Movement-level process modeling of microsurgical bimanual and unimanual tasks

Jani Koskinen,Bin Zheng,Roman Bednarik,Antti Huotarinen,Antti-Pekka Elomaa

doi:10.1007/s11548-021-02537-4

Abstract

PurposeMicrosurgical techniques require highly skilled manual handling of specialized surgical instruments. Surgical process models are central for objective evaluation of these skills, enabling data-driven solutions that can improve intraoperative efficiency.MethodWe built a surgical process model, defined at movement level in terms of elementary surgical actions (n=4) and targets (n=4). The model also included nonproductive movements, which enabled us to evaluate suturing efficiency and bi-manual dexterity. The elementary activities were used to investigate differences between novice (n=5) and expert surgeons (n=5) by comparing the cosine similarity of vector representations of a microsurgical suturing training task and its different segments.ResultsBased on our model, the experts were significantly more efficient than the novices at using their tools individually and simultaneously. At suture level, the experts were significantly more efficient at using their left hand tool, but the differences were not significant for the right hand tool. At the level of individual suture segments, the experts had on average 21.0 % higher suturing efficiency and 48.2 % higher bi-manual efficiency, and the results varied between segments. Similarity of the manual actions showed that expert and novice surgeons could be distinguished by their movement patterns.ConclusionsThe surgical process model allowed us to identify differences between novices’ and experts’ movements and to evaluate their uni- and bi-manual tool use efficiency. Analyzing surgical tasks in this manner could be used to evaluate surgical skill and help surgical trainees detect problems in their performance computationally.

Highlights

Small-scale procedures performed using a surgical microscope require a high degree of uni- and bi-manual dexterity, which form an essential part of surgical expertise
A central requirement toward this goal has been the development of surgical process modeling
We investigate if the surgical process model can be applied to extract sufficient information from a microsurgical training task to evaluate if: (1) expert surgeons will use their tools more efficiently than novices, (2) expert surgeons will display a higher level of similarity among surgical segments than novices and (3) experts’ will more frequently use their tools bi-manually than novices do in the microsurgical tasks

Summary

Results

Of the 11 participants, one expert participant had to be discarded due to equipment failure. The results imply that the differences were based more on the actions, and that novices and experts who participated in this study could be distinguished even without considering the targets. The results at suture level remained significant for the needleholder (expert similarity = 0.196, novice similarity = −0.169, t = −11.550, p < 0.01), but not for the microforceps (expert similarity = 0.052, novice similarity = 0.053, t = 0.054 p = 0.958). The difference in microforceps suturing efficiency rema ined statistically significant in the dataset where 60% of the target labels were changed The efficiency difference remained statistically significant in the

Conclusions

Introduction

Methods and materials

Discussion

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