Evaluation of the Quality of Educational YouTube Videos on Endoscopic Choanal Atresia

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J Rhinol. 2025;32(1):36-39

Publication date (electronic) : 2025 March 21

doi : https://doi.org/10.18787/jr.2024.00037

Shirin Irani, MD, MPH¹, Sevil Nasirmohtaram, MD^,2

¹Otorhinolaryngology Research Center, Amir-Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran

²Otorhinolaryngology Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran

Address for correspondence: Sevil Nasirmohtaram, MD, Otorhinolaryngology Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht 4165755199, Iran Tel: +989123865953, E-mail: sevil198@yahoo.com

Received 2024 November 2; Revised 2024 December 17; Accepted 2025 January 20.

Abstract

INTRODUCTION

For many years, traditional educational resources such as books, clinical practice guidelines, and journal articles have been foundational in medical education [1]. However, technological advancements have significantly transformed this landscape in recent decades, shifting education from traditional classrooms to online platforms [2]. Among these platforms, YouTube has emerged as one of the most widely used tools for teaching medical procedures and operations. Medical residents frequently turn to YouTube to learn surgical techniques and quickly identify potential mistakes [3]. Similarly, medical professors extensively use the platform to share videos of their own procedures [4]. YouTube is particularly popular in laparoscopic and endoscopic surgery, as these camera-based procedures are relatively straightforward to record. While surgical videos on YouTube offer numerous benefits, their quality can vary significantly, and the presence of misinformation may undermine their educational value [5,6].

The LAParoscopic surgery Video Educational GuidelineS (LAP-VEGaS) questionnaire was developed using the Delphi method to evaluate the quality of laparoscopic surgery training videos. This tool encompasses seven domains: introduction and surgeon information, patient and disease details, procedure description, surgical outcomes, educational content, material review, and curriculum usage [7]. It has been applied across various surgical fields, including general surgery, upper and lower gastrointestinal surgery, gynecological surgery, and urology, following thorough evaluation [8-11]. Some studies have also used LAP-VEGaS to assess the quality of videos in otolaryngology. For instance, one study evaluated YouTube videos of endonasal transsphenoidal surgery [10]. Additionally, Dikmen and Dikmen [12] used LAP-VEGaS to assess dacryocystorhinostomy (DCR) videos, comparing external and endoscopic techniques. Bitner et al. [13] also employed the tool to evaluate the quality of YouTube videos related to endoscopic procedures in rhinology.

Although it was originally designed for laparoscopic surgery, prior studies have demonstrated that LAP-VEGaS is also applicable to endonasal surgery, suggesting its potential to improve the quality of educational videos in this specialty [10-12]. Given the rarity of choanal atresia, residents and otolaryngologists often rely on educational videos to learn the surgical procedure. YouTube serves as a valuable resource for otorhinolaryngological specialists and residents to effectively learn endoscopic techniques. To our knowledge, no prior studies have examined the quality of surgical videos related to choanal atresia. Therefore, this study aimed to evaluate the quality of videos on endoscopic choanal atresia surgery using the LAP-VEGaS questionnaire.

METHODS

In this descriptive cross-sectional study, we searched YouTube using the keywords “choanal atresia,” “atresia of the choana,” “atresia,” “endoscopic choanal atresia,” and “endoscopic repair of choanal atresia.” After the initial search, one of the authors (SN) assessed the results, excluding duplicate videos, schematic films, videos demonstrating open surgical techniques instead of endoscopic methods, non-English videos, and those with purely theoretical explanations. Ultimately, 50 videos were selected (Fig. 1) and independently evaluated by two rhinologists who had completed specialized fellowships.

Fig. 1.

Flow chart of videos included in the current study.

The videos were evaluated using the LAP-VEGaS checklist, as outlined in Table 1. We utilized this assessment tool based on the work of Celentano et al. [7], whose copyright license permits its use with proper citation.

Table 1.

The LAParoscopic surgery Video Educational GuidelineS video assessment tool

LAP-VEGaS consists of 16 items divided into five categories: introduction (2 items), case presentation (4 items), procedure (4 items), outcome (4 items), and educational content (2 items) [7]. The first 15 items were scored as either 0 (not included) or 1 (included), while the last item was scored as 0 (not included), 1 (written commentary), or 2 (audio commentary), yielding a total score range of 0–17 for each video. The final assessments were reviewed by both authors, and in cases of disagreement, a third surgeon was consulted to reach a consensus. Data assessment and analysis were conducted during September and October 2023.

The data were analyzed using SPSS for Windows version 27 (IBM Corp.).

This research was approved by the ethical committee of Tehran University of Medical Sciences under the ethical code of “IR.TUMS.AMIRALAM.REC.1403.027.”

