INTRODUCTION Objective quantification of technical surgical skill in surgery remains poorly defined although delivery of and training in these skills is essential to the surgical profession. Attempts to measure hand kinematics to quantify surgical performance primarily rely on electromagnetic sensors attached to the surgeon’s hand or instrument. We sought to determine whether similar motion analysis could be performed using a marker-less video-based review, allowing for a scalable approach to performance evaluation. METHODS We recorded six reduction mammoplasty operations – a plastic surgery procedure in which the attending and resident surgeons operate in parallel. Segments representative of surgical tasks were identified using Multimedia Video Task Analysis software. Video digital processing was used to extract and analyze the spatio-temporal characteristics of hand movement. RESULTS Attending plastic surgeons appear to use their non-dominant hand more than residents when cutting with the scalpel, suggesting more use of counter-traction. While suturing, attendings were more ambidextrous with smaller differences in movement between their dominant and non-dominant hands than residents. Attendings also seem to have more conservation of movement when performing instrument tying than residents, as demonstrated by less non-dominant hand displacement. These observations were consistent within procedures and between the different attending plastic surgeons evaluated in this fashion. CONCLUSIONS Video motion analysis can be used to provide objective measurement of technical skills without the need for sensors or markers. Such data should be valuable in better understanding the acquisition and degradation of surgical skill, providing enhanced feedback to shorten the learning curve.

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Background In the treatment of melanoma, inguinal lymph node dissection (ILND) is the standard of care for palpable or biopsy-proven lymph node metastases. Wound complications occur frequently after ILND. In the current study, the multicenter American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) was utilized to examine the frequency and predictors of wound complications after ILND. Methods Patients with cutaneous melanoma who underwent superficial and superficial with deep ILND from 2005-2010 were selected from the ACS NSQIP database. Standard ACS NSQIP 30-day outcome variables for wound occurrences—superficial surgical site infection (SSI), deep SSI, organ space SSI, and disruption—were defined as wound complications. Results Of 281 total patients, only 14 % of patients had wound complications, a rate much lower than those reported in previous single institution studies. In a multivariable model, superficial with deep ILND, obesity, and diabetes were significantly associated with wound complications. There was no difference in the rate of reoperation in patients with and without wound complications. Conclusions ACS NSQIP appears to markedly underreport the actual incidence of wound complications after ILND. This may reflect the program’s narrow definition of wound occurrences, which does not include seroma, hematoma, lymph leak, and skin necrosis. Future iterations of the ACS NSQIP for Oncology and procedure-specific modules should expand the definition of wound occurrences to incorporate these clinically relevant complications.

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