Implementation of audiovisual recording in the operating room: a nationwide survey of stakeholder perspectives in France

Audiovisual recording technology, referred to as the Operating Room Black Box (ORBB), is increasingly adopted in operating rooms (ORs) across several countries. It is described as beneficial, with potential to improve training, performance, and patient safety. However, its implementation raises ethical and legal concerns, such as privacy, data security, and fears of misuse. These challenges require careful consideration alongside anticipated benefits. In France, ORBB use is emerging, yet no data exist on perceptions of professionals and patients. This study aims to identify obstacles and facilitators to ORBB implementation in French ORs. An observational, prospective, multicenter study was conducted, with questionnaire responses collected overall between 13 April 2023 and 16 July 2024. Three digital questionnaires were used: a 14-item questionnaire for anesthesia professionals, a 16-item questionnaire for surgical professionals, and a 16-item questionnaire for patients. These were distributed via partner organizations, including professional societies and patient associations. Data included sociodemographic information and opinions on risks, benefits, and conditions of ORBB implementation. The study included responses from 831 participants: 45.5% anesthesia professionals, 38.6% surgical professionals, and 15.9% patients. While many professionals (80.7%) recognized educational benefits, concerns about privacy (77.8%) and anxiety from constant monitoring (80.1%) were prominent. Patient perspectives were generally supportive, with 84.8% in favor, and many viewed ORBB as enhancing accountability (77.3%). Nevertheless, privacy concerns remained (66.7%). These results, from the first national survey of its kind in France, provide insights into stakeholder expectations and concerns. Patient and professional perspectives show both overlaps and divergences, which must be considered to guide ORBB deployment.