The first academic paper about the design of surgical videos was written by Gilder in 1988. He discussed a sequence of video shots, audio commentaries, and technical aspects of videotape editing. At that time, video editing involved videotape machines, cassette tapes, and handwritten record sheets (Gilder, 1988).

A quantitative study, conducted among 169 Canadian medical residents, showed that video and audio podcasts between 5-15 minutes were most preferred (Matava, Rosen, Siu, & Bould, 2013). A study conducted by Mota et al. (2018) suggested that different groups of surgical learners may have different preferences when using surgical videos.

• Practicing surgeons seemed to value the presence of tips and tricks, as well as information about technical skills

• While surgical residents favoured illustrations, narration, and other forms of explanatory information.

This suggested that surgeons may used videos to sharpen their own surgical technique, while residents watched to learn more generally.

1. What to Record?

a. What is the purpose of the recording?

1. Learning by observing the performance of an expert surgeon.

   • instructional guide for the surgical trainees

2. Learning by observing and reflecting upon one’s own performance.

   • Self-reflection - when the surgeon or trainee watched a video of a procedure performed by themselves

   • Coaching - when the surgeon or trainee watched a surgical video (of a procedure performed by himself or herself) with an expert observer or with a peer=

3. Learning by observing the performance of a surgical team.

   • learning nursing skills & analysis of interactions between the scrub nurse and surgeon during the surgery

4. Assessment of learner performance.

   • provide objective, actionable feedback to the learner based on actual, recent performance

   • reduce bias in assessment

   • Remote & crowdsourced approach to assessment possible, including the viewpoint of non-surgical staff

5. Assessment of the performance of a surgical team.

   • close-up view of the surgical field, points of view of health professionals and a general view of the operating room in combination with multiple sources of audio and physiological data were used progressively by so-called "operating room black-box" studies to examine the effects of team performance on surgical outcomes and patient safety

6. Patient education.

b. What Is to Be Recorded?

There are more than 20 surgical specialties and thousands of different surgical procedures. There are two main categories of recording:

1. Video recorded from instruments which capture video as part of the surgery (e.g. video based surgeries such as endoscopic, laparoscopic, and microscopic procedures)

2. Video recorded during open surgical procedures

c. Point of View

A surgical team typically consists of a surgeon, surgical assistants, anaesthesiologist, operating room nurse and circulating nurse. Each team member has a unique role and firstperson point of view of the procedure which is performed. Recording each member’s point of view allows us to capture this complex, multi-faceted team experience. In open surgery, the surgeon’s point of view probably provides the clearest view of the operating field, the key steps of the surgery, and how the instruments are manipulated. A video combining two or more points of view of the same surgical case is defined as a video with multiple points of view

2. How to Record?

a. which type of video camera should be used?

• endoscopic, laparoscopic, and microscopic cameras + head-mounted cameras, ‘Google Glass’, the smartphones, the ‘Exoscope’, and 360-degree cameras

• Modern smart mobile devices were also able to capture high-resolution videos in the operating room, by being attached to the surgical lights, or to the surgical microscopes

• Exoscope: a laparoscope was arm-mounted externally, facing the surgical field

where should the camera be positioned?

how should sound be recorded?

how should lighting be arranged?

• In 1971, Bronson described the distribution of surgical videos using videotapes. He stated that because of the invention of videotapes and videotape recorders, and because of their lower price compared to the film, and because of reusability of the tapes, video recording had become accessible to every surgeon. The author added that from now on surgeons will able to use surgical videos to show rare and interesting cases to surgical residents, and to share them with colleagues during meetings and conferences

• Around 1995, due to the development of digital technologies, CD-ROM (compact disc read-only memory) became a new medium for disseminating surgical videos (Keerl & Weber, 1995). DVD's (digital versatile discs), introduced in 1997, offered similar advantages to CD-ROMs with additional capacity up to 4.7 GB.

• YouTube is probably the biggest resource of surgical videos, which are represented from the perspective of a broad variety of producers, including individual surgeons, medical centers, hospitals, institutes, universities, surgical societies, private companies, etc

• Society webpages, such as American College of Surgeons, Royal College of Surgeons of England, SAGES, and The Rhinoplasty Society of Europe have media libraries composed of good quality, verified and validated surgical videos. Studies conducted by Mota et al. (2018) and Rapp et al. (2016) showed that these sources were more valued by practicing surgeons compared to surgical residents.