matthew roberts, vanessa bacal, mohammed mahdi, ethan d. grober mount sinai & women’s college...
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Matthew Roberts, Vanessa Bacal, Mohammed Mahdi, Ethan D. Grober
Mount Sinai & Women’s College Hospital, Division of Urology, Department of Surgery, University of Toronto
Intra-Operative Assessment of Technical Skill on Live Intra-Operative Assessment of Technical Skill on Live Patients Using Economy of Hand Motion: Patients Using Economy of Hand Motion:
Establishing Learning Curves of Surgical CompetenceEstablishing Learning Curves of Surgical Competence
Technical SkillTechnical SkillAcquired
Objectively, reliably assessed
OSATS: Objective Structured OSATS: Objective Structured Assessment of Technical SkillAssessment of Technical Skill
Discriminate novice & experienced surgeonsDiscriminate novice & experienced surgeons
Improvement with training over timeImprovement with training over time
Skills sets transfer to higher fidelity simulationsSkills sets transfer to higher fidelity simulations
Intra-Operative Assessment of Technical Skill Intra-Operative Assessment of Technical Skill - - Real Patients, Real Operating RoomsReal Patients, Real Operating Rooms - -
Subjective, Unvalidated Subjective, Unvalidated
Intra-Operative Assessment of Technical Skill Intra-Operative Assessment of Technical Skill - - Real Patients, Real Operating RoomsReal Patients, Real Operating Rooms - -
Subjective, Unvalidated Subjective, Unvalidated
??Variable patientsVariable patients
Variable operationsVariable operations
Variable instruments & technologyVariable instruments & technology
OR team changesOR team changes
Resource & time pressuresResource & time pressures
Measurement instrumentsMeasurement instruments
Hand-Motion AnalysisHand-Motion Analysis
Electro-magnetic Electro-magnetic measurement of hand position measurement of hand position & orientation& orientation # of hand movements# of hand movements hand travel distancehand travel distance hand speedhand speed
Hand-Motion AnalysisHand-Motion Analysis
In the In the surgical skills labsurgical skills lab:: Objective, reliable and valid Objective, reliable and valid measure of surgical competence on open, laparoscopic, measure of surgical competence on open, laparoscopic, endoscopic and microsurgical procedures endoscopic and microsurgical procedures
Correlates well with traditional lab-based measures of Correlates well with traditional lab-based measures of surgical competence – global ratings and checklists scores surgical competence – global ratings and checklists scores by trained expertsby trained experts
Pilot work and feasibility studies have been performed in Pilot work and feasibility studies have been performed in real operating rooms real operating rooms
Hand-Motion AnalysisHand-Motion Analysis
Hand-Motion AnalysisHand-Motion Analysis
Study ObjectivesStudy Objectives
1.1. Establish the feasibility of performing live Establish the feasibility of performing live intra-operative intra-operative hand-motion analysis while hand-motion analysis while operating onoperating on real patients real patients
2.2. Validate live, intra-operative assessments of Validate live, intra-operative assessments of economy of hand motion as an economy of hand motion as an objective objective measure of technical skill measure of technical skill
3.3. Use hand-motion analysis to Use hand-motion analysis to establish establish competency-based surgical learning curvescompetency-based surgical learning curves based on standards established by based on standards established by performance of experienced surgeonsperformance of experienced surgeons
MethodsMethods
NoviceNovice
ExperiencedExperienced
2 Surgeons2 Surgeons 2 Standardized Surgical 2 Standardized Surgical TasksTasks
Video recorded Video recorded
Hand motion analysisHand motion analysis
VasectomyVasectomy
Microsurgery-Vasectomy reversalMicrosurgery-Vasectomy reversal
2 blinded, experienced surgeons2 blinded, experienced surgeons Global rating scoresGlobal rating scores Checklists scoresChecklists scores Final product scoresFinal product scores
Methods – Video AnalysisMethods – Video Analysis
Methods – Video AnalysisMethods – Video Analysis
Methods – Video AnalysisMethods – Video Analysis
Hand motion data and blinded expert ratings of video-based surgical performance were:
Graphically compared over time Correlated using Pearson calculations
Methods – Data AnalysisMethods – Data Analysis
NoviceNoviceExperiencedExperienced
Total Hand MovementsTotal Hand Movements
0
50
100
150
200
250
300
350
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Case #
