The operating room CCTV system, introduced to strengthen patient safety and transparency in medical practice, has entered its third year, but half of patients do not know the system exists. Among patients who actually underwent surgery, a majority said they did not even know whether their procedure was recorded.
The operating room CCTV system requires the surgical process to be recorded at the request of the patient or guardian when the patient undergoes surgery under anesthesia, and it has been in effect since Sept. 2023. As the first such system in the world to be enacted into law, it drew major attention at the time of implementation.
On the 7th, according to the National Evidence based Healthcare Collaborating Agency (NECA)'s report, "Analysis of the current status of operating room CCTV operations and research on improvement measures," only 49.5% of 1,000 patients age 15 or older who had undergone surgery under general anesthesia or conscious sedation (local anesthesia and sleep sedation) within the past two years said in a survey that they knew about the operating room CCTV system.
Only 18.5% of patients said they had been recorded, while 55.7% said they did not know whether their surgery was filmed.
As for why they did not request recording, the most common answer, at 33.5%, was "I did not receive guidance," and 28.1% said "I did not know about the system."
The researchers said the current notification method, which relies on posting notices within medical institutions, is limiting use of the system.
By contrast, patients who actually used the system generally rated it positively.
The most common reason for requesting recording, at 74.6%, was "to prepare for medical accidents or malpractice." After recording, 84.9% of respondents said they felt reassured. Satisfaction was also higher among patients with recording experience than those without.
Cases also showed that thorough explanations increase use of the system.
One medical institution, the first in the country to operate operating room CCTV, saw patient consent rise from 53% initially to 85% after providing detailed explanations during the surgical consent process. At that institution, there were no cases of video leaks or increased disputes during operations, it was found.
However, limits were also revealed regarding its effectiveness as a device to prevent medical accidents.
In an analysis of 12 recently reported cases of ghost surgery and medical accidents, CCTV was installed in seven cases, but actual recording occurred in only one. In the others, recording did not take place due to missed patient requests for filming or lack of guidance.
In some ghost surgery cases, there were also statements that "illegal acts were committed only when there was no request to record on CCTV." The researchers said the CCTV system was being bypassed by avoiding recording rather than deterring crime.
By contrast, in medical disputes and sex crime cases, its function as post-incident evidence was confirmed. CCTV footage was mentioned in 57.1% of the case law analyzed and was used as key evidence in all cases involving patient molestation or sex crimes. There were also cases where it served as exculpatory evidence clearing medical staff of charges such as sexual molestation or involuntary manslaughter due to professional negligence.
Medical staff evaluations remained negative.
In a survey of 100 surgical medical staff, 72% said operating room CCTV negatively affects the trust relationship between patients and medical staff. Overall satisfaction with the system was 2.27 out of 5. In particular, ongoing concerns were raised about discouraging resident training and reducing opportunities to participate in surgery.
Medical staff cited as the most needed support measure a plan to clarify the scope of legal liability in the event of video leaks. They said the burden is heavy because medical institutions are required to bear uniform responsibility even for leaks caused by external factors such as hacking.
The researchers recommended that the government strengthen publicity to raise patient awareness of the system and consider partially reducing liability for leaks caused by external factors such as hacking for medical institutions that fully comply with security standards. They also said a separate management system should be established for recordings made for resident education to address concerns about reduced training.
The report said, "Operating room CCTV is not simply a matter of whether cameras are installed, but a complex task intertwined with patient safety, the rights of medical staff, and trust in the overall medical system," adding, "Continuous institutional improvements are needed to find a balance between patient protection and realities on the medical front lines."