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Article ; Online: Design and validation of an inertial measurement unit (IMU)-based sensor for capturing camera movement in the operating room.

Saun, Tomas J / Grantcharov, Teodor P

HardwareX

2021 Volume 9, Page(s) e00179

Abstract: Intraoperative surgical video enables better surgical training, continued performance enhancement for surgeons and system-level quality improvement initiatives, however the capture of high-quality intraoperative video of open surgical procedures is ... ...

Abstract	Intraoperative surgical video enables better surgical training, continued performance enhancement for surgeons and system-level quality improvement initiatives, however the capture of high-quality intraoperative video of open surgical procedures is difficult. Wearable cameras, typically in the form of a head-mounted action camera are frequently used for this purpose, although the video from these devices often contains significant motion artifact due to movement of the surgeon's head. When trying to compare the performance of various wearable cameras in the surgical setting, we could not find a motion sensor appropriate for this purpose. We therefore describe in this article the design, assembly and validation of a small sensor that can be attached to wearable cameras in the operating room to objectively quantify camera motion. The sensor incorporates an inertial measurement unit coupled to a microcontroller. Concurrent validity is established by comparing the positional sensing of the device to a geared tripod head that allows for fine, measured manipulations of the sensor in three orthogonal axes. The methodology of capturing, processing and reporting camera movement for a surgical procedure is also detailed.
Language	English
Publishing date	2021-02-16
Publishing country	England
Document type	Journal Article
ISSN	2468-0672
ISSN (online)	2468-0672
DOI	10.1016/j.ohx.2021.e00179
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Article ; Online: Development of the User Experience (UX) and Video Quality Evaluation (VQE) Instruments for Assessment of Intraoperative Video Capture Technology.

Saun, Tomas J / Grantcharov, Teodor P

Journal of surgical education

2020 Volume 78, Issue 1, Page(s) 201–206

Abstract: Objective: There exists a lack of technology to reliably and routinely capture high-quality video of open surgical procedures. To critically evaluate and compare new and existing technology solutions, we must have widely accepted evaluation criteria for ...

Abstract	Objective: There exists a lack of technology to reliably and routinely capture high-quality video of open surgical procedures. To critically evaluate and compare new and existing technology solutions, we must have widely accepted evaluation criteria for intraoperative camera devices. The objective, therefore, was to develop evaluation criteria for intraoperative camera devices, as well as the video product they produce. Design: A modified Delphi process that included 2 iterative surveys was used to build expert consensus and develop 2 evaluation instruments: one to evaluate the user experience (UX) of using an intraoperative camera device, and the second for video quality evaluation (VQE) of the video product. Setting: Global, through iterative online surveys. Participants: Surgeons who perform open surgery and have experience with intraoperative video capture. Results: Eighty-six experts participated in the first iteration of the survey and 46 in the second. Ten factors met the a priori cutoff for >80% agreement for the UX survey: (1) ease of setup/integration with current practice, (2) comfort, (3) distracting during case, (4) overall satisfaction with wearing the device, (5) would you use this device again, (6) would you recommend this device to colleagues, (7) the weight of wearing the device, (8) sufficient battery life, (9) ability to control device while operating, and (10) degree to which the device interferes or is incompatible with other surgical accessories. Six factors met the cutoff for the VQE survey: (1) camera stability, (2) brightness/exposure, (3) resolution/sharpness, (4) unobstructed view of the surgical field, (5) appropriate field of view, and (6) overall satisfaction with video quality. Conclusions: These instruments can be used to critically evaluate camera technologies for intraoperative video capture of open surgery.
MeSH term(s)	Humans ; Surgeons ; Surveys and Questionnaires ; Technology ; Video Recording
Language	English
Publishing date	2020-06-26
Publishing country	United States
Document type	Journal Article
ZDB-ID	2277538-9
ISSN	1878-7452 ; 1931-7204
ISSN (online)	1878-7452
ISSN	1931-7204
DOI	10.1016/j.jsurg.2020.06.011
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Article ; Online: Eye Tracking Use in Surgical Research: A Systematic Review.

