Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.
Department of Surgery, Isala Hospital, Zwolle, the Netherlands.
JAMA Surg. 2020 Jul 1;155(7):617-623. doi: 10.1001/jamasurg.2020.0741.
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.
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.
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.
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).
Audio recording during LC significantly improves the adequacy of depicting essential surgical steps and exhibits lower discrepancies between video and operative note.
重要性：腹腔镜胆囊切除术（LC）过程中发生的所有事件都无法在手术记录中充分重现。视频记录已被证实可以提供关于该手术的重要信息。
目的：据推测，额外的音频记录可以通过捕捉外科医生的考虑因素，提供更好的手术理解。
设计、地点和参与者：Simultaneous Video and Audio Recording of Laparoscopic Cholecystectomy Procedures（SONAR）试验是一项在荷兰进行的多中心前瞻性观察性试验，要求术者口述 LC 的基本步骤。纳入年龄在 18 岁及以上的择期 LC 患者。数据收集时间为 2018 年 9 月 18 日至 2018 年 11 月 13 日。
主要结果和措施：比较了视频记录和手术记录的充分性。充分性定义为对手术步骤的准确描述，以所有病例中适用步骤的数量除以充分步骤的数量来表示。如果存在差异，即视频记录中某个步骤得到了充分观察，但手术记录中没有充分报告，则由专家小组分析音频记录的附加价值以解决差异。
结果：共纳入 79 例患者（49 例女性[62.0%]；平均[标准差]年龄 54.3[15.9]岁）。视频记录在胆囊检查（记录，79 例中的 39 例[49.4%] vs 视频，79 例中的 79 例[100%]；P<0.001）、肝脏状况检查（记录，79 例中的 17 例[21.5%] vs 视频，79 例中的 78 例[98.7%]；P<0.001）和胆囊管和胆囊动脉的环形分离（记录，77 例中的 25 例[32.5%] vs 视频，77 例中的 62 例[80.5%]；P<0.001）方面的充分性更高。视频记录的总充分性更高（记录，1089 次观察中的 849 次[78.0%] vs 视频，1089 次观察中的 1005 次[92.3%]；P<0.001）。在视频和记录之间存在差异的情况下，附加的音频记录降低了胆囊检查（无音频，79 例中的 40 例[50.6%] vs 有音频，79 例中的 17 例[21.5%]；P<0.001）、肝脏状况检查（无音频，79 例中的 61 例[77.2%] vs 有音频，79 例中的 37 例[46.8%]；P<0.001）、胆囊管和胆囊动脉的环形分离（无音频，77 例中的 43 例[55.8%] vs 有音频，77 例中的 17 例[22.1%]；P<0.001）以及第一辅助套管的移除（无音频，79 例中的 27 例[34.2%] vs 有音频，79 例中的 16 例[20.3%]；P=0.02）、第二辅助套管（无音频，79 例中的 24 例[30.4%] vs 有音频，79 例中的 11 例[13.9%]；P<0.001）和第三辅助套管（无音频，79 例中的 27 例[34.2%] vs 有音频，79 例中的 14 例[17.7%]；P<0.001）差异的发生率。音频调整后的总差异较低（无音频，1089 次观察中的 254 次[23.3%] vs 有音频，1089 次观察中的 128 次[11.8%]；P<0.001）。
结论：LC 期间的音频记录显著提高了描述基本手术步骤的充分性，并降低了视频和手术记录之间的差异。
