Assessing and evaluating the impact of operative vision compromise (OViC) on surgeons' practice: a qualitative study

Assessing the effects of compromised vision in laparoscopic and robotic procedures is crucial to understanding its impact on surgical practice and patient safety. Our aim was to examine the impact of operative vision compromise (OViC) on surgeons' practice.

Intraoperative workload was qualitatively assessed using the NASA-TLX score. Participants included internationally trained surgeons performing laparoscopic sleeve gastrectomy (LSG) procedures. Video recordings of LSG procedures were quantitatively analyzed to assess OViC event frequency and duration to determine their influence on procedural time and surgical flow in a secondary care center. Surgeons' views on OViC were assessed using a custom survey. Cost analysis of basic expenditures was performed.

Among 109 participants, the overall NASA-TLX score for OViC was 71.7, indicating a high workload. Out of 81 LSG procedures, 77 experienced at least one lens fouling episode, resulting in 471 OViC events, including 371 lens cleaning occurrences. Significant positive correlations were found between total procedure time and several OViC variables. Compromised vision accounted for 19.3% of total operative time. Lens cleaning constituted 2.5% of the total operative time. In nine (11%) cases, lens cleaning added an average of 7 min per procedure, with the most severe case adding 15 min of operative time. The majority of surgeons (94%) found OViC to impair their performance and compromise patient safety, with 61% reporting witnessing surgical errors or complications directly attributable to OViC.

OViC was linked to increased procedure time, surgical flow disruptions, elevated surgeon workload, cognitive burden, and frustration, and potential patient safety concerns. These findings emphasize the need for innovative solutions to mitigate OViC, thereby potentially minimizing errors and enhancing operative outcomes.