Videoregistration of Surgery Should be Used as a Quality Control

Quality control of medical treatment is strictly organized and supervised. Efficacy and safety have to be proven in large randomized controlled trials, which need ethical review board approval. Content and quality of marketed drugs is controlled by industry and government. After market introduction, postmarketing surveillance is organized. This quality control is necessary to obtain reliable and predictable results and to detect even rare adverse events. Quality control of surgical treatments is close to nonexistent for individual surgical procedures and, therefore, rare adverse events cannot be detected by the sheer number of interventions analyzed. An ethical review board is rarely consulted before a new procedure is attempted or introduced. Although the outcome of surgery is surgeon and environment dependent, the only estimation of quality is results and complication rates. These, however, reflect publications by dedicated groups or data from surveys that do not necessarily reflect reality accurately. Complications are known to be under-reported whereas surveys reflect mean quality only. For most complication rates, it remains unknown which were preventable mistakes and which were unavoidable, random accidents. This huge discrepancy in quality control of medical and surgical therapies can be understood by specifics of each type of therapy. Strict quality control in surgery is, moreover, difficult to organize given that the outcome varies with the surgeon and surgical environment. Systematic videotaping of entire interventions has the potential of providing a quality control of surgery. This, moreover, has become technically feasible at low cost. In conclusion, we need to reflect and organize quality control in surgery. Systematic videotaping of entire procedures seems to be an inexpensive and easy way to organize this control.