The Impact of Operative Video Review and Annotation on Training in Endoscopic Pituitary Surgery: A Preclinical Randomised Controlled Study

ObjectiveThis study evaluated the effect of active operative video annotation on surgical education, specifically focusing on implementability, knowledge acquisition, skill development, and confidence. BackgroundResident duty hour restrictions necessitate more efficient surgical training, as steep learning curves in many procedures may result in residents completing training without gaining enough experience to perform them safely. Video annotation of operative videos, involving labeling of instruments and steps, might offer a secure and risk-free environment to improve surgical learning. MethodsA preclinical randomized controlled trial was conducted with novice neurosurgeons from multiple centres. Participants were assigned to annotate real-life operative videos or to the control group, who performed passive video review. At baseline and then following either video annotation or video review, both groups completed a simulated pituitary adenoma resection on a validated high-fidelity physical simulator and were assessed using knowledge quizzes, a modified Global Rating Scale (mGRS), and confidence surveys. Participants also completed an implementability questionnaire. ResultsFourteen participants completed the study. Psychometric surveys indicated 100% agreement on feasibility, acceptability, and appropriateness in the annotation group, significantly higher than the review group (p<0.001). Procedural knowledge score changes were significantly higher in the annotation group compared to the video review group (1.71, 95% CI: 0.19-3.41, p= 0.0479). The annotation group also significantly improved their operative performance from baseline, with mean mGRS increasing by 5.14 (95% CI: 2.36-7.93, p=0.004) versus 2.57 (95% CI: -1.30-6.44) (p=0.16) in the video review group. Confidence improved significantly in both groups (<0.05), with no significant difference between groups. ConclusionsActive video annotation is a feasible and acceptable tool for enhancing surgical education. It led to a higher change in knowledge score compared to passive video review and also improved skills and confidence from baseline, suggesting its suitability for integration into surgical training programs. Its impact, however, on real-world surgical performance and patient outcomes requires further study.