Assessing Efficiency in Microsurgery Using Motion Tracking Technology
Sarah M. Lyon, MD1, Weifeng Zeng, MD1, Hossein Mohamadipanah, PhD2, Carla Pugh, MD, PhD2, Michael Bentz, MD1, Samuel O. Poore, MD, PhD1
1University of Wisconsin, Division of Plastic and Reconstructive Surgery, Madison, WI, USA, 2Stanford University, Department of Surgery, Palo Alto, CA, USA
Background: Precise, efficient motions are important components of microsurgical technique and success. The current Halstedian model of resident microsurgical education confers this expertise in the operating room wherein residents acquire skills while operating on patients with the guidance of an experienced attending using graduated autonomy. This study compares motion patterns of microsurgeons in various career stages in a lab-based anastomosis model. We employ motion tracking technology to analyze hand and instrument motion to identify critical areas for trainee improvement
Methods: Plastic surgeons with varying levels of microsurgical experience performed microsurgical anastomoses on a validated blue blood chicken thigh model in a laboratory setting. Each microsurgeon was equipped with motion-tracking sensors connected to standardized positions on their hands and microsurgical instruments. Vessel branches < 0.03), path length (p < 0.03) and idle time (p < 0.001) were significantly different between experts and trainees. This trend was consistent for both the right and left hands as well as the microsurgical instruments. 17/17 (100%) participants agreed or strongly agreed that the anastomosis model was realistic in nature and 16/17 (94%) agreed or strongly agreed that real time motion feedback would be useful in their microsurgical training experience
Conclusion: Resident work hour restrictions and an emphasis on competency-based training create an increasing need for validated laboratory-based methods for microsurgical education. Path length, motion smoothness and time comparisons among trainees and expert microsurgeons objectively demonstrate areas of improvement in resident motion efficiency. Quantifiable motion parameters can provide a basis for structured resident feedback and competency assessment in microsurgery.
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