Motion Analysis as a Tool for the Evaluation of Oculoplastic Surgical Skill

Abstract

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.

The development of a virtual reality training programme for ophthalmology: repeatability and reproducibility (part of the International Forum for Ophthalmic Simulation Studies)

“…This has been demonstrated for a range of tasks including cataract surgery, 5 corneal suturing in a wet lab, 6 in oculoplastic surgery, 7 and in motion tracking studies both for phacoemulsification 8 and for skin suturing. 6,9 However, no specific analysis was ever undertaken with regard to the repeatability, reproducibility, or variability among novice trainees but rather these subjects were compared with more senior colleagues. 5,6,[8][9][10][11][12][13][14][15] What we therefore do not know is how an individual with minimal experience scores when undertaking the same task on several occasions (variability and reproducibility).…”

Comparison of two actuation systems for laparoscopic surgical manipulators using motion analysis

“…To date, however, there has been little work done on the analysis of hand and finger movements during surgical task execution [13,14]. Motion analysis has been used as an objective assessment of surgical skills [15,16]. Emam et al used motion analysis to compare two laparoscopic needle drivers with different handle design and demonstrated ergonomic superiority of one handle as it caused less angular acceleration, decreased angular velocity, and reduced joint displacement [17], confirming the utility of motion analysis as a tool for measuring the ergonomic performance of different instrument designs.…”

Man versus Machine: Software Training for Surgeons—An Objective Evaluation of Human and Computer-Based Training Tools for Cataract Surgical Performance

“…Inclusion criteria for both groups of systems included adult patients who had given informed consent, prior to undergoing routine phacoemulsification cataract surgery. Surgeons operated only on straightforward cases, and the inclusion criteria for patients were as follows: pupils fully dilating; mild to moderate cataract (1+ nuclear sclerosis or cortical lens opacity only); ability to fully lie flat and still for the duration of surgery; and no ocular comorbidity (e.g., glaucoma or pseudoexfoliation) [4]. …”

“…Exclusion criteria included a patient unable to give informed consent or not wishing to participate; nonroutine cataract (e.g., secondary to previous trauma or previous intraocular surgery); concurrent pathology that would exclude a clear view (e.g., corneal pathology); and complex cases not suitable for the less experienced surgical grade (e.g., very small pupil, mature cataracts, and patients with pseudoexfoliation) [4]. …”

“…These machine based tools are purely quantitative and have also been shown to statistically significantly discriminate between different surgical skill levels [3, 4]. The PhacoTrack software is one example where computer vision tracking has been applied to phacoemulsification surgery and successfully differentiated between junior and senior surgeons [5].…”