Anne van Dalen

102 I Chapter 3 music”. This indicates that procedures were performed in the familiar and natural way. 26, 52, 53 Quotes during the debriefings confirmed that there was often a very relaxed and good atmosphere in the OR. This may suggest that surveillance awareness and language did not seem to affect the surgical team’s performance and satisfaction. 54 This is not the first study describing the use of a video and MDR in the operating theatre. 55–57 However, the TOPPER- trial is, to the author’s knowledge, the first study that used a structured and automatically analysed video-assisted performance report as a tool for structured multidisciplinary debriefing, including all members of the operating team. In contrary to others, this study comprehensively explored the participant’s satisfaction with the use of an MDR in the OR, its performance report, and debrief methods. As stated in the literature review by Jue et al., the OR Black Box® is currently the most widespread surgical data recording technology in use in operative settings. 57 This pilot study has some limitations. As mentioned, the participants were asked to voluntarily participate and therefore the results may represent the opinion of beforehand enthusiastic, positively minded participants. One out of the six participating surgeons (MS) was beside a participant, also the project leader. This is an important bias to take into account whilst interpreting the results. To avoid bias, the 6 surgeons did not participate in the data analysis. On the other hand, leading by example is not necessarily wrong in starting disruptive initiatives. One may even argue that such an initiative simply needs a strong driver from within the community and leadership in order to succeed and result in successful implementation. Overall, the level of satisfaction among various users is very high, one may argue that the system lives up to different expectations indeed and certainly did not disappoint. Another barrier to interpretation of the study may be the fact that participants were asked to speak English during the OR Black Box® recordings. As mentioned above, the data analysis centre is situated in Toronto, Canada, and neither the software nor the ‘raters’ were able to understand and analyse Dutch. To facilitate interpretation of this learning system and maximize the information in the newly designed outcome report, authors chose upfront to revert away from bias that may have been caused by language issues. Indeed, it was believed to be not so much of a problem as the Dutch,