Patient safety and medical error remain important issues in healthcare systems worldwide. Vascular
surgery has advanced towards minimally invasive endovascular procedures which take place in the
hybrid operating room using X-ray imaging. Despite these advancements, relatively high rates of
errors and adverse events still occur. This poses the question: how can we observe, understand and
prevent these errors to create a safer hybrid operating room? To explore this, our research group
installed the first "Operating Room Black Box" in a hybrid operating room, recording patient vitals
and panoramic intraoperative video and audio data as a “fly on the wall”. Analysis of these
recordings, together with the input of expert physicians, psychologists and medical physicists, will
provide unique insights into technical and non-technical skills (communication, leadership, decision
making), quality of care and radiation safety during vascular surgery. Together, the aims in this
proposal will provide personalised video-based feedback to enhance endovascular surgical training,
facilitate postoperative debriefing of safety threats and positive safety behaviour, and assess the
impact of a new X-ray reducing technology on team performance and radiation safety. The successful
implementation of these initiatives will form strong evidence-based strategies to reduce error and
enhance healthcare personnel and patient safety in vascular surgery going forward.