Analysis of the Quality of Septoplasty Videos on YouTube and Validation of the IVORY-Grading-System Quality of Septoplasty Videos

Analysis of the Quality of Septoplasty Videos on YouTube and Validation of the IVORY-Grading-System Quality of Septoplasty Videos | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Analysis of the Quality of Septoplasty Videos on YouTube and Validation of the IVORY-Grading-System Quality of Septoplasty Videos Marcel Mayer, Tarik Bugra Isik, Ina Ev, Yigit Kurnaz, Numan Kirca, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5427027/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective This study aimed to analyze the educational quality of septoplasty videos on YouTube and validate the “Instructional Videos in Otorhinolaryngology by YO-IFOS-Grading-System” (IVORY-GS), the first otorhinolaryngology-specific video scoring system based on the IVORY Guidelines. Methods A search for “septoplasty,” “closed septoplasty,” and “deviated nasal septum surgery” was performed on YouTube in March 2023. Videos of surgeries on patients and cadaver dissections were included. The IVORY-GS was adjusted for septoplasty and applied to rate video quality based on criteria related to ethics, technical aspects, case presentation, surgical procedure, and organ-specific elements. Descriptive data on video characteristics was collected, including views, likes, video length, and time since publication. Statistical analyses were conducted to identify associations between video features and the IVORY-GS total score. Results Overall, 105 septoplasty videos were included. Among these, 40% demonstrated Cottle’s, while 53% followed Killian’s technique. Mean IVORY-GS total score for septoplasty videos was 25.3 (maximum 48). Video education quality was rated as moderate/high in 10%. Endoscopic versus macroscopic videos (p < 0.01) and videos published within the last 50 months versus those published earlier (p < 0.01) received significantly higher total scores. A significant correlation was found between the total score and number of likes (p = 0.02). A higher total score was a significant predictor for more likes (p = 0.02). Conclusion The analysis revealed only a small proportion of septoplasty videos available on YouTube being suitable for surgical training. The IVORY-GS has proven useful in assessing the educational value of otolaryngology-specific videos and can be beneficial for establishing a dedicated online platform for high-quality otorhinolaryngology surgery videos. Septoplasty Educational Videos IVORY Guidelines IVORY-Grading-System YouTube Figures Figure 1 Introduction Surgical education has undergone marked changes over time. While textbooks have traditionally been the main source of insight into techniques, there has been a need for visual demonstrations, including surgeries on cadavers, patients, or inorganic models 1 . A more modern development is digital education, especially video-based learning 2 . Surgical videos are a widely embraced learning aid for surgical training 3 – 6 . While video journals with peer-reviewing processes do exist 7 , 8 , they are not as widespread as freely available platforms like YouTube, which in turn lack strict regulation and quality control, allowing surgery videos to be published without any peer-reviewing process. In addition, some medical societies (e.g., the European Rhinologic Society) offer video material. But these online offers require a registration, membership, and are difficult to access. To aid authors in creating otorhinolaryngology surgery videos, Simon et al. established the IVORY Guidelines in 2021, albeit without a video assessment tool 9 . To address this, we shortly introduced the IVORY-Grading-System (IVORY-GS) based on the IVORY Guidelines, the first otorhinolaryngology-specific video scoring system, and implemented it on parotidectomy videos found on YouTube 10 . Septoplasty is a surgical procedure that aims at co a deviated nasal septum, with a history dating as far back as 17th century BC: the Edwin Smith Surgical Papyrus describes insertion of “two (other) plugs of linen saturated with grease in the inside of his two nostrils” for a patient with a fractured nose 11 . Since then, there have been many different approaches. Both Killian and Freer implemented submucous resections and advocated keeping the mucosa intact on both sides. 12 In 1929, Metzenbaum pioneered surgery for the correction of septum deviation using the swinging door technique to mobilize the caudal part of the septum. In 1948, Cottle and Loring introduced the “maxilla-premaxilla approach” through the hemitransfixion incision. 13 , 14 Septoplasty is one of the most common otorhinolaryngology procedures performed on adult patients worldwide 15 – 18 , with approximately 260,000 operations performed solely in the United States 19 . Despite being widely considered a “beginner's operation” 20 and commonly used in the surgical training of otorhinolaryngology residents 21 , septoplasty is a procedure difficult to master due to several techniques necessary to address different pathologies and poor visibility. Therefore, we decided to apply the IVORY-GS on septoplasty videos. The aim of this study was not only to analyze the educational quality of surgical videos, but also to further validate the IVORY-GS. Methods The search terms “septoplasty”, “closed septoplasty” and “deviated nasal septum surgery” were applied in YouTube’s search engine in March 2023. Videos of live surgeries on patients as well as cadaver dissection videos were included. Videos showing open septoplasty or septorhinoplasty as well as those additionally displaying sinus surgery were excluded. Video statistics including date of upload, view count, video length, number of likes, the authors’ country of origin and specialty were extracted. The age of the video was calculated in months between date of analysis (April 2024) and date of upload of the specific video. Regarding septoplasty specific information, the method of visualization (i.e., endoscopic, macroscopic, microscopic), the utilization of cotton pledgets, septal splints and tamponades, preoperative infiltration, whether additional turbinate surgery (partial or complete removal of the inferior nasal turbinate) was performed, and the specific septoplasty technique (i.e., Cottle’s, Kilian’s, other) were analyzed. The sections A-D of the IVORY Guidelines 9 were adopted excluding Section B, item 9: “When available, peer review of the video is recommended before publication, assessing the procedure (e.g., scientific validity, safety) as well as the quality of educational editing” as no peer reviewing process for uploading videos on YouTube is established and, therefore, the authors could not decide if a video was peer reviewed. Section E was redesigned to be organ-specific for a septoplasty. As section E of the IVORY Guidelines only describes recommendations for functional endoscopic sinus surgery, otology, vocal cord surgery, airway surgery, and plastic surgery, this section was adjusted by the surgical steps of a septoplasty based on “ENT-Head and Neck Surgery: Essential Procedures” by Theissing et al. 22 and a comprehensive review article on septoplasty authored by Scheithauer et al. 21 . These steps included the incision, the approach to the septal cartilage, mobilization of the pathological cartilage/bone, resection of the pathological cartilage/bone, reconstruction of the septum, and fixation (Table 1 ). These steps were exclusively rated according to their educational presentation. Each item of the sections A-E of the IVORY Guidelines was rated: 0 points indicated that the video was not in line with the guidelines’ recommendations, 1 point indicated that the video was partially accordant with the recommendations, 2 points indicated that the video fully reached the recommendations. Table 1 displays the herein used rating sheet modified from the IVORY Guidelines. The IVORY-GS total score was calculated by summarizing the points for each item of the sections A-E for each video. A maximum total score of 48 points was obtainable. The total score was subdivided into the grades A-F following the academic grading system of the USA, which expresses percentages as letters with A being equivalent to 90–100%, B being equivalent to 80–89%, C being equivalent to 70–79%, D being equivalent to 60–69%, and F being equivalent to less than 60%, respectively 23 . Two otolaryngologists experienced in septoplasty (MM, fifth year of residency; SS, consultant) independently assessed the videos according to the herein introduced IVORY-GS for septoplasty (Table 1 ). Where findings were not consistent between both raters, a consensus assessment was found following detailed discussion. Statistical Analyses SPSS software version 28.0 (IBM, Armonk, NY) was used for statistical analysis. Pearson’s correlation was used to measure the strength of correlation between metric variables. The student’s t-test was applied to compare differences between two independent groups for metric variables. Linear regression was used to calculate the strength and significance of the association between metric dependent and independent variables. p-values < 0.05 were defined as statistically significant. Results Basic characteristics of included videos Overall, 105 septoplasty videos were included in the analysis. The videos had been published between January 2 nd , 2009, and January 8 th , 2023. Most videos stemmed from India (n = 41; 39%), followed by the USA (n = 28; 27%), and Egypt (n = 9; 9%) (Figure 1a). Only one video (1%) displayed a cadaver dissection, whereas 104 videos (99%) showed septoplasty on alive patients. Eighty-four (80%) videos were produced by otorhinolaryngologists, while 21 (20%) videos were produced by surgeons specialized in otolaryngology and plastic surgery, plastic surgeons, maxillofacial surgeons, and surgeons of unknown specialty (Figure 1b). The mean number of views was 63,893.0 (SD 269,014.5) and the mean number of likes per video was 213.9 (SD ± 958.3; range 0 to 8,343), respectively. In 42 videos (40%), septoplasty according to Cottle’s technique was performed, whereas Kilian’s technique was applied in 56 (53%) of videos. Seven videos (7%) showed