Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Perspective
  • Published:

OPINION

Video review for measuring and improving skill in urological surgery

Nature Reviews Urology volume 16, pages 261–267 (2019)Cite this article

Subjects

Abstract

Interest is growing within the urological surgery community for objective assessments of technical skill. Surgical video review relies on the use of objective assessment tools to evaluate both global and procedure-specific skill. These evaluations provide structured feedback to surgeons with the aim of improving technique, which has been associated with patient outcomes. Currently, skill assessments can be performed by using expert peer-review, crowdsourcing or computer-based methods. Given the relationship between skill and patient outcomes, surgeons might be required in the future to provide empirical evidence of their technical skill for certification, employment, credentialing and quality improvement. Interventions such as coaching and skills workshops incorporating video review might help surgeons improve their skill, with the ultimate goal of improving patient outcomes.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Systematic assessment of surgical skill using video review.
Fig. 2: Video review for assessing skill and improving technique and outcomes.

Similar content being viewed by others

References

  1. Pucher, P. H., Aggarwal, R., Singh, P. & Darzi, A. Enhancing surgical performance outcomes through process-driven care: a systematic review. World J. Surg. 38, 1362–1373 (2014).

    Article  Google Scholar 

  2. Epstein, N. E. Multidisciplinary in-hospital teams improve patient outcomes: a review. Surg. Neurol. Int. 28, S295–S303 (2014).

    Article  Google Scholar 

  3. Fecso, A. B., Szasz, P., Kerezov, G. & Grantcharov, T. P. The effect of technical performance on patient outcomes in surgery: a systematic review. Ann. Surg. 265, 492–501 (2017).

    Article  Google Scholar 

  4. Birkmeyer, J. D. et al. Surgical skill and complication rates after bariatric surgery. N. Engl. J. Med. 369, 1434–1442 (2013).

    Article  CAS  Google Scholar 

  5. Dimick, J. B. & Varban, O. A. Surgical video analysis: an emerging tool for improving surgeon performance. BMJ Qual. Saf. 24, 490–491 (2015).

    Article  Google Scholar 

  6. Hu, Y.-Y. et al. Postgame analysis: using video-based coaching for continuous professional development. J. Am. Coll. Surg. 214, 115–124 (2012).

    Article  Google Scholar 

  7. Greenberg, C. C., Ghousseini, H. N., Pavuluri Quamme, S. R., Beasley, H. L. & Wiegmann, D. A. Surgical coaching for individual performance improvement. Ann. Surg. 261, 32–34 (2015).

    Article  Google Scholar 

  8. Vassiliou, M. C. et al. Evaluating intraoperative laparoscopic skill: direct observation versus blinded videotaped performances. Surg. Innov. 14, 211–216 (2007).

    Article  Google Scholar 

  9. Mills, J. T., Hougen, H. Y., Bitner, D., Krupski, T. L. & Schenkman, N. S. Does robotic surgical simulator performance correlate with surgical skill. J. Surg. Educ. 74, 1052–1056 (2017).

    Article  Google Scholar 

  10. Moorthy, K., Munz, Y., Sarker, S. K. & Darzi, A. Objective assessment of technical skills in surgery. BMJ 327, 1032–1037 (2003).

    Article  Google Scholar 

  11. Hampton, T. Efforts seek to develop systematic ways to objectively assess surgeons’ skills. JAMA 313, 782 (2015).

    Article  Google Scholar 

  12. Martin, J. A. et al. Objective structured assessment of technical skill (OSATS) for surgical residents. Br. J. Surg. 84, 273–278 (1997).

    Article  CAS  Google Scholar 

  13. Darzi, A., Datta, V. & Mackay, S. The challenge of objective assessment of surgical skill. Am. J. Surg. 181, 484–486 (2001).

    Article  CAS  Google Scholar 

  14. Vassiliou, M. C. et al. A global assessment tool for evaluation of intraoperative laparoscopic skills. Am. J. Surg. 190, 107–113 (2005).

    Article  Google Scholar 

  15. Goh, A. C., Goldfarb, D. W., Sander, J. C., Miles, B. J. & Dunkin, B. J. Global evaluative assessment of robotic skills: validation of a clinical assessment tool to measure robotic surgical skills. J. Urol. 187, 247–252 (2012).

