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Original Investigation
May 20, 2020

Association of Video Completed by Audio in Laparoscopic Cholecystectomy With Improvements in Operative Reporting

Author Affiliations
  • 1Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
  • 2Department of Surgery, Isala Hospital, Zwolle, the Netherlands
  • 3Department of Surgery, Zuyderland Medical Center, Sittard-Geleen and Heerlen, the Netherlands
  • 4Department of Surgery, IJsselland Hospital, Rotterdam, the Netherlands
  • 5Department of Pathology, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, the Netherlands
JAMA Surg. Published online May 20, 2020. doi:10.1001/jamasurg.2020.0741
Key Points

Question  Can systematic audio recording resolve discrepancies between systematic video recordings and narrative operative notes in laparoscopic cholecystectomy procedures?

Findings  In this multicenter study of 79 patients, video and audio recordings during laparoscopic cholecystectomy procedures significantly improved the adequacy of the depiction of essential surgical steps compared with narrative operative notes. The addition of audio recordings resolved some discrepancies between video recording and operative note.

Meaning  The study provides strong support in favor of additional audio recording during laparoscopic cholecystectomy procedures, which could lead to a better understanding of the operative procedure on review.


Importance  All events that transpire during laparoscopic cholecystectomy (LC) cannot be adequately reproduced in the operative note. Video recording is already known to add important information regarding this operation.

Objective  It is hypothesized that additional audio recordings can provide an even better procedural understanding by capturing the surgeons’ considerations.

Design, Setting, and Participants  The Simultaneous Video and Audio Recording of Laparoscopic Cholecystectomy Procedures (SONAR) trial is a multicenter prospective observational trial conducted in the Netherlands in which operators were requested to dictate essential steps of LC. Elective LCs of patients 18 years and older were eligible for inclusion. Data collection occurred from September 18, 2018, to November 13, 2018.

Main Outcomes and Measures  Adequacy rates for video recordings and operative note were compared. Adequacy was defined as the competent depiction of a surgical step and expressed as the number of adequate steps divided by the total applicable steps for all cases. In case of discrepancies, in which a step was adequately observed in the video recording but inadequately reported in the operative note, an expert panel analyzed the added value of the audio recording to resolve the discrepancy.

Results  A total of 79 patients (49 women [62.0%]; mean [SD] age, 54.3 [15.9] years) were included. Video recordings resulted in higher adequacy for the inspection of the gallbladder (note, 39 of 79 cases [49.4%] vs video, 79 of 79 cases [100%]; P < .001), the inspection of the liver condition (note, 17 of 79 [21.5%] vs video, 78 of 79 cases [98.7%]; P < .001), and the circumferential dissection of the cystic duct and the cystic artery (note, 25 of 77 [32.5%] vs video, 62 of 77 [80.5%]; P < .001). The total adequacy was higher for the video recordings (note, 849 of 1089 observations [78.0%] vs video, 1005 of 1089 observations [92.3%]; P < .001). In the cases of discrepancies between video and note, additional audio recordings lowered discrepancy rates for the inspection of the gallbladder (without audio, 40 of 79 cases [50.6%] vs with audio, 17 of 79 cases [21.5%]; P < .001), the inspection of the liver condition (without audio, 61 of 79 [77.2%] vs with audio, 37 of 79 [46.8%]; P < .001), the circumferential dissection of the cystic duct and the cystic artery (without audio, 43 of 77 cases [55.8%] vs with audio, 17 of 77 cases [22.1%]; P < .001), and similarly for the removal of the first accessory trocar (without audio, 27 of 79 [34.2%] vs with audio, 16 of 79 [20.3%]; P = .02), the second accessory trocar (without audio, 24 of 79 [30.4%] vs with audio, 11 of 79 [13.9%]; P < .001), and the third accessory trocar (without audio, 27 of 79 [34.2%] vs with audio, 14 of 79 [17.7%]; P < .001). The total discrepancy was lower with audio adjustment (without audio, 254 of 1089 observations [23.3%] vs with audio, 128 of 1089 observations [11.8%]; P < .001).

Conclusions and Relevance  Audio recording during LC significantly improves the adequacy of depicting essential surgical steps and exhibits lower discrepancies between video and operative note.

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