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A methodology for quantitative performance evaluation in minimally invasive surgery McBeth, Paul Bradley

Abstract

The objective of this work is to establish a methodology for reliably quantifying the performance of an expert surgeon in laparoscopy with the long-term goal of validating surgical simulations. A validated simulation will allow us to quantitatively assess surgeon performance and evaluate new tool designs. Quantitative performance and skill assessments are critical for evaluating the progress of surgical residents and the efficacy of different training programs. Current evaluation methods are subjective and potentially unreliable, so there is a need for objective methods to evaluate surgical performance. We identify a feasible method to measure kinematic and postural data in the live operating room setting. We used an optoelectronic motion analysis system to acquire postural data and tool tip trajectories of one expert surgeon over a period of four months. To assess reliability of performance measures, we created a hierarchical decomposition diagram describing the procedure in terms of surgical tasks, tool sequences and fundamental tool actions. Using tool tip kinematic data and postural data we extracted characteristic measures of performance and compared these measured distributions using the Kolmogorov-Smirnov statistic. For the most part our performance measures (with the exception of kinematic measures) show consistent reliability over time by a trained surgeon and little effect from patient variability, and so are likely reliable measures of performance. An expanded set of reliable kinematic measures will form the basis for quantifying surgical skill and should be useful in validating surgical simulations for use in training, certifying surgeons and designing and evaluating new surgical tools.

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