    Article  Google Scholar 

  16. Raza, S. J. et al. Surgical competency for urethrovesical anastomosis during robot-assisted radical prostatectomy: development and validation of the robotic anastomosis competency evaluation. Urology 85, 27–32 (2015).

    Article  Google Scholar 

  17. Hussein, A. A. et al. Development and validation of an objective scoring tool for robot-assisted radical prostatectomy: prostatectomy assessment and competency evaluation. J. Urol. 197, 1237–1244 (2017).

    Article  Google Scholar 

  18. Walsh, P. C., Marschke, P., Ricker, D. & Burnett, A. L. Use of intraoperative video documentation to improve sexual function after radical retropubic prostatectomy. Urology 55, 62–67 (2000).

    Article  CAS  Google Scholar 

  19. Davis, D. A. et al. Accuracy of physician self-assessment compared with observed measures of competence: a systematic review. JAMA 296, 1094–1102 (2006).

    Article  CAS  Google Scholar 

  20. Stern, J. et al. Surgeon perception is not a good predictor of peri-operative outcomes in robot-assisted radical prostatectomy. J. Robot. Surg. 5, 283–288 (2011).

    Article  Google Scholar 

  21. Reznick, R. K. Teaching and testing technical skills. Am. J. Surg. 165, 358–361 (1993).

    Article  CAS  Google Scholar 

  22. Touijer, K. et al. Quality improvement in laparoscopic radical prostatectomy for pT2 prostate cancer: impact of video documentation review on positive surgical margin. J. Urol. 173, 765–768 (2005).

    Article  Google Scholar 

  23. Cathcart, P. et al. Achieving quality assurance of prostate cancer surgery during reorganisation of cancer services. Eur. Urol. 68, 22–29 (2015).

    Article  Google Scholar 

  24. Lendvay, T. S., White, L. & Kowalewski, T. Crowdsourcing to assess surgical skill. JAMA Surg. 150, 1086–1087 (2015).

    Article  Google Scholar 

  25. Chen, C. et al. Crowd-sourced assessment of technical skills: a novel method to evaluate surgical performance. J. Surg. Res. 187, 65–71 (2014).

    Article  Google Scholar 

  26. Ranard, B. L. et al. Crowdsourcing–harnessing the masses to advance health and medicine, a systematic review. J. Gen. Intern. Med. 29, 187–203 (2014).

    Article  Google Scholar 

  27. Kowalewski, T. M. et al. Crowd-sourced assessment of technical skills for validation of basic laparoscopic urologic skills tasks. J. Urol. 195, 1859–1865 (2016).

    Article  Google Scholar 

  28. White, L. W. et al. Crowd-sourced assessment of technical skill: a valid method for discriminating basic robotic surgery skills. J. Endourol. 29, 1295–1301 (2015).

    Article  Google Scholar 

  29. Ghani, K. R. et al. Measuring to improve: peer and crowd-sourced assessments of technical skill with robot-assisted radical prostatectomy. Eur. Urol. 69, 547–550 (2016).

    Article  Google Scholar 

  30. Powers, M. K. et al. Crowdsourcing assessment of surgeon dissection of renal artery and vein during robotic partial nephrectomy: a novel approach for quantitative assessment of surgical performance. J. Endourol. 30, 447–452 (2016).

    Article  Google Scholar 

  31. Kaler, K. S. et al. Crowdsourcing evaluation of ureteroscopic videos using the post-ureteroscopic lesion scale (PULS) to assess ureteral injury. J. Endourol. 32, 275–281 (2017).

    Article  Google Scholar 

  32. Frasier, L. L. et al. A marker-less technique for measuring kinematics in the operating room. Surgery 160, 1400–1413 (2016).

    Article  Google Scholar 

  33. Glarner, C. E. et al. Quantifying technical skills during open operations using video-based motion analysis. Surgery 156, 729–734 (2014).

    Article  Google Scholar 

  34. Datta, V., Chang, A., Mackay, S. & Darzi, A. The relationship between motion analysis and surgical technical assessments. Am. J. Surg. 184, 70–73 (2002).

