YouTube is an accessible, user friendly cost-free and offers a wide range of information at our fingertips, which makes YouTube one of the most visited video platforms in the world. In recent years, its use in the medical community has been increasing, as it offers a large variety of medical and surgical videos. Several studies have shown evidence of the use of this platform by trainees in different surgical specialties[8], [10]–[12].
In recent years, its use in the medical community has been increasing, as it offers a large variety of medical and surgical videos.
Despite the accessibility and popularity in the medical community, surgical procedure-related videos available on YouTube are not peer-reviewed, therefore they usually lack the scholarly rigor required to be a reliable source of medical education[13]. Moreover, anyone can share videos on this platform unrestrictedly, occasionally affecting the quality of the videos, been compromised in terms of photography, edition and recording.
Robotic-assisted transabdominal Preperitoneal (RTAPP) has emerged as a strong option for the surgical management of inguinal hernia. Robotic surgery offers multiple benefits as improve visualization and dexterity, while been ergonomic for the surgeon, especially in difficult locations [14]. Nevertheless, the use of the robot is conditioned to the Surgeons trained in the platform or system, who must reach a high level in the learning curve to master this technique[14]. Many surgeons, unfamiliar with the use of the robot or this technique, rely on YouTube videos as an academic learning aid. On this study, we assessed the academic quality of the top 10 most viewed YouTube videos related to RTAPP surgery available to date of December 1, 2021.
After a rigorous review by a panel of experts, we evidenced that 50% of the videos had an evaluation lower than 3.5 (out of 5); only one video had a rating higher than 4.5, showing the compliance that academic materials should have, in order to be used by the trainees. Concerning the characteristics of the evaluated videos, most of them do not provide solid information about ports placement, docking of the robot or even describing - in written or narrated form - what the surgeon is performing in the different stages of the surgery. It is clear from these considerations that the videos evaluated could be labeled as a poor academic resource.
The punctual explanation of each one of the golden rules for inguinal hernia repair is beyond the scope of this article. However, it was striking that rules 1 and 2 (initial part of the surgery) and rules 9 and 10 (final part of the surgery), had an average score higher than 3.9 but that rules 3, 4, 5, 7 and 8 had a score lower than 3.5. Point emphasis on rule 7, which obtained an average score of 2.4.
Rule 7 consists of exploration of the deep inguinal canal for cord lipoma. If any lipoma is found at this level, it should be dissected because, if left untreated it may be a cause of recurrence of the hernia[6]. For this reason, this rule is essential during the surgery, furthermore, the importance of this rule is accentuated by the fact that only after having completed this step, the surgeon should proceed with the placement of the mesh[6].
Evidently, such a low score in this very important rule should warn us about the unreliability of the most viewed videos (Related to RTAPP) that can be found on YouTube, as an academic source. We believe that videos and audiovisual materials could become a valuable academic resource for trainee surgeons. An alternative, academic YouTube site would be convenient, in the same way as we have a Scholar Google search engine for scientific articles. The videos published in the platform must be regulated in such a way, that peer review would be mandatory, to set minimum requirements in terms of audiovisual quality and academic information provided during the video.
While this is being achieved, trainees should focus on official educational platforms. The incorporation of the Intuitive HUB system to robotic surgery will provide an excellent alternative to storage and access videos. This system is integrated to the Da Vinci Robot; allowing to record videos or images directly from the console. It will automatically place bookmarks of relevant moments of the surgery (stapling, Firefly imaging, etc), facilitating the edition for sharing this video on an academic platform; also offered by this system, where they can be stored either for on demand consultation or for live streaming.
The implementation and adoption of an educational platform with these characteristics, would be a revolutionary instrument in promoting a massive use of surgical videos among trainee surgeons, using this platform, will endorse to the trainees that the information published; is verified and reliable for surgical education. This will contribute to the knowledge needed by the trainee while performing robotic surgical procedures.