title: Objective Surgical Skill Assessment: An Initial Experience by Means of a Sensory Glove Paving the Way to Open Surgery Simulation?
abstract: BACKGROUND
  Simulation and training in surgery are very promising tools for enhancing a surgeon's skill base. Accurate tracking of hand movements can be a strategy for objectively gauging a surgeon's dexterity, although "open" work is much more difficult to evaluate than are laparoscopic tasks. To the authors' knowledge, a system taking into account the movements of each finger joint has never been applied to open surgery simulation. This work intends to make up for this shortcoming and to perform a data analysis of the surgeon's entire gesture.
  
  
  METHODS
  The authors developed a sensory glove to measure flexion/extension of each finger joint and wrist movement. Totally 9 experts and 9 novices performed a basic suturing task and their manual performances were recorded within 2 days of measurements. Intraclass correlation coefficients were calculated to assess the ability of the executors to repeat and reproduce the proposed exercise. Wilcoxon signed-rank tests and Mann-Whitney U-tests were used to determine whether the 2 groups differ significantly in terms of execution time, repeatability, and reproducibility. Finally, a questionnaire was used to gather operators' subjective opinions.
  
  
  RESULTS
  The experts needed a similar reduced execution time comparing the 2 recording sessions (p = 0.09), whereas novices spent more time during the first day (p = 0.01). Repeatability did not differ between the 2 days, either for experts (p = 0.26) or for novices (p = 0.86). The 2 groups performed differently in terms of time (p < 0.001), repeatability (p = 0.01), and reproducibility (p < 0.001) of the same gesture. The system showed an overall moderate repeatability (intraclass correlation coefficient: experts = 0.64; novices = 0.53) and an overall high reproducibility. The questionnaire revealed performers' positive feedback with the glove.
  
  
  CONCLUSIONS
  This initial experience confirmed the validity and reliability of the proposed system in objectively assessing surgeons' technical skill, thus paving the way to a more complex project involving open surgery simulation.
authors.affiliation: Department of Electronic Engineering, University of Rome Tor Vergata, Rome, Italy. Electronic address: saggio@uniroma2.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Saggio
authors.affiliation: Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Lazzaro
authors.affiliation: Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Sbernini
authors.affiliation: Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Francesco Maria
authors.initials: FM
authors.lastname: Carrano
authors.affiliation: Department of Electronic Engineering, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Passi
authors.affiliation: Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Arianna
authors.initials: A
authors.lastname: Corona
authors.affiliation: Biostatistics office, L'altrastatistica srl-Consultancy & Training, Rome, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Panetta
authors.affiliation: Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Achille L
authors.initials: AL
authors.lastname: Gaspari
authors.affiliation: Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Di Lorenzo
mesh_terms: D002983:Clinical Competence; D003020:Clothing; D004867:Equipment Design; D056228:Feedback, Sensory; D006225:Hand / Q000502:physiology*; D006801:Humans; D015203:Reproducibility of Results; D012815:Signal Processing, Computer-Assisted; D011795:Surveys and Questionnaires; D013536:Suture Techniques; D013647:Task Performance and Analysis; D014584:User-Computer Interface
keywords: Medical Knowledge; Practice-Based Learning and Improvement; Professionalism; Systems-Based Practice; assessment; education; open surgery; sensory glove; skill