Gil, Amalia M / Birdi, Sharon / Kishibe, Teruko / Grantcharov, Teodor P

The Journal of surgical research

2022 Volume 279, Page(s) 774–787

Abstract: Introduction: Eye tracking (ET) is a popular tool to study what factors affect the visual behaviour of surgical team members. To our knowledge, there have been no reviews to date that evaluate the broad use of ET in surgical research. This review aims ... ...

Abstract	Introduction: Eye tracking (ET) is a popular tool to study what factors affect the visual behaviour of surgical team members. To our knowledge, there have been no reviews to date that evaluate the broad use of ET in surgical research. This review aims to identify and assess the quality of this evidence, to synthesize how ET can be used to inform surgical practice, and to provide recommendations to improve future ET surgical studies. Methods: In line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic literature review was conducted. An electronic search was performed in MEDLINE, Cochrane Central, Embase, and Web of Science databases up to September 2020. Included studies used ET to measure the visual behaviour of members of the surgical team during surgery or surgical tasks. The included studies were assessed by two independent reviewers. Results: A total of 7614 studies were identified, and 111 were included for data extraction. Eleven applications were identified; the four most common were skill assessment (41%), visual attention assessment (22%), workload measurement (17%), and skills training (10%). A summary was provided of the various ways ET could be used to inform surgical practice, and three areas were identified for the improvement of future ET studies in surgery. Conclusions: This review provided a comprehensive summary of the various applications of ET in surgery and how ET could be used to inform surgical practice, including how to use ET to improve surgical education. The information provided in this review can also aid in the design and conduct of future ET surgical studies.
MeSH term(s)	Eye-Tracking Technology ; General Surgery ; Humans
Language	English
Publishing date	2022-08-06
Publishing country	United States
Document type	Journal Article ; Review ; Systematic Review
ZDB-ID	80170-7
ISSN	1095-8673 ; 0022-4804
ISSN (online)	1095-8673
ISSN	0022-4804
DOI	10.1016/j.jss.2022.05.024
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Article ; Online: Using the Operating Room Black Box to Assess Surgical Team Member Adaptation Under Uncertainty: An Observational Study.

Incze, Taylor / Pinkney, Sonia J / Li, Cherryl / Hameed, Usmaan / Hallbeck, M Susan / Grantcharov, Teodor P / Trbovich, Patricia L

Annals of surgery

2024

Abstract: Objective: Identify how surgical team members uniquely contribute to teamwork and adapt their teamwork skills during instances of uncertainty.: Summary/background data: The importance of surgical teamwork in preventing patient harm is well documented. ...

Abstract	Objective: Identify how surgical team members uniquely contribute to teamwork and adapt their teamwork skills during instances of uncertainty. Summary/background data: The importance of surgical teamwork in preventing patient harm is well documented. Yet, little is known about how key roles (nurse, anesthesiologist, surgeon, medical trainee) uniquely contribute to teamwork during instances of uncertainty, particularly when adapting to and rectifying an intraoperative adverse event (IAE). Methods: Audio-visual data of 23 laparoscopic cases from a large community teaching hospital were prospectively captured using OR Black Box®. Human factors researchers retrospectively coded videos for teamwork skills (backup behaviour, coordination, psychological safety, situation assessment, team decision making, leadership) by team role under two conditions of uncertainty: associated with an IAE versus no IAE. Surgeons identified IAEs. Results: 1015 instances of teamwork skills were observed. Nurses adapted to IAEs by expressing more backup behaviour skills (5.3x increase; 13.9 instances/h during an IAE vs. 2.2 instances/h when no IAE) while surgeons and medical trainees expressed more phycological safety skills (surgeons:3.6x increase; 30.0 instances/h vs. 6.6 instances/h and trainees 6.6x increase; 31.2 instances/h vs. 4.1 instances/h). All roles expressed less situation assessment skills during an IAE versus no IAE. Conclusions: ORBB enabled the assessment of critically important details about how team members uniquely contribute during instances of uncertainty. Some teamwork skills were amplified, while others dampened, when dealing with IAEs. Knowledge of how each role contributes to teamwork and adapts to IAEs should be used to inform the design of tailored interventions to strengthen interprofessional teamwork.
Language	English
Publishing date	2024-01-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	340-2
ISSN	1528-1140 ; 0003-4932
ISSN (online)	1528-1140
ISSN	0003-4932
DOI	10.1097/SLA.0000000000006191
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Article ; Online: A Novel Method of Setting Performance Standards in Surgery Using Patient Outcomes.

