Objective classification of residents based on their psychomotor laparoscopic skills

Chmarra, Magdalena K.; Klein, Stefan; Winter, Joost de; Jansen, Frank-Willem; Dankelman, Jenny

doi:10.1007/s00464-009-0721-y

Cited by 94 publications

(104 citation statements)

References 29 publications

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“…In laparoscopic surgery, however, it has been proved that this is not always the case [58]. Motion smoothness is also reported as a determining factor for manipulation tasks, such as those involving object grasping, transfer, cutting, or suturing [25,26,46]. Other motion metrics relate to the trainee's mastery of the task space, in terms of dimensions and orientation.…”

Section: Clinical Definition Of Metricsmentioning

confidence: 99%

“…Typically, this assessment requires the presence of a trained supervisor, and the definition of clear, structured checklists are necessary [28,53]. Table 6 shows the most widespread HMT capture systems for surgical assessment identified in the literature [44][45][46][47][48][49][50][51][52][53][54][55][88][89][90][91]. Their classification can be done according to the nature of the acquired information.…”

Section: Human Motíon Tracking In Real Settíngsmentioning

confidence: 99%

“…Most frequently, HMT systems are used on box trainers, where the performance of surgeons in basic and advanced reproducible tasks is recorded [45][46][47][48]53]. This trend can easily be explained, since there is a need to certify a surgeon's psychomotor skills before allowing him/her to opérate on a patient.…”

Section: Human Motíon Tracking In Real Settíngsmentioning

confidence: 99%

“…LDA correlates information from different metrics to detect redundancies, and additionally can perform classification based on the resulting simplified data. Chmarra et al explored the use of LDA combined with principal component analysis (PCA) as a way to compare performance on a box trainer for novices, intermediates, and experts using six different motion metrics [46]. Results yielded a success rate of 74% on a first report.…”

Section: Table6mentioning

confidence: 99%

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Methods and Tools for Objective Assessment of Psychomotor Skills in Laparoscopic Surgery

García

Sánchez-González

Lamata

et al. 2011

Journal of Surgical Research

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133

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Training and assessment paradigms for laparoscopic surgical skills are evolving from traditional mentortrainee tutorship towards structured, more objective and safer programs. Accreditation of surgeons requires reaching a consensus on metrics and tasks used to assess surgeons' psychomotor skills. Ongoing development of tracking systems and software Solutions has allowed for the expansión of novel training and assessment means in laparoscopy. The current challenge is to adapt and include these systems within training programs, and to exploit their possibilities for evaluation purposes. This paper describes the state of the art in research on measuring and assessing psychomotor laparoscopic skills. It gives an overview on tracking systems as well as on metrics and advanced statistical and machine learning techniques employed for evaluation purposes. The later ones have a potential to be used as an aid in deciding on the surgical competence level, which is an important aspect when accreditation of the surgeons in particular, and patient safety in general, are considered. The prospective of these methods and tools make them complementary means for surgical assessment of motor skills, especially in the early stages of training. Successful examples such as the Fundamentáis of Laparoscopic Surgery should help drive a paradigm change to structured curricula based on objective parameters. These may improve the accreditation of new surgeons, as 1 To whom correspondence and reprint requests should be addressed at Bioengineering and Telemedicine Centre (GBT), ETSI Telecomunicación, Universidad Politécnica de Madrid (UPM). Avda Complutense, 30, 28040, Madrid, Spain. E-mail: ioropesa@gbt.tfo. upm.es. well as optimize their already overloaded training schedules.

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Section: Clinical Definition Of Metricsmentioning

confidence: 99%

Section: Human Motíon Tracking In Real Settíngsmentioning

confidence: 99%

Section: Human Motíon Tracking In Real Settíngsmentioning

confidence: 99%

Section: Table6mentioning

confidence: 99%

See 2 more Smart Citations

Methods and Tools for Objective Assessment of Psychomotor Skills in Laparoscopic Surgery

García

Sánchez-González

Lamata

et al. 2011

Journal of Surgical Research

Self Cite

133

View full text Add to dashboard Cite

show abstract

“…The lack of realism is covered by physical (11,12) and hybrid simulators (13), which also implement automatic tools for the objective assessment of technical skills. Finally, another attempt to develop more automatic objective evaluation methods are the systems based on the motion analysis of surgical instruments (14)(15)(16). These systems compute metrics to quantify motion information regarding the use of the surgical instruments to establish the technical skill level of the surgeon.…”

