The use of electromagnetic motion tracking analysis to objectively measure open surgical skill in the laboratory-based model.
BACKGROUND
Technical performance has traditionally been assessed subjectively within the operating theater, with few successful attempts at objective analysis. The Imperial College Surgical Assessment Device (ICSAD) has already been shown to be a valid quantitative measure of dexterity in laparoscopic surgical simulation. We describe its application to the assessment of open surgical procedures.


METHODS
Fifty-one participants were recruited from four different levels of general surgical experience: basic surgical trainees (n = 12), junior specialist registrars (n = 13), senior specialist registrars (n = 13), and consultants (n = 13). They completed two tasks: a small bowel anastomosis and a vein patch insertion into an artery. Surgical performance was measured with the Imperial College Surgical Assessment Device, a motion analysis system that measures the number of hand movements made and time taken to complete a task. The four groups were compared statistically using the Kruskal-Wallis test (K-W). Pairwise group comparisons used the Mann-Whitney U test and p values were adjusted for multiple comparisons to determine the statistical significance of these comparisons.


RESULTS
Mean values for number of movements and time (secs) for small bowel anastomosis were 2,080/1,236 (basic surgical trainees), 1,673/1,016 (junior specialist registrars), 1,375/862 (senior specialist registrars), and 1,337/782 (consultants), respectively. Comparison of the medians by K-W revealed a p < 0.001 for each variable (No. of movements, time), respectively. Mean vein patch insertion results were 1,653/1,258, 1,297/1,006, 1,090/912, and 925/736 for each of the four groups. Again, comparison of the medians by K-W revealed a p < 0.001 for each variable.


CONCLUSIONS
These findings suggest that hand motion analysis may be an effective objective measure of dexterity in open surgical simulation.
Datta
V
V
Department of Surgical Oncology and Technology, Imperial College School of Medicine, London, United Kingdom.
Mackay
S
S
Mandalia
M
M
Darzi
A
A
D000714:Anastomosis, Surgical; D019917:Blood Vessel Prosthesis Implantation; D002983:Clinical Competence; D003253:Consultants; D004521:Educational Measurement; D055590:Electromagnetic Phenomena / Q000295:instrumentation*; D004739:England; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D007421:Intestine, Small / Q000601:surgery; D008505:Medical Staff, Hospital; D013536:Suture Techniques