Goldenberg, Mitchell G / Grantcharov, Teodor P

Annals of surgery

2017 Volume 269, Issue 1, Page(s) 79–82

Abstract: Objective: To describe a novel, outcome-based method of standard setting that differentiates between clinical outcomes rather than arbitrary educational goals.: Background: Standard setting methods used in assessments of procedural skill are ... ...

Abstract	Objective: To describe a novel, outcome-based method of standard setting that differentiates between clinical outcomes rather than arbitrary educational goals. Background: Standard setting methods used in assessments of procedural skill are currently not evidence-driven or outcome-based. This represents a potential obstacle for the broad implementation of these evaluations in summative assessments such as certification and credentialing. Methods: The concept is based on deriving a receiver operating characteristic curve from a regression model that incorporates measures of intraoperative surgeon performance and confounding patient characteristics. This allows the creation of a performance standard that best predicts a clinically significant outcome of interest. The discovery cohort used to create the predictive model was derived from pilot data that used the Global Evaluative Assessment of Robotic Skill assessment tool to predict patient urinary continence 3 months following robotic-assisted radical prostatectomy. Results: A receiver operating characteristic curve with an area under the curve of 0.75 was created from predicted probability statistic generated by the predictive model. We chose a predicted probability of 0.35, based on an optimal tradeoff in sensitivity and specificity (Youden Index). Rearranging the regression equation, we determined the performance score required to predict a 35%, patient-adjusted probability of postoperative urinary incontinence. Conclusions: This novel methodology is context, patient, and assessment-specific. Current standard setting methods do not account for the heterogeneity of the clinical environment. Workplace-based assessments in competency-based medical education require standards that are credible to the educator and the trainee. High-stakes assessments must ensure that surgeons have been evaluated to a standard that prioritizes satisfactory patient outcomes and safety.
MeSH term(s)	Clinical Competence/standards ; Follow-Up Studies ; Humans ; Incidence ; Male ; Middle Aged ; Ontario/epidemiology ; Patient Reported Outcome Measures ; Postoperative Complications/epidemiology ; Prostate/surgery ; Prostatectomy/education ; Prostatectomy/methods ; Retrospective Studies ; Robotic Surgical Procedures/education ; Surgeons/education ; Urinary Incontinence/epidemiology
Language	English
Publishing date	2017-11-28
Publishing country	United States
Document type	Journal Article
ZDB-ID	340-2
ISSN	1528-1140 ; 0003-4932
ISSN (online)	1528-1140
ISSN	0003-4932
DOI	10.1097/SLA.0000000000002562
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Article ; Online: Are We Ready for Our Close-up?: Why and How We Must Embrace Video in the OR.

Langerman, Alexander / Grantcharov, Teodor P

Annals of surgery

2017 Volume 266, Issue 6, Page(s) 934–936

MeSH term(s)	Humans ; Operating Rooms/supply & distribution ; Surgical Procedures, Operative ; Video Recording/statistics & numerical data
Language	English
Publishing date	2017-03-24
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	340-2
ISSN	1528-1140 ; 0003-4932
ISSN (online)	1528-1140
ISSN	0003-4932
DOI	10.1097/SLA.0000000000002232
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Article ; Online: Valuations of Surgical Procedures in the Medicare Fee Schedule.

