Using Motion‐Tracking to Objectively Assess Skill in Surgery

Abstract

ABSTRACT Background Surgical assessment often relies on subjective expert observation, which may introduce bias. We aimed to objectively differentiate skill levels in a complex simulated operative procedure using hand‐tracking metrics through a wearable mixed reality headset. Methods A validated paediatric open inguinal herniotomy simulator was used to simulate a surgical task composed of multiple sequential operative steps. Novices (medical students) and experts (paediatric surgeons) were recruited. After completing a pre‐task questionnaire, participants performed the task while wearing the mixed reality headset (Microsoft HoloLens 2). A post‐task questionnaire was completed. Metrics collected included total path length, average path length, average movement velocity and total time. Data are reported as mean (± SD) and analysis included descriptive statistics, frequency counts and comparative testing using t ‐tests. A p ‐value of < 0.05 was considered significant. Results A total of 33 participants were recruited (9 experts, 24 novices). The expert group had a shorter mean total path length: 287.0 ± 60.0 cm versus 450.1 ± 55.7 cm ( p < 0.0001). They also had a shorter mean path length; 71.8 ± 15.1 cm versus 112.5 ± 13.9 cm ( p < 0.0001). The expert mean velocity of movement was 0.17 ± 0.07 cm/s versus 0.14 ± 0.02 cm/s in novices ( p = 0.13). Experts took less time to complete the task: 458.1 ± 65.8 s versus 836.0 ± 70.0 s ( p < 0.0001). Conclusions This study objectively demonstrated that experts had a more efficient economy of movement and that hand‐tracking metrics can differentiate between novice and expert performance during a simulated complex surgical task.