Objective assessment of endoscopic surgical skills by analyzing direction-dependent dexterity using the Hiroshima University Endoscopic Surgical Assessment Device (HUESAD)

Abstract

We evaluated our system of objectively assessing endoscopic surgical skills. We developed the Hiroshima University Endoscopic Surgical Assessment Device (HUESAD), which records the movement of the tip of an endoscopic instrument precisely. The orbits of experienced surgeons (expert group) and those of medical students (novice group) were evaluated by measuring the deviation from the ideal course on horizontal and vertical planes. These data were integrated with the time taken to move the tip of an endoscopic instrument between a distal side pole (A) and a proximal side pole (C) (Task 1), and between a left side pole (D) and a right side pole (B) (Task 2). The integrated deviation of the expert group was significantly lower than that of the novice group on both the horizontal and vertical planes in Task 1 (P=0.0004, P=0.009) and Task 2 (P<0.0001, P=0.0002). Thus, the spatial perception of experts was significantly better than that of novices. We also found that the direction of the scope and the movement of the endoscopic instrument were related to difficulties in spatial perception for both experts and novices. HUESAD detected and resolved these differences based on the directions of the scope and movement of the endoscopic instruments. The HUESAD is a reliable system for assessing a surgeon's dexterity, based on direction and movement. It helps us to attain a higher degree of accuracy and to create an ideal setting for optimal endoscopic surgery.