H. Mohamadipanah1, K. H. Perrone1, J. Nathwani2, K. Peterson2, A. Witt1, A. Garren2, C. Pugh1 1Stanford University,General Surgery,Palo Alto, CA, USA 2University Of Wisconsin,General Surgery,Madison, WI, USA
Introduction:
A range of simulators with varying fidelity have been devoloped for surgical training. As the number and type of available simulators continues to increase, it is critically important to properly match simulator fidelity to trainee task and skill level to achieve cost and learning goals. We hypothesize that a sensor-based dexterity assessment during a suturing board task can accurately predict dexterity level during the performance of both open and laparoscopic simulated scenarios.
Methods:
Participants (N=45) completed three tasks: 1) securing six surgical knots on a suturing board, 2) completing a simulated open small bowel repair, and 3) performing a task during a simulated laparoscopic ventral hernia (LVH) repair. Participants’ hand movements were recorded using electromagnetic sensors and quantified using common motion metrics. A parametric correlational analysis was performed to assess the relationship between dexterity on the suture board and dexterity during the two simulated procedures.
Results:
There were multiple significant relationships between motion metrics on the suture board and motion metrics during simulated small bowel repair and the LVH task. The strongest correlations between the suturing task and open small bowel repair were seen in the “idle time” (r = +0.546, p<0.01) and “jerk magnitude” (r = +0.431, p<0.01) metrics. For the suturing task and the LVH task, the strongest correlations were seen in the “bimanual dexterity” (r = +0.326, p < 0.05) and “working volume” (r = +0.367, p<0.05) metrics.
Conclusion:
The correlation in motion metrics identified in this study between simple suturing board tasks and more complex open and laparoscopic simulation scenarios reflects a consistency in performance across simulators due to the participant’s level of dexterity and supports the utility of suturing boards in surgical training and assessment. The correlation between “idle time” and “jerk magnitude” for the suture board and small bowel repair may result from the pauses that take place when planning subsequent actions and the stop/start nature of placing each stitch during these two tasks. The correlation between “bimanual dexterity” and “working volume” for the suture board and LVH tasks may relate to use of the non-dominant hand as an effective assistant in both tasks. To decrease cost and prevent cognitive load distractions when learning fundamental psychomotor skills such as suturing and effective non-dominate hand use, trainees should demonstrate proficiency on low cost suture boards before training on higher fidelity, higher cost trainers.