    Article  Google Scholar 

  35. Mason, J. D., Ansell, J., Warren, N. & Torkington, J. Is motion analysis a valid tool for assessing laparoscopic skill? Surg. Endosc. 27, 1468–1477 (2013).

    Article  Google Scholar 

  36. Hung, A. et al. Utilizing machine learning and automated performance metrics to evaluate robot-assisted radical prostatectomy performance and predict outcomes. J. Endourol. 32, 438–444 (2018).

    Article  Google Scholar 

  37. Scally, C. P. et al. Video ratings of surgical skill and late outcomes of bariatric surgery. JAMA Surg. 151, e160428 (2016).

    Article  Google Scholar 

  38. Arvidsson, D. et al. Randomized clinical trial comparing 5-year recurrence rate after laparoscopic versus shouldice repair of primary inguinal hernia. Br. J. Surg. 92, 1085–1091 (2005).

    Article  CAS  Google Scholar 

  39. Hogg, M. E. et al. Grading of surgeon technical performance predicts postoperative pancreatic fistula for pancreaticoduodenectomy independent of patient-related variables. Ann. Surg. 264, 482–491 (2016).

    Article  Google Scholar 

  40. Goldenberg, M. G., Goldenberg, L. & Grantcharov, T. P. Surgeon performance predicts early continence after robot-assisted radical prostatectomy. J. Endourol. 31, 858–863 (2017).

    Article  Google Scholar 

  41. Paterson, C. et al. Videotaping of surgical procedures and outcomes following extraperitoneal laparoscopic radical prostatectomy for clinically localized prostate cancer. J. Surg. Oncol. 114, 1016–1023 (2016).

    Article  Google Scholar 

  42. Peabody, J. O. et al. Surgical skill and patient outcomes after robot-assisted radical prostatectomy. J. Urol. 197, e1129 (2017).

    Google Scholar 

  43. Goldenberg, M. G. et al. Feasibility of expert and crowd-sourced review of intraoperative video for quality improvement of intracorporeal urinary diversion during robotic radical cystectomy. Can. Urol. Assoc. J. 11, 331–336 (2017).

    Article  Google Scholar 

  44. Schlomm, T., Huland, H. & Graefen, M. Improving outcome of surgical procedures is not possible without adequate quality measurement. Eur. Urol. 65, 1017–1019 (2014).

    Article  Google Scholar 

  45. Schlomm, T. et al. Full functional-length urethral sphincter preservation during radical prostatectomy. Eur. Urol. 60, 320–329 (2011).

    Article  Google Scholar 

  46. Hu, Y.-Y. et al. Complementing operating room teaching with video-based coaching. JAMA Surg. 152, 318 (2017).

    Article  Google Scholar 

  47. Singh, P., Aggarwal, R., Tahir, M., Pucher, P. H. & Darzi, A. A randomized controlled study to evaluate the role of video-based coaching in training laparoscopic skills. Ann. Surg. 261, 862–869 (2015).

    Article  Google Scholar 

  48. Stefanidis, D. et al. Developing a coaching mechanism for practicing surgeons. Surgery 160, 536–545 (2016).

    Article  Google Scholar 

  49. Ibrahim, A. M., Varban, O. A. & Dimick, J. B. Novel uses of video to accelerate the surgical learning curve. J. Laparoendosc. Adv. Surg. Tech. A 26, 240–242 (2016).

    Article  Google Scholar 

  50. Greenberg, C. C., Dombrowski, J. & Dimick, J. B. Video-based surgical coaching: an emerging approach to performance improvement. JAMA Surg. 151, 282–283 (2016).

    Article  Google Scholar 

  51. Hogg, M. E. et al. Training in minimally invasive pancreatic resections: a paradigm shift away from “see one, do one, teach one”. HPB 19, 234–245 (2017).

    Article  Google Scholar 

  52. Palter, V. N., Beyfuss, K. A., Jokhio, A. R., Ryzynski, A. & Ashamalla, S. Peer coaching to teach faculty surgeons an advanced laparoscopic skill: a randomized controlled trial. Surgery 160, 1392–1399 (2016).