Gordon, Lauren E / Bohnen, Jordan D / Grantcharov, Teodor P

The New England journal of medicine

2019 Volume 381, Issue 4, Page(s) 389–390

MeSH term(s)	Fee Schedules ; Medicare ; United States
Language	English
Publishing date	2019-07-24
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	207154-x
ISSN	1533-4406 ; 0028-4793
ISSN (online)	1533-4406
ISSN	0028-4793
DOI	10.1056/NEJMc1906724
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Article ; Online: Video Technologies for Recording Open Surgery: A Systematic Review.

Saun, Tomas J / Zuo, Kevin J / Grantcharov, Teodor P

Surgical innovation

2019 Volume 26, Issue 5, Page(s) 599–612

Abstract: Video recording of surgical procedures is an important tool for surgical education, performance enhancement, and error analysis. Technology for video recording open surgery, however, is limited. The objective of this article is to provide an overview of ... ...

Abstract	Video recording of surgical procedures is an important tool for surgical education, performance enhancement, and error analysis. Technology for video recording open surgery, however, is limited. The objective of this article is to provide an overview of the available literature regarding the various technologies used for intraoperative video recording of open surgery. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines using the MEDLINE, Cochrane Central, and EMBASE databases. Two authors independently screened the titles and abstracts of the retrieved articles, and those that satisfied the defined inclusion criteria were selected for a full-text review. A total of 2275 publications were initially identified, and 110 were included in the final review. The included articles were categorized based on type of article, surgical subspecialty, type and positioning of camera, and limitations identified with their use. The most common article type was primary-technical (29%), and the dominant specialties were general surgery (22%) and plastic surgery (18%). The most commonly cited camera used was the GoPro (30%) positioned in a head-mount configuration (60%). Commonly cited limitations included poor video quality, inadequate battery life, light overexposure, obstruction by surgical team members, and excessive motion. Open surgery remains the mainstay of many surgical specialties today, and technological innovation is absolutely critical to fulfill the unmet need for better video capture of open surgery. The findings of this article will be valuable for guiding future development of novel technology for this purpose.
MeSH term(s)	Equipment Design ; Humans ; Surgical Procedures, Operative ; Video Recording/instrumentation
Language	English
Publishing date	2019-06-05
Publishing country	United States
Document type	Journal Article ; Systematic Review
ZDB-ID	2182571-3
ISSN	1553-3514 ; 1553-3506
ISSN (online)	1553-3514
ISSN	1553-3506
DOI	10.1177/1553350619853099
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Article ; Online: Assessment of 3-Dimensional vs 2-Dimensional Imaging and Technical Performance Using a Multiport Intraoperative Data Capture and Analytic System for Patients Undergoing Laparoscopic Roux-en-Y Gastric Bypass Surgery.

Gabrielli, Mauricio E / Saun, Tomas J / Jung, James J / Grantcharov, Teodor P

JAMA network open

2020 Volume 3, Issue 1, Page(s) e1920084

Abstract: Importance: Errors and adverse events occur frequently in health care. Three-dimensional (3-D) laparoscopic systems claim to provide more realistic depth perception and better spatial orientation compared with their 2-D counterparts.: Objective: To ... ...

