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Matthew Roberts, Vanessa Bacal, Mohammed Mahdi, Ethan D. Grober

Intra-Operative Assessment of Technical Skill on Live Patients Using Economy of Hand Motion: Establishing Learning Curves of Surgical Competence. Matthew Roberts, Vanessa Bacal, Mohammed Mahdi, Ethan D. Grober

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Matthew Roberts, Vanessa Bacal, Mohammed Mahdi, Ethan D. Grober

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  1. Intra-Operative Assessment of Technical Skill on Live Patients Using Economy of Hand Motion: Establishing Learning Curves of Surgical Competence Matthew Roberts, Vanessa Bacal, Mohammed Mahdi, Ethan D. Grober Mount Sinai & Women’s College Hospital, Division of Urology, Department of Surgery, University of Toronto

  2. Technical Skill Acquired Objectively, reliably assessed

  3. OSATS: Objective Structured Assessment of Technical Skill • Discriminate novice & experienced surgeons • Improvement with training over time • Skills sets transfer to higher fidelity simulations

  4. Intra-Operative Assessment of Technical Skill - Real Patients, Real Operating Rooms - Subjective, Unvalidated

  5. Intra-Operative Assessment of Technical Skill - Real Patients, Real Operating Rooms - Subjective, Unvalidated ? Variable patients Variable operations Variable instruments & technology OR team changes Resource & time pressures Measurement instruments

  6. Hand-Motion Analysis • Electro-magnetic measurement of hand position & orientation • # of hand movements • hand travel distance • hand speed

  7. Hand-Motion Analysis • In the surgical skills lab: Objective, reliable and valid measure of surgical competence on open, laparoscopic, endoscopic and microsurgical procedures • Correlates well with traditional lab-based measures of surgical competence – global ratings and checklists scores by trained experts • Pilot work and feasibility studies have been performed in real operating rooms

  8. Hand-Motion Analysis

  9. Hand-Motion Analysis

  10. Study Objectives Establish the feasibility of performing live intra-operative hand-motion analysis while operating onreal patients Validate live, intra-operative assessments of economy of hand motion as an objective measure of technical skill Use hand-motion analysis to establish competency-based surgical learning curves based on standards established by performance of experienced surgeons

  11. Methods Experienced Microsurgery-Vasectomy reversal Hand motion analysis 2 Surgeons 2 Standardized Surgical Tasks Vasectomy Video recorded Novice

  12. 2 blinded, experienced surgeons Global rating scores Checklists scores Final product scores Methods – Video Analysis

  13. Methods – Video Analysis

  14. Methods – Video Analysis

  15. Hand motion data and blinded expert ratings of video-based surgical performance were: Graphically compared over time Correlated using Pearson calculations Methods – Data Analysis Experienced Novice

  16. Total Hand Movements # Movements Novice Surgeon Experienced Surgeon Novice Surgeon Experienced Surgeon Case #

  17. Hand Travel Distances Novice Surgeon Experienced Surgeon Hand Travel Distance (m) Novice Surgeon Experienced Surgeon Case #

  18. Global Rating Scores Experienced Surgeon Novice Surgeon Global Rating Score Experienced Surgeon Novice Surgeon Case #

  19. Checklist Scores Experienced Surgeon Novice Surgeon Checklist Score Experienced Surgeon Novice Surgeon Case #

  20. Final Product Scores Experienced Surgeon Novice Surgeon Final Product Score Experienced Surgeon Novice Surgeon Case #

  21. Correlating Hand Motion & Video Performance Pearson correlation significant < 0.05 level (2-tailed)

  22. BAD BETTER

  23. Set up < 3mins Data obtained in 23/25 cases Surgical team easily trained HMA software and hardware $3500 Hand-Motion Analysis: Feasibility

  24. Conclusions Establish thefeasibilityof performing live intra-operative hand-motion analysis while operating on real patients Validate live, intra-operative assessments of economy of hand motion as anobjective measure of technical skill Use hand-motion analysis to establish competency-based surgical learning curvesbased on standards established by performance of experienced surgeons

  25. Utility of Hand Motion Analysis 1) Measure & track intra-operative surgical performance over time # Movements 2) Tool for immediate feedback to surgical trainees and training programs Novice Surgeon Experienced Surgeon 15 Case # 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

  26. Economy of Hand Motion - Future Directions - • Further validate this assessment technology: • More surgeons - with various levels of skill & experience • Different types surgeries - basic/complex, open/laparoscopic/endoscopic

  27. Intra-Operative Assessment of Technical Skill - Real Patients, Real Operating Rooms -

  28. Intra-Operative Assessment of Technical Skill on Live Patients Using Economy of Hand Motion: Establishing Learning Curves of Surgical Competence Matthew Roberts, Vanessa Bacal, Mohammen Mahdi, Ethan D. Grober Mount Sinai & Women’s College Hospital, Division of Urology, Department of Surgery, University of Toronto

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