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

Abstract

Objective quantification of technical operative skills in surgery remains poorly defined, although the delivery of and training in these skills is essential to the profession of surgery. Attempts to measure hand kinematics to quantify operative performance primarily have relied on electromagnetic sensors attached to the surgeon's hand or instrument. We sought to determine whether a similar motion analysis could be performed with a marker-less, video-based review, allowing for a scalable approach to performance evaluation. 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 with Multimedia Video Task Analysis software. Video digital processing was used to extract and analyze the spatiotemporal characteristics of hand movement. Attending plastic surgeons appear to use their nondominant hand more than residents when cutting with the scalpel, suggesting more use of countertraction. While suturing, attendings were more ambidextrous, with smaller differences in movement between their dominant and nondominant hands than residents. Attendings also seem to have more conservation of movement when performing instrument tying than residents, as demonstrated by less nondominant hand displacement. These observations were consistent within procedures and between the different attending plastic surgeons evaluated in this fashion. Video motion analysis can be used to provide objective measurement of technical skills without the need for sensors or markers. Such data could be valuable in better understanding the acquisition and degradation of operative skills, providing enhanced feedback to shorten the learning curve.