[Legal aspects of video registration during operations--the digital operating room assistant: opportunity or threat?]. / Juridische aspecten van videoregistratie bij operaties. De digitale operatieassistent: kans of bedreiging?

Video registration in hospitals is becoming increasingly frequent and an increasing number of surgical procedures are performed with the help of video imaging. The Technical University of Delft is developing a safety system that will use video images to directly inform medical staff of technical problems during surgery so that necessary adjustments can be made in time: the digital operating room assistant. However, the saving of video images is legally considered to be processing of personal data. Dutch privacy legislation requires that certain legal demands are taken into consideration. From legal point of view three situations can be distinguished where video images are being used: (a) as an essential part of treatment (endoscopic surgery, for example), (b) to enhance the quality of the procedure, and (c) for the purposes of peer assessment or education. To whom and in which way consent has to be asked, differs per situation. We recommend that video recordings of crucial points in the operation are included in the patient file. The same counts for incidental findings or complications if, according to the standard of a good caregiver, this is necessary for the further treatment of the patient. In addition to the doctor and the patient, in certain circumstances, access to the video recordings may also be granted to the Health Care Inspectorate and, to the Public Prosecutor. Covert video recording of an employee is a breach of privacy and essentially punishable by law. Video recordings may not themselves be used to assess the performance of the surgeon involved.

[Future of endoscopic surgery--German health law and minimal access surgery in an university hospital]. / Zukunft der endoskopischen Chirurgie--GSG-Probleme der MIC in einer Universitätsklinik.

The future development of endoscopic surgery depends on a medical and economical benefit. Medical advantages are demonstrated under professional conditions of practice in a retrospective study: endoscopical repair of the groin (TEP n = 44) vs. conventional Shouldice- (n = 17) and Lichtenstein (n = 19) method, laparoscopical hemifundoplication (n = 7) vs. traditional Nissen-Rosetti procedure (n = 3) and also resection of the sigmoid (lap. n = 26) vs. open surgery (n = 12). The overall hospital stay is shortend dramatically (primary hernia of the groin 8.8 (Shouldice) and 7.4 (Lichtenstein) vs. 3.1 days (TEP); (hemi-) fundoplication 11.1 (open) vs. 5.0 days (lap.); resection of sigmoid 19.0 (open) vs.17.0 days (lap.)) At the same time quality of care is held or improved. Comparison of real cost analysis revealed a better economical result (593-970 DM lower cost for TEP, 1.256 DM lower costs for lap. hemifundoplication, and 1.918 DM in case of lap. resection of sigmoid) for minimal-access-surgery (MAS), although particular costs for the endoscopic surgical procedure are increasing up to 100%, especially at the beginning (learning curve). The German payment-system does not regard the special conditions of MAS. There is no case-related payment for MAS due to the lower overall costs. Therefore the financial result is worse than for conventional treatment.