septoplasty, which did not match any common septoplasty technique (Table 2). IVORY-Grading-System The mean IVORY-GS total score was 25.3 (SD ± 6.6) out of a maximum of 48 points. The videos with the highest and the lowest total scores reached 43 and 7 points, respectively (Table 2). When grouping the videos according to the academic grading system of the USA, 73 videos (70%) achieved an F (Table 3). The next highest category, grade D (60–69%), included 21% of the videos, with a score range of 29 to 33 (Table 3). In the middle and higher categories, grade C (70–79%) and grade B (80–89%), significantly fewer videos were represented, with shares of 7% and 2%, respectively (Table 3). Only 1% of the videos reached the highest grade category, A (90–100%), with a score range of 43 to 48 (Table 3). The analysis showed a statistically significant correlation between the total score and the number of likes (p = 0.02, Pearson’s R = 0.23) (Table 4), which is in line with the results of linear regression analysis, which revealed a higher IVORY-GS total score to be a significant predictor for more likes (p = 0.02). Lastly, endoscopic compared to macroscopic videos (p 50 months ago were associated with a significantly higher total score. No association was found between length (p = 0.26) or specialty of the surgeon (p = 0.40) and the total score (Table 5). Discussion To the best of our knowledge this is the first study focusing on the systematic evaluation of septoplasty videos. In addition, this is the second study analyzing surgery videos using the recently introduced IVORY-GS. In our previous study, we introduced the IVORY-GS and utilized it to analyze 50 parotidectomy videos 10 . With this study, we turn our attention to septoplasty, a substantially more common 15 – 19 but less standardized 12 , 13 procedure. The analysis of the 105 septoplasty videos not only provided valuable insights into the characteristics and quality of these videos but also helped to further validate the IVORY-GS. We consider the evaluation of surgery video quality to be crucial for both medical professionals and students seeking educational resources for their surgical training. This requires a field-specific dedicated objective video assessment tool, which is what we intend the IVORY-GS to be. A tool similar to the IVORY-GS is the LAP-VEGaS video assessment tool 24 based on the LAP-VEGaS Practice Guidelines 25 , which was utilized in previous studies to analyze videos of neck dissections 26 , transsphenoidal surgeries 27 , thyroidectomies and parathyroidectomies 28 , respectively. The LAP-VEGaS video assessment tool was originally intended to evaluate the educational quality videos of laparoscopic procedures. Since it is not otorhinolaryngology-specific and only consists of nine criteria 24 , it is uncertain, if it can comprehensively assess the intricacies of otorhinolaryngological surgeries and deliver precise analyses of the educational quality of otorhinolaryngology-specific surgery videos. With five sections consisting of “Ethics”, “Technical aspects”, “Case presentation”, “Surgical procedure”, and “Organ-specific”, and a total of 24 criteria for parotidectomy or 25 criteria for septoplasty, we found the IVORY-GS to be well suited for analyzing the educational value of otorhinolaryngology surgery videos 10 . For the present study, we analyzed 105 septoplasty videos found on YouTube. The majority of the videos we examined fell short in terms of educational standards, aligning with the findings of Luu et al. 26 , De La Torre et al. 27 , Chorath et al. 28 . Compared to parotidectomy videos, an even larger proportion of the videos (70% compared to 58% 10 ) were rated F according to the academic system of the USA. With only one video receiving grade A, two videos grade B, and seven videos grade C, only 10% of the videos were of medium to high educational quality, and thus suitable for surgical training (Table 3 ). This highlights the compelling need for an otorhinolaryngology-specific surgical video platform with strict quality control, such as the IVORY-GS, prior to publishing. In the previous study analyzing parotidectomy videos, we demonstrated that the procedure was relatively standardized. More precisely, 82% of the videos featured microscopic approaches, 78% demonstrated modified Blair's incisions, and in 92% of the videos, the facial nerve was exposed anterogradely 10 . In contrast, septoplasty showed more variation in its approaches. Regarding operational technique, 53% of the videos utilized Cottle's technique, while 40% followed Killian's technique. Furthermore, 48% of the videos demonstrated preoperative infiltrations, while the remaining 52% did not. This wide array of approaches makes septoplasty a challenging procedure to master. Despite this variety, the endoscopic approach stood out as the most popular visualization, appearing in 85% of the videos, in contrast to the macroscopic (15%) and microscopic (0%) approaches. This most likely reflects the origin of the videos with almost 50% produced in India and Egypt and only 8% originating from Europe, where the macroscopic technique predominates. Studies conducted by Luu et al. 26 , De La Torre et al. 27 , and Chorath et al. 28 did not encompass an analysis of variations in technique. The mean number of views for the septoplasty videos was notably higher than the mean number of views for the parotidectomy, neck dissection or transsphenoidal surgery videos (63,893 compared to 19,714 10 , 25,368 26 , and 16,017 27 , respectively). This suggests a greater interest in septoplasty videos. This could be due to septoplasty being a more commonly performed procedure compared to parotidectomy 29 , neck dissection 30 and transsphenoidal surgery 31 . Additionally, as it is impossible to determine whether the audience comprises medical professionals or interested laypersons, the fact that septoplasty, unlike parotidectomy, neck dissection, and transsphenoidal surgery, is performed as part of aesthetic septorhinoplasty 32 , might have contributed to higher views, particularly among patients seeking information. Despite thyroidectomy and parathyroidectomy being less frequently performed procedures 33 , 34 , videos describing these procedures garnered a higher (72,977 for thyroidectomy) or comparable average number of views (60,001 for parathyroidectomy) than those featuring septoplasty 28 . In addition to evaluating septoplasty videos with the IVORY-GS, we collected various video data, including the method (macroscopic/microscopic/endoscopic), views, likes, video length and age in order to explore correlations and associations with the IVORY-GS total score, which can help viewers identify videos of higher educational value. A significant association between videos published 50 months ago or more recently compared to those published more than 50 months ago and a higher total score was found. This may be due to recent improvements in technical visualization and a shift towards a more didactic intent when publishing surgical videos. Furthermore, endoscopic videos were associated with a significantly higher total score compared to macroscopic videos, most likely because endoscopic videos provide a clearer view of the surgical area and relevant structures during the operation, making them more suitable for educational purposes. More likes were significantly correlated with a higher total score, reflecting that better educational quality is appreciated by the viewers. This correlation aligns with our previous study on parotidectomy videos, where we found a statistically significant correlation between likes and the IVORY-GS total score 10 . Likewise, the likes-to-dislikes ratio correlated with a higher score in Chorath et al.’s study on thyroidectomy and parathyroidectomy videos 28 , and in Luu et al.’s study on neck dissection videos 26 . For these reasons, we strongly recommend seeking endoscopic septoplasty videos with more likes and those published within the last 50 months for educational purposes. However, it is important to emphasize that even the best videos cannot replace hands-on education. Surgical training should primarily take place in a practical environment under the supervision of an experienced surgeon specializing in the particular procedure. Lastly, a higher IVORY-GS was a significant predictor for more likes in the linear regression analysis. This finding further validates the IVORY-GS as a suitable otolaryngology-specific rating instrument for surgical videos, as it indicates that qualitatively higher rated videos were also perceived to be better by their viewers. Various medical societies provide educational videos, but access to these resources is typically limited to their members. For residents to access these resources, they must first be aware of the existence of the relevant subspecialty society and then navigate a complex registration process. Given the consistently observed low quality of educational videos on YouTube, as highlighted in both our studies and numerous others, we advocate a simplified registration process for residents. Several limitations must be considered in interpreting the results of this study. Firstly, it is not always possible to ascertain, whether surgical videos found on YouTube are published for surgical training, patient information, or commercial reasons. Nevertheless, we chose to include all videos that met the abovementioned search criteria, as these videos represent what viewers might encounter and use while searching for septoplasty videos for surgical education. Additionally, while the first four sections of the IVORY-GS can be applied universally to all videos, the section “Organ-specific” must be adjusted for each surgical procedure. This might be particularly challenging for less common operations. In the case of septoplasty, the lack of standardization posed a challenge in appropriately adjusting Section E “Organ-specific” to accommodate the various techniques employed. As a result, we expanded Section E to include six aspects for septoplasty. It is worth noting that more complex procedures may require even more organ-specific aspects, potentially leading to an overrepresentation of Section E. Conclusion The current adaptation of