title: Objective assessment based on motion-related metrics and technical performance in laparoscopic suturing.
abstract: OBJECTIVE
  The aim of this study is to present the construct and concurrent validity of a motion-tracking method of laparoscopic instruments based on an optical pose tracker and determine its feasibility as an objective assessment tool of psychomotor skills during laparoscopic suturing.
  
  
  METHODS
  A group of novice ([Formula: see text] laparoscopic procedures), intermediate (11-100 laparoscopic procedures) and experienced ([Formula: see text] laparoscopic procedures) surgeons performed three intracorporeal sutures on an ex vivo porcine stomach. Motion analysis metrics were recorded using the proposed tracking method, which employs an optical pose tracker to determine the laparoscopic instruments' position. Construct validation was measured for all 10 metrics across the three groups and between pairs of groups. Concurrent validation was measured against a previously validated suturing checklist. Checklists were completed by two independent surgeons over blinded video recordings of the task.
  
  
  RESULTS
  Eighteen novices, 15 intermediates and 11 experienced surgeons took part in this study. Execution time and path length travelled by the laparoscopic dissector presented construct validity. Experienced surgeons required significantly less time ([Formula: see text]), travelled less distance using both laparoscopic instruments ([Formula: see text]) and made more efficient use of the work space ([Formula: see text]) compared with novice and intermediate surgeons. Concurrent validation showed strong correlation between both the execution time and path length and the checklist score ([Formula: see text] and [Formula: see text], [Formula: see text]).
  
  
  CONCLUSIONS
  The suturing performance was successfully assessed by the motion analysis method. Construct and concurrent validity of the motion-based assessment method has been demonstrated for the execution time and path length metrics. This study demonstrates the efficacy of the presented method for objective evaluation of psychomotor skills in laparoscopic suturing. However, this method does not take into account the quality of the suture. Thus, future works will focus on developing new methods combining motion analysis and qualitative outcome evaluation to provide a complete performance assessment to trainees.
authors.affiliation: Bioengineering and Health Technologies Unit, Jesús Usón Minimally Invasive Surgery Centre, Ctra. N-521, km 41.8, 10071, Cáceres, Spain. jasanchez@ccmijesususon.com.
authors.forename: Juan A
authors.initials: JA
authors.lastname: Sánchez-Margallo
authors.affiliation: Laparoscopy Unit, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain.
authors.forename: Francisco M
authors.initials: FM
authors.lastname: Sánchez-Margallo
authors.affiliation: Biomedical Engineering and Telemedicine Centre (GBT), ETSI Telecomunicación, Universidad Politécnica de Madrid (UPM), Madrid, Spain.|Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Zaragoza, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Oropesa
authors.affiliation: Laparoscopy Unit, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain.
authors.forename: Silvia
authors.initials: S
authors.lastname: Enciso
authors.affiliation: Biomedical Engineering and Telemedicine Centre (GBT), ETSI Telecomunicación, Universidad Politécnica de Madrid (UPM), Madrid, Spain.|Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Zaragoza, Spain.
authors.forename: Enrique J
authors.initials: EJ
authors.lastname: Gómez
mesh_terms: D000328:Adult; D002983:Clinical Competence; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D011597:Psychomotor Performance; D015203:Reproducibility of Results; D000066908:Simulation Training; D013536:Suture Techniques; D013647:Task Performance and Analysis; D014741:Video Recording
keywords: Intracorporeal suturing; Laparoscopic surgery; Motion metrics; Objective assessment; Surgical training; Suturing checklist