Motion analysis in the pediatric laparoscopic surgery (PLS) simulator: validation and potential use in teaching and assessing surgical skills.
BACKGROUND
Construct validity for the pediatric laparoscopic surgery (PLS) simulator has been established through a scoring system based on time and precision. We describe the development and initial validation of motion analysis to teach and assess skills related to pediatric minimal access surgery (MAS).


METHODS
Participants were asked to perform a standardized intracorporeal suturing task. They were classified as novices, intermediates, and experts. Motion in the four degrees of freedom available during traditional MAS (PITCH, YAW, ROLL and SURGE) was assessed using range, velocity, and acceleration.


RESULTS
Analysis of motion allowed discrimination between the 75 participants according to level of expertise. The most discriminating motion parameter was the acceleration in performing the ROLL (pronation/supination) with values of 30±27 for novices, 15±5 for intermediates, and 3.7±3 for experts (p<0.001).


CONCLUSIONS
Tracking and analyzing the motion of instruments within the PLS simulator allow discrimination between novices, intermediates, and experts, thus establishing construct validity. Further development may establish motion analysis as a useful "real time" modality to teach and assess MAS skills.
Division of Pediatric Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada.
Ahmed
A
Nasr
Division of General and Thoracic Surgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
Brian
B
Carrillo
Division of General and Thoracic Surgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
J Ted
JT
Gerstle
Division of General and Thoracic Surgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada. Electronic address: georges.azzie@sickkids.ca.
Georges
G
Azzie
D000328:Adult; D002648:Child; D002983:Clinical Competence; D003198:Computer Simulation; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000193:education*; D008297:Male; D008875:Middle Aged; D009048:Motor Skills; D010372:Pediatrics / Q000193:education*; D011446:Prospective Studies; D013043:Specialties, Surgical / Q000193:education*; D013536:Suture Techniques; D013996:Time and Motion Studies
Laparoscopic simulator; Minimally invasive surgery; Motion analysis; PLS