Aiming to provide an instructional and educational platform of learning for all surgeons around the world, JOVS puts great emphasis on instructional and educational video clips, photos, schematics of visualized surgical procedures. As part of this initiative, JOVS has launched a “Video Gallery” section dedicated to collecting all published articles containing video(s).
To enhance the presentation of the video articles and to further advance surgical education and techniques, we are honored to have brief interviews with the corresponding authors of video articles to share their valuable insights and surgical practices.
Corresponding Authors of Video Gallery
Tatsuya Nakao, New Tokyo Hospital, Japan
Thirugnanam Agasthian, National University Cancer Institute (NCIS), Singapore
Luigi Bonavina, University of Milan, Italy
Boon-Hean Ong, National Heart Centre Singapore, Singapore
Miroslav P. Peev, University of Chicago, USA
George Rakovich, Maisonneuve-Rosemont Hospital, Canada
Johannes Bonatti, University of Pittsburgh School of Medicine, USA
Hitoshi Igai, Japanese Red Cross Maebashi Hospital, Japan
Takuya Watanabe, Seirei Mikatahara General Hospital, Japan
Jun Suzuki, Yamagata University Faculty of Medicine, Japan
Paul T. Finger, Tulane University School of Medicine, USA
Takahiro Homma, St. Marianna University School of Medicine, Japan
Interviews
Tatsuya Nakao
Key message of the video: This case (28-year-old male, Marfan syndrome) developed rapid dilatation of the descending aorta after total arch replacement using frozen elephant technique (FET) (Frozenix), but it was technically easy to perform additional emergency thoracic endovascular aortic repair (TEVAR). There have been similar reports in the past using long elephant trunks, but unlike FET, additional TEVAR treatment is likely to be difficult.
Professor Tatsuya Nakao became president of New Tokyo Hospital, Japan in June 2023. He has been working as a foreign proctor of arch repair with the Frozenix open stent-graft (Japan Lifeline, Japan), especially in Taiwan region. He also has been serving as an editorial board member of AME Case Reports.
JOVS: What role do you think the presentation and dissemination of surgical videos play in the medical community?
Prof. Nakao: The widespread use of surgical video screenings has created many opportunities for real-time education in the medical community. Because the education is in a different environment than live surgery, repeated videos of the surgery are provided. It has the advantage of being visible.
JOVS: Would you be interested in viewing more videos from peer professionals on “total arch replacement with frozen elephant technique” or “thoracic endovascular aortic repair”, showcasing various techniques and procedures? If so, which surgical teams or regions' experiences would intrigue you the most?
Prof. Nakao: The Frozenix OSG has been commercially available as FET since July 2014 in Japan by Japan Life-line Co., Ltd. Prof. Roberto Di Bartolomeo’s group (University of Bologna, Italy) describes their FET surgery with an E-vita open plus system. On the other hand, off-label usage of TEVAR in place of the Frozenix has been performed in Taiwan region. The Frozenix has spread immediately all around Japan. The Frozenix FET technique is easy to learn, even from young less-experienced Drs. It includes a few pitfalls and should be a feasible bailout strategy. Therefore, the Frozenix could be used in many hospitals without hybrid theater and specialists of TEVAR procedure.
JOVS: Do you have preferred platforms or tools that you find most effective or user-friendly for recording and editing surgical videos? Additionally, are there specific approaches or techniques you employ when creating surgical videos to enhance their educational effectiveness?
Prof. Nakao: Surgical videos are recorded using a zoom camera on the ceiling during surgery (Panasonic System Solutions Japan Co., Ltd., operating room video distribution system). To edit surgical recordings, a staff member specializing in video processing is hired, and the surgeon picks up the image surgery time required for editing and requests the editing (using general editing software).
Thirugnanam Agasthian
Key message of the video: The key message of the video is the importance of awareness of various anatomical surgical variations when performing major lung resections especially segmentectomy. Though most variations can be predicted by preoperative CT scan mapping and planning it is still important to do meticulous intraoperative dissection and identification of the various structures before division.
Dr. Thirugnanam Agasthian is a thoracic surgeon practising in private practise at Mount Elizabeth Hospital in Singapore. His main areas of interest are thoracic oncology and minimally invasive surgery. Dr. Agasthian is a board member and founding president of the South East Asian Thoracic Society (SEATS) as well as founding board member of Asia Thoracoscopic Surgery Education Program (ATEP), Ethicon Thoracic Advisory Board and ASEAN VATS Study Group. Dr. Agasthian was previously the Deputy Director and Head of Surgical Oncology at National University Cancer Institute, Singapore (NCIS) at the National University Hospital (NUS), and a senior consultant at National Cancer Center Singapore (NCCS).
Dr. Agasthian believes surgical videos have completely transformed surgical education and training. Dr. Agasthian recalled that when he was a young surgeon apart from watching his senior mentors at surgery the only other form of mastering a surgical technique was from colored pictures from textbooks which were not realistic and instructive. Surgical videos however give a more accurate instructive real time version of the surgical technique. It can be watched repeatedly by the surgeon to master the fine points at his own time and pace. It is also a boon for surgeons who work in small remote hospitals to learn new surgical techniques. As many surgeons cannot travel to centers of excellence for various reasons to watch and learn from master surgeons, surgical videos offer an excellent alternative to learn remotely.
Mastery and perfection of surgical technique is never complete and can always be improved and is a lifelong process. Learning from other surgeons is an important integral part of the journey. Most major surgical meetings can accommodate only a few speakers to showcase their techniques. Due to this lack of adequate platforms, outstanding unrecognized surgeons are unable to showcase and share their techniques and innovations to the rest of the community. Dr. Agasthian is glad that JOVS has filled this important need and given a crucial platform and recognition for surgeons from which ever part of the world to showcase their work and techniques.
Dr. Agasthian also suggests that journals and societies should actively promote courses and instructive articles on surgical video editing as many surgeons still struggle with video editing. He thinks video editing should be made mandatory as part of surgical training curriculum especially early at resident level. Though there are many platforms for video editing, he personally use the AVS Video editor as he find it to be a simple and quick. However, there is no one perfect platform, and each surgeon must find one which suits their own needs.
Key message of the video: The video highlights the surgical challenges faced during delayed laparoscopic approach to a colovesical fistula (CVF) complicating acute sigmoid diverticulitis. A bladder-sparing, one-stage laparoscopic sigmoidectomy without use of uretheral stents was performed one month after the onset of symptoms and computed-tomography confirmation of CVF. Immediate preoperative cystoscopy and left uretheral catheterization was performed to allow retrograde injection of indocyanine-green and fluorescence-guided surgical dissection. Sigmoidectomy with transanal Knight-Griffen colorectal anastomosis was uneventful and no diverting ileostomy was required.
Luigi Bonavina, MD, PhD, FACS (Hon), FEBS, is a Full professor of surgery at the University of Milan Medical School and Director of the Department of Surgery at IRCCS Policlinico San Donato. After his general and thoracic surgical training at the University of Padua Medical School, Dr. Bonavina completed a Post-doctoral Research Fellowship at the University of Chicago and Creighton University. His current clinical practice focuses on surgical management of esophageal disease via minimally invasive transoral, thoracoscopic, and laparoscopic approaches. Dr. Bonavina has served as a Visiting Professor in several academic and non-academic institutions around the world. He has also been invited to deliver key-note lectures at major international meetings. He has authored more than 450 articles on peer-reviewed journals and more than 50 book chapters. He currently serves as an Associate Editor for Updates in Surgery, the official journal of the Italian Society of Surgery, and is a Member of the Editorial Board of World Journal of Emergency Surgery.
Dr. Bonavina has been nominated Honorary Member of the American college of Surgeons and of the Association of Laparoscopic Surgeons of Great Britain & Ireland. He is an active member of the Italian Society of Surgery, European Surgical Association, Académie National de Chirurgie, American Foregut Society, International Society for Diseases of the Esophagus, Society for Surgery of the Alimentary Tract, and World Society of Emergency Surgery. He has also served as past-president of the European Foregut Society.
Dr. Bonavina thinks surgical education is a lifelong process and visual cues through audio-visual material have a great potential to enhance this pathway. Video-based surgical education has been shown to be effective for teaching/learning surgical skills and operative techniques, and represents a very useful addition to the curriculum of medical students, surgical trainees, and expert surgeons as well. A structured platform providing well edited videos is a potent resource to augment practical knowledge and to integrate the information provided by articles in surgical journals.
Dr. Bonavina also would like to view more videos from peer professionals on laparoscopic treatment of colovesical fistula. He believes that high-quality videos demonstrating both laparoscopic and robotic techniques for CVF repair performed by expert surgeons and urologists cooperating in different clinical scenarios and hospital settings can further contribute to standardization of minimally invasive surgical care and better surgical outcomes with low conversion rates in these patients.
When it comes to recording and editing surgical videos, Dr. Bonavina believes it is a perfectible art and requires specific technical, scientific, and didactic skills. It should be done by expert professionals keeping in mind that the educational value depends on clarity of images and animations, audio/text narration, conciseness, and the ability to control replay speed and navigate through the video. A person typically retains less than 15% of the reading material and less than 30% of the listening material; however, retention of knowledge increases up to 50% when effective audio-visual materials are used for teaching purposes.
Boon-Hean Ong
Key message of the video: The novel cloud-based 3D reconstruction software solution that we have been using at our institution was extremely useful in performing complex thoracosopic segmentectomies, and that such cloud-based solutions may confer additional benefits over traditional non-cloud-based platforms.
Clinical Assistant Professor Boon-Hean Ong is a Senior Consultant and the Director of Thoracic Surgery at the National Heart Centre Singapore. He graduated from the Faculty of Medicine, National University of Singapore, then completed cardiothoracic surgery training at the National Heart Centre Singapore. He was then awarded the Singapore Ministry of Health-SingHealth HMDP Award to pursue an advanced clinical fellowship in general thoracic surgery at Brigham and Women’s Hospital, Harvard Medical School in the United States of America. Subsequently, he returned from fellowship training to practice cardiothoracic surgery with subspecialty interests in minimally invasive thoracic surgery, thoracic oncology and lung transplantation at the National Heart Centre Singapore. He currently the service chief at the Singapore General Hospital campus for the SingHealth Duke-NUS Lung Centre and is the Vice Chairman of the Chapter of Cardiothoracic Surgeons, Academy of Medicine Singapore.
Speaking of the role of surgical videos play in the medical community, Prof. Ong shares, “Presently, surgical videos represent a very important medium for spreading surgical innovation and education. With widespread availability of high-quality surgical videos on various platforms (including JOVS!), they have become an invaluable resource for surgeons of all levels to learn from each other and refine their surgical technique. This is especially so for rare and unusual operations or situations which many surgeons may not necessarily have encountered before during their formal surgical training. Moreover, the videos also allow for the rapid propagation of new, important techniques which then benefit countless patients worldwide that must undergo these operations.”
Prof. Ong is interested in viewing more videos from peer professionals on VATS segmentectomy guided by cloud-based 3D reconstruction platform. He mentioned, “I would be particularly interested to see what my colleagues in North America and Europe use, as I have previously only seen what the surgeons in East Asia (Japan/China/South Korea) normally use.”
Talking about the preferred platforms or tools for recording and editing surgical videos, Prof. Ong shares that he has only used the default Windows Movie Maker for the editing of my surgical videos, and he has found it sufficient for my needs. When editing his surgical videos for a presentation or publication, he find that the most important thing to try to achieve is to make sure that there is no wasted time in the video. Every frame should be illustrating an important point and should be either narrated or subtitled to bring the point across to the audience. Labelling the anatomical structures of interest at the appropriate juncture are also helpful for many viewers. Alternatively, he also finds that non-edited surgical videos have quite a lot of educational value when they are available, because we are able to see every step of a particular operation, but they do take longer to watch and are not commonly available.
Miroslav P. Peev
Video article: Multi-vessel off-pump total endoscopic coronary artery bypass—pearls and pitfalls
Key message of the video: Robotic coronary artery bypass grafting emerged as a safe and reproducible technique with excellent short- and long-term outcomes. This sternum sparing method allows the use of bilateral internal thoracic arteries (ITAs) as well as it provides the unique opportunity to access the various parts of the heart in a minimally invasive way while achieving substantially fewer complications, less pain, early discharge and return to work. In our video, we demonstrate an abbreviate version of our technique based on over 600 operations with guided reference to key pearls and pitfalls.
Dr. Miroslav Peev is a board-certified thoracic surgeon practicing all aspects of cardiovascular surgery at SSM St. Mary’s Hospital in Madison, WI. Dr. Peev completed my general surgery training at the New York University in Manhattan and subsequently CT surgery fellowship at the University of Chicago under the mentorship of Dr. Val Jeevanandam, Dr. Chris Salerno and Dr. Sam Balkhy. Dr. Peev have completed postdoctoral research fellowships at the Massachusetts General Hospital/Harvard Medical School in Boston as well as at the New York - Presbyterian/Weill Cornell Medical Centre in New York City. His research focuses on innovation and development of advanced technologies for heart and aortic surgery.
Dr. Peev thinks surgical videos are without a doubt an effective and easy to digest tool that allow rapid spread of research, techniques, and innovation within the surgical community. Guided surgical videos allow the audience to become quickly submerged in the pathology and the corresponding therapy. It is quite engaging and makes transfer of knowledge much easier.
Minimally invasive surgical revascularization is certainly an evolving field. As a strong proponent of innovation and robotic surgery, Dr. Peev is interested to learn more from the peers and the way bypass surgery is conducted using alternative less invasive techniques. For example, there are well known heart surgery groups in New York city as well as in Philadelphia known for their extensive expertise in MIDCAB and/or robotic assisted coronary bypass. Those surgeons have years of experience and plethora of knowledge that would help penetration of the minimally invasive heart surgery in the modern surgical practice.
There are wide variety of software that could help edit videos. Dr. Peev says, “I am pretty sure that the same result could be achieved using just about any of those. My personal preference is iMovie – user friendly software with all functions needed to create a high-quality video. In terms of recording, we use our standard operating room equipment. When building a video, I try to integrate chronologically the key steps of the operation with focus on the technique. As mentioned before, adding short text descriptions and guided audio tremendously help with understanding and communicating the main message of the video.”
George Rakovich
Video article: Thoracoscopic S2 segmentectomy by a posterior approach for a central metastasis: a case report
Key message of the video: There has to be a rationale that guides surgical approaches and technique. In this case, what guides the surgical approach (and justifies a posterior approach) is the goal of obtaining direct access to the structures at the root of the target segment. As a matter of principle, this minimizes required dissection, spares tissue planes, and streamlines the surgical procedure. It is also extremely helpful to break down the procedure into a series of key steps, which I tried to keep to a minimum. Each step has a well-defined surgical objective which involves well-defined anatomic structures, and steps follow one another in a logical sequence. This helps both with how one conceptualizes the procedure, as well as with future technical execution and, eventually, mentoring. Each step is highlighted using a key intraoperative view, and each of the proposed key views illustrates the optimal intraoperative exposure that one seeks; proper exposure is probably the most challenging aspect of S2 segmentectomy specifically (as well as segmentectomies in general), and it certainly warrants the surgeon’s due consideration, time, and effort. Inadequate exposure can make even a simple procedure tedious, while optimal exposure can make even difficult cases manageable.
Dr. George Rakovich is Chief of Thoracic Surgery at Maisonneuve-Rosemont Hospital, and he teaches at the University of Montreal School of Medicine in Montreal, Canada. Dr. Rakovich hold a Master’s degree in medical education, which involved research in visual perception, and he recently completed a preparatory program in philosophy, with a special interest in the philosophy of medicine. Dr. Rakovich’s clinical practice spans the field of thoracic surgery, but his interests are focused on advanced minimally invasive techniques and anatomic sublobar resection in particular. In collaboration with sister engineering schools, Dr. Rakovich supervises several graduate students and co-lead research programs in pulmonary and parenchymal staple line biomechanics and advanced imaging in lung resection surgery, with a view towards constant improvement of minimally invasive technique and patient outcomes. Dr. Rakovich has served on the editorial boards of several journals, most recently the World Journal of Surgery and Shanghai Chest.
Surgery, especially in the era of minimally invasive techniques, relies heavily on visual information. Minimally invasive surgery platforms make it both easier and more necessary to represent surgical procedures visually. Surgical videos are an ideal way to render the actual intraoperative appearance of tissues and anatomic structures, as opposed to static images and illustrations. On the other hand, schematic representations are a useful tool for conceptualization of 3D structures and anatomic relationships. In many ways, both intraoperative videos and illustrations are required for a proper grasp of surgical technique, much like a map is required for accurate navigation. An ideal video incorporates and makes use of this interplay between both conceptual and “real world” representations. The increasing sophistication of 3D imaging technologies, augmented reality, as well as virtual reality, will no doubt further expand the realm of surgical videos and maximize their didactic value.
Surgical technique is influenced by an evolving understanding of disease, by evolving technologies, and by evolving technical expertise. These, in turn, may be influenced by local or regional treatment philosophies and preferences. Access to surgical technologies may vary in relation to available resources (economic and otherwise) and is also a function of the structure of healthcare systems. One of the most interesting aspects of surgery is how surgeons adapt to their specific circumstances and maximize the use of the resources available to them. This often requires creative thinking and innovation, and so Dr. Rakovich thinks that appreciating techniques from multiple provenances and diverse contexts is an excellent way to foster surgical advancement.
JOVS: What are your preferred platforms or tools for recording and editing surgical videos?
Dr. Rakovich: Minimally invasive surgery makes recording surgical videos straightforward. We recover videos directly onto a memory stick from our thoracoscopic camera platform. Video editing software is now readily available, and even simple versions should be more than adequate for surgeons’ needs. High end “special-effects” are unnecessary and probably tend to distract from the more important points.
We are fortunate to have an outstanding audio-visual department as well as a medical illustrator in our hospital, and we routinely collaborate with them for our videos. They provide invaluable technical help, iron out “glitches”, suggest optimal selection of video sequences, help frame the focus and adjust the flow of the video images, and produce outstanding schematic representations. I also find that the use of a professional narrator really helps one to better follow the procedures. I encourage anyone with access to such specialists to involve them in their projects. I have found that they are very excited to have the opportunity to work on surgical technique, and I have had the opportunity to learn a lot from them as well.
Johannes Bonatti
Key message of the video: The key takeaway message in this video is that totally endoscopic coronary artery bypass grafting is well feasible using robotic technology. Colleagues watching the video can get very detailed guidance on how to place ports, harvest the left internal mammary artery, how to create comfortable conditions to perform a graft to coronary artery anastomosis with the surgical robot, and how to carry out the same.
Johannes Bonatti is an attending cardiac surgeon at the University of Pittsburgh Medical Center (UPMC) Heart and Vascular Institute and Professor of Cardiothoracic Surgery at the University of Pittsburgh. He has performed cardiac surgery using robotic devices since 2001 and has carried out 1000+ cases. He introduced and ran robotic heart surgery programs at Innsbruck Medical University, the University of Maryland, the Cleveland Clinic in Ohio, the Cleveland Clinic Abu Dhabi, and most recently re-introduced robotic cardiac surgery at UPMC. He held academic and leadership positions at these institutions and performed several “world firsts” including the first successful quadruple totally endoscopic coronary artery bypass grafting procedure in robotic fashion. Dr. Bonatti has published more than 380 papers according to ResearchGate and has given scientific talks at respected meetings around the world. He was President of the Minimally Invasive Robotics Association (MIRA) from 2011-2012 and President of the International Society for Minimally Invasive Cardiothoracic Surgery (ISMICS) during the 2017/2018 term. He is currently serving on the task forces for robotic cardiac surgery at EACTS and STS, and leads the corresponding working group at ISMICS.
Surgical videos have made learning surgical techniques much easier than in times when technical aspects of surgery were taught through descriptions or schemes in a text book or in a surgical atlas. Dr. Bonatti thinks video presentations are a main part the future of surgical teaching and learning.
Dr. Bonatti is very interested in viewing more videos from peer professionals on robotic totally endoscopic coronary artery bypass grafting, showcasing various techniques and procedures. He strongly suggests to include Dr. Husam Balkhy from the University of Chicago, USA, Dr. Sloane Guy from the Georgia Heart Institute, Gainesville, GA, USA , Dr. Gianluca Torregrossa from Lankenau Hospital, Pennsylvania, USA, Dr. Gulam Murtaza, SSM health, Madison WI, USA, Dr. Jean Luc Jansens from the CHU UCL Namur, Belgium, Dr. Dr. Nitin Rajput Medanta Gurugram, India, and Dr. Sathyaki Nambala from Apollo Hospitals, Bengaluru, India.
For video editing, Dr. Bonatti uses Adobe Premier Pro. He thinks surgical videos need a voice over, and he likes to include several team members to be part of the explanations to make the video more lively. For taking videos in the operating room it is extremely important that people who really know and understand the procedure take the video shots. Institutional video teams often lack this knowledge and film scenes that are important to the public but not for surgeons. If they are included, they need detailed real time instructions by people with surgical know how. When taking shots it is important to get zoom outs very often to see how the whole team is working. Often times only surgical details inside the operative field are shown and the big picture of the operation is lost.
Hitoshi Igai
Key message of the video: This surgical video demonstrates uniportal thoracoscopic right S3 segmentectomy for an impalpable right S3 tumor. With the increasing resolution and widespread use of computed tomography, surgeons are encountering a growing number of small and impalpable pulmonary lesions. In such cases, securing an adequate surgical margin during segmentectomy can be challenging. The main message of our video is that the preoperative simulation method we presented is simple, low-cost, and highly practical. It does not require special equipment and can be reproduced in many institutions. Therefore, I believe this technique has broad clinical applicability and may help surgeons achieve more reliable surgical margins for impalpable tumors in daily practice.
Dr. Hitoshi Igai completed his thoracic surgery residency at the Department of General Thoracic, Breast, and Endocrinological Surgery, Faculty of Medicine, Kagawa University. He subsequently worked at Kurashiki Central Hospital as a staff surgeon and at Kagawa University as an Assistant Professor. In 2010, he joined Japanese Red Cross Maebashi Hospital as an Assistant Director. From April 2016 to March 2017, he worked as a Postdoctoral Research Fellow at Toronto General Hospital Research Institute, University Health Network, Canada. He returned to Japanese Red Cross Maebashi Hospital in April 2017 and was promoted to Director in April 2023. Dr. Igai is a board-certified surgeon of the Japan Surgical Society and the Japanese Association for Chest Surgery. His research focuses on minimally invasive thoracic surgery, particularly uniportal video-assisted thoracic surgery, robotic surgery, and pulmonary segmentectomy, and he has authored more than 170 publications.
JOVS: Would you be interested in viewing more videos from peer professionals on other preoperative simulation approaches for uniportal thoracoscopic pulmonary segmentectomy?
Dr. Igai: Yes, I would be very interested in viewing such videos. In Japan, several useful techniques have been reported, including approaches using virtual-assisted lung mapping (VAL-MAP) and radiofrequency identification (RFID) marking. Although both methods require preoperative bronchoscopy, which makes the process somewhat more complex, they may further improve the accuracy of securing an adequate surgical margin when combined with the simulation method we presented. In particular, I find these techniques medically very valuable. However, in the case of RFID, one important issue is cost, because it is not currently reimbursed by the national health insurance system in Japan. I sincerely hope that this issue will be resolved in the future, as wider access to such technology could provide meaningful benefits for patients undergoing sublobar resection.
JOVS: Which platforms or tools do you typically use for recording and editing surgical videos, and what approaches or techniques do you employ to enhance their educational value?
Dr. Igai: I use Final Cut Pro for video editing. When creating a surgical video, the most important point for me is to ensure that the audience can immediately understand the key messages and technical highlights of the procedure. To enhance the educational value of the video, I try to include explanatory captions as well as clear identification of anatomical structures in as many scenes as possible. I believe that these visual annotations are essential for helping viewers follow the operative flow and understand the important technical aspects of the surgery more intuitively.
JOVS: From your perspective, what are the potential implications of artificial intelligence (AI) for surgical practice?
Dr. Igai: The development of artificial intelligence has been remarkable, and I believe its application in thoracic surgery will continue to expand in the future. For example, in cases such as the impalpable tumor presented in this video, AI may eventually enable real-time intraoperative localization based on preoperative computed tomography (CT) data. Such advances could improve precision and support safer and more effective surgical decision-making. In the future, surgeons will likely be expected not only to possess strong technical skills but also to have sufficient information technology (IT) literacy to understand and effectively utilize these emerging technologies. I believe that the integration of AI into surgical practice will become an increasingly important part of modern thoracic surgery.
Takuya Watanabe
Video article: Tips and tricks of uniportal video-assisted thoracoscopic surgery complex segmentectomy
Key message of the video: In this article, we presented several tips and technical points for performing complex segmentectomy using uniportal VATS. Uniportal VATS has inherent limitations, such as instrument interference and restricted maneuverability. However, with appropriate strategies and techniques, even complex procedures can be performed safely and reliably. The key message is that complex segmentectomy can be standardized even with a uniportal approach.
Dr. Takuya Watanabe is a thoracic surgeon with a focus on minimally invasive surgery and extended resection for locally advanced lung cancer. In the field of minimally invasive surgery, he has extensive experience in uniportal video-assisted thoracoscopic surgery (U-VATS). He has also completed several international fellowships and training programs to further develop his surgical skills. In Japan, he is an active member of the Japanese Uniportal VATS Interest Group (JUVIG), where he contributes to and leads multicenter clinical research. In addition to surgical practice, he is also involved in thoracic oncology and has conducted phase II and phase III trials related to perioperative treatment. Furthermore, he actively shares surgical knowledge and techniques internationally. As part of this effort, he manages his own YouTube channel, where he provides educational surgical videos for a global audience.
Dr. Watanabe stresses that surgical videos are useful not only for training surgeons but also for preoperative image training. They provide an important opportunity to learn procedures that are not commonly encountered, such as extended resections for locally advanced lung cancer. As opportunities for open thoracotomy have decreased, surgical videos have become an essential tool to complement clinical experience. He believes that learning from different approaches and techniques from other surgeons is important to improve his own surgical practice. He is particularly interested in the experience of European teams, such as those in European Society of Thoracic Surgeons (ESTS), and he hopes to learn from international perspectives.
Dr. Watanabe has mainly used Windows Movie Maker and has recently started using Clipchamp as well. In his view, expensive software is not always necessary, and these tools are sufficient for practical editing. To enhance educational value, he presents preoperative computed tomography (CT) images and surgical planning at the beginning. He also adds English subtitles to explain intraoperative thinking and technical tips, so that viewers can better understand the surgeon’s intention. YouTube is a convenient and accessible platform, and he also manages his own educational channel @taku527.
Dr. Watanabe thinks that artificial intelligence (AI) can be a useful tool for surgical planning, including tumor localization, analysis of resection areas, and selection of appropriate procedures. However, surgery itself is performed by surgeons, and it is difficult for AI to fully replace human decision-making and technical skills. He believes that as AI continues to develop, the role and importance of surgeons will become even greater.
Jun Suzuki
Video article: Thoracoscopic precision excision technique for small non-palpable lesions using radiofrequency identification lung marking system
Key message of the video: The primary takeaway is that we can achieve highly accurate, real-time localization and safe surgical margins for deeply located or hilar-adjacent nodules using the radio frequency identification (RFID) marking system. By exploring the lung surface with a receiver antenna, we can detect the implanted RFID marker; the system emits a sound whose pitch changes based on the distance to the marker, allowing us to pinpoint the exact location of non-palpable tumors. Crucially, because this audio feedback provides the tumor's location in real-time, surgeons can continuously monitor the distance during the excision. This allows us to make immediate adjustments and correct the resection line on the fly, ensuring we maintain an adequate margin without cutting too close to the lesion. Most importantly, this technique allows us to treat complex lesions while minimizing unnecessary parenchymal resection and limiting extensive hilum manipulation. This preserves lung function and maintains the feasibility of potential future surgical interventions for the patient.
Dr. Jun Suzuki is an Assistant Professor in the Department of Surgery 2, Yamagata University Faculty of Medicine, Japan. He graduated from Yamagata University Faculty of Medicine in 2006 and later earned his PhD from the same institution. After completing his junior residency at Yamagata University Hospital, he trained in general thoracic surgery at Shonai Municipal Hospital, Nihonkai General Hospital, and Saitama Cardiovascular and Respiratory Center, and has served in his current position since 2014. He is board-certified by the Japan Association for Chest Surgery, the Japanese Respiratory Society, and the Japan Society for Respiratory Endoscopy. His clinical and research interests include lung cancer, diagnostic imaging for thoracic surgery, preoperative assessment of pleural adhesions and vascular anatomy, thoracoscopic surgery, robotic thoracic surgery, and minimally invasive treatment for thoracic diseases. He is a member of several professional societies in thoracic surgery, respiratory medicine, endoscopic surgery, and lung cancer research, including International Association for the Study of Lung Cancer (IASLC). He has received regional and international awards, including the President’s Award at the 94th Tohoku Regional Meeting of the Japanese Association for Thoracic Surgery and the Best Video Award at The Asia-Pacific Innovative Thoracic Surgery Symposium 2025. He has authored or co-authored more than 100 peer-reviewed publications.
Surgical videos play an indispensable role in the modern medical community, particularly as a vital tool for “Off-the-Job Training” (Off-JT). While written reports and static images provide foundational knowledge, they often fall short in capturing the dynamic spatial relationships, tissue handling, and nuanced device angles required in complex surgeries. Disseminating high-quality surgical videos allows surgeons to mentally simulate procedures, establishing a safe and structured learning environment before introducing advanced techniques—such as uniportal video-assisted thoracic surgery (U-VATS) or robotic-assisted thoracic surgery (RATS)—into their own operating rooms. This visual dissemination is essential for standardizing high-quality surgical care across different facilities.
Dr. Suzuki is particularly interested in observing how various high-volume centers adapt and refine thoracoscopic precision excision technique. Specifically, the experiences of leading surgical teams in Asia, where the volume of minimally invasive thoracic surgeries is exceptionally high, as well as advanced centers in North America and Europe, would provide excellent comparative insights. Furthermore, seeing how different institutions integrate this thoracoscopic precision excision technique with various energy devices or robotic-assisted platforms would be incredibly valuable for standardizing high-quality surgical practices and improving patient outcomes.
Dr. Suzuki primarily use iMovie or Final Cut Pro for editing surgical videos. However, he believe there is no single “best” software; the most effective tool is simply the one you are most accustomed to and comfortable using. When it comes to enhancing educational effectiveness, the content’s structure matters most. The most effective approach is to present a comprehensive clinical picture rather than just the isolated excision itself. He always aim to include the preoperative 3D CT pathway planning alongside the intraoperative fluoroscopic and endoscopic views. Because the 3D CT pathway serves as a direct reference for the actual bronchoscopy procedure, bridging this gap between virtual planning and actual surgical execution is where the true educational value lies.
Dr. Suzuki thinks that artificial intelligence (AI) has transformative implications, particularly when integrated with advanced minimally invasive modalities like video-assisted thoracic surgery (VATS), RATS, and precision excisions. He notes that, in the short term, AI-driven computer vision will significantly enhance intraoperative safety through real-time anatomical recognition and navigation assistance. In the broader scope, he believes AI will revolutionize how we learn from surgical data. By automating the analysis of large-scale surgical videos and clinical outcomes, AI can provide objective, rapid feedback on our surgical quality. According to Dr. Suzuki, this will not only accelerate the refinement of individual surgical skills but also play a crucial role in standardizing high-quality surgical care globally, effectively bridging the gap in surgical outcomes between high-volume centers and other institutions. However, despite these remarkable advancements, Dr. Suzuki does not believe that machines will replace human surgeons anytime soon. Surgery often requires nuanced, split-second decision-making and adaptability to unpredictable anatomical variations—human elements that AI cannot currently replicate. Ultimately, AI will serve as a powerful partner to enhance our capabilities, rather than a substitute for the surgeon’s hands and mind.
Paul T. Finger
Video article: Finger iridectomy technique (FIT): anterior segment uveal melanoma biopsy
Key message of the video: This video teaches that diagnostic ciliary body tumor tissue can be retrieved through a 1 mm aspiration-cutter derived iridotectomy.
Paul T. Finger, MD, FACS, is a Professor of Ophthalmology at Tulane University School of Medicine and founding Director of Ocular Tumor Services at The New York Eye Cancer Center, the New York Eye and Ear Infirmary, and Tulane School of Medicine. Dr. Finger is internationally recognized for pioneering small incision ophthalmic surgical techniques. Among his most notable contributions are the Finger Iridectomy Technique (FIT), a minimally invasive approach for biopsy of anterior segment tumors and performing surgical iridotomy for narrow-angle glaucoma, and the development of Vitrectomy Retinotomy Aspiration Biopsy (VRAB) for choroidal tumors, which he published in the American Journal of Ophthalmology as early as 1990. He has further advanced minimally invasive orbital biopsy by utilizing his Finger Aspiration Cutter Technique (FACT). However, with regard to small incision biopsy, he is best known for his work on aspiration cutter-assisted biopsy of anterior segment and iris tumors, including the microincision approach for multifocal iris melanoma. Additionally, he authored the chapter on minimally invasive ocular tissue biopsy in his landmark 2025 textbook, Finger’s Essential Ophthalmic Oncology.
JOVS: Would you like to see more videos from fellow professionals demonstrating different techniques and procedures for “finger iridectomy technique”?
Dr. Finger: I commonly receive questions about my experience with ophthalmic aspiration-cutter-based microincision surgeries. However, I would like to hear about new ophthalmic applications of this technique and studies comparing aspiration-cutter biopsy to fine needle aspiration biopsy (FNAB) or open surgeries. It would be particularly interesting to see how ophthalmic microincision surgeries decrease morbidity and speed recovery. In addition, a cost-benefit analysis may make it more attractive to socialized medical systems.
JOVS: When recording and editing surgical videos, which tools and techniques do you typically rely on to ensure clarity and educational value?
Dr. Finger: When it comes to recording, high definition, in microscope surgical cameras ensure clarity and detail. Make sure the recorded image is in focus. Try to capture different angles and close-ups to convey a comprehensive view of the procedure. Admittedly, I am not an expert in videography. Therefore, I rely on professionals who commonly use tools like Adobe Premiere Pro and Final Cut Pro. For those looking for simplicity, I have used platforms like iMovie or Camtasia, which offer more straightforward interfaces that can produce high-quality results. Collaborating with a professional videographer can be invaluable to ensure the final product is both excellent and informative.
During editing, focus on a few key techniques. Narrate the procedure step-by-step. You will find that the act of writing out surgical steps will uncover teaching pearls which will greatly aid in understanding. Insertion of illustrations and arrows can be helpful. Make sure there is a logical flow and steady pace, which will help viewers retain information most effectively.
JOVS: What do you think are the potential implications of artificial intelligence (AI) for ocular surgery?
Dr. Finger: AI has the potential to transform ocular surgery. In training, AI can enable objective skill assessments and teaching simulations. I expect that pre-operative clinical examinations will be enhanced by AI-assisted image analysis and AI-enabled procedural planning. Intraoperatively, AI can provide surgeons with near real-time medical evidence about alternative surgical approaches. Such assistance will likely reduce errors and improve outcomes. Postoperatively, AI can be used for complication analysis to enhance and personalize patient recovery. However, significant obstacles to AI implementation include liability, dataset bias, AI hallucinations, and unequal patient access. The near-term implications of artificial intelligence include the AI augmentation of surgical judgment and post-treatment care. In the future, it may evolve towards selective autonomy, fundamentally redefining the surgeon's role and the nature of ocular surgery.
Takahiro Homma
Key message of the video: The core message is the “Safety and Anatomical Precision” of the pulmonary ligament approach for right S10 segmentectomy. S10 is often considered one of the most challenging segments due to its deep location and complex vascular branching. By initiating the dissection from the pulmonary ligament and performing the intersegmental division last, we can maintain clear orientation and ensure an adequate surgical margin. This “bottom-up” strategy transforms a complex, deep-seated procedure into a controlled, stepwise anatomical dissection, which is particularly beneficial in the limited working space of Uniportal Video-Assisted Thoracic Surgery (VATS).
Dr. Takahiro Homma is an Associate Professor, Department of Thoracic Surgery, St. Marianna University School of Medicine. His clinical and research focus lies in advanced minimally invasive techniques, particularly Uniportal VATS and Tubeless VATS. Over the past year, he has dedicated significant effort to refining complex segmentectomies and establishing standardized protocols for high-risk thoracic cases. Beyond the operating theater, he is deeply committed to medical education and the mentorship of surgical trainees. He believes that fostering clear communication and technical proficiency in the next generation is essential for the evolution of their field. As a member of the Board of Directors for JUVIG and a founder of the Japan Tubeless & Advanced Care Team (JTACT), he strives to integrate innovative surgical approaches with comprehensive perioperative care to improve patient outcomes.
JOVS: What role do surgical videos play in helping surgeons learn, share ideas, and improve their techniques?
Dr. Homma: Surgical videos serve as a “universal language” that transcends borders and seniority. While textbooks provide the anatomical theory, videos capture the dynamic reality—the tension of the tissue, the nuances of instrument handling, and the management of unexpected findings. In the era of minimally invasive surgery, where tactile feedback is limited, visual learning is paramount. Disseminating high-quality videos through platforms like JOVS helps level the playing field, allowing surgeons worldwide to visualize and adopt advanced techniques, ultimately leading to the standardization of safety and excellence in thoracic surgery.
JOVS: Surgical techniques are constantly evolving. Which approaches in “uniportal VATS right S10 segmentectomy with the pulmonary ligament approach” do you find most interesting?
Dr. Homma: Surgical technique is never static; it evolves through the synthesis of different perspectives. I am particularly interested in a “tubeless” (non-intubated) setting, as it would be incredibly insightful. Comparing these varied “technical flavors” helps us refine our own maneuvers for better efficiency and safety.
JOVS: Which platforms or tools do you typically use for recording and editing surgical videos, and what approaches or techniques do you employ to enhance their educational value?
Dr. Homma: For recording, high-definition 4K camera systems are my standard to ensure that even fine autonomic nerves and tissue planes are clearly visible. However, I firmly believe that high-quality visual footage alone is insufficient for effective surgical education.
To maximize the educational impact, I emphasize the following two approaches:
- Detailed Annotations and Subtitles:
I place great importance on adding text overlays during critical steps of the procedure. Beyond just labeling anatomical structures, I make it a point to provide short descriptions of the "logic" behind each maneuver. I believe that this allows viewers to understand not only how the instruments are being moved but also why a specific angle or plane was chosen at that moment. - Audio Commentary:
I strive to include voice-over narration whenever possible. A surgeon’s real-time reflection or post-operative explanatory commentary provides a narrative depth that a silent video simply cannot convey. By explaining the "tactile feel" of the tissue or subtle technical cautions—especially during a complex S10 dissection—I believe we can bridge the gap between watching a video and performing the actual surgery.
By integrating these verbal and textual elements with 3D reconstructions or schematics, I am convinced that a surgical video transcends being a mere record and becomes a truly comprehensive, self-explanatory educational tool.