The surgeon's assessment of endoscopic image quality is not reliable: A prospective monocentric study

This pilot study aimed to evaluate the reliability of surgeons' subjective assessment of endoscopic equipment quality during surgery and to determine the impact of standardized inspection protocols on equipment performance.

A prospective monocentric pilot study was conducted over two months at a French tertiary institution, comprising three phases: phase 1: real-time feedback from surgical and nursing teams on endoscopic image quality and equipment performance was collected via a structured questionnaire. Phase 2: operating room nurses underwent standardized training in inspecting telescopes and light cables to ensure consistent equipment evaluation. Phase 3: a follow-up survey was administered under strict control conditions, with systematic postoperative equipment checks.

Surgical satisfaction: no significant difference was observed in perceived image quality between phase 1 (7.3/10) and phase 3 (7.5/10). Malfunction rates: equipment malfunction decreased from 32.8% (phase 1) to 18% (phase 3), though this difference was not statistically significant (*P*=0.06). Subgroup improvements: in BL-TURB procedures, image quality and blue light performance improved between phases. Equipment removals: strict control in phase 3 led to the removal of defective equipment: 32% of light cables (6/19), 100% of blue light optics (4/4), and 69% of white light optics (9/13).

Surgeons' subjective assessment of endoscopic quality remained consistent despite a high rate of undetected equipment malfunctions. Implementing standardized inspection protocols improved performance in specific subgroups and resulted in the removal of a substantial portion of suboptimal equipment. These findings underscore the importance of routine equipment checks and continuous training to optimize surgical safety and efficiency.

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