Glarner Carly E, Hu Yue-Yung, Chen Chia-Hsiung, Radwin Robert G, Zhao Qianqian, Craven Mark W, Wiegmann Douglas A, Pugh Carla M, Carty Matthew J, Greenberg Caprice C
Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin, Madison, WI.
Center for Surgery & Public Health, Brigham & Women's Hospital, Department of Surgery, Beth Israel Medical Center, Boston, MA.
Surgery. 2014 Sep;156(3):729-34. doi: 10.1016/j.surg.2014.04.054. Epub 2014 Jun 21.
Objective quantification of technical operative skills in surgery remains poorly defined, although the delivery of and training in these skills is essential to the profession of surgery. Attempts to measure hand kinematics to quantify operative performance primarily have relied on electromagnetic sensors attached to the surgeon's hand or instrument. We sought to determine whether a similar motion analysis could be performed with a marker-less, video-based review, allowing for a scalable approach to performance evaluation.
We recorded six reduction mammoplasty operations-a plastic surgery procedure in which the attending and resident surgeons operate in parallel. Segments representative of surgical tasks were identified with Multimedia Video Task Analysis software. Video digital processing was used to extract and analyze the spatiotemporal characteristics of hand movement.
Attending plastic surgeons appear to use their nondominant hand more than residents when cutting with the scalpel, suggesting more use of countertraction. While suturing, attendings were more ambidextrous, with smaller differences in movement between their dominant and nondominant hands than residents. Attendings also seem to have more conservation of movement when performing instrument tying than residents, as demonstrated by less nondominant hand displacement. These observations were consistent within procedures and between the different attending plastic surgeons evaluated in this fashion.
Video motion analysis can be used to provide objective measurement of technical skills without the need for sensors or markers. Such data could be valuable in better understanding the acquisition and degradation of operative skills, providing enhanced feedback to shorten the learning curve.
尽管手术技术操作技能的传授与培训对手术专业至关重要，但目前对外科手术技术操作技能的客观量化定义仍不明确。测量手部运动学以量化手术操作表现的尝试主要依赖于附着在外科医生手部或器械上的电磁传感器。我们试图确定是否可以通过无标记的基于视频的评估进行类似的运动分析，从而实现一种可扩展的手术表现评估方法。
我们记录了六例缩乳手术——这是一种整形外科手术，主刀医生和住院医生同时进行操作。使用多媒体视频任务分析软件识别代表手术任务的片段。通过视频数字处理来提取和分析手部运动的时空特征。
在使用手术刀切割时，整形外科主刀医生似乎比住院医生更多地使用非优势手，这表明他们更多地使用了对抗牵引。在缝合时，主刀医生双手使用更为灵活，其优势手和非优势手之间的运动差异比住院医生更小。在进行器械打结操作时，主刀医生的动作似乎也比住院医生更连贯，这表现为非优势手的位移更小。在不同的手术过程以及以这种方式评估的不同整形外科主刀医生之间，这些观察结果都是一致的。
视频运动分析可用于在无需传感器或标记的情况下提供手术技能的客观测量。这些数据对于更好地理解手术技能的习得和退化、提供强化反馈以缩短学习曲线可能具有重要价值。
