title: Design and validation of an assessment tool for open surgical procedures.
abstract: BACKGROUND
  Laparoscopy is currently the gold standard for cholecystectomy. Recent literature suggests surgical trainees have limited exposure to open cholecystectomy, which may result in suboptimal performance in the event of conversion. Furthermore, most training and assessment models are designed for laparoscopic cholecystectomy, with limited opportunities for open simulator training. The present study's purpose was to design an inexpensive model for open cholecystectomy and to validate a performance assessment tool.
  
  
  METHODS
  The simulator comprises a porcine liver and gallbladder in a mock human abdomen with silicon skin. The assessment tool utilizes inexpensive infrared (IR) cameras to provide tracking of participant hand motions. Eleven novice general surgery trainees (<20 cholecystectomies) and five expert surgeons (>100 cholecystectomies) completed an open cholecystectomy using the simulator. Procedures were recorded and assessed by a blinded evaluator using a global rating scale. Tracking data analysis was based on number of movements and total path length.
  
  
  RESULTS
  Novices (t = 36.18 min) completed the procedure significantly slower than did experts (t = 19.53 min) (Mann-Whitney test U = 20, p < 0.05) and had significantly more hand movements (Mann-Whitney test U = 20, p < 0.05). Analysis of the total global rating scale scores showed a significant difference between novice (14/35) and expert (24/35) performance in all categories (Mann-Whitney test U = 58, p < 0.05).
  
  
  CONCLUSIONS
  The present model presents a realistic, low-cost tool for training and assessment of procedural skills in open cholecystectomy. The study demonstrated the validity of the IR tracking device as an objective assessment tool for open surgical skills training. Future training should incorporate this low-cost, highly effective training device into surgical curricula.
authors.affiliation: Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada, neil.rittenhouse@alumni.utoronto.ca.
authors.forename: Neil
authors.initials: N
authors.lastname: Rittenhouse
authors.forename: Bharat
authors.initials: B
authors.lastname: Sharma
authors.forename: Ranil
authors.initials: R
authors.lastname: Sonnadara
authors.forename: Alex
authors.initials: A
authors.lastname: Mihailidis
authors.forename: Teodor
authors.initials: T
authors.lastname: Grantcharov
mesh_terms: D000328:Adult; D000818:Animals; D002763:Cholecystectomy / Q000193:education* / Q000379:methods; D002983:Clinical Competence; D004195:Disease Models, Animal; D004502:Education, Medical, Continuing / Q000379:methods*; D005260:Female; D005705:Gallbladder Diseases / Q000601:surgery*; D006801:Humans; D007813:Laparotomy / Q000193:education*; D008099:Liver / Q000601:surgery; D008297:Male; D008348:Manikins; D015203:Reproducibility of Results; D013552:Swine