Standardization and quality assessment in surgery

This thesis focuses on two key themes in surgery: the standardization of colorectal surgery and the development and use of video-based tools for surgical quality assessment. The first part examines the standardization of procedures such as minimally invasive right hemicolectomy (MIHR) for right-sided colon cancer. The most optimal technique for MIHR has been developed, in which performing an intracorporeal anastomosis and extracting the specimen via a Pfannenstiel incision combined with low intra-abdominal pressure and the application of complete mesocolic excision, is associated with the best clinical outcomes. The Right study, a Dutch multicenter study, aims to develop and implement this standardized MIHR technique to reduce variability between hospitals and improve surgical outcomes. Another aspect of this thesis is the development and use of video-based tools in surgery. Through a systematic review, various tools used in minimally invasive surgery were identified. The findings show that validated tools enable reliable assessments of surgical quality, which is important for training and quality improvement. In addition, a video-based tool for MIHR was developed, based in part on previously established consensus regarding the critical steps of the procedure. Both trained medical students and surgeons were able to reliably assess these videos. A separate study showed that surgical trainees are capable of reliably assessing the critical view of safety in laparoscopic cholecystectomy videos using an existing tool. These findings highlight the value of video-based quality assessments in both surgical education and practice, contributing to improved training and ultimately better patient outcomes. In summary, this thesis emphasizes the importance of standardized techniques and objective, video-based quality assessments in surgery, which help reduce variability, improve outcomes and strengthen the training of future surgeons.