Experienced SurgeonExperienced Surgeon
Novice SurgeonNovice Surgeon
0
100
200
300
400
500
600
700
1 2 3 4 5 6
Experienced SurgeonExperienced Surgeon
Novice SurgeonNovice Surgeon
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Hand Travel DistancesHand Travel Distances
Experienced SurgeonExperienced Surgeon
Novice SurgeonNovice Surgeon
Case #
Han
d T
rave
l Dis
tanc
e (m
)
0
5
10
15
20
25
30
35
40
45
50
1 2 3 4 5 6
Experienced SurgeonExperienced Surgeon
Novice SurgeonNovice Surgeon
Global Rating ScoresGlobal Rating Scores
5
7
9
11
13
15
17
19
21
23
25
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Experienced SurgeonExperienced Surgeon
Novice SurgeonNovice Surgeon
Glo
bal R
atin
g S
core
Case #0
5
10
15
20
25
30
35
1 2 3 4 5 6
Experienced SurgeonExperienced Surgeon
Novice SurgeonNovice Surgeon
10
12
14
16
18
20
22
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Checklist ScoresChecklist Scores
Experienced SurgeonExperienced Surgeon
Novice SurgeonNovice Surgeon
Che
ckli
st S
core
Case #
0
2
4
6
8
10
12
1 2 3 4 5 6
Experienced SurgeonExperienced Surgeon
Novice SurgeonNovice Surgeon
0
1
2
3
4
5
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Final Product ScoresFinal Product Scores
Case #
Fin
al P
rodu
ct S
core
Experienced SurgeonExperienced Surgeon
Novice SurgeonNovice Surgeon
0
1
2
3
4
5
1 2 3 4 5 6
Experienced SurgeonExperienced Surgeon
Novice SurgeonNovice Surgeon
Correlating Hand Motion & Video PerformanceCorrelating Hand Motion & Video Performance
# Hand # Hand movementsmovements
Hand Travel Hand Travel DistanceDistance
TimeTime
Global Rating Global Rating ScoreScore
r = -0.83 -0.85 -0.86
Checklist ScoreChecklist Score -0.78 -0.81 -0.86
Final Product Final Product ScoreScore
-0.82 -0.87 -0.83
Pearson correlation significant < 0.05 level (2-tailed)Pearson correlation significant < 0.05 level (2-tailed)
# Hand # Hand movementsmovements
Hand Travel Hand Travel DistanceDistance
TimeTime
Global Rating Global Rating ScoreScore
-0.94 -0.95 -0.92
Checklist ScoreChecklist Score -0.88 -0.83 -0.78
Final Product Final Product ScoreScore
-0.90 -0.85 -0.70
BADBAD BETTERBETTER
• Set up < 3minsSet up < 3mins
• Data obtained in 23/25 casesData obtained in 23/25 cases
• Surgical team easily trainedSurgical team easily trained
• HMA software and hardware $3500HMA software and hardware $3500
Hand-Motion Analysis: Hand-Motion Analysis: FeasibilityFeasibility
Conclusions Conclusions
1.1. Establish theEstablish the feasibilityfeasibility of performing live of performing live intra-operative intra-operative hand-motion analysis hand-motion analysis while while operating on real patients operating on real patients
2.2. ValidateValidate live, intra-operative assessments of live, intra-operative assessments of economy of hand motion as aneconomy of hand motion as an objective objective measure of technical skill measure of technical skill
3.3. Use hand-motion analysis to Use hand-motion analysis to establish establish competency-based surgical learning curvescompetency-based surgical learning curves based on standards established by based on standards established by performance of experienced surgeonsperformance of experienced surgeons
Utility of Hand Motion AnalysisUtility of Hand Motion Analysis
0
50
100
150
200
250
300
350
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Case #
Experienced SurgeonExperienced Surgeon
Novice SurgeonNovice Surgeon
1) Measure & track intra-operative surgical performance over time
2) Tool for immediate feedback to surgical trainees and training programs
3) To establish that different procedures competency targets. HMA can be used to identify the ideal or minimum number of exposures required for technical competence
15
Economy of Hand Motion Economy of Hand Motion - Future Directions - - Future Directions -
Further validate this assessment technology: More surgeons - with various levels of skill &
experience Different types surgeries - basic/complex,
open/laparoscopic/endoscopic
Intra-Operative Assessment of Technical Skill Intra-Operative Assessment of Technical Skill - - Real Patients, Real Operating RoomsReal Patients, Real Operating Rooms - -
Matthew Roberts, Vanessa Bacal, Mohammen Mahdi, Ethan D. Grober
Mount Sinai & Women’s College Hospital, Division of Urology, Department of Surgery, University of Toronto
Intra-Operative Assessment of Technical Skill on Live Intra-Operative Assessment of Technical Skill on Live Patients Using Economy of Hand Motion: Patients Using Economy of Hand Motion:
Establishing Learning Curves of Surgical CompetenceEstablishing Learning Curves of Surgical Competence
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