Objective Assessment of Proficiency in Vaginal Cuff Closure Using Sensor Technology

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Faculty Advisor:Karen Noblett, MDPURPOSE:Establish concurrent and construct validity of motion analysis in differentiating laparoscopic psychomotor skills when suturing laparoscopically on a validated vaginal cuff model.BACKGROUND:Surgical simulation is most useful when it provides metrics that are accurate and meaningful to the learner. Motion analytics provides objective data that allows a comprehensive evaluation to assist with deconstructing complex tasks. This information may assist with formative feedback and deliberate practice.METHODS:Participants were divided based on number of laparoscopic vaginal cuff closures after hysterectomy. 15 Early Novices (0-20 procedures), 5 Advanced Novices (21-50 procedures), and 15 Experts (>51 procedures) in conventional laparoscopy and 24 Early Novices, 4 Advanced Novices, and 7 Experts in robotic-assisted laparoscopy were instructed to secure three stitches on a previously validated vaginal cuff model. A motion sensor was attached to each instrument, which subsequently recorded the hand movement of each participant. Each task was graded using the Global Operative Assessment of Laparoscopic Skills scale and a validated laparoscopic suturing checklist.RESULTS:Comparison analysis indicated Experts in conventional laparoscopy operated with less hand movement (P<.01) and higher hand smoothness (P<.01) compared to Early Novices. Advanced Novices did not show any significant difference to Experts in terms of hand movement (P>.01) or smoothness (P>.01). In contrast, Experts in robotics did not show a difference between Early or Advanced Novices in either of these metrics.DISCUSSION:Using a validated vaginal cuff model, hand movement and smoothness were found to correlate with experience for conventional laparoscopy. Robotic experience did not correlate with improved hand movement or smoothness on a conventional laparoscopic simulator.

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