the IVORY Guidelines is an otolaryngology-specific and suitable tool for evaluating septoplasty videos and can be thus recommended by the authors. This marks the second study utilizing the IVORY-GS, our findings demonstrating its versatility in assessing the educational quality of a broader range of otolaryngology-specific surgery videos. Moreover, the results indicate that the majority of septoplasty videos available online have low educational value. While factors such as more likes, endoscopic videos, and videos published within the last 50 months may serve as potential indicators of higher quality, we firmly advocate for the establishment of a dedicated otolaryngology-specific online video platform or easily accessible educational surgery videos provided by medical societies with robust quality control process, such as the IVORY-GS. Declarations Author Contribution MM: Conceptualization, Data curation,Formal analysis, Writing-original draft, MethodologyTBI: Data curation, Writing—review & editingIE: Data curation, Writing—review & editingYK: Data curation, Writing—review & editinNK: Data curation, Writing-review & editingAW: Data curation, Writing—review & editingSK: Writing-review & editingKKH: Writing-review & editing, MethodologyLN: Writing—review & editing, MethodologyPW: Writing-review & editing, MethodologyJPK: Writing-review & editing, Supervision, ProjectadministrationSS: Data curation, Writing—review & editing, Supervision, Methodology Financial Disclosure. The authors have no funding to declare. Conflict of interest. The authors declare that they have no conflict of interest. Ethics approval. All procedures performed in this study were in accordance with the ethical standards of the institution or practice at which the studies were conducted. 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Clin J Am Soc Nephrol CJASN . 2016;11(7):1260-1267. doi:10.2215/CJN.10370915 Tables Table 1. Modified IVORY Guidelines as a Video Assessment Tool for Septoplasty Videos. 0 1 2 Section A: Ethics 1 The name of the patient should not be mentioned, and medical data should be anonymized. Patients should not be recognizable (blur or obscure patient eyes, tattoos, or any other distinctive feature), unless these features are relevant (i.e., facial plastic surgery). patient data not anonymized; patient recognizable X patient not recognizable; data anonymized 2 Patient consent should be obtained, specifying if the film may be shared on social media, websites, or during conferences. Depending on local legislation, this may not be necessary if the video does not contain any personal identifiable information. patient consent not obtained X patient consent fully obtained 3 Relevant conflict of interest disclosure and sponsors (if any) should be reported if the video promotes a product or device. advertisement without disclaimer X no advertisement or advertisement with disclaimer Section B: Technical aspects 4 High-definition (720p or over), good-quality videos are recommended. <480p =480p ≥720p 5 Background noise, music, or commentary/discussions from the original video recording should be omitted. not omitted X omitted 6 Edited videos, less than 10 minutes long, showing all key aspects of a procedure and excluding irrelevant footage, are recommended. >15min, no key aspects included 10 - 15 min or not all key aspects included <10 min 7 Intelligible narration (voiceover) and/or closed captions are recommended (English for international audiences) non-intelligible or not included mostly intelligible intelligible throughout 8 Didactic illustrations (e.g., drawings, arrows, overlays) are recommended, especially to show and explain anatomy. not included (somewhat included) included 9 When available, peer review of the video is recommended before publication, assessing the procedure (e.g., scientific validity, safety) as well as the quality of educational editing. X x x Section C: Case presentation 10 Title page should indicate the name of the procedure performed and of the pathology, and the main operator name, institution (if any), and country. no information included information partially included full information 11 Brief presentation of relevant patient medical history is recommended (age and sex of the patient and sidedness of the disease should be indicated if relevant). relevant medical history not presented relevant medical history partially presented relevant medical history presented 12 Relevant preoperative workup should be shown. Imagery should be explained by arrows/overlays no relevant preoperative workup shown preoperative workup shown or mentioned but not explained preoperative workup shown or mentioned and explained Section D: Surgical procedure 13 It is recommended to specify patient setup or positioning on the operating table if these are nonstandard or procedure specific. non-standard and not explained X standard or non-standard and explained 14 Specific or novel surgical instruments or devices used during the film should be identified none identified some identified no novel instruments or all novel instruments identified 15 If an endoscope is used, angle, diameter, and length should be specified not explained partially explained angle, diameter, and length explained; If no endoscope was used 16 It is recommended that the film be divided in clearly identified surgical steps. not divided and/or steps missing surgical steps are clear, but not identified in video clearly divided, either through visuals or narration 17 Relevant pathology shown during the film should be identified and named. A picture of the specimen (with ruler) may be included if applicable. not identified identified but not measured identified, named and measured 18 For each phase of the procedure that is commented, highlighting specific surgical risks and tips to avoid them is recommended. no risks or tips mentioned some risks and/or tips mentioned risks and/or tips discussed relatively in depth 19 Final key points and take-home messages are recommended. no key-points and/or take-home messages X key points and/or take-home messages Section E: Organ-specific 20 Incision not shown, not explained partially shown complete hemitransfixation incision (right or left) or another incision with explanation 21 Approach not shown, not explained partially shown subperichondral/ subperiostal tunnel(s) completely shown 22 Mobilization not shown, not explained partially shown chondrotomy/osteotomy completely shown 23 Resection not shown, not explained partially shown cartilage and/or bone resection completely shown 24 Reconstruction not shown, not explained partially shown replantation of extracorporally straighthened material completely shown 25 Fixation not shown, not explained partially shown suture of the incision, fixation (septal splints) completely shown Table 2. Descriptive data for the included septoplasty videos. Variable Mean (SD ±) Views 63,893.0 (269,014.5) Length (min.) 9:25 (12:30) Likes 213.9 (958.3) Total score 25.3 (6.6) Method N (%) Endoscopic 89 (85) Macroscopic 16 (15) Microscopic 0 (0) Cotton pledgets Yes 26 (25) No 79 (75) Preoperative infiltration Yes 50 (48) No 55 (52) Turbinate surgery Yes 21 (20) No 84 (80) Septal splints Yes 17 (16) No 88 (84) Tamponade Yes 7 (7) No 98 (93) Technique Cottle 42 (40) Kilian 56 (53) NA 7 (7) Min.: Minute; N: Number of Videos; SD ± : Standard Deviation; NA: not applicable; Cottle’s technique: maxilla-premaxilla approach through the hemitransfixion incision with submucous resection of the pathologically deviated septum; Kilian’s technique: mucosal incision directly anterior to the deviated part of the septum with submucous resection of the pathologically deviated septum Table 3. Distribution of septoplasty videos according to IVORY-grading-system total score in academic grades Grade Percentage Total Score Frequency Percentage in relation to all videos A 90-100% 43-48 1 1% B 80-89% 38-42 2 2% C 70-79% 34-37 7 7% D 60-69% 29-33 22 21% F <60% 0-28 73 70% Table 4. Correlation between IVORY-grading-system total score and video features. R p-value Total score - Views 0.16 0.10 Total score – Length -0.05 0.63 Total score – Likes 0.23 0.02 Total score – Age -0.16 0.11 R: Pearson’s R, values in bold indicate statistically significant results Table 5. Variables associated with IVORY-grading-system total score. Adjusted R 2 p-value Likes 0.04 0.02 Views 0.02 0.10 T ORL vs. Non-ORL (25.37 vs. 26.25) 0.26 0.40 10 minutes (25.51 vs. 24.56) 0.65 0.26 50 months (27.02 vs. 23.49) 2.73 < 0.01 Endoscopic vs. macroscopic (25.93 vs. 20.94) -2.49 < 0.01 ORL: Otorhinolaryngology, values in bold indicate statistically significant results, T: test statistics for student’s t-test Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5427027","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":380217993,"identity":"abdfba19-fa4f-47aa-a534-bc3f7d2b6f4c","order_by":0,"name":"Marcel Mayer","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABC0lEQVRIie2RMWrDMBSGfyPIJEhHmUJ6goKKoRDSnqSLi8FeLJKpeEsg4Cw+gKCQXqG9gcHgLGm7ag0Bz4IsGTpUTrJ0EPFYiL7lLfp430OAw/FvmZymRggGeCVAzij8ODx5VNBdIbSLcrv43GjN8dSXUb17zGP4i3lZTTAa2JT7dRL4kkNIFUevIk9xTeuwkkgCq1LGPUKNMlNpQESeTZcs5RVF9TyzKd9Nj/wY5U2Nd2SYZxiwsW6VqVVRZos5X7yrlBCvDWMpWiW0hqmG+AVn4mPdBF7xZc4vahPGkzt7WOzpffYglqtoi/1LBLaab7Y0G93Ytpwwn3H1p4SfEQ70yy6vHA6H4xL5Bau0U40hnTS7AAAAAElFTkSuQmCC","orcid":"","institution":"University Hospital Cologne","correspondingAuthor":true,"prefix":"","firstName":"Marcel","middleName":"","lastName":"Mayer","suffix":""},{"id":380217994,"identity":"820b4e46-e2e7-4866-8e16-e655b099f63b","order_by":1,"name":"Tarik Bugra Isik","email":"","orcid":"","institution":"University Hospital Cologne","correspondingAuthor":false,"prefix":"","firstName":"Tarik","middleName":"Bugra","lastName":"Isik","suffix":""},{"id":380217995,"identity":"1359ac6d-bb78-4b24-b3a7-a8e831f77b41","order_by":2,"name":"Ina Ev","email":"","orcid":"","institution":"University Hospital Cologne","correspondingAuthor":false,"prefix":"","firstName":"Ina","middleName":"","lastName":"Ev","suffix":""},{"id":380217996,"identity":"b855d741-003b-4ed6-b380-734e8ddcbe5a","order_by":3,"name":"Yigit Kurnaz","email":"","orcid":"","institution":"University Hospital