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VideoRecordingintheORHighlightsNeedfor
EthicalConsiderations
ByWillBoggsMD February12,2016
NEWYORK(ReutersHealth)Increasinguseofvideorecordingintheoperatingroomhighlightstheneedfor
ethicalrecommendationstoprotectpatients,accordingtosurgeonsandanesthesiologists.

IntheirFebruary4onlinepaperinAnnalsofSurgery,Dr.CeliaM.DivinoandcolleaguesfromIcahnSchoolof
MedicineatMountSinai,NewYork,proposefiverecommendationsthataimtoensurethatalllegalguidelinesare
followedandthatvideorecordingsareaccomplishedethically:

*Thecreationofvideo/audiorecordingsshouldhaveaclearlystatedpurpose.

*Patientswhomayberecordedshouldbemadeawareofthatpossibilityandproperlyconsented.

*Patients,faculty,andstafflikelytobeincludedintherecordingshouldbenotifiedandgiventheopportunitytoopt
out.

*Anyalterationsintherecordingshouldbeclearlydisclosedtoaudiences.

*Allrecordingsshouldbeprotectedwiththesamesecurityandscrutinythathospitalsandphysiciansuseforother
medicalrecords.

"Therewillcontinuetobeethicalchallengeswithregardtorecordingintheoperatingroom,"theauthorsconcluded.
"Theseguidelinesshouldbealteredtokeeppacewithgrowingtechnologywhilenotinterferingwiththeclinical
benefitsofrecording.Theserecommendationsprovideaframeworkbywhichasurgeonshouldaddressrecordings
withintheoperatingroom."

Anaccompanyingarticleinthejournalprovidesoneexampleoftheuseofsurgicalvideo.

Dr.TylerR.GrendaandcolleaguesfromtheUniversityofMichigan,AnnArbor,describetheuseofintraoperative
videotoevaluateandimprovesurgeontechniqueandskill.

TheMichiganBariatricSurgicalCollaborativehasalreadylaunchedastatewideinitiativetousevideotostudythe
detailsofsurgicaltechniquewithlaparoscopicsleevegastrectomy.Surgeonswilluploadvideostoawebbased
reviewprogram,andpeersurgeonswillprovideevaluationsusingastandardizedinstrument.

Theseassessmentswillthenbeusedtoidentifythebesttechniques(technicalandoverallsteps)forperformingthe
procedure.Itmightbepossibletolinkdifferencesinintraoperativetechniquestoperioperativeoutcomes,aswellas
longtermoutcomes(suchasweightlossandresolutionofcomorbiddiseasesforbariatricprocedures).

Videorecordingslikethesecouldalsobeusedinpeercoachingandqualityimprovementinitiatives.

"Ultimately,intraoperativevideoanalysismaybeaversatiletoolforimprovingsurgicalperformance,with
applicationsforoptimizingsurgicaltechniqueandskill,"theauthorswrote.

"Thisstrategydependsonsocialcapitalandrelationshipsthataremaintainedthroughtrustandconfidentiality,
whichmaybebestbuiltwithinaregionalqualitycollaborativeorspecialtysociety.Byaddressingthesechallenges,
surgeonsmayunlockthepotentialbenefitsofvideobasedanalysisandopenupanewfrontierofsurgicalquality
improvement,"theysaid.

Dr.AlexanderJ.Langerman,fromVanderbiltUniversity,Nashville,Tennessee,hasusedtheGoProtovideoplastic
surgeryprocedures.HetoldReutersHealthbyemail,"Giventherapidemergenceofthistopicandthepotentialfor
mishapsinpatientandpractitionerprivacy,itwillbecriticalforgoverningbodiestodevelopstandardsforethicaluse

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2/19/2016 www.medscape.com/viewarticle/858713_print

ofvideoandaudiorecordingintheoperatingroom."

"Videorecordingintheoperatingroomiscoming,andpromisesatremendousnumberofbenefits,"Dr.Langerman
said."Societyexpectstransparencyfromtheoperatingroom,andwehaveadutytoembraceeffortsthatwill
improveourperformance.Weshouldstayaheadofthisissuetoensuretheprivacyofourpatientsandouroperating
roomcolleaguesisprotectedintheprocess."

"Thereiscontroversywhenthevideoisforqualityimprovementpurposessomewouldarguepatientshavea
societaldutytoparticipateifitposesminimalrisk,otherswouldsaythatpatientshavearighttooptoutofany
research,regardlessofthepurpose,"headded."Weshouldtakelessonsfromindustriessuchastransportationand
lawenforcementwhohaveandarefacingsimilarissues."

Dr.GarySutkin,fromtheUniversityofPittsburghSchoolofMedicineinPennsylvania,toldReutersHealthbyemail,
"Iusefilmforresearch,examininghowsurgeonscommunicatewitheachotherandlearnintheOR.Somuchof
surgerydependsonmomenttomomentdecisions,madebyaseniorsurgeonanddeliveredtothesurgicalteamto
achieveacoordinatedeffort.Iaminterestedinhowthosedecisionsarecommunicatedandcarriedout,andfilmisa
wonderfulwaytocapturethat."

"Mosthospitalsincludebeingfilmedforeducationalpurposesontheirconsentforms,"Dr.Sutkinsaid."Itisvitalthat
thepatientiscomfortableconsentingtobeingfilmed,isabletodeclinetobefilmed,andthatthefilmneverincludes
identifyinginformationaboutthepatient.Forexample,weneverfilmtheface,butit'salsoimportantnottomention
thepatientbynameonthefilm."

"Anypatientcandeclinetobefilmed,justlikeanymemberofthesurgicalteam(whowillbepartiallyidentifiable
behindamask)candeclinetobefilmed,"Dr.Sutkinsaid.

TheAgencyforHealthcareResearchandQualitypartiallysupportedthesecondarticle.Onecoauthorofthatstudy
reportedbeingownerofahealthcareanalyticscompany,whichwasnotinvolvedwiththearticle.

SOURCE:http://bit.ly/20mF3eTandhttp://bit.ly/1oplruQ

AnnSurg2016.

ReutersHealthInformation2016

Citethisarticle:VideoRecordingintheORHighlightsNeedforEthicalConsiderations.Medscape.Feb09,2016.

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