Department of Surgery, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands.
Department of Pathology, Free University Medical Center, Amsterdam, the Netherlands.
JAMA Surg. 2019 May 1;154(5):381-389. doi: 10.1001/jamasurg.2018.5246.
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.
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.
Among study cases, participating surgeons were requested to systematically capture predefined key steps of the surgical procedure intraoperatively on video in short clips.
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.
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).
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.
尽管结直肠外科领域不断取得进展，但手术质量仍存在差异。作为手术质量的内在组成部分，手术过程的技术信息仅反映在叙述性手术报告（NR）中，NR 已被发现具有主观性且经常遗漏重要信息。
研究系统视频记录（SVR）作为提高结直肠癌手术质量和安全性的潜在手段，重点关注其中的重要信息。
设计、地点和参与者：影像质量控制试验是一项前瞻性、观察性队列研究，于 2016 年 1 月 12 日至 2017 年 10 月 30 日在荷兰的 3 个中心进行。研究组纳入了 113 名 18 岁或以上、接受择期腹腔镜结直肠癌手术的患者。这些患者进行了病例匹配，并与仅接受 NR 的历史队列中的病例进行了比较。
在研究病例中，要求参与手术的外科医生在手术过程中系统地以短视频的形式记录手术过程中的预定义关键步骤。
分析 SVR 和 NR 中关于预定义关键步骤的重要信息的可用性。报告信息的充分性定义为报告中可用且充分的关键步骤的比例。在研究组中，比较了 SVR 和 NR 的充分性，单独使用 SVR 与 NR 以及在研究组中作为 NR 的补充与对照组中的单独使用 NR 进行比较。
在 113 名研究患者中，纳入了 69 名女性（61.1%）；平均（SD）年龄为 66.3（9.8）岁。在对照组中，NR 中 52.5%（18.3%）的平均（SD）步骤得到了充分描述。在研究组中，SVR（78.5%[16.5%]）和 SVR 与 NR 的组合（85.1%[14.6%]）的充分性均显著优于 NR 单独使用（均 P<0.001）。研究组与历史对照组在术后和病理结果方面唯一的显著差异是研究组的术后平均（SD）住院时间更短（8.0[7.7] vs 8.6[6.8]天；P=0.03）。
在腹腔镜结直肠癌手术中，将 SVR 作为 NR 的辅助手段，在记录手术的重要步骤方面可能优于单独使用 NR，从而增加了术中必要信息的整体可用性，并有助于质量控制和客观性。