Cologne","correspondingAuthor":false,"prefix":"","firstName":"Yigit","middleName":"","lastName":"Kurnaz","suffix":""},{"id":380217997,"identity":"22b8d1b3-d4e3-4c7c-837a-7a39c7047061","order_by":4,"name":"Numan Kirca","email":"","orcid":"","institution":"University Hospital Cologne","correspondingAuthor":false,"prefix":"","firstName":"Numan","middleName":"","lastName":"Kirca","suffix":""},{"id":380217998,"identity":"3d020fbf-4c2c-4c98-ac2e-d9bbf93c377b","order_by":5,"name":"Albert Wahl","email":"","orcid":"","institution":"University Hospital Cologne","correspondingAuthor":false,"prefix":"","firstName":"Albert","middleName":"","lastName":"Wahl","suffix":""},{"id":380217999,"identity":"95e8d285-5b4a-486c-9212-9f966b41f63c","order_by":6,"name":"Sofia Kourou","email":"","orcid":"","institution":"University Hospital Cologne","correspondingAuthor":false,"prefix":"","firstName":"Sofia","middleName":"","lastName":"Kourou","suffix":""},{"id":380218000,"identity":"dcaad5c0-271b-44f9-9a00-3f07cda3e3ed","order_by":7,"name":"Kevin Karl Hansen","email":"","orcid":"","institution":"University Hospital Cologne","correspondingAuthor":false,"prefix":"","firstName":"Kevin","middleName":"Karl","lastName":"Hansen","suffix":""},{"id":380218001,"identity":"2fc62577-5c37-4ea4-be67-caa6745dd6a8","order_by":8,"name":"Lisa Nachtsheim","email":"","orcid":"","institution":"University Hospital Cologne","correspondingAuthor":false,"prefix":"","firstName":"Lisa","middleName":"","lastName":"Nachtsheim","suffix":""},{"id":380218002,"identity":"085fc703-4606-4e5e-84b5-068a3015d537","order_by":9,"name":"Philipp Wolber","email":"","orcid":"","institution":"University Hospital Cologne","correspondingAuthor":false,"prefix":"","firstName":"Philipp","middleName":"","lastName":"Wolber","suffix":""},{"id":380218003,"identity":"ff2001b2-d736-4224-8d2c-bb17af6d0a00","order_by":10,"name":"Jens Peter Klussmann","email":"","orcid":"","institution":"University Hospital Cologne","correspondingAuthor":false,"prefix":"","firstName":"Jens","middleName":"Peter","lastName":"Klussmann","suffix":""},{"id":380218004,"identity":"06dfd0f1-30e6-4598-b7ad-61314c581921","order_by":11,"name":"Sami Shabli","email":"","orcid":"","institution":"University Hospital Cologne","correspondingAuthor":false,"prefix":"","firstName":"Sami","middleName":"","lastName":"Shabli","suffix":""}],"badges":[],"createdAt":"2024-11-10 17:08:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5427027/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5427027/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":71687319,"identity":"e452f086-c588-4329-a232-0ecfe064be80","added_by":"auto","created_at":"2024-12-17 17:36:23","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":134151,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ea) \u003c/strong\u003eCountry of origin of septoplasty video. \u003cstrong\u003eb)\u003c/strong\u003e Specialties of the authors.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5427027/v1/22919a3527604639382080b4.png"},{"id":84384148,"identity":"853cdb8f-4d50-4f10-8289-ac9384041d51","added_by":"auto","created_at":"2025-06-11 09:39:17","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":957102,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5427027/v1/139821fe-12f3-4ff6-8321-ccc3aa3b2ac2.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eAnalysis of the Quality of Septoplasty Videos on YouTube and Validation of the IVORY-Grading-System Quality of Septoplasty Videos\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSurgical education has undergone marked changes over time. While textbooks have traditionally been the main source of insight into techniques, there has been a need for visual demonstrations, including surgeries on cadavers, patients, or inorganic models\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. A more modern development is digital education, especially video-based learning\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. Surgical videos are a widely embraced learning aid for surgical training\u003csup\u003e\u003cspan additionalcitationids=\"CR4 CR5\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. While video journals with peer-reviewing processes do exist\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e, they are not as widespread as freely available platforms like YouTube, which in turn lack strict regulation and quality control, allowing surgery videos to be published without any peer-reviewing process. In addition, some medical societies (e.g., the European Rhinologic Society) offer video material. But these online offers require a registration, membership, and are difficult to access. To aid authors in creating otorhinolaryngology surgery videos, Simon et al. established the IVORY Guidelines in 2021, albeit without a video assessment tool\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. To address this, we shortly introduced the IVORY-Grading-System (IVORY-GS) based on the IVORY Guidelines, the first otorhinolaryngology-specific video scoring system, and implemented it on parotidectomy videos found on YouTube\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eSeptoplasty is a surgical procedure that aims at co a deviated nasal septum, with a history dating as far back as 17th century BC: the Edwin Smith Surgical Papyrus describes insertion of \u0026ldquo;two (other) plugs of linen saturated with grease in the inside of his two nostrils\u0026rdquo; for a patient with a fractured nose\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. Since then, there have been many different approaches. Both Killian and Freer implemented submucous resections and advocated keeping the mucosa intact on both sides.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e In 1929, Metzenbaum pioneered surgery for the correction of septum deviation using the swinging door technique to mobilize the caudal part of the septum. In 1948, Cottle and Loring introduced the \u0026ldquo;maxilla-premaxilla approach\u0026rdquo; through the hemitransfixion incision. \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eSeptoplasty is one of the most common otorhinolaryngology procedures performed on adult patients worldwide\u003csup\u003e\u003cspan additionalcitationids=\"CR16 CR17\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e, with approximately 260,000 operations performed solely in the United States\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e. Despite being widely considered a \u0026ldquo;beginner's operation\u0026rdquo;\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e and commonly used in the surgical training of otorhinolaryngology residents\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e, septoplasty is a procedure difficult to master due to several techniques necessary to address different pathologies and poor visibility. Therefore, we decided to apply the IVORY-GS on septoplasty videos. The aim of this study was not only to analyze the educational quality of surgical videos, but also to further validate the IVORY-GS.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe search terms \u0026ldquo;septoplasty\u0026rdquo;, \u0026ldquo;closed septoplasty\u0026rdquo; and \u0026ldquo;deviated nasal septum surgery\u0026rdquo; were applied in YouTube\u0026rsquo;s search engine in March 2023. Videos of live surgeries on patients as well as cadaver dissection videos were included. Videos showing open septoplasty or septorhinoplasty as well as those additionally displaying sinus surgery were excluded. Video statistics including date of upload, view count, video length, number of likes, the authors\u0026rsquo; country of origin and specialty were extracted. The age of the video was calculated in months between date of analysis (April 2024) and date of upload of the specific video. Regarding septoplasty specific information, the method of visualization (i.e., endoscopic, macroscopic, microscopic), the utilization of cotton pledgets, septal splints and tamponades, preoperative infiltration, whether additional turbinate surgery (partial or complete removal of the inferior nasal turbinate) was performed, and the specific septoplasty technique (i.e., Cottle\u0026rsquo;s, Kilian\u0026rsquo;s, other) were analyzed.\u003c/p\u003e\n\u003cp\u003eThe sections A-D of the IVORY Guidelines\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e were adopted excluding Section B, item 9: \u003cem\u003e\u0026ldquo;When available, peer review of the video is recommended before publication, assessing the procedure (e.g., scientific validity, safety) as well as the quality of educational editing\u0026rdquo;\u003c/em\u003e as no peer reviewing process for uploading videos on YouTube is established and, therefore, the authors could not decide if a video was peer reviewed. Section E was redesigned to be organ-specific for a septoplasty. As section E of the IVORY Guidelines only describes recommendations for functional endoscopic sinus surgery, otology, vocal cord surgery, airway surgery, and plastic surgery, this section was adjusted by the surgical steps of a septoplasty based on \u0026ldquo;ENT-Head and Neck Surgery: Essential Procedures\u0026rdquo; by Theissing et al.\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e and a comprehensive review article on septoplasty authored by Scheithauer et al.\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. These steps included the incision, the approach to the septal cartilage, mobilization of the pathological cartilage/bone, resection of the pathological cartilage/bone, reconstruction of the septum, and fixation (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). These steps were exclusively rated according to their educational presentation.\u003c/p\u003e\n\u003cp\u003eEach item of the sections A-E of the IVORY Guidelines was rated: 0 points indicated that the video was not in line with the guidelines\u0026rsquo; recommendations, 1 point indicated that the video was partially accordant with the recommendations, 2 points indicated that the video fully reached the recommendations. Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e displays the herein used rating sheet modified from the IVORY Guidelines. The IVORY-GS total score was calculated by summarizing the points for each item of the sections A-E for each video. A maximum total score of 48 points was obtainable. The total score was subdivided into the grades A-F following the academic grading system of the USA, which expresses percentages as letters with A being equivalent to 90\u0026ndash;100%, B being equivalent to 80\u0026ndash;89%, C being equivalent to 70\u0026ndash;79%, D being equivalent to 60\u0026ndash;69%, and F being equivalent to less than 60%, respectively \u003csup\u003e\u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. Two otolaryngologists experienced in septoplasty (MM, fifth year of residency; SS, consultant) independently assessed the videos according to the herein introduced IVORY-GS for septoplasty (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). Where findings were not consistent between both raters, a consensus assessment was found following detailed discussion.\u003c/p\u003e\n\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003eStatistical Analyses\u003c/h2\u003e\n \u003cp\u003eSPSS software version 28.0 (IBM, Armonk, NY) was used for statistical analysis. Pearson\u0026rsquo;s correlation was used to measure the strength of correlation between metric variables. The student\u0026rsquo;s t-test was applied to compare differences between two independent groups for metric variables. Linear regression was used to calculate the strength and significance of the association between metric dependent and independent variables. p-values\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were defined as statistically significant.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eBasic characteristics of included videos\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOverall, 105 septoplasty videos were included in the analysis. The videos had been published between January 2\u003csup\u003end\u003c/sup\u003e, 2009, and January 8\u003csup\u003eth\u003c/sup\u003e, 2023. Most videos stemmed from India (n = 41; 39%), followed by the USA (n = 28; 27%), and Egypt (n = 9; 9%) (Figure 1a). Only one video (1%) displayed a cadaver dissection, whereas 104 videos (99%) showed septoplasty on alive patients. Eighty-four (80%) videos were produced by otorhinolaryngologists, while 21 (20%) videos were produced by surgeons specialized in otolaryngology and plastic surgery, plastic surgeons, maxillofacial surgeons, and surgeons of unknown specialty (Figure 1b). The mean number of views was 63,893.0 (SD 269,014.5) and the mean number of likes per video was 213.9 (SD \u0026plusmn; 958.3; range 0 to 8,343), respectively. In 42 videos (40%), septoplasty according to Cottle\u0026rsquo;s technique was performed, whereas Kilian\u0026rsquo;s technique was applied in 56 (53%) of videos. Seven videos (7%) showed septoplasty, which did not match any common septoplasty technique (Table 2). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIVORY-Grading-System\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe mean IVORY-GS total score was 25.3 (SD \u0026plusmn; 6.6) out of a maximum of 48 points. The videos with the highest and the lowest total scores reached 43 and 7 points, respectively (Table 2). When grouping the videos according to the academic grading system of the USA, 73 videos (70%) achieved an F (Table 3). The next highest category, grade D (60\u0026ndash;69%), included 21% of the videos, with a score range of 29 to 33 (Table 3). \u0026nbsp;In the middle and higher categories, grade C (70\u0026ndash;79%) and grade B (80\u0026ndash;89%), significantly fewer videos were represented, with shares of 7% and 2%, respectively (Table 3). Only 1% of the videos reached the highest grade category, A (90\u0026ndash;100%), with a score range of 43 to 48 (Table 3).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe analysis showed a statistically significant correlation between the total score and the number of likes (p = 0.02, Pearson\u0026rsquo;s R = 0.23) (Table 4), which is in line with the results of linear regression analysis, which revealed a higher IVORY-GS total score to be a significant predictor for more likes (p = 0.02). Lastly, endoscopic compared to macroscopic videos (p \u0026lt; 0.01) and videos published \u0026le;50 months ago compared to those published \u0026gt;50 months ago were associated with a significantly higher total score. No association was found between length (p = 0.26) or specialty of the surgeon (p = 0.40) and the total score (Table 5).\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eTo the best of our knowledge this is the first study focusing on the systematic evaluation of septoplasty videos. In addition, this is the second study analyzing surgery videos using the recently introduced IVORY-GS. In our previous study, we introduced the IVORY-GS and utilized it to analyze 50 parotidectomy videos\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. With this study, we turn our attention to septoplasty, a substantially more common\u003csup\u003e\u003cspan additionalcitationids=\"CR16 CR17 CR18\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e but less standardized\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e procedure. The analysis of the 105 septoplasty videos not only provided valuable insights into the characteristics and quality of these videos but also helped to further validate the IVORY-GS. We consider the evaluation of surgery video quality to be crucial for both medical professionals and students seeking educational resources for their surgical training. This requires a field-specific dedicated objective video assessment tool, which is what we intend the IVORY-GS to be.\u003c/p\u003e \u003cp\u003eA tool similar to the IVORY-GS is the LAP-VEGaS video assessment tool\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e based on the LAP-VEGaS Practice Guidelines\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e, which was utilized in previous studies to analyze videos of neck dissections\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e, transsphenoidal surgeries\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e, thyroidectomies and parathyroidectomies\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e, respectively. The LAP-VEGaS video assessment tool was originally intended to evaluate the educational quality videos of laparoscopic procedures. Since it is not otorhinolaryngology-specific and only consists of nine criteria\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e, it is uncertain, if it can comprehensively assess the intricacies of otorhinolaryngological surgeries and deliver precise analyses of the educational quality of otorhinolaryngology-specific surgery videos. With five sections consisting of \u0026ldquo;Ethics\u0026rdquo;, \u0026ldquo;Technical aspects\u0026rdquo;, \u0026ldquo;Case presentation\u0026rdquo;, \u0026ldquo;Surgical procedure\u0026rdquo;, and \u0026ldquo;Organ-specific\u0026rdquo;, and a total of 24 criteria for parotidectomy or 25 criteria for septoplasty, we found the IVORY-GS to be well suited for analyzing the educational value of otorhinolaryngology surgery videos\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eFor the present study, we analyzed 105 septoplasty videos found on YouTube. The majority of the videos we examined fell short in terms of educational standards, aligning with the findings of Luu et al.\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e, De La Torre et al.\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e, Chorath et al.\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e. Compared to parotidectomy videos, an even larger proportion of the videos (70% compared to 58%\u003csup\u003e10\u003c/sup\u003e) were rated F according to the academic system of the USA. With only one video receiving grade A, two videos grade B, and seven videos grade C, only 10% of the videos were of medium to high educational quality, and thus suitable for surgical training (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). This highlights the compelling need for an otorhinolaryngology-specific surgical video platform with strict quality control, such as the IVORY-GS, prior to publishing.\u003c/p\u003e \u003cp\u003eIn the previous study analyzing parotidectomy videos, we demonstrated that the procedure was relatively standardized. More precisely, 82% of the videos featured microscopic approaches, 78% demonstrated modified Blair's incisions, and in 92% of the videos, the facial nerve was exposed anterogradely\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. In contrast, septoplasty showed more variation in its approaches. Regarding operational technique, 53% of the videos utilized Cottle's technique, while 40% followed Killian's technique. Furthermore, 48% of the videos demonstrated preoperative infiltrations, while the remaining 52% did not. This wide array of approaches makes septoplasty a challenging procedure to master. Despite this variety, the endoscopic approach stood out as the most popular visualization, appearing in 85% of the videos, in contrast to the macroscopic (15%) and microscopic (0%) approaches. This most likely reflects the origin of the videos with almost 50% produced in India and Egypt and only 8% originating from Europe, where the macroscopic technique predominates. Studies conducted by Luu et al.\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e, De La Torre et al.\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e, and Chorath et al.\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e did not encompass an analysis of variations in technique.