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Original Investigation
January 23, 2019

Comparison of Systematic Video Documentation With Narrative Operative Report in Colorectal Cancer Surgery

Author Affiliations
  • 1Department of Surgery, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
  • 2Department of Pathology, Free University Medical Center, Amsterdam, the Netherlands
  • 3Department of Surgery, Jeroen Bosch Hospitals, Hertogenbosch, the Netherlands
  • 4Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
  • 5Department of Surgery, IJsselland Hospital, Capelle aan den IJssel, the Netherlands
  • 6Department of Surgery, Havenziekenhuis, Rotterdam, the Netherlands
JAMA Surg. Published online January 23, 2019. doi:10.1001/jamasurg.2018.5246
Key Points

Question  Is there added value of systematic video recording compared with the narrative operative report with regard to the availability of essential information in laparoscopic colorectal cancer surgery?

Findings  In this multicenter cohort study in 113 patients, systematic video recording in laparoscopic colorectal cancer surgery as an adjunct to the narrative operative report was associated with improved documentation of important steps of the operation compared with narrative operative reporting alone.

Meaning  Systematic video recording in laparoscopic colorectal cancer surgery might add to the overall availability of important intraoperative information and improve quality control and objectivity.

Abstract

Importance  Despite ongoing advances in the field of colorectal surgery, the quality of surgical treatment is still variable. As an intrinsic part of surgical quality, the technical information regarding the surgical procedure is reflected only by the narrative operative report (NR), which has been found to be subjective and regularly omits important information.

Objective  To investigate systematic video recording (SVR) as a potential improvement in quality and safety with regard to important information in colorectal cancer surgery.

Design, Setting, and Participants  The Imaging for Quality Control Trial was a prospective, observational cohort study conducted between January 12, 2016, and October 30, 2017, at 3 centers in the Netherlands. The study group consisted of 113 patients 18 years or older undergoing elective laparoscopic surgery for colorectal cancer. These patients were case matched and compared with cases from a historical cohort that received only an NR.

Interventions  Among study cases, participating surgeons were requested to systematically capture predefined key steps of the surgical procedure intraoperatively on video in short clips.

Main Outcomes and Measures  The SVRs and NRs were analyzed for adequacy with respect to the availability of important information regarding the predefined key steps. Adequacy of the reported information was defined as the proportion of key steps with available and sufficient information in the report. Adequacy of the SVR and NR was compared between the study and control groups, with the SVR alone and as an adjunct to the NR in the study group vs NR alone in the control group.

Results  Of the 113 study patients, 69 women (61.1%) were included; mean (SD) age was 66.3 (9.8) years. In the control group, a mean (SD) of 52.5% (18.3%) of 631 steps were adequately described in the NR. In the study group, the adequacy of both the SVR (78.5% [16.5%], P < .001) and a combination of the SVR with NR (85.1% [14.6%], P < .001) was significantly superior to NR alone. The only significant difference between the study and historical control groups regarding postoperative and pathologic outcomes was a shorter postoperative mean (SD) length of stay in favor of the study group (8.0 [7.7] vs 8.6 [6.8] days; P = .03).

Conclusions and Relevance  Use of SVR in laparoscopic colorectal cancer surgery as an adjunct to the NR might be superior in documenting important steps of the operation compared with NR alone, adding to the overall availability of necessary intraoperative information and contributing to quality control and objectivity.

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