title: Analysis of the Structure of Surgical Activity for a Suturing and Knot-Tying Task.
abstract: BACKGROUND
  Surgical tasks are performed in a sequence of steps, and technical skill evaluation includes assessing task flow efficiency. Our objective was to describe differences in task flow for expert and novice surgeons for a basic surgical task.
  
  
  METHODS
  We used a hierarchical semantic vocabulary to decompose and annotate maneuvers and gestures for 135 instances of a surgeon's knot performed by 18 surgeons. We compared counts of maneuvers and gestures, and analyzed task flow by skill level.
  
  
  RESULTS
  Experts used fewer gestures to perform the task (26.29; 95% CI = 25.21 to 27.38 for experts vs. 31.30; 95% CI = 29.05 to 33.55 for novices) and made fewer errors in gestures than novices (1.00; 95% CI = 0.61 to 1.39 vs. 2.84; 95% CI = 2.3 to 3.37). Transitions among maneuvers, and among gestures within each maneuver for expert trials were more predictable than novice trials.
  
  
  CONCLUSIONS
  Activity segments and state flow transitions within a basic surgical task differ by surgical skill level, and can be used to provide targeted feedback to surgical trainees.
authors.affiliation: Department of Computer Science, The Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: S Swaroop
authors.initials: SS
authors.lastname: Vedula
authors.affiliation: Department of Computer Science, The Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Anand O
authors.initials: AO
authors.lastname: Malpani
authors.affiliation: Department of Electrical and Computer Engineering, The Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Lingling
authors.initials: L
authors.lastname: Tao
authors.affiliation: Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: George
authors.initials: G
authors.lastname: Chen
authors.affiliation: Department of Computer Science, The Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Yixin
authors.initials: Y
authors.lastname: Gao
authors.affiliation: Department of Computer Science, The Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Piyush
authors.initials: P
authors.lastname: Poddar
authors.affiliation: Department of Computer Science, The Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Narges
authors.initials: N
authors.lastname: Ahmidi
authors.affiliation: Department of Computer Science, The Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Christopher
authors.initials: C
authors.lastname: Paxton
authors.affiliation: Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Rene
authors.initials: R
authors.lastname: Vidal
authors.affiliation: Department of Computer Science, The Johns Hopkins University, Baltimore, Maryland, United States of America.|Department of Electrical and Computer Engineering, The Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Khudanpur
authors.affiliation: Department of Computer Science, The Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Hager
authors.affiliation: Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.
authors.forename: Chi Chiung Grace
authors.initials: CC
authors.lastname: Chen
mesh_terms: D002983:Clinical Competence; D019300:Medical Errors; D066231:Surgeons; D013536:Suture Techniques