\u003c/p\u003e \u003cp\u003eThe mean number of views for the septoplasty videos was notably higher than the mean number of views for the parotidectomy, neck dissection or transsphenoidal surgery videos (63,893 compared to 19,714\u003csup\u003e10\u003c/sup\u003e, 25,368\u003csup\u003e26\u003c/sup\u003e, and 16,017\u003csup\u003e27\u003c/sup\u003e, respectively). This suggests a greater interest in septoplasty videos. This could be due to septoplasty being a more commonly performed procedure compared to parotidectomy\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e, neck dissection\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e and transsphenoidal surgery\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e. Additionally, as it is impossible to determine whether the audience comprises medical professionals or interested laypersons, the fact that septoplasty, unlike parotidectomy, neck dissection, and transsphenoidal surgery, is performed as part of aesthetic septorhinoplasty\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e, might have contributed to higher views, particularly among patients seeking information. Despite thyroidectomy and parathyroidectomy being less frequently performed procedures\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e,\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e, videos describing these procedures garnered a higher (72,977 for thyroidectomy) or comparable average number of views (60,001 for parathyroidectomy) than those featuring septoplasty\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn addition to evaluating septoplasty videos with the IVORY-GS, we collected various video data, including the method (macroscopic/microscopic/endoscopic), views, likes, video length and age in order to explore correlations and associations with the IVORY-GS total score, which can help viewers identify videos of higher educational value. A significant association between videos published 50 months ago or more recently compared to those published more than 50 months ago and a higher total score was found. This may be due to recent improvements in technical visualization and a shift towards a more didactic intent when publishing surgical videos. Furthermore, endoscopic videos were associated with a significantly higher total score compared to macroscopic videos, most likely because endoscopic videos provide a clearer view of the surgical area and relevant structures during the operation, making them more suitable for educational purposes. More likes were significantly correlated with a higher total score, reflecting that better educational quality is appreciated by the viewers. This correlation aligns with our previous study on parotidectomy videos, where we found a statistically significant correlation between likes and the IVORY-GS total score\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. Likewise, the likes-to-dislikes ratio correlated with a higher score in Chorath et al.\u0026rsquo;s study on thyroidectomy and parathyroidectomy videos\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e, and in Luu et al.\u0026rsquo;s study on neck dissection videos\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. For these reasons, we strongly recommend seeking endoscopic septoplasty videos with more likes and those published within the last 50 months for educational purposes. However, it is important to emphasize that even the best videos cannot replace hands-on education. Surgical training should primarily take place in a practical environment under the supervision of an experienced surgeon specializing in the particular procedure.\u003c/p\u003e \u003cp\u003eLastly, a higher IVORY-GS was a significant predictor for more likes in the linear regression analysis. This finding further validates the IVORY-GS as a suitable otolaryngology-specific rating instrument for surgical videos, as it indicates that qualitatively higher rated videos were also perceived to be better by their viewers.\u003c/p\u003e \u003cp\u003eVarious medical societies provide educational videos, but access to these resources is typically limited to their members. For residents to access these resources, they must first be aware of the existence of the relevant subspecialty society and then navigate a complex registration process. Given the consistently observed low quality of educational videos on YouTube, as highlighted in both our studies and numerous others, we advocate a simplified registration process for residents.\u003c/p\u003e \u003cp\u003eSeveral limitations must be considered in interpreting the results of this study. Firstly, it is not always possible to ascertain, whether surgical videos found on YouTube are published for surgical training, patient information, or commercial reasons. Nevertheless, we chose to include all videos that met the abovementioned search criteria, as these videos represent what viewers might encounter and use while searching for septoplasty videos for surgical education. Additionally, while the first four sections of the IVORY-GS can be applied universally to all videos, the section \u0026ldquo;Organ-specific\u0026rdquo; must be adjusted for each surgical procedure. This might be particularly challenging for less common operations. In the case of septoplasty, the lack of standardization posed a challenge in appropriately adjusting Section E \u0026ldquo;Organ-specific\u0026rdquo; to accommodate the various techniques employed. As a result, we expanded Section E to include six aspects for septoplasty. It is worth noting that more complex procedures may require even more organ-specific aspects, potentially leading to an overrepresentation of Section E.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003e The current adaptation of the IVORY Guidelines is an otolaryngology-specific and suitable tool for evaluating septoplasty videos and can be thus recommended by the authors. This marks the second study utilizing the IVORY-GS, our findings demonstrating its versatility in assessing the educational quality of a broader range of otolaryngology-specific surgery videos. Moreover, the results indicate that the majority of septoplasty videos available online have low educational value. While factors such as more likes, endoscopic videos, and videos published within the last 50 months may serve as potential indicators of higher quality, we firmly advocate for the establishment of a dedicated otolaryngology-specific online video platform or easily accessible educational surgery videos provided by medical societies with robust quality control process, such as the IVORY-GS.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eMM: Conceptualization, Data curation,Formal analysis, Writing-original draft, MethodologyTBI: Data curation, Writing\u0026mdash;review \u0026amp; editingIE: Data curation, Writing\u0026mdash;review \u0026amp; editingYK: Data curation, Writing\u0026mdash;review \u0026amp; editinNK: Data curation, Writing-review \u0026amp; editingAW: Data curation, Writing\u0026mdash;review \u0026amp; editingSK: Writing-review \u0026amp; editingKKH: Writing-review \u0026amp; editing, MethodologyLN: Writing\u0026mdash;review \u0026amp; editing, MethodologyPW: Writing-review \u0026amp; editing, MethodologyJPK: Writing-review \u0026amp; editing, Supervision, ProjectadministrationSS: Data curation, Writing\u0026mdash;review \u0026amp; editing, Supervision, Methodology\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eFinancial Disclosure.\u0026nbsp;\u003c/strong\u003eThe authors have no funding to declare.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest.\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no conflict of interest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval.\u003c/strong\u003e All procedures performed in this study were in accordance with the ethical standards of the institution or practice at which the studies were conducted. No research on humans or animals was performed within this study.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eReznick RK, MacRae H. Teaching Surgical Skills \u0026mdash; Changes in the Wind. \u003cem\u003eN Engl J Med\u003c/em\u003e. 2006;355(25):2664-2669. doi:10.1056/NEJMra054785\u003c/li\u003e\n\u003cli\u003eMota P, Carvalho N, Carvalho-Dias E, Jo\u0026atilde;o Costa M, Correia-Pinto J, Lima E. Video-Based Surgical Learning: Improving Trainee Education and Preparation for Surgery. \u003cem\u003eJ Surg Educ\u003c/em\u003e. 2018;75(3):828-835. doi:10.1016/j.jsurg.2017.09.027\u003c/li\u003e\n\u003cli\u003eEsposito AC, Coppersmith NA, White EM, Yoo PS. Video Coaching in Surgical Education: Utility, Opportunities, and Barriers to Implementation. \u003cem\u003eJ Surg Educ\u003c/em\u003e. 2022;79(3):717-724. doi:10.1016/j.jsurg.2021.12.004\u003c/li\u003e\n\u003cli\u003eAhmet A, Gamze K, Rustem M, Sezen KA. 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Total Thyroidectomy as an Ambulatory Procedure in Community Practice. \u003cem\u003eOTO Open\u003c/em\u003e. 2020;4(3):2473974X20957324. doi:10.1177/2473974X20957324\u003c/li\u003e\n\u003cli\u003eKim SM, Long J, Montez-Rath ME, Leonard MB, Norton JA, Chertow GM. Rates and Outcomes of Parathyroidectomy for Secondary Hyperparathyroidism in the United States. \u003cem\u003eClin J Am Soc Nephrol CJASN\u003c/em\u003e. 2016;11(7):1260-1267. doi:10.2215/CJN.10370915\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1.\u0026nbsp;\u003c/strong\u003eModified IVORY Guidelines as a Video Assessment Tool for Septoplasty Videos.\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"107%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSection A: Ethics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003eThe name of the patient should not be mentioned, and medical data should be anonymized. Patients should not be\u003cbr\u003e\u0026nbsp;recognizable (blur or obscure patient eyes, tattoos, or any other distinctive feature), unless these features are\u003cbr\u003e\u0026nbsp;relevant (i.e., facial plastic surgery).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003epatient data not anonymized; patient recognizable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003eX\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003epatient not recognizable; data anonymized\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003ePatient consent should be obtained, specifying if the film may be shared on social media, websites, or during\u003cbr\u003e\u0026nbsp;conferences. Depending on local legislation, this may not be necessary if the video does not contain any\u003cbr\u003e\u0026nbsp;personal identifiable information.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003epatient consent not obtained\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003eX\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003epatient consent fully obtained\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003eRelevant conflict of interest disclosure and sponsors (if any) should be reported if the video promotes a product or device.