Recording of surgical processes: a study comparing senior and junior neurosurgeons during lumbar disc herniation surgery.

BACKGROUND: Evaluating surgical practice in the operating room is difficult, and its assessment is largely subjective.
OBJECTIVE: Recording of standardized spine surgery processes was conducted to ascertain whether any significant differences in surgical practice could be observed between senior and junior neurosurgeons.
METHODS: Twenty-four procedures of lumbar discectomies were consecutively recorded by a senior neurosurgeon. In 12 cases, surgery was entirely performed by a senior neurosurgeon with the aid of a resident, and in the 12 remaining cases, surgery was performed by a resident with the aid of a senior neurosurgeon. The data recorded were general parameters (operating time for the whole procedure and for each step), and general and specific parameters of the surgeon's activities (number of manual gestures, number and duration of actions performed, use of the instruments, and use of interventions on anatomic structures). The Mann-Whitney U test was used for comparison between the 2 groups of neurosurgeons.
RESULTS: The operating time was statistically lower for the group of senior surgeons. The seniors statistically demonstrated greater economy in time and in gestures during the closure step, for sewing and for the use of scissors, needle holders, and forceps. The senior surgeons statistically worked for a shorter time on the skin and used fewer manual gestures on the thoracolumbalis fascia. The number of changes in microscope position was also statistically lower for this group.
CONCLUSION: There is a relationship between surgical practice, as determined by a method of objective measurement using observation software, and surgical experience: gesture economy evolves with seniority.