Alejandro Rodriguez-Garcia, MD, Monica T Young, MD, Hope T Jackson, MD, Brant K Oelschlager, MD, Andrew S Wright, MD. University of Washington
Introduction: Online operative videos represent an important resource in surgical education and are used by 95% of residents, with YouTube being the most commonly accessed source. The user-generated nature of videos hosted on YouTube is potentially problematic, as content is not curated by quality. Rather, page views, personal browsing history, and other factors determine results of searches for specific operations. This creates a potential for videos that feature inadequate technique and common errors to become the most viewed for a given procedure. We set out to analyze the quality of the highest ranked laparoscopic cholecystectomy videos featured on YouTube.
Methods: After clearing browser history and cookies (which might influence search results), a YouTube search for “Laparoscopic cholecystectomy” was performed. Search results were screened to exclude animations and lectures; the top ten operative videos were evaluated. Three expert reviewers independently analyzed each of the 10 videos. Overall competence and case difficulty were each scored on a 1-10 visual analogue scale (VAS). Technical skill was rated using the GOALS score developed by Vassilou et al, using a Likert scale of 1-5 in each of 4 domains (excluding the autonomy domain which was impossible to evaluate in this context). Establishment of a critical view of safety (CVS) was scored according to criteria described by Sanford and Strasberg, where a score of 5 points (out of 6) is considered satisfactory. Videos were also screened for operative errors not listed by the previous tools.
Results: Mean competence score was 8.17 (range 5.3-9.3).and difficulty was 2.7 (range 1-8). GOALS score mean was 16.3 (range 13.3-20). Only one video achieved adequate critical view of safety; mean CVS score was 2.5 (range 0-6). Five videos were noted to have other potentially dangerous errors, including placing hot ultrasonic shears on the duodenum (n=2), blind dissection in Calot’s triangle (n=1), and damage to the liver capsule (n=2).
Conclusion: Top ranked laparoscopic cholecystectomy videos on YouTube show suboptimal technique with half of videos demonstrating potentially catastrophic errors and only one in ten having an adequate critical view of safety. While observing operative videos can be an important learning tool, surgical educators should be aware of the low quality of popular videos on YouTube. Dissemination of high-quality content on video sharing platforms should be a priority for surgical societies.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79921
Program Number: S112
Presentation Session: Education Technology, Teaching and Learning
Presentation Type: Podium