Assessing Microneurosurgical Skill with Medico-Engineering Technology.

Objectives: Most methods currently used to assess surgical skill are rather subjective or not adequate for microneurosurgery. Objective and quantitative microneurosurgical skill assessment systems that are capable of accurate measurements are necessary for the further development of microneurosurgery.

Methods: Infrared optical motion tracking markers, an inertial measurement unit, and strain gauges were mounted on tweezers to measure many parameters related to instrument manipulation. We then recorded the activity of 23 neurosurgeons. The task completion time, tool path, and needle-gripping force were evaluated for three stitches made in an anastomosis of 0.7-mm artificial blood vessels. Videos of the activity were evaluated by three blinded expert surgeons.

Results: Surgeons who had recently done many bypass procedures demonstrated better skills. These skilled surgeons performed the anastomosis with in a shorter time, with a shorter tool path, and with a lesser force when extracting the needle.

Conclusions: These results show the potential contribution of the system to microsurgical skill assessment. Quantitative and detailed analysis of surgical tasks helps surgeons better understand the key features of the required skills.