Video-taping: A mechanism to ensure quality control of endometriosis surgery

Before a new drug treatment can be introduced, the drug must undergo a special type of testing known as a randomised controlled trial (RCT). In an RCT, each person is randomly given one of two treatments. One half are given the new drug. The other half are given an ‘old’ drug whose effects are well known, or a placebo (‘dummy’ sugar pill).

At the end of the trial, the results of the two treatments are compared. The comparison gives doctors a reliable measure of the new drug’s efficacy (how well it works) and side effects compared with the ‘old’ drug or no drug. The new drug is released only if the trials show that it is an effective and safe treatment.

However, the situation is not so simple for surgery. A woman’s surgery depends on the locations and extent of her endometriosis, and the skill, experience and expertise of her surgeon. Therefore, each woman’s surgery is different. As a result, evaluating the effectiveness and side effects of surgery is almost impossible, because you do not have two standard treatments to compare.

In addition, it is generally considered unethical to carry out randomised controlled trials for surgery, because the trial would involve half the women having ‘proper’ surgery (having their endometriosis removed, etc), and the other half having ‘sham’ surgery (simply going in and out with a laparoscope, but not removing any endometriosis, etc).

A simple solution would be for surgeons to video-tape every woman’s surgery from beginning to end, and to give each woman a copy of her tape. You do not need to watch the video-tape, but you should keep it for future reference.

The tape would record your surgery, including any mistakes. If you experienced complications following the surgery, it would be easy for the surgeon — or another surgeon — to look at the tape and see what happened during the surgery. If they found any problems, they could deal with your complication quickly and efficiently.

The video-tape could also be used to ascertain that your surgery was performed accurately, meticulously and precisely, and that your apparent complications following surgery were not due to inadequate surgery.

If your symptoms recurred after surgery, the surgeon could go back to the video-tape to see if all the lesions had been removed, and thus determine whether your symptoms were due to the emergence of new lesions or a recurrence of old lesions.

Today, there is no excuse for not video-taping every endometriosis surgery. Doing so would ensure that there is a quality control mechanism for endometriosis surgery. CDs and DVDs allow the information to be stored and retrieved easily. Watermarking of the video-tape would allow it to be validated at a later date if necessary.

Surgeons who refuse to provide you with a video-tape of your surgery may not be confident of their ability to perform the very best surgery for you. This inaction provides ‘quality control’ of a sort. Unless surgeons are prepared to record their work, they will never be able to provide the necessary quality control to show that their surgery is an effective and successful treatment for most women with endometriosis.

Always ask your surgeon whether they will video-tape your surgery, and whether you can have a copy of the tape. If they refuse, you need to decide whether you have confidence in their ability to provide you with the best surgical care — after all, a good surgeon has nothing to hide.