the potential risk of information overload for surgeons who are already required to show supreme powers of concentration and application. Certainly doing things like constantly referring to a screen as a practitioner operates represents a departure from the traditional way of doing things.

But on the other hand, the coaching/collaborative element of having an extra pair of eyes on the procedure, an external specialist whose role is to watch and observe, can be seen as helping to mitigate the risk of lapses and mistakes which can creep in when under intense pressure. It is also why video is mostly used in conjunction with other technologies – like AR used in the Proximie platform – to make the flow of collaboration and information exchange as intuitive and streamlined as possible for the practitioner.

Raising standards and minimising risks

Finally, one specific area where surgical video is having a very obvious impact on the culture of surgical provision is with regards to complications during procedures. Such is the nature of surgery that problems can and do arise mid-operation, with sometimes tragic consequences for patients and serious repercussions for the practitioners involved. The more complex the procedure, the higher the risks.

Video’s role in event analysis and documentation is already widely recognised in this area, but there is a feeling it could go much further. This paper published by the BMJ covers proposals ranging from the mandatory recording of video for auditing purposes to the use of video data for research purposes, ‘microanalysing’ procedures to identify patterns in complications and therefore come up with safer, more effective ways of doing things.

In Canada, one surgeon has developed a ‘black box’ solution modelled on the flight data capture model that combines video, audio and patient data during a procedure. The concept, which is intended to create a comprehensive record of everything that went on during an operation, has several purposes, including providing evidence that could protect surgeons against accusations of malpractice and providing a robust resource for self- and peer-review of procedures to identify areas of improvement.

So overall, video has a key role to play in compliance and patient safety as well as in education, upskilling and continuous improvement. This paper even argues that the use of video recording in OR also helps to focus the attention of practitioners, reducing incidents of ‘off-topic’ conversations because they are aware they are being filmed.

From the evidence available, there is little doubt that surgical video applications like Proximie are having a transformational impact on practice, and will continue to do so as we head into the future and technologies continue to evolve. The further the use of video in surgery progresses and diversifies, the more opportunities for collaboration, knowledge sharing, skills development and continuous improvements in provision it will open up.