Objective assessment of colonoscope manipulation skills in colonoscopy training

  • Matthew S. Holden
  • Chang Nancy Wang
  • Kyle MacNeil
  • Ben Church
  • Lawrence Hookey
  • Gabor Fichtinger
  • Tamas Ungi
Original Article



Manipulation of the colonoscope is a technical challenge for novice clinicians which is best learned in a simulated environment. It involves the coordination of scope tip steering with scope insertion, using a rotated image as reference. The purpose of this work is to develop and validate a system which objectively assesses colonoscopy technical skills proficiency in an arbitrary training environment, allowing novices to assess their technical proficiency prior to real patient encounters.


We implemented a motion tracking setup to objectively analyze and assess the way operators perform colonoscopies, including an analysis of wrist and elbow joint motions. Subsequently, we conducted a validation study to verify whether our motion analysis could discriminate novice colonoscopists from experts. Participants navigated a wooden bench-top model using a standard colonoscope while their motions were tracked.


The developed motion tracking setup allowed colonoscopists of varying levels of proficiency to have their colonoscope manipulation assessed, and was able to be operated by a trained non-technical operator. Novice operators had significantly greater median times (101.5 vs. 31.5 s) and number of hand movements (62.0 vs. 21.5) than experts. Experts, however, spent a significantly greater proportion of time in extreme ranges of wrist and elbow joint motion than novices.


We have developed and implemented a hand and joint motion analysis system that is able to discriminate novices from experts based on objective measures of motion. These metrics could, thus, serve as proxies for technical proficiency during training.


Colonoscopy Simulation-based training Medical education Objective skill assessment 



Matthew S. Holden is supported by the Canada Graduate Scholarship from the Natural Sciences and Engineering Research Council of Canada and by the Walter C. Sumner Foundation Fellowship. Gabor Fichtinger is supported as a Cancer Care Ontario Research Chair in Cancer Imaging. Financial support was received from the SEAMO Educational Innovation and Research Fund. This work was financially supported as a Collaborative Health Research Project (CHRP #127797), a joint initiative between the Natural Sciences and Engineering Research Council of Canada (NSERC) and the Canadian Institutes of Health Research (CIHR). Funding was provided by Walter C. Sumner Foundation.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures in this study involving human participants were performed in accordance with the ethical standards of the institution, and were approved by the research ethics board at Queen’s University. This study does not contain any procedures involving animals.

Informed consent

All participation was voluntary, and written informed consent was obtained from all participants.


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Copyright information

© CARS 2017

Authors and Affiliations

  1. 1.Laboratory for Percutaneous Surgery, School of ComputingQueen’s UniversityKingstonCanada
  2. 2.Gastrointestinal Diseases Research Unit, Department of MedicineQueen’s UniversityKingstonCanada

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