Quantifying technical skills during open operations using video-based motion analysis

Abstract

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.

Electroencephalographic Monitoring of Brain Wave Activity During Laparoscopic Surgical Simulation to Measure Surgeon Concentration and Stress: Can the Student Become the Master?

“…Using VMA, Glarner et al were able to distinguish experienced from novice surgeons during reduction mammoplasties based on hand kinematics. 14 There is no debate that technical skills and the acquisition of these is an essential component of surgery and surgical training. However, there are many less tangible and non-technical skills that are significant constituents of surgical competence such as communication skills, concentration, and stress management.…”

A marker-less technique for measuring kinematics in the operating room

“…Previous work evaluating descriptive differences in dominant versus non-dominant hand movements in attending surgeons versus residents 18 demonstrated the feasibility of this approach for open surgical cases. Here, we have extended this work and sought to discern differences based on surgeon role and task relationship to the various stages of surgery, with the ultimate aim of identifying high-yield sections of open operations amenable to differentiating skill level and providing feedback metrics to surgeons.…”

“…Wearable technologies like GoPro® and mobile video glasses have also been successfully employed by our group and others. 18, 24 Additionally, some components of our current methodology, such as clip identification were time-intensive and not easily scalable. Ongoing evaluation of the kinematic differences between task sub-categories (e.g., T1 vs T2, S1 vs S3) could lead to the development of software capable of recognizing the kinematic patterns associated with suturing and tying tasks and sub-tasks, identifying and flagging clips for quick confirmation by the surgeon.…”

“…Our group has previously used marker-less tracking software to evaluate descriptive statistics of dominant vs non-dominant hand movement during reduction mammoplasty operations. 18 A unique ROI was defined at the start of every video clip, identifying a portion of the hand (generally the index finger or thumb) that remained in view for the entire clip. Because kinematic data are obtained by measuring the changes in the ROI over time, the actual location of the ROI does not matter as long as it follows the hand throughout a clip.…”

Advanced Engineering Technology for Measuring Performance

“…They are particularly susceptible to confusion of overlapping body segments and tracking unintended objects in the visual field. Despite the reality that existing operating room video may be suboptimal for tracking, researchers have demonstrated Engineering Technology for Measuring Performance the utility of markerless tracking in open procedures 19 and laparoscopic box trainers. 20…”