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eadvertisement without disclaimer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003eX\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eno advertisement or advertisement with disclaimer\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSection B: Technical aspects\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003eHigh-definition (720p or over), good-quality videos are recommended.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026lt;480p\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;=480p\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026ge;720p\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003eBackground noise, music, or commentary/discussions from the original video recording should be omitted.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003enot omitted\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003eX\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eomitted\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003eEdited videos, less than 10 minutes long, showing all key aspects of a procedure and excluding irrelevant footage, are recommended.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026gt;15min, no key aspects included\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e10 - 15 min or not all key aspects included\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026lt;10 min\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003eIntelligible narration (voiceover) and/or closed captions are recommended (English for international audiences)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003enon-intelligible or not included\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003emostly intelligible\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eintelligible throughout\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e8\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003eDidactic illustrations (e.g., drawings, arrows, overlays) are recommended, especially to show and explain anatomy.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003enot included\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e(somewhat included)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eincluded\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003eWhen available, peer review of the video is recommended before publication, assessing the procedure (e.g., scientific validity, safety) as well as the quality of educational editing.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eX\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003ex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003ex\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSection C: Case presentation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e10\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003eTitle page should indicate the name of the procedure performed and of the pathology, and the main operator name,\u003cbr\u003e\u0026nbsp;institution (if any), and country.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eno information included\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003einformation partially included\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003efull information\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e11\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003eBrief presentation of relevant patient medical history is recommended (age and sex of the patient and sidedness of the disease should be indicated if relevant).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003erelevant medical history not presented\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003erelevant medical history partially presented\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003erelevant medical history presented\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e12\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003eRelevant preoperative workup should be shown. Imagery should be explained by arrows/overlays\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eno relevant preoperative workup shown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003epreoperative workup shown or mentioned but not explained\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003epreoperative workup shown or mentioned and explained\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"7\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSection D: Surgical procedure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e13\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003eIt is recommended to specify patient setup or positioning on the operating table if these are nonstandard or\u003cbr\u003e\u0026nbsp;procedure specific.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003enon-standard and not explained\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003eX\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003estandard or non-standard and explained\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e14\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003eSpecific or novel surgical instruments or devices used during the film should be identified\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003enone identified\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003esome identified\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eno novel instruments or all novel instruments identified\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e15\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003eIf an endoscope is used, angle, diameter, and length should be specified\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003enot explained\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003epartially explained\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eangle, diameter, and length explained;\u003c/p\u003e\n \u003cp\u003eIf no endoscope was used\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e16\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003eIt is recommended that the film be divided in clearly identified surgical steps.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003enot divided and/or steps missing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003esurgical steps are clear, but not identified in video\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eclearly divided, either through visuals or narration\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e17\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003eRelevant pathology shown during the film should be identified and named. A picture of the specimen (with ruler) may be included if applicable.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003enot identified\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003eidentified but not measured\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eidentified, named and measured\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e18\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003eFor each phase of the procedure that is commented, highlighting specific surgical risks and tips to avoid them is\u003cbr\u003e\u0026nbsp;recommended.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eno risks or tips mentioned\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003esome risks and/or tips mentioned\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003erisks and/or tips discussed relatively in depth\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e19\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003eFinal key points and take-home messages are recommended.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eno key-points and/or take-home messages\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003eX\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003ekey points and/or take-home messages\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSection E: Organ-specific\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e20\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003eIncision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003enot shown, not explained\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003epartially shown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003ecomplete hemitransfixation incision (right or left) or another incision with explanation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e21\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003eApproach\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003enot shown, not explained\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003epartially shown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003esubperichondral/\u003c/p\u003e\n \u003cp\u003esubperiostal tunnel(s)\u003c/p\u003e\n \u003cp\u003ecompletely shown\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e22\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003eMobilization\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003enot shown, not explained\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003epartially shown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003echondrotomy/osteotomy completely shown\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e23\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003eResection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003enot shown, not explained\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003epartially shown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003ecartilage and/or bone resection completely shown\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e24\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003eReconstruction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003enot shown, not explained\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003epartially shown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003ereplantation of extracorporally straighthened material completely shown\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e25\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003eFixation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003enot shown, not explained\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003epartially shown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003esuture of the incision, fixation (septal splints) completely shown\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u0026nbsp;\u003c/strong\u003eDescriptive data for the included septoplasty videos.