Correlating motor performance with surgical error in laparoscopic cholecystectomy



Analysis of motor performance in minimally invasive surgery (MIS) is a new field with applications in surgical training, surgical simulators, and robotics. Force/torque and derivatives of tool tip position (velocity, acceleration, and jerk) are examples of measures of motor performance (MMPs). Few studies have measured MMPs or have correlated MMPs with surgical performance during MIS on humans. The objectives of this study were to determine the feasibility of a novel multimodal system to quantify MMPs in laparoscopic cholecystectomy and to attempt to correlate MMPs with the magnitude of error as a measure of surgical performance.


Novice and expert surgeons performed laparoscopic cholecystectomies in two groups of three patients each. MMPs were obtained using a combination of optical and electromagnetic tool tip tracking and a force/torque sensor on a modified Maryland dissector. Error scores for laparoscopic cholecystectomy were calculated using a previously validated system. Novice and expert measurements were compared, and correlations were made between error scores and MMPs.


Error scores were similar between novices and experts. Novice surgeons had a significantly greater mean velocity (566 ± 83 vs 85 ± 32 mm/s, p = 0.006) and acceleration (2,600 ± 760 vs 440 ± 174 mm/s2, p = 0.050) compared to expert surgeons. Force (16.5 ± 4.6 vs 18.3 ± 6.0 N, p = 0.829), position (121 ± 25 vs 135 ± 72 mm, p = 0.863), and jerk (19,600 ± 7,410 vs 2,430 ± 367 mm/s3, p = 0.138) were similar between groups. A positive correlation was found in novice surgeons between error score and jerk (Pearson correlation, 0.999; p = 0.035).


It is feasible to quantify MMPs in laparoscopic cholecystectomy. Novice and expert surgeons can be differentiated by MMPs; moreover, there may be a positive correlation between jerk and error score in novice surgeons.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2


  1. 1.

    Berguer R, Forkey DL, Smith WD (1999) Ergonomic problems associated with laparoscopic surgery. Surg Endosc 13: 466–468

    Article  CAS  PubMed  Google Scholar 

  2. 2.

    Datta V, Chang A, Mackay S, Darzi A (2002) The relationship between motion analysis and surgical technical assessment. Am J Surg 184: 70–73

    Article  PubMed  Google Scholar 

  3. 3.

    Datta V, Mackay S, Mandalia M, Darzi A (2001) The use of electromagnetic motion tracking analysis to objectively measure open surgical skill in the laboratory-based model. J Am Coll Surg 193: 479–485

    Article  CAS  PubMed  Google Scholar 

  4. 4.

    Eubanks TR, Clements RH, Pohl D, Williams N, Schaad DC, Horgan S, Pellegrini C (1999) An objective scoring system for laparoscopic cholecystectomy. J Am Coll Surg 189: 566–574

    Article  CAS  PubMed  Google Scholar 

  5. 5.

    Joice P, Hanna GB, Cuschieri A (1998) Errors enacted during endoscopic surgery—a human reliability analysis. Appl Ergon 29: 409–414

    Article  CAS  PubMed  Google Scholar 

  6. 6.

    Lim J, Kinnaird C, Hwang H, Hodgson A, Nagy A, Qayumi K (2004) Objective multi-modal surgical performance analysis. Surg Endosc 18: S281

    Article  Google Scholar 

  7. 7.

    Malik R, White PS, MacEwen CJ (2003) Using human reliability analysis to detect surgical error in endoscopic DCR surgery. Clin Otolaryngol 28: 456–460

    Article  CAS  PubMed  Google Scholar 

  8. 8.

    McBeth P (2002) A methodology for quantificative performance evaluation in minimally invasive surgery [Thesis]. University of British Columbia, Vancouver

  9. 9.

    McNatt SS, Smith CD (2001) A computer-based laparoscopic skill assessment device differentiates experienced from novice laparoscopic surgeons. Surg Endosc 15: 1085–1089

    Article  CAS  PubMed  Google Scholar 

  10. 10.

    Moorthy K, Munz Y, Sarker SK, Darzi A (2003) Objective assessment of technical skills in surgery. Br Med J 327: 1032–1037

    Google Scholar 

  11. 11.

    Rasmus M, Riener R, Reiter S, Schneider A, Feussner H (2004) In vivo kinematic measurement during laparoscopic cholecystectomy. Surg Endosc 18: 1649–1656

    Article  CAS  PubMed  Google Scholar 

  12. 12.

    Richards C, Rosen J, Hannaford B, Pellegrini C, Sinanan M (2000) Skills evaluation in minimally invasive surgery using force/torque signatures. Surg Endosc 14: 791–798

    Article  CAS  PubMed  Google Scholar 

  13. 13.

    Rosen J, Hannaford B (2001) Markov modeling of minimally invasive surgery based on tool/tissue interaction and force/torque signatures for evaluating surgical skills. IEEE Trans Biomed Eng 48: 579–591

    Article  CAS  PubMed  Google Scholar 

  14. 14.

    Seymour NE, Gallagher AG, Roman SA, O’Brien MK, Andersen DK, Satava RM (2004) Analysis of errors in laparoscopic surgical procedures. Surg Endosc 18: 592–595

    Article  CAS  PubMed  Google Scholar 

  15. 15.

    Stanton NA, Stevenage SV (1998) Learning to predict human error: issues of acceptability, reliability and validity. Ergon 41: 1737–1756

    CAS  Google Scholar 

  16. 16.

    Tang B, Hanna GB, Joice P, Cuschieri A (2004) Identification and categorization of technical errors by observational clinical human reliability assessment (OCHRA) during laparoscopic cholecystectomy. Arch Surg 139: 1215–1220

    CAS  PubMed  Google Scholar 

  17. 17.

    Tendick F, Downes M, Cavusoglu MC, Gantert W, Way LW (1998) Development of virtual environments for training skills and reducing errors in laparoscopic surgery. Proc SPIE 3262: 36–44

    Google Scholar 

  18. 18.

    Tendick F, Mori T, Way LW (1995) Future or laparoscopic surgery. In: Way LW, Bhoyrul S, Mori T (eds). Fundamentals of laparoscopic surgery. Churchill Livingstone, New York, pp 235–252

    Google Scholar 

  19. 19.

    Treat M (1996) A surgeon’s perspective on the difficulties of laparoscopic surgery. In: Taylor RH, Lavalleé S, Burdea GC, Mösges R (eds). Computer-integrated surgery. MIT Press, Cambridge, MA, pp 559–560

    Google Scholar 

  20. 20.

    Way LW, Stewart L, Gantert W, Liu K, Lee CM, Whang K, Hunter JG (2003) Causes and prevention of laparoscopic bile duct injuries. Ann Surg 237: 460–469

    Article  PubMed  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to K. A. Qayumi.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Hwang, H., Lim, J., Kinnaird, C. et al. Correlating motor performance with surgical error in laparoscopic cholecystectomy. Surg Endosc 20, 651–655 (2006).

Download citation


  • Laparoscopic cholecystectomy
  • Surgical error
  • Motion analysis