Abstract	Importance: Errors and adverse events occur frequently in health care. Three-dimensional (3-D) laparoscopic systems claim to provide more realistic depth perception and better spatial orientation compared with their 2-D counterparts. Objective: To compare the association of 3-D vs 2-D systems with technical performance during laparoscopic Roux-en-Y gastric bypass (LRYGB) procedures using a multiport intraoperative data capture system. Design, setting, and participants: This cohort study was performed between May and December 2018, with a total of 50 LRYGB procedures performed in an academic tertiary care center; recordings of the operations were evaluated with a 30-day follow-up. All procedures were performed by the same surgical team. Exposure: Surgical teams used 2-D or 3-D laparoscopic systems. Main outcomes and measures: Technical performance was evaluated using the Objective Structured Assessment of Technical Skill and surgical errors and events using the Generic Error Rating Tool. Results: Of the 50 patients who underwent LRYGB procedures, 42 (86%) were women, with a median (interquartile range) age of 42 (35-47) years and a median (interquartile range) body mass index of 46 (42-48), with no significant demographic differences between the groups whose operations were performed using the 2-D and 3-D systems. The mean (SD) number of errors per case was significantly lower in procedures using the 3-D laparoscopic system than in those using the 2-D system (17 [6] vs 33 [2]; P < .001). The mean (SD) number of error-related events was significantly lower in procedures using the 3-D system than in those using the 2-D system (6 [2] vs 11 [4]; P < .001). Mean (SD) Objective Structured Assessment of Technical Skill scores were significantly higher when the 3-D system was used than when the 2-D system was used (28 [4] vs 22 [3]; P < .001). Conclusions and relevance: In this limited sample of LRYGB procedures, the use of a 3-D laparoscopic system was associated with a statistically significant reduction in errors and events as well as higher Objective Structured Assessment of Technical Skill scores compared with 2-D systems.
MeSH term(s)	Adult ; Cohort Studies ; Female ; Gastric Bypass/methods ; Humans ; Image Enhancement/methods ; Image Interpretation, Computer-Assisted/methods ; Imaging, Three-Dimensional/methods ; Laparoscopy/methods ; Male ; Middle Aged ; Outcome Assessment, Health Care
Language	English
Publishing date	2020-01-03
Publishing country	United States
Document type	Comparative Study ; Journal Article
ISSN	2574-3805
ISSN (online)	2574-3805
DOI	10.1001/jamanetworkopen.2019.20084
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Article ; Online: Development of an International Standardized Curriculum for Laparoscopic Sleeve Gastrectomy Teaching Utilizing Modified Delphi Methodology.

Blackham, Ruth E / Rosenthal, Raul J / Higa, Kelvin / Gagner, Michel / Grantcharov, Teodor P / Hamdorf, Jeffrey M

Obesity surgery

2021 Volume 31, Issue 10, Page(s) 4257–4263

Abstract: Background: The performance of laparoscopic sleeve gastrectomy has increased markedly to become the single-most performed bariatric surgical procedure globally. To date, a means of standardized trainee teaching has not been developed. The aim of this ... ...

Abstract	Background: The performance of laparoscopic sleeve gastrectomy has increased markedly to become the single-most performed bariatric surgical procedure globally. To date, a means of standardized trainee teaching has not been developed. The aim of this study was to design a laparoscopic curriculum for trainees of bariatric surgery utilizing modified Delphi consensus methodology. Methods: A panel of surgeons was assembled to devise an academic framework of technical, non-technical and cognitive skills utilized in the performance of laparoscopic sleeve gastrectomy. The panel invited 18 bariatric surgeons experienced in laparoscopic gastrectomy from 11 countries to rate the items for inclusion in the curriculum to a predefined level of agreement. Results: A consensus of experts was achieved for 24 of the 30 proposed elements for inclusion within the first round of the curriculum Delphi panel. All components pertaining to anatomical knowledge, peri-operative considerations and non-technical items were accepted. A second round further examined six statements, of which three were accepted. Agreement of the panel was reached for 27 of the cognitive, technical and non-technical components after two rounds. Three statements found no consensus. Conclusions: Utilizing modified Delphi methodology, a curriculum outlining the most important components of teaching the procedure of laparoscopic sleeve gastrectomy, has been determined by a consensus of international experts in bariatric surgery. The curriculum is suggested as a standard in proficiency-based training of this procedure. It forms a generic template which facilitates individual jurisdictions to perform content validation, adapting the curriculum to local requirements in teaching the next generation of bariatric surgeons.
MeSH term(s)	Bariatric Surgery ; Clinical Competence ; Curriculum ; Gastrectomy ; Humans ; Laparoscopy ; Obesity, Morbid/surgery
Language	English
Publishing date	2021-07-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	1070827-3
ISSN	1708-0428 ; 0960-8923
ISSN (online)	1708-0428
ISSN	0960-8923
DOI	10.1007/s11695-021-05572-x
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