Abstract
Background
High levels of precision, as well as controlled, efficient motions, are important
components of microsurgical technique and success. An accurate and objective means
of skill assessment is lacking in resident microsurgical education. Here we employ
three-dimensional, real-time motion-tracking technology to analyze hand and instrument
motion during microsurgical anastomoses. We hypothesize that motion metrics can objectively
quantify microsurgical skill and predict the overall level of expertise.
Methods
Seventeen participants including medical students, plastic surgery residents, and
attendings performed two end-to-end arterial microsurgical anastomoses in a laboratory
setting. Motion tracking sensors were applied to standardized positions on participants'
hands and microsurgical instruments. Motion and time parameters were abstracted using
sensor-derived position data.
Results
A total of 32 anastomoses were completed and analyzed. There were significant differences
in time for task completion and idle time between attendings and junior residents
(post-graduate year (PGY)1–3). Path length and working volume consistently differentiated
between students and attendings for all phases of an anastomosis. Motion and time
data were less able to consistently distinguish attendings from residents stratified
by laboratory anastomosis experience.
Conclusion
Quantifiable motion parameters provide objective data regarding the efficiency of
microsurgical techniques in surgical trainees. These data provide a basis for microsurgical
competency assessments and may inform future structured feedback through instruction,
instruments, and technological interfaces.
Keywords
microsurgery - education - motion tracking - simulation
