EducationAnalysis of hand motion differentiates expert and novice surgeons
Introduction
Although laparoscopic surgery has many advantages, such as decreased scarring, faster recovery, and cosmetic advantages, laparoscopic surgical skills may be harder to learn for some surgeons, and in some ways differ from the techniques used in conventional open surgery. Specialized training is important and necessary for surgeons to perform laparoscopic surgery safely and accurately.
The number of operations performed by a surgeon is sometimes considered an indicator of surgical skill, and surgeons who have performed many operations are considered “expert surgeons.” In addition to facilitating the safe and efficient conduct of an operative procedure, experience enables surgeons to seek strategic remedies when faced with difficulties during an operation. The hand motions made by a surgeon during an operation may also reflect the skill of a surgeon. It is sometimes said that surgeons seek “economy of motion” in reference to manipulating surgical instruments, but measuring this desirable trait is a complex matter. We hypothesized that the hand motions of expert surgeons differ significantly from those of novice surgeons, regardless of whether the expert surgeons are familiar with the specific tasks during a particular operation.
Ordinarily, expert surgeons are distinguished from novice surgeons by performance scores, which are based on performance time, the speed with which instruments are manipulated, and the number of errors made during an operation. Performance scores are frequently used to assess surgeons being trained to perform laparoscopic procedures [1], [2], [3], [4] and have been used to distinguish experts from novices in the conduct of laparoscopic procedures. Performance scores alone, however, cannot assess the skills required for laparoscopic surgery. Other measures that may distinguish expert from novice surgeons being trained in laparoscopic procedures include psychomotor skills and eye–hand coordination [5], [6], [7], [8], [9], [10], [11], although these factors alone are neither necessary nor sufficient for distinguishing the skills of expert and novice surgeons in performing laparoscopic procedures.
The goal of this study was to identify latent factors possessed by experts in the conduct of laparoscopic procedures. Kinematic analysis of the motions made by a surgeon's forceps during a skill assessment task were evaluated, and two mathematical analysis techniques used to assign numerical values to features of surgical performance such as “fluctuation” and “unstable periodic orbits,” which may at least in part describe the concepts attributed to “economy of motion.”
Section snippets
Study participants
Participants in this study included 38 surgeons who have taken a laparoscopic surgery training course held at Kyushu University Training Center for Minimally Invasive Surgery [1], [12], [13]. Examinees were divided into two groups. The expert group included 11 expert surgeons, each of whom had performed >100 laparoscopic surgical procedures and completed the skill assessment task, and the novice group had 27 young surgeons, each of whom had performed <15 laparoscopic surgeries and had not
Detrended fluctuation analysis
We applied detrended fluctuation analysis to the center movement of both hands for all 38 participants. Figure 3A shows the plot for the initial scaling exponent, α1. The exponent α1 was significantly higher for the novice than for the expert group (P < 0.01), with α1 for the novice group being about 1.5 and that for the expert group about 1.0 (1/f), indicative of Brown noise (i.e., no correlation). These results indicate that the expert group, with a lower value of α1 was closer to “long-range
Discussion
The number of operations performed by a surgeon is sometimes considered an indication of surgical skill, and surgeons who perform large numbers of a particular type of surgery are often referred to as “expert surgeons” [18], [19], [20]. We have defined expert surgeons as those who previously performed >100 laparoscopic procedures. The aim of this study was to identify the unique characteristics of expert surgeons through a mathematical analysis of hand motion. We have applied mathematical
Conclusions
These mathematical analyses provide a new way of quantitative differences in the hand motions of expert and novice surgeons during a simulated laparoscopic procedure. Further studies of these analytic techniques are indicated, and may provide a useful tool in both training and assessment of future laparoscopic surgeons.
Acknowledgment
Drs Uemura, Tomikawa, Kumashiro, Miao, Sozaki, Ieiri, Ohuchida, Lefor, and Hashizume have no conflicts of interest or financial ties to disclose.
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2022, Applied ErgonomicsCitation Excerpt :Hand gestures have been compared between novices and experts in various working fields such as surgery (McNatt et Smith 2001; Lin et al., 2012; Megali et al., 2006) manutention jobs (Plamondon et al., 2014; Min et al., 2012) and music playing (Fernandes et Barros 2012; Parlitz et al., 1998; Jäncke et al., 2000). These studies showed differences in kinematics with experts displaying more stable and reproducible movement (Uemura et al., 2014; Fernandes et Barros 2012; Sakakura et al., 2018). In addition, experts have a specific coordination (Fernandes et Barros 2012) that allow them to avoid unnecessary movement (Zhou et al., 2019; Hofstad et al., 2013; Azari et al., 2020) and to minimize muscle force (Parlitz et al., 1998).
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2021, Artificial Intelligence in MedicineCitation Excerpt :The most common way of providing feedback is by offering visualizations to trainees. The most popular visualization shows the trajectories (5 articles) followed by novice and expert surgeons in 2D [68] and 3D [39,40,43,67] indicating with a different color the specific sub-movements of the novice surgeon. In addition, Uemura et al. [68] used bar charts showing the scores for several indicators, including the range in which each score was considered “good”.