\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" align=\"\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean (SD \u0026plusmn;)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eViews \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e63,893.0 (269,014.5)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eLength (min.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e9:25 (12:30)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eLikes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e213.9 (958.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eTotal score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e25.3 (6.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eMethod\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Endoscopic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e89 (85)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Macroscopic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e16 (15)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Microscopic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eCotton pledgets\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e26 (25)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e79 (75)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003ePreoperative infiltration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e50 (48)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e55 (52)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eTurbinate surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e21 (20)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e84 (80)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eSeptal splints\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e17 (16)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e88 (84)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eTamponade\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e7 (7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e98 (93)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eTechnique\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Cottle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e42 (40)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Kilian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e56 (53)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;NA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e7 (7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eMin.: Minute; N: Number of Videos; SD\u0026nbsp;\u003c/em\u003e\u0026plusmn;\u003cem\u003e: Standard Deviation; NA: not applicable; Cottle\u0026rsquo;s technique: maxilla-premaxilla approach through the hemitransfixion incision with submucous resection of the pathologically deviated septum; Kilian\u0026rsquo;s technique: mucosal incision directly anterior to the deviated part of the septum with submucous resection of the pathologically deviated septum\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u0026nbsp;\u003c/strong\u003eDistribution of septoplasty videos according to IVORY-grading-system total score in academic grades\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGrade\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal Score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage in relation to all videos\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e90-100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e43-48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e80-89%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e38-42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e70-79%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e34-37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e60-69%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e29-33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e21%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eF\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026lt;60%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0-28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e70%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cstrong\u003eTable 4.\u0026nbsp;\u003c/strong\u003eCorrelation between IVORY-grading-system total score and video features.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" align=\"\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 185px;\"\u003e\n \u003cp\u003eR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eTotal score - Views\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 185px;\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eTotal score \u0026ndash; Length\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 185px;\"\u003e\n \u003cp\u003e-0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eTotal score \u0026ndash; Likes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 185px;\"\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.02\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eTotal score \u0026ndash; Age\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 185px;\"\u003e\n \u003cp\u003e-0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eR: Pearson\u0026rsquo;s R, values in bold indicate statistically significant results\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5.\u0026nbsp;\u003c/strong\u003eVariables associated with IVORY-grading-system total score.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eAdjusted R\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eLikes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.02\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eViews\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eORL vs. Non-ORL\u003c/p\u003e\n \u003cp\u003e(25.37 vs. 26.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e0.40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u0026lt;=10 vs. \u0026gt;10 minutes\u003c/p\u003e\n \u003cp\u003e(25.51 vs. 24.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u0026lt;=50 vs. \u0026gt;50 months\u003c/p\u003e\n \u003cp\u003e(27.02 vs. 23.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e2.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.01\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eEndoscopic vs. macroscopic\u003c/p\u003e\n \u003cp\u003e(25.93 vs. 20.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e-2.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 0.01\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eORL: Otorhinolaryngology, values in bold indicate statistically significant results, T: test statistics for student\u0026rsquo;s t-test\u003c/em\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Septoplasty, Educational Videos, IVORY Guidelines, IVORY-Grading-System, YouTube","lastPublishedDoi":"10.21203/rs.3.rs-5427027/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5427027/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003e This study aimed to analyze the educational quality of septoplasty videos on YouTube and validate the \u0026ldquo;Instructional Videos in Otorhinolaryngology by YO-IFOS-Grading-System\u0026rdquo; (IVORY-GS), the first otorhinolaryngology-specific video scoring system based on the IVORY Guidelines.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA search for \u0026ldquo;septoplasty,\u0026rdquo; \u0026ldquo;closed septoplasty,\u0026rdquo; and \u0026ldquo;deviated nasal septum surgery\u0026rdquo; was performed on YouTube in March 2023. Videos of surgeries on patients and cadaver dissections were included. The IVORY-GS was adjusted for septoplasty and applied to rate video quality based on criteria related to ethics, technical aspects, case presentation, surgical procedure, and organ-specific elements. Descriptive data on video characteristics was collected, including views, likes, video length, and time since publication. Statistical analyses were conducted to identify associations between video features and the IVORY-GS total score.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOverall, 105 septoplasty videos were included. Among these, 40% demonstrated Cottle\u0026rsquo;s, while 53% followed Killian\u0026rsquo;s technique. Mean IVORY-GS total score for septoplasty videos was 25.3 (maximum 48). Video education quality was rated as moderate/high in 10%. Endoscopic versus macroscopic videos (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and videos published within the last 50 months versus those published earlier (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) received significantly higher total scores. A significant correlation was found between the total score and number of likes (p\u0026thinsp;=\u0026thinsp;0.02). A higher total score was a significant predictor for more likes (p\u0026thinsp;=\u0026thinsp;0.02).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe analysis revealed only a small proportion of septoplasty videos available on YouTube being suitable for surgical training. The IVORY-GS has proven useful in assessing the educational value of otolaryngology-specific videos and can be beneficial for establishing a dedicated online platform for high-quality otorhinolaryngology surgery videos.\u003c/p\u003e","manuscriptTitle":"Analysis of the Quality of Septoplasty Videos on YouTube and Validation of the IVORY-Grading-System Quality of Septoplasty Videos","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-17 17:28:18","doi":"10.21203/rs.3.rs-5427027/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cc017610-1204-443f-af20-427a09260035","owner":[],"postedDate":"December 17th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-06-11T09:39:02+00:00","versionOfRecord":[],"versionCreatedAt":"2024-12-17 17:28:18","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5427027","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5427027","identity":"rs-5427027","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}