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Surgical task analysis of simulated laparoscopic cholecystectomy with a navigation system



   Advanced surgical procedures, which have become complex and difficult, increase the burden of surgeons. Quantitative analysis of surgical procedures can improve training, reduce variability, and enable optimization of surgical procedures. To this end, a surgical task analysis system was developed that uses only surgical navigation information.


   Division of the surgical procedure, task progress analysis, and task efficiency analysis were done. First, the procedure was divided into five stages. Second, the operating time and progress rate were recorded to document task progress during specific stages, including the dissecting task. Third, the speed of the surgical instrument motion (mean velocity and acceleration), as well as the size and overlap ratio of the approximate ellipse of the location log data distribution, was computed to estimate the task efficiency during each stage. These analysis methods were evaluated based on experimental validation with two groups of surgeons, i.e., skilled and “other” surgeons. The performance metrics and analytical parameters included incidents during the operation, the surgical environment, and the surgeon’s skills or habits.


   Comparison of groups revealed that skilled surgeons tended to perform the procedure in less time and involved smaller regions; they also manipulated the surgical instruments more gently.


   Surgical task analysis developed for quantitative assessment of surgical procedures and surgical performance may provide practical methods and metrics for objective evaluation of surgical expertise.

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This research was partly supported by the Fund for the Improvement of Research Environment for Young Researchers and Grants-in-Aid (KAKENHI) from the Ministry of Education, Culture, Sports, Science and Technology (MEXT; Nos. 23680056, 22650115, and 24103704).

Conflict of interest

Takaaki Sugino, Hiroshi Kawahira, and Ryoichi Nakamura declare that they have no conflicts of interest.

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Corresponding author

Correspondence to R. Nakamura.

Additional information

Part of this work first appeared on the 27th International Congress on Computer Assisted Radiology and Surgery (CARS2013), Heidelberg, Germany, June 26–29, 2013 (Int J CARS 8(Suppl 1):S173–S174, 2013).

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Sugino, T., Kawahira, H. & Nakamura, R. Surgical task analysis of simulated laparoscopic cholecystectomy with a navigation system. Int J CARS 9, 825–836 (2014).

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  • Surgical task analysis
  • Surgical navigation system
  • Laparoscopic cholecystectomy
  • Surgery evaluation