RESULTS

In this study, we systematically reviewed 50 training videos on endoscopic choanal atresia surgery, selected from a total of 108 videos available on YouTube based on our inclusion criteria. The view counts for these videos ranged from 28 to 27,000, with the number of likes varying from 0 to 278.

The videos’ median score was 7, with scores ranging from a minimum of 1 to a maximum of 16. Evaluation using the LAP-VEGaS checklist revealed that most videos provided an adequate video introduction, typically including essential information such as the title and author details. Among the assessed categories, the case presentation section received the highest scores.

As shown in Table 2, the three most commonly reported items across the videos were step-by-step approach, patient anonymity, and title, listed in descending order. In the introduction category, the item title including pathology and procedure received a notably high score. Patient anonymity achieved the highest overall score; however, there was a significant lack of information regarding preoperative workup and treatments in the case presentation section.

Table 2.

Summary of video scores based on the (LAP-VEGaS) video assessment tool

In the procedure category, the only item that attained relatively high scores was the step-by-step approach. In the outcome category, the majority of videos (49 out of 50, or 98%) did not provide information on hospitalization time, and 45 videos (90%) failed to address patient morbidity. Lastly, in the educational content category, only 4 videos (8%) incorporated visual aids such as pictures, snapshots, diagrams, or tables.

DISCUSSION

In this study, we evaluated 50 videos on endoscopic choanal atresia surgery. The view counts of the reviewed videos ranged from a modest 28 to an impressive 27,000, reflecting a wide spectrum of user engagement. The substantial variation in likes, from 0 to 278, further suggests that viewer satisfaction does not necessarily correlate with video quality or educational value.

While most videos provided adequate introductions and adhered to patient anonymity principles, they often lacked critical details such as time spent in the operating room, hospitalization duration, morbidity rates, and functional outcomes. Notably, the case presentation section received the highest scores, primarily due to the inclusion of a step-by-step approach, which is essential for surgical education. However, this focus on procedural steps often came at the expense of preoperative considerations and postoperative outcomes. The absence of postoperative information—particularly regarding hospitalization time and patient morbidity—represents a significant gap in these educational resources. Such details are vital for understanding the implications of surgical interventions and preparing residents to manage postoperative care effectively. Additionally, the lack of visual aids in the educational content diminished the potential impact of these videos.

Our analysis indicated that online training videos for endoscopic choanal atresia surgery generally had low educational quality, with a median LAP-VEGaS score of 7. Previous studies using the LAP-VEGaS tool have also identified low educational quality in otolaryngology training videos. For example, an evaluation of endonasal transsphenoidal surgery videos on YouTube revealed an average score of only 3±9 across 43 videos, with an average length of 7 minutes. The lowest scores were related to patient positioning and surgical team dynamics (0.4) and surgical outcomes (0.2), underscoring the omission of essential components in creating high-quality educational content [10]. Dikmen and Dikmen [12] assessed 30 high-quality DCR videos using LAP-VEGaS and compared external and endoscopic techniques. They found that videos related to the external method had a mean score of 2.98±10.65, which was significantly higher than those for the endoscopic technique, which scored 3.7±8.44 (p=0.009). Overall, many YouTube videos in this field fail to meet necessary educational standards. In the field of rhinology, Bitner et al. [13] evaluated the quality of YouTube videos on endoscopic procedures and concluded that while these videos are integral to surgical education, their quality is highly inconsistent. This highlights the need for stricter regulations and improvements in video-sharing practices.

We identified two insights that could inform future research. First, while LAP-VEGaS has been used to assess endoscopic otolaryngology procedures, there is a need for a specialized extension of the tool tailored specifically for endoscopic surgery. Second, prior research has employed two different scoring methods for LAP-VEGaS questions [14]. One method uses a 0–1 scale (0=not presented; 1=presented), while the other employs a 0–2 scale (0=not presented; 1=partially presented; 2=completely presented). Based on our experience, we believe the 0–2 scale is easier to implement and provides more nuanced evaluations.

This study has some limitations. First, the small sample size may limit the generalizability of our findings to other surgical fields and procedures. Second, videos produced in languages other than English were excluded, which means the results may not apply to educational videos created for non-English-speaking trainees. Third, the study focused exclusively on YouTube and did not include videos from other online platforms, such as free video websites or purchasable content, which may differ in quality and perspective. This restricts the generalizability of our findings, and future research should expand the scope to include these platforms for a more comprehensive evaluation.

In conclusion, while YouTube videos have become a widely used resource for surgical education among residents and trainees, our findings indicate that their quality is often inadequate for effective learning. Residents and trainees should approach these resources with caution, considering their potentially limited educational value. There is a pressing need for the development of high-quality academic videos on online platforms to enhance the educational value of endoscopic surgical techniques.

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