American Council of Academic Plastic Surgeons
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Current Techniques and Limitations in Obtaining High-Quality Craniomaxillofacial Surgical Videos for Trainee Education: A Systematic PRISMA Review
Erik Reiche, MD1; Patrick R. Keller, MD1; Danielle Trakimas, MD2; Richard J. Redett, MD1, FACS; Devin Coon, MD, MSE1
1Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA, 2Department of Otorhinolaryngology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

Background: Use of educational surgical videos by surgical trainees has become a key component of case preparation and is associated with improved trainee performance. Intraoperative educational videos of craniomaxillofacial, oromaxillofacial, and head and neck procedures (collectively ‘CMF’) are often of low-quality due to poor visualization of deep structures in tiny spaces, crowded headspace with bulky headlights, limited lines of sight, and issues with light over-exposure from spot headlights. We systematically reviewed literature on current techniques and limitations in obtaining high-quality education-oriented CMF surgical videos and we describe an affordable and accessible protocol to obtain such videos using a modified GoPro (GoPro HERO 8; GoPro Inc, San Mateo, CA) rig
Methods: Literature review following PRISMA guidelines was conducted using the MEDLINE database. The search was not limited by date, and focused on 3 search concepts: (1) CMF procedures, (2) intraoperative surgical videos, and (3) education-focused videos (Figure 1). CMF procedures included palatopharyngeal, oculoplastics, rhinoplasty, and select head & neck procedures (Table 1). Two authors independently reviewed titles and abstracts of 237 articles. 40 eligible articles were fully reviewed. 13 were included. Our video acquisition protocol is described
Results: Common equipment included action cameras, scopes (laparoscope, exoscope, borescope), and camcorders. Typical mounting positions included head or headlight, OR table, or handheld. Common limitations included poor handling of bright light, absence of surgeon point-of-view, need for intraoperative adjustments, surgeon bodily interference, and high cost (Table 2; Supplemental Table 1). We describe an adaptable, augmented GoPro Hero 8 rig that mitigates these limitations (Figure 2). Total cost of the rig and add-ons is less than $400. Total battery life with 10,000 mAh was 7 hours 42 minutes at 4K, 60FPS
Conclusion: Acquisition of high-quality educational surgical videos in deep operative fields is difficult and represents an opportunity for improvement in surgical training. Available solutions have major limitations. Dramatic recent improvements in action cameras have made high-resolution head-mounted filming accessible. By incorporation into a custom OR videography setup, high-quality educational CMF surgical videos can be obtained in a multitude of operative settings, lowering the bar of entry for others to create high-quality CMF surgical videos.

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