Section: Introductionmentioning

confidence: 99%

Systems and technologies for objective evaluation of technical skills in laparoscopic surgery

Sánchez‐Margallo

García

et al. 2013

Minimally Invasive Therapy & Allied Technologies

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Minimally invasive surgery is a highly demanding surgical approach regarding technical requirements for the surgeon, who must be trained in order to perform a safe surgical intervention. Traditional surgical education in minimally invasive surgery is commonly based on subjective criteria to quantify and evaluate surgical abilities, which could be potentially unsafe for the patient. Authors, surgeons and associations are increasingly demanding the development of more objective assessment tools that can accredit surgeons as technically competent. This paper describes the state of the art in objective assessment methods of surgical skills. It gives an overview on assessment systems based on structured checklists and rating scales, surgical simulators, and instrument motion analysis. As a future work, an objective and automatic assessment method of surgical skills should be standardized as a means towards proficiency-based curricula for training in laparoscopic surgery and its certification.

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Forces of Tool-Tissue Interaction to Assess Surgical Skill Level

et al. 2018

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IMPORTANCE The application of optimal forces between surgical instruments and tissue is fundamental to surgical performance and learning. To date, this force has not been measured clinically during the performance of microsurgery. OBJECTIVES To establish a normative catalog of force profiles during the performance of surgery, to compare force variables among surgeons with different skill levels, and to evaluate whether such a force-based metric determines or differentiates skill level. DESIGN, SETTING, AND PARTICIPANTS Through installation of strain gauge sensors, a force-sensing bipolar forceps was developed, and force data were obtained from predetermined surgical tasks at the Foothills Medical Centre, University of Calgary, a tertiary care center that serves Southern Alberta, Canada. Sixteen neurosurgeons (3 groups: novice, intermediate, and experienced) performed surgery on 26 neurosurgical patients with various conditions. Normative baseline force ranges were obtained using the force profiles (mean and maximum forces and force variability) from the experienced surgeons. Standardized force profiles and force errors (high force error [HFE], low force error [LFE], and force variability error [FVE]) were analyzed and compared among surgeons with different skill levels. MAIN OUTCOMES AND MEASURES Each trial of the forceps use was termed successful or unsuccessful. The force profiles and force errors were analyzed and compared. RESULTS This study included 26 patients (10 [38%] male and 16 [62%] female; mean [SD] age, 43 [15] years) undergoing neurosurgery by 16 surgeons (6 in the novice group, 5 in the intermediate group, and 5 in the experienced group). Unsuccessful trial-incomplete significantly correlated with LFE and FVE, and unsuccessful trial-bleeding correlated with HFE and FVE. The force strengths exerted by novice surgeons were significantly higher than those of experienced surgeons (0.74 vs 0.00; P < .001), and force variability decreased from novice (0.43) to intermediate (0.28) to experienced (0.00) surgeons; however, these differences varied among surgical tasks. The rate of HFE and FVE inversely correlated with surgeon level of experience (HFE, 0.27 for novice surgeons, 0.12 for intermediate surgeons, and 0.05 for experienced surgeons; FVE, 0.16 for novice surgeons, 0.10 for intermediate surgeons, and 0.05 for experienced surgeons). The rate of LFE significantly increased in intermediate (0.12) and novice (0.10) surgeons compared with experienced surgeons (0.04; P < .001). There was no difference in LFE between intermediate and novice surgeons. Stepwise discriminant analysis revealed that combined use of these error rates could accurately discriminate the groups (87.5%). CONCLUSIONS AND RELEVANCE Force-sensing bipolar forceps and force analysis may help distinguish surgeon skill level, which is particularly important as surgical education shifts to a competency-based paradigm.

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Objective classification of residents based on their psychomotor laparoscopic skills

Cited by 94 publications

References 29 publications

Methods and Tools for Objective Assessment of Psychomotor Skills in Laparoscopic Surgery

Methods and Tools for Objective Assessment of Psychomotor Skills in Laparoscopic Surgery

Systems and technologies for objective evaluation of technical skills in laparoscopic surgery

Forces of Tool-Tissue Interaction to Assess Surgical Skill Level

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