Related Experiment Video
Updated: May 15, 2025
Robotic Left Hepatectomy using Indocyanine Green Fluorescence Imaging for an Intrahepatic Complex Biliary Cyst
Published on: June 24, 2022
Artificial intelligence-enhanced video-based assessment of surgical quality for training in laparoscopic right
Salvador Morales-Conde1, Andrea Scammon Duran2, Andrea Balla1
1Department of General and Digestive Surgery, University Hospital Virgen Macarena, University of Sevilla, Sevilla, Spain; Unit of General and Digestive Surgery, Hospital Quirónsalud Sagrado Corazón, Sevilla, Spain.
Introduction:
The study aims to propose a standardised workflow with critical views for surgical quality assessment (SQA) in laparoscopic right hemicolectomy (LRH), to disseminate it through a "Marginal Gains" course, and to evaluate its impact through artificial intelligence (AI) enhanced video-based assessment (VBA).
Materials And Methods:
Expert colorectal surgeons proposed a protocol for SQA in LRH based on evidence and consensus. A course ("Marginal Gains") comprising remote e-learning and on-site clinical immersion was organised to disseminate the proposed approach to LRH. Videos of procedures performed by participants before and after the course were analysed by experts (SQA items) and AI (workflows). Descriptive and inferential statistic was used to study the applicability of the proposed protocol and the impact of the course.
Results:
A protocol with 21 SQA items over 9 phases for LRH was proposed. Four surgeons successfully completed the pilot "Marginal Gains" course. Across the 8 videos uploaded, VBA showed that the proposed SQA items were appliable in 82.7 % (139/168 items) of the cases. Three out of 4 of the participants had higher SQA scores after the course, with an overall improvement of 30 % (20.75 ± 13.2 vs 32.75 ± 2.99 points; p = 0.126). All participants performed intracorporeal anastomosis after the course, with a significant quality improvement (1.5 ± 1.73 vs 3.75 ± 0.5 points; +56 %; p = 0.046). Overall, mean operative times increased by 00:23:38 after the course (01:36:03 ± 00:10:43 vs 01:59:41 ± 00:48:02; p = 0.465).
Conclusion:
This study advocates for a paradigm shift in surgical education and practice by proposing, piloting, and measuring the impact of a structured, step-based approach to LRH.
