Video Recording in the OR Highlights Need for Ethical Considerations

Increasing use of video recording in the operating room highlights the need for ethical recommendations to protect patients, according to surgeons and anesthesiologists.

In their February 4 paper in Annals of Surgery, Dr. Celia M. Divino and colleagues from Icahn School of Medicine at Mount Sinai, New York, propose five recommendations that aim to ensure that all legal guidelines are followed and that video recordings are accomplished ethically:

* The creation of video/audio recordings should have a clearly stated purpose.

* Patients who may be recorded should be made aware of that possibility and properly consented.

* Patients, faculty, and staff likely to be included in the recording should be notified and given the opportunity to opt out.

* Any alterations in the recording should be clearly disclosed to audiences.

* All recordings should be protected with the same security and scrutiny that hospitals and physicians use for other medical records.

“There will continue to be ethical challenges with regard to recording in the operating room,” the authors concluded. “These guidelines should be altered to keep pace with growing technology while not interfering with the clinical benefits of recording. These recommendations provide a framework by which a surgeon should address recordings within the operating room.”

An accompanying article in the journal provides one example of the use of surgical video.

Dr. Tyler R. Grenda and colleagues from the University of Michigan, Ann Arbor, describe the use of intraoperative video to evaluate and improve surgeon technique and skill.

The Michigan Bariatric Surgical Collaborative has already launched a statewide initiative to use video to study the details of surgical technique with laparoscopic sleeve gastrectomy. Surgeons will upload videos to a web-based review program, and peer surgeons will provide evaluations using a standardized instrument.

These assessments will then be used to identify the best techniques (technical and overall steps) for performing the procedure. It might be possible to link differences in intraoperative techniques to perioperative outcomes, as well as long-term outcomes (such as weight loss and resolution of comorbid diseases for bariatric procedures).

Video recordings like these could also be used in peer coaching and quality improvement initiatives.

“Ultimately, intraoperative video analysis may be a versatile tool for improving surgical performance, with applications for optimizing surgical technique and skill,” the authors wrote.

“This strategy depends on social capital and relationships that are maintained through trust and confidentiality, which may be best built within a regional quality collaborative or specialty society. By addressing these challenges, surgeons may unlock the potential benefits of video-based analysis and open up a new frontier of surgical quality improvement,” they said.

Dr. Alexander J. Langerman, from Vanderbilt University, Nashville, Tennessee, has used the GoPro to video plastic surgery procedures. He told Reuters Health by email, “Given the rapid emergence of this topic and the potential for mishaps in patient and practitioner privacy, it will be critical for governing bodies to develop standards for ethical use of video and audio recording in the operating room.”

“Video recording in the operating room is coming, and promises a tremendous number of benefits,” Dr. Langerman said. “Society expects transparency from the operating room, and we have a duty to embrace efforts that will improve our performance. We should stay ahead of this issue to ensure the privacy of our patients and our operating room colleagues is protected in the process.”

“There is controversy when the video is for quality-improvement purposes — some would argue patients have a societal duty to participate if it poses minimal risk, others would say that patients have a right to opt out of any research, regardless of the purpose,” he added. “We should take lessons from industries such as transportation and law enforcement who have and are facing similar issues.”

Dr. Gary Sutkin, from the University of Pittsburgh School of Medicine in Pennsylvania, told Reuters Health by email, “I use film for research, examining how surgeons communicate with each other and learn in the OR. So much of surgery depends on moment-to-moment decisions, made by a senior surgeon and delivered to the surgical team to achieve a coordinated effort. I am interested in how those decisions are communicated and carried out, and film is a wonderful way to capture that.”

“Most hospitals include being filmed for educational purposes on their consent forms,” Dr. Sutkin said. “It is vital that the patient is comfortable consenting to being filmed, is able to decline to be filmed, and that the film never includes identifying information about the patient. For example, we never film the face, but it’s also important not to mention the patient by name on the film.”

“Any patient can decline to be filmed, just like any member of the surgical team (who will be partially identifiable behind a mask) can decline to be filmed,” Dr. Sutkin said.