Dear Sir,
The COVID-19 pandemic has been an extremely challenging time for health workers worldwide. Even though some non-surgical specialties have seen a greater demand in their duties, surgical specialties have shown a significant decline in their activity, focusing mainly on emergencies. Plastic and Maxillofacial surgeons have been especially impacted, not only because of their high percentage of elective surgeries being suspended, but also because they are subject to an increased risk of virus exposure during intraoral surgeries. This has consequently affected residents’ surgical training programs with modifications to their rotations and even temporarily redeployment to other areas. In this sense, means of distant teaching like simulation training and webinars have been of increased interest to keep – to some extent – residents’ training.1
Intraoperative video recordings and live surgery broadcastings have been already explored in literature as ways to improve residents' education. The use of GoPro cameras (GoPro Inc., California, US) in surgical residents’ feedback has shown to be an excellent tool for dynamic education, leading to potential enhancement of technical skills.2 Some authors have even proposed modifications in order to correct shortbacks like magnification and battery life.3 Recording videos in intraoral surgery represents a greater challenge due to the depth of the oral cavity and the reduced work space. In this study we compared video recordings in palatal closure surgeries from three different point of views (POVs).
The camera used was a GoPro Hero 7 Black (GPH7B). The GPH7B includes a touchscreen and offers high-quality video recording up to 4 K with 60 frames per second (FPS), voice command controls and is waterproof down to 10 m deep. It also allows 720p live video broadcasting and offers up to 90 min of continuous video recording. Settings used for our study were 720p, 60 FPS and narrow field of view in order to optimize battery duration. The POVs used were: with a head-strap by the First Surgeon (FS); with a head-strap by the First Assistant (FA) and Hand-held by the First or Second Assistant (HH) after an aseptization process of the camera consisting in a 5 min bath in a 10% povidone-iodine solution (taking advantage of the camera's waterproof properties) followed by rinsing off the povidone with sterile water or saline solution, drying the camera with sterile gauze pads and wrapping it in sterile Tegaderm (3 M Enterprise, Minnesota, US) keeping a frontal opening for the lens. When using the head-strap, the camera was tilted in a 30°–45° angle in order to get the most adequately framed image (Figure 1 ). Voice control commands were used in order to optimize recordings and battery times while keeping surgeons scrubbed in when using the head-mounted camera. No frontal lights were used.
Figure 1.
GoPro attached with a head-strap with an approximate angle of 30°–45° to assure optimal recording.
Comparisons of the three POVs can be seen in Supplementary Video 1. In our experience, the quality of video recordings were better when used by the FS and the HH methods (Figure 2 ). The latter has the disadvantage of occupying one of the assistant's hands, however it offers a unique advantage by being able to record videos practically inside the mouth. Regarding the safety of this innovative method, a previous study by Purnell et al. reported their 9-year experience in more than 2000 cases with the use of a waterproof camera previously immersed in 10% povidone-iodine (diluted 1:25 in sterile water) without increasing the risk of infection or contamination, not only in intraoral surgeries (clean-contaminated wounds) but also in clean procedures like cranioplasties.4 Another device reported to be adapted for POV recording is the use of a head-mounted smartphone, however the entire assembly had a weight of almost 300 g compared to the 117 g of the GPH7B which could increase strain during long procedures.5 The use of video-recording glasses has also been published, being a comparable POV to the FS head-mounted GPH7B, but still poses the same disadvantages when compared to the HH in terms of the versatility of having an aseptisized camera in the operating table.
Figure 2.
Photographic comparison of the three point of views using the GoPro camera: (A) first-assistant, (B) first surgeon and (C) hand-held.
Some surgeons prefer using the operating microscope for intraoral surgeries like cleft palate repair, allowing high-resolution video recording, however this is not available in all centers, especially those of developing countries. In terms of costs, the GPH7B has a current price of US $329.99 and the head strap US $19.99 (www.gopro.com), which is reasonable considering the costs of other commercially available intraoperative surgeon POV recording systems.
During these difficult times, alternatives must be explored in order to maintain residents’ training within possible. Optimal intraoral surgical video recordings can be obtained with the use of a GPH7B camera, especially by aseptisizing it with iodine-povidone, offering a reproducible, safe and low-cost method to improve residents' training during the pandemic.
Funding
This study was funded entirely by its authors.
Ethical approval
All procedures performed involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Pictures and videos of patients have parent's signed consent for publication.
Author contribution
All authors participated in the development, writing and revision of this article.
Declaration of Competing Interest
The authors declare no conflicts of interest with any of the products, devices or drugs mentioned in this manuscript.
Footnotes
Supplementary material associated with this article can be found, in the online version, at doi:10.1016/j.bjps.2020.10.068.
Appendix. Supplementary materials
Supplementary Video 1. Side by side comparison of intraoral surgery recording with a GoPro Hero 7 Black camera used with a head-strap by the first surgeon, by the first assistant and hand-held by an assistant after the aseptization described process. (Still Image Provided: First Assistant with GoPro Point of View.)
References
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Associated Data
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Supplementary Materials
Supplementary Video 1. Side by side comparison of intraoral surgery recording with a GoPro Hero 7 Black camera used with a head-strap by the first surgeon, by the first assistant and hand-held by an assistant after the aseptization described process. (Still Image Provided: First Assistant with GoPro Point of View.)