PLoS ONE (Jan 2016)

Analysis of the Structure of Surgical Activity for a Suturing and Knot-Tying Task.

  • S Swaroop Vedula,
  • Anand O Malpani,
  • Lingling Tao,
  • George Chen,
  • Yixin Gao,
  • Piyush Poddar,
  • Narges Ahmidi,
  • Christopher Paxton,
  • Rene Vidal,
  • Sanjeev Khudanpur,
  • Gregory D Hager,
  • Chi Chiung Grace Chen

DOI
https://doi.org/10.1371/journal.pone.0149174
Journal volume & issue
Vol. 11, no. 3
p. e0149174

Abstract

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BACKGROUND:Surgical tasks are performed in a sequence of steps, and technical skill evaluation includes assessing task flow efficiency. Our objective was to describe differences in task flow for expert and novice surgeons for a basic surgical task. METHODS:We used a hierarchical semantic vocabulary to decompose and annotate maneuvers and gestures for 135 instances of a surgeon's knot performed by 18 surgeons. We compared counts of maneuvers and gestures, and analyzed task flow by skill level. RESULTS:Experts used fewer gestures to perform the task (26.29; 95% CI = 25.21 to 27.38 for experts vs. 31.30; 95% CI = 29.05 to 33.55 for novices) and made fewer errors in gestures than novices (1.00; 95% CI = 0.61 to 1.39 vs. 2.84; 95% CI = 2.3 to 3.37). Transitions among maneuvers, and among gestures within each maneuver for expert trials were more predictable than novice trials. CONCLUSIONS:Activity segments and state flow transitions within a basic surgical task differ by surgical skill level, and can be used to provide targeted feedback to surgical trainees.