Synthesis of the clinical utilities and issues of intraoperative imaging devices in clinical reports: a systematic review and thematic synthesis.

Abstract

Background: Intraoperative imaging devices (i-ID), such as intraoperative optical coherence tomography (iOCT), offer surgeons critical insights previously unobservable, enhancing surgical precision and safety. Despite their benefits, i-IDs present challenges that necessitate early identification and synthesis of clinical issues to promote safer surgical implementation. This study aims to explore the potential of Qualitative Evidence Synthesis (QES) for synthesising qualitative evidence from clinical reports regarding the clinical utility and issues associated with iOCT devices.

Methods: In June 2022, we conducted a systematic literature search using PubMed, Web of Science, Embase, and the Cochrane Library for articles on iOCT for retinal surgery. Criteria included articles in English, with at least ten cases, and providing qualitative insights into iOCT's utilities and issues. We performed thematic synthesis from the identified articles using qualitative data analysis software, beginning with initial coding of the 'Results' and 'Discussion' sections to create themes reflecting iOCT's utilities and issues. The created themes were further refined through axial coding and were used to construct a model illustrating iOCT's potential influence on patient outcomes. The reliability and validity of the themes were ensured through independent coding, expert consultations, and iterative revisions to achieve consensus among reviewers.

Results: The QES approach enabled systematic data extraction and synthesis, providing a comprehensive view of both the utilities and issues associated with iOCT. Our findings emphasise the significant role of iOCT in enhancing decision-making, specifically in membrane peeling tasks and in detecting preoperatively undetected conditions such as full-thickness macular holes. This study also revealed critical insights into the technical challenges associated with iOCT, including device malfunctions and procedural interruptions, which are vital for improving device safety and integration into surgical practice.

Conclusion: The application of QES facilitated a thorough investigation into the clinical utilities and issues of iOCT, encouraging the application of this method in the ongoing evaluation of i-ID technologies. This initial experience with QES confirms its potential in synthesising qualitative clinical data and suggests its applicability to other i-ID modalities. This approach enhances the reliability of findings and provides a solid foundation for assessing clinical utilities and issues for policymakers and medical specialists.