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A study of psychomotor skills in minimally invasive surgery: what differentiates expert and nonexpert performance

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Abstract

Background

A high level of psychomotor skills is required to perform minimally invasive surgery (MIS) safely. To assure high quality of skills, it is important to be able to measure and assess these skills. For that, it is necessary to determine aspects that indicate the difference between performances at various levels of proficiency. Measurement and assessment of skills in MIS are best done in an automatic and objective way. The goal of this study was to investigate a set of nine motion-related metrics for their relevance to assess psychomotor skills in MIS during the performance of a labyrinth task.

Methods

Thirty-two surgeons and medical students were divided into three groups according to their level of experience in MIS; experts (>500 MIS procedures), intermediates (31–500 MIS), and novices (no experience in MIS). The participants performed the labyrinth task in the D-box Basic simulator (D-Box Medical, Lier, Norway). The task required bimanual maneuvering and threading a needle through a labyrinth of 10 holes. Nine motion-related metrics were used to assess the MIS skills of each participant.

Results

Experts (n = 7) and intermediates (n = 14) performed significantly better than the novices (n = 11) in terms of time and parameters measuring the amount of instrument movement. The experts had significantly better bimanual dexterity, which indicated that they made more simultaneous movements of the two instruments compared to the intermediates and novices. The experts also performed the task with a shorter instrument path length with the nondominant hand than the intermediates.

Conclusions

The surgeon’s performance in MIS can be distinguished from a novice by metrics such as time and path length. An experienced surgeon in MIS can be differentiated from a less experienced one by the higher ability to control the instrument in the nondominant hand and the higher degree of simultaneous (coordinated) movements of the two instruments.

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Acknowledgments

The authors thank the surgeons, residents, medical students, and interns for participating in this study.

Disclosures

Erlend F. Hofstad, Cecilie Våpenstad, Magdalena K. Chmarra, Thomas Langø, Esther Kuhry, and Ronald Mårvik have no conflicts of interests or financial ties to disclose.

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Authors and Affiliations

  1. Department of Medical Technology, SINTEF Technology and Society, PB 4760 Sluppen, 7465, Trondheim, Norway

    Erlend Fagertun Hofstad, Cecilie Våpenstad & Thomas Langø

  2. Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway

    Magdalena Karolina Chmarra

  3. Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway

    Esther Kuhry & Ronald Mårvik

  4. Department of Surgery, St. Olav’s Hospital, Trondheim University Hospital, Trondheim, Norway

    Esther Kuhry & Ronald Mårvik

  5. National Center for Advanced Laparoscopic Surgery, St. Olav’s Hospital, Trondheim University Hospital, Trondheim, Norway

    Esther Kuhry & Ronald Mårvik

Authors
  1. Erlend Fagertun Hofstad
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  2. Cecilie Våpenstad
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  3. Magdalena Karolina Chmarra
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  4. Thomas Langø
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  5. Esther Kuhry
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  6. Ronald Mårvik
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Corresponding author

Correspondence to Erlend Fagertun Hofstad.

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Hofstad, E.F., Våpenstad, C., Chmarra, M.K. et al. A study of psychomotor skills in minimally invasive surgery: what differentiates expert and nonexpert performance. Surg Endosc 27, 854–863 (2013). https://doi.org/10.1007/s00464-012-2524-9

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  • DOI: https://doi.org/10.1007/s00464-012-2524-9

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