    Article  Google Scholar 

  53. Nakada, S. Y., Hedican, S. P., Bishoff, J. T., Shichman, S. J. & Wolf, J. S. Expert videotape analysis and critiquing benefit laparoscopic skills training of urologists. JSLS 8, 183–186 (2004).

    PubMed  PubMed Central  Google Scholar 

  54. Sarle, R. et al. Surgical skill quality improvement: utilizing a peer video review workshop for surgeons performing robotic prostatectomy. J. Urol. 197, e698 (2017).

    Article  Google Scholar 

  55. Matsuda, T. et al. The endoscopic surgical skill qualification system in urological laparoscopy: a novel system in Japan. J. Urol. 176, 2168–2172 (2006).

    Article  Google Scholar 

  56. Mori, T., Kimura, T. & Kitajima, M. Skill accreditation system for laparoscopic gastroenterologic surgeons in Japan. Minim. Invasive Ther. Allied Technol. 19, 18–23 (2010).

    Article  Google Scholar 

  57. Carter, S. C. et al. Video-based peer feedback through social networking for robotic surgery simulation: a multicenter randomized controlled trial. Ann. Surg. 261, 870–875 (2015).

    Article  Google Scholar 

  58. Law, H., Ghani, K. R. & Deng, J. Surgeon technical skill assessment using computer vision based analysis. Proc. Mach. Learn. Res. 68, 88–99 (2017).

    Google Scholar 

  59. Sehrawat, A. et al. Simulation-based cryosurgery intelligent tutoring system prototype. Technol. Cancer Res. Treat. 15, 396–407 (2016).

    Article  Google Scholar 

  60. Skinner, A. et al. Development and application of a multi-modal task analysis to support intelligent tutoring of complex skills. Int. J. STEM Educ. 5, 14 (2018).

    Article  Google Scholar 

  61. Mucksavage, P., Lee, J., Kerbl, D. C., Clayman, R. V. & McDougall, E. M. Preoperative warming up exercises improve laparoscopic operative times in an experienced laparoscopic surgeon. J. Endourol. 26, 765–768 (2012).

    Article  Google Scholar 

  62. Moldovano, R., Târcoveanu, E., Dimofte, G., Lupascu, C. & Bradea, C. Preoperative warm-up using a virtual reality simulator. JSLS 15, 533–538 (2011).

    Article  Google Scholar 

Download references

Acknowledgements

The authors thank all the surgeons and support staff from the Michigan Urological Surgery Improvement Collaborative.

Reviewer information

Nature Reviews Urology thanks M. Goldenberg, R. Satava and P. Pucher for their contribution to the peer review of this work.

Author information

Authors and Affiliations

  1. School of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA

    Zachary J. Prebay

  2. Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA

    James O. Peabody

  3. Department of Urology, University of Michigan, Ann Arbor, MI, USA

    David C. Miller & Khurshid R. Ghani

Authors
  1. Zachary J. Prebay
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. James O. Peabody
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David C. Miller
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Khurshid R. Ghani
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

K.R.G. and Z.J.P. researched data for the article and wrote the manuscript. D.C.M., K.R.G. and Z.J.P. made substantial contributions to discussion of content. All authors reviewed and/or edited the article before submission.

Corresponding author

Correspondence to Khurshid R. Ghani.

Ethics declarations

Competing interests

K.R.G. has received contract support from Blue Cross Blue Shield of Michigan for serving as the Co-Director of the Michigan Urological Surgery Improvement Collaborative. K.R.G. has also received an Intuitive Surgical Inc., Technology Research grant. D.C.M. has received contract support from Blue Cross Blue Shield of Michigan for serving as the Director of the Michigan Urological Surgery Improvement Collaborative. Z.J.P and J.O.P. declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Related links

AMT: https://www.mturk.com

C-SATS: https://www.csats.com

MUSIC: http://musicurology.com/

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Prebay, Z.J., Peabody, J.O., Miller, D.C. et al. Video review for measuring and improving skill in urological surgery. Nat Rev Urol 16, 261–267 (2019). https://doi.org/10.1038/s41585-018-0138-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41585-018-0138-2

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing