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
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 think 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.