The use of electromagnetic motion tracking analysis to objectively measureopen surgical skill in the laboratory-based model

BACKGROUND: Technical performance has traditionally been assessed subjectiv ely within the operating theater, with few successful attempts at objective analysis. The Imperial College Surgical Assessment Device (ICSAD) has alre ady been shown to be a valid quantitative measure of dexterity in laparosco pic surgical simulation. We describe its application to the assessment of o pen surgical procedures. STUDY DESIGN: Fifty-one participants were recruited from four different lev els of general surgical experience: basic surgical trainees (n = 12), junio r specialist registrars (n = 13), senior specialist registrars (n = 13), an d consultants (n = 13). They completed two tasks: a small bowel anastomosis and a vein patch insertion into an artery. Surgical performance was measur ed with the Imperial College Surgical Assessment Device, a motion analysis system that measures the number of hand movements made and time taken to co mplete a task. The four groups were compared statistically using the Kruska l-Wallis test (K-W). Pairwise group comparisons used the Mann-Whitney U tes t and p values were adjusted for multiple comparisons to determine the stat istical significance of these comparisons. RESULTS: Mean values for number of movements and time (secs) for small bowe l anastomosis were 2,080/1,236 (basic surgical trainees), 1,673/1,016 (juni or specialist registrars), 1,375/862 (senior specialist registrars), and 1, 337/782 (consultants), respectively. Comparison of the medians by K-W revea led a p < 0.001 for each variable (No. of movements, time), respectively. M ean vein patch insertion results were 1,653/1,258, 1,297/1,006, 1,090/912, and 925/736 for each of the four groups. Again, comparison of the medians b y K-W revealed a p < 0.001 for each variable. CONCLUSIONS: These findings suggest that hand motion analysis may be an eff ective objective measure of dexterity in open surgical simulation. (J Am Co ll Surg 2001;193:479-485. (C) 2001 by the American College of Surgeons).