In this post I introduce an ongoing study on digital video technologies in the operating theatre. Examples of questions we address in our study are: How do surgical trainees learn to operate on real patients without increasing patient risks? How do surgeons come to make critical decisions during operations? How have new technologies changed learning and decision making?
Today many operations are performed through natural openings or small incisions in the patient’s body. Key to these operations is the laparoscope, that is, the camera that is inserted in the body cavity. The view that is picked up by the laparoscope is then magnified and projected onto screens around the operating table (see Figure). Surgeons can record the laparoscopic view, allowing them to replay the operation afterwards, for instance to reflect on how the operation went or to demonstrate to trainees and patients how a procedure is done. Edited versions of these recordings are sometimes disseminated through Youtube and other platforms, with running commentaries added to the visuals.
Using video to investigate surgery
We collect two types of data: we record the laparoscopic view of operations and we record the use of laparoscopes with hand-held or in-built cameras. The former might be called ‘naturally occurring data’ in that whenever a laparoscope is used it produces digital data, which can be recorded and made available for clinical and social science research. The latter involve researchers and/or clinical staff making video-recordings. We use these data in three ways. First, to address the kinds of questions asked above, about learning, decision making and impact of technology. Second, to provide a resource for health professionals to reflect on their work in operating theatres. Third, to offer a glimpse of what happens inside operating theatres to the general public. One year into the project we can summarize our first findings with the regard to the questions mentioned above as follows.
How do surgical trainees learn to operate on real patients?
We explored how a trainer and trainee jointly achieve surgical care in these situations, that is, when the trainee holds the laparoscopic scalpel. We analysed laparoscopic video recordings and audio recordings, transcribing what the trainer and trainee said and did moment-by-moment. We found that the actions performed by the trainee with the scalpel served as mini-gestures, signalling to the trainer exactly where and when the trainee was about to cut. The trainer’s speech served as prompts, signalling to the trainee to continue or to change his course of action. We take this as one of the key strategies that surgical trainers and trainees use to manage patient safety when the trainee holds the scalpel.
How do surgeons make decisions during operations?
Decision making has become a key term in discussions about the quality and safety of health care. We analysed laparoscopic video recordings and audio recordings focusing on who says what to whom alongside what is visible through the laparoscope prior to the cutting of the cystic duct and the cystic artery. Our analysis shows that in our data set the decision to cut was always made in collaboration, irrespective of whether it was a consultant or a registrar who was operating. By asking, e.g., “Are you happy?” the ‘operating’ surgeons sought confirmation from their (senior) colleagues prior to making the cuts.
How have new technologies changed learning and decision making?
We also investigate how laparoscopy shapes clinical practice and education in the operating theatre. When operating laparoscopically the screens that project what the operating surgeons do inside the patient’s body are visible to everybody in the theatre. In traditional, open surgery the operative field is visible only to the people standing at the operating table, with the best view granted to the lead surgeon. Now that more people have equal access to the operative field surgeons can consult other surgeons at a distance, and they can teach trainees and involve them in the decision making even if they are not standing at the operating table. Our research aims to explore how laparoscopy reconfigures learning and decision making in the operating theatre in that way.
Author: Jeff Bezemer