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January 5, 2000

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Video Review Comes to the Operating Room: Videotaping Surgeries Offers Opportunities to Improve Outcomes

Many athletes, including golfers and baseball and football players, videotape and review games to improve their performances. Now, in a study reported in the January issue of Urology, Johns Hopkins researchers conclude that videotaping also can help doctors improve the outcome of prostate surgeries and possibly others.

"To the best of my knowledge, the use of videotaping to improve outcomes has not been done before in any surgical field," says Patrick Walsh, M.D., director of the Brady Urological Institute and lead author of the study. "In radical prostatectomy, minor differences in surgical techniques can have a major impact on results. Surgeons who have less than optimal results should consider videotaping every operation and, when they have a successful one, they should watch the videotapes and see what they did right."

Lifesaving radical prostatectomy is an extremely tricky operation, Walsh says, that can result in impotence or incontinence. Because of this, between March 1997 and January 1998, Walsh videotaped the radical prostatectomy surgeries of 62 sexually active men. The patients also completed anonymous, health-related, quality-of-life surveys.

The researchers found that when patients were asked at 12 months whether they had a problem with urination, 98 percent said they did not have a problem or, if they had a problem, it was small. At 18 months, 86 percent of the men reported being potent, with the recovery of sexual function varying with age. "I found that there were patients who did well early, and some patients who didn't do well until later," says Walsh.

To investigate the differences, Walsh painstakingly reviewed videotapes of 10 patients who were continent and potent at three months and compared them to videotapes of 10 men who were not potent at one year. He identified four small arbitrary variances in surgical technique that were associated with better outcomes and went on to show that this could be explained by minor variances in the anatomy of these patients.

Walsh then watched all tapes, without knowing in advance the outcomes, and scored the surgeries for the presence of these four minor differences. He found that the four techniques were predictive of side effect rates.

"Surgeons who don't have good outcomes would benefit from videotaping their operations," says Walsh. "Then, when they have a success, they can go back and see if they can find what makes the difference in their technique." Walsh also believes that swapping tapes among institutions will improve surgeries.

The prostate is a muscular, walnut-shaped gland about an inch and a half long that sits directly under the bladder. Its main function is to produce part of the fluid for semen. Prostate cancer is the most common male cancer, striking more than 175,000 men in the United States each year. For more information about nerve-sparing radical prostatectomy, visit http://prostate.urol.jhu.edu/clinic/surgery/surg.html.

Other authors of the study include Penny Marschke, Deborah Ricker and Arthur L. Burnett.


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