Smart Surgery

Case study: Improving efficiency of surgical video capture

29 Sep 2021

Challenge: Demonstrate the use of CX-ADVANCE to improve efficiency in the workflow of surgical video-based assessment in quality-focused organizations.


The University of Iowa system of Hospitals and Clinics (UIHC) represent over 1,500 providers in 200 specialties that include advanced surgical procedures. UIHC has been continuously designated the number one hospital in Iowa for the past 32 years by US News and World Report. Additionally, the surgical service line is an MSBAQIP accredited center of excellence and has Blue Distinction from United Health Care.

Dr. John Cromwell, UIHC clinical professor of gastrointestinal surgery and the Director of Surgical Quality & Safety, leads a team that describes their work as a “focus on the application of artificial intelligence, machine learning, predictive analytics, and medical devices to improving the quality and safety of surgical care”.      

Another team member is Dr Peter Nau, a bariatric surgeon, clinical associate professor of surgery and Director of the Digestive Health Program, and a pioneer of two of the most challenging bariatric procedures: gastric bypass and gastric sleeve. He has a dedicated interest in surgical video-based analysis (VBA) to continuously improve patient outcomes.

Caresyntax joined Dr.’s Cromwell and Nau to document efficiencies gained by using the CX-ADVANCE software to streamline surgical video capture to simplify VBA workflow on the path to improved surgical outcomes.

Problem Statement                                                                                                 

Manual capture of videos for review is time consuming and labor intensive. The process requires an individual physically track OR towers with recorded surgical video, manually download the videos to a USB flash drive from the endoscopic tower (“tower”) and upload the USB-based file to a laptop. Surgeons participating in reviews are then notified via an email — also manually created — directing them to the video file now ready for VBA.


Improve workflow and reduce clinician burden by automatically capturing surgical videos using the CX-ADVANCE software.


Document, through clinician experience, improved workflow, and time savings with the use of CX-ADVANCE for video capture prior to evaluation.

Current VBA Workflow

  1. Surgical team obtains consent from the patient.                                                     
  2. A RN must push the “Record” button on the tower.
  3. A bariatric surgery is performed and completed.
  4. A RN must push “stop Recording” button on the endoscopic.                       
  5. Nau places a USB flash drive in the tower and manually downloads the case file for his surgery. (Multi-GB video files can take 10+ minutes per  case)                                                                                                                         
  6. When Dr. Nau is not the operating surgeon, he must return to the ORs at the end of the day, manually identify the case on the tower, and download. (30+ minutes)                                                                                                               
  7. Nau returns to the office and uploads videos from USB to laptop. (30 minutes)                                                         
  8. Nau checks video quality and completeness. (10 minutes)                             
  9. Nau manually sends email(s) to surgeon(s) completing the VBA. (10 minutes)
  10. Assessors access the video online and complete the assessment. (< 10 minutes)
  11. Assessing surgeons email Dr. Nau (or participating surgeon) that they have completed the VBA. (5 minutes)                                                                      

Total time to initiate a VBA: 105+ minutes (does not include surgical procedure time)

CX-ADVANCE VBA Supported Workflow

  1. Surgical team obtains consent from the patient.                                                     
  2. A circulating nurse selects patient from the worklist and video recording automatically begins. (<5 minutes)      
  3. A bariatric surgery is performed and completed.
  4. A circulating nurse selects “end case” from the screen, and the video recording is completed.                                                                                          
  5. Recorded surgical videos are automatically uploaded and linked to the participating surgeon’s case in CX-ADVANCE. (0 minutes)
  6. Surgeons’ assessors are automatically notified that a new case is available for VBA. (0 minutes)
  7. Assessing surgeons access the video platform by clicking/tapping a hyperlink in the email (laptop, mobile device) and are taken directly to the case video. (< 1 minute)
  8. Assessing surgeons complete the VBA. (< 10 minutes)                                       
  9. CX-ADVANCE automatically sends an email notification to the evaluated surgeon that a new VBA assessment is available.

Total time: < 11 minutes (does not include surgical procedure time).


In a single specialty domain, there is improvement of over 90 minutes in the daily workflow of capturing surgical videos for evaluation and quality improvement efforts by utilizing CX-ADVANCE as compared to a manual process. These savings could be multiplied across all surgical specialties within an organization, saving clinicians hundreds of precious hours per year while enabling their active participation in surgical outcome improvement.

Time to Evaluate Bariatric Video Casesblog


Assessing variation in technique for sleeve gastrectomy based on outcomes of surgeons ranked by safety and efficacy: a video-based study.

Varban OA, Thumma JR, Finks JF, Carlin AM, Kemmeter PR, Ghaferi AA, Dimick JB.

Surg Endosc. 2019 Mar;33(3):895-903. doi: 10.1007/s00464-018-6382-y. Epub 2018 Aug 15.

PMID: 30112611


Evaluating the Effect of Surgical Skill on Outcomes for Laparoscopic Sleeve Gastrectomy: A Video-based Study.

Varban OA, Thumma JR, Finks JF, Carlin AM, Ghaferi AA, Dimick JB.

Ann Surg. 2021 Apr 1;273(4):766-771. doi: 10.1097/SLA.0000000000003385.

PMID: 31188214



Physician Champion : Michael Woods MD

Clinical Improvement Lead : Jackie Tonkel

Clinical Study Lead : Valerie Ekstrom


UIHC TEAM              

Executive Sponsor: John Cromwell MD

Physician Champion: Dr Peter Nau MD





© Copyright 2021. Caresyntax Corp.

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