This study shows that force discrimination in a defined VR environment correlates to needle insertion time, idle time, and hand smoothness when performing subclavian central line placement. Fine motor force discrimination may serve as a valid and objective assessment of the skills required for successful needle insertion when placing central lines.
The
surgical process remains elusive to many. This paper presents
two independent empirical investigations where psychomotor skill metrics
were used to quantify elements of the surgical process in a procedural
context during surgical tasks in a simulated environment. The overarching
goal of both investigations was to address the following hypothesis:
Basic motion metrics can be used to quantify specific aspects of the
surgical process including instrument autonomy, psychomotor efficiency,
procedural readiness, and clinical errors. Electromagnetic motion
tracking sensors were secured to surgical trainees’ (N = 64) hands for both studies, and several motion metrics
were investigated as a measure of surgical skill. The first study
assessed performance during a bowel repair and laparoscopic ventral
hernia (LVH) repair in comparison to a suturing board task. The second
study assessed performance in a VR task in comparison to placement
of a subclavian central line. The findings of the first study support
our subhypothesis that motion metrics have a generalizable application
to surgical skill by showing significant correlations in instrument
autonomy and psychomotor efficiency during the suturing task and bowel
repair (idle time: r = 0.46, p <
0.05; average velocity: r = 0.57, p < 0.05) and the suturing task and LVH repair (jerk magnitude: r = 0.36, p < 0.05; bimanual dexterity: r = 0.35, p < 0.05). In the second study,
performance in VR (steering and jerkiness) correlated to clinical
errors (r = 0.58, p < 0.05) and
insertion time (r = 0.55, p <
0.05) in placement of a subclavian central line. Both gross (dexterity)
and fine motor skills (steering) were found to be important as well
as efficiency (i.e., idle time, duration, velocity) when seeking to
understand the quality of surgical performance. Both studies support
our hypotheses that basic motion metrics can be used to quantify specific
aspects of the surgical process and that the use of different technologies
and metrics are important for comprehensive investigations of surgical
skill.
Background: Pancreatoduodenectomies at high risk for clinically relevant pancreatic fistula are uncommon, yet intimidating, situations. In such scenarios, the impact of individual surgeon experience on outcomes is poorly understood. Methods: The fistula risk score was applied to identify high-risk patients (fistula risk score 7e10) from 7,706 pancreatoduodenectomies performed at 18 international institutions (2003e2020). For each case, surgeon pancreatoduodenectomy career volume and years of practice were linked to intraoperative fistula mitigation strategy adoption and outcomes. Consequently, best operative approaches for clinically relevant pancreatic fistula prevention and best performer profiles were identified through multivariable analysis models. Results: Eight hundred and thirty high-risk pancreatoduodenectomies, performed by 64 surgeons, displayed an overall clinically relevant pancreatic fistula rate of 33.7%. Clinically relevant pancreatic fistula Author Contributions: Conception/design (F Casciani, MT Trudeau, CM Vollmer); data acquisition (all authors); data interpretation (all authors) critical revisions (all authors); final approval (all authors).All individuals claiming authorship meet all of the following 3 conditions: (1) Authors made substantial contributions to conception and design, and/or acquisition of data, and/or analysis and interpretation of data; (2) Authors participated in drafting the article or revising it critically for important intellectual content; and (3) Authors gave final approval of the version to be published.
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