Colin F Mackenzie1, Shiming Yang2, Evan Garofalo3, Peter Fu-Ming Hu2,4, Darcy Watts2, Rajan Patel2, Adam Puche5, George Hagegeorge2, Valerie Shalin6, Kristy Pugh5, Guinevere Granite7, Lynn G Stansbury8, Stacy Shackelford9, Samuel Tisherman4. 1. School of Medicine (UMDSOM) Shock Trauma Anesthesiology Research Center, University of Maryland, 11 S Paca St, Suite LL-01, Baltimore, MD, 21201, USA. cmack003@gmail.com. 2. School of Medicine (UMDSOM) Shock Trauma Anesthesiology Research Center, University of Maryland, 11 S Paca St, Suite LL-01, Baltimore, MD, 21201, USA. 3. Department of Basic Sciences, University of Arizona School of Medicine, Tucson, AZ, 85724, USA. 4. Department of Surgery, UMDSOM, Baltimore, MD, 21201, USA. 5. Anatomy and Neurobiology, UMDSOM, Baltimore, MD, 21201, USA. 6. Department of Psychology, Wright State University, Dayton, OH, 45435, USA. 7. Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA. 8. Harborview Injury Prevention and Research Center, University of Washington, Seattle, USA. 9. Joint Trauma System, Defense Health Agency Combat Support, Falls Church, USA.
Abstract
BACKGROUND: Hand motion analysis by video recording during surgery has potential for evaluation of surgical performance. The aim was to identify how technical skill during open surgery can be measured unobtrusively by video recording during a surgical procedure. We hypothesized that procedural-step timing, hand movements, instrument use and Shannon entropy differ with expertise and training and are concordant with a performance-based validated individual procedure score. METHODS: Surgeon and non-surgeon participants with varying training and levels of expertise were video recorded performing axillary artery exposure and control (AA) on un-preserved cadavers. Color-coded gloves permitted motion-tracking and automated extraction of entropy data from recordings. Timing and instrument-use metrics were obtained through observational video reviews. Shannon entropy measured speed, acceleration and direction by computer-vision algorithms. Findings were compared with individual procedure score for AA performance RESULTS: Experts had lowest entropy values, idle time, active time and shorter time to divide pectoralis minor, using fewer instruments. Residents improved with training, without reaching expert levels, and showed deterioration 12-18 months later. Individual procedure scores mirrored these results. Non-surgeons differed substantially. CONCLUSIONS: Hand motion entropy and timing metrics discriminate levels of surgical skill and training, and these findings are congruent with individual procedure score evaluations. These measures can be collected using consumer-level cameras and analyzed automatically with free software. Hand motion with video timing data may have widespread application to evaluate resident performance and can contribute to the range of evaluation and testing modalities available to educators, training course designers and surgical quality assurance programs.
BACKGROUND: Hand motion analysis by video recording during surgery has potential for evaluation of surgical performance. The aim was to identify how technical skill during open surgery can be measured unobtrusively by video recording during a surgical procedure. We hypothesized that procedural-step timing, hand movements, instrument use and Shannon entropy differ with expertise and training and are concordant with a performance-based validated individual procedure score. METHODS: Surgeon and non-surgeon participants with varying training and levels of expertise were video recorded performing axillary artery exposure and control (AA) on un-preserved cadavers. Color-coded gloves permitted motion-tracking and automated extraction of entropy data from recordings. Timing and instrument-use metrics were obtained through observational video reviews. Shannon entropy measured speed, acceleration and direction by computer-vision algorithms. Findings were compared with individual procedure score for AA performance RESULTS: Experts had lowest entropy values, idle time, active time and shorter time to divide pectoralis minor, using fewer instruments. Residents improved with training, without reaching expert levels, and showed deterioration 12-18 months later. Individual procedure scores mirrored these results. Non-surgeons differed substantially. CONCLUSIONS: Hand motion entropy and timing metrics discriminate levels of surgical skill and training, and these findings are congruent with individual procedure score evaluations. These measures can be collected using consumer-level cameras and analyzed automatically with free software. Hand motion with video timing data may have widespread application to evaluate resident performance and can contribute to the range of evaluation and testing modalities available to educators, training course designers and surgical quality assurance programs.
Authors: Colin F Mackenzie; Mark W Bowyer; Sharon Henry; Samuel A Tisherman; Adam Puche; Hegang Chen; Valerie Shalin; Kristy Pugh; Evan Garofalo; Stacy A Shackelford Journal: J Am Coll Surg Date: 2018-05-04 Impact factor: 6.113
Authors: Colin F Mackenzie; Stacy A Shackelford; Samuel A Tisherman; Shiming Yang; Adam Puche; Eric A Elster; Mark W Bowyer Journal: Surgery Date: 2019-07-25 Impact factor: 3.982
Authors: Mark W Bowyer; Deborah A Kuhls; Danielle Haskin; Richard A Sallee; Sharon M Henry; George D Garcia; Frederick A Luchette Journal: J Surg Res Date: 2013-02-27 Impact factor: 2.192