title: Assessing Microneurosurgical Skill with Medico-Engineering Technology.
abstract: OBJECTIVE
  Most methods currently used to assess surgical skill are rather subjective or not adequate for microneurosurgery. Objective and quantitative microneurosurgical skill assessment systems that are capable of accurate measurements are necessary for the further development of microneurosurgery.
  
  
  METHODS
  Infrared optical motion tracking markers, an inertial measurement unit, and strain gauges were mounted on tweezers to measure many parameters related to instrument manipulation. We then recorded the activity of 23 neurosurgeons. The task completion time, tool path, and needle-gripping force were evaluated for three stitches made in an anastomosis of 0.7-mm artificial blood vessels. Videos of the activity were evaluated by three blinded expert surgeons.
  
  
  RESULTS
  Surgeons who had recently done many bypass procedures demonstrated better skills. These skilled surgeons performed the anastomosis with in a shorter time, with a shorter tool path, and with a lesser force when extracting the needle.
  
  
  CONCLUSIONS
  These results show the potential contribution of the system to microsurgical skill assessment. Quantitative and detailed analysis of surgical tasks helps surgeons better understand the key features of the required skills.
authors.affiliation: Department of Mechanical Engineering, The University of Tokyo, Tokyo, Japan.
authors.forename: Kanako
authors.initials: K
authors.lastname: Harada
authors.affiliation: Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan. Electronic address: amor-tky@umin.ac.jp.
authors.forename: Akio
authors.initials: A
authors.lastname: Morita
authors.affiliation: Department of Mechanical Engineering, The University of Tokyo, Tokyo, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Minakawa
authors.affiliation: Department of Mechanical Engineering, The University of Tokyo, Tokyo, Japan.
authors.forename: Young Min
authors.initials: YM
authors.lastname: Baek
authors.affiliation: Department of Neurosurgery, Tokyo Metropolitan Police Hospital, Tokyo, Japan.
authors.forename: Shigeo
authors.initials: S
authors.lastname: Sora
authors.affiliation: Department of Mechanical Engineering, The University of Tokyo, Tokyo, Japan.
authors.forename: Naohiko
authors.initials: N
authors.lastname: Sugita
authors.affiliation: Department of Neurosurgery, NTT Medical Center Tokyo, Tokyo, Japan.
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Kimura
authors.affiliation: Department of Neurosurgery, Teishinkai Hospital, Sapporo, Japan.
authors.forename: Rokuya
authors.initials: R
authors.lastname: Tanikawa
authors.affiliation: Department of Surgical Neurology, Research Institute for Brain and Blood Vessels-Akita, Akita, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Ishikawa
authors.affiliation: Department of Mechanical Engineering, The University of Tokyo, Tokyo, Japan.
authors.forename: Mamoru
authors.initials: M
authors.lastname: Mitsuishi
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000592:standards; D002983:Clinical Competence / Q000592:standards*; D004521:Educational Measurement; D005260:Female; D018737:Hand Strength; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008866:Microsurgery / Q000592:standards*; D008875:Middle Aged; D009493:Neurosurgery / Q000592:standards*; D066231:Surgeons; D013525:Surgical Instruments; D014741:Video Recording
keywords: Anastomosis; Medical engineering; Microsurgery; Neurosurgery; Surgical skill assessment; Training