Utilizing Novel Force Measures to Quantify Differences in Surgical Performance: A Pilot Study (1090-004314) (Research Abstract Professor Rounds: Group 2)
Start time: Thursday, January 28, 2021, 10:00 AM End time: Thursday, January 28, 2021, 11:00 AM Session Type: Research Abstracts (Completed Studies)
Recent data have directly linked technical skill of practicing surgeons to perioperative complications.1-5 Such complications increase cost of care by 3-10 times.6,7 Unfortunately, practicing surgeons stop receiving performance feedback and their skill starts decelerating the day they graduate from training. Importantly, no reliable method of surgical skill assessment exists today to identify poor performers. Simulation-based evaluation offers a robust objective assessment method that has been shown in trainees to reliably distinguish performers based on self-reported experience.8,9 However, the current surgical simulation assessment methods lack granularity, which is needed to better distinguish surgeons of varying skill levels. Thus, the research question we hoped to answer in the current study was: can the incorporation of novel sensors of force applied during surgical anastomosis creation on a simulator model quantify differences in surgical performance and experience?
In order to obtain tissue level metrics, our group has recently developed a simulated elastomeric intestinal anastomosis model. This model allows for the measurement of suture tension along the suture line (provided by puncture resistant piezoelectric sensors). Following IRB approval, a convenience sample of surgical novices and practicing general surgeons were recruited. Participants were asked to perform an end-to-end intestinal anastomosis. The following metrics were captured on participants’ performance: time per stitch (in seconds), the maximum force applied to stitches (averaged across all stitches thrown), the final stitch tension (standing tension upon completion of the anastomosis), and the variability in force applied across the suture line (the range beyond/below the mean). All force measures are reported in Newtons. A Mann-Whitney U test was performed to compare differences between groups.
Two surgical novices and six practicing surgeons participated in this study. The novel force sensors embedded in our developed intestinal anastomosis model revealed that experienced surgeons performed stitches significantly faster (p=0.02) and with less maximum force (p=0.006) than novices. Furthermore, experienced surgeons displayed less final stitch tension (p=0.006) and less variability in the force applied during the anastomosis (p=0.006).
We obtained validity evidence that the novel sensors used to assess force in the current study can distinguish between surgeons of varying skill levels. These robust measures of surgical performance may be valuable additions to surgical training curricula to assess trainees and provide them objective feedback on their performance.
Co-Presenter: Ramses Martinez, Purdue University
Disclosure: No financial relationships with ineligible companies.