Methods: An objective performance rating tool was devised. This instrument is comprised of standardized criteria with global rating and operation-specific components, each rated on a 5-point Likert scale. The total potential score was 100. Complete phacoemulsification cataract extraction operations were recorded through the operating microscope of surgeons with a range of experience (group A, Ͻ50 procedures; group B, 50-249 procedures; group C, 250-500 procedures, and group D, Ͼ500 procedures). These were then scored by independent expert reviewers masked to the grades of the surgeons. The U test was used to evaluate statistical significance. Results: We evaluated 38 surgical videotapes of 38 surgeons (group A, 11 surgeons; group B, 10 surgeons; group C, 5 surgeons; and group D, 12 surgeons). Mean±SD overall scores were as follows: group A, 32.0±5.3; group B, 55.0±12.6; group C, 89.0±4.7; and group D, 90.0±11.1. Statistically significant differences were found between groups A and B (P=.002) and groups B and C (P=.003), but not between groups C and D (PϾ.99). Conclusion: The Objective Structured Assessment of Cataract Surgical Skill scoring system seems to have construct validity with cataract surgery and, thus, may be valuable for assessing the surgical skills of junior trainees.
To evaluate motion analysis as a discriminator of ophthalmic plastic surgical skill between surgeons of varying experience. Methods: Thirty subjects were divided into 3 groups based on surgical experience: novice (Ͻ5 performed procedures; n=10), intermediate (5-100 procedures; n=10), and expert (Ͼ100 procedures; n=10). Detailed 3-dimensional motion data from surgeons performing 2 oculoplastic surgical tasks on a wet laboratory skills board were obtained using the Qualisys motion capture system. The first task was a deep 3-1-1 suture. The second was skin closure with a continuous suture. The main outcome measures were time, overall path length, and total number of movements. Kruskal-Wallis analysis was performed to evaluate statistical significance. Results: Highly significant differences were found during the skin closure task between all groups for mean time (P=.002), overall path length (P =.002), and number of movements (P = .001). For the deep stitch, highly significant differences were also found for time (P Ͻ.001), path length (P Ͻ .001), and number of movements (PϽ .001). Conclusions: Motion analysis, using this technology, was able to differentiate between surgeons of varying experience performing oculoplastic tasks, thus demonstrating construct validity. This technique may be useful in the objective quantitative measurement of oculoplastic skill, with potential applications for training and research.
Endonasal DCR surgery offers a very attractive alternative to the well established technique of external DCR surgery for the treatment of primary acquired nasolacrimal duct obstruction with equivalent success rates, shorter surgical time and higher patient satisfaction.
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